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July 4, 2024

Fertility Fundamentals: Understanding Ovulation, Conception, and Infertility Issues

Fertility and various aspects associated with it is an important knowledge that everyone should know about. Whether you are a young girl stepping into adulthood or a woman trying to get pregnant, knowing how a woman’s reproductive system works can be immensely helpful.

Not just for women, an understanding of the fundamentals of fertility can be useful for men as well, as this can help them take care of the women in their lives in a better way.

In this article, we will provide you with an overview of three important aspects related to fertility – ovulation, conception and infertility.

1. Ovulation

The process of the release of a mature egg from one of the ovaries and its movement along the fallopian tube towards the uterus so that it can be fertilized is known as ovulation. It is a part of a woman’s menstrual cycle.

As an egg reaches maturity, it is released from the ovary. It then moves along the fallopian tube and reaches the uterus where it waits for a sperm to get fertilized. During this waiting period, the lining of the uterus gets thickened to prepare for the fertilized egg.

In case of no conception, the uterine lining and the unfertilized egg are shed along with blood. This is known as menstruation. Ovulation usually happens once a month, about two weeks before the next period. Usually, ovulation lasts from 16 to 32 hours.

Key Facts about Ovulation

  • On average, an egg lives for 12-24 hours after leaving the ovary.
  • Only one egg is released during each ovulation.
  • Ovulation is a delicate process that can be affected by illnesses, stress or other lifestyle aspects.
  • A fertilized egg is implanted about 6 to 12 days after ovulation.
  • Every woman is born with millions of immature eggs waiting to be ovulated.
  • A woman may experience menstrual periods even without ovulation.
  • On the other hand, ovulation can occur even without a menstrual period.
  • Sometimes women experience light blood loss or spotting during ovulation. However, this may not be experienced by everyone.
  • Some women may experience pain or aching during ovulation. This is known as ‘middle pain’.
  • An egg disintegrates and is absorbed into the uterine lining if it is not fertilized.

2. Conception

Conception is the process of a sperm and egg joining together. This happens when a sperm swims up through the vagina and fertilizes an egg in the fallopian tube. This can happen after hours of having unprotected sex. The fertilized egg then gets implanted into the uterus leading to conception. This is the first step of pregnancy.

Once an egg is fertilized, it moves down the fallopian tube, dividing into multiple cells in the process. A fertilized egg is known as a zygote. Around a week after the sperm has fertilized an egg and the zygote reaches the uterus, the zygote grows into a cluster of about 100 cells, called a blastocyst. The blastocyst attaches itself to the lining of the uterus, a process known as implantation.

However, it is essential to remember that all conception does not lead to implantation. Sometimes implantation can be unsuccessful leading to the fertilized egg being flushed out during the next menstrual period.

In case of successful implantation, the cells continue to divide with some cells developing into a baby and others forming the placenta. During this time, women release hormones that signal the body that a baby is growing inside the uterus. These hormones also inform the body not to shed the lining of the uterus. This is why during pregnancy women do not experience menstrual periods. This is also the first way of knowing that someone is pregnant.

Timeline for Conception

The menstrual cycle is closely linked to conception and ovulation. Usually, menstrual cycles are 28 days long, but the length can vary from one woman to another. The exact time of ovulation of a woman is dependent on the menstrual cycle.

Let’s break down the timelines to understand this clearly:

  • Day 1 of menstrual cycle: First day of periods.
  • Around day 14 (after the first day of the menstrual cycle): Ovulation takes place
  • Within 24 hours of ovulation: Conception takes place when the sperm fertilizes and egg
  • Around 6 days after fertilization: The fertilized egg implants into the uterine lining
  • Around day 21 (after the first day of the menstrual cycle): If implantation has been successful, the woman is pregnant. However, a positive pregnancy test result may take another five to seven days to come.

The Process Behind a Positive Pregnancy Test

So what triggers a positive pregnancy test?

A fertilized egg travels through the fallopian tube to the uterus after conception. The fertilized egg, known as an embryo, gets attached to the wall of the uterus, which triggers the formation of the placenta. The placenta produces and releases a hormone called human chorionic gonadotropin (hCG) into your blood and urine. This is the hormone that’s captured in pregnancy tests. hCG starts appearing in a person’s blood after 11 days after conception, however, it may take longer to show up on an at-home pregnancy test.

The Ovulation Cycle

Now that we have a better idea about ovulation and conception, let’s take a deeper look into the ovulation cycle. The ovulation cycle can be roughly divided into two parts:

Follicular Phase

The phase starting from the first day of the last menstrual cycle till ovulation. This can be different for different women, lasting from 7 days up to even 40 days.

Luteal Phase

The second half of the cycle that lasts from the day of ovulation until the beginning of the next period. This period has a more precise timeline and usually lasts for only 12 to 16 days.

So, all in all, ovulation is what decides how long a woman’s cycle is. External factors such as illness, stress, and disruption to the normal routine can mess up your ovulation cycle, thus, in turn, messing up the time when your period will start.

Tips to Track Your Ovulation to Get Pregnant

If you’ve been trying to get pregnant, tracking the ovulation cycle can be immensely helpful. This can ensure that your efforts are fruitful. Here are some of the things that you can try:

  • Rhythm Method or Calendar Method: This is one of the most inexpensive methods to track your ovulation. You simply need to track your menstrual history to track your ovulation. It takes at least 6 menstrual cycles to understand the pattern. Calculate the longest ones and the shortest ones and then do a simple subtraction to determine which days are your most fertile ones.
  • Standard Days: This method is similar to the calendar method and works very well for women who have regular cycles between 26 to 32 days. If your cycle is more or less of this length, your most fertile days would be between days 8 and 19.
  • Basal Body Temperature Method: This method involves using a special thermometer to track your basal body temperature to predict ovulation. When the basal body temperature dips to the lowest reading and then rises by about half a degree, then you will know that ovulation has taken place.
  • Cervical Mucus Method: Another indicator is a change in your cervix’s discharge. Closer to ovulation, the mucus will feel slippery, clear and thin. It can even stretch between the fingers.
  • Ovulation Predictor Kits: Over-the-counter ovulation predictor kits are available that can help too. They measure the levels of luteinizing hormone in the urine. As this hormone rises, the ovary releases an egg. A test strip of an ovulation kit looks similar to a pregnancy test kit. A positive result indicates that you should be ovulation in the next 12 to 24 hours. This is the best time to try to conceive.
  • Ovulation Tracker Apps: Technology has made our lives easier in various ways, including ovulation. A wide range of apps are available online which can help you keep track of your cycle and ovulation. Digital wearables can help you in this process too.
  • Consult a Doctor: If you’ve been trying to conceive for a year without success, then taking a medical opinion can be useful. Medical consultation is also useful in case you have other medical issues such as polycystic ovarian syndrome or irregular periods.

3. Infertility

Let’s now talk about the third issue in question – Infertility.

Infertility is defined as a condition where a woman can’t get pregnant after one year of trying to conceive. Infertility can be caused by various reasons such as endometriosis, ovulatory disorders, low sperm count or low testosterone. Age can be a major factor in infertility.

However, today, many treatments are available to treat a woman’s infertility.

Types of Infertility

Infertility is primarily of three types:

  • Primary Infertility: When a woman has never been pregnant and cannot conceive after one year of regular unprotected sexual intercourse, then it is termed primary infertility. For women older than 35 years, the time limit is considered to be six months.
  • Secondary Infertility: When women can’t get pregnant again, after having at least one successful pregnancy.
  • Unexplained Infertility: When no plausible cause has been found through fertility testing to explain why a woman cannot get pregnant.

Is Infertility Common?

Infertility has become more common than before. The WHO has classified infertility as an acute disease. In Malaysia, infertility rates range between 10 to 15%.

Causes of Infertility

Infertility can be caused due to a variety of reasons. The causes can concern any one of the partners or sometimes both the partners. Some of the common causes of infertility include:

  • Age, especially in the late 30s and 40s. For men, fertility starts decreasing when they get closer to 50.
  • Excessive alcohol consumption.
  • Smoking or using tobacco products.
  • Being overweight or underweight.
  • Eating disorders such as bulimia and anorexia.
  • Environmental toxins exposure such as pesticides, chemicals and leads.
  • Radiation therapy or chemotherapy.
  • Over-exercising.
  • Sexually transmitted infections.
  • Substance abuse.
  • Abnormalities in the pituitary gland or hypothalamus of your brain.
  • Chronic conditions and diseases such as kidney disease.

Infertility Causes Specific to Women

While the above symptoms can be experienced by both men and women, some causes can be specific to only women such as:

  • Endometriosis
  • Autoimmune conditions such as lupus or celiac disease
  • Structural abnormalities of the vagina, uterus or fallopian tubes
  • Pelvic inflammatory disease
  • Polycystic ovary syndrome
  • Poor egg quality known as primary ovarian insufficiency
  • Sickle cell anaemia
  • Uterine polyps or uterine fibroids
  • Thyroid disease
  • Previous surgical sterilization
  • Congenital or surgical absence of ovaries
  • Absent or infrequent menstrual periods

Treatment of Infertility

Treatment of infertility is dependent on the cause of infertility and the goals one wants to achieve. Both the partner’s age, how long they have been trying to conceive and their personal preferences are important factors in deciding the course of treatment. One or both partners may need infertility treatment.

Infertility treatment for women

The most common treatments for women include:

  • Lifestyle changes: Women are often asked to make lifestyle changes such as losing or gaining weight, stopping smoking or stopping the use of any kinds of drugs they are on and improving their overall health. Health improvement can increase the chances of pregnancy.
  • Medications: Women may be given fertility drugs to stimulate the ovaries so that they create more eggs. This, in turn, can increase their chances of getting pregnant.
  • Surgery: Surgery may be used, if required, to treat infertility such as opening blocked fallopian tubes, removal of polyps, scar tissue or fibroids.

Infertility treatment for men

If the male partner is infertile, treatments are done to address issues related to the penis and/or testes:

  • Medication: Medications can be used to increase the levels of testosterone or other hormones in the body. These drugs also treat erectile dysfunction and other issues.
  • Surgery: Some men may face an issue with blockages in the tubes that carry sperm or have structural problems with the penis and testes. Surgery may be recommended in such cases. Specialists may also suggest Varicocele surgery to make sperm healthier, which can improve the chances of conception.

Navigating the Journey of Fertility

A woman’s reproductive system is complex and is susceptible to health issues which can range from simple period problems to complex infertility issues. No issue is minor, when it comes to the reproductive system of a woman as a small issue can lead to a major problem if left untreated.

The care should start right after a girl gets her first period. Speaking to a gynaecologist on time can go a long way in avoiding bigger issues in the future.

Require expert advice or specialized treatment? Please arrange an appointment with our specialist.

Dr Siti Maisarah Ahmad
Consultant Obstetrician, Gynaecologist & Reproductive Medicine (Visiting)

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