Dear Dr. Marc,
Is there any way to tell if you are actually ovulating ? After surgery, my tubes are now clear. I have no history of any other fertility problems ( they were blocked with endometriosis). I’ve done 3 rounds of Clomid and well nothing so far…. I get positive OPK tests every month…
People have been trying to pinpoint ovulation for generations. The information is just as useful for those who are trying to avoid pregnancy, as those who are trying to conceive. Unfortunately, no one method is perfect for everybody. Fortunately, there are multiple options and most women can find at least one that works for them. The following methods are listed in chronological order (earliest to latest in the menstrual cycle):
Ultrasound: Transvaginal ultrasound can detect the dominant follicle 6-8 days before ovulation. With sequential ultrasounds over multiple days, one can predict ovulation with significant reliability. Further, once the follicle disappears, you can be confident that ovulation has occurred. This method requires multiple visits to the doctor and therefore can be quite expensive and time consuming. Additionally, follicles can occasionally ovulate then fill back up with fluid making them look as if they have not ovulated when they actually have.
Cervical mucus change: In the 1-3 days preceding ovulation, many women notice a change in the consistency of their cervical mucus. The mucus becomes thin and stretchy, similar in consistency to raw egg whites. This method involves checking the mucus on a daily basis with your fingers. Some women are not comfortable with this method.
Ovulation prediction kits: These kits are designed to detect, in the urine, the surge of lutenizing hormone (LH), which induces ovulation. LH is released by the brain and ovulation follows 24-48 hours later. This method is very reliable, but also has some potential problems. One problem is that LH is always released in small amounts by the brain. Sometimes this small amount can be mistaken by the test for the “surge” and thus cause a false positive. Additionally, the water content (diluteness) of urine fluctuates significantly throughout the day. If the urine is too dilute (too much water) it can result in a false negative result.
Mittelschmerz: Abdominal pain associated with ovulation. Many women do not feel anything with ovulation, while others recognize a vague pressure sensation in their lower abdomen for a few minutes to hours surrounding ovulation. Some women however, suffer significant abdominal pain related to ovulation. Consistent Mittleschmerz pain recorded on a menstrual calendar is a reasonably reliable sign of ovulation.
Progesterone level: Once ovulation occurs, the follicle from which the egg was released begins to produce progesterone. An elevated level of progesterone is a reliable sign that ovulation has occurred. Usually it is tested 5-8 days after ovulation to get the peak level.
Menstruation: Menses occur only after a rise then fall of progesterone. The only thing that can cause progesterone to rise and fall is ovulation. Therefore, menses is a reliable sign that ovulation has occurred (usually about 14 days prior to the first day of bleeding). As with all the other methods however, vaginal bleeding does not always indicate prior ovulation. This is because not all vaginal bleeding is actually menstruation. If bleeding is due to an endometrial polyp or PCOS for example, it is not true menstruation and therefore does not indicate prior ovulation. With that being said, regular, predictable periods are almost always a sign of prior ovulation.
Pregnancy: Pregnancy is the only 100% reliable test that ovulation has occurred.
Hopefully that is helpful Kim. If your OPKs are becoming positive as expected, it is reasonable to believe that you are ovulating. We know that women with endometriosis tend to have a more difficult time becoming pregnant even if their tubes are open and they are ovulating regularly. Considering this, I’d recommend that you discuss your situation with your doctor or a fertility specialist.
Best of luck,