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 2/15/21
Ovulation is the process in which a mature egg is released from an ovarian follicle, into your fallopian tube.
What is ovulation and why is it important?
Ovulation is the process in which a mature egg is released from an ovarian follicle, into your fallopian tube. It marks the end of the follicular phase — in which your follicles grow and mature — and the beginning of the luteal phase, which prepares your endometrial lining for implantation in case fertilization occurs.
Ovulation occurs midway through your cycle. For women with regular 28 days cycles, ovulation usually takes place around cycle day 14. But many women do not have regular cycles, and any cycle lasting between 21 and 35 days is considered normal. Depending on the length of your cycle, you may ovulate well before or much later than cycle day 14.
Needless to say ovulation is so important! After all, without an egg, there is no chance at conception. Additionally, knowing when ovulation to accurately time intercourse can help you get pregnant faster. But ovulation is also a great indicator of overall health in women of reproductive age and a lack of ovulation (also called anovulation) can signal an underlying medical condition.
What are the symptoms of no ovulation?
Anovulation may happen during a regular cycle. In fact, this accounts for around one-third of clinically normal menstrual cycles. Irregular cycles are typically the main indication you are not ovulating, whether you don’t have a period at all or your periods are erratic.
Lack of cervical mucus may also be a sign of anovulation, unless of course you have had previous cervical surgeries which might explain this symptom. If you are used to tracking your cycle via basal body temperature tracking and you see an irregular body temperature pattern, this may also signify anovulation.
If you are using ovulation tests twice a day and still never get positive results, this can indicate that luteinizing hormone (LH) has not surged and you did not ovulate. If you never get a positive LH test, we recommend consulting your doctor.
What causes anovulation?
Polycystic ovarian syndrome (PCOS) is by far the most common cause of anovulation. PCOS is a common and unfortunately underdiagnosed endocrine dysfunction in women of reproductive age. Its global prevalence is estimated between 6% and 28.5%. The numbers may be far higher though, with the number of undiagnosed women being as high as 75%.
PCOS is a condition characterized by an excess amount of androgens (male sex hormones) that cause a hormone imbalance. This imbalance causes abnormal levels of LH and follicle stimulating hormone (FSH), which can prevent stimulation of a follicle to release an egg (a.k.a. anovulation).
But anovulation may have several other causes, including:
- Extremely high stress levels
- High Prolactin levels
- Abnormally low or high body weight
- Extreme exercise
- Thyroid dysfunction
- Premature ovarian failure
Polycystic ovarian syndrome (PCOS) is by far the most common cause of anovulation.
How do I test for anovulation?
Before you can find how if you’ve ovulated, you first need to predict when ovulation is going to occur. As we mentioned, ovulation occurs midway through our cycles, but the exact ovulation date varies from woman to woman.
Luckily, there are several methods to predict ovulation, including basal body temperature tracking, cervical mucus monitoring, and ovulation (LH) tests. There are pros and cons to each method so it’s important to choose the best method for you and your cycle.
Basal body temperature (BBT) tracking: BBT tracking involves monitoring the slight changes in your body’s lowest resting temperature that occur before and after ovulation. BBT tracking is pretty cheap — all you need is a thermometer with two decimal places — but for accuracy you need to test at the same time each morning before getting out of bed. BBT can also be easily influenced by alcohol consumption, bad sleep, varying room temperatures, or warm snuggles from a loved one.
Cervical mucus monitoring: Cervical mucus monitoring consists of observing the changes in cervical mucus consistency during your fertile window. This is another cheap and convenient method as all you need to track is yourself! (Although devices like kegg can be helpful.) However, some women may not have enough cervical mucus due to cervical surgery and semen can be mistaken for cervical mucus after intercourse.
Ovulation tests: Ovulation tests, or LH tests, measure luteinizing hormone levels in urine to detect the LH surge that triggers ovulation. These tests remain the most reliable method for predicting ovulation, although they may not work for women with PCOS or other hormone imbalances. Some women may have longer surges and get several days of positive tests, while others may have short surges, and might even need to test twice a day to make sure they don’t miss the surge. Some women never get a positive ovulation test, no matter how often they test, and this might be a sign of anovulation. If you never get a positive LH test, we recommend consulting your doctor.
However, ovulation prediction methods do not confirm ovulation
Yet it is important to know that not every LH surge or fertile cervical mucus observation is followed by the release of an egg. Your body may gear up to ovulate, but this doesn’t mean that ovulation actually occurred. This is why confirming ovulation is so important!
Measuring progesterone or its metabolites is one of the most common and reliable ways to confirm ovulation. Progesterone is the hormone produced by the empty follicle after ovulation has occurred. If no egg is released, then there won’t be a follicle to produce any progesterone. A lack of progesterone signals anovulation.
You can measure progesterone levels in blood, however this method is invasive and can give an incomplete picture because serum progesterone has been shown to fluctuate hour by hour.
Or you may test the urine metabolite of progesterone, PdG. After progesterone circulates through your bloodstream it is metabolized by your liver and excreted as PdG into your urine. PdG levels in urine correlate to progesterone levels in blood, and PdG is not subject to the same fluctuations as progesterone.
Additionally, PdG testing is non-invasive, meaning it allows for testing over multiple days. This is important for confirming what we call “successful” ovulation, which means an egg was released and PdG levels (and therefore progesterone) remained elevated for a long enough period of time to allow for the best possible chance at conception.
Proov is the first and only FDA cleared PdG test kit to confirm successful ovulation at home. A single positive Proov test confirms that ovulation did in fact occur that cycle. But, we really like to see four positive Proov tests on days 7, 8, 9, and 10 after peak fertility (i.e. a positive LH test) to confirm that ovulation was successful and not hurting your chances of pregnancy.
Proov is the first and only FDA cleared PdG test kit to confirm successful ovulation at home.
If you never get a positive Proov PdG test, this could be a sign of anovulation in which case we recommend consulting your doctor. He or she can discuss options with you and may be able to prescribe ovulation inducing medication.
Understanding and being able to recognize the signs of anovulation will help you detect any issues that may be preventing you from conceiving sooner!