Written by: Dr. Amy Beckley, PhD, Founder and Inventor of the Proov test — the first and only FDA-cleared test to confirm successful ovulation at home.
Written on 8/16/21
The short answer is no: without an LH surge, you cannot ovulate.
A luteinizing hormone (LH) surge can help you predict when you’re ovulating so that you can time intercourse around your fertile window and get pregnant faster. But some women may never see an LH on their at-home ovulation tests. Is it possible to ovulate without an LH surge?
The short answer is no: without an LH surge, you cannot ovulate. Keep reading to learn more about LH and why having a surge is so important.
What is LH and why is it important?
Luteinizing hormone is one of the main reproductive hormones that plays a crucial role during your cycle. At the beginning of your cycle, estrogen rises as your ovaries start maturing follicles in preparation for ovulation.
Once a follicle is ready and contains a mature egg, the elevated estrogen level sends a signal to your brain that it’s time for ovulation! Your brain then releases an LH surge which triggers ovulation. Without LH, there is nothing that causes the follicle to release the egg.
Most women ovulate about 12-24 hours after an LH surge. Tracking LH levels with LH tests (also called ovulation tests) can help you identify a surge in order to pinpoint your fertile window — i.e. the short period of time when an egg is present and conception is even possible.
How do I know if I’m not having an LH surge?
Tracking LH levels with ovulation tests can help you determine whether or not you’re having an LH surge. Many threshold-based ovulation tests, like Proov Predict, are designed to turn positive when 25 mIU/ml of LH is present in urine. A positive Proov Predict test indicates an LH surge and identifies your two most fertile days.
That being said, it is possible to miss an LH surge as they can be very short — sometimes they only last 12 hours. To ensure you catch your LH surge, we recommend beginning testing early in your cycle and testing multiple times per day (but more on this later!). Don’t worry: the Proov Insight app will prompt you when to test based on your unique cycle!
It’s common for women to have an anovulatory cycle (meaning a cycle in which ovulation does not occur) every once in a while. But, if you test according to the Proov Predict protocol for multiple cycles and never get a positive result, this could be a sign that you have no LH surge meaning you're not ovulating.
It’s common for women to have an anovulatory cycle (meaning a cycle in which ovulation does not occur) every once in a while.
How high does my LH surge need to be in order to ovulate?
As we mentioned, LH is the hormone that triggers the follicle to release the egg (i.e. triggers ovulation). In order for that to happen LH needs to surge, meaning the hormone essentially needs to increase drastically and quickly to cause the ovary to release the egg.
You may be wondering, Is there a certain level that LH needs to reach in order for ovulation to occur? The answer is yes! And there have been several studies conducted to answer this exact question.
Studies show that a natural LH surge can range anywhere from 20 to 100 mIU/ml. This means that any value above 20 mIU/ml would predict ovulation and any value less than this may indicate anovulation.
This is additionally supported by other studies that show us that an LH level of 25-30 mIU/ml is the best predictive value of ovulation. In this study, researchers tested LH tests that turned positive at 15, 20, 25, 30, 35, and 40 mIU/ml, then tracked how long it took until a woman actually ovulated (24, 48, or 73 hours).
The study found that an LH test with a threshold of at least 25 mIU/ml predicted ovulation with more specificity than LH tests with different threshold values. The good news is that the FDA also follows this guidance; the FDA standard threshold for urine-based LH tests is 25 mIU/ml.
So can you ovulate without an LH surge?
Is it possible to ovulate without an LH surge? The bottom line is that you cannot ovulate without an LH surge. On top of showing us the threshold that best predicts ovulation, one of the above studies showed us that most women who only reached an LH level of 15 mIU/ml did not ovulate. This means lower levels of LH are not a good, accurate predictor of ovulation — even if that woman sees an increase in LH over her baseline levels.
You may ask then, "Can I ovulate with low LH?" While some people believe that you do not have to have a surge that hits a certain level, the data shows us that there is a certain level (25 mIU/ml) that is most predictive of ovulation. And we believe it’s important to get the most accurate and reliable information possible from your LH tests!
If you never get a positive LH test or suspect you’re consistently not having LH surges, we recommend consulting your doctor.
How do I use Proov Predict?
Proov Predict was designed with science, research, and FDA guidance in mind, which is why our tests turn positive when at least 25 mIU/ml of LH is present in urine.
Now that you understand the importance of a threshold-based test with a positivity level of at least 25 mIU/ml, it’s time to start using one! Proov Predict was designed with science, research, and FDA guidance in mind, which is why our tests turn positive when at least 25 mIU/ml of LH is present in urine.
When using Proov Predict, we recommend downloading the Proov Insight app for all-month tracking, numeric results, info on what they mean, and a personalized action plan. It will make your life easier!
While the app will lay out the testing protocol for you day by day, here’s a quick preview. You’ll begin testing with Proov Predict 18 days before your next suspected period. So if your cycle is 28 days long, you’ll begin using Proov Predict on cycle day 10.
From there, the Proov Insight app will prompt you to test two times per day — once in the morning and once in the evening. This is because LH surges can be short (as we saw above) and we want to make sure you don’t miss it.
The Proov Insight app will take your LH results one step further by providing numeric LH values. Once your LH value is over 25 mIU/ml, the test is positive and that is considered your “peak day!” It signals that you have entered your two most fertile days and no longer need to continue testing
While you cannot ovulate without an LH surge, understanding the importance of LH thresholds can help you get more out of your ovulation test results.