Every women's body is different and her menstrual cycle is also different. Menstrual Cycle Monitoring is the process of evaluating or understanding a women's menstrual cycle by observing and documenting the various changes happening to the body through Physical examination, Ultrasound evaluation, hormonal testing and in some cases investigating tissue samples (biopsies)
Menstrual cycle monitoring is done in two cases:
Couples undergoing a Timed Intercourse (TI) cycle: To determine whether and when normal ovulation will occur.
Couples undergoes ovarian induction for IUI/IVF: To determine the dosage and timing of fertility drugs and to identify the time for OPU/IUI or any complications like OHSS.
What Every Couple Trying To Conceive Should Know About the Menstrual Cycle:
- The average duration of a woman's menstrual cycle is 28 days but it may vary form woman to woman by +/- 7 days.
- In a 28 day cycle ovulation occurs around day 14 (+ /or minus two days), prior to the next cycle. But this window may be earlier or later in women.
- Follicles are egg containing sacs inside the ovaries that has a developing ovum inside them.
- The growth of follicles and ovulation is influenced by two Key hormones LH and FSH.
- In a natural cycle many follicles are recruited in each cycle but only one matures and releases the ovum.
- Between D5 to D13 the follicles start growing and maturing. This increase in size accompanied with increase in levels of LH and FSH. By monitoring the size of follicles and increase in LH levels we can determine the tentative date of ovulation.
- Estrogen levels also increase between D5-D13 and help in the thickening of uterine lining in preparation for possible implantation. This estrogen is secreted by the growing follicles under up regulation by FSH.
- About 36 hrs before ovulation (D12-14) there is a sudden spike in LH and FSH levels.
- This mid cycle LH surge is instrumental in inducing rupture and release of Ovum.
- This LH surge induces the egg to undergo the last stages of maturation that is needed for the egg to be fertilized.
- After the ovulation the follicle starts secreting Progesterone.
- Progesterone circulates to the uterus where it causes changes that allow the endometrium to receive the egg for implantation. Progesterone counteracts the stimulation effects of estrogen on cervical mucus.
- In some women usually who are overweight have irregular periods although ovulatory cycle’s takes place the ovum doesn’t get released and remains in the follicle and eventually turns into a cyst. Women with PCOS are anovulatory (do not ovulate).
- If pregnancy occurs, the newly implanted egg will release a hormone known as human chorionic gonadotropin (HCG). HCG maintains the production of estrogen and progesterone for several weeks until the placenta itself takes over the production of these hormones.
- In the absence of pregnancy, progesterone levels will drop two weeks after ovulation. The drop in progesterone level precipitates menstrual bleeding.
What Can a Doctor Tell You About Your Ovulation?
A pregnancy consultant can help you understand your menstrual cycle better. By evaluating your menstrual cycle though Ultrasound/Blood tests, a pregnancy consultant can tell you if and when you are likely to ovulate. What are the best days to have intercourse that will result in conception?
Increase in Basal Body temperature (BBT) also is indicative of impending Ovulation. Look for changes in cervical secretions under microscopic examination which might reflect changes in the hormones during menstrual cycle.