Last week I went to a doctor. A regular run of the mill general practitioner. This is something I have not done in about two years. Given that I am a doctor, I tend not to go to doctors. I like to avoid taking medication most of the time, and would rather treat my sinus infection and allergies with a Neti pot. I can get prescriptions from my friends and coworkers when needed. I have no need for a PCP! Except for that pesky pap. We also have to get some lab work done in anticipation of IVF this summer, so I found myself a doctor and off I went.
As the nurse was doing my intake, she asked if I could recall the first day of my last menstrual period. Ha! Could I recall it? Yes, and I could tell you how many days it has been, when I will likely ovulate next and then how many days it will be until my next period. I remember a day when I honestly couldn’t keep track of my cycle. It was regular, happened about every 28 days and I usually knew what *week* I was in, but I am so much more in tune with things now, for better or worse.
So what is a monthly cycle like for me? It all starts on cycle day 1 (CD1), with the first day of your period. Mine always starts full force, no spotting to herald it’s impending arrival. I have pretty bad cramps for about an hour and that’s it. After a few days of bleeding we are 3-4 days into what is known as the follicular phase. That’s when the FSH produced in the brain is nudging the ovaries to start growing follicles. Eventually one will get big enough that it will take over, making estrogen which suppresses the others and becoming the Lead Follicle.
What am I doing while my body is doing all this? Counting days. I usually ovulate around day 16, so I’m looking for clues as to when this might happen. As the Lead Follicle makes more estrogen, the cervical fluid changes, becoming more watery and receptive to sperm, eventually it will start to look like egg white (aka EWCM). Once this happens, it’s time to get busy. This is “fertile” cervical fluid, and this is when the sperm have their best shot at making it through that cervix.
Once the estrogen levels reach a high enough level for long enough, the brain gets the signal that it’s time to ovulate and releases a spike of LH. This triggers the Lead Follicle to release it’s mature egg, starting the follicular phase. The shell is left behind in the ovary and becomes what is known as a corpus luteum. This produces progesterone, which helps make the uterine lining ready to accept that fertilized egg once it makes its way there.
After the EWCM makes its appearence, I start peeing on sticks: Ovulation Prediction Kits (OPKs). These measure the level of LH in the urine and will tell you when that LH surge has happened. You know ovulation will happen withing 24-36 hours of the surge, so if you haven’t already started having sex now is the time to *really* get busy, and keep at it for the next 2-3 days.
I used to take my basal body temperature as well. You set your alarm for 6 am every morning, and using a special extra-sensitive thermometer, you measure your temperature every morning. Once the corpus luteum starts making progesterone, your temp should increase about one degree. This indicates that you have in fact ovulated. Unforutnately, this is too late to help you figure out when to have sex. And since I ovulate every month, I didn’t care that I had already ovulated. I wanted to know before the fact. So I stopped doing this.
If the sperm finds the egg, and settles in to the uterine lining, eventually it will start making hormones (hCG) that will keep it growing. You can detect this hormone in the urine about two weeks after ovulation. If the egg doesn’t implant, eventually the corpus luteum shrivels up, the progesterone levels drops, and that triggers menstruation. Back to CD 1.
The two week wait is the hardest part of this whole cycle for me. I feel good the first week, because I know we have had great timing. We always have great timing. So I always think we have a chance. This is the month for us! And then week two starts. I start taking home pregnancy tests about 10 days after ovulation because *sometimes* you can get a positive result early. But that’s always negative, which is ok because that’s really early. I wait until 12 days after ovulation. Take another test. It’s always negative too. And that’s really depressing because my period always shows up that afternoon. And we start all over again.
Now that we’ve been at this almost 2 years, I’ve pretty much accepted that well timed sex is not going to get us pregnant. For whatever reason, things just don’t happen the normal way for us. We don’t know what the underlying problem is, but hopefully we will get lucky with IVF and that will get us our baby. In the meantime, we keep trying. I keep counting days, watching for EWCM and peeing on sticks. It’s not hopeless, and it gives me something to keep my mind occupied during these months when we are taking a break from treatments.
But come August, we will be embarking on a completely different road to pregnancy. I’m a bit terrified actually, mainly because I don’t know what we will do if it doesn’t work. But I’m excited at the same time, because I think it is the best chance we have.