How do i know when i’m ovulating ?
Dear Dr Mitchell,
I am 28-years-old and married. My husband and I are trying to have a baby. It took us three years to get pregnant but I had a misabortion so they did a D&C. I went to all my appointments and my doctor said I can try again. However, I don’t know how to tell when I am ovulating. Please help.
I am sorry to learn of the loss of your pregnancy in the form of a missed abortion. A missed abortion is a situation in which the foetus dies and is retained in utero. This is usually associated with the loss of the usual symptoms of pregnancy such as nausea, vomiting, bloating and breast tenderness.
In the majority of cases when a missed abortion occurs this is usually due to an abnormality in the make-up of the foetus.
Other causes of a missed abortion include infections such as toxoplasmosis (obtained from cat litter infected with the virus), rubella, cytomegalovirus, herpes simplex virus, syphilis and Human Immunodeficiency Virus (HIV). Patients who are lupus anticoagulant antibody positive also have an increased risk of a missed abortion. This condition is a blood disorder which gives a high risk of development of a clot in the leg.
Recurrent pregnancy losses, small babies or even sudden intrauterine death of the foetus at an advanced stage of pregnancy can be treated with good outcome in subsequent pregnancies.
It is not unusual to have a missed abortion and then go on to have successful pregnancies in the future. The fact that it took three years for you to conceive is significant. Most couples will conceive in a year after regular sexual intercourse at least two to three times per week. It could be that you are not ovulating regularly or that your husband has a problem with his sperm count or quality.
Menstrual cycles which are associated with ovulation tend to be regular – usually every 21 to 35 days with an average of 28 days, associated with mid cycles (approximately day 14) breast tenderness, bloating or pelvic discomfort. Ovulatory cycles also tend to be associated with some amount of period pains on the first to third days of the menses. The nature of the cervical mucus also changes when ovulation occurs. At this time the mucus becomes clear and very “stretchy” or elastic, a feature called spinbarket.
Ovulation is presumed to have occurred if the basal body temperature is measured each morning before getting out of bed and at around mid cycle (day 14 approximately) there is basal body temperature rise of 0.4 – 0.6F. A urine test to check the levels of the hormone called leutinizing hormone (LH) may be done as a simple home test. This kit may be purchased in the local pharmacies. A blood test to measure the progesterone level in the blood on day 21, counting from the first day of the last menstrual period is usually very accurate in predicting whether ovulation has occurred.
It is quite possible that you will need to have induction of ovulation done to improve your chance of conception and reduce the waiting period to the time of conception. If the simple home tests such as urinary LH levels and basal body temperature checks confirm ovulation, then you should try to time your sexual activity around this time to optimise your chance. You should try for regular sexual activity at least two to three times per week. If you are not ovulating then consult your doctor for further assistance. It is a good practice to take folic acid tablets daily to reduce birth defects in the brain and spinal cord, so buy a bottle and start taking one tablet daily.
Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via e-mail to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.
