Ovulation Issues-- Amos Grunebaum, MD-- 02/02/04

By Amos Grunebaum
WebMD Live Events Transcript

Are you ovulating? Are you sure? How can you best track your fertility and deal with out-of-sync cycles? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us to talk about understanding and charting your ovulation, as well as the causes of and treatments for ovulation problems. 

The opinions expressed herein are the guest's 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: I am TTC. I haven't had a period since December. The first day of my last real period was 12/17/03. Since then on the day my cycle was due again I had spotting, and bleeding, but not my normal period. This happened again the day that I thought I was supposed to ovulate on Jan. 29. I had spotting until last night. Nothing today. Is there a chance that I am not ovulating, or that I am pregnant? I really can't tell if and when I ovulate.

Dr. Amos: What you are describing is among one of the most common concerns on our fertility web site. The medical diagnosis when you miss your period is amenorrhea,' not getting your period. There are only a few possibilities why a woman won't get her period:

• The first is pregnancy, and a pregnancy test should be positive if you miss your period because of being pregnant.
• The next possibility is menopause, which happens eventually to all women, and is likely the cause when it happens when you are well past 40-45. A blood test in your doctor's office should tell you if it's menopause of not.
• The next frequent reason for not getting a period is 'anovulation,' not ovulating. A regular menstrual comes about 14 days after ovulation, and if you don't ovulate then your period won't come, or it could be very irregular, and you may have some spotting on and off.

If you want to get pregnant then you obviously need to ovulate, and your doctor can try finding out why you do not ovulate. In many cases your doctor can induce bleeding with medications and then give you certain medicines to induce ovulation and help you get pregnant.

Member question: Does being overweight make it hard to detect ovulation?

Dr. Amos: That all depends how you want to detect ovulation. If your menstrual cycles are regular then you pretty much know you are ovulating. Another way to detect ovulation is keeping a temperature chart in our fertility center; this should not be influenced by being obese. And then you can test your urine with ovulation predictor kits before ovulation or do blood tests a week later.

Member question: Is it possible to only ovulate every other month? Maybe only from one ovary? I ask because I usually feel ovulation on my right side, but not my left.

Dr. Amos: It's highly unusual to only ovulate from one ovary and not the other. If your cycles are regular (are they?) then you should ovulate every month. Your "feeling" of ovulation does not necessarily mean it's just from that side.

Member question: Is ovulation the same time every month? In midcycle?

Dr. Amos: The time period between ovulation and the next period is constant, usually around 14 days. The period between the first day of bleeding/your cycle can vary. In a 28-day cycle, ovulation happens in the middle around CD 14 (28-14). But in a 35-day cycle ovulation happens on CD 21 (35-14 = 21) and on CD 10 in a 24-day cycle (24-14 = 10).

Member question: Are there symptoms of ovulation, such as swollen breasts, tender nipples and/or water retention? Every month about midcycle I get these symptoms and cannot figure out why.

Dr. Amos: These may be symptoms of ovulation, but they are not enough to make the diagnosis with sufficient evidence. Regular periods, BBT curves, OPK, cervical mucus changes, and/or elevated progesterone levels seven days later are the reliable methods of tracking ovulation.

Member question: Do things such as Vitex, Dong Quai, or Fertility Blend help with ovulating in any way?

Dr. Amos: No they do not, at least not from a scientific point of view. There are no clear scientific studies that these over-the-counter herbal medications work in inducing ovulation. And there are not enough studies showing that they are safe. When you do not ovulate, you should have your doctor do some tests. For example, a low thyroid condition can affect ovulation. None of the above medications are likely to affect the thyroid. So the best is to see your doctor to find out what if anything is going on, and then find out how to treat it.

Member question: Dr. G I have been on Clomid for four cycles now, being monitored by my ob-gyn. I ovulate around CD 18 or so. How common is it for the ovulation pain to be a little more severe with the Clomid?

Dr. Amos: Many women report more ovarian discomfort on Clomid than without it. That is because Clomid stimulates the ovaries. In response, many more follicles than usual start growing. They distend the capsule of the ovary and that can create pain, more than usual.

Member question: Is it possible to ovulate the day after you stop bleeding?

Dr. Amos: It is possible to ovulate any time in your cycle, even the day after you stop bleeding. Most women usually ovulate around CD 14 or so, but much earlier and much later ovulations are possible.

Member question: How many times a day should you have sex before ovulation to get pregnant? One time a day, every 48 hours, two times a day?

Dr. Amos: Once a day, every day during the fertile days is optimal. In addition you should make love regularly 2 to 3 times a week every week. This information is based on several scientific studies, which also show that making love every other day is OK too.

Member question: According to the WebMD ovulation calendar I was ovulating from 1/25-1/31 and my DH and I have been BD since 1/24 up until 1/31. I have a 33-day cycle and my last period was 1/10. If you BD like crazy how come there is only a 10% chance of you getting pregnant? 

Dr. Amos: Let me first correct something. You ovulate only on one day of your cycle, not six days. You can get pregnant from making love during the five days before the day of ovulation and the day of ovulation. I am not sure what you mean by "BD like crazy." Making love more than once a day is not suggested, because the sperms have not enough time to recover. So once a day, every day is OK, even every other day is fine. If he has enough sperm then there is an about 20%-25% chance getting pregnant each month (not 10%).

Member question: I starting charting this month and have had temps that go up and down! I don't think that I have ovulated and I am getting frustrated. I have had no EWCM or any CM for that matter! Is there any other way to know if I ovulated besides buying ovulation predictor kits? Thanks (P.S. I am on CD20).

Dr. Amos: On CD 20 it may be a little too early to see if you are ovulating. You may want to keep charting at the WebMD Fertility Center. We can check your chart there and have it evaluated by one of our experts It's very difficult to interpret a chart yourself and getting some help will make you understand better what's going on.

Member question: Dr. I am 41 and TTC and was pregnant, but had mc (Downs) in second month. I have been TTC since then -- one year ago. I have painful periods for just that day they start. I am using ovulation predictor kit and can ovulate anywhere from day 12-22. LH tests OK. I went to a fertility doctor and my levels were fine -- LH FSH etc. I am wondering if this variance in ovulation intervals is OK.

Dr. Amos: It is not OK to have such irregular ovulation. This may be a sign that there could be a problem. It also makes your cycles very irregular, and that makes it difficult to estimate when/if ovulation happens. You should discuss as soon as possible with your infertility doctor (is it a reproductive endocrinologist?) what to do next. At 41 you should not lose extremely valuable time, and start going on the quickest path to pregnancy.

Member question: My H/B and I have been trying for about a year now. It's been 10 months no contraception, six months seriously trying. My menstrual cycles are 28 days exactly. At first we were only using a calendar and my mucus changes as a guide. The past two months I've used an ovulation predictor kit. Still no luck. I'm 31 and my H/B is 41. Should we have fertility testing done?

Dr. Amos: Yes, you should. The first step is usually the sperm count. I suggest to each and every of my patients to start off with the sperm count. Only when you have established that it's normal can you move on to the next tests. The majority of infertility problems in women who ovulate regularly are that his sperms are not OK. Then the next test is to check your fallopian tubes. This is usually done with a hysterosalpingogram or a laparoscopy.

Member question: I track my temperatures every morning. The first part of my cycles the temperatures are low (ranging from 97 degrees to 97.5 degrees) and the last part of my cycle my temperatures are high (ranging from 97.7 degrees to 98.3 degrees). Does this for sure mean I am ovulating?

Dr. Amos: It sounds as if you are ovulating. But to be sure, you may want to have someone else look at the chart. Only by directly taking a close look can an expert make sure that you do ovulate. And you can keep your chart at the WebMD Fertility Center, where experts can review the charts and comment.

Member question: Is there anything that increases the chance of ovulation? Also, how well do ovulation kits work?

Dr. Amos: Ovulation kits work fairly well but have disadvantages. In certain conditions like PCOS (polycystic ovarian syndrome) they can be false positive, and sometimes they can be false negative. If you do not ovulate then only seeing a doctor can help you find out what the problem is. Taking over-the-counter medications is useless without knowing exactly what it is that you are treating.

Member question: Can you still have a 28-day cycle and ovulate earlier/later than CD 14?

Dr. Amos: If your cycles are very regular then ovulation usually happens about 14 days prior to the next cycle. That would be about 14 days plus/minus one to two days.

Member question: The first day I used OPKs I had no idea what CD I was on because I am very irregular, but the line was really dark, then the lines became lighter and lighter the next four days. Do you think I was o'ing that first day?

Dr. Amos: Impossible to say if the OPK was positive the first day. This is how OPKs work: OPKs test for the LH hormone, which rises shortly before ovulation. So when you are not about to ovulate the OPK is negative. When it first (emphasis on FIRST) turns positive then ovulation is likely to happen within the next 12-36 hours, emphasis on WITHIN. Ovulation can happen in 12 or 36 hours. The OPK can stay positive for several days, and if you test only on a day when it's already positive and you do not have a negative the previous day then it's impossible to know exactly when ovulation happened.

Member question: After having a D&E how long does it usually take before you ovulate?

Dr. Amos: The time after D&E is similar to the time after a miscarriage. It can take two to eight weeks for ovulation to happen after a D&E. If it hasn't happened two to three months later then you should talk to your doctor.

Member question: While taking Clomid is it OK to perform OPKs and not chart, or do you feel that it's best have intercourse every couple days and not track ovulation so closely?

Dr. Amos: OPKs can be incorrect for several days after you stop Clomid. Taking a temperature curve while on Clomid provides you with reassurance that you doing the right thing.

Member question: Is it true that when I do ovulate I get an egg-white consistency discharge?

Dr. Amos: Yes, it's true. At the time of ovulation there is an increase in the estrogen hormone. This hormone increases as ovulation approaches and it changes the cervical mucus from a thick consistency to first a thin consistency, and this consistency becomes 'stretchy', called 'spinnbarkeit.' When you touch this mucus with two fingers and pull it apart, you can extend it for several inches.

Member question: At age 41 with three children, the youngest is youngest 10, what chance do I have for normal ovulation now?

Dr. Amos: With regular menstrual cycles your chance of ovulating is excellent. The question is whether the eggs are still of high quality. Your doctor can do a blood test on CD 3 to confirm the quality of the eggs.

Moderator: Thanks to Dr. Grunebaum and everyone who came today. I'm sorry we couldn't get to all of the excellent questions. Please be sure to visit Dr. G on his message board TTC: Trying to Conceive and visit our other TTC message boards.

And, as Dr. Amos mentioned in some of his answers, now you can learn even more about getting pregnant by joining the WebMD Fertility Center. Sign up for support, expert chart review, and tons of great TTC information. You'll learn everything you need to know about increasing your chances of conceiving. Go to fertility.webmd.com for more info.