About Ovulation: Live Class with Dr. Christine Marie Rubio

Dr. Christine explained that ovulation is a biological process that involves the interplay of a woman’s brain, hormones, and reproductive system. It is important for everyone to study and understand the ovulation process so that we can understand the menstrual cycle better. “To increase the chance of getting pregnant and for those who don’t want to get pregnant, they need to be informed about ovulation, as well as those who don’t want to take pills or they don’t want foreign objects in their body like IUD,” she said.

In the next slide, she explained the different phases of the menstrual cycle which include the follicular phase and the luteal phase. Remember that when fertilization does not occur after the luteal phase, you will have your menstruation. If there’s fertilization, it’s successful fertilization that leads to pregnancy. The follicular phase happens between menstruation and ovulation. 

Obi

After the follicular phase, ovulation takes place, and then the luteal phase. Ovulation happens only for about 24 hours. After 24 hours, the egg will not be viable. The luteal phase is commonly fixed as it lasts for 14 days. Having sex as close as possible to the time of ovulation increases the chance of pregnancy. If a woman has sex 6 or more days before she ovulates, the chance she will get pregnant is virtually 0.

Although the sperm can survive up to 6 days, on average, it’s only 3 days because 6 days are too long. So, if she has sex 5 days before she ovulates, her probability of pregnancy is about 10%. If she has sex on the day of ovulation, not the 2 days before, the chance of getting pregnant is about 30%. But these figures are average because it will still depend on many factors like a woman’s age.

Timing of Ovulation Phase 

When you know your average menstrual cycle length, you can work out when you ovulate. For example, if you have a 28-day menstrual cycle, you will count from the first day of menstruation until the first day of the next first day of your next menstruation, usually when you go to an OB-GYN’s clinic. Count from the first day of the menstruation until the first day of the next menstruation. The luteal phase is usually fixed so you will subtract 14, ovulation happens around day 14, so the most fertile days are days 12, 13, and 14. If you will ovulate on Day 14, you have sexual contact on Day 12 and Day 13, most likely when your ovulation period starts, the sperm is still viable.

Another example is if your menstrual cycle is 35 days so you will subtract again around 14 so your ovulation should be on about day 21. The most fertile period will be the 19th day or Days 19, 20, and 21. If your cycle is short, for example, day 21 minus 40 so your ovulation will fall on day 7 or you will ovulate on day 5, 6, or 7. However, if your menstrual cycle is short, there is no guarantee that you will ovulate on the exact day based on the timing or calculation. Some women have irregular cycles and are difficult to work out an average cycle length.

This can make it hard to work out when ovulation happens. If it’s all too hard, Dr. Christine and many other medical experts highly suggest that having sex every 2-3 days covers all bases and improves your chance of getting pregnant. Because sometimes it is very challenging to precisely determine when you will exactly have ovulation. OB-GYNs recommend couples to have regular sex, around 2-3 times a week in case they’re struggling with the timing of their ovulation period. 

Different Ways to Test for Ovulation

In the next slide, Dr. Christine pointed out that there are different ways to test for ovulation. “But please take note that this is not the ovulation phase for sex, when you ovulate, the follicle should be raptured so that it will start the ovulation phase. This is not really a 100% guarantee.”

Basal body temperature – We have every menstrual cycle by principle, every menstrual cycle every day should be monitored by the patient. On a certain day, there is a time when the body temperature suddenly shoots up very slightly. For example, your body temperature rises 0.2 ℃ on Day 16. Usually, the ovulation started on Day 14. “This is a very tedious way of monitoring your ovulation day,” Dr. Christine commented.

Cervical mucus – It is the natural vaginal discharge that is usually called white mense. On days 1-3, you will notice no vaginal discharge. On days 4-6, you will notice that it has a thick consistency. Then, on days 7 to 9, it will be the day of your ovulation as you will notice that your discharge becomes very slippery and it stretches out when you touch it. “If you notice that your discharge is slippery, it means you’re fertile because that consistency will help the sperm to swim easier. So you need to remember this to indicate when your ovulation day will be,” explained Dr. Christine. 

Ovulation test kit – This is a test for the luteinizing hormone. Similar to a pregnancy test, you can see luteinizing hormones in blue color. Usually, the ovulation will happen within 24-48 hours. When you use this test and notice that you got positive or there are two lines, the doctors usually advise you to give sexual contact tomorrow or in 48 hours. 

Serum progesterone – It is a test to measure the amount of progesterone in the blood. Usually done in clinics, this test is used to check if and when you are ovulating. “Make sure you’ll have sexual contact in the next day or two days, okay?” Dr. Christine said.

If you are having a hard time with your ovulation, you may try ovulation induction. It is the process of using medications to stimulate ovulation in women who have irregular or absent ovulation (anovulation). There are many factors why some women are having difficulties in getting pregnant such as lifestyle modifications, meal factors or eating habits, etc. You should maintain proper weight or normal BMI. Also, avoid smoking and heavy alcohol drinking, and other vices which can negatively affect your ovulation. 

Myth and Truth About Menstrual Cycle and Ovulation

In the next slide, Dr. Christine shared some information about myth-busting concerning the menstrual cycle and ovulation.

Myth #1 – Pregnancy can happen if the couple engaged in sexual intercourse anytime.

Truth: A woman can only get pregnant for a few days during her menstrual cycle, knowing that ovulation lasts for only 24 hours and a sperm cell survives in a woman’s body for a maximum of 6 days. This means the chances of getting pregnant in a given month are very little. 

“Some women are curious why they easily become pregnant although they only did it once. That’s because they have it during the ovulation period. It does not matter really on how many times because the most important factor that greatly influences the sexual encounter in a month is the proper timing within the ovulation period,” Dr. Christine explained.

During the ovulation phase, the hormones in our brain interplay along with our reproductive organs. Knowing the basics can help you easily understand the menstrual cycle better, especially for those who want to increase their chance of getting pregnant and who don’t want artificial contraception, as well as those who want to avoid pregnancy.

Myth #2 – Women who have Type O blood have difficulties in getting pregnant.

Truth: There are no proven studies about this. So, it is not true. 

Questions and Other Reproductive Health Concerns from the Audience

In this part, we will answer several questions and concerns from the audience of the 8th live class. 

Question no. 1

Mom

Hi Doc! I started my menstruation this month, October 3 but it’s like spotting or brown discharge. Then, after October 6, and I had a heavy flow, and then it ends in October 12

Obi

I suggest that you don’t wait  for the heavy flow, because the maximum will be on the second and third day. You will not count on the first day. I’ve said that you may use some prescription drugs like letrozole, and anastrozole. But please, as I said, don’t take these without your doctor’s prescription. Sometimes , we give hormones like estrogen and progesterone to aid in pregnancy.

Question no. 2

Mom

When will the ovulation start exactly? Is it before menstruation or after menstruation?

Obi

Ovulation happens in between during the follicular phase. During menstruation in the follicular phase, it is the time when your egg cells develop into mature egg cells. Take note of this sequence: Follicular phase, then ovulation, then luteal phase. So, it happens in between. Simply subtract the 28 days cycle to 14 days. 

“Usually the ovulation happens on the 14th day. It’s not really before or after menstruation. The most appropriate term is in between. I suggest that you try documenting your menstrual cycle and track your menstruation period,” Dr. Christine explained.

Question no. 3

 

Mom

How can I ovulate despite having PCOS and I’m afraid to take medicine? I am already 4 years married but not yet pregnant.

Obi

There are many factors that affect PCOS and ovulation like overweight and other issues. You need to target a normal body weight. You also need to consider the frequency of sexual contact with your husband because there are times that some of our patients have little frequency of sexual contact with their partner. Once is enough as long as you timed it right. To help you ovulate, there are ovulation inducing agents or medicines to increase your ovulation.

“I want you to know that you should not be scared because you will be guided by your doctor, especially considering your age because as we grow older, our chance of getting pregnant is decreasing. You need to have an active consultation with your OB-GYN.” In order to fully address your concern, there are many things that should be addressed, not only ovulation but your other reproductive organs like the fallopian tube, etc. 

Question no. 4  

 

Mom

If your endometrium is thick, how does it affect fertility or ovulation?

Obi

Actually, this is subjective. After ovulation, the endometrium should be thick enough for the possible embryo to be implanted successfully. However, there are other pathological issues when the endometrium is thicker than the usual. This means there is an endometrium hormonal imbalance. The first sign is that your menstruation is abnormal. If that’s the case, usually getting pregnant can be challenging. Your endometrium should be thick enough.

Question no. 5 

 

Mom

Doc, I have regular menstruation but I’m struggling to get pregnant. I’m 9 years married to my hubby. What do I need to do?

Obi

Remember that ovulation is not only the factor you need to consider when you want to get pregnant.  If you have regular menstruation, that means you also have regular ovulation. You also need to consider having your husband tested, particularly semen analysis. Sometimes, several men, the partner or husband, may have possible fertility issues. It’s important to check both partners and examine if you have problems or not. Or perhaps you have an issue in your fallopian tube. 

Question no. 6  

Mom

Doc, is it true that even if you don’t reach orgasm, is it still possible to get pregnant?

Obi

Yes, it is possible to get pregnant. For girls, if you ovulate during the fertile period, it is possible that you get pregnant even though you don’t reach orgasm because the mature egg cells are already there to be fertilized. For boys, it’s still possible because there is a term called pre-ejaculation, the time when they still don’t completely release their semen but in just small or moderate amounts. 

 

Question no. 7  

Mom

Is the ovulation kit accurate?

Obi

There’s no guarantee that there’s not an exact test to determine ovulation. So, it is pretty accurate in determining if your luteinizing hormones are high. When it detects if you have high or low luteinizing hormones, more or less you will ovulate within 24 to 48 hours. It is helpful when you exactly time your sexual intercourse with your partner. If you are trying to get pregnant, you may try to use the ovulation test.

Question no. 8

Mom

I have endometriosis, Is there any chance for me to get pregnant despite my condition?

Obi

Yes, it’s not impossible that you will get pregnant. There are a lot of  women who have endometriosis where there is an implantation of the endometrial tissue which can block the fallopian tube, making the pregnancy difficult as the sperm and egg cell can’t meet properly. There is a treatment for endometriosis. You need to be examined by your doctor and checked your reproductive organs, especially your fallopian tube. You should also consider luteinizing examinations as well.

Question no. 9

 

Mom

What is the best advice you can give to someone who has PCOS in terms of ovulation and want to conceive? 

Obi

Maintain a healthy lifestyle. Take your vitamins and eat properly. Monitor your weight and keep it in the normal state. Go to your OB-GYN and ask for other treatments as well to assess your problem, like having ovulation induction medications. OF course, even if you have PCOS, you need to have regular sexual contact and right timing with your husband.

CONCLUSION

We learned about ovulation and why it contributes to a successful pregnancy, as well as the timing of the ovulation phase and different ways to test for ovulation. Keep the main points in this article in mind and check if your ovulation is normal or if not, we highly suggest that you visit a certified OB-GYN to help you in normalizing your ovulation. In the next article, we will discuss the second part of the 8th live class.