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A Fertility Doctor Answers Top Questions About Ovulation and Your Fertility

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Written in Partnership with HRC Fertility, January 29, 2016

FertilityAuthority asked Dr. Sanaz Ghazal, a fertility doctor with HRC Fertility in Fullerton, CA, to answer seven of the most common questions we get about ovulation and fertility.

FertilityAuthority: How do I know when I’m, ovulating?
Dr. Ghazal: Women usually ovulate around the middle of their menstrual cycle, about two weeks from the start of the period. The average menstrual cycle is between 28 and 32 days. If you have a 28-day menstrual cycle, you will usually ovulate between days 12 and 14. If you have irregular periods it can be difficult to calculate if and when she is ovulating.

Q: What are signs of ovulation?
A: If you have regular, predictable menstrual periods, it is usually a good sign that you are ovulating. Sometimes women experience symptoms when ovulating that include light spotting, slight cramping on one side of the pelvis, increased sex drive, breast tenderness, and abdominal bloating. Another common sign of ovulation is a notable change in the consistency of the cervical mucus.

Q: When am I most fertile?
A: To optimize the chance of achieving a pregnancy, have intercourse a few days before and after ovulation. Once the egg is released from the follicle it survives for only about 12 to 24 hours. Sperm can survive for several days in the female reproductive tract so having intercourse around the time of ovulation improves the likelihood that viable sperm will be present when the egg is released. If fertilization does not occur, the egg undergoes atresia and is reabsorbed by the body.

Q: If I don’t have a period, does that mean I’m not ovulating?
A: Ovulation and periods usually go hand in hand, and it is uncommon to ovulate without a period. There are rare circumstances, such as uterine scarring, where a woman may be ovulating, but not experiencing normal menses.

Q: If I have a period, does that mean I am ovulating?
A: Not necessarily. Some women experience uterine bleeding even though they may not be ovulating. This type of anovulatory bleeding is usually irregular in timing and amount of flow and can be due to a variety of factors. Anovulatory bleeding requires further evaluation by your doctor.

Q: I’m not sure if I’m ovulating. How can I know?
A: There are a few tests that can be done to determine if a woman is ovulating. Measuring basal body temperature daily throughout the menstrual cycle is one way to check. A mid-cycle increase in basal body temperature is a sign that ovulation likely occurred. The problem with this test is that it does not reliably determine when ovulation occurred and the daily measurements can be tedious and inaccurate. Your doctor may also order a mid-luteal phase progesterone level. An elevated progesterone level provides evidence of recent ovulation. Serial transvaginal ultrasounds may also be used to monitor the growth of ovarian follicles.

More and more women are now monitoring ovulation using home ovulation predictor kits (OPKs). These kits detect LH in the urine and can help determine when ovulation is happening and define the time interval for greatest fertility. There are a few other tools that a doctor can use to determine if ovulation is happening.

Q: Are there treatments that can me ovulate?
A: The best treatment for ovulatory dysfunction depends on the cause of the problem, but most cases can be overcome with medications and fertility treatment. Medications like clomiphene citrate, letrozole, and injectable hormones can be used to produce follicles and mature eggs. Human chorionic gonadotropin (hCG) is a hormone that acts like LH in the body and injecting this hormone will trigger ovulation by mimicking the LH surge. In specific cases, leuprolide acetate is another medication that can be used to trigger ovulation.

The important point here is that most cases of ovulatory dysfunction can be treated in order to help you conceive. If you are struggling with infertility and think you may have a problem with ovulation you should seek assistance from a specialist. A fertility specialist will gather information to determine if you are ovulating, the underlying cause, and can suggest a personalized treatment plan to help you achieve your goals.

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