When can you get pregnant?
You can't get pregnant if you are not ovulating because there is no egg for the sperm to fertilize. You can get pregnant if you have unprotected sex anywhere from 5 days before ovulation until 1 day after ovulation.
Whether you are trying to get pregnant or trying to avoid getting pregnant, it's important to understand your menstrual cycle and how it relates to your fertility. There are a lot of myths and misinformation surrounding fertility. Once you learn exactly how and when pregnancy can happen, you'll have a better idea of when you can and can't get pregnant.
You can get pregnant if you have unprotected sex anywhere from 5 days before ovulation until 1 day after ovulation. You can't get pregnant if you are not ovulating because there is no egg for the sperm to fertilize. When you have a menstrual cycle without ovulating, it's called an anovulatory cycle. There are a lot of underlying issues that can cause this. It's a common reason for infertility.
How do you know if you’re ovulating?
Ovulation occurs when an egg is released from your ovary. It usually happens about 10 to 16 days before your period starts. It's difficult to predict exactly when you're ovulating because the length of your cycles can vary from month to month. Even if your menstrual cycles are the same length, you may not always ovulate on the same day.
Another sign of ovulation is that your cervical mucus, the discharge from your vagina, may be wetter, clearer, and more slippery around the time of ovulation. Your body temperature may rise slightly after ovulation as well. There are also ovulation predictor kits that can detect an increase in the levels of certain hormones in your urine.
What causes anovulatory cycles?
Anovulation is usually the result of an imbalance of the hormones that control ovulation. It begins with a surge in luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels. Anything that interferes with these hormones can cause anovulation, which can be caused by several underlying conditions, including:
Obesity. A high body mass index (BMI) can cause you to have excess male hormones such as testosterone, called androgens. This can interfere with the hormones that regulate ovulation.
Low body weight or excessive exercise. As with having a high BMI, having a low BMI or excessively exercising can cause anovulation. It does this by disrupting the release of the hormones that control ovulation from your pituitary gland.
Stress. Stress also affects the hormones that control ovulation. One study found that women who had high levels of an enzyme that indicates stress in their saliva took 29% longer to conceive than those with low levels of the enzyme.
Polycystic Ovarian Syndrome (PCOS). PCOS is the most common cause of hormonal imbalance in women of childbearing age. It affects approximately 1 in 10 women. PCOS causes you to produce excess androgens. High levels of androgens cause the follicles, or sacs, in your ovaries that contain your eggs to remain small. This can prevent your body from releasing eggs.
Abnormalities in TSH or Prolactin. Thyroid-stimulating hormone (TSH) and Prolactin are both hormones produced by your pituitary gland. If levels of these hormones are abnormal, it can interfere with the hormones you need to ovulate. Problems with your thyroid gland can lead to over or underproduction of these hormones.
How is anovulation treated?
Anovulation is usually treated with fertility drugs. There are several commonly prescribed fertility drugs, including:
Clomiphene citrate (CC). Around 80% of women will ovulate and 40% will get pregnant using CC. It works by stimulating the hormones that cause your body to release an egg.
Human chorionic gonadotropin (hCG). This causes your ovary to release an egg, usually 36 to 72 hours after it's given. This is the same hormone that pregnancy tests measure. So, if you take a pregnancy test after receiving hCG, you will get a false-positive result.
Follicle stimulating hormone (FSH). This is a lab-created version of the hormone that causes the eggs to mature in your ovaries. This may be used on women who don't get pregnant with CC or who don't make their own FSH. FSH treatment has a risk of 20% to 30% of pregnancy with multiplies. Use of FSH has to be closely monitored by your doctor.
GnRH agonists and antagonists. These are synthetic hormones that are used to control the release of LH.
Risks of fertility medicines
There are many different types of hormones used to treat anovulation. Your doctor will closely monitor you while you are on these to minimize the risk of side effects, including:
- Ovarian hyperstimulation, which can cause serious complications such as blood clots, kidney damage, twisting of your ovaries, and fluid collecting in your abdomen or chest.
- Pregnancy with multiple babies, which occurs in about 20% of pregnancies that result from fertility drugs.
- Ectopic pregnancy, which is a pregnancy that occurs outside of your uterus.
- Adnexal torsion, which is twisting of your ovaries.
- Possibly increased risk of ovarian cancer, though this is still being researched.