Ultrasound-Guided Ovulation Monitoring Versus Home Ovulation Tests and Psychosocial Outcomes in Subfertile Couples: Prospective Cohort Study

Abstract

Objective: To assess whether ultrasound-guided ovulation monitoring, compared to home ovulation tests, increases stress levels or impairs sexual function in subfertile couples. Design: A prospective cohort study. Setting: Academic medical centre from November 2023 to October 2024. Population: A total of 311 subfertile couples are trying to conceive. Methods: Subfertile couples were allocated to two groups: the ultrasound-guided ovulation monitoring group and the home ovulation tests group and were surveyed over four menstrual cycles. Stress, anxiety, depression, and sexual function of both partners were investigated through questionnaires. Main Outcome Measures: Perceived stress scale. Results: During the four menstrual cycles, neither significant between-group differences nor group-by-cycle interaction effects were observed for stress, anxiety, or depression in either partner (all p > 0.05). However, a significant cycle effect was identified over the 4 cycles: anxiety levels increased in women (p = 0.037), while both anxiety (p < 0.020) and depression (p < 0.001) rose significantly in men. Additionally, across the study period, women's Female Sexual Function Index scores (p = 0.021) and men's erectile function (p < 0.001) showed a significant decline. In terms of pregnancy outcomes, the ultrasound-guided group achieved a pregnancy rate twice that of the test group (adjusted OR = 2.12, 95% CI 1.32–3.39, p = 0.002). Conclusion: Ultrasound-guided ovulation monitoring shortens time to conception, with no evidence of increased emotional distress or impaired sexual function.