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Are you ovulating?

I'm Mrs Uma Gordon, consultant gynaecologist and specialist in reproductive medicine and surgery. I'm also the Clinical Director of Bristol Fertility Clinic. Often when a couple comes to see me for fertility assessment, that means investigation. When we are starting off the initial workup, it's usually the female that thinks that she's got a problem. That's because her periods are coming two days early or two days late. They're heavy, they're light. But really these things don't matter. As long as your periods are coming every month, that means you're ovulating. If your periods are happening for more than 35 days cycle, then you're not ovulating. So that's a simple guide, a simplistic guide.

I also have female patients coming and saying that progesterone levels are low, so they're not ovulating, but the progesterone blood test may not have been timed correctly because there is a narrow window through which the progesterone rises and falls in the second half of the cycle. And if we haven't timed it correctly, it may falsely tell you that you're not ovulating. So if you're having periods every 28, or 30 days, then you are ovulating and there is no need to do a progesterone test. For example, in my own practice, I haven't done a progesterone test in several years now because the information is obtained simply from your menstrual cycle.

Another thing you need to be aware of is tracking ovulation. It can be very stressful for the couple and having timed intercourse can be quite difficult for the man as well. What really should not be done is basal body temperature charting, where you chart your temperature. The Royal College of Obstetricians and Gynecologists guides us that basal body temperature charts should not be used because you're constantly looking at your temperature and ruminating over it, and that itself can affect your cycle subtly, and therefore we would say, please don't use them.

In terms of the timing of intercourse, again, the clinician who is seeing you should be able to look at your menstrual cycle and say, "This is the best time for you to be having intercourse." Usually, it's four to six days prior to ovulation. Once you ovulate, you can have any amount of intercourse, but the cervix almost closes down with the mucus changing, and the sperm is not able to penetrate as it did before. So the timing of intercourse is important. Tracking ovulation, let it not be stressful for you. Don't worry too much about progesterone levels, because your cycle pattern is enough to indicate to us whether you're ovulating or not.

I hope that's helpful.

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