Did I ovulate given my luteinizing hormone (LH) surge, estrogen (E1G) levels, and symptoms such as flushed cheeks, nipple sensitivity, and bladder pressure while undergoing fertility treatment with letrozole (letrozole) and progesterone supplementation?

Ovulation Assessment Based on Your Hormone Data and Symptoms

Yes, you ovulated, most likely on CD14 or early CD15, based on your LH surge pattern, declining estrogen after the peak, and subsequent progesterone rise.

Evidence of Ovulation in Your Cycle

LH Surge Confirmation

• Your LH peaked at 45 on CD14 (FMU), which represents a clear 2-4 fold increase above your baseline levels (CD13 LH was 26.7), meeting the criteria for an LH surge 1
• Ovulation typically occurs 28-36 hours after the beginning of the LH rise, or 8-20 hours after the LH peak 2, 1
• Your LH began rising on CD13 (26.7) and peaked on CD14 (45), then declined to 22 by CD14 evening and further to 18.6 by CD15, which is the expected pattern for ovulation 3

Estrogen Pattern Supporting Ovulation

• Your E1G peaked at 377.1 on CD12, which is the expected preovulatory estrogen surge that triggers the LH surge 4
• The decline in E1G from 377.1 (CD12) to 258.6 (CD15) indicates the post-ovulatory estrogen drop that occurs 12 hours prior to ovulation as LH induces marked reduction in estrogen production 1
• This reciprocal relationship between declining estrogen and rising LH is a reliable marker of impending ovulation 1

Progesterone Confirmation

• Your PDG level of 1.1 on CD15 represents the early post-ovulatory progesterone rise 5
• While this is still low, LH induces a 2-3 fold increase in progesterone production above baseline levels starting around ovulation 1
• A cycle is confirmed ovulatory when serum progesterone exceeds 5.0 ng/ml on day 7 post-ovulation 6, so you would need to continue monitoring PDG over the next several days to confirm adequate luteal function

Clinical Symptoms Alignment

• Your severe cramps and side pain on CD14 align with periovulatory pain, which is a reliable clinical marker of ovulation 1
• The progression from very slippery fertile EWCM on CD11 to sticky/gluey mucus on CD13, then abundant EWCM on CD14-15 followed by wetness, matches the typical periovulatory cervical mucus pattern 1
• Flushed cheeks, nipple sensitivity, and bladder pressure on CD14-15 are consistent with the hormonal shifts occurring around ovulation 5

Timing Interpretation for Letrozole Cycles

Expected Ovulation Day

• Given your LH peak on CD14 morning (45) and the decline by evening (22), ovulation most likely occurred late CD14 or early CD15 2
• The 28-hour interval from the ascending limb of your LH surge (which began CD13 evening/CD14 morning) places ovulation around CD14 afternoon/evening 2

Letrozole Effects on Your Cycle

• Letrozole works by inhibiting aromatase, which converts androgens to estrogens, and this suppression is maintained throughout treatment 7
• Your E1G peak of 377.1 is appropriate for letrozole cycles, as aromatase inhibitors yield lower peak serum estrogen levels compared to other ovulation induction protocols 8, 9
• The LH surge mechanism remains intact with letrozole, as the drug does not impair the hypothalamic-pituitary response to estrogen feedback 7

Critical Monitoring Points Going Forward

Luteal Phase Assessment Needed

• You must continue monitoring PDG daily through at least CD22 to confirm sustained progesterone levels above 5 μg/mL throughout the implantation window 5
• Research shows that while 95% of women may have a PDG rise confirming ovulation, only 58% maintain sustained adequate levels during the critical implantation window, indicating potential ovulatory dysfunction even when ovulation occurs 5
• If your PDG does not remain elevated above 5 μg/mL for 7-10 days post-ovulation, this suggests luteal phase deficiency requiring progesterone supplementation 5, 6

Multi-Peak LH Pattern Consideration

• Your LH showed multiple peaks (26.7 on CD13, 45 on CD14, then 25.3 beta LH on CD14), which is a normal variant 3
• LH surges marked by several peaks are associated with smaller follicle sizes before rupture and lower LH levels on the day of ovulation, but this does not prevent successful ovulation 3
• The extreme variability in LH surge configuration, amplitude, and duration is normal in ovulating women 3

Optimal Intercourse Timing

• Your most fertile days were CD11-14, with peak fertility on CD13-14 based on your EWCM, rising LH, and peak estrogen 5
• The average fertile window extends 2.7 days prior to the LH surge through 2.6 days after, giving approximately 5-6 fertile days total 5
• Intercourse on CD13-14 would have been ideally timed for conception given your ovulation on CD14/15 2