Reproductive Endocrinologist, Dr. Marie Werner debunks three of the biggest myths surrounding infertility care.
MYTH: “An Ovulation Predictor Kit (OPK) can clearly predict ovulation in all patients”
Ovulation predictor kits (OPK) are available for home use to detect timing ovulation and help couples determine the optimal time for intercourse. Each kit will be slightly different, so it is important to follow package instructions precisely.
The kits typically work by detecting luteinizing hormone (LH) which appears in the urine approximately 12 hours after it appears on a blood test. In most cases, an egg will be released within 36 hours from the start of an LH surge. If the urine detects it 12 hours after the start, you may be ovulating 24 hours from the time you test positive. This is assuming of course that you are detecting the start of when LH is present in the urine, but no guarantees here.
It is important to note that patient-specific characteristics can make it difficult to interpret these tests. For instance, patients with Polycystic Ovarian Syndrome (PCOS) are known to have high resting LH levels, and they may always test positive on these kits, or just get unclear readings.
In other cases women with ovarian insufficiency may also have high LH levels, making the test difficult to interpret. Even with the correct use of these kits, greater than 5% of the time the kit will detect ovulation when it is not actually occurring.
If you are getting fairly predictable cycles (25-35 days in between menses), then ovulation predictor kits can be helpful in determining the approximate day of ovulation. If you can determine that you are ovulating on a schedule each month (for instance- always day 13-14), then use an app to track the rest of the cycles.
Keep in mind, that if you are under the age of 35, you should seek help after trying for a year. Over the age of 35, you should seek help after 6 months of trying to conceive.
MYTH: “Being on the pill for too long will delay pregnancy”
The birth control pills get a bad rap in relation to fertility. The pill is a reliable form of conception and has useful non-contraceptive benefits.
Many women rely on birth control pills for the treatment of painful periods, irregular bleeding, and infrequent menstrual cycles. Like any medication birth control can be associated with risks, but in the right healthy young woman, the benefits usually outweigh the risks.
Now let’s talk about birth control and fertility. In some cases, it can take longer to get your first period after stopping the pill. For most women, the average time to the next period is about 32 days, and in one study over 98% of patients had a spontaneous return of menses in less than 90 days.
So if you are ready to conceive, but on the pill, the recommendation is to stop using 3 months prior to trying to conceive, so you have time to get that first period.
If your cycles don’t return regularly it is likely not the pill’s fault. More often birth control pills will mask underlying symptoms that may impact fertility, by ensuring you get your period like clockwork.
Learn more about your menstrual cycle in this blog: 8 Things a Gynecologist Wants You to Stop Doing During Your Period
MYTH: “The egg that I naturally ovulate each month should be my best one”
At the start of a menstrual cycle (1st day of heavy bleeding) the ovaries are typically quiet. In a woman who has regular menstrual cycles, a follicle (egg) then starts to grow.
Typically, one follicle will be selected amongst the group to ovulate (release) in the middle of the cycle, giving a single chance at pregnancy. However, that follicle does not necessarily contain your best egg; it is just the one that responded to the hormonal signals released by the brain.
Unfortunately, the other follicles (which could have contained better eggs), undergo the process of cell death and never get used. But don’t worry too much, next month the eggs will be replaced by another group. Because women are born with all the eggs they will ever have, this process is how women use up their eggs over time.
Now if you are having difficulty getting pregnant, a fertility specialist can help by understanding this process. Treatment may encourage more than one egg to grow in a given month, increasing the odds that the right sperm will find the right egg.
Alternatively, your doctor may recommend more advanced treatment such as in vitro fertilization (IVF) where medication is given to recruit all the eggs in a given cycle and then select the best single embryo for pregnancy.