Cycle Monitoring with Your Fertility Doctor

Cycle monitoring can be done in various ways. This article will discuss cycle monitoring in the context of working with fertility doctors where routine ultrasounds and blood work are done. You can also monitor ovulation through other means, through less invasive methods, at home. For information related to at home ovulation monitoring methods, please click here.

The objective of cycle monitoring is to determine when ovulation occurs, to therefore determine the best time for conception (through insemination or sexual intercourse).

When cycle monitoring through a fertility expert, multiple visits would be needed at various points during a cycle, all with the objective of preparing for ovulation. Since every woman's cycle is different, its hard to predict exactly how often a woman would need to go in, or when ovulation will occur.

A rough outline follows:

 

  • Day 1

    Your menstrual cycle begins; first day of bleeding. This is considered Day 1 of your menstrual cycle. 

  • Day 3

    On day 3 of the cycle, you may go to the fertility clinic for a baseline ultrasound. 

    Here, fertility medications will start. You may take Climiphene citrate, Letrozole or other medications. 

    Ultrasound is then performed from time to time to monitor maturation of follicles in the ovaries. 

  • Day 6-12

    Between days 6 and 12, you may go back into the clinic for more ultrasounds and/or blood work. 

    The doctors will monitor estradiol and LH, for a continued assessment of follicle development and predict ovulation. 

    Some clinics may have a women go to the clinic every day leading up to ovulation to repeat blood tests and ultrasound. 

What are the Doctors Expecting from Your Follicles?

This whole time, the doctor is counting your ovarian reserve and looking for between  6 and 10 follicles that range between 2-10 mm in diameter.

Once your follicle grows 1-2 mm a day and when your dominant follicle reaches 20-24 mm, in combination with good hormone levels, your doctor will be assured it is a good time for ovulation.

  • Once You're Ready for Ovulation

    The doctor will notify you this is the time for conception if ovulation is expected naturally. Conception can be achieved through sexual intercourse or artificial insemination. 

    In some cases a injection of hCG is given intra-muscularly to trigger ovulation. 

  • 3 Days after Insemination

    Following insemination, progesterone suppositories may be used, one in the morning and one at night, starting the morning after the insemination or 3 days after the hCG injection. 

    These progesterone suppositories may be continued until a pregnancy test is performed on day 28. 

  • Day 28

    At Day 28, a pregnancy test is performed.