Ovulation Tracking
Am I ovulating and how can I accurately predict my fertile window?
This is not something that is only useful for those trying to conceive, learning to understand your cycle can be hugely empowering for all menstruating women. This can be helpful even if it is only to work out when you are fertile to avoid an unwanted pregnancy.
This is not one for the men in this group, however, if you are trying to conceive, I urge you to read this too. It’s important that you are also knowledgeable on how ovulation works to best support your partner - trying to conceive is not only the woman’s job!
Two important starting points:
1. If you are on the oral contraceptive pill, you do not ovulate, and this is not information for you.
2. Period apps (Clue/Flow) only predict your fertile window correctly 21% of the time. The results are not reliable even if you have a regular cycle! Please, please do not try to conceive by only having sex around the time your app tells you that you are in your fertile window.
3. Having sex 1-2 days before ovulation gives the couple 1 in 5 chances of conceiving. This might surprise you that this is the 2 most fertile days of the cycle and there is still only a 20% chance!
4. Ovulation strips are not suitable for some women (more detailed below). These strips are testing for a surge in LH which precedes ovulation - for some women this surge happens 12 hours before ovulation, for others it could be anywhere between 18-36 hours. So, whilst you don’t know which is true for you, having sex when you get a positive result may not be the best way!
Some facts about ovulation:
° Ovulation occurs once a cycle
° The egg can live for around 24 hours post ovulation but is most likely to be fertilised in the 12 hours after ovulation
° Sperm can survive in the female reproductive tract for around 4 days
° So ideally, for conception we need fresh sperm waiting for the egg to drop
° Having sex 1-2 days before ovulation gives the couple 1 in 5 chances of conceiving. This might surprise you that this is the 2 most fertile days of the cycle and there is still only a 20% chance!
° The chance of conceiving on the day of ovulation is 1 in 7 - this drops because the egg is most likely to be fertilised in that first 12 hours.
° 6-4 days before ovulation there is a 10% chance of conceiving.
° Outside of these days there is no chance at all (0%).
The best way to accurately predict when you are ovulating, or your ‘fertile window’ is carrying out a daily practice of recording what’s going on in your body. This includes temperature, cervix position, hormone surges and how you feel (physically and emotionally)
This gives you feedback about your reproductive health:
° Understanding your hormones and the connection between emotion, lifestyle, and fertility
° Teaches us to connect with our bodies enough to sense ovulation
° May unearth pathology or deficiency e.g., with BBT charting you could find out that you have low thyroid function or perhaps are not ovulating at all
° Provides your practitioner with valuable information for their treatment and feedback about how you are responding to your treatments (if I am treating you, please share all this information with me!).
What you need to chart your cycle - alone each of these are not enough to accurately track ovulation - the best way is a combined method.
° Somewhere to record your data: pen + paper or apps like Clue, Fertility Friend, or Flow.
° A specific BBT/ovulation thermometer (different to a normal thermometer as its more sensitive, down to 2 decimal places). Digital is preferable over a mercury one.
° Ovulation test strips are a tool, they also should NOT be followed alone. Please remember these do not work for everyone.
Some tips for those trying to conceive:
° TURN OFF the ovulation predictor setting on your period tracking app, these are only correct 21% of the time.
° Never look at data on one day only. Ovulation tracking is all about patterns which build up over time.
° The research shows that for most couples, you need to give trying to conceive a go for a year. However, this ‘year’ is based on 12 x 28 cycles with ovulation occurring, not a timeline of 12 months. Please give yourself ovulating 12 times - when you know when you are ovulating and can track it properly.
° If you have been on the oral contraceptive pill it takes some women up to 9 months to fall back into a regular cycle (or what is regular for them), so please don’t put pressure on yourself to conceive immediately!
° Talk to your partner about what you are tracking - the onus should not fall on you alone to dictate the schedule
° Although we are aiming for sex on the day before and day of ovulation, no matter which days you are ovulating, best practice is having sex every 2-3 days of your entire cycle. This alleviates pressure on the sex on the fertile days and allows for any miscalculation in your ovulation or allows for ovulation to occur on a different day than predicted! Remember we are ever changing humans whose hormones are affected by sleep, stress, emotions and so much more, so, even with a regular cycle, ovulation is unlikely to occur on the same day every cycle!
° Find your support system. Trying to conceive can be an incredibly lonely time for many couples (often more so for the woman), so make sure you have people to talk to, offload and share your frustrations with. This might be a practitioner, friend, family member or a therapist. Please do not underestimate how important this is - remember stress and worry affect your hormones so having strong support is an integral part of a successful conception.
What to record:
1. Days and details of menstruation -
° Mark each day of bleeding,
° It’s intensity (heaviness - how often do you have to change your pad, tampon, or cup),
° Are there any clots (note size, bigger than 1p, 50p),
° Colour of blood,
° Pain (location, duration, sensation, do you take any medication for the pain)
2. Daily resting temperature (BBT - Basal/Resting body temperature)
° You need a thermometer that is specific to two decimal places
° Oestrogen dominates the first half (follicular phase) of the cycle and promotes vasodilation (opening of blood vessels), allowing more heat to be dispersed, so our resting temperature is lower.
° Progesterone dominates the second half (luteal phase) and causes vasoconstriction (blood vessels constricting), not allowing the heat to be released, so we see a higher resting temperature in the second half of the cycle.
° The result is we see two very distinct phases of temperatures 36.11 - 36.38 degrees Celsius in the first half, then 36.44-37 degrees Celsius in the second half. We are looking for a rise in temp of 0.2-0.6 degrees. A rise is considered sustained if there are 3 consecutively high temperatures.
° After a few cycles can see the data build up and use it to predict ovulation. Do not overthink your daily temperature as you can go into a spin if even one reading is off! We are looking for overall patterns, we are not looking at each day, or even one cycle - you need at least 3 to see a pattern!
° You are most fertile the 2-3 days before your temperature rise, so after a few cycles of tracking you should get a better idea of which day of your cycle you ovulate (if you have a relatively regular cycle)
° Temp must be taken FIRST THING on waking. As soon as we start moving the temperature is affected. Try to be consistent - keep the thermometer in the same place by your bed and stick to putting the thermometer on the same side of your mouth each morning. Make sure to put the thermostat all the way in under your tongue.
° Please note a BBT reading can be influenced by: aircon, getting fewer than 3 hours of quality sleep, having a fever, jet lag, electric blanket, drinking alcohol the night before, very hot weather, stress.
° This sustained biphasic BBT change confirms that you have ovulated
Record the data on a graph/app
3. Cervical mucus - quality and quantity - monitoring cervical mucus alone really can increase chances of falling pregnant! (Days below based on a 28-day cycle, adapt for your cycle)
° Check mucus in your underwear, on toilet paper, feel internally (there is always some mucus present at the back of the cervix) and note down any sensations associated.
° Right after your period (days 6-9) your mucus will be more dry - unlikely to be in fertile window
° It moves to being stickier (suggesting oestrogen is starting to rise, from day 10), and goes to thin, elastic and able to be stretched out like an egg white (10-14), suggesting we are close to ovulation.
° On ovulation (14), the mucus is thinner and slippery and wettest!
° From ovulation, for a short period (1-2 days), it goes back to thick or sticky (15-16)
° Then back to being dry until your next period (16-28).
° This can be tricky to track, especially when you first start. If you are trying to conceive, then of course there is likely to also be semen involved. The keynote here is that semen does not stretch.
° If you are not making much mucus this may be due to vaginal infections, antihistamines, cough medicine, chlorinated swimming pools, high doses of VitC (1000 mg daily), Clomid (fertility drug) and TTC - semen can make it confusing, again semen does not stretch.
° Dehydration!! Please make sure when you are trying to conceive that you are drinking 2L of water a day minimum.
° More info on cervical mucus below.
4. At home ovulation kits / OTKs - ovulation strips
° These test for the presence of Luteinising hormone, LH which can be tested in the urine. A surge in LH precedes ovulation so seeing a surge in LH suggests ovulation is about to happen - for some women this surge happens 12 hours before ovulation, for others it could be anywhere between 18-36 hours.
° Start testing at least 2-3 days before ovulation (start from day 8 for the first few cycles if you have a 28-day cycle)
° Different tests have a different level of ‘positive’ so there is a lack of sensitivity between them.
° Just because you have a surge in LH doesn’t mean that you definitely ovulate. The hormone LH (luteinising hormone) drives ovulation, but these tests do not confirm that ovulation has occurred! To confirm ovulation a two phase BBT chart is required.
° These tests are not suitable for women close to or over 40 as sometimes these women have a constantly elevated level of LH (so it will be almost always showing positive ovulation).
° If you are going through IVF many of the medications used will cause higher levels of LH so again these tests are not suitable.
° Lastly, if you have PCOS (polycystic ovarian syndrome) then these tests may not be suitable for you. If you are still lucky enough to have a regular cycle of around 28-33 days it might be worth giving these a go, but with very irregular cycles knowing when to start testing might be difficult! If you are seeing constantly positive test results this may mean your LH levels are elevated and so this is not an accurate predictor of ovulation.
5. Cervix position -
° The cervix changes shape/position during your cycle to encourage/accommodate conception.
° Start feeling around for your cervix from around day 6/7 of cycle (shortly after period).
° Wash your hands then find a comfortable position (squatting/ sitting on the toilet/ one foot up on a bench - like inserting a tampon so whatever is comfortable for that).
° Insert one clean index finger into your vagina and move it gently upward until the spongey feeling of the vagina gives way, reaching the firmer cervix. Depending on how much of your finger goes in, this tells you if it is high (more space) or low (less space)
° You will need to go through one full cycle at least to understand these changes!
° If your cervix feels Open, high, and soft - like touching your lips, this is likely to be around ovulation.
° If it feels Closed, low and firm - like touching the tip of your nose, this is likely to be outside your fertile window and not ovulating.
° Somewhere between - approaching your fertile window!
6. Secondary signs and symptoms - jot these down for 3-5 cycles and see if you start to notice a pattern!
° For example, skin changes, breast changes, mittelschmerz (one-sided, lower abdominal pain associated with ovulation), libido increase, light spotting, increased sense of smell or taste. Remember these need to be tracked for a few cycles to understand if they are a one off or are a sign of ovulation for you.
Understanding cervical mucus:
° The 4 types of cervical mucus: L,S,P,G. Practically differentiating between S+P is almost impossible so we group them together.
° On the Left you see L type: a small rise in oestrogen drives production of a pre-ovulatory mucus. The fibres act like a filter, catching abnormal sperm (so they can’t enter the vagina). You are likely to see this type 3-4 days before ovulation
° S+P type (middle image) - in the ovulation window! S type is the egg white, stretchy kind, and P the slippery, wet kind. Together these aligned fibres facilitate sperm movement through the vagina, cervix, uterus into the Fallopian tubes. This type allows the process of activation, the final stage of sperm maturation that occurs in the female reproductive tract. You see this mucus in the 24 hours pre ovulation.
° G type (right hand image): is thicker and sticky. The fibres have no pattern, and it acts as a barrier to infection and to sperm. This is seen 24 hours after ovulation for a few days. This comes under the presence of progesterone (or with a lack of oestrogen).
