Using Ovulation Tests with PCOS: Can You Trust the Accuracy?

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The short answer is NO! If you’re using ovulation tests with PCOS, you can’t always trust the accuracy of your results.

But that doesn’t mean tracking your ovulation with PCOS is impossible.  You just need to know the right tricks.

So read on to find out what PCOS is, how it affects the accuracy of ovulation tests – and what you can do to track your ovulation.

What Exactly is PCOS?


Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that can cause you to not ovulate. As you know, if you don’t ovulate, you can’t get pregnant.

This is known as anovulation, and it’s the #1 cause of infertility. 

Some women with PCOS develop several cysts on their ovaries (hence the name ‘polycystic’). 

Yet, some women with PCOS have no cysts at all.

No one’s exactly sure what causes PCOS, but it’s linked to excess levels of hormones.

The main hormones involved in PCOS include:

  • Androgens: Although these are known as ‘male hormones,’ both men and women have them. Women with PCOS tend to have higher levels of androgens. High androgens can throw other hormones out of whack.

  • Insulin: This is the hormone that keeps your blood sugar steady. Around 65-70% of people with PCOS are insulin resistant. Insulin resistance increases androgen production, making things even more imbalanced.

  • Luteinizing hormone (LH): LH helps control your menstrual cycle and triggers ovulation. Women with PCOS tend to have elevated LH levels. High LH can hike up androgen production, creating a vicious cycle.

To truly grasp how PCOS affects ovulation, let’s recap the hormonal changes that occur during menstrual cycles. 

A Quick Recap on Your Menstrual Cycle…

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Let’s break down what menstrual cycles look like without PCOS.

The menstrual cycle is ruled by a medley of hormones, including:

  • Estrogen
  • Progesterone
  • Luteinizing hormone (LH)
  • Follicle-stimulating hormone (FSH).

Rightly named, FSH stimulates the growth of ovarian follicles. Follicles are small fluid-filled sacs in your ovaries that house immature eggs. 

LH on the other hand is in charge of triggering ovulation. 

At the beginning of your cycle (aka your follicular phase), LH and FSH are low. 

Each month, a batch of follicles starts to mature in your ovaries. And eventually, a dominant follicle emerges. This triggers the body to boost estrogen production. 

This creates a cascade of other hormone changes, including a rise in LH and FSH. 

Around 24-36 hours before ovulation, LH surges. This spike initiates ovulation, allowing the follicle to release the egg. 

If a sperm meets up with the egg in the fallopian tube, fertilization occurs, and viola!  You’re pregnant!

But if fertilization doesn’t happen, progesterone and estrogen fall, and your period arrives. 

After ovulation, LH and FSH drop, going back to their initial levels. 

How Does PCOS Affect Ovulation?

PCOS Affect Ovulation

With PCOS, the eggs don’t always mature. This means they’re not always released on schedule, and sometimes – not at all. 

This can lead to irregular periods or even missed cycles. 

You can see how this can cause major problems when you’re trying to conceive.

So why does this happen?
Well, for a few reasons. High androgen levels are part of it.
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High androgen levels can lead to irregular cycles that are over 35 days long. This could mean having as few as 8 cycles per year. And the less cycles you have, the more difficult it’ll be to get pregnant.

Also, many women with PCOS have high LH levels throughout their cycle. This LH excess increases androgen production even more (testosterone in particular), making things even more imbalanced.

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PCOS can also lead to estrogen dominance. This is where estrogen levels get too high compared to progesterone. 

While you need estrogen to trigger the LH surge, having too much estrogen can cause problems with fertility.

How Accurate are Ovulation Tests With PCOS?

It depends on which test you use. 

More on that in a bit – but first, let’s briefly cover how they work.

How Do Ovulation Tests Work?

ovulation test with PCOS

Ovulation tests (i.e. ovulation predictor kits or OPKs), measure LH in your urine to pinpoint the surge. 

The trouble is, most OPKs are based on thresholds and don’t measure your actual hormone values. 

This may work just fine if you have average hormone values. But not if your hormone levels are too high or too low.

And spoiler alert: If you have PCOS, there’s a good chance your hormone levels won’t fall in line with ‘normal’ thresholds. 

As mentioned above, PCOS can cause high levels of LH throughout your cycle. It can even cause multiple LH rises, leading to false-positives on regular OPKs. 

This can make it difficult to pinpoint when the true LH surge occurs.

All this, just to predict your ovulation. With PCOS, it’s tricky to nail down your ovulation day and fertile window if you rely solely on OPKs. 

It’s important to note that while LH can help predict ovulation; it doesn’t confirm it. And around 33% of all menstrual cycles are anovulatory, meaning no egg is released.

That’s why if you have PCOS, it’s difficult to know when ovulation happened – or if it occurred at all. 

Why Regular Ovulation Tests Can Give False Results

LH levels are not one-size-fits-all. Here’s what I mean…

One study found that on the day before ovulation, the average LH level was 44.6 mIU/mL. Yet, some women had LH levels as high as 101 mIU/mL or as low as 6.5 mIU/mL. 

Clearly, the LH range is a huge one. And that’s the problem with using ovulation tests based on thresholds. 


you reach that threshold, you get a positive result. But if you don’t fall into that threshold, you may get a false-negative.

And if your LH levels are higher than the average threshold, you may get a false-positive.

This can be incredibly frustrating when you’re trying to conceive. 

An OPK may say you’re in your fertile window – when really you’re not. Or you may be ovulating, but the test simply can’t detect it.

And to add more confusion, if you use different ovulation tests, you might get different results. 

This makes it tough to know which one to trust.

Plus, not everyone’s LH surge looks the same. 

LH surge looks the same with PCOS

Some women have a rapid surge that happens in a day, while others take 2-6 days. Some have one LH spike, while others have two. There are even plateau patterns where LH stays steady for several days. 

LH stays steady for several days.

And some people with PCOS have a high LH baseline even before ovulation occurs! 

You can see how basing everything off LH thresholds is NOT the most accurate option.

Imagine taking an ovulation test on all these days and getting a false-positive result.

To avoid this, you should use an ovulation test best suited for you.

What is the Best Ovulation Kit for PCOS?

If you have PCOS, quantitative tests are best. That’s because quantitative tests measure actual hormone values rather than thresholds. 

best ovulation kit for pcos

Remember – LH levels can be dramatically different for people with PCOS. That’s why having the actual hormone values can help pinpoint ovulation.

But LH is not the only hormone that’s helpful for tracking ovulation. Estrogen and progesterone offer clues too.

Just before ovulation, estrogen shoots up. This triggers the pituitary gland to release LH. So an estrogen peak can give hints about when ovulation will occur.

Another helpful measure is progesterone, which rises after an egg is released. Elevated progesterone metabolite PdG levels confirm ovulation, so you know when to have sex. 

Inito is the only fertility monitor that measures LH, estrogen, and progesterone metabolite PdG. This provides a complete picture of what’s going on in your body.

But there’s still one more thing that can mess up your test results: which LH unit the ovulation test measures.

Beta LH vs. Alpha LH: What’s the Difference?

Did you know LH comes in two different units? Yep, it’s true! 

LH and FSH both have beta and alpha subunits. Their alpha units are identical, while their beta units are unique.

That’s why it’s important to know whether your ovulation tests measures alpha or beta LH.

Tests that measure alpha LH are more likely to cross react. You may try to check your LH, but the test may pick up FSH and give you the wrong results. 

So when it comes to accuracy, go for a test that measures beta LH, like Inito. That way you’ll have way less chances of cross reactivity.

How Do I Know If I’m Ovulating with PCOS?

Tracking ovulation with PCOS can be tricky – but it is doable. 

The more insights you have into your cycle, the easier it is to nail down your fertile window (i.e. the time you’re most likely to get pregnant).

Your fertile window is around 6 days long. It includes the four days before ovulation, ovulation day, and the day after ovulation. 

You can track your ovulation using the following methods:
track your ovulation
  • Check out your cervical mucus. Before ovulation, your cervical mucus increases and becomes stickier. But on ovulation day, cervical mucus may look clearer and more slippery, similar to the feel of egg whites.
  • Track your basal body temperature (BBT). The day before ovulation, your basal body temperature is at its lowest point. But after ovulation, BBT rises. Keeping tabs on your BBT can offer clues about whether ovulation occurred. 

But keep in mind, cervical mucus and BBT, aren’t the most reliable ways of tracking ovulation. 

Hormone imbalances can affect cervical mucus production. And BBT can get thrown off by stress, lack of sleep, fever, alcohol, and certain medications. 

So what is the most effective way to track your ovulation?

 Use a fertility monitor. Tracking your hormones with a fertility monitor like Inito not only predicts when ovulation may happen, it confirms it. In fact, Inito’s ability to identify your fertile window is shown to increase your chances of getting pregnant by 89%!

Inito also comes with a handy app so you can track your history of results, along with personalized hormone charts you can share with your doctor. You can even get notifications reminding you when it’s time to test.

Summing it Up

  • PCOS is an imbalance of hormones that can cause you to not ovulate.
  • Women with PCOS may have high androgen levels, insulin resistance, or cysts on their ovaries. 
  • Luteinizing hormone (LH) surges 24-36 hours before ovulation. That’s why most ovulation tests measure LH.
  • An LH surge cannot confirm ovulation; it only predicts it.
  • Most OPKs only measure hormone thresholds, not hormone values.
  • People with PCOS often have high baseline LH levels or experience more than one LH spike. 
  • That’s why ovulation tests don’t always offer accurate results if you have PCOS.
  • To confirm ovulation, choose a test that measures estrogen, progesterone, and LH.

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