Peeing on Sticks: A Review of Ovulation Tests

Peeing on sticks: it's not just for pregnancy any more! If you are trying to get pregnant, or just using yourself for a fun science experiment (in which case we should be friends), you can purchase test kits to predict ovulation.

The two most common test brands are Clear Blue and First Response. If you are using the test kits because you want to conceive, you don't want to waste a good egg on a test that's difficult to interpret - every month counts! So, I did you a favor and peed on several sticks to compare products. Ok, I actually dipped the sticks into  my pee, but more on that later.  I was in no way paid (I wish) or otherwise influenced by these companies to review their products. I independently used myself as a guinea pig, for the sake of science and your reproductive success. You're welcome.

First Response Test & Confirm Ovulation Test

Price: $28.99 for 10 tests plus one digital confirmation test
OR $19.89 for 10 tests plus one pregnancy test

How it works: The test predicts ovulation by measuring the amount of luteinizing hormone (LH), which is the hormone responsible for triggering ovulation.

Result interpretation: The result window shows a dark pink line closest to the thumb grip of the test (the part you hold) - - this is the reference line. A second line appears closest to the business end of the stick (the part you pee on) - - this is your result. If the result line is absent or is fainter than the reference line, the test is negative. If the result line is the same color or darker than the reference line, the result is positive. If your test kit includes the digital confirmation test, you can use it to confirm a suspected positive result.

Results: A negative result indicates the absence of an LH surge. A positive result indicates the presence of an LH surge and ovulation is predicted to occur within the next 24-36 hours.

Product notes: First Response also sells a package of daily digital tests, but the cost is greater than the Clear Blue daily digital tests ($47.99 for 20 tests versus $39.99). I elected to use the non-digital test option to compare the effectiveness of a kit with a lower price point.

Clear Blue Advanced Digital Ovulation Test

Price: $29.99 for 10 tests 

OR $39.99 for 20 tests

How it works: This test also predicts ovulation by measuring LH, but it includes an additional feature of measuring estrogen levels. Rising estrogen levels precede the LH surge.

Result interpretation: A blank circles indicates a negative result. A flashing smiley face (emoticons will have a whole new meaning now) indicates a rise in estrogen levels or "high fertility". A static smiley face is a positive result or "peak fertility". 

Results: A negative result indicates the test did not detect rising estrogen or LH levels. According to the test instructions, a flashing smiley face indicates "high fertility" and you should "have intercourse to increase your chances of becoming pregnant". There are a few issues with this claim. For starters, if you are using the test kit to determine when to inseminate, you need to wait until you receive a "peak fertility"result. In the event that you plan to fertilize an egg through sexual intercourse, you may have several days of a "high fertility" result before a positive LH surge. Sex is great and all, but it's a lot of pressure for both you and your partner if you demand baby-making time for days on end. From what I've read, doing it several days in a row is also not ideal for sperm counts.When the test shows a static (not flashing) smiley face, ovulation is predicted to occur in the next 24-36 hours - this is go time!

Product notes: Clear Blue also offers a daily digital test that only measures LH levels ($36.99 for a 20 count package). If you want to cut out the flashing smiley face result, you can purchase this test instead, but there isn't much difference in price. Also, I found the smiley face to be beneficial, which I'll explain more when summarizing my personal results (keep reading, I took pictures of my pee sticks for you!). 

The Testing Process

To compare products, I tested with both brands during the same cycle. The instructions for each state you can hold the stick under your urine stream, or you can collect the urine in a disposable cup (or non-disposable, it's your business - - just don't invite me over for a beverage, ever). I chose what I've termed the "collect and dip method" for logistical reasons. Simultaneously holding two sticks under my urine stream seemed like a challenge I didn't want to face. Also, I have terrible aim. I didn't want to risk peeing all over the wrong part of the test sticks, or worse -- my hand. I tested every morning immediately after waking, which is recommended due to the concentration of hormone levels.

Hint: if you use the First Response Test & Confirm kit, you should opt for the collect and dip method. This way you will have urine left for the digital confirmation test. 

My Results

Based on my average cycle length, I started testing on cycle day 6. No surprises here. As expected, both tests were clearly negative. The First Response test showed a faint pink result line and the Clear Blue test showed a blank circle. 

Cycle day 6, Test Day 1

On the second day of testing, the First Response test still showed a faint pink result line. However, the Clear Blue test showed a flashing smiley face, indicating a rise in estrogen levels. According to the test instructions, this result is supposed to occur for about two days before a positive ovulation result (as you'll learn, this was NOT my experience). 

Cycle Day 7, Test Day 2

The third day showed, as expected, a flashing smiley face on the Clear Blue test. For the First Response test, I observed a significant change in the color of the result line. To me, the result and reference lines appeared to be the same color pink. Without influence of the Clear Blue test, this looked like a positive result, so I used the digital confirmation test. The digital results revealed a "NO". 

Cycle Day 8, Test Day 3

Cycle Day 8, Test Day 3: First Response Digital Confirmation

Day 4: another smiley face for the Clear Blue test. At this point, the pink lines of the First Response test still looked the same color to me, but I had already been tricked once, so I decided to wait until the Clear Blue test turned positive before using the First Response confirmation again. 

Problem: because the First Response kit only includes one digital confirmation kit, I had to buy a second kit so I would have another confirmation test. Or so I thought. It turns out I mistakenly bought the kit that includes a pregnancy test instead of an ovulation confirmation test. Fooled again!

Cycle Day 9, Test Day 4

On the fifth day of testing, the Clear Blue test showed yet another day of the flashing smiley face. This was the fourth day of the Clear Blue "peak fertility" result and at this point I began worrying. To compound my worry, the result line of the First Response test went back to being as faint as it was in the first two days of testing.

Cycle Day 10, Test Day 5

Day 6: another day of the flashing smiley face and the faint pink line. 

Cycle Day 11, Test Day 6

On the seventh day of testing, the pink result line was darkening again, which gave me some hope that I might still ovulate. Although I was growing sick of the smiley face by now, it also helped me feel like my body was moving in the right direction.

Cycle Day 12, Test Day 7

Day 8 of testing: more of the same. 

Cycle Day 13, Test Day 8

On the ninth day of testing (cycle day 14), that damn pink line grew faint again. Since my average cycle length is 24 days, every ovulation and fertility prediction calendar says I should have ovulated by now. I was about 90% convinced that I was not going to ovulate this month and would have to resume my experiment again during the next cycle. By now, I developed a love-hate relationship with the flashing smiley face. It seemed to be going on for far too long, but it continued to provide some evidence that perhaps my ovaries would still relinquish an egg . I told myself I would test for ONE MORE DAY. If I didn't see a positive result, I'd stop testing until next cycle. 

Cycle Day 14, Test Day 9

OMG, I can ovulate!!!!!

It's a good thing I gave myself one more day, because on the tenth day of testing, I finally achieved the long-awaited static smiley face, which indicates a positive result for the Clear Blue test.

And look at that brilliant pink result line! What a beauty! It's difficult to see in this picture, but the result line appeared slightly darker than the reference line. As I explained earlier, I didn't have a First Response digital confirmation test, but my best guess is that this shows a positive result. 

Cycle Day 15, Test Day 10

Recommendation

Definitely use the digital tests! There is too much guessing when it comes to those blasted pink lines and the price difference isn't significant enough to justify the difficulty the inconclusive results. 

From the perspective of predicting ovulation, I think the "peak fertility" result is rather worthless (or maybe my hormones are just messed up, who knows?!). That being said, I do think it has value in providing some morale and encouragement. You may think that's silly, but if it weren't for the continued flashing smiley face, I probably would have stopped testing and convinced myself that ovulation wasn't happening this month. There isn't much of a price difference between the non-advanced and advanced tests, so I say spend an extra dollar or two for your own peace of mind. 

Happy ovulating!

Hello, I have baby fever

Hello (a parody written from the perspective of 35-year-old Adele)

Hello, it's me.

I was wondering if after all these years you'd like to meet, 

to go over my cycle.

They say my eggs are getting older and my fertility's decreasin’.

Hello, can you hear me?

I'm in California dreamin’ about havin’ your baby, 

while we're young and healthy.

I've forgotten how it felt to want to use birth control.

There's such a difference between us and a million miles.

Hello, I have baby fever.

I must have called a thousand times, 

to tell you our gene compatibility is top notch.

But when I call you never seem to be home.

Hello, I have baby fever.

At least I can say that I've tried, to tell you my ovulation is near.

But it don't matter, it clearly doesn't tear you apart at all.

Hello, how are you?

It's so typical of me to talk about myself, I'm sorry.

I hope that you're well.

Did you ever make it out of that town where nothing ever happened?

It's no secret that the both of us are running out of time.

So hello from my uterus.

I must have called a thousand times,

to tell you our gene compatibility is top notch.

But when I call you never seem to be home.

Hello, I have baby fever.

At least I can say that I've tried, to tell you my ovulation is near.

But it don't matter, it clearly doesn't tear you apart at all.

Oooohh, fertilize.

Oooohh, reproduce.

Oooohh, DNA.

Baby please.

Hello, I have baby fever.

I must have called a thousand times,

to tell you our gene compatibility is top notch.

But when I call you never seem to be home.

Hello, I have baby fever.

At least I can say that I've tried, to tell you my ovulation is near.

But it don't matter, it clearly doesn't tear you apart at all. 

Chadwick's Sign (or why your cervix might be blue)

Sore boobs, nausea, mood swings, fatigue - no, these are not lyrics to a clever rap song (that I'm aware of), rather these are classic symptoms of early pregnancy. If you have these symptoms, possess functional female reproductive organs, and have had vaginal intercourse with a sperm-bearing partner in the recent past, you could always pee on a stick to find out if there is an embryo inhabiting your uterus. But, wait, there's another early pregnancy indicator that you might not be aware of: Chadwick's sign!

Under usual circumstances, the cervix is pink (cervical pink, now there's a new crayon color just waiting to be invented). With pregnancy, blood flow to the uterus dramatically increases, resulting in the cervix developing a bluish tint. This color change is referred to as Chadwick's sign, which can appear as soon as 6 weeks after conception . Ok, ok, so maybe this is not the most convenient way to gauge whether you might be pregnant, unless you are hypermobile, or have an exceptionally curious partner, but still, it's quite fascinating. Plus, cervical self-exams are completely possible (more info available at: http://www.beautifulcervix.com/participate/).

A woman's total blood volume actually increases 30-50% during pregnancy, so it's no wonder that this can make your cervix a little blue.

Babies come from gametes: The truth about the birds and bees

If "the talk" your parent(s) gave you about the birds and the bees was anything like mine, it probably went a little something like this...

Mom: "When a man and a woman love each other... blah, blah, blah."
Me: (rolls eyes) "I already know this stuff, mom. I read about it in the encyclopedia."
Mom: "Blah, blah, blah."
Me: (looks disgusted because mom is talking about genitals)
Mom: "Blah, blah, blah.. and that's how a baby is made. Do you have any questions?"
Me: "No."

My mom deserves a huge round of applause because she did a great job handling that painfully awkward conversation. Not to mention, she let me live even though I was a little smart ass who thought looking up the terms "intercourse" and "reproduction" in a book somehow made me an authority on the subject. She also said many important, intelligent things that were not "blah" but that's how my know-it-all, embarrassed, 11 year-old self interpreted the content. Sorry, mom.

I won't pretend to know how to explain the origins of babies to children, but since we are all adults here (or seriously advanced children... does your mom know you're reading this?) we can say it like it is: there are lots of ways that babies are made!

First off, all babies might be gooey balls of love, but not all of them come from love. Sometimes babies are products of lust or failed birth control or too much tequila. Whatever the reasons behind conception, the worth of the baby is no different.

Secondly, not all babies are made by a man and a woman. To be accurate, all human babies are made from a sperm and an egg. But how this happens and who is involved in the baby-making varies from zygote to zygote. Here are some baby-making methods that were probably missing from your birds and bees talk:

• Eggs without sperm: Two people with eggs in a relationship, whether they be two women or a woman and a transman or any other combination, still have lots of options for pregnancy. One or both of the partners may choose to attempt pregnancy using donor sperm (preferably they try at different times because one pregnant person per household is plenty). They may choose a donor from a sperm bank or use a donor that is known to them (a friend or relative that is willing to donate). Once the sperm supply is identified, the partner attempting pregnancy may be inseminated in a clinic that offers alternative insemination services or choose to inseminate at home. Another option, in the case of partnered women each with a functional uterus, is to use one partner's egg and have the other partner carry the baby. This would occur through in vitro fertilization: the eggs would be retrieved from one partner, fertilized by donor sperm in a petri dish, and then implanted into the uterus of the partner carrying the baby. Single women who want to get pregnant without a partner, may also opt to use the alternative insemination techniques previously described.

• Sperm without eggs: Making babies when neither partner has eggs or a uterus is a little trickier but science can help with this too. One of the partner's sperm can be used to impregnate a surrogate. The surrogate can be known or someone who is found through a surrogacy agency. Depending on the arrangement, the surrogate may be directly inseminated with the sperm (using her own egg) or, as is typically the case, eggs will be obtained through an egg donor. In the case of a donor, the eggs will be fertilized with sperm via in vitro fertilization and then implanted into the surrogate's uterus. This is more common as the surrogate then has no genetic relationship to the baby she carries, avoiding messy legal repercussions. 

Alternative insemination techniques or in vitro fertilization may also be used when a man and women have difficult conceiving "the old-fashioned way".

Additionally, making a baby doesn't have to involve your own gametes (reproductive cells). No, I'm not referring to storks. I'm talking about adoption, an option for many families who can't conceive on their own or just opt not to.

So, now you know the truth: babies come from gametes. The rest is variable. And you're welcome. Your answer to "where do babies come from?" just became a lot less awkward. 

OMG Everyone Has Genital HPV

Ok, so not everyone has genital HPV but unless you've taken a vow of life-long celibacy (which you intend to take seriously) chances are you've already had a genital HPV infection, you have one now, or you'll get one in the future. Before you freak out and run to your nearest STD clinic for treatment, take a deep breath and read this post in its entirety.

HPV stands for human papillomavirus, an extremely common virus that infects skin cells, including cells that line body cavities such as the vagina, anus, and mouth. Of the 100+ types of HPV that have been identified, about 40 are able to infect the genital region. While HPV is the most common sexually transmitted infection, affecting at least 50% of sexually active individuals, it has many characteristics that make it complicated, confusing, and unlike other STIs.

To begin with, the outcomes of genital HPV infection are highly variable. Most people with HPV are asymptomatic, will never know they are infected, and will eventually rid themselves of the virus through the defenses of their own immune system. Those are the lucky folks. Some types of HPV result in the development of genital warts while other types cause cellular changes that over time can lead to the development of cancer. In fact, HPV is responsible for nearly all cases of cervical cancer. Speaking of cervical cancer, if you haven't read The Immortal Life of Henrietta Lacks, please stop reading this and proceed to your nearest bookstore immediately. It's that good.

How people become infected with HPV is rather clear: skin-to-skin contact including contact with mucous membranes. That means anyone who is rubbing their naked body on anyone else's naked body is at risk for genital HPV infection. It doesn't matter what your sexual orientation is or what type of specific sex acts you partake in (sorry kids, dry humping won't keep you HPV-free). Barrier devices such as condoms and dental dams can decrease the risk of HPV transmission but the virus can still be spread to or from areas that the device doesn't cover.

What remains rather murky regarding HPV transmission is when exactly people are contagious and how long people can be infected before displaying evidence of the virus. Also, it is completely possible to be infected with more than one type of HPV. These factors make it nearly impossible to tell how long a person has been infected, who they were infected by, and whether they are at risk for infecting their current or future partners.

Even if you are one of the aforementioned lucky folks, it does not mean that the person you share your HPV with will be so lucky. Different strokes for different folks in the world of HPV. Fortunately, prevention against four of the particularly nasty HPV types is now available in the form of a vaccine. The HPV vaccine Gardasil provides protection against HPV types 6, 11, 16, and 18 and is approved for use in females and males ages 9-26. HPV types 6 and 11 cause approximately 90% of genital wart cases, while HPV 16 and 18 are responsible for most cases of HPV-related cancers. Vaccinating against HPV provides a dramatic reduction in risk, for both yourself and your lover(s). And yes, preteens should be vaccinated before they are sexually active in order to save them the agony of genital warts or an HPV-related cancer. Will vaccinating against a STI cause children to run out and have sex (yes, this is actually a debate to some people)? You tell me - does vaccinating against chickenpox cause kids to run around looking for playmates covered in chickenpox since they are now protected from their oozing pox blisters?

For those of us who have aged beyond 26 or who may have acquired one or more types of HPV prior to vaccination, don't despair! There have been many advances in science and medicine that have allowed HPV-related cancers to become increasingly preventable. Just because you have one of the high-risk (cancer-causing) strains of HPV does not mean you have, or will get, cancer. If you follow your doctor's recommendations for routine health screenings, such as for Pap smears*, the early cellular changes that MIGHT eventually result in cancer, can be monitored and treated before any cancer develops.

HPV may be the most common sexually transmitted infection but there is plenty you can do to decrease its potential harm. Don't let HPV catch you with your pants down!


*While cervical Pap smears are routine for anyone with a cervix, anal Pap smears are not nearly as common. Anyone who frequently has anal sex, particularly MSM (men who have sex with men) who engage in anal receptive sex, should find a medical provider who is educated in LGBT health, or at least willing to become educated, and inquire about anal Paps for detection of HPV-related cellular changes. Paps are not fun but anal cancer is far worse.