3. Ovulating or not ovulating ... that is the question

OK so I was doing all the things – eating better, going to acupuncture, sleeping more, noting my periods etc – sure the acupuncture Doctor said I was ovulating but was I?  My TCM doctor would ask all about my periods, date started, date finished, flow, any clots and colour. She told me to use pads not tampons as it was important to watch your flow throughout the period so you could learn about your menstrual health. (this obviously doesn’t give a complete picture, but is probably helpful indicator if you know what you are looking for).  I kept a careful record and reported back.

I said to her many times that I didn’t think I was ovulating, and she replied each time that she thought I was. My cycles were 21 days, were super short and mostly brown staining.  To describe them as periods was pretty generous but I was trying to get myself to a better place, mentally – so optimism was part of my plan. Slowly but surely they started to get longer, maybe just by a day or two, but my cycle seemed to be getting closer to a normal length of 26/28 days.

Even though the Doctor said she believed I was ovulating, she said I could test this.  Her preference was to measure BBT (Basel Body Temperature).  She told me to buy a simple thermometer which had two decimal places and to record my temperature every morning at the same time and before getting out of bed. The premise of this is that your BBT rises after ovulation. If you record this every day in a graph and the temperature line rises, ovulation likely occurred. If the line stays flat, that may be indicative of no ovulation taking place.  There is a whole world of monthly temperature “chart reading” forums out there and I must say I became quite engaged in it.  Even now, I love a good chart analysis. I have included an image of a temp chart below so you can see what I mean.

My quest for ovulation information sparked another Google marathon. Every night, waiting room, train journey, 4am insomnia session … “ovulation”, “how do you know if you are ovulating”, “ovulation monitoring”, periods without ovulating”, “how to know if you are ovulating” and well didn’t I go on another learning journey.  I had absolutely no clue that ovulation monitoring was an entire industry of its very own.

So, it turned out that there were a thousand different ways to monitor ovulation (ok, maybe not quite a thousand, but there were a good few). A lot of them are temperature based, others monitor your LH levels (luteinizing hormone – which is a hormone produced by your body which stimulates egg release) usually by peeing on a stick. Some combine the two.

Obviously the best and most accurate way is by way of blood tests, but let’s face it, unless you have access to blood testing on an ongoing basis, this is difficult.  Bloodwork can monitor your entire hormone profile, including LH levels, estradiol and FSH (follicle stimulating hormone). Some of these need to be carried out at certain times of your cycle, for example day 3 (baseline bloods), day 14 and day 21.  Blood tests can also test something called AMH (Anti-Mullerian Hormone) which can be done at any time of the month and is thought to be a good indicator of ovarian reserve. 

I had a lot of blood tests over the years, but there was no way this could be done to monitor ovulation. 

The good news is that there are many ways to monitor this yourself.  They aren’t all perfect, but some (in isolation or combined) helped me to get a reasonably clear picture. 

My late-night googling told me that LH rises into a short peak midcycle and it is this “surge” that gives your body the signal to ovulate.  There are many schools of thought on how soon after the surge your body ovulates, for some ladies it is 48 hours … for me it was about 12 hours.  Catching the surge is really helpful as if you can DTD (do the deed) on the day of the surge and in the days that follow, this helps to isolate the appropriate time to tie in with ovulation.

Here are some of the methods I used in my quest for ovulation detection.

1.       Basal body temperature (BBT) – manual thermometer – this is slightly more labour intensive. It requires you to manually record your BBT with a digital thermometer to two decimal places every day. You have to do this at exactly the same time, as soon as you wake up, before you pee, before you move from bed, before you drink/eat anything, before you have sex… before anything…. Every single day.  This, as I discovered, is not always easy.  For example, there are times when peeing simply has to take priority. There are days when you only remember 20 minutes after you have woken and are merrily going about your business. It means that your temperature taking is always on your mind and can be a tad disruptive, if you forget, it is very annoying, it effects the results you can achieve.  I tended to do this in conjunction with other methods, for example the LH strips or the clear blue ovulation tracker.  I just felt that it wasn’t enough on its own.  I recorded my results in an application called Fertility Friend.  There is a serious online community around this app and there is endless online help with assisting on interpretating your “chart”. The red crosshairs in the graph below are ovulation detected by the app, based on the data (you can manually over-ride this in which case the lines are blue). If the lines are dotted instead of solid, this represents a tentative ovulation detection and that your fertility signs are somehow in conflict. I must confess, I became something of a chart-reading addict.  I'll maybe do a post on some charts down the line as it really is an art form. You will see the dotted lines in the second image because it looks like there was a temperature rise around day 10 and then day 12 too. However a more sustained rise happened at day 16, so that looks to be the app's best guess.

2.       Apps – there are A LOT of fertility tracking apps or cycle tracking apps. Hundreds. For me, I used Fertility Friend and Ava. 

3.       Cheap internet LH strips – in the days approaching when I thought I was or should be ovulating I started peeing on a stick.  How do these work? Well perhaps annoyingly, pretty similar to a pregnancy test.  Using my first morning urine (FMU) or later in the day preferably after at least a 4-hour hold, I captured my mid-flow urine in a small container and dipped in the strip or wand and waited for a result.  These are simply a small strip which you dip in urine and wait for a result.  Then, after the appropriate time, I looked at the strip and evaluate whether the test line is darker than the control line.  Depending on the make (and there are MANY different types) this can be obvious or less obvious.  I did find myself trapped in bathrooms for more time than I would care to admit, looking at lines in different lights trying to work out if it was darker (LH was surging) or whether the lines were the same shade (nearly there but not quite surging). 

You can bulk buy cheapies from various websites. 

4.       More expensive fertility/ovulation checkers – I used a make called Clearblue but there are others available. Even within the Clearblue range there are different levels you can go to, for example, the fertility monitor which is like a mini computer to digital wands which you insert a strip into and it interprets the results for you.  I didn’t use the fertility monitor so I can’t comment on this.  I used the advanced digital wands with the boxes of refills.  These were still pretty pricey and because of this, I didn’t use these every month and tended to combine this with using the cheap strip tests.  I would use the cheap ones for more days and, as I felt the time for ovulation was getting closer, I started to use the digital wands as well.

Some prefer the digital wands it interprets the line darkness for you and you don’t get absorbed into the madness of looking at lines in different lights to see if the test line is darker than the control line. A flashing smiley face appears when you are in your high fertile window and a solid smiley (which stays for 48 hours) when you are in your peak fertility window.  Personally, while this was really very good, I did like to see the strip tests as well so I could try to understand what the lines looked like.

5.       Ava bracelet – this really is a lovely little device – not cheap – but it is wearable tech that you put around your wrist at night and then sync with the app in the morning.  I loved it.  It measured my heart rate, temperature, sleep hours and more – The app created graphs or “charts” based on the nightly readings and it highlighted when it thought your fertile window was. It also retrospectively gave a tick for ovulation following a sustained temperature rise and identified when it considered you ovulated. Also, and this was one of the best features, it opened a door to a wonderful private Facebook community, where chart readers, fellow Ava users could chat and learn from each other.  I joined a due-date babies’ group for the whole duration of my first pregnancy and it allowed me to group together with other women who were at the same stage in their pregnancy.  

This device is not flawless – I read many complaints from those who didn’t feel it was accurate for them.  In particular I suffered with occasional ovarian cysts which sometimes made my cycles irregular.  I read that the Ava bracelet is designed for cycles between 24-35 days and if your cycles are outside this, then the predictions may not be accurate.  I also took a slight reaction to the strap on my wrist at night and felt it’s presence on my wrist when trying to get to sleep which took a little bit of getting used to.  I think the cost has to fall in the cons category too, although I personally thought the value of the information was worth it.

I raise the above just so that my review is an accurate reflection of my own experience, I was actually really pleased with it.  The app was excellent, I loved the charts which were really easy to read.  Overall it was really lovely tech that didn’t require you to do anything other than wear, sleep and sync. I've included a copy of the graphs below so you can see how it looks in the app.

6.       Ovusense – Initial caveat … I ordered this because I always worried about external temperatures affecting the ava bracelet.  This seemed to me to be a game-changing little fertility tracker. This device is a vaginal sensor for cycle tracking, it is also marketed for those trying to conceive and for those with PCOS. However, I didn’t get to use it because I conceived and so I returned it unopened and unused. 

Even though I didn’t get to personally use it, I do feel it is worth a mention because I thought this was a really brilliant option and I would have absolutely loved to use it. It manages PCOS and irregular cycles and gives a fertile window of up to 8 days.  It also predicts and confirms ovulation. As someone who had hypothyroid issues and repeated cysts, I was really looking for a tracker that could understand and adapt to these.  The fact that Ovusense core was a vaginal sensor was attractive to me because it was taking a core reading unaffected by external temperatures (such as air con, open windows etc).  I think you can choose a skin sensor or a vaginal sensor, but for me, I wanted to try the vaginal one as I thought it would be the most accurate.

nb. The above are not affiliate links, just normal old-fashioned hyperlinks to give you an idea of what I’m talking about.

So all of the above confirmed what Dr F had said, it certainly looked like I was in fact ovulating. 

This. Was. A. Miracle.

I couldn’t believe it, after everything I had done to my body it was still fighting through.  Good grief, I think I sat around for a while just marveling at the human body. Over the months of monitoring this, I picked up my body’s rhythm and the other signs of ovulation.  I began to understand the follicular phase, the days up to ovulation and the luteal phase.  I would look at discharge consistency (clear egg white is what you’re looking for), noted any one-sided cramping (sometimes a sign of ovulation) and was aware of my confidence (apparently your self-confidence can increase in your fertile window).  I really wanted to understand what my body was doing.

I then gave myself a kick up the backside and set about seeing a fertility doctor, asap!  Dr F recommended someone she knew in a local town, Dr F (by the end of this, I will have worked my way through the entire alphabet).  Anyway, Dr A was retiring but he agreed to see me nonetheless.  He was a lovely man.  He was kind, patient and very understanding about my personal history.  He took some blood tests (including AMH).  These came back and, well, despite my delight at ovulation, they were really not good.  My AMH was very, very low. This meant that my ovarian reserve and/or egg quality was extremely poor.  The other readings were also a bit all over the place and when read together it all looked quite bleak.  No surprises there, given my history.

That said, there was some hope which was of course better than no hope.  At the beginning I had no real hormone profile to speak of and now I had one. Ok, it was a terrible one with results all over the place and a poor prognosis, but it was one, right? Remember, I’m all about blind optimism at this stage.

So now I had to find a fertility clinic.  The old one I had previously been to had closed down and there was only one other one in my area which I wasn’t overly keen on.  So back to the internet searching.  I had heard so much about fertility clinics abroad (especially if egg or embryo donation was going to be my chosen course) so cue the 4am searching …

Summary – its worth getting to know your cycles whether you are trying to get pregnant or not, Knowledge = power!! Some women ovulate early, some late and some bang on day 14. In all the forums I lurked in, there were so many women who ovulated much earlier or later than they thought and only found out with certainty once they started to monitor their cycles.  If you know your body’s rhythm (including the body’s ovulation signs), then you can begin to get a clearer picture of your fertile window.