What is Ovulation? Ovulation refers to the time when the ovary releases a matured egg for fertilization. The matured egg, once released, moves to the Fallopian tube and waits for the sperms to arrive. Typically, the egg remains available for 12 to 24 hours and there are chances of pregnancy in case a sperm meets the egg during that time period. Ovulation is, thus, one of the most important part of the female menstrual cycle that dictates pregnancy.
Ovulation is characterized by a surge in two hormones released by the pituitary gland – the luteinizing hormone (LH) and the follicle stimulating hormone (FSH). The time at which ovulation exactly occurs typically depends on the length of the female menstrual cycle and it may take place between 10th and 19th day into the cycle Tracking ovulation: Tracking the day of ovulation is a simple, yet an important step in your path to successful conception. To track ovulation, you must know the length of your average menstrual cycle, which can be calculated by counting the number of days between the first day of your last menstrual period (LMP) to the day before the next menstrual cycle. For example, your LMP was on July 10 and the next period arrives on August 9, then the length of menstrual cycle is 30 days. Ovulation takes place two weeks prior to the expected date of the next menses. So for an average menstrual cycle of 30 days, ovulation may take place around the 16th day. The fertile period ( the days to have intercourse to have pregnancy) would be day 12 to day 17( that is 4 days prior to ovulation to 1 day after ovulation) and day 14 , 15 & 16 considered as most fertile. To check your fertile period, click here. What if my menstrual periods are irregular ? If your menstrual cycles are irregular, or coming at an interval of more than 32 days, you may have a problem with ovulating normally as well as could be difficult in your case to predict ovulation days with accuracy, hence you must consider seeing an infertility specialist for the same.
Does regular periods always mean I am ovulating each cycle ? –NO6 ways to check if you are ovulating —
1)Basal body temperature chart: Charting out the basal body temperature (BBT) every morning just after getting up during the course of a menstrual cycle is a way to track ovulation naturally. Typically, after the ovulation has happened, the BBT rises by about half a degree centigrade. Therefore, by making a note of the rise in temperature every day, you can predict if ovulation has happened. Half a degree rise in BBT may signify that the fertile window is already over, so it is not useful to time the intercourse as the best time to have intercouse is already gone. The following chart explains how to record BBT.
2) Cervical secretion/mucus (CM) changes: The cervix keeps on producing different kinds of mucous through the menstrual cycle. By closely observing the kind of mucous that the cervix is producing at different time periods in a menstrual cycle, you can have a fair idea about the time when you are most likely to ovulate. This method is more reliable than a BBT chart, since changes in CM can be observed before ovulation. The following chart describes CM changes during a typical menstrual cycle:
|Menstrual Phase||How it Feels to Touch||Appearance|
|Before ovulation||Dry||No mucous at all.|
|Fertile period||Sticky and moist||White/cream coloured cloudy, thick and slightly stretchy mucous. May break easily when stretched.|
|Highly fertile period (ovulation)||Slippery, stretchy, lubricated and wet||Watery, thin, highly stretchy and transparent mucous that resembles egg white.|
|After ovulation||Dry and sticky||Cream coloured or opaque white mucous which is highly thick.|
3) Cramping pain mid cycle: Some women experience “Mittelschmerz” in the middle of their menstrual cycle, a German term that translates to “middle pain.” This pain is usually a result of follicle breaking apart to release an egg A typical midcycle cramping may last for a few minutes to over a few hours. You can try to identify the following signs of midcycle pain to assess your fertility:
- It usually occurs on one side of the pelvis.
- There is no previous warning of cramping and it occurs suddenly
- Cramping pain usually shifts sides from one month to another.
- Rather than being a dull ache, the midcycle cramping pain is sharp and intense.
- It typically occurs two weeks before the expected date of the next period.
- Would usually settle down in a day or so
- Its considered as a positive sign as it indicates ovulation ; Moreover, it’s an important day to try for pregnancy as it is the likely day of ovulation in the month.
4) Urinary ovulation detection kits: Urinary ovulation detection kits look for an increase in the amount of LH(ovulation hormone) to figure out whether estimated date of ovulation. It is an easy and simple way to know about the fertile period during each month and is especially useful in the cases when partners are not able to spend quality time with each other every month or when a woman has an irregular cycle. Urine-based ovulation prediction kits notice a surge in LH, which usually starts to happen one or two days before ovulation. The egg is usually released by the ovary between 12 and 24 hours of the beginning of the LH surge. This, in turn, marks the period when you are most likely to get pregnant and so should time the intercourse accordingly. If the strip comes positive, it indicates impending ovulation in the next 12-24 hours, hence it’s important to try that day as well as the next day as the 2 most important fertile days in the cycle. However, as the LH surge happens for a very short period, around 12 hrs only, it may happen and still get missed on the LH kit, hence is not 100% reliable. It may thus also add confusion and frustration in timing intercourse accordingly. Hence, trying as per your fertile period calculation, and trying every alternate day during that time should suffice. In case the problem persists, it’s better to see an infertility specialist who can do folliculometry study by ultrasound as explained below, which would be a much more reliable and accurate way of timing the day of ovulation.
5) Ultrasound folliculometry: Ultrasound folliculometry refers to a series of ultrasound tests specially used in the case of women who are trying to conceive. These ultrasound tests are used to specifically check the growth of the follicle in the ovary serially as well as the lining of the womb (endometrial thickness). The test thus
- Gives the most direct evidence of follicular growth as well as proof of ovulation
- Is a good tool for tracking follicular growth, calculating the most fertile days and time intercourse accordingly
- Helps to detect minor disturbances in ovulation and follicular growth such as follicles not growing at the right pace, problems with spontaneous follicular rupture necessitating hCG injections to induce rupture, subtle abnormalities such as Luteinized Unruptured follicle, short luteal phase etc which would otherwise go undetected and labelled as unexplained infertility
Ultrasound folliculometry can be conducted in the following two ways:
Transabdominal: A clear gel is applied to the abdomen of the female as she lies in a face-up position on the examination table. The doctor then uses a transducer and presses it against the abdominal skin to see the ovaries and the developing follicle. You need to be full bladder for the test else the uterus and ovaries cannot be seen on an abdominal examination.
Transvaginal: In this method, the transducer is inserted into the vagina to click the images of the ovaries more closely. The transducer is first protected with a cover and lubricated with a small amount of clear, water-based gel. You need to pass urine before the test as a full bladder does not allow good visualization of the uterus and ovaries. It’s more sensitive and accurate than an abdominal ultrasound test.
6) Serum Progesterone The serum progesterone blood test is another test that helps the infertility specialist to identify whether the woman is ovulating. Progesterone is a hormone produced by the ovaries that helps prepare the uterus for pregnancy, and helps maintaining it once it happens. Typically, the levels of progesterone are low at the start of the menstrual cycle. However, the levels gradually rise and the peak occurs a few days after ovulation. The levels return back to normal in case there is no pregnancy. Hence, the test is ordered around 7 days prior to expected day of ovulation, eg, day 21 of a typical 28 day cycle. High progesterone levels at this time, typically >3ng/ml indicate that there has been ovulation in this cycle. Serum progesterone levels are detected using a blood test. It is typically conducted to figure out the following:
- Whether the ovaries are working fine
- Whether the female is ovulating
- In case of trying to differentiate between a healthy pregnancy, ectopic pregnancy and risk of miscarriage