No LH Surge? What Does It Mean?

You might have heard of luteinizing hormone (LH) if you've been trying to get pregnant. But if not, don't worry; in this article, we will discuss everything you need to know about the LH surge and what it means for ovulation.

It's an important subject when trying to conceive because the LH surge can help you appropriately time sex to improve your chance of getting pregnant. Without further ado, let's get into it-- what is the LH surge? How do we measure it? And, what to do if you aren’t able to detect the LH surge? 

LH is one of the hormones that is part of the menstrual cycle. Ovulation is the mid-way point in the menstrual cycle, where an egg gets released from a mature follicle, making it ready to be fertilized by sperm. The primary hormone that causes ovulation is LH. About a day before ovulation, the pituitary gland releases LH pulses with increased frequency, leading to a “surge” in the hormone concentration in our blood. As a result of this surge, the follicle bursts open, releasing the egg, typically 24-36 hours later. 

Ovulation predictor kits (OPK), predict ovulation time by measuring LH surge in our urine. Think of it as a pregnancy kit, but for ovulation. A surge detected on the OPK can help you time sex around ovulation, to either help you conceive or avoid pregnancy. 

The baseline for LH is 0.7-12.9 IU/L. Whenever LH rises above the threshold (12.2-118 IU/L), the OPK reveals positive results, meaning you will most likely ovulate in the next 24-36 hours. On the other hand, if your LH is lower than or within the baseline, the OPK will provide a negative result, meaning your LH is not surging. 

Like a pregnancy test, an OPK does not always provide accurate results. This inaccuracy can occur if you test earlier or later than you should. Additionally, medical conditions like Polycystic Ovarian Syndrome (PCOS) may show differences in the way your body releases LH, leading to inaccurate results on the OPK. If you think something might be fishy, talk to your doctor!

As mentioned earlier, an LH surge is a dramatic rise or spike in LH level, indicating ovulation within 24-36 hours. There are three main types of LH surge. These include; 

1. Single or "Spike" pattern: This is the second most common type of LH surge, with about 42% of women in this bracket. Here, the LH level rises exponentially and falls sharply to the baseline. 

2. Biphasic pattern: This is the most common LH surge type where LH rises gradually, goes down for some time, and then rises for the second time before dipping back to baseline. Although there are two LH surges, it doesn't mean you will ovulate twice ( ovulation usually occurs once within a menstrual cycle). People within this group only ovulate after the second LH surge. 

3. Plateau pattern: Here, the surge lasts 2-3 days before returning to baseline. Some research studies suggest that women in this bracket have a higher chance of getting pregnant.  

Again, a negative OPK result means no LH surge. But here is the thing: You could still ovulate and get pregnant even with a negative result because, as we explained earlier, the OPK may not be accurate for everyone (i.e. PCOS or other hormonal disorders or challenges in timing when to check your OPK). This means that the LH strips may not be accurately tracking your ovulation.

Another thing to know is that you could still menstruate without the occurrence of an LH surge. This phenomenon is called anovulatory cycle. Anovulation can lead to irregular menstrual cycles and difficulties in conceiving because there is no egg released for fertilization to occur. 

Yes, although rare, ovulating without an LH surge is possible. There are two explanations for this. Firstly, you probably took the test at the wrong time and got a negative result, meaning there was no surge when, in fact, there was a surge earlier or later than the time you took the test.

This scenario is prevalent in women with irregular cycles. The second reason may be that your LH threshold may be lower or higher. As long as there is a rise (not necessarily a surge), where LH falls within 12.2-118 IU/L, you can ovulate. 

First, you need to ensure there is genuinely no LH peak. Don't test just a few times and assume there is no surge. We advise, especially for women with irregular periods, to test twice (morning and evening) every day for 30 days. This timing ensures that you don’t miss out on your fertile window. If, after monitoring for 30 days, you still don't receive a positive result, you could try lifestyle changes in diet, sleep, and exercise, to see if that helps produce a clearer LH surge.  At Doveras, we have dedicated experts who can guide you with tailored lifestyle plans to help you balance your hormones and conceive faster. 

Lastly, you should consult a healthcare provider if you are sure that you are doing everything right and still not getting positive results on an OPK or other digital fertility testers. Your HCP will thoroughly assess your condition and determine if further treatment is required. 

"If I’m not detecting a LH surge, could I be pregnant?" For most people, the answer is probably no as there is actually overlap with the chemical molecules of LH and bHCG (i.e. the pregnancy hormone). Accordingly, the OPK is more likely to come up positive if you are actually pregnant, even though it is not detecting the LH surge.  

In summary, a rise in LH may cause ovulation. Whatever the situation, ovulation can occur once the LH level falls within 12.2-118 IU/L. Individuals with hormone conditions or irregular cycles may not detect the LH surge on OPK.  However, it is important to speak with your doctor if you’re having a hard time with tracking ovulation at home. 

Further, if you're struggling with hormonal imbalances that are hindering your ability to conceive, it may be beneficial to make lifestyle adjustments. Join us at Doveras today, where we specialize in shaping habits that improve your chances of conceiving naturally.