Written by: Georgie Kovacs, founder and host of Fempower Health podcast
Written on 12/22/20
When trying (and especially when struggling) to conceive, we want to know, “Did it work this month? Am I pregnant?” When the answer is “no,” we want to know why. In today’s blog, we’re going to focus on implantation and what we can do to optimize it.
Before we dive in, it is important to emphasize that a woman’s body is incredibly complex with hormone fluctuations throughout a given cycle, all with the intent to make a baby, whether you would like to have a child or not. Thus, it is important to recognize that implantation, while critical, is one of many parts leading to a successful pregnancy.
What is implantation and when does it occur?
According to Jill Blakeway’s book Making Babies, implantation occurs when the embryo attaches to the endometrium. Once the fertilized egg is nestled here (about 7-10 days after ovulation), the pregnancy hormone human chorionic gonadotropin (hCG) starts to increase. This is the hormone that typical at-home pregnancy tests read.
HCG plays an important role in that it tells the corpus luteum — formed from the collapse of the follicle that released the egg — to release more progesterone, a hormone that plays a significant role in conception and nourishing the embryo.
Progesterone is an important hormone which does the following:
- Switches off FSH (follicle stimulating hormone) and LH (luteinizing hormone)
- Stabilizes the endometrium
- Causes a rise in BBT (basal body temperature)
- Plugs the cervix by closing it and thickening the cervical mucus
HCG plays an important role in that it tells the corpus luteum — formed from the collapse of the follicle that released the egg — to release progesterone.
Who knew one hormone could do all this? Until recently, the only way to understand your progesterone levels was to visit your doctor on day 21 of your cycle for a blood draw. These blood tests only show progesterone levels at that moment. In my experience during my fertility journey, doctors used this one-point-in-time simply to validate ovulation rather than understand whether you had sufficient progesterone levels throughout your luteal phase.
With PdG (progesterone metabolite) tracking, you can now measure your levels over several days to ensure they remain adequately elevated over time. Proov, for example, is the first and only FDA cleared PdG test kit to confirm successful ovulation. Successful ovulation refers to an ovulatory event where an egg is released and PdG levels remain elevated for long enough to allow for the best possible chance at conception.
What are common signs and symptoms of implantation?
While your body may show signs that the embryo has implanted, not experiencing these does not indicate a lack of implantation either. As with most things women’s health, there is also a lack of data on the percentage of women who experience them.
Additionally, given progesterone is the dominant hormone after ovulation, some of the symptoms you experience may be due to the progesterone levels rather than implantation itself.
However, here are signs that may be indicators of implantation, specifically:
- Implantation Spotting: According to Toni Weschler’s Taking Charge of Your Fertility, when the fertilized egg burrows into the uterine lining, it can cause implantation spotting. This would occur about a week to 10 days after ovulation.
- Maintenance of High Basal Body Temperature: While it would be ideal to share that there is a quick answer here, like the two week wait, you have to wait. If charting your cycle, a BBT over the coverline for 18 days gives reason to believe that one ovulated, the embryo has implanted, and one is pregnant. However, some early pregnancy tests allow you to test as early as the 10th day of elevated temperature.
Some women have reported tenderness and lower back pain in addition to symptoms typically seen with the luteal phase of the menstrual cycle given progesterone dominance.
While your body may show signs that the embryo has implanted, not experiencing these does not indicate a lack of implantation either.
How do I tell the difference between implantation spotting and my period?
Sometimes it is difficult to determine whether spotting is due to implantation, the start of your period, or something else. Women can spot around ovulation, due to implantation, or something that requires medical attention such as an infection, ectopic pregnancy, endometriosis, or even cancer.
It is for this reason it is important to monitor your body’s signs and symptoms, and formally track your cycle. That way you can assess how far into your menstrual cycle you are along with other symptoms you are exhibiting to better understand what might be happening.
How do I improve implantation?
It might help to begin with understanding what might impact implantation so you can rule out concerns first. According to Dr. Lora Shahine (click here to listen to my podcast interview with her), a reproductive endocrinologist and author of Not Broken: An Approachable Guide to Miscarriage and Pregnancy Loss, the following may impact implantation:
- Submucosal fibroids: Muscular balls of tissue located within the uterine cavity.
- Uterine polyps: Overgrowths (similar to skin tags) in the uterine lining. Admittedly, studies have not shown a direct correlation to miscarriage, but several experts argue they may impact implantation.
- Uterine scarring (e.g., Asherman’s syndrome): A presence of scar tissue usually found after a uterine surgery.
- Septate uterus: A deformity in the uterus, where if the embryo implants near this area, it can impact implantation.
- Luteal phase defect: When your body does not produce enough progesterone or your uterus does not respond to it.
Autoimmune issues, genetics, and toxins may also play a role.
As you can see from this list, there could be structural issues with your body that you and your doctor can discuss. Some are more straightforward to assess while others are more complex.
Improving implantation begins with understanding what might impact implantation so you can rule out concerns first.
As with most things related to women’s health, the answer is “it depends.” More funding and clinical trials are needed as well as the acknowledgement that our hormones create a complex and dynamic situation such that it really is about personalized medicine. In the meantime, we should be grateful for women who’ve had struggles, like Amy, the founder of Proov, and are building tools and educating women on information they need to know to ultimately make informed decisions.
About Georgie Kovacs and Fempower Health
Georgie is the founder and host of the Fempower Health podcast, a top 10 women’s health podcast with 5 stars on Apple. She is an advocate leveraging her 20+ years in healthcare and personal fertility journey to transform women’s healthcare, answering your health questions. She brings on top experts in women’s health with the aim of educating women about their bodies to have more empowered (and speedy) health journeys.
Follow Fempower Health on Instagram for the latest in women’s health.
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