Dr Ahmed Ismail

Consultant Gynaecologist & Fertility Expert

FAQs to Gynaecologist

I want to know when I ovulate?

Ovulation is the release of an egg from the ovary usually in the middle week of female menstrual cycle. It is during this time the egg travels down the fallopian tube where it might be fertilized by a sperm.

A normal woman's menstrual cycle lasts between 28 and 32 days on average, but can vary between 24 and 35 days. The beginning of each cycle is considered to be the first day of her menstrual period. Ovulation generally happens between 10 to 19 days of the menstrual cycle ( it may vary among women). Ovulation often occurs around day 14 of the 28 days menstrual cycle in general. However, It is not guaranteed that this day should be relied upon if you are trying to get pregnant.

Ovulation signs and symptoms may include:

  • Abdominal cramps. Ovulation triggers mild abdominal cramps, one-side backache, tenderness in a tummy. This condition is called Mittelschmerz - from the German "middle pain". This may last a few minutes to a few hours.
  • Change in vaginal secretions. Just before ovulation, there is an increase in clear, slippery and stretchy cervical mucus due to increased estrogen levels. These secretions typically resemble raw egg whites.
  • Change in basal body temperature. Basal body temperature increases slightly during ovulation. Ovulation may also lead to a 0.4 to 1.0 degree increase in body temperature. This is driven by the hormone progesterone that is secreted when an egg is released. Women are generally most fertile for two to three days before the temperature achieves its maximum. This may be detected by using a basal body temperature (BBT) thermometer. Nevertheless Queensway Clinic team do not believe in this method of ovulation detection.

Phases of the Menstrual Cycle:

The menstrual cycle can be divided into three different phases - the follicular phase, ovulation and the luteal phase.

  • The Follicular phase - The follicular phase lasts from the first day of your period to the day of ovulation. During this phase, your body prepares itself to accept and support a pregnancy. The endometrium (lining of the uterus) grows and thickens, and the vaginal environment also changes in order to become more sperm friendly. In the ovaries, several ovarian follicles develop, of which one becomes dominant before ovulation. This phase is called the follicular phase because growth and maturation of the egg occurs inside a follicle, and the two hormones dominating the follicular phase are follicle-stimulating hormone (FSH) and estradiol (a form of oestrogen).
  • Ovulation - Ovulation is the key event of the menstrual cycle. Each cycle, only one egg/ovule is released from the dominant ovarian follicle in response to a surge in luteinising hormone (LH), and can only be fertilised for up to 48 hours. It is important to accurately identify when you are ovulating if you are trying for a baby in order to maximise your chances of getting pregnant.
  • The Luteal phase - The luteal phase is the final phase of the menstrual cycle and lasts from your day of ovulation to the last day before your next period. Glands in the endometrium secrete proteins in preparation for the implantation of the fertilised egg (embryo). If you get pregnant, the embryo will implant itself in the endometrium during this phase. If implantation does not occur, the endometrium starts to break down and is eventually sloughed off: this is menstruation. The luteal phase is named after the corpus luteum (Latin for "yellow body"), a structure that grows in the ovary. It is dominated by progesterone, which is also the hormone responsible for the rise in body basal temperature (BBT).

Precise identification of your ovulation day allows you to time your baby-making intercourse for the most fertile days of your menstrual cycle to increase your chances of getting pregnant. Confirmation of ovulation in the home environment is only possible through measuring body basal temperature (BBT). It is therefore necessary for the temperature measurement to be highly accurate in order to confirm ovulation within hours.

Key Facts of Ovulation:

  • An egg lives 12-24 hours after leaving the ovary
  • Normally only one egg is released each time of ovulation
  • Ovulation can be affected by stress, illness or disruption of normal routines
  • Some women may experience some light blood spotting during ovulation
  • Implantation of a fertilized egg normally takes place 6-12 days after ovulation
  • Each woman is born with millions of immature eggs that are awaiting ovulation to begin
  • A menstrual period can occur even if ovulation has not occurred
  • Ovulation can occur even if a menstrual period has not occurred
  • If an egg is not fertilized, it disintegrates and is absorbed into the uterine lining.

     

    Ovulation detection through medical help

    • Regular follicle tracking ultrasound scans. Another way of determining your ovulation is through an ultrasound scan.  An ultrasound scan is also usually used when it is critical for fertilization to take place at the precise time of ovulation, such as for artificial insemination.  This method of predicting ovulation is very reliable

    The scans usually start around the 10th day of the menstrual cycle (day 1 is the first day of the period) however, this does depend on the length of the cycle. It is usual to have two or three scans generally on alternate days. The purpose of this type of scan is to assess the thickness of the endometrium (lining of the womb), which needs to reach 7mm or above to be suitable for a pregnancy to implant and to assess follicular growth and ovulation. For ovulation to occur the follicle needs to reach between 18-24mm.

    • 21 day blood test of ovulating. A blood test is performed to measure hormone levels to determine whether you're ovulating  to check for the presence of progesterone. The "day 21 test" needs to be taken at exactly the right time to be accurate, and that is 7 days after ovulation.
      The test measures progesterone and if it is above a certain level it will confirm that you ovulated and that you had enough progesterone in your system to get pregnant and stay pregnant.
      A level greater than 20nmol/L indicates that ovulation took place next
    • Microscopy for ferning and spinnbarkeit . Ferning is one of the methods for determining ovulation. A sample of cervical mucus are placed it on a microscope slide, and allowed it to dry. If the woman is in her most fertile period, that is, if she is near ovulation, ferning is easy to see under the microscope.

    Estrogen levels increase just prior to ovulation. The increased levels of estrogen are associated with an increased level of electrolytes (salts) in the saliva. When dried, the electrolytes form the classic ferning pattern. Ferning, observed in saliva, is an easy way to predict ovulation. Ferning is generally seen for the period two days before to two days after ovulation.

    The mucus becomes so tenacious that it can be stretched in threads up to 10-15cm long at the time of ovulation. This quality of the mucus is called 'spinnbarkeit' and is used for the thread test to diagnose ovulation. Spinnbarkeit mucus is the stringy, stretchy quality of cervical mucus found especially around the time of ovulation. Usually a result of high estrogen levels, spinnbarkeit mucus refers to the egg white quality of cervical mucus that is easier for sperm to penetrate.

For more information or an appointment at Queensway Gynaecology Clinic call:

Landline: 0207-935 55 40 / 0207-935 66 00

Mobile:

English: 077 409 444 73 / 077 457 481 88 / 077 450 461 44

Russian: 078 351 255 50 / 078 351 255 51 / 077 962 309 99 / 077 450 461 44

Lithuanian: 077 962 309 99 / 078 351 255 50

Arabic: 077 409 444 73 / 077 457 481 88

Email: info (at) queensclinic.co.uk

Bupa axappphealthcare cigna Aetna