But lots of women experience other physical symptoms that let them know they are ovulating. If you tune in, you may notice some in yourself. We recommend letting that knowledge just confirm what the Big Three are telling you; don’t count on any of them to guide your attempts at conception.
It’s
perfectly normal to have—or not have—any of these symptoms when you are
ovulating, and the pattern will be different for every woman.
• Water retention
• Breast sensitivity or
tenderness
• Heightened senses
• Increased libido (some of my [Jill’s] patients
have noticed that they are more desirable to the opposite sex at this time,
too; one woman told me that she could always tell she was ovulating because men
would approach her in the street and on the subway)
• “Mittelschmerz”—a dull
pain as the follicle swells or a sharp one as the egg bursts out (felt on the
same side of the abdomen as whichever ovary is releasing the egg); may be very
mild, more or less like “gas pain,” or more emphatic; may feel like a cramp as
the follicle bursts
• Mid-cycle bleeding, caused by the sudden drop in estrogen
when there’s not enough progesterone to sustain the endometrium (occurs in
about 10 percent of women)
• Abdominal bloating
• Swollen vulva
• Increased
energy; feeling of being more dynamic and outgoing; feeling more attractive (or
even thinner!)
• Increased sense of well-being and optimism
• Swollen lymph gland
in groin (on whichever side ovulation is occurring)
Ovulation Predictor Kits
There
is a less hands-on way of knowing when you ovulate: an ovulation predictor kit,
available in any drugstore. These kits work pretty much like a home pregnancy
test, but they are looking for a different hormone: LH, which triggers the
release of the mature egg from the follicle. So you pee on the stick (or “hold
it in your urine stream”) for a few seconds, wait a few minutes, and watch for
an indicator line to appear (or not). You do one a day leading up to when you
expect to ovulate.
When it detects a rise in LH, you’ll ovulate in the next
twenty-four to forty-eight hours. Start having sex every day, or every other
day, as soon as you see the faintest indication of LH.
Tracking
ovulation this way costs a lot more than tracking cervical mucus changes or
BBT. Each kit typically contains five tests and costs about $15. That’s enough
to get you through one cycle, unless you have irregular cycles, in which case
you could easily need more than one box to hit the target. Regardless, you may
find the convenience worth the cost.
Ovulation
predictor kits have one clear advantage over charting BBT: as the name
promises, they predict ovulation,
whereas tracking your temperature will tell you only when you have ovulated.
But the results can sometimes be misleading.
• Just because LH is detected does not mean you will ovulate. In some cases, LH spikes but the follicle doesn’t heed the call to rupture, and no egg is released.
• Some women have false LH surges several days before ovulation. This is especially common in women with polycystic ovarian syndrome. If you get a result that seems too early, keep testing to see if you get another, more realistic spike a bit further down the road.• Women over 40 sometimes have elevated levels of LH in general, so when they use these kits, there may be several days when it looks as though they’re ovulating, and they can’t tell which one is the real deal.
Ferning
Time was, if you needed to know whether you were ovulating, your doctor would take a sample of cervical mucus during an internal exam performed near the expected time of ovulation, place a drop of it on a slide, allow it to dry for a few minutes, and then pop it under the microscope to look for telltale “ferning.” Near ovulation, high levels of estrogen increase the level of electrolytes (salts) in body fluids, including cervical mucus. When viewed under a microscope, those salts form a distinctive crystalline pattern resembling the leaves of a fern or frost on a window. The pattern is there only on the three or four days before ovulation. (Outside your fertile time, dried mucus looks like random dots.) So if the doctor saw the pattern, he or she knew you were in your most fertile period, just before ovulation. (The doctor would simultaneously check the mucus for spinnbarkeit, or stretchiness, to confirm the conclusion.)
With all the sensitive hormone tests available today, not many doctors are spending much time peering through a microscope looking for ferns. But if you are so inclined, you can do it yourself, using a microscope the size of a tube of lipstick and a sample of your saliva (or your cervical mucus, but the saliva is that much easier to get on the slide). You can buy a personal ovulation microscope, which magnifies things about fifty times, as part of a kit available at any drugstore or online. Expect it to set you back between $20 and $50. The slide and microscope are reusable, so this is a one-time investment and may be cheaper than an adequate supply of the pee sticks, if not quite as precise. For the best results, have sex on the day you first see the ferning and every day or every other day until the ferning disappears.
With all the sensitive hormone tests available today, not many doctors are spending much time peering through a microscope looking for ferns. But if you are so inclined, you can do it yourself, using a microscope the size of a tube of lipstick and a sample of your saliva (or your cervical mucus, but the saliva is that much easier to get on the slide). You can buy a personal ovulation microscope, which magnifies things about fifty times, as part of a kit available at any drugstore or online. Expect it to set you back between $20 and $50. The slide and microscope are reusable, so this is a one-time investment and may be cheaper than an adequate supply of the pee sticks, if not quite as precise. For the best results, have sex on the day you first see the ferning and every day or every other day until the ferning disappears.
Ultrasound
For the sake of covering all the bases, we want to mention that ovulation can also be detected by sonogram. You’re not going to use this for most conception planning, but when the precise day of ovulation is key to a fertility treatment such as intrauterine insemination (IUI) or in vitro fertilization (IVF), both of which are discussed in chapter 25, this is how your doctor will tell. If that level of precision is not required, the doctor will most likely rely on hormone blood tests.
Which Way Is Best?
What is the best way for you to figure out when you are ovulating? We recommend that you pick whichever approach seems simplest, easiest, most appealing, or niftiest to you. I (Sami) generally recommend ovulation predictor kits to my patients who want to keep closer tabs on the situation themselves. I (Jill) prefer BBT charting with cervical mucus tracking because the process of documenting ovulation also provides me with other useful information.
You may find other ovulation-related products on the market, some of which combine a few of the strategies discussed here. Sometimes we hear from patients about positive experiences with a fertility monitor or some other gadget, and who knows what will be developed next. Although we certainly haven’t provided a comprehensive listing here, we have covered the simplest and most straightforward, useful, and effective methods commonly in use today.
If this all seems like more than you want to manage, we hope you’ll focus on at least one message: if you see egg-white mucus, have sex! I (Jill) had a patient who had been peeing on ovulation predictor sticks for several months but still wasn’t pregnant. She’d been getting erratic results with the tests because her LH was elevated across the board (not unusual for a woman of 43), so it was hard to know if she was timing inter-course correctly. Recently, she called me to report, “I remembered what you said about watching for egg whites, so when I saw it, I went right home and met my husband. And now we’re pregnant!” Sometimes it’s just that simple.
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