Fertility Charting: Plotting Success

WebMD Live Events Transcript

Are you in synch with your cycles? Do you want to know when you are most fertile, or if you're even ovulating at all? Charting your daily temperatures can help you with these questions and more, and just might help you get pregnant faster. Robert Warnock, MD, from the WebMD Fertility Center talked about charting a course to pregnancy, as part of the Preserving Your Fertility Cyber Conference, on Sept. 29, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MEMBER QUESTION:
What do you think is ideal between charting, using ovulation predictor kits (OPKs), and the monitors when trying to get the best intercourse timing?

WARNOCK:
I always say that charting is most useful retrospectively, in other words, to evaluate what has happened during the preceding months. If you're looking for a tool to anticipate the most appropriate days to conceive, either using a fertility monitor and/or OPKs are most appropriate.

MEMBER QUESTION:
My temps are up and down. My cervix is still open, and I still have cervical mucus. I'm on day 24. What does this mean?

WARNOCK:
That means either that you have not ovulated yet in the cycle or that your temperature measurements are imprecise, making it impossible to tell.

MEMBER QUESTION:
Can you clarify cervical position and opening and how to correlate that with ovulation?

WARNOCK:
Cervical position is very variable and its observation very subjective, so I'd rather not go into detail here. It's very important to notice the position of the cervix in relation to one's cycle if these position differences are obvious. Cervical mucus, however, is more easily observed, and in a typical cycle mucus becomes clear during the late follicular phase as the estrogen reaches its peak prior to ovulation. Once ovulation occurs, the progesterone antagonizes the estrogen effect and causes the mucus to become thick and cloudy.

MEMBER QUESTION:
Taking temps when waking up. Does that mean the minute you wake up?

WARNOCK:
Yes, within a few minutes of waking up and certainly before getting out of bed.

MEMBER QUESTION:
On my BBT chart I had two spikes within five days. I had a positive OPK on the first spike and egg white cervical mucus and a high, soft cervix for both. What does this mean?

WARNOCK:
Egg white cervical mucus can persist and come and go depending on hormone levels until ovulation actually occurs. Along with that, temperature variability can occur prior to ovulation, but it would be very unusual to have a sustained temperature rise more than once in a given cycle.

"Mucus changes are the least objective part of charting and seem to produce a lot of confusion and worry."

MEMBER QUESTION:
I noticed that if I have the blankets on me I have a significantly higher temp than with it off. How can I create the exact same situations daily when the outside temp keeps fluctuating?

WARNOCK:
Try to sleep under the same environmental conditions every night with the understanding that some variability will occur and is unpreventable.

MEMBER QUESTION:
How does cervical mucus differ if you are not ovulating?

WARNOCK:
If you are not ovulating, the mucus should stay clear, thin, and stretchy if there are significant levels of estrogen around.

MEMBER QUESTION:
Is it possible to have no cervical mucus? Or very little?

WARNOCK:
There are very rare conditions in which a woman's cervical mucus is inadequate. There is much variability among women's mucus production and their observations of their mucus. Mucus changes are the least objective part of charting and seem to produce a lot of confusion and worry. What I would recommend is that someone who is trying to conceive record her observation of these factors, but I would not focus on this information within the chart.

MEMBER QUESTION:
I am charting and also using OPKs. I always get a positive the same day my chart shows I ovulated. Does that mean my period of ovulation is short? I know most girls ovulate the day after their + OPK. Is my window of opportunity shorter than most?

WARNOCK:
OPKs usually turn positive 12 to 24 hours prior to ovulation. So it's possible to have an OPK turn positive and have ovulation on the same day. I wouldn't worry about the window of opportunity, so long as the OPK turning positive generally agrees with the temperature rise.

MEMBER QUESTION:
Dr. Warnock, does ovulation happen on the first day of rising temps for consecutive days?

WARNOCK:
Ovulation occurs prior to the temperature rising. So generally it's the day before the temperature rise.

MEMBER QUESTION:
It seems like I ovulate by charting, but I have TTC for 11 years. My RE says charting looks good but you cannot judge on that. I have had all the blood work. Are there spots on the chart that may show too much hormone, etc.? Are there other things to look for other than ovulation rise?

WARNOCK:
Admittedly, temperature charting is not as accurate as some of the more high-tech methods that REs use for determining the quality of ovulation. If a chart looks normal, however, there's good reason to suspect other factors are causing infertility, such as a male factor and/or a tubal factor.

MEMBER QUESTION:
What pregnancy signs can be read from a temperature chart?

WARNOCK:
Some, but not all, charts will display a "triphasic" pattern that is obvious during the fourth week of the cycle. Also, sometimes women report "implantation" dip at the time of implantation, but this is not at all reliable. The best way to diagnose pregnancy is with a pregnancy test around the time that menses are expected.

MEMBER QUESTION:
I just started charting my cycle this month and my temperatures have been varying daily from 96.6 to 97.1. I'm CD 17. Is it normal for my temps to vary this much daily?

WARNOCK:
Yes. That much temperature variation is OK. What matters is that a discernible biphasic pattern develops, indicating ovulation. A biphasic pattern is a clear shift in the average temperature between the observation prior to ovulation and after ovulation. What we're talking about here is the appearance of plateaus before ovulation and after ovulation. In a biphasic chart, there are two plateaus: one prior to ovulation and one after.

A triphasic chart would show a second temperature rise to a third plateau approximately one week after ovulation. But triphasic patterns are more or less a curiosity, and one should not worry about whether or not a chart is appearing triphasic in anticipation of menses.

"If you consistently have short or abnormal luteal phases, this could be a sign that your ovulation is insufficient to produce a pregnancy."

MEMBER QUESTION:
What is the most important charting tool: BBT, saliva, cervical mucus, or cervix position?

WARNOCK:
The temperature charting is much more objective and subject to critical evaluation than these other observations.

MEMBER QUESTION:
Does ovulation occur at any time of day or is it usually in the AM?

WARNOCK:
That's a good question. Honestly I don't know, but I suspect it occurs at any time.

MEMBER QUESTION:
I know temps rise after ovulation, but can that happen as much two days before? Or is it a day before? Or does it mean ovulation has very recently occurred (within hours)?

WARNOCK:
A temperature rise prior to ovulation would be unrelated to the ovulation and could prove confusing.

MEMBER QUESTION:
I have been charting for a few months and have determined that my luteal phase is only 11 days -- on the short side. Is this a major factor in my inability (thus far) to conceive?

WARNOCK:
Most experts believe that luteal phase deficiency is a reflection of a poor or suboptimal ovulation. If you consistently have short or abnormal luteal phases, this could be a sign that your ovulation is insufficient to produce a pregnancy.

MEMBER QUESTION:
What is a luteal phase? Sorry, I don't recognize the term.

WARNOCK:
The luteal phase is the second half of the cycle; in other words, it's the time of the corpus luteum that develops from a follicle after ovulation. This period typically lasts 14 days. If conception does not occur, the corpus luteum disappears, progesterone production falls off, temperature returns to baseline, and menses begins.

MEMBER QUESTION:
What if the length of cycles appears to vary so tremendously that it is hard to determine the beginning/end of it?

WARNOCK:
The beginning and end of a cycle are marked by the onset of a menstrual period. The temperature observations should not be used to delineate a cycle. If bleeding is confusing to the point that there is not a discrete beginning and end of a period, then something else could be going on and the bleeding should be addressed by your doctor.

MEMBER QUESTION:
What if you do not have a period? When does your new cycle begin?

WARNOCK:
If your period's more than two weeks late, then your cycle is abnormal and a new one has not begun. It's time to see your doctor.

MEMBER QUESTION:
On day 14 I went from 97.3 to 97.9. I assumed this meant ovulation because of other ovulation symptoms. However on day 15 and 16 my temps dipped to 97.5. What could this mean? I am on day 16 now.

WARNOCK:
When temperatures are confusing it's important to wait and see if a pattern develops. Sometimes the pattern doesn't make sense until menses begins. This is an important point. It's best to evaluate a chart in its entirety; in other words, after menses begins. That's because a normal luteal phase is consistently 14 days, so it's possible to look back from the date of onset of menses to clarify a confusing temperature pattern.

MEMBER QUESTION:
How many days after my last Clomid pill should I start charting?

WARNOCK:
You should start charting before taking Clomid. We think it's important to record your temperatures every day of the cycle from cycle day 1 on. That means even during menses and even while taking Clomid.

"Use a fertility chart as an organizing tool when one is trying to conceive. Try not to obsess mentally from day to day about individual observations or specific factors."

MEMBER QUESTION:
Is it possible to feel in your body when you ovulate?

WARNOCK:
Definitely yes. But don't worry about it if you don't feel yourself ovulate. Some women say that they feel ovulation regularly for a period of their lives, and then the sensation mysteriously disappears for a while, despite the fact they continue to ovulate.

MEMBER QUESTION:
If the cycle is so irregular that it lasts between 28 to a max of 50 days and you are to take medication between the 14th and the 25th day -- in other words, around the time of ovulation -- can one determine the appropriate moment to take the medication by charting?

WARNOCK:
I assume you're referring to progesterone supplementation, which is begun after ovulation. It's important to start this medication only after you're sure you have ovulated. If you have the varying length cycles you described, the date of your ovulation is varying significantly. I would think it would be important to document ovulation with both an OPK and a temperature rise to a post-ovulatory plateau before starting the medication.

MODERATOR:
We are just about out of time. Do you have any final charting comments for us, Dr. Warnock?

WARNOCK:
Generally my best advice is to use a fertility chart as an organizing tool when one is trying to conceive. Try not to obsess mentally from day to day about individual observations or specific factors. As I said before, it's best to look at the cycle as a whole to determine if there are factors that could be improved.

MODERATOR:
Thanks to Robert Warnock, MD, for joining us. For more information about this and other fertility issues, be sure to explore all the TTC info here at WebMD, including our message boards and regular live chats with Amos Grunebaum, MD. You can also explore the web site of RESOLVE: The National Infertility Association, at www.resolve.org.

Warnock reviews charts and answers questions on the message boards of the WebMD Fertility Center, our one-stop site dedicated to helping couples conceive faster by helping women understand their bodies and get in synch with their cycles. Go to fertility.webmd.com for more information.

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