Ninety-five menstrual cycles were studied in 20 women undergoing donor artificial insemination (AID). In 49 cycles basal body temperature (BBT) changes were charted daily and both daily cervical mucus scoring (modified Insler score) and daily realtime ultrasonography (USS) were performed from day 11 to ovulation. AID was performed only on the day of follicular rupture. A control group, not subjected to USS, were inseminated two to three times per cycle over 46 cycles in the periovulatory period. The Insler score was found to be a reliable indicator of follicular development and rupture. The BBT was found to be less reliable than the Insler score or USS. While USS may be used to confirm follicular development, the Insler score is reliable and less costly.
PIP: This study was designed to compare the accuracy and reliability of the basal body temperature (BBT), cervical mucus, and daily real-time ultrasonography (USS) methods in the prediction of ovulation. A total of 95 menstrual cycles in 20 women undergoing donor artificial insemination were analyzed. In 49 cycles, BBT changes were charted daily and both daily cervical mucus scoring (modified Insler score) and USS were performed from day 11 until ovulation. Artificial insemination was performed only on the day of follicular rupture. A control group, not subjected to USS, was inseminated 2-3 times/cycle over 46 cycles in the periovulatory period. The Insler score was found to be a reliable indicator of follicular development and rupture. Follicular rupture occurred on the day of the maximal score in 31% of cycles. The maximal score was noted 24 hours before follicular rupture in 47.5%. The BBT was less reliable than the Insler score or USS. In 15% of 49 cycles, there was no clear change in thermal pattern despite USS-confirmed ovulation and a good Insler score. USS confirmation of ovulation was made 24 hours or more before the shift in 17.5% of cycles and 24 or more hours after the thermal shift in 69.5%. Of the 20 subjects, 2 became pregnant during USS-determined cycles and 5 in the absence of USS monitoring. While USS may be used to confirm follicular development, the Insler method is reliable and less costly. It is easily mastered, there is minimal individual variation between observers, and no technical or biochemical facilities are required. It is recommended that, in women undergoing artificial insemination with biphasic temperature graphs, the Insler score should be determined daily from day 11 until the maximal score is passed, with inseminations done daily when the score exceeds 10.