Pinpointing Ovulation when Trying to Conceive

While nearly every other species of animals knows when they ovulate, we women pee on sticks, look at spit under a microscope, and even wake up each morning to take our temperature- all in an attempt to determine the elusive impending ovulation.

Research shows that women using ovulation prediction kits (detecting urinary hormones) to determine fertility only captured 30% of their fertile window (source). When using the calendar method, only a mere 3% of women with regular cycles were in their fertile window (source). This is a serious problem. Not only because daily intercourse (or intercourse every other day) throughout the 6 days of the fertile window significantly increase the odds of conception, but because many of us are starting our families at an older age and time is not on our side.


Given that the current options for predicting the fertile window are not always accurate, it's not surprising that we have lots of questions concerning when we ovulate. For this post, we held a Q&A with veteran and expert OB-GYN, Dr. Don Aptekar, on the most commonly asked questions he receives when his patients are trying to conceive. 


Q: What is the most commonly asked question you get from women trying to conceive?

A: That one hasn’t changed at all over the past 40 years:  it’s when do I ovulate or when can I get pregnant.


Q: What is the biggest misunderstanding couples have while trying to conceive?  

A: The biggest misunderstanding is what day they ovulate and timing the fertile window. Many women believe they ovulate day 14. Even though we now have apps and the internet, there is still misguided information on what day women ovulate. Day 14 is based on an average from a group of women and an estimate for a 28-day cycle. Women have been found to ovulate on any day between day 8-20 in any given cycle.  

Q: What recommendations do you give to women that haven't gotten pregnant in 6-12 months but appear to ovulate? 

 A: If they have regular cycles and have been timing their fertile window properly,  I tell them that to get their partner's sperm checked out. There is a general misconception that the problem is more likely to be due to the woman when in reality is it can equally be the man's issue. 

Q: What is the number one reason why couples have a difficult time getting pregnant? 

The number one reason my patients have a difficult time conceiving is that they 1) have not waited long enough and 2) are timing intercourse wrong.  

Women in general are fertile for about 6 days total each month depending on how long their partner’s sperm is viable. Outside of the fertile window there is a zero percent chance of conception. Studies have found that ovulation can occur any where from day 6 to day 21 and that it varies each month (Source). 

Q: What surprises you the most during a doctor’s visit for women trying to conceive?

A: Nothing surprises me anymore and things haven’t changed since the 70s. Every year a new group of people come in and couples have the same questions. Even with the internet there are still the same questions, except now people try and self diagnose themselves. Once a month I see someone who believes they have a  fertility problem from what they have read online and then the next month they are pregnant.

Honestly, I suppose I’m more surprised by the woman who get pregnant who didn’t think they could. 


Q: So you spend most of your time explaining ovulation?

A: Yes- nearly every visit is explaining when they ovulate and historically it hasn't been easy for women to pinpoint.  I’ve found that it causes too much stress to have patients track their temperature on their own and LH sticks don’t work for everyone. I’m looking forward to when Priya launches to give women a stress free and reliable option.


Q: What ways can women pinpoint their fertile window? 

To determine ovulation, I recommend my patients use biomarkers such as hormones (LH sticks), the cervical fluid method, and temperature - but only if it doesn't cause additional stress to their lives. 


Q: What other questions do women come to you with?

A: My patients always try and eliminate possible reasons for why they aren’t getting pregnant. They will say “I’m taking cough medicine and I do this and do that…” They want to know if they are allergic to sperm or if their cervical mucus is too thick. It’s a completely natural thing to ask about, but the reality is that for the majority of my patients it all comes back to timing intercourse.

Other commonly asked questions are around what they can and can’t do. The hardest thing for my patients is to make decisions about what they can and can’t take. I tell them no medication is approved for pregnancy and the next question is, “so then what should I take for my allergies?”  I explain that if you really don’t need it to manage a disease, than don’t take it. If you get a headache, try rest and hydration. If your headache is so bad that you feel that you need to go to the ER, then you should probably take your medication, but I’m telling you, no medication has been approved for pregnancy.  

If you are trying to get pregnant and there is a chance you may be pregnant, before you take a medication ask yourself, “is this something I really need?”  If it is, then talk to your doctor about your options. 


Q: What about drinking alcohol while trying to conceive?

Alcohol is always a big one I get asked about. Alcohol is not approved in pregnancy - ever. But the truth is the majority of women I see drink early in the pregnancy because they didn't know they were pregnant. Drink a little bit of alcohol and the risk is minuscule, but I’m not going to tell someone it’s ok. My advice to you is that from time of ovulation to onset of the next period you shouldn’t drink.  That way you don’t have a big concern. We don’t understand all the risks so it’s best not to drink.