Trying to conceive.
Until we started to try our 1st baby, it had never occurred to me how much of a minefield trying to conceive can be. I naively assumed that you just had a lot of sex and at some point you would get pregnant. I didn’t actually know how my reproductive system worked or what actually happened in my cycle when I wasn’t having a period.
At school you’re told that most woman have 28 day cycles. This is the average length but of course we’re not all average. Most women actually have cycles ranging from 20 to 35 days and some even longer. Just because you’re cycle isn’t 28 days, it doesn’t mean that there is anything wrong with you – it’s just the way your body works.
The menstrual cycle is broken down into 3 phases:
The cycle begins on the 1st day of bleeding (CD1). As the lining of the womb is shed, the pituitary gland in the brain starts to release a hormone called FSH – Follicle Stimulating Hormone which tells the ovaries to start maturing eggs ready for release, known as ovulation. The eggs whilst in their sacs are called follicles. Between 10 and 20 follicles will start to develop, but of these only 1 or 2 will mature fully. As the follicles develop and grow, they release oestrogen which in turn tells the lining of the womb to thicken up ready for a fertilised egg. This part of a woman’s cycle can last anywhere between 6 and 21 days.
As the follicles grow, the oestrogen continues to be released and when it reaches a certain level, the pituitary gland releases another hormone called LH – Lutenising Hormone. This LH surge causes the most mature follicle or follicles to release its egg. This is called ovulation. The egg makes it way through the fallopian tubes, hoping to meet sperm on its way. Sperm can live inside the woman’s body for up to 6 or 7 days, although 5 is the normal length of time. The egg however only survives for up to 24 hours. If it is not fertilised during this time, it dies. For this reason, the 5 days before ovulation and the day after or of ovulation are the most fertile days of the cycle.
Post Ovulatory or Luteal Phase.
After the egg has been released, the empty follicle produces progesterone which tells the womb lining to release fluid to nourish the approaching egg. If the egg has been fertilised, it will implant in the lining and the follicle will continue to release progesterone to nourish it. If fertilisation does not occur, the follicle with break down and stop producing progesterone and the womb lining will be shed, starting the next cycle. This phase can last between 10 and 16 days and is usually the same length for each cycle. The pre-ovulatory phase can however vary between 7 and 19 days. The egg can take 5 to 10 days to reach and then implant in the womb lining. If your luteal phase is less than 10 days, the progesterone will not be released for long enough to enable the egg to implant. This is called a Luteal Phase Defect which can be treated with progesterone supplements under your doctor’s care.
So, in the average 28 day cycle, there is only a window of up to 6 days where a woman can become pregnant with the most fertile time being the day before ovulation, and the day of ovulation itself. As this centres around ovulation, if you are having problems trying to conceive, it’s worth getting to know your cycle so that you can identify your most fertile days. There are a number of ways of doing this:
Ovulation Predictor Kits – OPKs. These are available from most chemists and supermarkets and look like pregnancy tests but work slightly differently. They work by detecting the LH surge that happens as the follicle is about to release the egg. This is detected in the urine and so you quite simply, wee on them! A positive (where the test line is the same colour or darker than the control line) OPK will usually indicate that ovulation will occur within 24-36 hours. If you don’t know when you ovulate, you may need to use these for several days before you get a positive result.
Basal Body Temperature charting (BBT). The Basal Body Temperature is basically the resting or base temperature. This is best taken when you wake up. When ovulation occurs, the BBT increases by at least 0.1 degrees Celsius, due to the production of progesterone. This method will only tell you when you have ovulated, i.e. after the event however; it is very useful for getting to know your cycles. To chart your BBT, you need a thermometer that measures up to 2 decimal places. Normal thermometers will not work as you will not see the temperature increase unless you can get readings down to a tenth of a degree – specific BBT thermometers are available to buy. Take your temperature as soon as you wake up. You must remain in bed as any kind of excess movement can increase the temperature. Record the reading on a chart – which again shows up to a tenth of a degree (there are free ones to download on the web). Plot your temperature each day on the graph and overtime, you will see that at some point, your BBT increases and stays raised. This is called a thermal shift, and occurs after ovulation. To see that you have ovulated, your BBT will be at least 0.1 degrees higher than the previous 3 days and remain at least 0.1 degrees higher for a further 3 days. It sounds very complicated, but it really isn’t when you get the hang of it. There are pieces of software available on the internet that chart for you (Ovusoft or Fertility Friends), or you can buy BBT diaries from places such as Boots. This can also help you to calculate your Luteal Phase.
Monitoring your Cervical Mucus. The consistency of cervical mucus changes throughout your cycle and by observing and monitoring these changes, it is possible to predict when ovulation will occur. During the fertile phase of your cycle, the mucus becomes more stretchy and pliable to help the sperm move freely through the cervix. To check your mucus, use a clean finger or toilet paper to examine your cervical fluid. As ovulation approaches the amount of mucus produces will increase and the consistency will be sticky. Directly prior to ovulation, it will increase in quantity greatly and will be semi transparent and slippery and will look a bit like raw egg white (EWCM). This indicates your most fertile time and ovulation will be imminent. Cervical position also changes during your cycle and you can check this. It is best to check it at the same time every day, after a shower in the morning is a good time. Insert a finger into your vagina and look for the end of your cervix. Prior to ovulation you may not be able to find the cervix as it moves high up into the cavity, softens and opens. After ovulation has occurred the cervix will drop, become firm and close. Just before menses the neck of the cervix will feel like the end of your nose with a dimple in it. Over time you will notice a pattern to your cervical movement but it can be quite subtle and take a while to get the hang of.
So, having established how long your cycles are, when you ovulate and how long your luteal phase is, what next? Well, the best time to have sex to conceive is during the 5 days before and day after ovulation. It is thought that sex on alternate days during this time is the best way to achieve a pregnancy. Medically, that’s fine but many couples can feel that this is pressured and so prefer to have sex every 3rd day up to ovulation. It is thought that sex after a break of say 2 weeks or so increases the quantity of the sperm. What is crucial is that you have sex around this time and unless you know your partner has a low sperm count the more times the better. If your partner has a low sperm count or after several months trying every day it might be better to go to every other day to allow the sperm to build back up.
Other tips for conceiving are:
Iron wont necessary help improve your chances of conception. But when you do become pregnant, it’s important that you don’t become iron deficient. Pregnancy causes increased iron needs because of your increased blood volume and the iron needs of your baby. An iron supplement is an easy way to ensure your body is ready when the time comes. Talk to your doctor to determine the appropriate dosage.