Facts on Fertility and Ovulation

This article is for people and their partners who are interested in learning or learning more about getting pregnant, or anyone who wants to learn about fertility (ability to get pregnant). The goal of this activity is to help you talk to and work with your doctor and healthcare team about any fertility concerns.

You will learn about:

• The menstrual cycle and its phases

• Hormones and fertility

• Ovulation and the fertile window

• Tracking ovulation

• Talking to your doctor and healthcare team and questions you can ask

Every month your body goes through a series of changes -- your menstrual cycle -- to prepare for a possible pregnancy. A mature egg is released from an ovary (ovulation) and moves to where it can potentially be fertilized (joined with a sperm).

At the same time, the lining of your uterus (your endometrium) builds up so the egg can take hold there if fertilized. If it doesn't get fertilized, your endometrium sheds and the tissue and blood pass through your cervix and vagina out of your body. This is your period or menstruation.

Each menstrual cycle begins with the first day of your period and ends the day before your next period.

Your menstrual cycle is primarily controlled by 4 main hormones -- follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone.

These hormones will interact and go through important changes during each of your cycle's 3 phases:

• Follicular phase: FSH increases to help the egg mature. Estrogen and progesterone are low, causing your endometrium to shed (first day of your cycle)

• Ovulatory phase: Estrogen increases causing LH levels to surge, which leads to ovulation. Estrogen then goes down while progesterone goes up

• Luteal phase: FSH and LH go back down. Estrogen increases again and, with progesterone, helps build up your endometrium. If the egg is not fertilized, progesterone and estrogen go down and the next menstrual cycle starts

Ovulation is the part of the menstrual cycle each month when pregnancy can happen. During ovulation, a mature egg is released from an ovary and moves down your fallopian tube where it can potentially be fertilized. The egg stays there for about 12 to 24 hours.

The average menstrual cycle is 28 days long. Ovulation usually happens about halfway through around day 14 (the exact day of ovulation can be different for different women). The fertile window is the 6 days each menstrual cycle when you're most likely to get pregnant (conceive). It includes the 5 days before ovulation and the day of ovulation.

Once inside the female reproductive system, sperm can live for as long as 5 days under the right conditions. So the chances of getting pregnant are highest when sperm are present in your fallopian tube during the fertile window.

To help track your cycle, you can use a calendar to record the day your period starts every month. This can help you know when you're going to be ovulating and will be most likely to get pregnant.

You can check with your healthcare team about other ways to help track when you're ovulating, such as with an ovulation predictor test or by checking changes in your temperature, cervical mucus, saliva, or certain symptoms.

Your doctor may recommend checking certain hormones levels that can affect your fertility.

• Estrogen: levels that are too high or too low can impact fertility

• Progesterone: low levels can interfere with preparing the endometrium for pregnancy

• Estradiol (a form of estrogen): levels that are too low can affect your menstrual cycle and fertility. Too much estradiol can also affect fertility and may impact certain health conditions that affect fertility

You can talk to your doctor or healthcare team member about different ways to help measure or track your hormone levels and how it may help with getting pregnant.

Knowing when you're likely to be ovulating and when your fertile window is can be helpful when you're trying to get pregnant.

To increase your chances, it's usually recommended that you have vaginal sex (where your partner's penis enters your vagina) every day or every other day for the 5 days before ovulation, the day of ovulation, and the day after. So during your fertile window, plus the day after.

Understanding your menstrual cycle, hormones, and ovulation can be important for your fertility. Having irregular cycles, no periods, or abnormal bleeding may mean you aren't ovulating and can affect your fertility.

Talking to your doctor or healthcare team member can help. Menstrual cycles can be different for different people, so they can help you understand what's normal or regular for you. They can also help you understand when you may be ovulating and the best time to try to get pregnant, as well as check for any health conditions if you are having a problem.

Questions you can ask about fertility and ovulation can include:

• What should I know about my fertility?

• How can I track my cycle and know when I'm ovulating?

• When and how often should I have sex to increase my chances of getting pregnant?

• What should I know about my hormone levels and how can we check them?

• Is there anything that should be checked regarding my partner's fertility?

• What should I do if I feel stressed or depressed?

• Where can I find more information and resources?

Congratulations!

You have successfully completed the program Facts on Fertility and Ovulation.

View Additional Materials on this topic that you may find useful:

Female Reproductive Health

Planning for Pregnancy

Trying to Conceive

Your Menstrual Cycle

Ovulation Calculator

Top Questions About Your Menstrual Cycle

For Your Patient