All things ovulation

By Constance McGraw, MPH

What is Ovulation?

Ovulation is the release of a single mature egg from the ovaries and is pertinent for getting pregnant. This typically occurs 36-40 hours after a surge in luteinizing hormone (LH). The released egg travels through the fallopian tube, remaining viable for just 12-24 hours unless fertilized by sperm.

To enhance your chances of conception, tracking your menstrual cycle, along with observing ovulation signs like cervical mucus and utilizing ovulation tests, can help pinpoint the optimal time for intercourse. If you need help of a fertility specialist, book a consultation with one near you.

How do I know if I am ovulating with PCOS?

Women with Polycystic Ovary Syndrome (PCOS) often face irregular or absent menstrual cycles, making it essential to recognize signs of ovulation to increase the likelihood of getting pregnant. Identifying ovulation with PCOS can be tricky, but it's not impossible. Here are some key methods to help you determine if you are ovulating:

1. Track Your Menstrual Cycles:

Monitoring your menstrual cycles can provide valuable insights. If you notice cycles that are irregular or longer than the typical 28-30 days, it may indicate an ovulation issue.

2. Basal Body Temperature (BBT) Charting:

Measure your temperature when at rest, using a digital thermometer upon waking. A rise of 0.5°F to 1.0°F in your BBT typically occurs 1-3 days after ovulation due to an increase in progesterone.

3. Cervical Mucus Observation:

Pay attention to changes in your cervical mucus. Dry or sticky mucus at the beginning of your cycle transforms into a wet, egg-white-like consistency as ovulation approaches.

4. Ovulation Prediction Kits:

Ovulation prediction kits detect the surge of luteinizing hormone (LH) that precedes ovulation. However, PCOS can result in elevated LH levels, making the kits less reliable for some women.

If you're still uncertain about your signs of ovulation with PCOS, consult a doctor for an evaluation. They may recommend seeing a fertility specialist or reproductive endocrinologist. These experts can perform hormonal tests, assess your medical history, and possibly conduct an ultrasound to help identify your ovulation patterns. Following this assessment, they may recommend medications to promote more consistent ovulation, including:

• Clomiphene: Clomiphene, often referred to as Clomid, is frequently prescribed to stimulate the ovaries and induce ovulation in women with PCOS.
• Letrozole: Letrozole is another medication that can assist with ovulation in PCOS by promoting the release of hormones necessary for ovulation.

Why am I not ovulating on letrozole?

Letrozole, originally developed for breast cancer treatment, also causes ovulation. By reducing estrogen levels, Letrozole stimulates the release of hormones that facilitate ovulation. According to recent research, Letrozole use in patients with PCOS resulted in 61.2% of participants ovulating compared to those not using Letrozole.

The number of cycles required to induce ovulation can vary based on an individual's fertility, and in some cases, ovulation may not occur despite multiple attempts. This can occur for a number of reasons, with research showing that age, age at first menstrual cycle, baseline Follicle Stimulating Hormone (FSH) or Luteinizing Hormone (LH) levels, and anti-müllerian hormone (AMH) levels, being possible contributing factors.

It is necessary to talk with your healthcare provider if you have not been responding to your medication to assess if a higher dose or a different medication is needed. Generally, healthcare providers advise against using ovulation induction medications for more than six cycles.

What is ovulation testing?

Ovulation testing is a valuable tool for individuals trying to conceive. It helps pinpoint the most fertile days of the menstrual cycle, increasing the chances of successful conception. If you need help of a fertility specialist, book a consultation with one near you.

Why is ovulation testing important?

Trouble with ovulation is a common cause of infertility. For couples trying to conceive, knowing when ovulation is likely to occur can be very useful in planning the best time for intercourse. If a woman is struggling to get pregnant, it's essential to determine if she's ovulating.

What does ovulation testing entail?

There are various ways to test for ovulation, including tracking basal body temperature (BBT), using urine test kits for LH levels, having blood tests for specific hormones, or undergoing a transvaginal ultrasound. A fertility specialist can help set up tests for you and navigate the process, book a consultation at a clinic near you.

What are ovulation test kits?

Ovulation test kits, also known as ovulation predictor kits (OPKs), provide a straightforward way to predict your fertile window. These at-home test kits can help you track changes in your Luteinizing Hormone (LH) levels in a convenient way. LH levels rise in your urine just before ovulation, typically within 12 to 24 hours (usually around 14 days before your menstrual period starts). The surge of LH is a clear sign of upcoming ovulation. By detecting this surge, OPKs help you anticipate the best time for conception.

How do you choose an ovulation test?

Ovulation tests can be purchased online or at your local pharmacy. They also come in several forms, and it's important to find one that aligns with your preferences and budget.

• Ovulation Test Strips: Ovulation test strips, also known as paper test kits, are a cost-effective option. These strips work by detecting the surge of luteinizing hormone (LH) in your urine, which signifies approaching ovulation. If you prefer a budget-friendly and straightforward approach, ovulation test strips may be the right choice for you.
• Digital Ovulation Test Kits: Digital ovulation test kits are a more advanced option. They provide a clear digital readout of your LH levels, removing any guesswork. Some fertility test kits check for both LH and estrogen in the urine. This does not necessarily increase your chances of pregnancy and should not be used if you are taking medicines to help you ovulate.

How do you use ovulation test kits?

To catch the LH surge, start testing at least 2 days before your expected ovulation day, and continue until you detect the surge or as directed. The majority of test kits include multiple tests, so you can spread them out over a few days to increase your chances of catching that surge.

If your menstrual cycles are irregular, it's a good idea to time your urine tests based on the earliest and latest possible dates when you might ovulate.

Occasionally, ovulation may not occur in a cycle despite an LH surge. If ovulation is not detected in 2 or more cycles in a row, there may be a problem with ovulation, and you should discuss this with a healthcare provider. Find a fertility specialist and book a consultation.

Are ovulation tests accurate?

Ovulation tests, when used correctly, can be 96-99% accurate. These tests are specifically designed to detect the surge of luteinizing hormone (LH) that precedes ovulation. This LH surge typically occurs 24-38 hours before the release of an egg, making it a reliable indicator of your fertile window. Even though ovulation test accuracy is high when detecting LH in urine, some women can have LH surges that do not result in ovulation.

Some factors to keep in mind:

• Timing is crucial: To ensure accuracy, it's important to follow the manufacturer's instructions regarding when and how often to test. Missing the LH surge can lead to inaccurate results.
• Individual variation: Hormone levels can vary from person to person, so what's considered a significant surge for one individual may be different for another. It's essential to establish your baseline LH levels for a more accurate interpretation.
• External factors: Certain medications or medical conditions can affect LH levels, potentially impacting the accuracy of the test. If you have concerns or doubts, consulting a healthcare professional is advisable.

What are other factors that can affect your ovulation test results?

Ovulation tests are incredibly useful, but there are a few things to keep in mind to ensure accurate results. Here are some common factors that can lead to either false positives or false negatives:

• Polycystic Ovary Syndrome (PCOS) and Luteinized Unruptured Follicle Syndrome (LUFS): If you have PCOS or LUFS, you might experience LH surges without actual ovulation. This can result in misleading test results.
• Other Factors to Consider: Certain factors, such as pregnancy, recent pregnancy, menopause, and specific prescription fertility medications, can also affect the accuracy of your ovulation test results. If you've recently stopped taking birth control, it may take several months for your cycle to stabilize, making it challenging to predict ovulation accurately during this transition period.

By understanding these factors, you can use ovulation tests more effectively and interpret the results with greater confidence. If you ever need more education or individualized support, try out our fertility support, first week is free.

References:

1.  American Society for Reproductive Medicine (ASRM) (2014). Am I ovulating? Retrieved November 2023 from https://www.reproductivefacts.org/globalassets/_rf/news-and-publications/bookletsfact-sheets/english-pdf/Am_I_ovulating.pdf.

2.   American Pregnancy Association (n.d.). How to Use Ovulation Kits & Fertility Monitors. Retrieved November 2023 from https://americanpregnancy.org/getting-pregnant/infertility/ovulation-kits/.

3. Su HW, Yi YC, Wei TY, Chang TC, Cheng CM. Detection of ovulation, a review of currently available methods. Bioeng Transl Med. 2017;2(3):238-246. Published 2017 May 16. doi:10.1002/btm2.10058.