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 12/8/20
What is ovulation?
Ovulation is the release of an egg from your ovary into the fallopian tube. This process usually happens on a monthly basis and marks the end of the follicular phase and the beginning of the luteal phase.
We start every natural cycle with a specific number of antral follicles. Your body recruits one of them and makes it grow until it reaches maturity. As it grows, the follicle releases estrogen in your blood, thickening your uterine lining and preparing it for implantation in case fertilization occurs.
As the follicle grows, it releases estrogen into your blood which thickens the uterine lining and prepares it for implantation.
Having reached a certain size and a certain level of estrogen, the now mature follicle sends a signal to your brain that it is ready to ovulate. This signal triggers a surge of luteinizing hormone and causes your ovary to release the egg from its follicle.
Ovulation occurs anywhere between 24-36 hours after an LH surge, hence the importance of tracking your cycle with ovulation tests in order to monitor your LH progression and detect your fertile window. The egg is then viable for up to 24 hours, and if fertilization doesn’t occur the uterus sheds its lining and you get your period.
Why is progesterone important?
If during the follicular phase estrogen is king, right after ovulation it is progesterone’s turn to shine! While there are many tiny pieces that need to work together in order to make the fertility machine function, progesterone plays an essential role in your menstrual cycle and in pregnancy. If estrogen builds up your endometrium, progesterone maintains and controls this growth, making the lining receptive for the embryo.
Slowly increasing during the beginning of the luteal phase, progesterone levels peak around 7 days post ovulation. Progesterone is the hormone responsible for stabilizing the uterine lining (you’ll remember that estrogen is responsible for thickening it) and making it “sticky” enough for an embryo to implant.
So what is ovulation quality?
The quality of your ovulation is determined by how much progesterone you have after ovulation and how long it remains elevated for. High quality ovulation is referred to as “successful” ovulation. Successful ovulation occurs when progesterone levels rise and remain elevated on days 7, 8, 9, and 10 after peak fertility.
Successful ovulation occurs when progesterone levels rise and remain elevated on days 7, 8, 9, and 10 after peak fertility.
If your progesterone levels rise then drop or never rise, it can indicate a suboptimal ovulation or that ovulation didn’t occur at all. It sometimes happens that the corpus luteum formed in the place of the now empty follicle doesn’t produce enough progesterone to ensure a healthy luteal phase, and if no egg is released then there is no corpus luteum to release progesterone at all.
In this case, your progesterone levels may be low to start with and may also drop sooner than they should, shortening your luteal phase and bringing your period on earlier than expected. This is called a luteal phase defect, which can be fairly common and unfortunately too often overlooked by patients and healthcare providers alike.
How do I confirm successful ovulation?
Confirming successful ovulation involves ensuring your progesterone levels are high enough and stay elevated throughout your luteal phase. Until recently, the golden standard for measuring progesterone was via a one-time blood draw.
But studies show that progesterone blood test results can be flawed since the corpus luteum releases progesterone in blood in pulsations. The fluctuations can be big — up to 8 fold in a 90-minute period and from 2.3 to 40.1 ng/mL over a 24-hour period, for the same patient. Ideally, we would test several times to get an average but this can be rather invasive, expensive, and time consuming.
Sixty years ago scientists discovered that once it circulates through your blood, progesterone is metabolized by your kidneys and then excreted in your urine in the form of PdG. Since then, PdG has been extensively studied in hopes of offering an alternative to blood testing.
Scientists discovered that once it circulates through your blood, progesterone is metabolized by your kidneys and then excreted in your urine in the form of PdG.
Enter PdG tests!
Contrary to the fluctuating serum level, PdG levels are more stable and offer a more even measure of what your blood levels averaged the day before. We also know that PdG and progesterone levels in blood correlate.
Since one is measured in urine and the other one in blood, the unit of measure is different: 5 ug/ml of PdG in urine is the equivalent of 10ng/ml of progesterone in blood. This is the accepted level of progesterone to confirm good ovulation quality by most doctors.
Additionally, since PdG testing is non-invasive, you can test levels over multiple days — critical when confirming successful ovulation during the 7-10 day window.
Confirm successful ovulation with Proov
Proov is the first and only FDA cleared PdG test kit to confirm successful ovulation at home. We recommend testing with Proov daily on days 7, 8, 9, and 10 after peak fertility. Four positive Proov tests during this window confirms that ovulation was in fact successful.
Proov is the first and only FDA cleared PdG test kit to confirm successful ovulation at home.
If you get anything less than four positive Proov tests, this could be a sign of unsuccessful ovulation or low PdG levels. If you never get a positive Proov test, this could be a sign of anovulation in which case we recommend consulting your doctor.
How do I improve ovulation quality?
Improving ovulation quality involves increasing PdG levels. Here are some of our favorite ways to improve ovulation quality:
Seed cycling: Seed cycling is a naturopathic remedy that helps you naturally balance your estrogen and progesterone levels by eating certain types of seeds during the two phases of your cycle: flax and pumpkin during the follicular phase, and sesame and sunflower during the luteal phase.
Diet changes: You can incorporate some foods into your diet that have been shown to improve PdG production and ovulation quality. Some of these foods include brussel sprouts, broccoli, beans, pumpkin, and spinach, among others.
Herbal supplements: Herbal supplements may be an option, provided that you consult with your doctor before starting any new supplements. A few herbals that have been shown to improve PdG production include vitex, red raspberry leaf, and maca.
Prescription medications: When all else fails, it may be time for modern medicine to kick in. If none of the previously mentioned methods help, we recommend consulting your doctor who can prescribe progesterone supplements or ovulation inducing medications.
Confirmation of successful information is key if you are trying to conceive! PdG testing gives you access to this information and empowers you to take the necessary steps to make sure you better your chances for pregnancy.