By Mary Sabo, L.Ac DACM
For couples trying to conceive naturally, the absolute most basic key factor is timing intercourse or sperm exposure with ovulation. Getting the timing right on this can quite obviously increase or decrease odds of conceiving each month and for busy couples with demanding schedules and/or with children already, it can be tricky to find the time to ensure plenty of sperm exposure. Understanding the signs and signals a woman’s body provides around the fertile time of ovulation can help ensure exposure is optimal for conception each month. It also helps a woman and her doctor understand when it might be time for some extra fertility support or addition medical treatments with a fertility doctor if conception is not happening.
Ways to Track Ovulation…
Fertile Discharge
In the days after menstruation and leading up to ovulation, called the follicular phase, the ovary simultaneously grows a follicle (containing an egg) while releasing estrogen, which thickens the uterine lining. The rising estrogen levels also stimulate the cells in cervix (the opening of the uterus into the vagina) to create a mucus, which comes out as vaginal discharge. This mucus is often referred to as “fertile mucus” or “egg white cervical mucus” as it can look like stretchy clear raw egg whites. It is slippery and accompanied by a wet vaginal sensation and sometimes watery discharge too. Sometimes it can also appear cloudy and stretchy. The cervix produces this discharge for 1-5 days before ovulation. It not only lubricates the vagina, but it also provides passage and nutrients for sperm so they can swim through the vaginal canal, cervix, into the uterus, and out to fertilize an ovulated egg in the fallopian tube. Sperm can survive in this mucus for up to 5 days, so the more days it is present, the longer the fertile window. As we age, the number of days the mucus is detected and its abundance may decrease. After ovulation, the vaginal discharge becomes white, opaque and creamy like lotion in response to rising progesterone.
LH Surge on Ovulation Predictor Sticks (OPK)
Once the follicle size and estrogen levels reach their peak, the brain can sense that an egg is ready and releases the hormone LH (Luteinizing Hormone) that signals the egg to “mature” and the ovary to ovulate that egg. This LH hormone can be detected in the urine, which is how an ovulation predictor kit (OPK) works. A positive OPK stick detects the signal from the brain to the ovary telling it to ovulate, which it typically does within 12-36 hours. Both of these signs, slippery discharge and LH surge, happen in the days BEFORE ovulation, which is the ideal window for intercourse, as it is better for to sperm to be in the fallopian tube waiting for an egg to ovulate rather than trying to catch it a day after ovulation. Around ovulation, some women also experience symptoms like mild cramping or twinges over the ovary, water retention, constipation, moodiness, breast tenderness, an increase in libido, and/or headaches. Egg white discharge and/or a positive OPK do not confirm ovulation. They only predict it is likely about to happen. It is possible to have both present and not ovulate, as is the case in some women with polycystic ovarian syndrome (PCOS). Learn more about PCOS here. Also, some women do not get positive OPKs but still ovulate. The only way to absolutely confirm ovulation is testing for the presence of progesterone in the blood after ovulation, which your GYN or fertility doctor can do.
For some women, OPKs are confusing and the peak day is unclear. In this case, we recommend writing the cycle day on the used stick and saving it in a plastic bag to compare the darkness of the positive line. The darkest line is the positive. Also, you can try changing up the sample timing. It is typically recommended to test in the morning with the first urination. If this isn’t working for you, try mid-afternoon or evening instead.
Basal Body Temperature Shift
Some women experience very few symptoms around ovulation, including very little discharge, which can make it difficult to time intercourse. In these cases, OPKs can help, but if ovulation is still unclear (for some women, OPKs are unreliable), tracking the basal body temperature (BBT) can be useful. The BBT is the body’s temperature at rest and is measured first thing upon waking while still in bed in the morning. The BBT is typically lower than the normal 98.6° F we associate with our “normal” body temperature. In the presence of estrogen only (in the follicular phase), the BBT typically hovers in the low to mid 97s, sometimes even high 96s. After ovulation, in response to the presence of progesterone, the BBT rises 0.5-1° and should be closer to or above 98°. This rise should happen after the egg white mucus and LH surge. Tracking the BBT can sometimes provide the first clues if pregnancy occurs as the BBT will stay high and sometimes rise even higher after implantation. If pregnancy does not occur, the BBT will drop before or during the period. If a clear and sustained rise in BBT is not detected, ovulation may not be occurring. This method is the only tool that tests for actual ovulation, but can sometimes be confusing and hard to interpret. The egg white mucus and LH surge do no confirm that a woman is ovulating, just that she is likely to do so soon. Testing the blood for progesterone through your MD or fertility doctor a week after suspected ovulation can also confirm whether or not ovulation is occurring.
This tool is also helpful for patients who are working with an acupuncturist as the pattern the BBT makes can give the practitioner information to influence treatments that will help improve the health of the hormones and cycle. It provides data to track to ensure improvements are being made from cycle to cycle. In a 28 day cycle, ovulation is typically around cycle day 14, while the positive OPK is around day 12 or 13. The egg white fertile discharge might be present from CD10-14. If cycles are longer, ovulation is later, and if cycles are shorter, ovulation is likely earlier. If you suspect your luteal phase (days from ovulation to period) is shorter than 10 days, talk to your practitioner or doctor as it could be negatively affecting fertility.
The dip in temperature is typically aligned with ovulation. See how the temperatures after the dip are higher than before and stay high? This indicates ovulation and the presence of progesterone. Ideal timing of intercourse is in the days leading up to the dip and subsequent rise in temperature.
The Fertile Window and Implantation
Once ovulated, the egg is quickly picked up by the fallopian tube and is available for fertilization by sperm within 12-24 hours. If an egg is not fertilized, it will dissolve within 12-24 hours. After the ovary spits out the egg, what’s leftover of the follicle is converted into a gland that produces progesterone called the “corpus luteum”. Progesterone is released from the ovary independently of whether or not the egg is fertilized but is on its own timer and will stop after 10-14 days if it doesn’t receive a signal to continue production. Progesterone helps the lining become more glandular and specific receptors start to express on the surface that will allow an embryo to attach and implant. If an egg is fertilized, it will start to grow into an embryo capable of implantation within 5-7 days, all while meandering through the tube to the uterus. If an embryo successfully implants, it will burrow in, hook up to a blood supply and start secreting a hormone called HCG (human chorionic gonadotropin). This is the “pregnancy hormone” that is detected on home pregnancy urine tests and it is also the hormone that signals the ovary to continue producing progesterone, which sustains the lining and prevents a period from happening. If the ovary does not receive this HCG signal, it will stop progesterone and estrogen production and the lining will shed in response, thus starting the cycle over.