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Can you get pregnant when the ovulation test is negative?

Can you get pregnant when the ovulation test is negative?

Kindara | March 10, 2021 | trying to conceive
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If you're trying to conceive, you might be using an ovulation test to predict when you're the most fertile. Ovulation tests and ovulation predictor kits (OPKs) measure the levels of luteinizing hormone (LH), in your urine (1). A consistently negative test can leave you with many questions, such as, ‘did I even ovulate?’, ‘Did I do the test wrong?;’ or ‘Did I start testing too late in my cycle?’.  Dr. Eric Flisser, Medical Director, Reproductive Medicine Associates of NY, helps to demystify the science behind the false negative. 

 "LH is the hormonal ‘trigger’ that initiates the process that culminates in ovulation," explains Dr. Eric Flisser, Medical Director, Reproductive Medicine Associates of NY, LLP. "Since LH is typically only present in very low levels on any given day, LH tests are typically negative. When there is a surge in the release in LH hormone to trigger ovulation, there is a large increase in the concentration of LH in the blood and subsequently a higher concentration in the urine too.  When the concentration rises to a threshold level, the ovulation predictor test can detect it, and turns it positive, indicating the presence of LH, and tipping off the user that ovulation will soon happen. LH levels typically recede quickly back to baseline (typically within 24-48 hours), which makes it a useful test to track ovulation." 

Ovulation test kits can be great at predicting when you'll ovulate (they don't confirm if you actually did), but they aren't flawless, says Dr. Flisser. "Since no test is truly perfect, false test results must always be suspected as a possibility. Good tests, however, should have low false negative rates."  Also, an ovulation test typically works well at predicting the fertile window for folks with consistently  regular periods. But whether or not you have regular cycles, can you get pregnant when the test reads negative? Is there such a thing as a false positive? Why might these occur? Let's look at the answers to these common questions. 

What could cause a false negative OPK? 

"It is possible to conceive successfully even if the ovulation test is negative. When this happens, ovulation occurred despite a negative ovulation test result; this is a special type of test failure called a ‘false negative,’" says Dr. Flisser. A false negative can happen when your urine is diluted, and since LH surges happen in the early morning, you want to wait for a few hours to test so that the LH can be detectable in your urine. Don't drink a ton of fluid before you test, and also avoid peeing for an hour or two (2). False negatives can also occur as a manufacturing defect, so you may want to repeat the test, or try a different kind, if you think you might be ovulating anyway. 

What could cause a false Positive OPK? 

An ovulation test can tell you that ovulation is imminent when it actually isn't. This can happen to folks with polycystic ovary syndrome (PCOS), a syndrome characterized by elevated levels of androgens, irregular periods, and/or polycystic ovaries (you need at least two of these to be diagnosed with PCOS) (3). 

"Urine tests for LH are typically not meant to be ‘quantitative.’ That is, they are not meant to measure exactly how much LH, just that there is ‘enough,’” clarifies Dr. Flisser. Those with PCOS regularly have high levels of LH, so the OPK might indicate that ovulation will happen — which is often referred to as a false peak — when it actually won't (4). PCOS inhibits ovulation by interfering with the hormones necessary to make it happen (5). It's not that people with PCOS will never ovulate, but ovulation tends to be unpredictable and infrequent, and therefore OPKs aren't likely to work for you if you have PCOS. 

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What else can cause a false positive? Clomiphene (often referred to as the brand name Clomid), a fertility drug aimed at triggering ovulation, stimulates your hormones to produce an LH surge that stays elevated (6). Because of that persistently high LH, you might get a false positive if you take an ovulation test too soon after you finish the Clomid prescription.  In order to potentially dodge that, pay extra close attention to the timing of the dose and when you take an ovulation test. Ovulating with clomiphene takes place 5-10 days after you take the last pill, so it's recommended that you wait  3 days after completing the dose before taking an ovulation test (7). 

If you're over the age of 40, you may also find yourself getting a positive result on an ovulation test, but in actuality, that indication of an LH surge doesn't predict ovulation (8). “By definition, women in menopause no longer ovulate,” says Dr. Flisser, “but they have consistently high LH levels, which would trigger positive urine test results.” You don't have to be fully into menopause to have those results either; those in perimenopause (also called the menopause transition) have increased levels of LH, those not as high as those of folks in menopause (9). 

Ovulation test kits can prove tricky for some, and for others, they're a great way to assess your fertile window and to get a sense of your menstrual cycle. Be tenacious and consistent about testing and don't hesitate to reach out to your health care provider with questions.

About the author

Chanel Dubofsky's writing on gender, reproductive health, popular culture, and religion, can be found in New York Magazine, Lilith, Rewire, Modern Fertility, Cosmopolitan, and others. She lives in Brooklyn, New York. Follow her on Instagram at cdubofsky.

References +
1

Luteinizing Hormone (Blood). (2021). Retrieved February 7, 2021, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=luteinizing_hormone_blood

2

How to Use Ovulation Test Strips to Predict Your Most Fertile Days. (2020, April 7). Retrieved February 7, 2021, from https://www.whattoexpect.com/getting-pregnant/ovulation/ovulation-test-strips/#:~:text=To%20get%20the%20most%20accurate,urine%20about%20four%20hours%20later.

3

Polycystic ovary syndrome. (2020, October 3). Retrieved February 7, 2021, from https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439

5 Causes of PCOS. (n.d.). Retrieved February 7, 2021, from https://med.virginia.edu/research-in-reproduction/patient-information/causes-of-pcos/
6 Clomid. (2020, June 22). Retrieved February 7, 2021, from 

https://www.drugs.com/pro/clomid.html#s-34076-0

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