- We spend so much time at school
learning about English, maths, biology,
but very few of us know about our natural cycle.
So today's topic
is all about understanding your natural cycle
and when you're ovulating.
Now a woman's cycle generally speaking,
is somewhere between 28 to 35 days.
If your cycles are either shorter or longer than this,
please contact your general practitioner
and make a referral to see a fertility specialist
so that we can have a look
and see what's happening with your cycles.
Women should really consider several things
when they're trying to become pregnant.
And I utilize a little acronym called SSRUP.
The first one is sex,
and timing sex around ovulation is particularly important.
And we'll talk a little bit about ovulation
towards the latter part of this presentation.
And of course it does take two to tango.
So we do need sperm, that's the other S.
And of course, not only does the sperm need to be healthy,
swimming in a forward progression,
but also there needs to be a good amount
of good-looking sperm that has the ability
to fertilize an egg.
The next thing is a receptive uterus.
A uterus that's structurally normal
with no impediment for pregnancy.
So when you see any one of us as fertility specialists,
we're gonna be asking questions about your menstrual cycle.
If they're heavy, alternatively, if you have any pain.
And this may give us an indication
as to whether you might have things like endometriosis.
Of course, you need to have open tubes
because the tubes are particularly important
'cause they're the conduit
or the pathway where the sperm and the egg can mate.
And fertilization of the egg
actually occurs in the tube itself.
And lastly, you need to ovulate.
So let's talk a little bit about ovulation.
A woman's cycle commences on day one
when she has her period.
And at this point in time,
all the hormones are really quite low.
So estrogen and progesterone are very low.
The brain secretes a hormone called
follicle-stimulating hormone.
And what this is like is it's like fertilizer
for a woman's ovaries.
Every single woman has a certain number of follicles
that are within her ovary at any given point in time.
And the follicle-stimulating hormone
will gently stimulate one of those follicles
to become a big dominant follicle.
So I want you to imagine that in actual fact
the little follicle sitting on an ovary
are in actual fact seedling
sitting in a little flower box.
And think about that FSH, the follicle-stimulating hormone
coming from the brain as if it is fertilizer
for those little seedlings.
So what happens is the FSH or the fertilizer,
slowly increases during the first part
of the menstrual cycle,
from day one to approximately day 14.
And that fertilizer gently stimulates
one of the little seedlings
to become a big beautiful sunflower.
Now it'll block out the sunlight
or the other little seedlings,
and therefore, you only ever get one seedling a month.
Now in nature, in terms of your ovaries,
the same thing happens.
Follicle-stimulating hormone gently increases
during the menstrual cycle.
It causes one of the follicles
to become bigger and bigger and bigger.
And through the process of hormones,
it suppresses the growth of the other little follicles.
And so ultimately, a woman will have one large follicle
that it will eventually break open just like an egg opening,
releasing the egg, or an eggshell opening rather,
releasing the egg so that it can go down the fallopian tube.
Now, often that's done around day 14.
And most women will know that you can also purchase
from the pharmacy or alternatively from a supermarket,
ovulation kit tests.
These test for a hormone called luteinizing hormone
which surges or starts to increase
in the day preceding your ovulation.
And what it does is it causes that egg shell to rupture
and allow the little egg to be released from the ovary,
so that eventually it goes down the fallopian tube.
Now, during this period of time,
women may also find that their cervical mucus
becomes quite stringy,
and in other cases, because the egg shell has opened up
releasing a little bit of fluid,
they might also notice a little bit of pain
particularly in the ovary where the egg's been released.
Now from there, within 24 hours,
that egg needs to be fertilized.
So it's really important that during these,
what we term our fertility window,
that you're having sex
in order to maximize the chances of pregnancy.
Now, once that egg is subsequently fertilized,
then it'll go down the fallopian tube
and head into the uterus where it subsequently implants.
Now in the absence of an egg being fertilized,
then a woman will anticipate a period some two weeks later.
So where the egg shell actually opens up
and releases the egg,
the rest of the egg shell collapses on itself,
forming something called a corpus luteum.
And that produces progestogen which is the major hormone
that drives the rest of the menstrual cycle
from day 14 through to around about day 28.
Now, just as something is happening in the ovaries,
another processes is also happening within the uterus.
And the uterus is very dependent on the hormones
that are being produced within the ovaries
to maintain an adequate environment suitable for pregnancy.
So the first part of our cycle from day one to day 14,
has a whole amount of estrogen that's being produced
from that large, big follicle that's within the ovary.
Now that estrogen is a little bit like watering the grass
on the surface of the MCG.
So if you imagine the MCG,
and you imagine the grass growing during the first part
of the 14 days of the menstrual cycle, that grass grows.
And if you think of the embryo,
is like the beach volleyball, the big volleyball
that's been thrown around the MCG
as all the patrons of the MCG do the Mexican wave.
And you think about that little beach ball
then nestling into the grass.
So during the first part of the menstrual cycle,
the lining of the womb gets really nice and thick,
once ovulation occurs, that egg or that beach ball
wants to land in the grass
or the thickened endometrium of the lining of the womb.
Now, if you're pregnant, then of course the progestogen
continues to support that little embryo
and support the grass that's growing
or the lining of the womb becoming nice and thick.
And in the absence of becoming pregnant,
then all the hormones,
both the estrogen and the progestogen,
which are the major hormones
in the latter part of the cycle, drop.
And as a result, it's a little bit like cutting the grass
of the surface of the MCG.
And this is when a woman will experience a period.
So whilst the ovaries and the uterus
are two separate organs,
in actual fact, they are intimately related I suppose,
when it comes to conception.
We need in the first part of the cycle,
the ovary to grow a follicle,
produce a huge amount of estrogen,
which then subsequently stimulates the uterus to grow,
or the the lining of the womb of the uterus
to thicken up and grow in preparation for pregnancy.
Once you ovulate,
then the ovary produces a whole amount of progestogen
to support a pregnancy.
And that little egg then moves down into the fallopian tube,
into the uterus to implant.
And then if you are pregnant, the little pregnancy hormone
that's produced called hCG
continues to stimulate the ovary to produce progestogen
and to stop you from having a period
so that that embryo can continue to nestle in, implant,
and of course, develop into a baby.
So understanding our menstrual cycle
is particularly important.
For some women, the menstrual cycle may not be 28 days.
And a bit may be 35 days or even longer.
And so it's really important at that point in time
to realize that when you are ovulating,
is generally 14 days before you would expect a period.
So for a woman who's having regular 35-day cycles,
then ovulation, generally speaking, occurs around day 21.
In my opinion, if you're ovulating any more than 35 days,
then you really, or sorry,
you're having a period more than 35 days,
you really should be seeing a fertility specialist
so that we can give you medication
in order to stimulate the ovaries
and allow ovulation to occur in a more frequent manner.
This doesn't mean IVF.
This basically means ovulation induction,
where we still are timing sexual intercourse
around ovulation.
So when's the best time to conceive?
Well, the best time to conceive is around ovulation
as I've stated before.
And so for a woman who's having a regular 28-day cycle
that's day 14.
So I tend to say to patients and to couples,
to have sex every second day through
from day 10 through to day 20.
Realizing that sperm normally stays
in the genital tract of a woman
for approximately two to three days.
So that means if you ovulate a little bit earlier
or a little bit later,
there should still be sperm up in the tubes
for fertilization to occur.
Of course, as I said before,
if you're having a 35-day cycle,
then of course ovulation is occurring day 21.
And so you should really be having sex then from day 15
through to day 25 to cover off the same fertility window.
So I hope that goes in part
to explaining what a natural cycle is.
When's the best time to conceive,
and what are the requirements to conception.
To refresh, sex, timed around ovulation,
having healthy sperm, a receptive uterus
with no impediments to pregnancy,
ovulating, and of course, having open tubes.
And the last thing is P for patients.
As you commence your fertility journey,
it's important to remember that the chances of pregnancy
are around 20% per month.
As a young woman less than the age of 35,
I'd suggest that you do this for approximately a year
before considering help from a GP or specialist.
And alternatively, if you're over the age of 35,
then please see a doctor a lot earlier around the age of 36.
Sorry, at six months.
However, the most important thing is,
if at any point in time you feel
that your fertility is compromised by any one of the factors
that I spoke to before, I.e. not having enough sex,
you're worried about your partner's sperm,
the uterus in terms of bleeding may be heavy
or alternatively painful,
or alternatively you've had any history
of sexually transmitted infections
where there may be a concern about blocked tubes.
And indeed you're not ovulating frequently,
then seek the advice of a fertility specialist
much earlier than one year, and much earlier than six months
for a woman over the age of 35.
I hope you enjoyed this video about your natural cycle
and when's the best time to conceive.
We've got a whole bunch of other videos on fertility,
so if you wanna listen to them more,
please click on the subscribe button,
or alternatively, leave a comment below.
It's really important to take control
of your fertility health.
So if you need to, please contact us at Melbourne IVF
and make an appointment
with any one of our fertility specialists.