What Are the Most Common Signs of Fertility in Women?
Dr. Angel Rivera
When it comes to getting pregnant, ovulation is one of the most important things to understand.
Knowing when you are ovulating and being aware of the signs of ovulation can help you time intercourse correctly which can increase your chances of conceiving.
In this article, we will discuss the most common signs of ovulation in women and also explain how to know when you are most fertile while also delving into fertility tests and treatment options for irregular ovulation.
What is ovulation?
Ovulation is the release of an egg from one of your ovaries and the egg then travels down the fallopian tube where it may be fertilized by a sperm.
If fertilization does not occur, the egg is shed during menstruation.
Knowing your ovulation schedule is important because it is the time when you are most fertile and can become pregnant.
There are a few signs of ovulation that can help you determine when is your peak ovulation window.
What is the ovulation window?
The ovulation window is the time during your menstrual cycle when you are most fertile and have the highest chance of conceiving.
The average ovulation window lasts for six days, with peak fertility occurring on the day of ovulation.
The average time of ovulation is between days 11 and 21 of the menstrual cycle with the menstrual cycle starting on the day you get your menstrual period, but it can vary from woman to woman. To increase your chances of conception, you need to have frequent unprotected sex with your partner during your ovulation window.
It is common to have sex every day or every other day during this period if you do not know when you are ovulating.
However, if you look for signs of ovulation or track your menstruation cycles, you can get a clearer picture of when you are ovulating and have sex in the few days leading up to your most fertile window.
It needs to be noted that male sperm can live inside your reproductive tract for several days after ejaculation so sex every day is not a necessity although you can still have it that frequently if you and your partner so desire.
What are the common signs of ovulation?
There are some common signs of ovulation that can help you determine when you are ovulating.
These signs can be used in conjunction with each other or on their own to help determine approximately when you are ovulating. The most common signs include:
Basal body temperature
Your basal body temperature (BBT) is your lowest body temperature in a 24-hour period and is usually measured first thing in the morning after you wake up.
You will need to take your temperature at the same time in the morning for several months to get an accurate picture of your BBT.
Your body temperature may drop slightly right before ovulation and then rise the day after ovulation and stay elevated until you get your period.
If you experience irregular menstruation cycles it may make it more difficult to get an accurate read on your ovulation cycle.
You may experience a sharp pain on one side of your lower abdomen right before you ovulate, usually during the middle of your cycle.
The cause of the pain is unknown but it is theorized that it may be because the egg is released from the ovary or due to a follicle stretching your ovary.
The pain is also referred to as "mittelschmerz" which means “middle pain” in German. It normally only lasts a few minutes to a few hours and is nothing to be concerned about unless the pain is severe or lasts for more than a day.
Changes in cervical mucus
During your menstrual cycle, the amount and consistency of your cervical mucus changes.
Just before ovulation, you will notice an increase in clear, slippery vaginal discharge that resembles raw egg whites and this is a sign that your body is getting ready for ovulation and is known as “egg white cervical mucus” (EWCM).
The increase in EWCM is caused by a rise in estrogen levels right before ovulation and this type of cervical mucus provides the best environment for sperm to travel through the cervix and fertilize an egg.
Ovulation test results
A positive ovulation test result means that you will ovulate within the next 24-48 hours. You can buy ovulation tests, also called ovulation predictor kits, over the counter at your local pharmacy or online.
The test works by detecting the surge in luteinizing hormone (LH) that occurs right before ovulation.
To take the test, you will need to urinate on a test strip or pee in a cup and place the test strip in your urine.
The test strip will have a control line and a space for a test line. If a line appears in the test line section after the strip comes into contact with your urine then you are about to ovulate which is the best time to have unprotected sex with your partner if you are trying to conceive.
These tests are accurate but you still may get some false results and the chances of these false results increase if you have polycystic ovary syndrome (PCOS).
Increased sex drive
An increased sexual desire is another common sign of ovulation and is caused by the surge in estrogen that occurs right before you ovulate.
The increase in sex drive usually peaks around the time you are most fertile (the day of ovulation and the few days leading up to it) but can vary from woman to woman.
If you notice a sudden increase in your sexual desire then it may be a sign that you are about to ovulate.
Saliva ferning pattern
If you look at your saliva under a microscope right before ovulation, you will notice that it has a fern-like pattern which is similar to the crystal pattern of frost on a window.
The pattern is caused by the high levels of estrogen in your body. To test for this, you will need to put a drop of saliva on a slide and wait for it to dry.
Once it is dry, look at it under a microscope and you will be able to see the fern-like pattern. If you don’t see the pattern, it does not mean that you are not ovulating, it just means that your estrogen levels are not high enough for the test to work.
Breast tenderness is another common sign of ovulation and is caused by a surge in estrogen that occurs right before you ovulate.
The tenderness usually peaks around the time you are most fertile, which is the days leading up to ovulation.
If you notice a sudden increase in breast tenderness then it may be a sign that you are about to ovulate although there are other causes for it too such as fertility drugs.
If you have breast tenderness and other premenstrual syndrome (PMS) symptoms such as cramping or bloating, it could indicate you are about to ovulate and are fertile.
Cervical position changes
The position of your cervix changes throughout your menstrual cycle in response to the hormone levels of estrogen and progesterone.
Just before ovulation, you will notice that your cervix is high up, soft, and open which makes it easier for sperm to travel through the cervix and fertilize an egg.
If you want to check your cervical position, you will need to insert your fingers into your vagina and feel for the cervix. It feels like a small bump at the top of the vagina and is usually more difficult to find just before or after ovulation.
Can I know the exact date of ovulation?
You can not know the exact date of ovulation but you can estimate it by tracking your menstrual cycle.
The average menstrual cycle is 28 days long but it can range from 21 to 35 days.
Ovulation usually occurs in the middle of the cycle, around day 14, but it can vary from woman to woman and even cycle to cycle. If you have a regular menstrual cycle, you can estimate when you will ovulate by counting back 14 days from the date of your next period. For example, if your last period started on October 31, you would expect to ovulate around November 14.
However, if your cycle is irregular then it is more difficult to predict when you will ovulate.
There are many ovulation predictor kits (OPKs) available that can help you predict when you will ovulate. Also, if you have sex every day or every other day around the time of ovulation then it likely will not be important which exact day you ovulated.
Ultrasound has been used for studies to track the exact day of ovulation but ultimately this is not needed to conceive.
How can I tell if my ovulation is irregular?
If you have irregular ovulation then it is more difficult to predict when you will be fertile.
The best way to track your ovulation if it is irregular is by using an ovulation predictor kit (OPK).
As noted above, ovulation test kits measure the levels of luteinizing hormone (LH) in your urine which surges right before you ovulate.
You can also track your basal body temperature (BBT) which is your temperature when you first wake up in the morning.
If your basal body temperature does not rise or you have inconsistent test results using an ovulation predictor kit, it may mean that you have ovulation problems.
Furthermore, if you have irregular periods or missing periods, which is not getting a period at all, these are telltale signs of ovulation inconsistencies.
What are the causes of irregular ovulation?
There are many causes of irregular ovulation and these include:
Ovulation disorders can lead to infertility and the most common ones include:
Polycystic ovary syndrome (PCOS)
If you suffer from polycystic ovary syndrome (PCOS), your ovaries may not release an egg each month or they may not release a healthy egg.
PCOS is a health condition that is one of the most common causes of female infertility and is caused by a hormonal imbalance. The symptoms of PCOS include irregular periods, excess hair growth, weight gain, and acne.
The hypothalamus is the part of the brain that controls the pituitary gland which in turn controls the ovaries.
If the hypothalamus is not functioning properly, it can disrupt the menstrual cycle and is a risk factor for irregular ovulation.
Hypothalamic dysfunction can be caused by stress, weight gain, or eating disorders.
Premature ovarian failure
Also called primary ovarian insufficiency, premature ovarian failure occurs when a woman's ovaries stop working before she turns 40.
The signs and symptoms of premature ovarian failure include irregular periods, hot flashes, night sweats, vaginal dryness, and mood swings.
Prolactin is a hormone that helps with milk production during pregnancy but can also interfere with ovulation by reducing estrogen production.
High levels of prolactin can be caused by stress, certain medications, or pituitary gland disorders.
Damaged fallopian tubes
Tubal infertility refers to when you are unable to conceive due to damaged fallopian tubes.
The fallopian tubes are reproductive organs that transport the egg from the ovaries to the uterus and if they are damaged, they can prevent you from getting pregnant.
Damaged fallopian tubes can be caused by a sexually transmitted infection that causes pelvic inflammatory disease or a previous surgical treatment such as for an ectopic pregnancy which is when the embryo attaches to somewhere outside the uterus such as the fallopian tubes.
Endometriosis is when the tissue that normally lines the inside of the uterus (endometrium) grows outside the uterus which can cause pain and irregular bleeding, and carries the risk of infertility.
The signs and symptoms of endometriosis include pelvic pain, painful periods, pain during sex, and fatigue.
Uterine or cervical issues
Cervical stenosis is a medical condition when the cervix, which is the opening to the uterus, is too small or blocked which can prevent sperm from reaching the egg.
Cervical stenosis can be caused by a birth defect, surgery, or scar tissue from a previous infection such as gonorrhea or chlamydia.
Fibroids are benign polyps in the uterus that can range in size from tiny seedlings to large, bulky masses.
Benign tumors called myomas may also grow in the uterine wall. While fibroids and myomas are noncancerous, they can cause fertility problems by interfering with the implantation of a fertilized egg or by distorting the shape of the uterine cavity. If you have an abnormally shaped uterus then you also may have difficulty conceiving too.
Finally, if your cervix does not produce the correct mucus this may also hinder the chances of the sperm fertilizing the egg.
In some cases, the cause of infertility is unknown which is called unexplained infertility and can be frustrating for couples as they may feel like they are doing everything right but still are not able to conceive.
What are the fertility tests used by doctors to detect ovulation?
There are several types of fertility tests that your doctor or fertility specialist may use to detect ovulation.
A progesterone blood test is often used to check for ovulation signs. It is a test that is usually done seven days after you ovulate (around day 21) and measures the progesterone levels in your blood.
The hormone progesterone typically has elevated levels after you ovulate and if your results are low it may be a sign of infertility.
Other blood work may also be run to check your levels of follicle-stimulating hormone (FSH), anti-mullerian hormone (AMH), estrogen, prolactin, thyroid hormones, and androgens, which are sex hormones.
Your doctor may also want to perform a transvaginal ultrasound which can detect if follicles are developing in your ovaries. Follicles are hormone-filled sacs in your ovaries that help your body regulate your menstrual cycle.
What are treatment options for irregular ovulation?
If you are having difficulty conceiving due to irregular ovulation then there are treatment options available.
Your doctor may first ask for a hysterosalpingogram, which is a specific X-ray to check your uterus and fallopian tubes, and for your partner to take a fertility test to check the viability of his sperm via a semen sample and semen analysis to see if he is the one who has an infertility diagnosis.
One common fertility treatment is Clomid (clomiphene citrate) which is a medication that helps induce ovulation that has a good pregnancy success rate. It works by blocking estrogen receptors in the brain which causes your body to release more FSH, which then stimulates the follicles in your ovaries to mature and release an egg on a regular cycle.
Ovulation is a crucial step in the fertility process and there are many different signs that your body uses to signal imminent ovulation.
There is a risk that some signs may be misleading and that you may not be ovulating; however, your doctor can check for signs of ovulation with a simple blood test.
If you are not ovulating, there are treatment options available that can also help if your partner also gets a fertility test to check the viability of their sperm.
If you have any more questions about signs of fertility or fertility issues, please talk to your doctor, health care provider, or fertility expert.
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