By fertility experts from Spain.
Kate Davies, Founder of “Your Fertility Journey” is answering the most common questions about monitoring ovulation during your infertility journey.
That’s a really good question to get started with. I think when you’re trying to conceive, it can all seem incredibly bewildering and certainly if you’re going through fertility treatments you actually feel as though you often lose control over yourself. It’s very much under the guidance of your doctor, there’s a lot of unknowns, it’s a really difficult time, but even before that even just starting out trying to conceive, the best thing that you can do is to get empowered and get the awareness of your body and your cycles and your fertility because that is the most empowering thing that you can do, and it’s almost like taking ownership back which is so important. Also, there’s quite a lot of research to show that your timed conception can be significantly reduced with fertility awareness knowledge. Having an understanding of your cycles and particularly your fertile time can make such a difference to your ability to conceive and optimizes your fertility. I think there is this massive assumption and we’re told in school that we ovulate on day 14 of a 28-day cycle, but in reality, very few women have a 28-day cycle. Even if they do, very few women will ovulate on day 14, so I see so many women all the time with maybe normal cycles or short cycles or long cycles, and still, they’re not ovulating on day 14, and there’s kind of a bit of a myth that I think within the medical profession we perpetuate that myth, and I think it’s time that we stopped saying that because it’s not true. Ovulation can move from month to month and can be determined by so many variable factors, so f. e. your ovulation can be delayed if you’re ill, your ovulation can be delayed if you’re under stress, even things like travelling or change in routine can impact your fertility and when you ovulate and one thing is for certain over the last couple of months, I’ve seen some wacky cycles from ladies that were probably having really normal cycles, and they have suddenly got these longer or even shorter cycles because of the impact of stress based on what’s been going on in our world over the last couple of months. That just shows you how our bodies are so sensitive to all the different things that happen around us. So if you’re having a long or a short cycle, it’s particularly difficult to identify your fertile time, and that’s when cycle monitoring comes in.
Depending on how you decide to monitor ovulation, you might be looking for different physiological data that might give you some indication when you’re observing your fertility. Let’s assume to start with, that you’re maybe women are looking at monitoring their temperature, so the temperature is one of the fertility indicators. There are actually three fertility indicators, temperature, cervical mucus and position of the cervix and all of those three change throughout the cycle, so when you’re monitoring ovulation you’re actually looking for that fertile time and if I was looking f. e. at a temperature chart, I’m looking what we call the presence of the biphasic curve, and that’s showing me that the temperature, which is a direct reflection of your progesterone is changing as you come into your fertile time or as you ovulate, and it looks very different on the temperature chart, so that’s one way of observing it.
There are lots and lots of different ways in which you can monitor your cycle. Now, as I’ve mentioned there are three fertility indicators, but there are still other ways. Generally, when women start thinking about monitoring their cycle probably the first thing they’ll do, especially in a very technical world that we live in now is they’ll probably think about using an app. Apps if they’re just using the date so you put the date of the first day of your period and you Carry on through all the way through the cycle, and that’s using what we call a calendar method, and this calendar method is literally going on the dates, so it’s almost making the assumption that you will ovulate mid-cycle depending on the length of your cycle, so if we go back to what I’ve just talked about in the fact that women don’t ovulate mid-cycle, then you can see that this calendar method where it’s using dates is actually notoriously inaccurate and quite misleading. When I see women that are using this, and they’ll come to me and say Kate you know my app tells me that I’m ovulating on a day 16, but actually that is so wrong. What is unfortunately happening is that these women are relying on this calendar method, and then this is really giving them incorrect data so they could be potentially completely missing the fertile time. The fertile time is all based on the life of the egg and the life of the sperm. Now the life of the egg is really short, it’s about 12 hours potentially up to 24 hours, so a really short window and then when you think of it like that, you think how on earth does anybody ever conceive in a month, how does that happen. The fact is that sperm can live a lot longer, so sperm can live in the vagina for around about 5 days possibly even up to 7. Therefore, you’ve got a much bigger fertile window. When we’re talking about a fertile window, we’re talking about those few days before ovulation and the day of ovulation, that is your fertile window, the day after ovulation, it’s very unlikely that you will conceive because the egg will have gone by that point. Therefore if you’re using a calendar method and you’re relying on what it tells you, then potentially you are completely missing that time.
Another way of monitoring your fertility that many women choose to do is to look at luteinizing hormone kits. This is measuring your LH or luteinizing hormone, they sometimes have other words or the terminology, but LH kits are generally what people know. These are looking for your surge in luteinizing hormone prior to ovulation, but they are notoriously inaccurate again, they’re certainly not suitable for all women, and particularly some women f.e. who have PCOS or a cystic ovarian syndrome will naturally have raised and elevated levels of luteinizing hormone anyway, so they’re going to get a lot of incorrect and inaccurate notifications that they are luteinizing but also with women who aren’t using or don’t have PCOS, they can still have these inaccurate results. For my patients I don’t recommend them at all, they’re very expensive, and it literally is paying money down the drain because you have to use a lot of luteinizing hormone sticks in a calendar month to look for that LH, so not only they are expensive, but they’re inconsistent, and they’re quite time-consuming and a bit of a faff, if I’m brutally honest. Certainly, it is not my favourite and something that I wouldn’t recommend.
The next way of monitoring fertility is to look at your temperature and in relation to what we call basal body temperature. Basal body temperature is kind of like your external temperature, and so the most common way of observing your basal body temperature is to use a thermometer underneath the tongue. This can be an accurate way of monitoring your fertility, and s I mentioned earlier with temperature, you’re looking for that rise of progesterone. Throughout the cycle when you’re monitoring your temperature, you’re looking at what is happening with your progesterone levels, and you’re looking for that temperature rise which is indicative that ovulation has already occurred. A basal body temperature, it’s telling you that you’ve ovulated now like I mentioned basal body temperature recording can be a very accurate method, however, it can be quite inconvenient because you need to take your temperature exactly the same time every day in the morning before you do anything before you sit up, before you have a drink, before you speak to your partner, before you do anything and that’s not going to be great for everybody’s lifestyle. Ideally, you need to take it at the same time, every day and again with our work patterns that might not be feasible. Especially if you’re trying to do this and you maybe you have a young child, then the likelihood of being disturbed getting up at different times is going to be highly likely. Also, there can be disturbances in doing it f.e. if you don’t sleep very well that night. If you have had alcohol the night before that can disturb your temperature recording, so there’s a lot of different factors. Even the external temperature into some extent can influence it, so how cold your room is can influence your basal body temperature, so it’s a good and cheap way of doing it, but it has its issues as well.
The next way that you can monitor your temperature or other physiological data is a lot more emerging now, and again this is partly with our technical world. There are a lot more ways that you can do it, and this is opened up fertility monitoring to so many more women and couples, and this is by using a sensor so you can use a sensor and this will provide with some physiological data. F.e. there are a number of monitors that use skin temperature to monitor the progesterone or the temperature, and also other data that you can provide it with. The concern about that is that skin is not an accurate recording for fertility, they’re not actually particularly accurate, and they’re not going to give you the accurate temperature recording. Also, I’ve mentioned earlier with basal body temperature because it’s going to be potential to have fluctuations in various things that external temperature for example so again it’s not really as accurate as we would like it to be.
So the most accurate way of monitoring temperatures is going to make an awful lot of sense in a minute is through what we call your core body temperature. Your core body temperature is the temperature inside, it’s the temperature that your body is really good at controlling and keeping exactly as it should be. It’s that temperature that is so important for all our organs and our general health. Measuring your core body temperature is so accurate because it’s exactly what it should be. You are less likely to have any impact from any of the fluctuations due to external temperature f. e. or any other factors because it’s really what your body is doing very well. Core body temperature, the monitor and the sensor that monitors core body temperature on the market at the moment is something called OvuSense. I use OvuSense with a lot of my patients based on its accuracy. To be completely transparent and for transparency, I will say that I work alongside the company OvuSense, and that’s important to say that I came across OvuSense about 6 years ago and came across it actually by fluke. I couldn’t believe how I came across it and at the time the company was very, very small. They were looking to increase their team, and I read about it, and I thought wow this is exactly what I’m doing with my patients with basal body temperature but, it’s even more accurate and even more convenient and therefore I was fascinated by it.
I thought this is something that I really wanted to learn more about because this could be a game-changer from my patients, so I got involved with a company and like I said I work alongside them, and I was really happy to put my professional name to this organization because it was just doing what I really wanted it to do for my patients. I’m gonna explain a bit more about it later on but, just to give you an overview, it provides a live ovulation prediction which is fantastic because if you are trying to conceive, you really want to know when you’re about to ovulate. As I mentioned earlier with a basal body temperature that shows you when you’ve already ovulated and based on the life of the egg that could potentially be too late, so what ideally you want is a sensor or a way of knowing when you’re about to ovulate. This is able to do that which is fantastic, and it’s the only monitor that is out there and is able to do that and it is also able to confirm ovulation with 99% accuracy, which is so important for a large group of women f.e. for women with PCOS who may not know whether they’re ovulating, it’s so important that they find that information out and because that can make it a real difference so to have that accurate confirmation is crucial.
OvuSense is a regulated medical device, it’s the only monitor to have full regulatory approval, and that’s in the UK in Europe, in Canada, USA, Australia, and I may well have forgotten some other places. It’s the only one to have, which is fantastic, it’s also research-based and this is incredibly important to me because being a nurse consultant, all of my backgrounds is to make sure that everything I recommend has that research base to it. Otherwise to me, there’s no point in considering it. It’s got its roots in a lot of research, it’s had two clinical trials, and it’s also had six peer-reviewed publications, so it’s got an impressive research background. OvuSense monitors the core body temperature and it this because it is using a vaginal sensor overnight. It is actually very similar to a tampon although, it’s a thermal material, it’s made out of silicon, and it’s medical-grade silicone, and it feels just like a tampon as long as it’s inserted correctly. You shouldn’t feel it and that’s exactly the case, pop in a night, overnight it records five-minute recordings of your temperature. That’s crucial because if you remember when I went back and talking about basal body temperature, that’s just one recording first thing in the morning. It gives you a really accurate determination of all the temperatures that occur overnight and then it smoothes out that data and it provides you with the most accurate reading so that that is a crucial part of it.
Then, in the morning, you take the sensor out, you wash it in just water, and you then pop it to your iPhone or your Android, and it downloads that data, so there are no downloads that are happening while you’re asleep nothing like that, no crazy kind of waves going anywhere it’s only when you take the sensor out in the morning, pop it to your phone and it downloads that data and then it pops it on a chart, and so y can see everything. It gives you that convenience of not having to worry about taking a temperature in the morning as long as you get four hours sleep that night, then it can give you a good reading, doesn’t matter if you’re getting up and down at Wight, to go to a little one or anything like that. If you go to bed and you want to have sex, you just take the sensor out and then pop it back in afterwards. It’s not going to cause any problems if you go to the toilet at Wight, you can just take it out and pop it back in again, so very easy to use. Most women find it incredibly comfortable, there are no issues with it at all, and it suits the majority of women, so as I mentioned earlier it is able to give you that live ovulation prediction, and it actually gives you a 24-hour notification or an alert if you like, that you’re going to ovulate with 96% accuracy, so very convenient for couples who perhaps are juggling busy lifestyles and work and want to make sure that they’re close to that crucial time, so it does give you that accuracy of notification. I think it’s also important to point out that as I mentioned earlier the life of the sperm, so any sex that occurs in those five days prior to operation can result in a pregnancy so you don’t have to worry about just finding that one day before but certainly you’ve got that fertile window that you can use an actual fact, and OvuSense is able to give you an eight-day fertile window, so it gives you a little bit more time to make sure that you’re going to cover off that time nicely.
OvuSense Pro is very similar to OvuSense but it’s actually the next level up, The OvuSense Pro is due to be launched in June and I’m really excited about it because it is actually to be used with your clinician, so it’s for women and couples who are kind of starting their treatments and basically it’s to give your clinician more information, and the reason that this is the case, is that over the years OvuSense has been used and the research that has been done on the product but also most importantly the cycles that we’re seeing so OvuSense is a huge amount of data and has all this data set of thousands and thousands of women and thousands and thousands of cycles and from this, they’ve been able to identify a set of cycle patterns or characteristics that we’re seeing in women and what we’re finding is these are we’re seeing these time and time and time again and these cycle characteristics are fitting into certain areas and certain I guess they’re determining potentially what is then happening later on in pregnancy or in their fertility. It is actually helping to aid diagnosis of particular fertility issues which is really exciting, such as PCOS, PCOS can take years and years, it could take on average 13 years for a woman to have a diagnosis of PCOS, so that’s a long time what we’re finding is the cycle patterns that we’re seeing can reduce that time to diagnosis, but it’s also showing and this is really interesting it also seems to be highlighting the potential miscarriage risk as well. It is very exciting, and as I said, it’ll be launched in June, but we’re very excited about it because we feel that it would be a fantastic benefit to both women and their clinicians in helping them diagnose fertility issues and potential miscarriage risk in the future.
With basal body temperature, you can take it under the tongue. You can actually take your basal body temperature either vaginally or anally using a thermometer as well, but it can be a bit tricky, and probably not everybody would necessarily want to do. If you do decide to use a different route, stick to that route for two reasons. One infection you don’t want to be kind of using your thermometer in different places, but also it’s quite important if you start changing then you will notice that it’ll be different on your chart, so once you’ve chosen one kind of route then stick with that.
Your temperature rises at ovulation, or just after ovulation, so with the basal body, so you will see it after ovulation when in that 24 hours that might happen is difficult to say, so you don’t really know when your ovulation occurred in that 24 hours before but you know that it did occur at some point during that time. With OvuSense because it’s taking so many intervals over 5-minute intervals overnight then you’re going to have probably a more accurate pattern, but again it’s still quite difficult to know exactly when your ovulation occurred during that time but certainly as long as you’re following the idea of the fertile time and knowing that any sex that occurs in the five days possibly in seven days prior to that ovulation can result in a pregnancy, so it’s really important to remember that as well.
I recommend to my patients that they if it’s not a hassle and they were quite happy to do it that you continue to use your sensor, and you monitor your cycles throughout, and you don’t need to do that forever in a day, I like to see at least 3% of cycles because then that gives me a lot of data to look at. The luteal phase is a vital stage in the cycle, so for somebody that might not be sure the luteal phase is after ovulation, and that’s when progesterone is really important. You need to have good progesterone levels to support an implant in pregnancy, and if you like to build up a good womb lining, so your womb lining is like a nice comfy duvet that the embryo will be able to implant.
Having good progesterone is crucial, and with OvuSense you’ll be able to monitor your progesterone levels by one looking at how long your luteal phase is and it needs to be between 10 and 16 days to support that implanting pregnancy. Also, you need to make sure that your progesterone stays elevated during that whole luteal phase and maybe starts to drop down the day of your period or the day before. One important fact is a lot of ladies are told when they’re trying to conceive that they’ll go and have a progesterone blood test done and unfortunately, this blood test is called a day twenty-one progesterone, which makes your doctor think that it always has to be done on day 21, but actually it doesn’t. It’s only accurate if taken on day 21 of a 28-day cycle and again if we go back to what I started off talking about, in fact, these irregular cycles and very few women have a 28-day cycle, so with progesterone, you have to time that test seven days prior to your next period. Now if you’re not charting your cycles that can be really difficult to know. How do you know when seven days before your next period is because last time I looked none of us have a crystal ball, but with charting, you can really get an understanding of your luteal phase length. Then you can work out generally when seven days before your next period would be, and that’s particularly important with long or short cycles. Using the sensor during the luteal phase is not a problem at all, it’s not going to interfere with implantation at all. You can happily continue to use it without any problems.
Because your periods are irregular, it can be difficult for you to identify when you’re ovulating and again it goes back to what I was saying with LH ticks that actually you’re probably having to do quite a lot over a period of time and actually that can be quite stressful. I mentioned the fact that it can be inconvenient and expensive, but actually, the stress of doing it and this is what I hear from a lot of my patients is they find the whole thing stressful so to answer a question of whether it’s accurate, it does depend on you and whether your periods are irregular for a reason. Having had a PCOS diagnosis if that is the case, then they won’t be working for you, I generally find them not to be accurate and particularly with irregular cycles, and I do worry that women will be waiting for that LH surge and potentially because they’re inaccurate, be missing ovulation completely, so it does worry me from that point of view.
When is the best time to have sex during that time, well so like I’ve said, the life of the sperm is about five possibly up to seven days, and the life of the egg is very short twelve 24 hours, so any sex that occurs in the five days maybe even seven before ovulation can result in a pregnancy. What you want to be doing is maximizing that time before ovulation, get yourself a reliable method for monitoring your cycles and then really use that information to feel quite empowered as to when you need to be having regular sex. I think it’s also important to say that you should be having sex regularly, ideally throughout the cycle. I know when you’re trying to conceive, sex does become all about baby-making, and therefore it can be really difficult to kind of keep it going especially if you know that you’ve ovulated, but there are a few reasons why it’s quite important. If you’re not using any monitors, it’s important to have regular sex so you can make sure you catch that time. The other reason why it’s important to have sex every two to three days is that actually, you’re going to have a better quality sperm around ovulation if you’re having regular sex. The third thing and this is really interesting, recent research has shown that if you’re having regular sex then you are reminding the lining of the womb that sperm is acceptable and it’s not a foreign body whereas if you’re having sex infrequently then the lining won’t be very receptive to sperm because it will view it as a foreign body, which I think is fascinating.
Normal luteal chase needs to be between 10 and 16 days, the follicular phase which is the phase up to ovulation can vary, so that can be shorter or longer, but ideally the luteal phase needs to be between 10 and 16 days. A short luteal phase can be an issue generally you won’t have much longer luteal phase as long as you’ve ovulated, then your luteal chase will fall within the 16 days, and that’s when you’ll get a period at the end of that time at some point. A short luteal phase so luteal phase less than 10 days so 9 days or less can absolutely have implications for your fertility and it is one of the things that with obvious sense, they’ve been able to identify and again that’s one of the reasons with OvuSen Pro is that we’ve been able to identify that a short luteal phase can be an issue. Anything shorter than like I said, ten days could be an issue. Someone women might get the odd short luteal phase and then the next few cycles will be absolutely normal, and that’s fine it’s nothing to worry about but if you’re consistently having a short luteal phase and that can be a problem.
So OvuSense is working hard on determining the data that your body is giving it, so if your body is giving it good data then it’s able to give you that notification. If for some reason and the data or the quality of data is not so good, and that can be the case with PCOS, not always will women get a notification, ideally, they will but on some circumstances, they won’t or if you’ve not been consistent with your use prior to ovulating, then obviously this can struggle to give you that notification. It really will depend on the data that your body is giving it as long as it’s good quality then ideally yes absolutely you should be getting that notification. Like I said, as long as you’re concentrating on the fact that you’ve got that fertile window and you’re maximizing that time, then you shouldn’t run into any problems.
Like I said earlier, we don’t really know exactly in those 24 hours when you ovulate. What you will do is you will notice that your temperature is at a certain level and then you’ll get a rise and some point in that time you will have ovulated. If you’re using basal body temperature, then it’s an indication that you’ve already ovulated. If we’re using core body temperature, with OvuSense then that’s giving you an earlier notification that you’re either about to ovulate or that you have ovulated, I hope that helps.
Obviously, if you’re single then you can’t have regular sex, so I don’t know whether you’re using donor sperm, I don’t know what your circumstances are, but you can only do what you can do. I mean clearly, women who don’t have very regular sex, can still get pregnant so I wouldn’t worry too much about it. With donor sperm, it can be a bit more tricky. What I would say to you is use a monitor because then you’re able to identify what’s happening in your cycles and when you’re in your fertile time so you can maximize that time. If you’re using frozen sperm, then I think you need to use it within the 24-hour period, so you’re going have to be quite careful when you’re using that. Ideally, once you’ve got an idea of when you generally ovulate, then you want to be kind of using your frozen sperm 24 hours before that time. If you’re a little bit too early with that then you could potentially miss it based on the life of frozen sperm. It is more tricky, but you would struggle to do it completely without a monitor unless you had a real awareness of when you’re ovulating.
Low levels of progesterone can impact your luteal chase, that’s certainly what we find. There can be other reasons, women with PCOS may have a short luteal phase. There can be other hormonal disorders that can cause that. Women who have a low ovarian reserve can potentially have a shorter luteal phase as well, so there can be various different reasons for it. Naturally, you can consider acupuncture which is the only complementary therapy which is research-based to improve fertility, particularly surrounding IVF. The isn’t a huge amount of research there, but there is some, and certainly anecdotally with my patients, I do see it a really big improvement in their cycle lengths and particularly the luteal phase with regular acupuncture, so that might be something you want to think about. Other options are using progesterone to treat the luteal phase to lengthen that time. It’s a bit of a controversial subject, and not all clinicians will prescribe progesterone to support luteal chase, they are more likely to prescribe progesterone once pregnant if you’ve had recurrent miscarriages but certainly having that discussion with your clinician and asking whether that would be something that they will be willing to do if it is very obvious that you have a short luteal phase, you can certainly have those discussions.
If your periods are normally regular and your period started five days later, then who knows, I mean you had a longer cycle that month, so that month will have meant that you ovulated later in that cycle. The next cycle, it really depends it’s impossible to know whether you are likely to ovulate later or earlier or at the same time as you would normally do. For sure is in the previous cycle you ovulated later. You probably ovulate before day 14, so it would be worth understanding your ovulation, your fertile time a little bit more because it sounds as though you could be ovulating potentially quite a bit earlier, and you don’t want to miss it, so I would definitely suggest getting a bit more of an understanding and awareness of your cycle.
Yes, definitely. I mean you can use OvuSense to determine how well things are going for you during that time as well as looking at when you’re going to ovulate, which is useful information when you’re all having IVF. You can monitor the success of the medications you’re taking and in particular the luteal chase. I would say OvuSense absolutely would be good for you and certainly, a lot of women who are having IVF will use it during that time as well.
I think it’s important and I’m really pleased that we kind of talked about that. It is an issue and what I find is that women who will have progesterone is taken, and it’s timed inaccurately are then given the devastating diagnosis that they’re not ovulating which most likely isn’t true. It is because the test was timed inaccurately. What happens then is that treatments will be recommended based on the fact you’re not ovulating. I don’t know if that was necessarily the case for you, I can see that you’re having ICSI so there might be that there could be some other issues with male fertility factor, but I mean certainly, if you don’t know if you’re ovulating, find out if you’re ovulating, start monitoring your cycles and really make the most of this empowering information and you never know.