Ovulation: How to find it, what is normal and why it's important.

 

Ovulation Q&A with Dr. Don Aptekar, M.D., FACOG

 

"When I started doing LH-sticks I got so confused. I was worried why it was taking forever to show that I was fertile and then some months I wouldn't even see a positive LH stick. I had so many questions about ovulation." - Carol J, interviewee on trying to conceive experiences. 


Whether you are just starting the fertility journey or you have been trying for several months, you may find that you have a load of questions about your menstrual cycle and ovulation. Detecting ovulation can be tricky and confusing so we meet with fertility expert, Dr. Don Aptekar, to get to the bottom of some of the most frequently asked questions regarding ovulation.  
 

Terminology 101:

  • Anovulation means that you do not ovulate.
  • Oligoovulation is irregular ovulation, which medical translates to ovulating fewer than 8 cycles in a year.
     

Q: Why should I learn about my ovulation cycle? 

The main reason is to find your fertile window, since this is the only time you can conceive each month. Also,  if you are not ovulating, you can not get pregnant.  If you have regular cycles and PMS symptoms, you are most likely ovulating.

If you have irregular cycles and no hormonal imbalances, this may simply mean that it will take your longer to get pregnant. A woman in her twenties with regular cycles, for example, may ovulate 12 times a year compared to a woman with irregular cycles who may ovulate 6 times a year.

To learn more about problems with ovulation click here

Q: How can I use my ovulation data to get pregnant?

There are typically about 6 days a month you are fertile. Having intercourse two days before you ovulate will significantly increase your chances of getting pregnant (see graph). As you can see, the day after you ovulate that is a 0% chance of getting pregnant. 

There are several techniques to determine your fertile window.


Q: If I have regular cycles do I still need to learn when I ovulate? 

Learning about your ovulation cycle will help you pinpoint your fertile window. 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.  

Recording information or using an app to track your cycles will also help your doctor understand more about your fertility. 


Q: Are there any health concerns if I don't ovulate regularly? 

Most women who have ovulatory dysfunction do not realize they have a problem until they are trying to conceive. Ovulatory dysfunction is responsible for 40% of infertile women. Not ovulating, directly speaking, does not harm your health. It can indicate, however, that there are hormonal problems.

If you are in your late 30s and starting to have irregular periods, this could just be a sign that you are entering perimenopause, which is perfectly healthy.

If you are not ovulating, however, due to a hormonal imbalance, this can be a serious issue and needs medical attention whether you are trying to conceive or not.

 

Q: If I have regular cycles, does that mean I am ovulating?

Most likely yes. It is not possible to have a true menstrual cycle without ovulation, however, it is possible to bleed and confuse the bleeding for a menstrual cycle (see question below).

Typically if you are not ovulating, your cycles will let you know by being irregular.  In general, if your cycle is 1) regular each month and 2) you get PMS symptoms (ie: breast tenderness, change in mood) then you are ovulating.

 

Q: Is it possible to menstruate and not ovulate?

While very uncommon, it is possible to have anovulatory bleeding (menstruation without ovulation). This is perfectly normal for girls when they first start their periods and for women that are near menopause. Menstruation with out ovulation also occurs in women who are on certain types of birth control. 

If you are not on birth control and between 20-34 years of age and are not ovulating or ovulating regularly, this may indicate an underlying problem and you should seek medical help. Read here for What your Period Says About your Fertility. 

 

Q: I’m concerned I’m not ovulating, what can I do?

If you are not having cycles, then you should consult with your doctor. The most important sign of ovulation, besides pregnancy,  is that you are having cycles. You have menstrual cycles because of a wave of hormones and the wave of hormones are what makes your body ovulate and have your period. 

 

Q: What are ways my doctor will help me to determine ovulation?  

  • They may ask you to chart your BBT and cervical mucus at home for a few cycles
  • They may perform a 21 day progesterone test to see if you have a natural rise in progesterone after ovulation
  • They may recommend ultrasound (not as common because to track follicle development you have to get ultrasounds over a one to two week period).

 

Q: Can't I just use my app to tell me when I am fertile? 

Women can ovulate anywhere between day 8 and day 20 in their cycle and this day can change each month. Apps are a guess when you ovulate based on averages. They are not a true measure of your ovulation. 

We are working on a vaginal sensor that captures your continuous core temperature Click here to learn more. 

 

Q: What if I am ovulating every month and still not pregnant?

First, have your man check his sperm. In infertile couples, approximately 40% is due to male-factor infertility, 40% is due to female-factor infertility and 20% is due to both (source). If his sperm is fine, your doctor may suggest checking your fallopian tubes next. If everything is fine with both partners, it may just take longer. Check out Trak, - a male fertility testing system your man can do from home.  


Q: What should I do if I have irregular periods?

If your cycles are shorter than 21 days, or longer than 36 days, you may have ovulatory dysfunction and should talk to your doctor.  Irregular periods indicate that you may not be ovulating or that you are not ovulating regularly.

Doctors need data about your cycle to be able to tell you what is normal or not, so make sure you are keeping track of your cycles each month including your period start and end date. To truly tell if your periods are regular or not, doctors need 6- 12 months of data. 


Q: What are the most common causes and concerns of ovulatory dysfunction?

The most common cause is  Polycystic ovary syndrome (PCOS), followed by obesity, not enough weight, extreme exercise, peripmenopause, stress and thyroid dysfunction. Although, keep in mind that perimenopause is not a dysfunction, it is a natural part of life. 
 

Q: Are there any natural treatments?

This depends on the cause. In some cases it can be solved by lifestyle changes including diet changes, losing weight, decreasing stress and eliminating drinking and smoking.

Weight loss is probably a biggy. If you lose 10 pounds it can make your cycle regular. Quit smoking.

 

Q: Is it normal not to ovulated every month?

It's normal for women in later in their 30s- they naturally may ovulate less than every month. Even if you are ovulating, age is the best determinant of egg quality. If you are in your 30s or 40s, may not make a perfect egg each month that can be fertilized. 

 

Q: My LH Sticks are not showing a positive test result

Regular cycles and not ovulating is unusual, so if you have regular cycles you are most likely ovulating. If you are regular, feel PMS, and your LH sticks still say that you are not ovulating, then I would recommend trying different LH sticks or doing them twice a day. 
 

Q: Does being overweight affect ovulation?

Yes, it can, but not always. Weight fluctuation causes more issues with ovulation and hormones if you are at a steady weight and in balance.  Estrogen is metabolized in fat cells which may cause a hormonal imbalance and women with PCOS tend to have higher estrogen levels.  

 

Q: Can you still have a 28-day cycle and ovulate earlier/later than day 14?

Yes.  Factors such as stress can influence ovulation and studies have found that ovulation can occur any where from day 8 to day 20 and that it varies each month. What does or should stay consistent is your luteal phase, or the phase after you ovulate. 

Also,  keep in mind that you don’t ovulate day '14', you ovulate '14' days prior to your period starting. It’s a retroactive assessment.

 

Q: Do ovulation sticks confirm ovulation?

No - they confirm the spike in hormones, in other words, they confirm the conditions that ovulation is likely to occur.  

 

Q: Do I ovulate on the same day every month?

Maybe, maybe not. This varies person to person. 

Unless there is an obvious concern, like not having a period at all, I tell my patients that the most important thing is to try is to enjoy the process and relax. Incorrect timing is the number one reason why my patients do not get pregnant as quickly as they hoped.