UNDERSTANDING TTC & CONCEPTION

End goal: sperm, meet egg...

By popular demand, here is a conception article! I'm so frequently asked to cover content on fertility, cycles, conception...so here it is, hopefully to dispel all myths and set you on a path to pregnancy.

As the image above suggests, the end goal here is for a sperm to fertilise an egg. But if you've been ttc (trying to conceive) for months with no luck, you might be pulling your hair out trying to figure out what's going wrong. But there might be nothing wrong to begin with - it might be purely in the timing of it all.

Here's something you may have seen before, even if it was only in high school. It's an average menstrual cycle - and shows a woman's period, ovulation and the complex interactions of several hormones around these things. Your cycle is split into two parts. Firstly, the part from the beginning of your period and ovulation, where your hormones are ripening an egg to release (ovulation). The second part is after ovulation, where your body is actively waiting for a fertilised egg to implant into the wall of your womb. If this doesn't occur in a certain time, your hormone levels drop and result in your period starting. And then the whole cycle begins again.

But here's the thing. We only ever see the average cycle. 28 days. Not sure about you, but I've never been an average woman. Looking at this average cycle does not take your individual circumstances into consideration. Nor does it consider your individual, set cycle.

See, the second part of your menstrual cycle, which is called the luteal phase, is usually a set number of days. In Ms Average, this is 14 days in length. 14 days from ovulation to period, each month. 14 days in which fertilisation can take place and a pregnancy could implant. However, the luteal phase will differ from woman to woman. This is one reason why we all have different cycle lengths (e.g. Ms Short has a 25 day cycle, and Ms Long has a 31 day cycle). But the other contributor to cycle length, and what will vary in every cycle you have, is the first stage - the follicular phase.

As we mentioned earlier, this part is where your body is growing and maturing an egg in your ovaries for release at ovulation. The time that this takes varies in each woman and each cycle. If you have regular periods, then this is probably fairly consistent (i.e. happening at a similar point in each cycle). However, if you have irregular periods, then it is happening at different points in your cycle. This is important, because in order to conceive you need to time intercourse around ovulation. If you don't know when ovulation is occuring, you will not be able to optimise your chances of conceiving!

By pinpointing ovulation, you'll also be able to track how long your luteal phase is each month - remembering that this stays fairly consistent. If you have a 12 day luteal phase, you'll know that your period should show up around 12 days after ovulation - and if it doesn't then perhaps pregnancy has occurred!

Let's take a look at these things if we rejig the 'average' menstrual cycle image from above:

Firstly, we see Ms Short's shorter cycle. Ovulation for her happens around day 10, and she has a 14 day luteal phase. This means she has a cycle length of 24 days (4 days shorter than Ms Average). If she is trying to conceive and is timing intercourse around day 14, thinking she is Ms Average, she has already missed her ovulation window.

Then Ms Long's longer cycle. She ovulates around day 21, and has an 11 day luteal phase. This means she has a cycle length of 32 days. If she times intercourse around day 14, thinking she is Ms Average, she will also miss her ovulation and conception window. She'll also likely get false hope of pregnancy if her period doesn't show on day 28 as she thinks it should.

You might now be having a little insight into your own cycle. It is 100% different from everyone else. But what do you need to do in order to know more? How can you optimise your chances of conceiving?

This is where cycle tracking is important.

For a couple of cycles at least, you will need to track your signs and symptoms to try and pinpoint ovulation, and then when you think ovulation has occurred, you can measure your luteal phase to predict pregnancy/your period.

How can you predict ovulation?

Well, there are a number of subtle signs your body gives you:

  • Biggest hint: a change in your cervical fluid/vaginal discharge. Fertile fluid or mucous is similar to egg whites - it is clear, very stretchy and slippery (can look like a clear glob) and is perfect for helping transport sperm to the egg. This may be quite confronting to think you have to keep an eye out for this, but it will be rewarding for you when you first notice the change from your regular vaginal discharge to the egg white discharge!

  • Second hint: your body temperature will change slightly. So slightly that a regular thermometer won't pick up the change. You can get a 'basal body thermometer' if you want to track this change, and you must take your temperature at the same time every day, and before you get out of bed. If you do this correctly and chart your temperature, you will see a temperature rise of around 0.5C once ovulation has occurred. Again, sounds complex, but it's super exciting to track that rise and know you have ovulated!

  • Cervix changes...yep another weird one. But didn't I warn you this was about getting to know your body?! During ovulation, your cervix will change to optimise conception. By feeling your cervix through the cycle you may begin to recognise these changes as ovulation is approaching. Normally, your cervix is quite firm, tightly closed, and can be quite low to feel. As ovulation approachs, it softens, opens slightly and rises a bit. When you feel those changes, you know you're good to go!

  • Other body signs that ovulation is happening: you may get very light spotting, or cramping in your pelvis/low in one side of your abdomen. This is because the ends of your fallopian tubes are rubbing against your ovary to help release the egg. You may also notice a rise in your sex drive as your body naturally tries to increase conception chances.

  • Luteinising hormone tracking...the images above don't show all of the hormones involved in the  menstrul cycle. Luteinising hormone [LH] is a hormone that peaks just before ovulation and is responsible for triggering the process of ovulation. You can buy LH tracking kits, where you pee on a stick (yep, like a pregnancy test) once or twice a day. When you see a peak, or positive reading, you know your LH is high and triggering ovulation in the next 12-24 hours.

Ok, so now we have worked on your cycle. It may take a couple of cycles to get to know you. But in the meantime, what else do we need to know? Especially if you already know when you ovulate, and you're still not pregnant?

Well - 2 really important things - the lifespan of a sperm and the lifespan of an egg.

A sperm can live for 5 days in the vagina and the womb. An egg lives maximum 24 hours, if that. This means if you have sex at or after ovulation, you've probably missed the window for that cycle. Knowing that a sperm lives 5 days, and an egg about 1 day gives us approximately 6 days per cycle to conceive. Outside of this window, pregnancy is really unlikely to happen.

Sperm also need time to travel up the vagina, through the cervix and the womb to the fallopian tubes where they wait for the egg to be released. Again, waiting until ovulation occurs is probably too late for this. Therefore, to optimise your chances of pregnancy, you should be having sex before ovulation. For healthy couples, having sex every 2nd day during the fertile window is recommended. Even having sex once 5 days before ovulation can still result in pregnancy. 

Right - so I know when I ovulate, we are having sex every 2nd day in my fertile window - now what? When can I do the pregnancy test?

Ok, if you've done eeeeeverything above, we enter what's known in ttc forums around the world as the 'two week wait' [tww] - a nod to the average 14 day luteal phase until pregnancy or your period shows. But why the wait?

Well, if a sperm happens to fertilise the egg, this newly formed little embryo needs to keep traveling down the fallopian tubes to your womb, where it can implant. As it travels, it continues to develop by splitting into more and more cells that will eventually form your baby and a placenta. It can take 9 or 10 days even for this little embryo to implant into your womb. That's why doing a pregnancy test too early is useless - you'll get a negative result even if you actually conceived.

Once the little embryo implants, it begins to secrete a pregnancy hormone - human chorionic gonadotropin [hcg]. This is the hormone that is detected in a home pregnancy test. However, in early pregnancy this hcg rises slowly from a level of 0 - it can take 2 or more days to double its level. Some home pregnancy tests can detect hcg levels as low as 6, but commonly you'll only get a positive test when your hcg is around 10-20. The other thing to consider is that hcg is secreted into your blood stream, and then excreted in your wee at a much lower amount. This means although you might have a high level in your blood, it can take time for this to build into your wee. 

What am I trying to say? Well - getting a positive pregnancy test might just take time and patience. If your embryo implants at day 6 after ovulation, 2 or 4 days later your hcg might have risen to a detectable level, meaning you get a positive test probably before your period is due. If your embryo implants at day 10, and rises slowly, then it might be another 4-6 days before you get a positive test.

Sometimes, it just takes time. Also - doing your pregnancy tests first thing in the morning can help as your wee is likely more concentrated and therefore containing more of the hormone for the test to detect.

Troubleshooting TTC

Where to from here if you've followed all of the above and still no pregnancy? Does it mean something is seriously wrong?
Well, no, it doesn't. If you have irregular cycles, it can mean irregular ovulation. If you notice great variation in your follicular and luteal phases, it might be a good idea to chat with your GP about this. We can do blood tests to check for ovulation and your hormone levels. Sometimes, it's a matter of optimising your lifestyle - eating better, moving more, losing some weight if you are overweight can all help your hormones to normalise and help with ovulation. Same goes for your partner - lifestyle changes can improve the health of the sperm drastically and may be all that is needed.

For healthy couples under 35, it can take 12 months to conceive. This is even after hormonal birth control is stopped - this has no impact on fertility (although the Depo Provera shot is the only one to delay return to fertility). If you are older than 35 or have other medical conditions that may be impacting on fertility, it's recommended to seek medical advice after trying for 6 months. 

Wishing a positive test to all of you who want it!

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