This blog post is written by Dr. Lucky Sekhon, reproductive endocrinologist, infertility specialist, board certified OBGYN, at RMA of New York. Dr. Sekhon has particular expertise in fertility...
We often start the "trying to conceive" process by taking steps to understand our cycles. Many of us do so by using ovulation trackers, taking our temperatures, tracking our cervical mucus, and various other methods. These strategies can be helpful for those of us with regular cycles, but they often fall short for women with irregular cycles. This is because everyone’s hormones behave differently, and for us to really take control of our health and fertility, we must gain insights on our personal cycles.
Understanding Cycle Tracking
To really understand cycle tracking, it is important to first know the role that hormones play in the process. For women with regular cycles, the process begins with a release of follicle-stimulating hormone (FSH), causing follicles to grow in a woman’s ovaries. An egg develops in the biggest follicle. This follicle begins to release estrogen as it grows. The release of estrogen causes the uterine lining to thicken, providing the best environment for a fertilized egg to implant and grow. The rise in estrogen signals that a woman is about to ovulate, and that it could be a good time to start having intercourse.
Sperm can live in the uterus for 48 hours, which allows it to be present when an egg is released. The spike in estrogen then informs the brain to release luteinizing hormone (LH), which causes the egg to move from the ovary to the uterus. This process is called ovulation. Women can conceive during this time if an egg is released. If an egg is in fact released in the cycle, the follicle containing the egg transforms into a corpus luteum and begins to produce progesterone and estrogen. This is where a woman would see a drastic spike in progesterone levels and a smaller spike in estrogen, confirming that an egg has been released.
Precision Nutrition shared the perfect visual below that explains this best (keep in mind this image highlights behavior in a typical 28-day cycle):
Ovulation kits and trackers use surges of estrogen and LH to measure whether or not we are ovulating. High levels of estrogen can indicate that we are about to ovulate, while spikes in LH can signal ovulation. When these hormones reach a certain threshold, the ovulation tests return a positive result. In other words, once these hormones pass a certain pre-set amount, we are told we are ovulating.
The reality is, many women do not follow this regular pattern.
What This Means If You Have PCOS
While this process may work for women who have “perfect” cycles and regular hormone levels, it is not helpful for the majority of us, whose cycles differ. Some women’s cycles stray slightly from the norm, while others are completely different. For example, women with PCOS frequently have consistently high levels of LH. This means that a woman with PCOS could have a baseline LH level that is higher than the tests’ threshold. The test will read this hormone level as a surge of LH and tell a woman she is ovulating, when in reality, this is the woman’s normal hormone balance. This makes ovulation trackers completely unhelpful for those of us with irregular hormones and cycles. The tests do not understand our cycles, and therefore cannot differentiate a hormone baseline from a surge. Almost all of these tests explicitly say that their technology will not work for women with PCOS. This is because they do not account for the large variation of hormone levels in women.
Below is a graph displaying how LH trends vary based on a woman’s cycle.
It would be more useful for women with PCOS (or irregular cycles) to track actual hormone levels daily to give a sense of personal baseline hormone levels. That way, when we do have a surge of LH, we will be able to see a difference, instead of being told we are constantly ovulating. It is important for women to learn about our body’s hormone trends AND not just the amount of a hormone at a given time. Once we have data on our cycles, we can understand our hormone patterns and better detect the best times to conceive.
Use Quantitative Tests
Women with PCOS, and all women with irregular cycles, can track hormone levels and learn about cycles by using quantitative tests, which provide a personalized fertility profile. As opposed to tests which use threshold hormone levels based on the “perfect woman” (who doesn’t exist), tools such as OOVA learn a woman’s baseline hormone levels in order to detect LH and progesterone spikes from there.
This is vital for women with irregular hormone levels. Everyone is different, and when trying to conceive, it is crucial for us to know our own fertility profiles. It is important to look for surges of LH and progesterone, yet to notice these hormone spikes a woman must know her baseline. OOVA can alleviate the stress of trying to conceive and enable us to feel more in control of our health and fertility by understanding our unique, individual cycles.
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