Parenting: Preconception
Before she tried to get pregnant with her first child, Lynne Ticknor, a parent
educator from Clarksville, Md., read Taking Charge of Your Fertility (Collins, 2006) by Toni Weschler. She was fascinated by this in-depth look at
ovulation and started tracking her cycles.
"After charting three cycles on paper for practice, I definitely started to notice a trend," she says. "During the fourth cycle, I charted and followed Weschler's advice for getting pregnant with a girl and – boom – I got pregnant with my daughter. I followed the same path for my additional children and, although it took longer than one month to get pregnant the subsequent times, we now have four children."
All women should be as well-informed as Ticknor. Although ovulation is the clock that regulates our reproductive systems, most women are completely unaware of how it works and how it can be manipulated, tracked and predicated.
The following are a few of the most frequently asked questions about ovulation, answered by Dr. Jill Powell, assistant professor of obstetrics, gynecology and women's health at Saint Louis University.
Q. Do women ovulate every month?
A. Most women do ovulate every month but some things can prevent it, such as stress or significant weight loss or gain or certain conditions.
Q. Do you get a period if you don't ovulate?
A. No. However, if you don't get a period as planned you can still sometimes have breakthrough bleeding. In fact, breakthrough bleeding is not uncommon for someone who is not ovulating regularly. When you do ovulate, about 14 days later your body gets a signal to have period. If you don't get that signal, you can get very thick and unstable uterine lining, and that may result in a discharge that may be mistaken for a period, but isn't one.
Q. When you first start your periods do you ovulate?
A. Yes, the first period always is a result of the first ovulatory cycle. However, it's not unusual for the first year or so after starting her period for a teenager's cycle to be irregular. That means she isn't yet ovulating regularly.
Q. How does ovulation work?
A. There are several components to ovulation, but the important one is in your brain. The brain makes the hormones that tell your ovaries to ovulate. At the beginning of the cycle, the brain signals the body to begin releasing hormones. These hormone levels rise until they cause the ovary to release an egg. The egg travels through the fallopian tubes to the uterus. If there is no sperm present, the egg is not fertilized and does not implant. Instead, it disintegrates, and the hormone levels begin to fall. When they reach a certain stage, the lining is shed and bleeding occurs. If there is sperm present, fertilization may occur. If it does, when the egg reaches the uterus it may implant itself in the wall of the uterus. From that, a baby can grow.
Q. Are there any "symptoms" of ovulation?
A. Sometimes. They can include a slight pain in the side. Some women can even tell which side they release an egg on because of a small twinge they can feel. This is called mittelschmerz, which literally means "middle pain." There is also an increase in cervical mucous. Many women report an increased sex drive. Before ovulation, the temperature dips slightly and then rises after ovulation, but this is only of interest to women who are tracking ovulation either to facilitate or avoid pregnancy.
Q. What can keep you from ovulating?
A. There are several factors, including the following:
- Birth control pills. This is the only way to consciously stop ovulation. Some brands may be taken
continuously to suppress periods as well. - Stress. This can cause the brain to temporarily suspend ovulation. It's not unusual with my college student population to not have periods in May or December, which is finals time.
- Exercise. Someone who exercises strenuously may stop having periods, which signals a lack of ovulation. This is generally women who are in sports that require a lot of daily training. There's a good study on runners that shows there's a definite set point, a certain mileage, at which each of them will stop having periods. Dial that level of training back below that point, and their periods will start up again. This also applies to gymnasts, dancers, anyone in a strenuous, continuous activity.
- Severely underweight. Again, there's an individual set point for weight, and below that a woman will not have periods. If she gains above that point, they will start again.
- PCOS. This is a condition that affects a woman in a number of ways, including impacting her fertility, and one of the factors is anovulatory cycles.
Q. What are some basic problems associated with irregular ovulation?
A. This can be a problem if you are tracking ovulation either from a desire to get pregnant or in an effort to avoid pregnancy. What happens with the menstrual cycles is that it will always come about 14 days after you ovulate, so you can always predict retrospectively when you ovulated. The problem is that doesn't help you when you're trying to time intercourse to achieve pregnancy. Fortunately, there are other methods such as Basal Body Temperature (BBT) charting, cervical mucous tracking and more and more high-tech gadgets to help pinpoint ovulation.
Q. Is it dangerous to not ovulate?
A. No! In fact, data [says] that ovulating constantly, unlike in the past when women spent much of their adult lives either pregnant or breastfeeding and ovulated much less frequently, actually increases the risk for ovarian cancer. Things that suppress ovulation (more pregnancies, more breastfeeding and birth control pills) may actually reduce that risk.
Q. If birth control pills suppress ovulation, why do you have periods on birth control pills?
A. You don't have to have a period when taking hormonal contraception. Most companies have it built into a pack because people feel reassured by it. There's no medical reason a period has to occur.
Q. What is the connection between PMS and ovulation?
A. PMS can only occur after ovulation, because the symptoms that are associated with PMS – among them breast tenderness, bloating, mood changes, etc. – are caused by release of the hormone progesterone. PMS can start immediately after ovulation or may appear only in the few days before a woman's period. Again, birth control pills will also control PMS symptoms.
