What Type of Ovulation Tests Are Best for Me?

Ovulation tests can be divided into a few categories: digital tests, sticks, and strips. This guide will help you decide which test is best for you. 

By OBGYN Dr. Kenosha Gleaton

Ovulation tests can help track the presence of urinary luteinizing hormone (LH) levels, allowing you to determine your fertile window.  With many options on the market, you may be wondering how to decide. This is our guide to the three types of tests, and the pros and cons of each.  

The first and most important thing to know is that the three test types we outline below use the same mechanism to test urinary LH levels. The difference is not in the test itself, but rather the form factor, or casing around the test. What do we mean by that? Let’s dive in…  

Ovulation Test Sticks (Midstream Tests) 

 Ovulation midstream tests are simple analog tests for predicting ovulation. Because of the casing, you can pee directly on the test wick or dip the test in a cup of urine. The results show up in the test window within minutes. Unlike a pregnancy test, two lines alone is not a positive result since your body makes LH at low levels throughout your cycle. A positive result is when the test line is as dark or darker than the control line.

Pros:

• Easy to use, urine cup is optional but not required as you can pee directly on the test
• Plastic neutral, which mean that for every pound of plastic Natalist sells, we facilitate the removal of a pound of plastic pollution—giving your purchase a net-zero plastic footprint

Ovulation Test Strips

The Ovulation Test Kit includes midstream tests without the plastic casing! Test strips are also simple to use—you dip the test in a cup of urine and test results display within minutes. Because they don’t have casing, they are much less expensive and better for the environment (just like our hCG test strips, which use 81% less plastic than midstream tests). Because of their size, ovulation test strips are easier to save so you can track your results over time. Our test kit even comes with a cycle tracker where you can store tests. 

Pros:

• Best option for the environment
• Comes with cycle tracker
• Most affordable option per test
• Allows you to test more frequently 

Digital Ovulation Tests

Digital ovulation tests are like ovulation test sticks but with a battery, a computer chip that reads the test results, and a tiny LCD screen that displays the results. Not only do digital tests consume more natural resources to produce, but they are the worst option for Mother Earth. In our opinion, the electronic waste created is not worth the benefit of having a result displayed digitally. Plus, digital tests are more expensive.  

How Do Ovulation Tests Work?

Unlike the pregnancy hormone (hCG) which is only produced when pregnant, the ovulation hormone (LH) is present throughout your entire cycle. At the beginning and end of your cycle, your LH levels are relatively low, but usually about halfway into your cycle, you will experience what is known as your LH surge. An LH surge is when your urinary LH levels suddenly spike, and it conveniently happens 16-48 hours before you ovulate. In the chart below, you will see what a typical LH level pattern is during a 28 day cycle. As you notice, very soon after the LH surge, ovulation occurs. 

Most women have a urinary LH surge concentration of 20 to 100 mIU/ml. And most tests, regardless of type, can detect as low as 25–30 mIU/ml which accommodates tracking from a baseline level (<10 - 20mIU/mL) to an identified peak or surge (>20-40+ mIU/mL). [1-2] So, most ovulation test sensitivities will fall in this range and when your urinary LH levels are between 25-30 mIU/ml, you will receive a positive result! 

What Is Ovulation Test Sensitivity?

Natalist’s ovulation tests have a sensitivity of 25 mIU/ml, so when your urinary LH levels are at or surpass 25 mIU/ml, you will receive a positive result!  Our test is qualitative, meaning there are two possible results: low LH (<25 mIU/ml) or LH Surge (25+ mIU/ml). 

If the test line is the same color or darker than the control line, that’s a positive result and means you are undergoing your LH surge. Remember that if your result is positive and reflects the color change associated with an LH surge, you will likely ovulate within the next 16-48 hours. 

When the test line is lighter than your control line, your result is negative, meaning your LH levels are low. Again, this happens since the control line has a sensitivity of 25 mIU/ml, and when your urinary LH levels have not met that threshold, it will cause the test line to be lighter than the control line. So, you should keep testing until your test line is the same color or darker than the control line, indicative of a positive result. 

Ovulation Tests Aren’t For Everyone

Though ovulation tests are designed to have a sensitivity that is respective of a wide age and demographic range, unfortunately, there is no “normal” urinary LH level. It’s rare, but some women may have LH surge levels lower than the common range of 25-30 mIU/ml, making it difficult to track their ovulation pattern as the test will likely never provide a positive result. Furthermore, in a 2015 study, it was found that across forty middle-aged women, urinary LH levels ranged from 6.4-101.0 mIU/ml 24 hours prior to ovulation. [3] Additionally, it was also reported that undiagnosed medical issues are also a leading factor in having abnormal ovulation test results as they cause LH levels to remain low. For example, Polycystic Ovarian Syndrome (PCOS) occurs in 12% of women and prevents them from ovulating. [4] Consequently, these individuals experience a lack of LH surges and may not observe any positive results while using ovulation tests. 

Other common issues that may cause you to receive no positive results include [5]: 

• Hypothalamic dysfunction: LH is produced by the pituitary gland, which is attached to the hypothalamus. Disruptancies to the hypothalamus, including physical and emotional stress as well as changes in weight, can cause a decrease in urinary LH levels, thereby preventing ovulation. 

• Premature ovarian failure (primary ovulation insufficiency): Causes for ovary to stop producing eggs and lowers production of estrogen in women under age of 40 due to either an autoimmune response or premature loss of eggs held in ovary. 

Please consult with your provider if you are experiencing negative results (i.e. no LH surges) for multiple cycles in a row. 

Key Takeaways

• Ovulation tests can help track the presence of urinary luteinizing hormone (LH) levels, allowing you to determine your fertile window
• There are three main types of tests: sticks, strips, and digital
• Ovulation test sticks, also known as midstream tests, are easy to use and don’t require a urine cup
• Ovulation test strips are the same test without the plastic casing! This option is the most affordable and environmentally friendly
• Digital ovulation tests are easy to read, but are more expensive and create unnecessary electronic waste 

References:

1. Su HW, Yi YC, Wei TY, Chang TC, Cheng CM. Detection of ovulation, a review of currently available methods. Bioeng Transl Med. 2017;2(3):238-246. Published 2017 May 16. doi:10.1002/btm2.10058
2. Leiva RA, Bouchard TP, Abdullah SH, Ecochard R. Urinary Luteinizing Hormone Tests: Which Concentration Threshold Best Predicts Ovulation? [published correction appears in Front Public Health. 2018 Nov 30;6:345]. Front Public Health. 2017;5:320. Published 2017 Nov 28. doi:10.3389/fpubh.2017.00320
3. Johnson, Sarah & Weddell, Sarah & Godbert, Sonya & Freundl, Guenter & Roos, Judith & Gnoth, Christian. (2015). Development of the first urinary reproductive hormone ranges referenced to independently determined ovulation day. Clinical Chemistry and Laboratory Medicine. 10.1515/cclm-2014-1087. 
4. Sheehan MT. Polycystic ovarian syndrome: diagnosis and management. Clin Med Res. 2004;2(1):13-27. doi:10.3121/cmr.2.1.13
5. Female Infertility. Mayo Clinic. August 2021. https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/syc-20354308

 Originally published March 31, 2021. Updated for accuracy and relevancy on January 10, 2024. 

Dr. Kenosha Gleaton is board-certified in gynecology and obstetrics and is the Medical Advisor of Natalist. She received her MD from MUSC and completed her residency at Carolinas Medical Center in Charlotte, NC.

Dr. Gleaton is passionate about women, health equity, and mentoring. She is the CEO of The EpiCentre, an OBGYN spa-like practice, and is a Clinical faculty member of Charleston Southern University. She is also a member of the American College of Obstetrics & Gynecology, the American Association of Gynecologic Laparoscopists, and the American Association of Professional Women