Getting the Full Picture on Your Cycle
Written by: Dr. Amy Beckley, PhD, Founder and Inventor of the Proov test – the first and only FDA-cleared test to confirm successful ovulation at home.
Written on 8/29/20
Remember when we believed we could get pregnant at any moment? Those were the days — thanks high school sex ed! While we now know that’s not true, there are still ways to increase your chances of conception during other phases of your cycle.
In fact, you can improve your fertility by testing in both phases of your cycle and considering treatment options afterward. Taking the time to test your hormones before adding supplements or making lifestyle changes can save you time and money in future cycles!
There are two main phases of your cycle that require different tests to measure whether your hormones are where they need to be in order to conceive. Let’s take a look at which parts of your cycle require certain testing!
1. Early Cycle Testing
You can get Cycle Day 3 (CD3) blood work from your doctor or in mail-away test kits. These tests can measure several different hormones, including anti-mullerian hormone (AMH), FSH, and estrogen. Your doctor may order these tests to learn more about your ovarian reserve, or the number of follicles a woman has left.
Since AMH is produced by premature follicles it is considered a biomarker for ovarian reserve. A normal AMH level can be anywhere from 0.7 to 2.0 ng/mL. Anything less than 0.7 can be a sign of low ovarian reserve and anything higher than 3.0 can indicate PCOS.
The pituitary gland releases FSH at the beginning of each cycle to stimulate egg growth. As a woman’s ovarian reserve declines with age, more FSH is required to mature an egg. High levels of FSH can be an indicator of low ovarian reserve. FSH levels less than 9 IU/mL are considered healthy, between 9 and 15 can indicate slightly reduced or reduced ovarian reserve, and levels above 15 may indicate low ovarian reserve.
Estrogen — or more specifically estradiol — is typically measured in conjunction with FSH, since high levels of estradiol can suppress FSH production. For example, if your FSH levels are low and look normal, sometimes estradiol high levels can actually inhibit FSH production and cover up signs of low ovarian reserve. Since these two hormones go hand in hand, it’s a good idea to test one along with the other!
2. Follicular Phase Testing (first half of your cycle)
The follicular phase begins on the first day of your period — also called “cycle day 1” or CD1 for short — and ends on the day of ovulation. During this phase, the pituitary gland produces follicle stimulating hormone (FSH), which stimulates the ovary to produce follicles in preparation to release an egg during ovulation. Once the largest follicle becomes dominant, it produces estrogen, the hormone that thickens the uterine lining in preparation for implantation and pregnancy.
This phase is all about preparing for ovulation. There are several tests you can try during the follicular phase to learn more about your hormone levels including blood work, LH tests, cervical mucus monitoring, and more.
Towards the end of your follicular phase (around day 11 of a 28-day cycle), you’ll want to start testing for peak fertility. Understanding your peak fertility is the first step in determining when to have intercourse. Using certain fertility tools can help prepare your body to fertilize an egg, putting you one step closer to conceiving. There are several methods for tracking peak fertility, including ovulation predictor kits (LH tests), cervical mucus monitoring, and basal body temperature tracking.
OPKs measure luteinizing hormone, which surges about 24-48 hours before ovulation is supposed to occur. OPKs are 99% accurate at detecting LH surges and are a great option for tracking peak fertility. However, like women, every OPK is different and may work better or worse from woman to woman. You can learn about my experience with different OPKs here.
Cervical mucus monitoring is another peak fertility tracking option. At most points in your cycle, cervical mucus is dry and sticky. But around ovulation, cervical mucus consistency changes; it becomes wet and stretchy to allow sperm an easy journey up the cervix. While monitoring your own cervical mucus can take some getting used to, products like kegg can help simplify the process!
BBT tracking involves measuring the slight changes in the body’s lowest resting temperature during peak fertility. Before ovulation occurs, BBT will dip and after ovulation, BBT will rise and stay elevated for several days. While this method works for many women, BBT can be easily influenced by a hot bedroom, snuggling a loved one, or even alcohol.
Regardless of the method you choose, a peak fertility reading means you’ll ovulate soon and intercourse is most likely to result in conception!
Luteal Phase Testing (second half of your cycle)
The luteal phase begins on the day of ovulation and ends on the first day of your period. After an egg is released, the empty follicle (a.k.a. corpus luteum) produces progesterone, which stabilizes the uterine lining and ensures it’s ready to receive an embryo. Progesterone creates a healthy uterine environment in which an embryo can thrive.
During this phase you can confirm that you did in fact ovulate and that ovulation was healthy. “Healthy” ovulation means that not only was an egg released, but post-ovulation hormone levels remained elevated for a long enough period of time to allow for the best possible chance at conception.
There are a few methods to confirm ovulation: BBT tracking, serum progesterone blood test, and PdG (urine progesterone metabolite) tests.
Remember BBT from the follicular phase? Those changes in BBT not only predict ovulation, but confirm it happened, too. But since fluctuations in BBT are only secondary symptoms of a progesterone increase, BBT can indicate ovulation but fails to tell you if ovulation was healthy.
Serum progesterone blood draws on the other hand confirm ovulation with a precise progesterone level. However, they only show that level at one point in time and can fluctuate up to 30 times in one day. As I mentioned, progesterone must stay elevated for long enough for ovulation to be considered healthy, so a test done at 8 am vs. 3 pm could give you a very different assumption about your levels.
Luckily with PdG testing you can confirm an egg was released and that ovulation was healthy! Proov is the first and only FDA cleared at-home PdG test kit. Since Proov is urine-based and non-invasive, you can track PdG over several days and confirm healthy ovulation from the comfort of your own bathroom. After a peak fertility reading, you’ll want to count 7 days and test with Proov on days 7, 8, 9, and 10 after suspected ovulation. Four positive Proov tests during this window confirms healthy ovulation!
Considering Treatment Options
It’s important to test your hormone levels at different stages of your cycle so you have critical information about your unique cycle! Knowing what your test results mean can guide you to make a few possible lifestyle changes that could help improve your chances at getting pregnant. I’ve recommended a few things you can start doing now that could help you get that BFP!
While we can’t increase ovarian reserve, you can ensure each and every egg has the best possible chance at conception when it is released by improving ovulation quality. The following methods are also great options if luteal phase testing shows insufficient or lack of ovulation. (If you are not ovulating, I recommend consulting your doctor.)
- Seed cycling: Seed cycling involves eating certain seeds during certain phases of your cycle to promote a hormone balance. During the follicular phase, eating raw pumpkin and flax seeds promotes estrogen production, while sesame and sunflower seeds boost progesterone production during the luteal phase.
- Lifestyle changes: Sometimes changes in diet, herbal supplements, or exercise habits can have positive effects on progesterone levels and ovulation health. Before adding any supplements, please consult your doctor.
- Talk with your doctor: I always recommend consulting your doctor if you’re not sure of your test results or are looking for medications to improve ovulation quality.
Have questions about your Proov tests? Feel free to reach out to us at email@example.com!