Clinically, ovulation monitoring is an important means to diagnose the presence or absence of ovulation, while predicting the time of ovulation and guiding the timing of sexual intercourse, which in turn can greatly increase the chance of conception. The following methods are commonly used: 1. Basal body temperature (BBT): Measurement method: Qi Guohua, Department of Obstetrics and Gynecology, Shekou People’s Hospital, Shenzhen 1) After 6-8 hours of sleep. 2）Without any disturbance, i.e. after sleeping and waking up without any activity. 3) Table under the tongue for 5 minutes (with a women’s thermometer – as shown below) Remarks: ? Indicates body temperature ⊙ Indicates day with sex, indicate time × Indicates menstrual period Normal BBT with ovulation is biphasic (temperature increase > 0.3 degrees during high temperature period). Anovulatory BBT is monophasic (no hyperthermia). Luteal insufficiency BBT is a slow rise or fall in temperature or less than 0.3 degrees in the high temperature period or lasts less than 10 days. Luteal atrophy is bleeding during the high temperature phase of BBT. a temperature higher than 37 degrees during the high temperature phase of BBT suggests an endometrial infection (tuberculosis). Recommendation: Ovulation monitoring by BBT in natural cycle (10% of biphasic BBT is LUF), starting 2 days after menstruation and having intercourse every 3 days for a total of 4 times. 2. Ultrasound ovulation monitoring: ultrasound can distinguish follicles of 2-4mm (vaginal ultrasound is clearer). The first ultrasound after menstruation to understand the pelvic status, starting from the 9th day of menstrual cycle, 1-3 days to observe once, through continuous observation, we can see the follicles gradually grow and migrate to the ovarian surface, the dominant follicle (10mm) can be identified on the 9th-12th day, when the follicle diameter <12mm, the follicle increases 1mm per day, when the follicle diameter >14mm, the growth rate is 2mm/day, when the follicle When growing to 14mm, ultrasound is done every other day. The average diameter of clomiphene mature follicles is between 18-22mm (max 24mm) and the average diameter of Gn mature follicles is bounded by 15-18mm (max 18-20mm); OHSS occurs in relation to the increase of small follicles. The endometrium is less than 6mm, which makes pregnancy difficult and should be supplemented with estrogen (supplementation with Glaxo, 1 – 2mg in early follicular phase and 4 – 8mg in late follicular phase). Mature follicles are located on the surface of the ovary. Recommendations: Ovulation monitoring with vaginal ultrasound or combined with blood hormone measurement or combined with LH urine test paper when ovulation is induced or superovulation. 3. Blood sex hormone measurement: The level of sex hormones in the blood varies at different stages of the menstrual cycle. To analyze whether the serum sex hormone level is normal, the timing of the blood draw must be considered (see below). Blood sex hormones are usually measured at two times to observe the presence of ovulation: ① mid-menstrual period (ovulation), mainly to observe the presence of LH peak (>40U /L), and E2 peak (400pg /ml, mature follicle range 120 – 550pg/ml); ② day 21 of menstruation (or 7 days of BBT rise), mainly to observe progesterone and estrogen levels, P>5ng/ml indicates the presence of ovulation, P in less than 10ng/ml, although there is ovulation, but there is luteal insufficiency, P>15ng/ml is normal. Note: E2 concentration: 1000-1500 pg/ml (representing 2-3 mature follicles). high risk value for OHSS occurrence: E2 concentration 1500-2000 pg/ml. contraindicated for HCG injection: E2 concentration >2000 pg/ml, diameter ≥16mm, follicles >4. 4. Urinary ovulation test (urinary LH) self-monitoring : It is used to test the urinary LH peak in the middle of menstruation, so as to determine the hormone to promote ovulation or to inform the user that ovulation is about to occur. Within 48h after the urinary LH peak, ultrasound shows an ovulation rate of 92.4%. 5. Cervical mucus examination: 1-2 days before or on the day of ovulation, there should be a large amount of clear cervical mucus with lamb’s tooth crystals on the smear and dilated cervical opening. However, it can only understand the general situation of estrogen and cannot confirm the diagnosis of ovulation. 6.Diagnostic scraping: influenced by ovarian estrogen and progesterone, there are obvious mid-term changes in the endometrium in the middle of menstruation: 5-7 days before menstruation for late changes in secretion. If endometrial examination is done before menstruation or within 12 hours of menstruation for proliferative changes, it indicates anovulation. In recent years, a special case of pseudoluteal insufficiency has been discovered: for ovulation and normal luteal function, there is no secretory phase change due to the lack of P receptor in the endometrium, and the endometrial examination is proliferative phase change. The diagnosis of pseudoluteal insufficiency is endometrial histology + endometrial P receptor assay. Treatment is the administration of hMG with E2 during the follicular phase to synergistically promote the production of endometrial P receptors. Note: Pre-treatment before ovulation promotion 1. Tubal effusion. 2, endometrial problems. 3, High body temperature in the luteal phase. 4.Uterine fibroids, adenomyoma, endometriosis. 5, High androgen level, high LH level. (Dain 35 and/or metformin and/or dexamethasone re-tested after three weeks, can be continuous can cycle) 6, excessive FSH and/or E2 levels in early follicular phase. 7, high PRL blood (check PRL, to be the second – four days of menstruation, fasting, sitting still for 1 hour, blood draw at 10 – 11 am).