Zita West - Zita West’s Guide to Getting Pregnant

If you don’t have an understanding of this basic information about the two phases of the menstrual cycle, all the other indicators of fertility you are trying to evaluate just won’t ‘add up’.

Christine, who was 34, had had one child with IVF. Two further attempts at IVF had been unsuccessful. She came along to our clinic to see what she could do to improve her chances. Having looked through her questionnaire, apart from the fact that she was tired from coping with a toddler, and also a little bit underweight, there were no obvious lifestyle factors that might be affecting her chances. I went back to basics with her and asked about her cycles and sex, and suggested that, as she had irregular cycles, a session of fertility awareness would benefit her. I could tell she thought that this would be a total waste of time, as she’d been told that she wasn’t ovulating.

‘How do you know you don’t ovulate?’ I asked. She said that when she used the ovulation – predictor kits (see below), nothing happened. When I asked about her cervical secretions, she said she didn’t have any. Then I started to ask about her periods and how long her bleed lasted. Her bleed lasted 7 days, and on the 8th and 9th days there was what she thought was mucus but mixed with the blood; she also thought that this was part of her bleed. Her cycles were quite varied – between 28 and 38 days – so by her calculations if anything were going to happen it wouldn’t be on the 8th or 9th day of her period; it would be much later in the cycle. She was wrong about this.

She went on to conceive naturally a month later.

I could write about many more cases like this, of women who have had IVF when they have never even been offered the most basic kind of help with understanding their fertility.

Luteinizing hormone can be measured by ovulation – predictor kits, which use chemicals to identify the presence of LH in your urine. LH is not released all at once, but rises and falls for 24 to 48 hours. The LH rise usually begins in the early morning while you are sleeping; it appears in your urine about 4 to 6 hours later. For this reason, first-morning urine may not give the best result. It is important to follow the instructions on the kit for optimum results.

If you are able to recognize the pattern of your cervical secretions, ovulation – predictor kits have little value except to reassure you. You may just want to use them to cross – check your other signs of impending ovulation. If you have irregular cycles or multiple patches of fertile cervical secretions before ovulation, however, ovulation kits can be helpful.

I think ovulation – predictor kits are fine – so long as they’re used in conjunction with examining your cervical secretions (see below). They can also encourage women to have sex only when the predictor kit indicates – therefore missing out on opportunities for sex during the preceding five days, which is essential to maximize the chances of conception.

There is absolutely no point rushing out and buying an ovulation-predictor kit if you don’t have at least a rough idea of your cycle. I see women who have got into a real muddle using them, and have often convinced themselves that they’re not ovulating because, without any idea of what their normal cycle is, they’ve used the kit at the wrong time.

Once you know your own, individual cycle, the kit can help confirm when ovulation is coming up – but by then you will be so confident of reading your own body’s fertility indicators that you won’t need it!

Your secretions are your fertility . It is my hope that all women trying for a baby get to know and focus on this. If you take only one thing from this chapter, take this: recognizing the range of and changes to your secretions is key to understanding your fertility, because they are so closely linked to oestrogen levels.

Cervical secretions are produced continuously by the glands lining the cervix, and provide a slightly acidic barrier during the infertile phase of your menstrual cycle, protecting against any bacteria or germs that can enter the body via the vagina.

These secretions are influenced by the changing hormones of your cycle, as we have seen, and provide the most useful indicator of hormonal activity. Highly fertile secretions, which tend to resemble raw egg white, are stimulated by peak oestrogen levels, and not only indicate that ovulation is imminent, but also provide channels for the sperm to swim along and an optimum environment for sperm. Influenced by oestrogen, the secretions at this time are also more alkaline, protecting the sperm from the normal acidity of the vagina.

For women who have spent a long time on the Pill, cervical secretions and the way they change during a cycle can be something of a mystery. Coming up to ovulation, cervical secretions become more obvious, but only by looking at and feeling them can a woman be really sure of what stage in her cycle she is at.

The easiest way to assess the presence and quantity of oestrogen in your bloodstream, and gain clues about your fertility status, is to check your cervical secretions throughout your cycle.

Increased production of oestrogen, as your body prepares for ovulation, stimulates the cells of the cervix to produce more secretions, which creates an increasingly wet and slippery feeling around the vagina as you approach ovulation. While your cervical secretion pattern may vary from cycle to cycle, a typical cervical secretion pattern over the course of a menstrual cycle will look like this:

• Day 1 of your cycle is marked by bleeding, which may continue for between 3 and 5 days, depending on what is normal for you.

• Immediately following the end of a period, cervical secretions aren’t produced in any noticeable quantities and the vagina can be described as quite dry.

• After a couple of days, you may notice a creamy – white secretion which has no odour and produces no discomfort. It may leave a bit of a mark on undergarments.

• This creamy – white secretion then becomes a little thinner and whiter, and increases a little in quantity. Some women have described this as being similar in colour and consistency to moisturizing lotion.

• Over the next couple of days these secretions change quite dramatically, becoming increasingly more clear and ‘elastic’.

• Just prior to ovulation, cervical secretions become completely clear, exceedingly ‘stretchy’ and can be described as resembling raw egg white. This is the peak time for cervical – secretion production, and with good reason: for sperm to reach an egg they need to be able to swim upwards, and through a lubricated channel that allows this. In addition, when looked at under a microscope, these cervical secretions appear to have channels within them, assisting the sperm even further. Not all women notice the elasticity or stretchiness of these highly fertile secretions, but they may simply be aware of an increased wetness. Some women even describe this as feeling as if they have wet themselves. This may be because this type of secretion is produced in small ‘pulses’ from the top of the cervix.

• Almost immediately following ovulation, the cervical secretions stop being clear and stretchy, and revert back to a thicker creamy secretion, which can become quite ‘blobby’ over the next few days. This is the progesterone effect. It creates a bit of a seal to the cervix (neck of the womb), designed to prevent any foreign bodies – from sperm to bacteria – ascending the womb. It also makes the vagina more acidic and hostile to sperm.