One of the first things I want to know when working with a new fertility client is whether ovulation is occurring. I also get an enormous number of questions about this topic! I hope this answers your question, “How do I know if I’m ovulating?”
Here’s a visual representation of all the inner workings of your menstrual cycle. I’m imagining it will be a helpful reference as you work your way through this post!
Ovulation Prediction, Detection, & Confirmation 101
Menstrual Cycle Charting
Basal Body Temperature (BBT)
During the follicular phase (1st part of the menstrual cycle before ovulation) BBT is usually between 97 – 98 degrees Fahrenheit. About 1 day before ovulation BBT will generally be at its lowest point. After ovulation, in response to progesterone, BBT will begin to rise, anywhere from .4-1 degree Fahrenheit. It will bounce around a little but should remain elevated throughout the luteal phase until progesterone starts to decline one to two days before menstrual bleeding. This is called a biphasic pattern and is one of the simplest ways to detect ovulation.
If ovulation does not occur you won’t see the characteristic bump in temperature, because without ovulation the follicle will not transition to a corpus luteum and release progesterone.
BBT is generally taken orally around the same time in the morning before getting out of bed. It is important to use a special thermometer that measures 1/100th of a degree, rather than 1/10th of a degree. These are readily available through most pharmacies and online.
Cervical Mucus
Cervical mucus is secreted by the cervical and endocervical glands. Its appearance and consistency vary throughout the menstrual cycle. After menstrual bleeding, you may experience a few dry days. As you get closer to ovulation, your cervical fluid will become more watery and copious in response to rising estrogen levels. This watery discharge has been compared to egg whites and represents your most fertile cervical fluid. This type of stretchy fluid is most abundant within 1 day before ovulation. Once ovulation has passed your cervical fluid will again become thicker and more white in appearance, with the possibility of a few dry days prior to bleeding.
The days of watery, egg white cervical mucus leading up to ovulation are your most fertile days!
Cervical fluid can be assessed when you go to the bathroom. Wipe a dry piece of toilet paper along the vulva and vaginal opening before urinating. You will notice that it is slippery and very wet. You may also see or feel this cervical fluid on your underwear throughout the day.
The combination of assessing cervical mucus and BBT is called the symptothermal method. This can be used for both contraception and to improve the likelihood of conception. There are many ways to track this information.
- Paper Charting: There are tons of these available on the internet for free!
- You can also use a tracking app on your phone.
- I personally like Kindara, if you want a free app to enter data manually.
- Femometer Digital Basal Body Thermometer: This is a basic inexpensive BBT thermometer you can grab online. Every pharmacy has a version of this and they’re usually about $10. Just be sure to get one that measures to the 1/100th of a degree and is appropriate for your unit of measure, either Fahrenheit or Celsius.
- Femometer Vinca II is a blue tooth oral basal body temp thermometer that automatically syncs with an app on your phone to record your BBT.
- TempDrop is a wearable device that measures your axillary temperature multiple times throughout the night. You do not have to wake up at a specific time and take an oral BBT. It offers an associated app, but I think a lot of womxn are still manually entering the data point into whatever app they’re currently using. This is great if it feels like an undoable task in your morning stupor to remember to take your temp before you move around or if the damn thermometer always seems to fall under the bed or wherever things go to hide when you need to find them in the dark. Ha! 🙂
If you want additional information on this topic, my favorite resources for menstrual tracking are:
Ovulation Predictor Kits (OPK)
Urinary Luteinizing Hormone
Luteinizing hormone (LH) is released from your brain (anterior pituitary) all month long, however, production surges midcycle in response to an estrogen peak. This surge in LH causes ovulation. An increase in urinary LH can therefore be used to predict ovulation within a 48 hour time period but is generally closer to 20 +/- 3 hours.
I generally recommend to start testing for a urinary LH surge on cycle day 9 (cycle day 1 is defined as the first day of menstrual bleeding, not spotting). Testing twice a day is the best way to catch the surge, but it is generally thought that the onset of the LH surge occurs between midnight and 8 AM. So if you’re testing first-morning urine, you’ll likely catch it. But twice a day is a more fail-safe method.
It is important to remember that urinary LH PREDICTS ovulation. It does not confirm it. This information is helpful for general body awareness, and timing of intercourse or intrauterine insemination to improve the chance of conception or prevent it. If you’re tracking cervical fluid, you will notice that it likely becomes more watery and copious just before your LH surge.
If you notice that you get a positive LH surge at strange times in your cycle, this may be an indicator of PCOS. Talk with your provider if this is the case. PCOS causes changes in the pulsatile release of LH and a higher baseline LH throughout the month which may alter your ability to use LH strips.
Urinary Estrogen Metabolite (Estrone-3-Glucuronide, AKA E1-3-G)
The estrogen metabolite, estrone-3-glucuronide, can be detected in urine. As I mentioned above, estrogen is released from the follicle as it matures. Once estrogen reaches a certain threshold it triggers the brain to release a large amount of LH. This surge of LH causes ovulation. Therefore, estrogen can be used as an even earlier predictor of ovulation.
Check out the image, under cervical mucus, to check out the rise in estrogen!
There are a few commercially available urinary tests for estrogen, which, when used in combination with LH surge indicator strips, can help to widen the window used in the prediction of ovulation and theoretically helpful to time intercourse or IUI for conception.
- LH Strips
- Femometer Ovulation Strips: These strips are relatively inexpensive (50 strips for $13) and Femometer offers an APP (paid) to read them. You don’t need the app to read them.
- Femometer also offers a Bluetooth LH strip reading device called Ivy that syncs the LH info with your app and logs the level of LH present. Ivy requires special LH strips that you can grab on their website or other online retailers.
- Clearblue Advanced Digital Ovulation Test: Assesses LH & Estrogen.
- This has been my go-to for ovulation prediction because it provides an assessment of estrogen & LH, meaning you are often aware of a wider fertility window. It’s also digital so there is no guessing or squinting or holding strips in a different light to see if they’re positive.
- Mira Fertility Analyzer: Assesses LH & Estrogen
- You may be able to assess progesterone later this year as well.
There are about a million basic and fancy options for measuring LH at this point. If you have one you like, let me know. I’m always looking at the different options and love feedback.
Progesterone
After ovulation, the dominant ovarian follicle will transition into the corpus luteum which secretes progesterone. This can be detected in your blood and a metabolite of progesterone can be measured in your urine.
Serum Progesterone
A blood draw used to measure serum progesterone during the mid-luteal phase (about 7 days post ovulation) of your cycle can be used to detect ovulation retrospectively. A serum level greater than 3 ng/mL at this point in your cycle is a pretty good indicator that you’ve ovulated. Some researchers propose a level of 5 or even as high as 6 ng/mL to really signify ovulation. I’m looking for a slightly higher threshold of 10-15 ng/mL to be high enough to really sustain a pregnancy, but the first hurdle is to detect ovulation.
Urinary Progesterone Metabolite (Pregnanediol 3-Glucuronide, AKA PDG)
PDG is a metabolite of progesterone in urine. When this marker is higher than 5 mcg/mL for three consecutive days, ovulation has likely occurred.
Serum progesterone testing just requires a blood draw and a provider to order the test. There are even places online that allow you to order your own tests but I always think it’s a great idea to partner with a trusted practitioner. If you need a provider, check out the links below in the resources section!
PROOV is an at-home test for PDG, the progesterone metabolite found in urine that I mentioned above. You can test your urine over a 4 day period during the mid-luteal phase. If your test is negative, work with your provider to dig into this further, do a serum progesterone if you haven’t, and strategize on a plan forward.
Ultrasound
Serial Transvaginal Ultrasound (TVUS) can be done throughout your cycle to assess the ovaries and uterus for consecutive follicular and endometrial changes. TVUS is the most expensive, invasive, and inconvenient way to assess for ovulation and has to be ordered and reviewed by a qualified provider. Your best option is generally a reproductive endocrinologist or OB/Gyn if you are considering this testing.
Ovulation Prediction vs. Detection vs. Confirmation
There are so many ways to assess ovulation, but it’s important to know if your assessment method predicts, detects, or confirms ovulation! Here’s a helpful chart.
You Don’t Have To Do This Alone!
If you’re thinking about getting pregnant or struggling with fertility, consider working with a holistically-minded provider who can offer a thorough assessment of your whole health and provide personalized therapeutic options. You don’t have to do this alone! 🙂
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REFERENCES
- Su H-W, Yi Y-C, W T-Y, Chang T-C, Cheng C-M. Detection of Ovulation, a Review of Currently Available Methods. Bioeng Transl Med. 2017 Sept; 2(3):238-246.
- Ecochard R, Leiva R, Bouchard T, et al. Use of Urinary Pregnanediol 3-Glucuronide to confirm ovulation. Steroids. 2013;78(10):1035-1040.
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