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Pinpointing Ovulation when Trying to Conceive

Pinpointing Ovulation when Trying to Conceive

Nicole Knight, AHCJ | May 7, 2021 | trying to conceive
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Tired of another month gone by without a positive pregnancy test? Priya Fertility Monitor Now Available


We’ll go to great lengths in our quest to pinpoint ovulation — whether that’s peeing on test strips, counting days, or grabbing a thermometer the instant we wake each morning.

Frustratingly, our hard work doesn’t always result in a positive pregnancy test. Ovulation prediction kits (OPKs) may work only 14-23% of the time to help couples identify when to have sex when the odds of pregnancy are highest. Worse, just 3% of women with regular cycles time sex to their fertile window by using the Calendar Method (1,2). 

We deserve better. More and more of us these days are starting our families later in life — that means every cycle counts. And science tells us that having sex during our fertile window and during the 2 days before ovulation, in particular, may dramatically increase our chances of getting pregnant (3).

So it's no shock that we want answers about the best ways to know when we’re fertile.

For this post, we held a Q&A with fertility veteran and expert OB-GYN, Dr. Don Aptekar. He answered the most common questions he hears when his patients are trying to conceive. 

Q: What is the most commonly asked question you get from women trying to conceive?

A: That one hasn't changed at all over the past 40 years. It's either, "When do I ovulate?" or "When can I get pregnant?"

Q: What is the biggest misunderstanding couples have while trying to conceive?  

A: There are two actually, and they center on ovulation and the fertile window. Many women believe they ovulate on day 14 of their cycle, but this isn't true for the majority of women. The notion about day 14 is based on an average from a group of women and an estimate for a 28-day cycle. However, a 28-day cycle is not the norm, even among women with regular cycles. Research further shows just 10% of women ovulate on day 14 of the menstrual cycle (4). 

As for the fertile window, couples may not realize that the fertile window is the 5 days before ovulation and ovulation day itself. It's exceedingly rare to conceive outside of the fertile window (4).

Q: What recommendations do you give to women who haven't gotten pregnant in 6-12 months, but appear to be ovulating? 

 A: If they have regular cycles and have been timing their fertile window correctly, I tell them to get their partner's sperm checked out. There is a general misconception that the problem is more likely to be due to the woman when, in reality, male factors may be the culprit in 40-50% of couples who can't conceive (5). 

To see whether there is a male fertility issue, a man typically will undergo a complete semen analysis to evaluate sperm production and function. A provider also may discuss or recommend lifestyle changes that may improve sperm quality (6). 

Q: What is the number one reason why couples have a difficult time getting pregnant? 

There are two reasons that my patients have a difficult time conceiving. The first is they haven't waited long enough, and the second is they're having sex on the wrong days.

Women are typically fertile for about 6 days total each month, but This fertile window is unique to each couple and depends on factors like the longevity of the egg and sperm. Sperm may survive up to 5 days in fertile cervical mucus, but the egg may live just 12-24 hours after ovulation (7, 8).

Additionally, couples may be timing sex to day 14 of a woman's cycle, thinking this is when she's ovulating. We know, however, that only 30% of women ovulate between day 10 and day 17 of the menstrual cycle. Most women ovulate sometime between cycle days 11 and 21, and it varies from one cycle to the next (7, 9).

Q: What surprises you the most during a doctor's visit for couples trying to conceive?

A: Nothing surprises me anymore after decades of practicing medicine. Every year, a new group of hopeful couples comes in with the same questions. These days, however, more people are trying to self-diagnose themselves with the information they find online. 

Once a month, I see someone who believes they have a fertility problem based on what they read online, but then the next month, they are pregnant. Honestly, I suppose I'm more surprised by the woman who got pregnant who didn't think they could. 

Q: What ways can women pinpoint their fertile window? 

I advise my patients to track their biomarkers, such as luteinizing hormone, cervical mucus, and basal body temperature (BBT). These biomarkers offer clues about when ovulation is near, and BBT may confirm ovulation has occurred. However, I only recommend tracking biomarkers if it doesn't cause additional stress to their lives. 

Q: So you spend most of your time explaining ovulation?

A: Yes, I spend nearly every visit explaining when women ovulate. Historically, it hasn't been easy for women to pinpoint. 

I've found that it may cause too much stress for patients to track their temperature on their own, and at-home luteinizing hormone (LH) tests don't work for everyone and can be misleading. I'm looking forward to the launch of Priya, which provides a stress-free and reliable option to determine when they’re ovulating.

Priya Fertility's intravaginal sensor designed to help you pinpoint your fertile window and maximize your chances of getting pregnant.Learn About The Priya Fertility Monitor

Q: What about drinking alcohol while trying to conceive?

Alcohol is always a big one I get asked about. There is no safe time to drink alcohol during pregnancy. Alcohol use during pregnancy may cause miscarriage, stillbirth, and a number of lifelong behavioral, physical, and cognitive disabilities in a child. For men, we also know alcohol may harm sperm quality and may also affect fetal development (10, 11).  

Oftentimes, women may drink around the time of conception or shortly afterward because they didn't know they were pregnant. My advice is to refrain from drinking from the time of ovulation to the start of your next period. That way you don't have a big concern. We don't understand all the risks, so it's best not to drink.

Q: What other questions do you hear from women who are trying to get pregnant?

A: My patients always try and eliminate possible reasons for why they aren't getting pregnant. They will say, "I'm taking cough medicine, and I do this and do that…" They want to know if they are allergic to sperm or if their cervical mucus is too thick. It's a completely natural thing to ask about. However, for the majority of my patients, it all comes back to timing sex.

My patients also ask about what they can and can't do. The hardest thing for my patients is making decisions about medications. I tell them no medication is approved for pregnancy and the next question is, "so then what should I take for my allergies?" I explain that if you really don't need it to manage a disease, then don't take it. If you get a headache, try rest and hydration. If your headache is so bad that you feel that you need to go to the ER, then you should probably take your medication, but I'm telling you, no medication has been approved for pregnancy.  

If you are trying to get pregnant or there is a chance you may be pregnant, before you take medication — including any supplements, herbs, vitamins, basically anything that’s not food — ask yourself, "Is this something I really need?" If it is, then talk to your doctor about your options. 

It’s natural to be hungry for information in your quest to start or grow your family. By relying on trusted sources for the facts about your fertility, you can rest assured you’re taking the right steps to know when you’re ovulating to get pregnant as quickly as possible.

Tired of another month gone by without a positive pregnancy test? Priya Fertility Monitor Now Available

References +
How Not to Waste Another Month When Trying to Conceive
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