Women attending Fertility North will initially take part in an investigative ‘Tracking Cycle’. This is principally to check that the orderly process of egg maturation and ovulation is taking place and to assess whether there is an ovulatory cause of the couples infertility.
During a menstrual cycle immature eggs found in the ovary, undergo orderly maturation and ovulation. This is when the ovary releases a mature egg which is capable of undergoing fertilisation when the right conditions are met in the fallopian tubes.
Follicle stimulating hormone (FSH) and luteinising hormone (LH) are released from the pituitary gland (found at the base of the brain) under control of both higher brain centres and feedback from ovarian hormones. These hormones stimulate the immature eggs in the ovary to undergo growth and maturation (follicles).
This process releases oestrogen and progesterone from the maturing follicles, which then stimulates the endometrium (lining of the uterus) so that it is ready to accept a fertilised egg (embryo), to undergo implantation, and hence achieve a pregnancy.
It is important that these two hormones are produced in appropriate amounts throughout the monthly cycle for normal ovulation to occur.
Blood testing, starts from day two of the menstrual cycle, and is repeated about 5 to 7 times throughout the cycle.
Absolute confirmation of ovulation is a positive pregnancy test. However, a number of changes in blood hormone concentrations and the appearance of the ovaries in an ultrasound picture can provide strong evidence that ovulation will or has occurred.
The female sex hormone oestrogen is produced by the cells surrounding a maturing egg within the ovary. As the egg matures, more oestrogen is produced, reaching a peak level about two days before ovulation. If more than one egg matures simultaneously, the oestrogen produced by the ovary is greatly increased.
Oestrogen levels can be measured in blood or by blood test and its effects on the body are usually obvious, particularly by the amount and consistency of mucus discharged from the vagina. As the oestrogen level increases, the amount of mucus increases. This mucus is stringy and has the appearance and consistency of raw egg white.
As the egg matures a cyst called a follicle develops on the ovary. This follicle, which can be seen and measured on an ultrasound picture of the ovaries, may grow to about 2cm in diameter just before ovulation. Serial ultrasound pictures are another way of detecting ovulation.
Ovulation is triggered by a surge of Luteinising Hormone (LH) from the pituitary gland. LH also stimulates the ovary to begin producing the hormone progesterone. Progesterone is only produced in significant amounts after ovulation has occurred and can be measured in the blood. Progesterone changes the consistency of the vaginal mucus so that it becomes tacky or sticky. This hormone also causes a slight increase in body temperature.
In summary, ovulation may be detected by changes in the ultrasound measurement of follicle size, vaginal mucus, a small increase in body temperature and by changes in the amounts of oestrogen, LH and progesterone in the blood. The value of body temperature charts is limited because ovulation has already occurred by the time a temperature rise is recognised.
Ovulation usually occurs regularly, once a month from puberty until the menopause, apart from times of pregnancy and breast-feeding. In some women ovulation does not occur regularly, or may not occur spontaneously at all. This may be due to an abnormality with the ovaries, the pituitary gland or some other unrelated illness such as anorexia.
A number of tests are necessary to determine the cause of this situation before appropriate treatment can be given.