# What is Ovulation?????



## Carol66 (Sep 25, 2006)

Hi

Hopefully not as daft a question as it sounds!  

When I had cycle monitoring we could always see a dominant follie growing in text book fashion.  My lining would thicken nicely. I would always get the required blue lines at day 14 (I’m a regular day 28/29 girl) the follicle would then appear to have collapsed a day or so later suggesting ovulation.  But then always on my day 21 blood test my progesterone levels were never high enough and so was then told that I hadn’t actually ovulated and all the other signs were to be ignored as the progesterone level was the key one.

I am about to undergo a FET and am unsure whether to do natural or medicated.  I think I would rather do natural because I always get cysts when I am down regging – which incidentally is consistent with a study I have found on the net which suggests that women with progesterone levels of less than 5 on day 21 or more likely to develop cysts when taking buserelin.  However I don’t know if I am suitable for natural cause of the ovulation question.  

All/any advice welcome 

Carol


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

Hi

I just typed a long reply and lost it 

As far as I'm aware, to have natural fet you would need to ovulate, which means releasing eggs during monthly cycles.

You mention that you got a positive opk (ovulation predictor kit) on cd (cycle day) 14 but opk's only detect LH (lutenizing hormone) surge and not actual ovulation.  You would usually ovulate around 36hours after getting a positive opk.  If this was the case, then it could be that you weren't ovulating until around cd16...and so having progesterone tested on cd21 would be too early.

Progesterone peaks at 7dpo (days past ovulation) which is ideally when it should be tested...having tested on cd21 assumes ovulation on cd14...if you don't ovulate until cd16 then try to get progesterone tested on cd23 etc etc.  Even though you have 28/29 day cycles this doesn't necessarily mean you're ovulating cd14/15...its a complete myth that luteal phase (from ovulation to period) are always 14 days...luteal phase can be anywhere between 10 - 17/18 days and be classed as normal (I'm the other way & actually ovulate cd14/15 but my cycles are 30/31 days long but my progesterone levels are naturally pretty high !!)

Progesterone is released from the corpus luteum which is the area of the follie where egg ruptured...so if you're scans showed this then it really could be that your progesterone levels were just tested a day or so too early - which can make a difference.

They usually like progesterone levels to be 30nmol/l (some say over 40nmol/l) to indicate ovulation happened - basically egg released.

Progesterone prepares the womb lining for possible implantation and then sustains early pregnancy until placenta takes over.

Another reason could be that your follies don't contain any eggs...a follicle is fluid filled cyst and whilst the majority will contain an egg, not all will.

You mention cysts developing whilst downregging (DR) during ivf...I think they are more likely to occur in those ladies who start DR at the beginning of their cycles (eg cd 1, 2)...if DR is started on cd21 of their cycle then this can help prevent cysts developing (I started on cd21 & was fine).

With regards to whether you are able to have natural fet - I think this is something you really need to discuss with your consultant as they know your medical history and is afterall the expert.  They should be able to advise whether its feasible for you to have natural fet or whether you will require medicated fet.

When we had recent fet I had to have progesterone levels checked month prior to starting as it was only couple of months since I'd had ivf...my progesterone levels were fine & showed I'd ovulated fine so I then started natural fet following month...scans from cd2 onwards to check womb lining and developing follicles...then embies put back at "right" time...some women may not have any medication at all but although mine was a natural fet I was still prescribed cyclogest to help stop womb lining breaking down...

Not sure if helped 
Good luck
Natasha


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## Carol66 (Sep 25, 2006)

Hi Natasha

Sorry you lost your post - feel like kicking the PC when it happens to me

Thanks for such a thorough response you really do understand all of this  

Just to clear up a few points from my earlier post (apologies for not being clearer);  on my first fresh cycle I was LP day 2 got the cyst despite 3 weeks of buserelin the final week at double dose I ended up getting the B***er drained.

Next fresh cycle I was moved to LP day 21 exactly for the reason you described hormones on the way down less resistance etc.  Unfortunately still got cyst this time not as big so not wanting to drain rather kept me on the buserelin until it had shrunk.

You are right the opk were usually positive for more than a 24 hour period ie often did more than one and would often go to the clinic shortly after and see what the scan showed.  Actually on one memorable day had two scans a few hours apart and saw the complete and collapsed follicle at each scan! Collapsed not necessarily being the same as ruptured I was to discover. Was also given an HCG injection once as part of cycle monitoring but still no progesterone surge which my then consultant said that I had probably got LUFS (luteinised unruptured follicle syndrome) and then helpfully went on to say that most in the profession didn't believe in it!!!!!
I agree with what you have said about getting the day right for prog testing and on a couple of cycles I had to go and get blood tests  on d21 and d23. 

Re the consultant advice I have got 2 different options from 2 different clinics - 1 (ARGC) saying that they would like to do a natural and the other (LH) saying medicated (although at first they too said natural until I raised concerns re the synchronicity of my hormones)  - I think most jump to natural as soon as they hear "regular 28 day cycles"

It seems that one thing that most of the industry do agree on is progesterone post ET.  It is one thing that I get on my soapbox about (being on the low side myself) I have read a number of American websites where they still have the debate of whether low progesterone is a symptom or cause of miscarriages - most practitioners here seem to believe that low progesterone is a symptom ie the pg has started to fail and the prog starts to drop as a result.  In the states many women report "saving" their pg after significantly increasing their progesterone supplements etc etc
Sorry went on a bit there.

What stage are you now at?  Hope everything is going really well for you    

Carol


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

Hi again

I know what you mean regards the progesterone...I have naturally high progesterone levels whenever been tested (in fact the lowest I've had is 48 and that was cycle after our first fresh ivf !!)...I always get severe migraines just before AF ("aunt flow" - period) arrives and consultant says this is where my high prog levels have crashed.  With the fresh ivf I was on 800mg cyclogest a day during 2ww but starting spotting just before test day & got a bfn...AF showed up within an hour of stopping the cyclogest.  When we had natural fet recently, I was again on 800mg cyclogest and starting spotting on the day AF should've showed up (obviously as "natural" cycle) so just before test day - I tested early on "official" day & got a bfn then for some unknown reason I tested again around middayish & got a very very faint bfp (same as when I had 2 early mc) but all subsequent tests were again bfn  I stopped the cyclogest and AF showed up within a day so again I'm sure it was just the cyclogest holding back my AF but not enough progesterone to support my womb lining & any pregnancy.

We had follow up with consultant other day and he's convinced that with this last fet "something" did try to happen ie embie(s) did try to stick albeit only short lived.  I have to have extra medications for immune & blood clotting disorders (diagnosed after 2 early mc's last year - naturally conceived) which I do believe have helped me.  Anyway, we discussed my naturally high progesterone levels & the fact I always seem to spot early during treatment so we're adding in extra meds for next fet.  We start our next fet next cycle (October)...I'll be having the extra meds for the disorders (clexane, baby aspirin & prednisolone) as well as Cyclogest, Crinone 8% and also extra Ovitrelle (hcg) jabs which should hopefully help - fingers crossed !!
We had 4 frosties (all Grade 1 x 4 cell) from our first ivf - 2 were thawed & survived 100% at last fet so we're praying that the last 2 will have same thaw success rate and with all these extra meds that it works !!

So although I'm having "natural" "unmedicated" fet, I say that in the loosest sense of the word !!!!!

Anyway, wishing you lots of luck - when do you start your fet   Which clinic are you at 

Take care
Natasha


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## MackLM (Feb 21, 2006)

Hi Natatsha, 

I was hoping you'd be on this board!  As you are so knowledgeable, I could really do with a bit of education and advice...

I have just had 2nd ICSI failure.  As far as I know, there are no probs on my side and we are being treated for MF.  DH has v low count, motility and morphology.  The 1st time around I didn't hold out much hope, kinda saw it as a trial run.  However, this time I feel devastated as we had more eggs, seemed better quality and even though we had a day 3 transfer, the clinic took 2 others to blastocyst and were able to freeze them (1 of poorer quality which they said was 'worth a try' freezing)...

So now, were in FET territory.    It's all happened so quick as I want to start this month (day 1 today).  Clinic said they don't usually do it so soon after failed ICSI but said it was ok as I have regular cycles.  (Just can't wait as I know they're there!)  Worried that just because I have regular cycles, doesn't mean I ovulate does it?  I have used opk's before and got the smiley faces, but I understand this doesn't necessarily mean ovulation.  I'm worried that the clinic are not doing any tests and I don't want to waste my frosties!

I'm also wondering whether I need tests for implantation/immune problems.  Can't help thinking that if our frosties got to blast, then the ones on board should have also got to blast, so why didn't they implant?!?!?    But don't know what tests they can do?  What tests were you given and what meds are for what condition?  I'm so confused!  I'm not due to go to the clinic until day 10.

Thank you so much for your help!!

MackLM


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