Lack of ovulation: causes, diagnosis, treatment. What to do if there is no ovulation - the doctor advises

The main task of a woman on Earth is considered to be procreation. Of course, both a woman and a man participate in the process of conception, but whether a representative of the fairer sex endures a pregnancy and gives birth to a healthy child depends only on herself. Ovulation is necessary for fertilization to occur. Ovulation and conception are two interrelated conditions, because in the absence of ovulation, fertilization is impossible. Signs of ovulation are almost always noticed by a woman (consciously or not), so knowing them is necessary not only for planning a long-awaited pregnancy, but also for preventing an unwanted one.

Menstrual cycle and its phases

To define the term “ovulation”, you should understand the concept of “menstrual cycle”.

During the menstrual cycle, functional and structural transformations successively occur in the female body, which affect not only the reproductive system, but also the rest (nervous, endocrine and others).

The formation of the menstrual cycle, which is physiological for the female body, begins during puberty. The first menstruation or menarche occurs at the age of 12 - 14 years of girls and draws a line under the first period of puberty. The menstrual cycle is finally established after a year to a year and a half and is characterized by the regularity of menstrual bleeding and a relatively stable duration. During the specified time (1 - 1.5 years), the cycles of a teenage girl are anovulatory, that is, there is no ovulation, and the cycles themselves consist of two phases: follicular and luteal. Anovulation during the formation of a cycle is considered an absolutely normal phenomenon and is associated with insufficient production of hormones necessary for ovulation. By approximately 16 years of age, the menstrual cycle acquires its own individual characteristics, which persist throughout life and regular ovulation appears.

Physiology of the menstrual cycle

The average duration of the menstrual cycle ranges from 21 to 35 days. The duration of menstrual bleeding is 3–7 days. For most women, the total cycle length is 28 days (75% of the population).

It is customary to divide the menstrual cycle into two phases, the boundary between which is ovulation (in some sources a separate ovulatory phase is distinguished). All changes that occur periodically and are repeated approximately every month in a woman’s body, in particular in the reproductive system, are aimed at ensuring complete ovulation. If this process does not occur, the cycle is called anovulatory, and the woman is, accordingly, infertile.

Phases of the “female” cycle:

First phase

In the first phase (another name is follicular), the pituitary gland begins to produce follicle-stimulating hormone, under the influence of which the process of proliferation (maturation) of follicles or folliculogenesis starts in the ovaries. At the same time, over the course of one month, about 10–15 follicles begin to actively grow in the ovary (either in the right or in the left), which become proliferating or maturing. The maturing follicles, in turn, synthesize estrogens necessary for the final completion of the process of maturation of the dominant follicle, that is, they are temporary glands. Under the influence of estrogen, the main (dominant) follicle forms a cavity around itself, which is filled with follicular fluid and where the egg “ripens”. As the dominant follicle grows and a cavity forms around it (now called the Graafian vesicle), follicle-stimulating hormone and estrogens accumulate in the follicular fluid. As soon as the process of maturation of the egg is completed, the dominant follicle sends a signal to the pituitary gland, and it stops producing FSH, as a result of which the Graafian vesicle ruptures and a mature, full-fledged egg is released into the “light.”

Second phase

So what is ovulation? The second phase (conventionally) is called ovulatory, that is, the period when the Graafian vesicle ruptures and the egg appears in the free space (in this case in the abdominal cavity, often on the surface of the ovary). Ovulation is the process of direct release of an egg from the ovary. The rupture of the main follicle occurs under the “banner” of luteinizing hormone, which begins to be secreted by the pituitary gland after a signal is given to it by the follicle itself.

Third phase

This phase is called the luteal phase, as it occurs with the participation of luteinizing hormone. As soon as the follicle bursts and “releases” the egg, the corpus luteum begins to form from the granulosa cells of the Graafian vesicle. During the process of granulosa cell division and formation of the corpus luteum, progesterone begins to be synthesized along with the pituitary gland secreting LH. The corpus luteum and the production of progesterone are designed to preserve the egg in case of fertilization, ensure its implantation into the uterine wall and maintain pregnancy until the placenta is formed. The formation of the placenta is completed by approximately 16 weeks of pregnancy and one of its functions includes the synthesis of progesterone. So, if fertilization has occurred, then the corpus luteum is called the corpus luteum of pregnancy, and if the egg does not meet the sperm, then the corpus luteum undergoes reverse changes (involution) by the end of the cycle and disappears. In this case, it is called the corpus luteum of menstruation.

All the described changes affect only the ovaries and are therefore called the ovarian cycle.

Uterine cycle

Speaking about the physiology of the menstrual cycle and the ovulation cycle, it should be noted the structural changes that occur in the uterus under the influence of certain hormones:

Desquamation phase

The first day of the menstrual cycle is considered to be the first day of menstruation. Menstruation represents the rejection of the overgrown functional layer of the uterine mucosa, which was ready to receive (implant) a fertilized egg. If fertilization does not occur, then desquamation of the uterine mucosa occurs along with blood - menstrual bleeding.

Regeneration phase

Follows the desquamation phase and is accompanied by restoration of the functional layer with the help of reserve epithelium. This phase begins during bleeding (at the same time the epithelium is rejected and restored) and ends on the 6th day of the cycle.

Proliferation phase

It is characterized by the proliferation of stroma and glands and coincides in time with the follicular phase. With a 28-day cycle, it lasts up to 14 days and ends when the follicle matures and is ready to rupture.

Secretion phase

The secretory phase corresponds to the phase of the corpus luteum. At this stage, thickening and loosening of the functional layer of the uterine mucosa occurs, which is necessary for the successful introduction of a fertilized egg into its thickness (implantation).

Signs of ovulation

Knowing its signs will help determine the day of ovulation, for which you need to pay great attention to your body. Of course, ovulation cannot always be suspected, because its manifestations are very subjective and sometimes go unnoticed by a woman. But changes in hormonal levels that occur every month make it possible to “calculate” and remember the sensations during ovulation and compare them with those that occur again.

Subjective signs

Subjective signs of ovulation include those that the woman herself feels and which only she can tell about. Another name for subjective signs is sensations:

Stomach ache

One of the first signs of ovulation is pain in the lower abdomen. On the eve of follicle rupture, a woman may, but not necessarily, feel a slight tingling in the lower abdomen, usually on the right or left. This indicates a maximally enlarged and tense dominant follicle, which is about to burst. After its rupture, a small wound, a few millimeters in size, remains on the lining of the ovary, which also bothers the woman. This is manifested by minor aching or nagging pain or discomfort in the lower abdomen. Such sensations disappear after a couple of days, but if the pain does not go away or is so acute that it disrupts your usual way of life, you should consult a doctor (ovarian apoplexy is possible).

Mammary gland

There may be pain or increased sensitivity in the mammary glands, which is associated with hormonal changes. The production of FSH stops and the synthesis of LH begins, which is reflected in the chest. It becomes swollen and rough and becomes very sensitive to touch.

Libido

Another characteristic subjective sign of approaching and occurring ovulation is increased libido (sexual desire), which is also due to hormonal changes. It is so predetermined by nature that it ensures procreation - since the egg is ready for fertilization, it means that sexual desire needs to be strengthened to increase the likelihood of sexual intercourse and subsequent pregnancy.

Increased sensations

On the eve and during the period of ovulation, a woman notes an aggravation of all sensations (increased sensitivity to smells, changes in color perception and taste), which is also explained by hormonal changes. Emotional lability and sudden changes in mood (from irritability to joy, from tears to laughter) cannot be ruled out.

Objective signs

Objective signs (symptoms of ovulation) are those that are seen by the examining person, for example, a doctor:

Cervix

During a gynecological examination during the ovulatory phase, the doctor may note that the cervix has softened somewhat, the cervical canal has opened slightly, and the cervix itself has risen upward.

Edema

Swelling of the extremities, most often the legs, indicates a change in the production of FSH to the production of LH and is visible not only to the woman herself, but also to her relatives and the doctor.

Discharge

During ovulation, vaginal discharge also changes in nature. If in the first phase of the cycle a woman does not notice spots on her underwear, which is due to a thick plug that clogs the cervical canal and prevents infectious agents from entering the uterine cavity, then during the ovulatory stage the discharge changes. The mucus in the cervical canal dilutes and becomes viscous and viscous, which is necessary to facilitate the penetration of sperm into the uterine cavity. In appearance, cervical mucus resembles egg white, stretches up to 7–10 cm and leaves noticeable stains on the underwear.

Blood in the discharge

Another characteristic objective, but optional, sign of ovulation. Blood in the discharge appears in very small quantities, so the woman may not notice this symptom. One or two drops of blood enter the fallopian tube, then into the uterus and into the cervical canal after the dominant follicle ruptures. Rupture of the follicle is always accompanied by damage to the tunica albuginea of ​​the ovary and the release of a small amount of blood into the abdominal cavity.

Basal temperature

This symptom can only be identified by a woman who regularly keeps a basal temperature chart. On the eve of ovulation, a slight (0.1 - 0.2 degrees) drop in temperature occurs, and during the rupture of the follicle and after the temperature rises and remains above 37 degrees.

Ultrasound data

An increase in the size of the dominant follicle and its subsequent rupture are reliably determined using ultrasound.

After ovulation

Some women, especially those who use the calendar method of birth control, are interested in symptoms after ovulation has occurred. In this way, women calculate “safe” days regarding unwanted pregnancy. These signs are very uncharacteristic and may coincide with early symptoms of pregnancy:

Vaginal discharge

As soon as the egg is released from the main follicle and dies (its lifespan is 24, maximum 48 hours), the discharge from the genital tract also changes. Vaginal leucorrhoea loses its transparency, becomes milky, possibly interspersed with small lumps, sticky and does not stretch well (see).

Pain

Within one to two days after completion of ovulation, discomfort and minor pain in the lower abdomen disappear.

Libido

Sexual desire gradually fades away, since now there is no point for sperm to meet with the egg, it has already died.

Basal temperature

If at the moment of rupture of the Graafian vesicle the basal temperature is significantly higher than 37 degrees, then after ovulation it decreases by several tenths of a degree, although it remains above 37 degrees. This sign is unreliable, since even after conception has occurred, the basal temperature will be above 37 degrees. The only difference is that by the end of the second phase (before the start of menstruation), the temperature will drop to 37 degrees or below.

Acne

On the eve and at the moment of ovulation, hormonal changes occur in the body, which affects the condition of the facial skin - acne appears. Once ovulation is complete, the rash gradually disappears.

Ultrasound data

An ultrasound can reveal the dominant follicle that has collapsed due to rupture, a small amount of fluid in the retrouterine space, and the later forming corpus luteum. Ultrasound data are most indicative in the case of dynamic research (maturation of follicles, determination of the dominant follicle and its subsequent rupture).

Signs of conception

Before talking about the signs of pregnancy after ovulation, it is worth understanding the terms “fertilization” and “conception.” Fertilization, that is, the meeting of the egg with the sperm, occurs in the fallopian tube, from where the fertilized egg is sent to the uterus. In the uterine cavity, the fertilized egg chooses the most convenient place and attaches to the uterine wall, that is, it is implanted. After implantation has occurred, a close connection is established between the maternal body and the zygote (future embryo), which is supported by changes in hormonal levels. The process of securely fixing the zygote in the uterine cavity is called conception. That is, if fertilization has taken place, but implantation has not yet occurred, this is not called pregnancy, and some sources indicate a term such as “biological pregnancy.” Until the zygote is firmly established in the thickness of the endometrium, it can be expelled from the uterus simultaneously with menstrual flow, which is called a very early miscarriage or termination of biological pregnancy.

Signs of conception are very difficult to determine, especially for an inexperienced woman, and appear approximately 10 to 14 days after ovulation:

Basal temperature

During a possible pregnancy, the basal temperature remains at a high level, about 37.5 degrees, and does not decrease before the expected menstruation.

Implantation retraction

If in the second phase of the cycle after ovulation the basal temperature remains elevated (more than 37) almost until the onset of menstruation, then at the moment the zygote implants into the uterine mucosa, it slightly decreases, which is called implantation retraction. Such a drop is characterized by a mark below 37 degrees, and the next day by a sharp jump in temperature (more than 37 and higher than it was after ovulation).

Implantation bleeding

When a fertilized egg tries to settle in the thickness of the uterine mucosa, it somewhat destroys it and damages nearby small vessels. Therefore, the implantation process, but not necessarily, is accompanied by slight bleeding, which can be seen in the form of pinkish spots on the underwear, or one or two drops of blood.

Change in well-being

From the moment of implantation, a shift in hormonal levels occurs, which is manifested by lethargy, apathy, possibly irritability and tearfulness, increased appetite, changes in taste and olfactory sensations. Also, in the early stages of pregnancy, a slightly elevated body temperature can be noted, which is associated with the influence of hormones (progesterone) on the thermoregulation center. This phenomenon is absolutely normal for pregnancy and is aimed at suppressing the mother’s body’s immunity and preventing miscarriage. Many women take a rise in temperature and deterioration in well-being as the first signs of ARVI.

Discomfort in the lower abdomen

Somewhat unpleasant sensations or even cramps in the lower abdomen for one, maximum two days are also associated with implantation of the zygote and are absolutely physiological.

Mammary gland

Increased sensitivity, swelling and soreness in the mammary glands persists after ovulation. The possibility of conception is indicated by a slight increase in these symptoms.

Delayed menstruation

If menstruation has not started, it’s time to take a pregnancy test and make sure you’re right.

When does ovulation occur and how long does it last?

All women are interested in when ovulation occurs, because this is important for calculating favorable days for conception or for preventing unwanted pregnancy. As already indicated, the ovulatory period is the time that lasts from the moment the main follicle ruptures until a full-fledged egg enters the fallopian tube, where it has every chance of being fertilized.

It is impossible to determine the exact duration of the ovulatory period, due to the fact that even for a particular woman it can change in each cycle (lengthen or shorten). On average, the entire process takes 16 – 32 hours. It is the process, not the viability of the egg. But the lifespan of a released egg is simpler, and this time is 12 – 48 hours.

But if the lifespan of an egg is quite short, then sperm, on the contrary, remain active for up to 7 days. That is, if sexual intercourse took place on the eve of ovulation (a day or two before), then it is quite possible for the “fresh” egg to be fertilized by sperm that were “waiting” for it in the tube and have not lost their activity at all. It is on this fact that the calendar method of contraception is based, that is, the calculation of dangerous days (3 days before ovulation and 3 days after).

When it comes

A simple calculation will help determine the days of ovulation, but approximately. Ovulation occurs at the end of the first phase of the cycle (follicular). To know on what day a certain woman ovulates, she needs to know the duration of her cycle (we are talking about regular cycles).

The duration of the follicular phase is different for everyone and ranges from 10 to 18 days. But the duration of the second phase is always the same for all women and corresponds to 14 days. To determine ovulation, it is enough to subtract 14 days from the entire length of the menstrual cycle. As a result, it turns out that if the cycle lasts 28 days (minus 14), we get the 14th day of the cycle, which will mean the approximate day the egg is released from the follicle.

Or the cycle lasts 32 days, minus 14 - we get the approximate 18th day of the cycle - the day of ovulation. Why, when talking about such a simple calculation, is it called approximate? Because the menstrual cycle, and especially the ongoing ovulation, are very sensitive processes and depend on many factors. For example, ovulation may occur prematurely (early) or late (late).

The onset of early rupture of the follicle and release of the egg can be triggered by the following factors:

• significant stress;
• lifting weights;
• significant sports loads;
• frequent coitus;
• hazardous production;
• a common cold;
• change in climate, lifestyle or diet;
• excessive smoking or drinking alcohol;
• sleep disturbance;
• hormonal imbalance;
• taking medications.

Late ovulation is said to occur if it occurs (with a 28-day cycle) on days 18–20. The reasons for this process are the same as the factors that provoke the early rupture of the main follicle.

How to calculate ovulation

All women need to know how to calculate ovulation, especially those who have tried for a long time and unsuccessfully to get pregnant. For this purpose, there are several developed methods for determining ovulation. All methods can be divided into “biological” and “official”, that is, laboratory and instrumental methods.

Calendar method

• duration of the cycle (it should not be too short, for example, 21 days and not very long, 35 days) - the optimal duration is 28 - 30 days;
• regularity - ideally, menstruation should come “day after day”, but a deviation of +/- 2 days is allowed;
• the nature of menstrual flow - menstruation should be moderate, without clots and no more than 5 - 6 days, and the nature of the flow should not change from cycle to cycle.

We subtract 14 from the length of the cycle (the length of the luteal phase) and conditionally take the day of ovulation (it can shift). We mark the calculated date on the calendar and add 2 days to 2 days after - these days are also considered favorable for fertilization.

Basal temperature

A more reliable method is the method of calculating ovulation using a basal temperature chart. To calculate favorable days for conception, the following conditions must be met:

• measurement of basal, that is, in the rectum, temperature for at least three months;
• drawing up a schedule (this item is required) of basal temperature;
• measurements should be taken in the morning, after a night's sleep, at the same time and without getting out of bed.

According to the compiled schedule, we mark the first phase of the cycle, during which the temperature will remain below 37 degrees, then a pre-ovulatory decrease during the day (by 0.1 - 0.2 degrees), a sharp rise in temperature (by 0.4 - 0.5 degrees) and subsequent temperature stay above 37 degrees (second phase). A sharp jump will be considered the day the egg leaves the Graafian vesicle. We mark this day on the calendar and also do not forget about 2 days before 2 days after.

Tests to determine ovulation

Special tests for identifying the ovulatory process can be easily purchased at any pharmacy (see). The tests are based on detecting high levels of luteinizing hormone in any biological fluid (blood, urine or saliva). A positive test indicates the release of a mature egg from the ovary and its readiness for conception.

Gynecological examination

When conducting a gynecological examination, the doctor can quite reliably identify signs of ovulation using functional diagnostic tests. The first is a method for determining the distensibility of cervical mucus. The forceps captures mucus from the external pharynx of the cervix, and then its branches are separated. If the mucus is viscous and the separation of the jaws reaches 10 cm or more, this is considered one of the symptoms of ovulation. The second is the “pupil method”. The increasing mucus in the cervical canal stretches it, including the external pharynx, and it becomes slightly open and round, like a pupil. If the external pharynx is narrowed and there is practically no mucus in it (“dry” neck), then this indicates the absence of ovulation (it has already passed).

Ultrasound – follicle measurement

This method allows you to determine with a 100% guarantee whether ovulation has occurred or not. In addition, using ultrasound folliculometry, you can create your own menstrual cycle schedule and ovulation calendar and find out whether it is approaching or completed. Characteristic ultrasound signs of upcoming ovulation:

• growth of the main follicle plus expansion of the cervical canal;
• identification of the main follicle that is ready to rupture;
• control of the corpus luteum, which forms at the site of the burst follicle, detection of fluid in the retrouterine space, which indicates ovulation has occurred.

Hormonal method

This method is based on determining the amount of estrogen and progesterone in the blood. The latter begins to be released in the second phase of the cycle, when the resulting corpus luteum begins to function. About 7 days after the egg is released from the ovary, progesterone in the blood increases, which confirms that ovulation has occurred. And the day before and on the day of ovulation, estrogen levels decrease significantly. The method is labor-intensive and requires repeated blood donations and finances.

Lack of ovulation

If there is no ovulation, this phenomenon is called anovulation. It is clear that in the absence of ovulation, pregnancy becomes impossible. It should be noted that a healthy woman of childbearing age experiences up to two to three anovulatory cycles per year, which is considered normal. But if there is no ovulation all the time, then they talk about chronic anovulation and one should look for the causes of this condition, since the woman is diagnosed with “Infertility.” Causes of chronic anovulation include:

• thyroid diseases;
• overweight or obesity;
• polycystic ovary disease;
• diabetes;
• lack of weight;
• hyperprolactinemia;
• ovarian dysfunction;
• chronic inflammation of the ovaries;
• endometriosis of the ovaries and uterus (hormonal imbalance in general);
• constant stress;
• excessive physical activity (sports, household);
• harmful working conditions;
• pathology of the adrenal glands;
• tumors of the pituitary gland or hypothalamus and other pathologies.

The following factors can lead to temporary (transient) anovulation:

• pregnancy, which is natural, no menstrual cycle, no ovulation;
• breastfeeding (most often during lactation there are no menstruation, but there may be, but the cycle is usually anovulatory);
• premenopause (ovarian function is fading, so the cycles will be anovulatory rather than ovulatory);
• taking contraceptive pills;
• stress;
• following a specific diet for weight loss;
• increase in body weight or its sharp decrease;
• change of usual environment;
• climate change;
• change of usual working conditions.

If there is no ovulation, what should you do? First of all, you should consult a doctor who will determine what caused this condition and how serious it is (chronic or temporary anovulation). If anovulation is temporary, the doctor will recommend adjusting your diet, stopping worrying and avoiding stress, changing your job (for example, one involving night shifts to day shifts), and taking vitamins.

In case of chronic anovulation, the gynecologist will definitely prescribe additional examination:

• sex hormones (estrogens, progesterone, prolactin, testosterone, FSH and LH) and adrenal and thyroid hormones;
• Ultrasound of the pelvic organs;
• colposcopy (according to indications);
• hysteroscopy (according to indications);
• diagnostic laparoscopy.

Depending on the identified cause, appropriate treatment is prescribed, the final stage of which is stimulation of ovulation. Basically, clostilbegit or clomiphene are used to stimulate ovulation, usually in combination with gonadotropic hormones (Menopur, Gonal-F). Ovulation stimulation is carried out during three menstrual cycles, and if there is no effect, the stimulation cycle is repeated after three cycles.

Question answer

Yes, such online calendars are quite suitable for calculating ovulation days, but their effectiveness reaches only 30%, which is based on the calendar method for determining ovulation.

Question:
With an irregular cycle, will chronic anovulation necessarily occur?

Yes, irregular cycles are more often anovulatory, although this is controversial. Even if your periods “jump” every month, ovulation may occur, but, as a rule, not in the middle of the cycle, but at the beginning or end.

This method is unreliable and has not been scientifically confirmed, but there is a hypothesis that “female” sperm, that is, those that contain the X chromosome, are more tenacious, but slower. Therefore, in order to give birth to a girl, it is necessary to have sexual intercourse two to three days before expected ovulation. It is during this time that the slow X sperm will reach the released egg and fertilize it. If you have sexual intercourse at the peak of ovulation, then the fast “male” sperm will outstrip the female ones and you will have a boy.

I repeat, the method is unreliable. Spermatozoa containing the Y chromosome or “male” are more nimble and mobile, but are very sensitive to the acidic environment in the vagina, so sexual intercourse should take place on the day of ovulation, which must be confirmed by ultrasound. “Male” sperm, despite their activity, die very quickly, but if coitus took place on the day of ovulation, their death will not yet occur, and “male” sperm will reach the egg faster than “female” ones and fertilize it.

Question:
I play professional sports. Could this cause a lack of ovulation?

Certainly. Professional sports loads are very significant, which not only leads to persistent anovulation, but also to disruptions in the functioning of the hypothalamic-pituitary-adrenal-ovarian system. Therefore, you have to choose, either professional sports and fame, or the birth of a child.

A woman’s ability to become pregnant and bear a child is associated with many factors. This complex process is regulated not only by the ovaries or uterus, but also by the brain, adrenal glands, and thyroid gland.

The preparation of the female body for pregnancy is repeated monthly and is called the menstrual cycle.

Menstrual cycle

Cyclic changes in a woman’s reproductive system last from the first day of menstruation until the onset of the next menstruation. Ovulation occurs in the middle of the menstrual cycle. It represents the release of a mature germ cell from a burst follicle in the ovary and further movement into the fallopian tube through the abdominal cavity.

What happens after ovulation? If healthy sperm are present in the fallopian tubes, it means that after ovulation, fertilization is highly likely to occur.

Typically, the release of the egg occurs on days 12–14 of the menstrual cycle. But this is only possible if it is done regularly. If the cycle is irregular, or too short or long, ovulation may occur on other days.

If for some reason the egg is unable to leave the follicle, ovulation does not occur and fertilization is impossible. This situation in gynecology is called anovulation, and the cycle is anovulatory.

Anovulatory cycles

Anovulatory cycles can lead to permanent infertility. They can be periodic, rare or constant. Constant anovulation is called chronic, and it is almost always based on a pathological process in the female body.

Sometimes the lack of ovulation is due to external factors. In this case, after they stop, the normal cycle is restored on its own.

But there are also physiological anovulatory cycles, which are a kind of protective reaction of the body.

Physiological anovulation

The physiological absence of ovulation prevents pregnancy that is currently unwanted for a woman and protects the body from excess stress.

Normally, anovulatory cycles occur when:

• pregnancy;
• lactation;
• menopause.

Pregnancy and lactation

Since the simultaneous coexistence of two pregnancies is impossible, the female body is reliably protected from re-fertilization due to changes in hormonal balance. Physiological anovulation occurs after conception and continues until childbirth. It also protects a woman from pregnancy and breastfeeding.

But this method of contraception should be used with caution.

Physiological anovulation continues only with frequent and regular feeding - at least every 2-3 hours. Night breastfeeding is mandatory. But even in this situation there is no guarantee of reliable contraception.

The menstrual cycle can resume at any time. Moreover, you can get pregnant in the absence of menstruation, after ovulation, which precedes their appearance.

Climax

After 50 years, women experience postmenopause, which is manifested by constant age-related anovulation. The period from the last regular menstruation to its persistent absence is accompanied by periodic anovulatory cycles.

Their number gradually increases, and after 12 months the ability to ovulate is completely lost.

Anovulation associated with external factors

The absence of ovulation when exposed to external factors is usually reversible. This process is partly compensatory and protects the body from pregnancy under conditions of excessive stress or exhaustion. Typically, intense exercise and fasting lead to reversible anovulation:

1. Anovulatory cycles in female athletes are not uncommon. If physical activity continues to increase, menstruation also stops - amenorrhea develops. Pregnancy in this situation is impossible.
2. During fasting - forced, associated with fasting or illness - a similar process occurs. Periodic absence of ovulation is replaced by persistent absence and is accompanied by amenorrhea. When adequate nutrition is restored, the ability to release an egg is restored.

There is also artificially induced anovulation. It occurs when using certain hormonal and contraceptive drugs. At the same time, the woman retains menstrual-like the reaction is monthly bleeding, but the ability to become pregnant is reliably blocked. When hormonal contraceptives are discontinued, the reproductive function of the female reproductive system is restored.

Pathological anovulation

Pathological reasons for the lack of ovulation are most often associated with diseases of the genital organs or brain. Disruption of the interaction of these two structures also leads to blocking the release of the egg from the ovaries.

Most common diseases leading to pathological anovulation are:

1. Hyperprolactinemia.
2. Polycystic ovary syndrome.
3. Luteinization syndrome unovulated follicle.

In addition, many endocrine diseases lead to suppression of the release of a mature egg. These include low thyroid function, disease or Itsenko-Cushing syndrome, disruption of the hypothalamus and pituitary gland.

Hyperprolactinemia

Prolactin is a lactation hormone. Blocking the release of the egg is one of its functions. Exactly hyperprolactinemia explains why ovulation does not occur during lactation. An increase in the level of this hormone outside of breastfeeding is often the cause of female infertility.

Lead to hyperprolactinemia various reasons. Among them are stress, thyroid diseases, disorders hypothalamic-pituitary interactions, taking certain medications. Sometimes hyperprolactinemia is a symptom of a pituitary tumor - prolactinoma.

For this reason, all women with elevated prolactin levels are referred for a brain examination.

Polycystic ovary syndrome

This is a neuroendocrine disease characterized by increased production of sex hormones and prolactin. Symptoms of polycystic ovary syndrome include:

• Scanty periods, even their absence.
• Anovulation.
• Obesity.
• Excessive body hair growth.
• Infertility.

The exact cause of polycystic ovary syndrome is unknown. But the probability of anovulatory infertility with it approaches 80–90%.

Luteinization syndrome unovulated follicle

This is a hormonal disease in which the normal menstrual cycle is imitated. On days 12–14, an increase in rectal temperature and a change in vaginal discharge are noted.

But after “ovulation,” fertilization does not occur, because the direct release of the germ cell from the ovary does not occur. Due to normal hormone levels, ovulation and a two-phase cycle are only simulated.

It is believed that luteinization syndrome unovulated follicle is a consequence of endometriosis.

Signs of an anovulatory cycle

The release of the female reproductive cell from the ovary on the 14th day of the menstrual cycle may be accompanied by abdominal pain and poor health. Also, on days 12–14, many women notice a change in vaginal discharge and an increase in rectal temperature.

If no changes occur within a month, an anovulatory cycle can be suspected. Signs of lack of ovulation:

1. Vaginal discharge is the same throughout the month.
2. When measuring rectal temperature on the 12th–14th day of the cycle, there is no rise.
3. There is no pain in the abdomen on days 12–14, if there was any before.

Also, signs of lack of ovulation include a sudden change in the nature of menstruation. Scanty or too abundant discharge, or its untimely onset, allows one to suspect an anovulatory cycle.

Tactics for anovulation

Women often ask their gynecologist how to get pregnant if there is no ovulation. Without treatment this is impossible. Fertilization can occur only after ovulation, usually on days 12–16 of the cycle, since the lifespan of the egg is short.

Anovulatory cycles today are common cause of female infertility.

If pregnancy does not occur within a year, and there is suspicion of this pathology, a consultation with a gynecologist is necessary. It is he who will determine what to do if there is no ovulation.

With anovulatory cycles, it is very important to determine the cause of the disease. In most cases, such infertility is treatable.

Treatment

Treatment is selected only after the cause of this condition has been established. Main directions:

1. When exposed to external factors, you need to change your lifestyle - normalize your diet, reduce stress, stop taking contraceptives. Usually, after a couple of months, the menstrual cycle is restored, and after ovulation you can become pregnant.
2. At hyperprolactinemia medications are prescribed that suppress hormone production. If it is due to a pituitary tumor, surgery is sometimes recommended. At dishormonal diseases, corrective or hormone replacement therapy is prescribed.
3. Surgical treatment is also indicated in the case of polycystic ovary syndrome. After surgery, the likelihood of pregnancy increases dramatically.
4. If anovulatory cycles are associated with endocrine diseases, then treatment should be carried out by a gynecologist-endocrinologist. With adequate selection of medications, the normal cycle is quickly restored.
5. If the cause of the disease cannot be influenced, gynecologists perform ovarian stimulation - Clomiphene, Puregon and other similar drugs. The probability of pregnancy after ovulation stimulated by drugs is quite high.

In modern medicine, the absence of ovulation is not sentence. This is only a reason for a comprehensive examination. If the cause of anovulation is identified and adequately treated, pregnancy occurs within one to two years.

Ovulation: what is it in simple words and when does it happen?

The reproductive period takes up almost half of a woman's life. It lasts on average from 11-12 years, when a teenage girl has her first menstruation, to 48-50 years, when menopause is established. And all this time, the body patiently, month after month, prepares to accept and nurture the future new person.

“By extracting” more and more follicles from the ovarian reserves, the woman’s body releases eggs from them. This process is called “ovulation”. Let's take a closer look at some points.

• What is ovulation in girls in simple words
• How to determine the day of ovulation in women
• Ovulation test
• Ovulation stimulation
• Ovulation period
• How to determine the day the oocyte leaves the follicle
• Symptoms

What is ovulation in girls

Ovulation occurs once a month in every female if she:

• not pregnant;
• does not breastfeed;
• has no problems with hormones;
• does not take birth control pills.

Perhaps the wording of the question is a little incorrect - ovulation occurs not only in young girls, but also in mature women, until the menopause period begins. What is ovulation and when does it occur - a question to which the clearest and most detailed answer will be given by a gynecologist or gynecologist-endocrinologist. How does it manifest itself?

If we touch lightly on the field of biology, the overall process looks like this.

What many consider to be the end of the menstrual cycle - regular bleeding - is actually the beginning of the ovulatory cycle. On the day when spotting appears on the pad, indicating the rejection of the endometrial layer that turned out to be “extra”, several small - so-called antral - follicles begin to slowly mature. The supply of them in the body of a newborn girl approaches a million, but throughout life it steadily decreases. Most follicles do not reach the maturity stage. Having begun to grow on the first day of a new cycle, they undergo atresia and resolve, with the exception of 1 or 2.

At about 8-9 days, ultrasound already shows 5-10 antral follicles in each ovary. At this point, the dominant one, that is, the largest one, is determined. It is he who is destined to rupture on days 12-14 of the cycle, release an egg and turn into. The process of formation and release of an egg is called ovulation.

This is the most favorable time for, dangerous for those who do not plan to expand their family, and favorable for those who want to become parents.

Early ovulation occurs on days 11-12 of the cycle. comes around 19-20 days. Both cases are not anything different from the norm, because many factors influence the menstrual cycle of women:

• changing of the living place;
• stress;
• any diseases;
• taking medications;

Sometimes a woman constantly ovulates during these periods. If fertility is preserved and there are no hormonal or sexual diseases, then there is no need to worry: this means that this is the individual norm for this woman.

What is the day of ovulation

The day of ovulation is “day X,” which becomes the beginning of a new life if it is destined to be born.

In teenage girls, ovulation cycles are not established immediately. If menstruation begins early, around age 11, the entire first year may consist of anovulatory cycles. This should not cause concern: the “dance” of hormones has not yet subsided, the body has not adjusted the mechanism by which it will work properly until menopause.

However, this does not mean that young girls do not have to worry about the need for contraception: ovulation can happen in any month. Not always (especially at first) and not every girl will be able to feel the distinctive signs of ovulation: it does not manifest itself in any way, because it is not a disease, but a natural process, and it can often be tracked only by ultrasound and jumps in basal temperature. But more on that later.

Gynecologists achieve stimulation of ovulation by injecting drugs. hCG appears, which is administered intramuscularly when the follicle has already become dominant, but has not yet reached its maximum. This gives an impulse to the oocyte to mature and break away from the wall of the ovarian follicle. After an HCG injection, ovulation occurs approximately 36-48 hours later.

Such an injection can be given to the patient before, so as not to miss the time most suitable for the injection of the husband’s or donor’s sperm.

It denotes the natural ability to bear children. During this period, the woman becomes pregnant as the egg is released.

This process occurs in the middle of the menstrual period. However, if pregnancy does not occur, then it is worth thinking, perhaps there is no ovulation, why? What are the reasons?

Ovulation may not occur for physiological reasons. For example, it is believed that if a girl starts her period, she can become pregnant. Of course it can, but the likelihood of this is very low. Stable functioning of the reproductive system and regulation of hormone secretion are not established immediately, which is why teenage girls have irregular menstruation. Research shows that many menstrual cycles are anovulatory. Is this related? that the follicles do not mature normally, which improves over time.

Anovulation may also occur during pregnancy. The woman’s hormonal background is changed, there is no cyclic rhythmic release of hormones. And during lactation, there is an increase in prolactin in the blood, which also prevents ovulation, as with pathological hyperprolactinemia.

Presence of diseases

Most often, the lack of ovulation is caused by a number of serious gynecological and endocrine ailments.

Here are the main reasons why there is no ovulation:

• polycystic ovary syndrome ();
• reduced estradiol content;
• excessively high level of follicle-stimulating agent ();
• infantilism;
• high degree of obesity;
• exhaustion (anorexia);
• hyperprolactinemia;
• dysfunction of the pituitary gland;
• thyroid disease.

If you examine patients with such diseases, you can understand why they do not ovulate. Usually they have hormonal imbalances that affect all stages of egg development.

Endocrine diseases play a special role. The fact is that the regulation of the secretion of some hormones is interdependent. Therefore, women with diabetes and thyroid diseases often have problems conceiving.

For example, a pathology such as insulin resistance, associated with impaired transfer of sugar into the cell, can cause anovulation. When glucose supply is disrupted, insulin production in the pancreas increases. The effect of insulin resistance on conception is still being studied, but it has been found that in women, with changes in the HOMA index, which determines the level of disorders, polycystic ovary syndrome is more likely to develop. This also occurs in type 2 diabetes.

Insulin resistance can be physiological or pathological. Physiological is observed even in teenage girls, and if you do not adhere to proper nutrition and do not follow the regime, it can lead to the development of diabetes, PCOS and anovulation.

Problems with conception can occur even if a woman simply gets sick before ovulation, this can also negatively affect the process. After all, at this moment the body becomes involved in the fight against infection, the organs work in stress mode, the production of hormones changes, and this is the reason why ovulation is delayed and does not exist. It may come later or not appear at all.

Chronic stress

Constant and increased stress is one of the significant reasons why there is no ovulation. Nervous stress, mental overload and chronic stress are among the most common reasons for delaying this process. Excessive shock can become a stopping mechanism for ovulation. Moreover, with its complete absence for a very long period.

The regulation of the reproductive function of the body is called neurohumoral. This suggests that the brain controls the secretion of hormonal substances.

Stress and overexertion create pathological foci in the brain tissue that affect the production of gonadotropic hormones. Therefore, treatment of this type of disorder can be difficult and sometimes lengthy.

If external influences are not eliminated in a timely manner, the process may deepen and then not only will pregnancy not occur, but diseases of other organs may also develop. Stress ulcers most often appear in the stomach; they can lead to bleeding, disruption of the supply of nutrients to the body, and as a result, decreased immunity, changes in the blood coagulation system, and much more.

Stopping taking hormonal medications

In this case, the cycle returns to its natural state, for which the body requires some time. And hormonal imbalance explains why there is no ovulation.

This period is different for every woman. Some need a short period of time, others – up to several months.

It all depends on:

• health conditions;
• physiological age of the body;
• duration of drug use.

Sometimes women decide to plan a pregnancy and stop taking contraceptives, but pregnancy does not occur. There is no need to get scared ahead of time, because the reason why there is no ovulation is clear, but before planning you still need to visit a doctor. Contraceptives can also have the opposite effect and instead of one egg, 2-3 will mature, which will lead to multiple pregnancies. It is much more difficult to endure, the risk of complications for the mother and fetus increases, which means more careful preparation is required.

Change in body weight

The reasons why there is no ovulation may be related to weight loss.

The fact is that the female body needs fat to ensure normal physiological processes. It is a natural estrogen (female hormone) store and androgen converter. The latter is an important element that supports optimal ovulation. In women who are extremely thin, menstruation may disappear altogether. Especially if the process is complemented by a lack of appetite due to stress.

Normally, a woman's body should contain at least 18-20 percent body fat of the total weight. Otherwise, problems arise and there is no ovulation, why? Mainly due to the fact that the body is not able to reach the level of estrogen required for the maturation of eggs and their release from the ovaries.

Obesity also causes problems with conception. Estrogen accumulates in adipose tissue, an excess of which in the body leads to a decrease in the production of follicle-stimulating hormone and impaired follicle maturation. Therefore, in obese women, pregnancy may not occur. Many cases have been described where, by following a diet and reducing the index, only 10% of women became pregnant naturally.

Even when preparing for IVF, body mass index must be taken into account. To increase your chances of getting pregnant, you need to improve your diet and exercise to lose weight.

Increased physical activity

Intense physical activity and sports do not always benefit a woman. Especially with excessive enthusiasm. As a result, this is another reason for the lack of ovulation. Of course, you should not abandon such activities. You just need to do them in moderation, without overloading, unless, of course, you are planning a pregnancy.

This mainly applies to women with low body weight and low levels of fatty tissue. This includes those who do running, swimming, ballet, etc.

They usually have in combination:

• physical stress of the body;
• emotional stress;
• low fat ratio;
• changes in thyroid function.

All these factors explain why there is no ovulation and no pregnancy.

Problems with ovulation are often observed among female athletes, especially during intensive preparation for competitions. When a woman is planning a pregnancy, she should reconsider her lifestyle. This does not mean giving up sports completely. Moderate-intensity training can be continued. But participation in competitions is not only physical stress, but also psychological stress.

Change of scenery

If a woman does not ovulate, this may be due to travel or moving to a new place of residence. This reason is one of the most common factors that provoke lack of ovulation.

The body can regard the emotional outburst experienced as stress. This is caused by a sharp change in climate and habitual rhythm of life. Disruption of the body's biological clock does not go away without leaving a trace. It takes time to adapt. This is especially pronounced when there is a sharp change in time or climate zone.

But this doesn't happen to everyone. Sometimes, with a sudden change of situation, for example, while on a business trip, there are no special disturbances, but when returning home, malaise appears; a cold may appear even in the summer, an exacerbation of chronic diseases and the absence or delay of menstruation.

Women whose profession involves constant travel - flight attendants, conductors - also experience such pathological conditions.

The body can adapt over time and the menstrual cycle will improve. But sometimes adaptive abilities are reduced and in order not to harm your health you have to change your specialty.

In such cases, most often a woman’s monthly cycle lengthens due to delayed ovulation. During such a period, menstruation and ovulation may be absent altogether.

Reduced number of ovulations due to menopause

Lack of ovulation is also observed during menopause. The reduction in their number begins at about 30 years of age. For some women earlier, for others later. If girls have anovulatory cycles 1-2 times a year, then for older women - almost every month. And sometimes more often. It is for this reason that it becomes more difficult to get pregnant as you age, and why during this period, due to the lack of ovulation, you sometimes do not have regular periods.

Anovulation prevents pregnancy. To find out the cause, you need to undergo a full examination by a gynecologist. If no pathologies are found in the reproductive organs, the endocrine system and other possible causes of anovulation should be checked.

If you want to get examined and find out why you are not ovulating, you can contact the AltraVita clinic. Here you can take all the tests and get advice from doctors who have been dealing with infertility problems for many years. You don’t have to visit specialized specialists in other clinics; we have gynecologists, reproductive specialists, therapists, endocrinologists and even psychologists on our staff. Come and we will help you restore your health.

What is ovulation? How not to miss a good moment for conception? Everything is very simple - we focus on the signs and symptoms of ovulation, use basal temperature, an ovulation test and folk remedies - and pregnancy is in our pocket!

Ovulation: what is it?

Ovulation(from the Latin ovum - egg) is one of the stages of the menstrual cycle, which is the process of rupture of a mature follicle with the release of a mature egg capable of fertilization from the ovary into the abdominal cavity.

The process of ovulation is controlled by the hypothalamus by regulating (via gonadotropin-releasing hormone) the release of hormones secreted by the anterior pituitary gland: LH (luteinizing hormone) and FSH (follicle-stimulating hormone). In the follicular phase of the menstrual cycle before ovulation, the ovarian follicle grows under the influence of FSH. When the follicle reaches a certain size and functional activity, under the influence of estrogens secreted by the follicle, an ovulatory LH peak is formed, which triggers the “maturation” of the egg. After maturation, a gap is formed in the follicle through which the egg leaves the follicle - this is ovulation. There is approximately 36 to 48 hours between the ovulatory LH peak and ovulation. During the corpus luteum phase after ovulation, the egg usually moves down the fallopian tube towards the uterus. If fertilization of the egg occurs during ovulation, then on days 6-12 the zygote enters the uterine cavity and the implantation process occurs. If conception does not occur, the egg dies in the fallopian tube within 12-24 hours.

Ovulation and conception

When does ovulation occur?

Average Ovulation occurs on the fourteenth day of the menstrual cycle(with a 28-day cycle). However, deviation from the average is often observed and to a certain extent is the norm. The length of the menstrual cycle itself is not a reliable source of information about the day of ovulation. Although usually with a shorter cycle ovulation occurs earlier, and with a longer cycle - later.

The ovulation rhythm, which is constant for every woman, undergoes changes within 3 months after an abortion, within a year after childbirth, and also after 40 years, when the body prepares for the premenopausal period. Physiologically, ovulation stops with the onset of pregnancy and after the cessation of menstrual function.

How does ovulation and conception occur?

The female body is endowed with two ovaries, located on either side of the uterus. The ovaries produce hormones, the most famous of which are estrogen and progesterone.

The ovaries contain eggs even at the stage of intrauterine development of a girl. There are hundreds of thousands of eggs in a newborn's two ovaries. True, all of them are inactive until the onset of puberty and the first ovulation, that is, until about 12 years of age. During this time, a certain number of cells die, but 300,000 - 400,000 full-fledged eggs remain. From the moment of the first ovulation until the onset of menopause, a woman will experience from 300 to 400 menstrual cycles, as a result of which the same number of oocytes will mature and can become fertilized. During the menstrual cycle, one of many eggs matures in the ovaries.

Under the influence of follicle-stimulating hormone (FSH) of the pituitary gland, an endocrine gland on the lower surface of the brain, the follicle (sac) with the egg selected for ovulation in a given cycle begins to grow. The diameter of the follicle at the beginning of the cycle does not exceed 1 mm, and after 2 weeks it reaches 20 mm. As the follicle grows, a bulge forms on the surface of the ovary, which by the middle of the cycle increases to the size of a grape. Inside the follicle there is fluid and a small nucleolus with a diameter of 0.1 mm.

The period of maturation of the egg until its release from the ovary can last from 8 days to a month, although on average it lasts about 2 weeks. The main factor influencing the duration of this process is the time it takes the body to reach its estrogen threshold. High levels of estrogen stimulate a sharp increase in the content of luteal stimulating hormone (LH), which causes the egg to break through the ovarian wall within one to two days after a sharp rise in its level. Midway through the cycle, approximately 12 days after the start of menstruation, the pituitary gland releases large amounts of luteinizing hormone (LH), and ovulation occurs approximately 36 hours later.

Chromosomes located in the nucleus of cells are carriers of the genetic code. The purpose of fertilization is the fusion of two sex cells (gametes) originating from individuals of different sexes. All cells of the human body contain 46 chromosomes. Therefore, two gametes must form a new cell, which also contains 46 chromosomes. A simple addition would result in 92 chromosomes, but this would lead to a biological error, the consequence of which would be the termination of the race. Consequently, each partner must halve its number of chromosomes (to 23). In the egg, a reduction in the number of chromosomes occurs after the pituitary gland releases luteinizing hormone several hours before ovulation. For such a transformation, 20 - 36 hours are enough for her. Preparing itself to receive a sperm, the egg pushes half of its chromosomes to the periphery, into a small sac called the first polar body. The meeting with the sperm must occur at a strictly defined time. If this happens earlier, the egg will not be ready to receive the sperm, since it will not have time to divide its chromosomes; if - later, then she risks missing the period of maximum readiness for fertilization.

Next 14 days after ovulation, the second part of the cycle, take place in preparation for conception of the uterine mucosa. All preparation is in vain if conception does not occur, and its biological consequences will pass along with menstrual bleeding. But in one of the ovaries a new egg is already preparing for ovulation.

What happens after ovulation during conception?

The egg released from the follicle, having reduced the chromosomes, enters the fallopian tubes, which are connected to the ovary with their soft fimbriae. The fringes resemble an open flower at the end of the stem. And its living petals capture the egg as it moves. The fusion of the egg and sperm usually occurs in the fallopian tube itself.

The fallopian tube is a cylindrical muscular organ; inside it is lined with a mucous membrane covered with villi and containing glands that produce secretions. This structure facilitates the movement of the egg and (if fertilization has occurred) the embryo into the uterus.

To fertilize an egg, sperm must enter the body at approximately the same time that the egg leaves the follicle. This may seem easy to achieve, but the egg only lives for 24 hours or less after ovulation, and the sperm remains capable of fertilizing it for only a few days. Thus, sexual intercourse must happen at your most opportune time if you want to get pregnant.

Thus, ovulation period– the most successful period for conceiving a child. In this regard, it is important to be able to determine when does ovulation occur. You can do this yourself at home, for example, by measuring your basal temperature. Special devices have also been developed (for example, ClearPlan Easy Fertility Monitor), which, based on the hormone content in urine analysis, can more accurately determine the moment of ovulation: ovulation tests. More accurate determinations can be made in a clinical setting, for example, by ultrasound monitoring the growth and development of the follicle and determining the moment of its rupture.

When planning conception naturally, the procedure of in vitro fertilization and artificial insemination, one of the most important points is the moment of ovulation itself.

Symptoms of ovulation:

How to determine ovulation?

Symptoms of ovulation that a woman can notice without a doctor:

• short-term pain in the lower abdomen,
• increased sexual desire.

During a gynecological examination during ovulation, an increase in the amount of mucus secreted from the cervical canal is observed. In addition, sometimes they use the stretchability and transparency of mucus, and also observe its crystallization, which can be done using a special microscope for home use.

The next most accurate method for determining ovulation is measuring basal temperature. An increase in mucous discharge from the vagina and a decrease in rectal (basal) temperature on the day of ovulation with an increase the next day most likely indicates ovulation. The basal temperature chart reflects the temperature effect of progesterone and indirectly (but quite accurately) allows you to determine the fact and day of ovulation.

All of these listed signs of ovulation and methods for determining it provide only approximate results.

Signs of ovulation, which are stated by the doctor:

How to accurately recognize ovulation?
There are methods that help to absolutely determine the moment of ovulation:

Ultrasound observation (ultrasound) of the growth and development of the follicle and determination of the moment of its rupture (ovulation), see photo. Ultrasound monitoring of follicle maturation is the most accurate method for determining ovulation. After the end of menstruation, approximately on the 7th day of the cycle, the gynecologist performs an ultrasound using a vaginal sensor. After this, the procedure should be carried out every 2-3 days to monitor the preparation of the endometrium. Thus, it is possible to predict the date of ovulation.

dynamic determination of luteinizing hormone (LH level) in urine. This method is simpler and can be applied at home using ovulation tests. Ovulation tests begin to be carried out 2 times a day, 5 - 6 days before expected ovulation, strictly following the instructions.

Ovulation test at home

Home ovulation tests work by detecting a rapid rise in the amount of luteinizing hormone (LH) in the urine. A small amount of LH is always present in the urine, but 24-36 hours before ovulation (the release of an egg from the ovary), its concentration increases sharply.

Using Ovulation Tests

On what day should testing begin? This day depends on the length of your cycle. The first day of the cycle is the day when menstruation begins. Cycle length is the number of days that have passed from the first day of the last menstruation to the first day of the next.

If you have a regular cycle, then you need to start doing tests ~17 days before the start of your next menstruation, since the corpus luteum phase after ovulation lasts 12-16 days (on average, usually 14). For example, if the usual length of your cycle is 28 days, then testing should begin on the 11th day, and if 35, then on the 18th.

If your cycle lengths vary, choose the shortest cycle in the last 6 months and use its length to calculate the day to start testing. If your cycles are very inconsistent and there are delays of a month or more, using tests without additional monitoring of ovulation and follicles is not reasonable due to their high cost (using tests every few days can miss ovulation, and using these tests every day is not worth it ).

When used daily or 2 times a day (morning and evening), these tests give good results, especially when combined with ultrasound. With simultaneous monitoring by ultrasound, you can not waste tests, but wait until the follicle reaches approximately 18-20 mm, when it is able to ovulate. Then you can start doing tests every day.

Performing an ovulation test

You can take an ovulation test at any time of the day, but you should stick to the same test time whenever possible. You should refrain from urinating for at least 4 hours before the test. Avoid excess fluid intake before testing, as this may reduce the amount of LH in the urine and reduce the reliability of the result.

Determining ovulation using test strips: place the test strip in a jar of urine up to the line indicated on the test for 5 seconds, place it on a clean, dry surface, and watch the result after 10-20 seconds.

Determining ovulation using a test device: Holding the tip of the absorbent pointing down, place it under a stream of urine for 5 seconds. You can also collect the urine in a clean, dry container and place the absorbent in the urine for 20 seconds. Holding the tip of the absorbent pointing downwards, remove the absorbent from the urine. Now you can put the cap back on. The result can be seen in 3 minutes.

Ovulation test results

Results of determining ovulation using a test strip: 1 strip means that an increase in LH levels has not yet occurred, repeat the test after 24 hours. 2 stripes - an increase in LH levels is recorded, the intensity of the strip next to the control one indicates the amount of the hormone. Ovulation is possible when the stripe intensity is the same as the control or brighter.

Results of determining ovulation using a test device: Look at the result window and compare the result line on the left near the arrow on the body of the stick with the control line on the right. The line closest to the arrow on the body is the result line, which shows the level of LH in the urine. Further to the right of the arrow on the body of the stick there is a control line. The control line is used for comparison with the result line. The control line always appears in the window if the test was carried out correctly.

If the result line is paler than the control line, the LH surge has not yet occurred and testing should be continued daily. If the result line is the same or darker than the control line, then the release of the hormone in the ear has occurred, and within 24-36 hours you will ovulate.

The most suitable 2 days for conception begin from the moment when you determine that the LH surge has already occurred. If sexual intercourse occurs within the next 48 hours, your chance of getting pregnant will be maximized. Once you have determined that an outlier has occurred, there is no need to continue testing.

Types of Ovulation Tests

The most common are disposable test strips for determining ovulation, similar to pregnancy tests, their price is not high.

There are also devices for determining ovulation, which are gradually replacing expensive one-time tests; they also quite accurately determine the moment of ovulation, but they are also multifunctional and more economical, they do not need to be changed every time after use and they are designed for many years of work.

The tests allow you to fairly accurately determine ovulation; experts attribute the existing errors in the results of ovulation tests only to their incorrect use.

Thus, by combining several methods to determine the moment of ovulation, you can track the long-awaited ovulation with an absolute guarantee. After all, it is on these days that the chance for successful conception is the highest: there is ovulation - conception is possible.

Ovulation calendar

Using ovulation data from a basal temperature chart or tests for at least 3 months, you can create an ovulation calendar. The calendar allows you to predict the day of the next ovulation, thus making it possible to plan conception and pregnancy.

Ovulation and pregnancy

For a woman, the few days before and after ovulation represent the fertile phase during which conception and pregnancy are most likely.

There is a noticeable difference in the timing of ovulation among different women. And even for the same woman, the exact timing of ovulation varies from month to month. Menstrual cycles may be longer or shorter than average and may be irregular. In rare cases, it happens that women with very short cycles ovulate around the end of the menstrual bleeding period, but in most cases, ovulation occurs regularly at the same time.

Not only the actual conception of the child, but also its gender depends on the time of conception in relation to the time of ovulation. Directly at the moment of ovulation, there is a high probability of conceiving a boy, while before and after ovulation, a girl is more likely to be conceived. This is explained by the fact that sperm with the Y chromosome (boys) are faster, but live shorter and are less stable in an acidic environment before ovulation than with the XX set (girls). If the egg is already moving toward fresh sperm, the “boys” will reach it faster. If sperm “wait” for an egg for a long time, most of the sperm remain in it to conceive a girl.

The likelihood of conception and pregnancy is generally highest on the day of ovulation and is estimated at approximately 33%. A high probability of pregnancy is also noted on the day before ovulation - 31%, two days before it - 27%. Five days before ovulation, the probability of conception and pregnancy is 10%; four days - 14% and three days - 16%. Six days before ovulation and the day after it, the likelihood of conception and pregnancy during sexual intercourse is very low.

Considering that the average “lifespan” of sperm is 2-3 days (in rare cases it reaches 5-7 days), and the female egg remains viable for about 12-24 hours, then the maximum duration of the fertile period is 6-9 days and the fertile period corresponds to a phase of slow increase (6-7 days) and rapid decline (1-2 days) before and after the day of ovulation, respectively. Ovulation divides the menstrual cycle into two phases: the follicle maturation phase, which with an average cycle duration is 10-16 days and the luteal phase (corpus luteum phase), which is stable, independent of the duration of the menstrual cycle and is 12-16 days. The corpus luteum phase refers to the period of absolute infertility; it begins 1-2 days after ovulation and ends with the onset of a new menstruation. If for one reason or another ovulation does not occur, the endometrial layer in the uterus is thrown out during menstruation.

Ovulation stimulation

Lack of ovulation is one of the common causes of infertility.

Ovulation disorders are caused by dysfunction of the hypothalamic-pituitary-ovarian system and can be caused by inflammation of the genitals, dysfunction of the adrenal cortex or thyroid gland, systemic diseases, tumors of the pituitary gland and hypothalamus, intracranial pressure, and stressful situations. Ovulation disorders can be hereditary in nature (primarily, it is a tendency to certain diseases that interfere with ovulation). Anovulation - the absence of ovulation during childbearing age - is manifested by a disturbance in the rhythm of menstruation such as oligomenorrhea (menstruation lasting 1-2 days), amenorrhea, dysfunctional uterine bleeding. Lack of ovulation is always the cause of a woman's infertility.

One of the common causes of infertility is the lack of ovulation, most often due to hormonal imbalance, which, in turn, can occur due to stress, brain injury, abortion, etc. To treat this condition, a complex of hormonal drugs is used that stimulate ovulation and cause superovulation, when several eggs mature in the ovaries at the same time, which increases the chances of fertilization, and is widely used in the IVF procedure.

Another cause of infertility may be, for example, luteal phase deficiency - LPF, when ovulation has occurred and the concentration of progesterone in the second phase of menstruation is insufficient for implantation of the embryo into the uterus. In this case, treatment is carried out aimed at stimulating the function of the corpus luteum of the ovary and increasing the level of progesterone in the blood. However, correction of NLF is not always successful, since this condition is often associated with other gynecological diseases and requires a thorough examination.

If a woman has a disruption in the process of follicle maturation and, accordingly, ovulation, ovulation is stimulated. For this purpose, special medications are prescribed - ovulation inducers. Prescribing medications leads to stimulation of the development of one or more eggs in patients, which will then be ready for fertilization. Before prescribing such serious therapy, a full range of tests is carried out to determine the woman’s hormone levels. In addition to the use of ovulation stimulation, regular diagnostics using ultrasound are also carried out. After ovulation, if it is still not possible to become pregnant naturally, the patient undergoes intrauterine insemination or IVF. There is a big difference in the method of stimulating ovulation for IVF and for natural conception: in the first case, several eggs are achieved, in the second - 1, maximum 2.

Drugs to stimulate ovulation

The most commonly used drugs to stimulate ovulation are Clostilbegit and gonadotropic hormone drugs.

Preparations of gonadotropic hormones contain hormones of the endocrine gland of the pituitary gland - gonadotropins. These are follicle-stimulating hormone - FSH and luteinizing hormone - LH. These hormones regulate the process of follicle maturation and ovulation in a woman’s body and are secreted by the pituitary gland on certain days of the menstrual cycle. Therefore, when medications containing these hormones are prescribed, follicle maturation and ovulation occur.

Such drugs include Menopur (contains the hormones FSH and LH) and Gonal-F (contains the hormone FSH).

The drugs are available in injection form, administered intramuscularly or subcutaneously.

How is ovulation stimulated?

Various ovulation stimulation schemes are used depending on the type of ovulation disorder and the duration of the disorder. When using a regimen with Clostilbegit, the latter is prescribed from days 5 to 9 of the menstrual cycle. A combination of this drug with gonadotropins is often used. In this case, Clostilbegit is prescribed from days 3 to 7 of the menstrual cycle with the addition of Menopur (Puregon) on certain days.

When carrying out ovulation stimulation, a very important point is to carry out ultrasound monitoring, that is, monitoring the maturation of the follicle using an ultrasound machine. This allows you to make adjustments to the treatment regimen and promptly avoid such side effects of stimulation as the growth of several follicles. The frequency of ultrasound examinations during the treatment program is on average 2-3 times. During each examination (monitoring), the number of growing follicles is counted, their diameter is measured and the thickness of the uterine mucosa is determined.

When the leading follicle reaches a diameter of 18 millimeters, the doctor may prescribe the drug Pregnil, which completes the final process of egg maturation and causes ovulation (direct release of the egg from the follicle). Ovulation after Pregnil administration occurs within 24-36 hours. Depending on the type of marital infertility, during the period of ovulation, either intrauterine insemination is carried out with the sperm of the husband or donor, or the time of sexual intercourse is calculated.

Depending on the duration and cause of infertility, the woman’s age, the pregnancy rate per attempt is 10–15%.

Conditions for ovulation stimulation:

1. Examination of a married couple.
List of tests:
HIV (both spouses)
Syphilis (both spouses)
Hepatitis B (both spouses)
Hepatitis C (both spouses)
Smear for degree of purity (woman)
Bacteriological cultures: chlamydia, mycoplasma, ureaplasma, trichomonas, candida, gardnerella (both spouses)
Smear for oncocytology (woman)
Therapist's conclusion about the possibility of pregnancy
Ultrasound of the mammary glands
Blood test for antibodies to rubella, that is, the presence of immunity (protection) in a woman

2. Patent fallopian tubes.
Since fertilization occurs in the fallopian tube (“Physiology of Conception”), patent fallopian tubes are an important condition for pregnancy. Assessment of fallopian tube patency can be carried out using several methods:

• Laparoscopy
• Transvaginal hydrolaparoscopy
• Metrosalpingography

Since each method has its own indications, the choice of method is determined jointly by you and your attending physician at the appointment.

3. Absence of intrauterine pathology
Any abnormalities in the uterine cavity prevent pregnancy (“Intrauterine pathology”). Therefore, if a woman has indications of trauma to the uterine mucosa (curettage of the uterine cavity during abortion and bleeding, inflammation of the uterine mucosa - endometritis, intrauterine device and other factors), hysteroscopy is recommended to assess the condition of the uterine cavity (“Hysteroscopy”).

4. Satisfactory sperm quality
Satisfactory sperm quality – absence of male factor infertility. If intrauterine insemination is not planned, a postcoital test (“Postcoital test”) is recommended before inducing ovulation.

5. Absence of acute inflammatory process
Absence of acute inflammatory process of any localization. Any inflammatory disease is a contraindication for many diagnostic and therapeutic procedures in medicine, since it carries a risk of worsening the patient’s condition.

It is best to use folk remedies to stimulate ovulation only after consulting a doctor.

Ovulation photo taken during IVF surgery

The 3rd photo shows that several eggs have matured (after preliminary stimulation of ovulation).