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How do self-observed cycle symptoms correlate with ovulation?

Authors:
  • green-ivf, Grevenbroich, Germany & Depart. Gyn/Ob University of Cologne, Germany

Abstract

The symptoms of self-observation of the menstrual cycle (basal body temperature, mucus symptom, autopalpation of the cervix) are often regarded as not reliable for ovulation detection. In a prospective study 87 NFP cycles are monitored additionally with ultrasound and LH tests to calculate the correlation of the ovulation-time with the symptoms of self-observation. Our results show that the symptoms of self-observation allow a reliable detection of the time of ovulation. Only a short introduction into the method of self-observation is a necessary precondition. The reliable detection of ovulation gives the opportunity of cycle analysis of large groups especially in long time investigations. In this way a large set of valuable and reliable data on normal and disturbed menstrual cycles will be available.
... The cycles are evaluated according to the so-called "double-check" principle: two parameters each secure both the beginning and the end of the fertile window [2]. There is a high correlation between the cycle parameters used (cervical mucus, temperature rise and calculation rules) with objective ovulation [3,4]. Ovulation in cycles in which Sensiplan is applied is in 81% about 1-2 days before the temperature rise (mean of 0.92 ± 1.17 days before temperature rise) or 0.11 ± 1.31 days after the day of peak cervical mucus. ...
... Ovulation in cycles in which Sensiplan is applied is in 81% about 1-2 days before the temperature rise (mean of 0.92 ± 1.17 days before temperature rise) or 0.11 ± 1.31 days after the day of peak cervical mucus. Using both parameters, 89% of clinical ovulations are within in an interval ± 1 day to objective ovulation confirmed by vaginal ultrasound [3]. For this study, both parameters were used to locate ovulation and to locate the window of implantation. ...
... The cycle analysis with determination of the first and last fertile days was carried out by both the user and specially trained project staff. The latter also determined the time of ovulation as so-called clinical ovulation according to a definition previously published [3]. This ensured reliable determination of the follicular phase length, ovulation day, luteal phase length and location of the implantation window with highest implantation probability on the 5th-9th postovulatory days in the cycle [3,6]. ...
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Purpose: Many physicians and other healthcare professionals are often asked questions on interfering factors for conception by couples with a desire for children. Such possible disturbances include, for example, the very common minor diseases, stress and also sexual intercourse during the suspected implantation period. Non-scientifically based statements about disturbances in conception cycles, as found in many layman publications and on the internet, can strongly unsettle couples with a desire for children and force them into corset of rules of conduct. Therefore, a systematic scientific evaluation of the impact of disturbances on conception is urgently needed. Methods: A search for possible disturbances in natural conception cycles together with up to three of the respective pre-cycles in a large cycle database from users of the symptothermal method of natural family planning in Germany was performed. Disturbances were qualified by scientific panel decision and analysed statistically with their effects on the chances of spontaneous conception. Mixed logistical regression models and survival time analyses were used. Results: A total of 237 women with a total of 747 cycles could be included in the analysis. In 61% of all 237 conception cycles, disturbances occurred. The statistical analysis shows that disturbances in natural conception cycles unexpectedly increase the likelihood of pregnancy by an overall factor of 1.32 (95% CI 1.04-1.70). Sexual intercourse in the window of implantation does not decrease the chances of conception. Relaxation states at the time of ovulation and/or during the implantation period have no representable effect and do not increase the chance of pregnancy. Conclusions: Couples trying to conceive should at least be informed that disturbances in conception cycles, such as minor diseases, stress or sexual intercourse during the implantation period do not interfere with conception. Relaxation has no effect in favour of success. This takes away the guilty feeling of couples, fearing that they possibly did something wrong in cycles without the desired pregnancy.
... The identification of the FW is possible by recognition of physical symptoms and signs that women are able to notice themselves, like CM Monitoring (CMM), bleeding rhythm, auto-palpation of the cervix, basal body temperature measurement, etc. [47,48]. The effectiveness of this methods depends on the accurate identification of the fertile window (FW) and adaptation of sexual behavior [49]. Based on the results of the selected studies, it is possible to conclude that CM secretions are a reliable predictor of imminent fertility. ...
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Background: Cervical Mucus (CM) is a viscous fluid produced by the secretory cells of the cervical crypts. The CM undergoes modifications throughout the cycle that make it have different biochemical and biophysical characteristics, becoming a crucial element for the identification of ovulation. Since CM is rich in secreted proteins, it may represent moreover a source of biomarkers for female reproductive tract diseases. Objective: This review is an attempt to collect relevant knowledge about the physicochemical properties and functions of the cervical mucus, including its important role as a clinical marker of female fertility, and draws attention to CM as a source of potential proteomic biomarkers. Findings: All the assessed studies evidenced that the observation of the CM allows the identification of the days with the highest probability of pregnancy. CM proteome changes throughout the menstrual cycle have been revealed. Few proteomic studies on the constitutive protein composition of CM of fertile women have been conducted to date. In the CM of patients affected by endometriosis have been identified some proteins that could represent potential biomarkers of the disease. Conclusion: There is still limited knowledge about the physicochemical properties and functions of the CM and how these undergo to changes during menstrual cycle. CM is a reliable predictor of fertility. Further characterization of CM proteins would contribute to a better understanding of the key role they have on fertility, reproduction and biological regulation. CM may represent moreover a source of biomarkers for gynecological diseases.
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The exact time of ovulation within the menstrual cycle is important for the reproductive function in women. What is ovulation? How can fertility awareness be described? What is the appropriate time for intercourse to achieve conception? Its frequency? What is the span of the fertility window? What are the features of natural family planning? What are disorders of ovulation? What are the main principles of anovulation management? The Biblical verses dealing with the sexual behavior of two women associated with ovulation were studied from a contemporary viewpoint.
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The interval of peak fertility during the menstrual cycle is of limited duration, and the day of ovulation varies, even in women with fairly regular cycles. Therefore, menstrual cycle apps identifying the “fertile window” for women trying to conceive must be quite precise. A deviation of a few days may lead the couple to focus on less- or non-fertile days for sexual intercourse and thus may be worse than random intercourse. The aim of the present investigation was to develop a scoring system for rating available apps for determining the fertile window and secondarily pilot test 12 apps currently available in both German and English (consisting of 6 calendar-based apps: Clue Menstruations- und Zykluskalender, Flo Menstruationskalender, Maya-Mein Periodentracker, Menstruationskalender Pro, Period Tracker Deluxe, and WomanLog-Pro-Kalender; 2 calculothermal apps: Ovy and Natural Cycles; and 4 symptothermal apps: myNFP, Lady Cycle, Lily, and OvuView). The calendar-based apps were investigated by entering several series of cycles with varying lengths, whereas the symptom-based apps were examined by entering data of cycles with known temperature rise, cervical mucus pattern, and clinical ovulation. The main criteria for evaluating the cycle apps were as follows: (1) What methods/parameters were used to determine the fertile window? (2) What study results exist concerning that underlying method/parameters? (3) What study results exist concerning the app itself? (4) Was there a qualified counseling service? The calendar-based apps predicted the fertile days based on data of previous cycles. They obtained zero points in our scoring system, as they did not comply with any of the evaluated criteria. Calculothermal apps had similar deficits for predicting the most fertile days and produced suboptimal results (Ovy 3/30 points and Natural Cycles 2/30 points). The symptothermal apps determined the fertile days based on parameters of the current cycle: Lady Cycle scored 20/30 points, myNFP 20/30 points, Lily 19/30 points, and OvuView 11/30 points. We concluded that the available cycle apps vary according to their underlying scientific quality and clear rating criteria have been suggested. Three of the tested apps were judged to be eligible for further study. The scientific evaluation of cycle apps depends on good prospective studies undertaken by independent investigators who are free of commercial bias.
Chapter
Durch Ultraschalltechnik und Hormondiagnostik ist in der ärztlichen Praxis ein Zyklusmonitoring möglich geworden, das detaillierte, präzise, kurzfristige und objektive Informationen über die hormonellen Veränderungen im Zyklus und die Ovulationsvorgänge liefert. Demgegenüber steht die NFP-Methode mit einer subjektiven und geradezu primitiv anmutenden Selbstbeobachtung durch die Frau. Sie nimmt für sich in Anspruch, die hochfruchtbare Zeit ebenfalls, aber auf viel einfachere und kostengünstige Art und Weise ausreichend präzise zu erfassen. Aus wissenschaftlicher Sicht sind Vorbehalte und Bedenken gegen diese Vorgehensweise durchaus verständlich. Nur wenn eine enge zeitliche Korrelation zwischen den subjektiv beobachteten Symptomen und der objektiven Ovulation besteht, kann diese Methode sowohl bei Kinderwunsch als auch zur Vermeidung einer Empfängnis eingesetzt werden. Der wissenschaftlichen überprüfung dieses Zusammenhangs wurde deshalb in den letzten 25 Jahren großes Interesse entgegengebracht.
Article
Fertility awareness-based methods rely on the principles of reproductive physiology. The knowledge of the fertile days of the menstrual cycle can be used to avoid or plan a pregnancy. This article focuses on the contraceptive use. Fertility awareness-based methods include calendar methods, basal body temperature-based methods, cervical secretion methods and combined methods such as the symptothermal method. For all these methods, varying contraceptive efficacy rates have been reported. Pregnancy rates during actual use (including inconsistent or incorrect use) should be taken into account. It is suggested that the symptothermal method, which is a combination of the temperature-based method and cervical secretion method, is most reliable, but there is a lack of randomized trials comparing methods and combinations.
Article
Background Couples wishing to conceive try to optimize the chances of becoming pregnant by timing intercourse to fall on those days which they think are fertile; however, the fertile window exhibits extensive variation, even in relatively regular cycles. Women can acquire qualified information concerning their current state of fertility by cycle observation using natural family planning (NFP) methods, also called fertility awareness methods. Objective The aim of this review is to illuminate the current state of the art on optimizing conception with the help of self-observation of cycle parameters. Material and methods Scientific publications (peer reviewed) concerning the correlation of self-observed cycle parameters with the day of ovulation, the probability of conception within the self-observed fertile window and time to pregnancy studies including timing intercourse. The data are predominantly derived from prospective cohort studies of several European and American databases. Results According to conception probability analyses women are able to identify the days when intercourse is most likely to result in pregnancy by observing cervical secretions (externally at the vulva). There is a close correlation between self-observed parameters and ovulation in the cycle. The results of the time-to-pregnancy studies suggest that pregnancy rates are better in fertile women as well as in subfertile women when self-observation of the fertile window and fertility-focused intercourse are applied. Conclusion Previous results justify the integration of fertility awareness methods into the management of subfertility. Cycle observation is a non-invasive, safe and cost-effective first-line method; nevertheless, further randomized controlled studies are necessary.
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Die Familienplanung hat sich infolge des Strukturwandels in entwickelten Gesellschaften erheblich verändert. Schwangerschaften werden oft genau und nach langjähriger Kontrazeption geplant, die Kinderzahl ist niedrig. Der Kinderwunsch fällt immer öfter in das letzte Viertel der fertilen Lebensphase einer Frau, in der die Fertilität möglicherweise gravierend nachgelassen hat. Eine Umfrage des Allensbach-Instituts 2007 ergaben, dass ca. 25 % der Patientinnen in einer gynäkologischen Sprechstunde einen Kinderwunsch haben. Das Wissen um den natürlichen Zyklus und um die natürliche Fruchtbarkeit ist gering, und 80 % der befragten Studienteilnehmerinnen sind über die altersabhängig nachlassende Fertilität falsch informiert.
Chapter
Durch Ultraschalltechnik und Hormondiagnostik ist in der ärztlichen Praxis ein Zyklusmonitoring möglich geworden, das detaillierte, präzise, kurzfristige und objektive Informationen über die hormonellen Veränderungen im Zyklus und die Ovulationsvorgänge liefert. Demgegenüber steht die NFP-Methode mit einer subjektiven und geradezu primitiv anmutenden Selbstbeobachtung durch die Frau. Sie nimmt für sich in Anspruch, die hochfruchtbare Zeit ebenfalls, aber auf viel einfachere und kostengünstige Art und Weise ausreichend präzise zu erfassen. Aus wissenschaftlicher Sicht sind Vorbehalte und Bedenken gegen diese Vorgehensweise durchaus verständlich. Nur wenn eine enge zeitliche Korrelation zwischen den subjektiv beobachteten Symptomen und der objektiven Ovulation besteht, kann diese Methode sowohl bei Kinderwunsch als auch zur Vermeidung einer Empfängnis eingesetzt werden. Der wissenschaftlichen Überprüfung dieses Zusammenhangs wurde deshalb in den letzten 25 Jahren großes Interesse entgegengebracht.
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