The Physiology of Hypothalamic-Pituitary-Ovarian (HPO) Reset
Exogenous synthetic estrogens and progestins maintain high feedback that silences hypothalamic pulsatile GnRH and prevents the pituitary LH surge. Once cleared, the HPO axis awakens, allowing antral follicles to mature.
Following a miscarriage or chemical pregnancy, residual beta-hCG can cross-react with LH receptor assays, causing false-positive OPKs until systemic hCG drops below 5 mIU/mL.