By listing your BBT on a chart you can see your pattern for fertility. ... Temperature ranges very tremendously but are typically between 96.5 - 97.5 before ovulation ... If I am doing OPKs, why should I still bother to take my BBTs?
Basal body temperature is the lowest temperature attained by the body during rest (usually during sleep). It is generally measured immediately after awakening and before any physical activity has been undertaken, although the temperature measured at that time is somewhat higher than the true basal body temperature (see Fig. 1). In women, ovulation causes an increase of one-half to one degree Fahrenheit (one-quarter to one-half degree Celsius) in basal body temperature (BBT); monitoring of BBTs is one way of estimating the day of ovulation. The tendency of a woman to have lower temperatures before ovulation, and higher temperatures afterwards, is known as a biphasic][ pattern. Charting of this pattern may be used as a component of fertility awareness.
The higher levels of estrogen present during the pre-ovulatory (follicular) phase of the menstrual cycle lower BBTs. The higher levels of progesterone released by the corpus luteum after ovulation raise BBTs. The rise in temperatures can most commonly be seen the day after ovulation, but this varies and BBTs can only be used to estimate ovulation within a three day range.
If pregnancy does not occur, the disintegration of the corpus luteum causes a drop in BBTs that roughly coincides with the onset of the next menstruation. If pregnancy does occur, the corpus luteum continues to function (and maintain high BBTs) for the first trimester of the pregnancy. After the first trimester, the woman's body temperature drops to her pre-ovulatory normal as the placenta takes over functions previously performed by the corpus luteum.
Very rarely, the corpus luteum may form a cyst. A corpus luteum cyst will cause BBTs to stay elevated and prevent menstruation from occurring until it resolves, which could take weeks or months.
Regular menstrual cycles are often taken as evidence that a woman is ovulating normally, and irregular cycles is evidence she is not. However, many women with irregular cycles do ovulate normally, and some with regular cycles are actually anovulatory or have a luteal phase defect. Records of basal body temperatures can be used to accurately determine if a woman is ovulating, and if the length of the post-ovulatory (luteal) phase of her menstrual cycle is sufficient to sustain a pregnancy. Some fertility computers and software can help a woman to determine these factors.
Pregnancy tests are not accurate until 2-3 weeks after ovulation. Knowing an estimated date of ovulation can prevent a woman from getting false negative results due to testing too early. Also, 18 consecutive days of elevated temperatures means a woman is almost certainly pregnant.
Tracking basal body temperatures is a more accurate method of estimating gestational age than tracking menstrual periods.
Charting of basal body temperatures is used in some methods of fertility awareness, and may be used to determine the onset of post-ovulatory infertility. However, BBTs only show when ovulation has occurred; they do not predict ovulation. Normal sperm life is up to five days, making prediction of ovulation several days in advance necessary for avoiding pregnancy.
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proc/asst, drug (G1/G2B/G3CD)
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proc/asst, drug (G1/G2B/G3CD)
Ovule means "small egg". In seed plants, the ovule is the structure that gives rise to and contains the female reproductive cells. It consists of three parts: The integument(s) forming its outer layer(s), the nucellus (or remnant of the megasporangium), and the megaspore-derived female gametophyte (or megagametophyte) in its center. The megagametophyte (also called embryo sac in flowering plants) produces an egg cell (or several egg cells in some groups) for fertilization. After fertilization, the ovule develops into a seed.
In flowering plants, the ovule is typically located inside the portion of the flower called the gynoecium. The ovary of the gynoecium produces one or more ovules and ultimately becomes the fruit wall. Ovules are attached to placenta in the ovary through a stalk-like structure known as a funiculus. Different patterns of ovule attachment, or placentation, can be found among plants.
In gymnosperms such as conifers, ovules are typically borne on the surface of an ovuliferous (ovule-bearing) scale, usually within an ovulate cone (also called megastrobilus).
In some extinct plants (e.g. Pteridosperms), megasporangia and perhaps ovules were borne on the surface of leaves. In other extinct taxa, a cupule (a modified leaf or part of a leaf) surrounds the ovule (e.g. Caytonia or Glossopteris).
The ovule appears to be a megasporangium with integuments surrounding it. Ovules are initially composed of diploid maternal tissue, which includes a megasporocyte (a cell that will undergo meiosis to produce megaspores). Megaspores remain inside the ovule and divide by mitosis to produce the haploid female gametophyte or megagametophyte, which also remains inside the ovule. The remnants of the megasporangium tissue (the nucellus) surround the megagametophyte. Megagametophytes produce archegonia (lost in some groups such as flowering plants), which produce egg cells. After fertilization, the ovule contains a diploid zygote and then, after cell division begins, an embryo of the next sporophyte generation. In flowering plants, a second sperm nucleus fuses with other nuclei in the megagametophyte forming a typically polyploid (often triploid) endosperm tissue, which serves as nourishment for the young sporophyte.
An integument is a protective cell layer surrounding the ovule. Gymnosperms typically have one integument (unitegmic) while angiosperms typically have two (bitegmic). The evolutionary origin of the inner integument (which is integral to the formation of ovules from megasporangia) has been proposed to be by enclosure of a megasporangium by sterile branches (telomes). Elkinsia, a preovulate taxon, has a lobed structure fused to the lower third of the megasporangium, with the lobes extending upwards in a ring around the megasporangium. This might, through fusion between lobes and between the structure and the megasporangium, have produced an integument.
The origin of the second or outer integument has been an area of active contention for some time. The cupules of some extinct taxa have been suggested as the origin of the outer integument. A few angiosperms produce vascular tissue in the outer integument, the orientation of which suggests that the outer surface is morphologically abaxial. This suggests that cupules of the kind produced by the Caytoniales or Glossopteridales may have evolved into the outer integument of angiosperms.
The integuments develop into the seed coat when the ovule matures after fertilization.
The integuments do not enclose the nucellus completely but retain an opening at the apex referred to as the micropyle. The micropyle opening allows pollen to enter the ovule for fertilization. In gymnosperms (e.g., conifers), pollen is drawn into the ovule on a drop of fluid that exudes out of the micropyle. Subsequently, the micropyle closes. In angiosperms, only a pollen tube enters the micropyle. During germination, the seedling's radicle emerges through the micropyle.
Located opposite from the micropyle is the chalaza where the nucellus is joined to the integuments. Nutrients from the plant travel through the phloem of the vascular system to the funiculus and outer integument and from there apoplastically and symplastically through the chalaza to the nucellus inside the ovule. In chalazogamous plants, the pollen tubes enter the ovule through the chalaza instead of the micropyle opening.
The nucellus (plural: nucelli) is part of the inner structure of the ovule, forming a layer of diploid (sporophytic) cells immediately inside the integuments. It is structurally and functionally equivalent to the megasporangium. In immature ovules, the nucellus contains a megasporocyte (megaspore mother cell), which undergoes sporogenesis via meiosis. In gymnosperms, three of the four haploid spores produced in meiosis typically degenerate, leaving one surviving megaspore inside the nucellus. Among angiosperms, however, a wide range of variation exists in what happens next. The number (and position) of surviving megaspores, the total number of cell divisions, whether nuclear fusions occur, and the final number, position and ploidy of the cells or nuclei all vary. A common pattern of embryo sac development (the Polygonum type maturation pattern) includes a single functional megaspore followed by three rounds of mitosis. In some cases, however, two megaspores survive (for example, in Allium and Endymion. In many cases, all four megaspores survive. For example in Fritillaria type embryo sac development (illustrated by Lilium in the figure) three of the megaspores fuse to form a triploid nucleus. The subsequent arrangement of cells is similar to the Polygonum pattern, but the ploidy of the nuclei is different.
After fertilization, the nucellus may develop into the perisperm that feeds the embryo. In some plants, the diploid tissue of the nucellus can give rise to a seed through a mechanism of asexual reproduction called nucellar embryony.
The haploid megaspore inside the nucellus gives rise to the female gametophyte, called the megagametophyte.
In gymnosperms, the megagametophyte consists of around 2000 nuclei and forms archegonia, which produce egg cells for fertilization.
In flowering plants, the megagametophyte (also referred to as the embryo sac) is much smaller and typically consists of only seven cells and eight nuclei. This type of megagametophyte develops from the megaspore through three rounds of mitotic divisions. The cell closest to the micropyle opening of the integuments differentiates into the egg cell, with two synergid cells by its side that are involved in the production of signals that guide the pollen tube. Three antipodal cells form on the opposite (chalazal) end of the ovule and later degenerate. The large central cell of the embryo sac contains two polar nuclei.
The pollen tube releases two sperm nuclei into the ovule. In gymnosperms, fertilization occurs within the archegonia produced by the female gametophyte. While it is possible that several egg cells are present and fertilized, typically only one zygote will develop into a mature embryo as the resources within the seed are limited.
In flowering plants, one sperm nucleus fuses with the egg cell to produce a zygote, the other fuses with the two polar nuclei of the central cell to give rise to the polyploid (typically triploid) endosperm. This double fertilization is unique to flowering plants, although in some other groups the second sperm cell does fuse with another cell in the megagametophyte to produce a second embryo. The plant stores nutrients such as starch, proteins, and oils in the endosperm as a food source for the developing embryo and seedling, serving a similar function to the yolk of animal eggs. The endosperm is also called the albumen of the seed.
Ovulation is the phase of a female's menstrual cycle in which a mature egg is released from the ovarian follicles into the oviduct. After ovulation, during the luteal phase, the egg will be available to be fertilized by sperm. Concomitantly, the uterine lining (endometrium) is thickened to be able to receive a fertilized egg. If no conception occurs, the uterine lining as well as blood will be shed during menstruation.
In humans, ovulation occurs about midway through the menstrual cycle, after the follicular phase. The few days surrounding ovulation (from approximately days 10 to 18 of a 28 day cycle), constitute the most fertile phase. The time from the beginning of the last menstrual period (LMP) until ovulation is, on average, 14.6 days, but with substantial variation between women and between cycles in any single woman, with an overall 95% prediction interval of 8.2 to 20.5 days.
The process of ovulation is controlled by the hypothalamus of the brain and through the release of hormones secreted in the anterior lobe of the pituitary gland, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In the pre-ovulatory phase of the menstrual cycle, the ovarian follicle will undergo a series of transformations called cumulus expansion, which is stimulated by FSH. After this is done, a hole called the stigma will form in the follicle, and the ovum will leave the follicle through this hole. Ovulation is triggered by a spike in the amount of FSH and LH released from the pituitary gland. During the luteal (post-ovulatory) phase, the ovum will travel through the fallopian tubes toward the uterus. If fertilized by a sperm, it may implant there 6–12 days later.][
The follicular phase (or proliferative phase) is the phase of the menstrual cycle during which the ovarian follicles mature. The follicular phase lasts from the beginning of menstruation to the start of ovulation.
For ovulation to be successful, the ovum must be supported by the corona radiata and cumulus oophorous granulosa cells. The latter undergo a period of proliferation and mucification known as cumulus expansion. Mucification is the secretion of a hyaluronic acid-rich cocktail that disperses and gathers the cumulus cell network in a sticky matrix around the ovum. This network stays with the ovum after ovulation and has been shown to be necessary for fertilization.][
An increase in cumulus cell number causes a concomitant increase in antrum fluid volume that can swell the follicle to over 20 mm in diameter. It forms a pronounced bulge at the surface of the ovary called the blister.][
Estrogen levels peak towards the end of the follicular phase, which causes a surge in levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This lasts from 24 to 36 hours, and results in the rupture of the ovarian follicles, causing the egg to be released from the ovary via the oviduct.
Through a signal transduction cascade initiated by LH, proteolytic enzymes are secreted by the follicle that degrade the follicular tissue at the site of the blister, forming a hole called the stigma. The cumulus-oocyte complex (COC) leaves the ruptured follicle and moves out into the peritoneal cavity through the stigma, where it is caught by the fimbriae at the end of the fallopian tube (also called the oviduct). After entering the oviduct, the ovum-cumulus complex is pushed along by cilia, beginning its journey toward the uterus.][
By this time, the oocyte has completed meiosis I, yielding two cells: the larger secondary oocyte that contains all of the cytoplasmic material and a smaller, inactive first polar body. Meiosis II follows at once but will be arrested in the metaphase and will so remain until fertilization. The spindle apparatus of the second meiotic division appears at the time of ovulation. If no fertilization occurs, the oocyte will degenerate approximately 24 hours after ovulation.][
The mucous membrane of the uterus, termed the functionalis, has reached its maximum size, and so have the endometrial glands, although they are still non-secretory.][
The follicle proper has met the end of its lifespan. Without the ovum, the follicle folds inward on itself, transforming into the corpus luteum (pl. corpora lutea), a steroidogenic cluster of cells that produces estrogen and progesterone. These hormones induce the endometrial glands to begin production of the proliferative endometrium and later into secretory endometrium, the site of embryonic growth if fertilization occurs. The action of progesterone increases basal body temperature by one-quarter to one-half degree Celsius (one-half to one degree Fahrenheit). The corpus luteum continues this paracrine action for the remainder of the menstrual cycle, maintaining the endometrium, before disintegrating into scar tissue during menses.][
The start of ovulation can be detected by signs. Because the signs are not readily discernible by people other than the woman herself, humans are said to have a concealed ovulation. In many animal species there are distinctive signals indicating the period when the female is fertile. Several explanations have been proposed to explain concealed ovulation in humans.
Women near ovulation experience changes in the cervix, in mucus produced by the cervix, and in their basal body temperature. Furthermore, many women experience secondary fertility signs including Mittelschmerz (pain associated with ovulation) and a heightened sense of smell, and can sense the precise moment of ovulation.
Many women experience heightened sexual desire in the several days immediately before ovulation. One study concluded that women subtly improve their facial attractiveness during ovulation.
Symptoms related to the onset of ovulation, the moment of ovulation and the body's process of beginning and ending the menstrual cycle vary in intensity with each woman but are fundamentally the same. The charting of such symptoms — primarily basal body temperature, Mittelschmerz and cervical position — is referred to as the sympto-thermal method of fertility awareness, which allow auto-diagnosis by a woman of her state of ovulation. Once training has been given by a suitable authority, fertility charts can be completed on a cycle-by-cycle basis to show ovulation. This gives the possibility of using the data to predict fertility for natural contraception and pregnancy planning.
The moment of ovulation has been photographed.
Disorders of ovulation are classified as menstrual disorders and include oligoovulation and anovulation:
The World Health Organization (WHO) has developed the following classification of ovulatory disorders:
Ovulation induction is a promising assisted reproductive technology for patients with conditions such as polycystic ovary syndrome (PCOS) and oligomenorrhea. It is also used in in vitro fertilization to make the follicles mature before egg retrieval. Usually, ovarian stimulation is used in conjunction with ovulation induction to stimulate the formation of multiple oocytes. Some sources include ovulation induction in the definition of ovarian stimulation.
A low dose of human chorionic gonadotropin (HCG) may be injected after completed ovarian stimulation. Ovulation will occur between 24–36 hours after the HCG injection.
Contraception can be achieved by suppressing the ovulation.][
The majority of hormonal contraceptives and conception boosters focus on the ovulatory phase of the menstrual cycle because it is the most important determinant of fertility. Hormone therapy can positively or negatively interfere with ovulation and can give a sense of cycle control to the woman.][
Estradiol and progesterone, taken in various forms including combined oral contraceptive pills, mimics the hormonal levels of the menstrual cycle and engage in negative feedback of folliculogenesis and ovulation.][
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M: ♂ MRS
proc, drug (G3B/4BE/4C)
M: ♀ FRS
proc/asst, drug (G1/G2B/G3CD)
Menstrual cycle is the cycle of changes that occurs in the uterus and ovary for the purpose of sexual reproduction. It is essential for the production of eggs and for the preparation of the uterus for pregnancy. The menstrual cycle occurs only in fertile female humans and other female primates.
In humans, the length of a menstrual cycle varies greatly between women (ranging from 25 to 35 days), with 28 days designated as the average length. Each cycle can be divided into three phases based on events in the ovary (ovarian cycle) or in the uterus (uterine cycle). The ovarian cycle consists of the follicular phase, ovulation, and luteal phase whereas the uterine cycle is divided into menstruation, proliferative phase, and secretory phase. Both cycles are controlled by the endocrine system and the normal hormonal changes that occur can be interfered using hormonal contraception to prevent reproduction.
By convention, menstrual cycles are counted from the first day of menstrual bleeding. Stimulated by gradually increasing amounts of estrogen in the follicular phase, discharges of blood (menses) slow then stop, and the lining of the uterus thickens. Follicles in the ovary begin developing under the influence of a complex interplay of hormones, and after several days one or occasionally two become dominant (non-dominant follicles atrophy and die). Approximately mid-cycle, 24–36 hours after the Luteinizing Hormone (LH) surges, the dominant follicle releases an ovum, or egg in an event called ovulation. After ovulation, the egg only lives for 24 hours or less without fertilization while the remains of the dominant follicle in the ovary become a corpus luteum; this body has a primary function of producing large amounts of progesterone. Under the influence of progesterone, the endometrium (uterine lining) changes to prepare for potential implantation of an embryo to establish a pregnancy. If implantation does not occur within approximately two weeks, the corpus luteum will involute, causing sharp drops in levels of both progesterone and estrogen. These hormone drops cause the uterus to shed its lining and egg in a process termed menstruation.
In the menstrual cycle, changes occur in the female reproductive system as well as other systems (which lead to breast tenderness or mood changes, for example). A woman's first menstruation is termed menarche, and occurs typically around age 12-13. The end of a woman's reproductive phase is called the menopause, which commonly occurs somewhere between the ages of 45 and 55.
The average age of menarche in humans is 12–13 years, but is normal anywhere between ages 8 and 16. The average age of menarche is about 12.5 years in the United States, 12.72 in Canada, 12.9 in the UK and 13.06 ± 0.10 years in Iceland. Factors such as heredity, diet and overall health can accelerate or delay menarche. The cessation of menstrual cycles at the end of a woman's reproductive period is termed menopause. The average age of menopause in women is 52 years, with anywhere between 45 and 55 being common. Menopause before age 45 is considered premature in industrialised countries. Like the age of menarche, the age of menopause is largely a result of cultural and biological factors; however, illnesses, certain surgeries, or medical treatments may cause menopause to occur earlier than it might have otherwise.
The length of a woman's menstrual cycle will typically vary, with some shorter cycles and some longer cycles. A woman who experiences variations of less than eight days between her longest cycles and shortest cycles is considered to have regular menstrual cycles. It is unusual for a woman to experience cycle length variations of less than four days. Length variation between eight and 20 days is considered as moderately irregular cycles. Variation of 21 days or more between a woman's shortest and longest cycle lengths is considered very irregular.
The menstrual cycle can be described by the ovarian or uterine cycle. The ovarian cycle describes changes that occur in the follicles of the ovary whereas the uterine cycle describes changes in the endometrial lining of the uterus. Both cycles can be divided into three phases. The ovarian cycle consists of the follicular phase, ovulation, and the luteal phase whereas the uterine cycle consists of menstruation, proliferative phase, and secretory phase.
The follicular phase is the first part of the ovarian cycle. During this phase, the ovarian follicles mature and ready to release an egg. The latter part of this phase overlaps with the proliferative phase of the uterine cycle.
Through the influence of a rise in follicle stimulating hormone (FSH) during the first days of the cycle, a few ovarian follicles are stimulated. These follicles, which were present at birth and have been developing for the better part of a year in a process known as folliculogenesis, compete with each other for dominance. Under the influence of several hormones, all but one of these follicles will stop growing, while one dominant follicle in the ovary will continue to maturity. The follicle that reaches maturity is called a tertiary, or Graafian, follicle, and it contains the ovum.
Ovulation is the second phase of the ovarian cycle in which a mature egg is released from the ovarian follicles into the oviduct. During the follicular phase, estradiol suppresses production of luteinizing hormone (LH) from the anterior pituitary gland. When the egg has nearly matured, levels of estradiol reach a threshold above which this effect is reversed and estrogen actually stimulates the production of a large amount of LH. This process, known as the LH surge, starts around day 12 of the average cycle and may last 48 hours.
The exact mechanism of these opposite responses of LH levels to estradiol is not well understood.:86 In animals, a Gonadotropin-releasing hormone (GnRH) surge has been shown to precede the LH surge, suggesting that estrogen's main effect is on the hypothalamus, which controls GnRH secretion.:86 This may be enabled by the presence of two different estrogen receptors in the hypothalamus: estrogen receptor alpha, which is responsible for the negative feedback estradiol-LH loop, and estrogen receptor beta, which is responsible for the positive estradiol-LH relationship. However in humans it has been shown that high levels of estradiol can provoke abrupt increases in LH, even when GnRH levels and pulse frequencies are held constant,:86 suggesting that estrogen acts directly on the pituitary to provoke the LH surge.
The release of LH matures the egg and weakens the wall of the follicle in the ovary, causing the fully developed follicle to release its secondary oocyte. The secondary oocyte promptly matures into an ootid and then becomes a mature ovum. The mature ovum has a diameter of about 0.2 mm.
Which of the two ovaries—left or right—ovulates appears essentially random; no known left and right co-ordination exists. Occasionally, both ovaries will release an egg; if both eggs are fertilized, the result is fraternal twins.
After being released from the ovary, the egg is swept into the fallopian tube by the fimbria, which is a fringe of tissue at the end of each fallopian tube. After about a day, an unfertilized egg will disintegrate or dissolve in the fallopian tube.
Fertilization by a spermatozoon, when it occurs, usually takes place in the ampulla, the widest section of the fallopian tubes. A fertilized egg immediately begins the process of embryogenesis, or development. The developing embryo takes about three days to reach the uterus and another three days to implant into the endometrium. It has usually reached the blastocyst stage at the time of implantation.
In some women, ovulation features a characteristic pain called mittelschmerz (German term meaning middle pain). The sudden change in hormones at the time of ovulation sometimes also causes light mid-cycle blood flow.
The luteal phase is the final phase of the ovarian cycle and it corresponds to the secretory phase of the uterine cycle. During the luteal phase, the pituitary hormones FSH and LH cause the remaining parts of the dominant follicle to transform into the corpus luteum, which produces progesterone. The increased progesterone in the adrenals starts to induce the production of estrogen. The hormones produced by the corpus luteum also suppress production of the FSH and LH that the corpus luteum needs to maintain itself. Consequently, the level of FSH and LH fall quickly over time, and the corpus luteum subsequently atrophies. Falling levels of progesterone trigger menstruation and the beginning of the next cycle. From the time of ovulation until progesterone withdrawal has caused menstruation to begin, the process typically takes about two weeks, with 14 days considered normal. For an individual woman, the follicular phase often varies in length from cycle to cycle; by contrast, the length of her luteal phase will be fairly consistent from cycle to cycle.
The loss of the corpus luteum can be prevented by fertilization of the egg; the resulting embryo produces human chorionic gonadotropin (hCG), which is very similar to LH and which can preserve the corpus luteum. Because the hormone is unique to the embryo, most pregnancy tests look for the presence of hCG.
Menstruation (also called menstrual bleeding, menses, catamenia or a period) is the first phase of the uterine cycle. The flow of menses normally serves as a sign that a woman has not become pregnant. (However, this cannot be taken as certainty, as a number of factors can cause bleeding during pregnancy; some factors are specific to early pregnancy, and some can cause heavy flow.)
Eumenorrhea denotes normal, regular menstruation that lasts for a few days (usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal). The average blood loss during menstruation is 35 milliliters with 10–80 ml considered normal. Women who experience Menorrhagia are more susceptible to iron deficiency than the average person. An enzyme called plasmin inhibits clotting in the menstrual fluid.
Painful cramping in the abdomen, back, or upper thighs is common during the first few days of menstruation. Severe uterine pain during menstruation is known as dysmenorrhea, and it is most common among adolescents and younger women (affecting about 67.2% of adolescent females). When menstruation begins, symptoms of premenstrual syndrome (PMS) such as breast tenderness and irritability generally decrease. Many sanitary products are marketed to women for use during their menstruation.
The proliferative phase is the second phase of the uterine cycle when a hormone causes the lining of the uterus to grow, or proliferate, during this time. As they mature, the ovarian follicles secrete increasing amounts of estradiol, an estrogen. The estrogens initiate the formation of a new layer of endometrium in the uterus, histologically identified as the proliferative endometrium. The estrogen also stimulates crypts in the cervix to produce fertile cervical mucus, which may be noticed by women practicing fertility awareness.
The secretory phase is the final phase of the uterine cycle and it corresponds to the luteal phase of the ovarian cycle. During the secretory phase, the corpus luteum produces progesterone, which plays a vital role in making the endometrium receptive to implantation of the blastocyst and supportive of the early pregnancy, by increasing blood flow and uterine secretions and reducing the contractility of the smooth muscle in the uterus; it also has the side effect of raising the woman's basal body temperature.
The average menstrual cycle lasts 28 days. The variability of menstrual cycle lengths is highest for women under 25 years of age and is lowest, that is, most regular, for ages 35 to 39. Subsequently, the variability increases slightly for women aged 40 to 44. Usually, length variation between eight and 20 days in a woman is considered as moderately irregular menstrual cycles. Variation of 21 days or more is considered very irregular.
As measured on women undergoing in vitro fertilization, a longer menstrual cycle length is associated with higher pregnancy and delivery rates, even after age adjustment. Delivery rates after IVF have been estimated to be almost doubled for women with a menstrual cycle length of more than 34 days compared with women with a menstrual cycle length shorter than 26 days. A longer menstrual cycle length is also significantly associated with better ovarian response to gonadotropin stimulation and embryo quality.
The luteal phase of the menstrual cycle is about the same length in most individuals (mean 14/13 days, SD 1.41 days) whereas the follicular phase tends to show much more variability (log-normally distributed with 95% of individuals having follicular phases between 10.3 and 16.3 days). The follicular phase also seems to get significantly shorter with age (geometric mean 14.2 days in women age 18-24 vs. 10.4 days in women aged 40–44).
The most fertile period (the time with the highest likelihood of pregnancy resulting from sexual intercourse) covers the time from some 5 days before until 1 to 2 days after ovulation. In a 28‑day cycle with a 14‑day luteal phase, this corresponds to the second and the beginning of the third week. A variety of methods have been developed to help individual women estimate the relatively fertile and the relatively infertile days in the cycle; these systems are called fertility awareness.
Fertility awareness methods that rely on cycle length records alone are called calendar-based methods. Methods that require observation of one or more of the three primary fertility signs (basal body temperature, cervical mucus, and cervical position) are known as symptoms-based methods. Urine test kits are available that detect the LH surge that occurs 24 to 36 hours before ovulation; these are known as ovulation predictor kits (OPKs). Computerized devices that interpret basal body temperatures, urinary test results, or changes in saliva are called fertility monitors.
A woman's fertility is also affected by her age. As a woman's total egg supply is formed in fetal life, to be ovulated decades later, it has been suggested that this long lifetime may make the chromatin of eggs more vulnerable to division problems, breakage, and mutation than the chromatin of sperm, which are produced continuously during a man's reproductive life. However, despite this hypothesis, a similar paternal age effect has also been observed.
Some women with neurological conditions experience increased activity of their conditions at about the same time during each menstrual cycle. For example, drops in estrogen levels have been known to trigger migraines, especially when the woman who suffers migraines is also taking the birth control pill. Many women with epilepsy have more seizures in a pattern linked to the menstrual cycle; this is called "catamenial epilepsy". Different patterns seem to exist (such as seizures coinciding with the time of menstruation, or coinciding with the time of ovulation), and the frequency with which they occur has not been firmly established. Using one particular definition, one group of scientists found that around one-third of women with intractable partial epilepsy have catamenial epilepsy. An effect of hormones has been proposed, in which progesterone declines and estrogen increases would trigger seizures. Recently, studies have shown that high doses of estrogen can cause or worsen seizures, whereas high doses of progestrone can act like an antiepileptic drug. Studies by medical journals have found that women experiencing menses are 1.68 times more likely to commit suicide.
Mice have been used as an experimental system to investigate possible mechanisms by which levels of sex steroid hormones might regulate nervous system function. During the part of the mouse estrous cycle when progesterone is highest, the level of nerve-cell GABA receptor subtype delta was high. Since these GABA receptors are inhibitory, nerve cells with more delta receptors are less likely to fire than cells with lower numbers of delta receptors. During the part of the mouse estrous cycle when estrogen levels are higher than progesterone levels, the number of delta receptors decrease, increasing nerve cell activity, in turn increasing anxiety and seizure susceptibility.
Estrogen levels may affect thyroid behavior. For example, during the luteal phase (when estrogen levels are lower), the velocity of blood flow in the thyroid is lower than during the follicular phase (when estrogen levels are higher).
Among women living closely together, it was once thought that the onsets of menstruation tend to synchronize. This effect was first described in 1971, and possibly explained by the action of pheromones in 1998. Subsequent research has called this hypothesis into question.
Research indicates that women have a significantly higher likelihood of anterior cruciate ligament injuries in the pre-ovulatory stage, than post-ovulatory stage.
The different phases of the menstrual cycle correlate with women’s moods. In some cases, hormones released during the menstrual cycle can cause behavioral changes in females; mild to severe mood swings can occur.The menstrual cycle phase and ovarian hormones may contribute to increased empathy in women. The natural shift of hormone levels during the different phases of the menstrual cycle have been studied in conjunction with test scores. When completing empathy exercises, women in the follicular stage of their menstrual cycle performed better than women in their midluteal phase. A significant correlation between progesterone levels and the ability to accurately recognize emotion was found. Performances on emotion recognition tasks were better when women had lower progesterone levels. Women in the follicular stage showed higher emotion recognition accuracy than their midluteal phase counterparts. Women were found to react more to negative stimuli when in midluteal stage over the women in the follicular stage, perhaps indicating more reactivity to social stress during that menstrual cycle phase. Overall, it has been found that women in the follicular phase demonstrated better performance in tasks that contain empathetic traits.
Fear response in women during two different points in the menstrual cycle has been examined. When oestrogen is highest in the preovulatory stage, women are significantly better at identifying expressions of fear than women who were menstruating which is when oestrogen levels are lowest. The women were equally able to identify happy faces, demonstrating that the fear response was a more powerful response. To summarize, menstrual cycle phase and the oestrogen levels correlates with women’s fear processing.
However, the examination of daily moods in women with measuring ovarian hormones may indicate a less powerful connection. In comparison to levels of stress or physical health, the ovarian hormones had less of an impact on overall mood. This indicates that while changes of ovarian hormones may influence mood, on a day-to-day level it does not influence mood more than other stressors do.
Infrequent or irregular ovulation is called oligoovulation. The absence of ovulation is called anovulation. Normal menstrual flow can occur without ovulation preceding it: an anovulatory cycle. In some cycles, follicular development may start but not be completed; nevertheless, estrogens will be formed and stimulate the uterine lining. Anovulatory flow resulting from a very thick endometrium caused by prolonged, continued high estrogen levels is called estrogen breakthrough bleeding. Anovulatory bleeding triggered by a sudden drop in estrogen levels is called changes. Anovulatory cycles commonly occur before menopause (perimenopause) and in women with polycystic ovary syndrome.
Very little flow (less than 10 ml) is called hypomenorrhea. Regular cycles with intervals of 21 days or fewer are polymenorrhea; frequent but irregular menstruation is known as metrorrhagia. Sudden heavy flows or amounts greater than 80 ml are termed menorrhagia. Heavy menstruation that occurs frequently and irregularly is menometrorrhagia. The term for cycles with intervals exceeding 35 days is oligomenorrhea. Amenorrhea refers to more than three to six months without menses (while not being pregnant) during a woman's reproductive years.
George Preti, an organic chemist at the Monell Chemical Senses Center in Philadelphia and Winnefred Cutler of the University of Pennsylvania's psychology department, discovered that women with irregular menstrual cycles became regular when exposed to male underarm extracts. They hypothesized that the only explanation was that underarms contain pheromones, as there was no other explanation for the effects, which mirrored how pheromones affect other mammals.
While some forms of birth control do not affect the menstrual cycle, hormonal contraceptives work by disrupting it. Progestogen negative feedback decreases the pulse frequency of gonadotropin-releasing hormone (GnRH) release by the hypothalamus, which decreases the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by the anterior pituitary. Decreased levels of FSH inhibit follicular development, preventing an increase in estradiol levels. Progestogen negative feedback and the lack of estrogen positive feedback on LH release prevent a mid-cycle LH surge. Inhibition of follicular development and the absence of a LH surge prevent ovulation.
The degree of ovulation suppression in progestogen-only contraceptives depends on the progestogen activity and dose. Low dose progestogen-only contraceptives—traditional progestogen only pills, subdermal implants Norplant and Jadelle, and intrauterine system Mirena—inhibit ovulation in about 50% of cycles and rely mainly on other effects, such as thickening of cervical mucus, for their contraceptive effectiveness. Intermediate dose progestogen-only contraceptives—the progestogen-only pill Cerazette and the subdermal implant Nexplanon—allow some follicular development but more consistently inhibit ovulation in 97–99% of cycles. The same cervical mucus changes occur as with very low-dose progestogens. High-dose, progestogen-only contraceptives—the injectables Depo-Provera and Noristerat—completely inhibit follicular development and ovulation.
Combined hormonal contraceptives include both an estrogen and a progestogen. Estrogen negative feedback on the anterior pituitary greatly decreases the release of LH, which makes combined hormonal contraceptives more effective at inhibiting follicular development and preventing ovulation. Estrogen also reduces the incidence of irregular breakthrough bleeding. Several combined hormonal contraceptives—the pill, NuvaRing, and the contraceptive patch—are usually used in a way that causes regular withdrawal bleeding. In a normal cycle, menstruation occurs when estrogen and progesterone levels drop rapidly. Temporarily discontinuing use of combined hormonal contraceptives (a placebo week, not using patch or ring for a week) has a similar effect of causing the uterine lining to shed. If withdrawal bleeding is not desired, combined hormonal contraceptives may be taken continuously, although this increases the risk of breakthrough bleeding.
Breastfeeding causes negative feedback to occur on pulse secretion of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH). Depending on the strength of the negative feedback, breastfeeding women may experience complete suppression of follicular development, follicular development but no ovulation, or normal menstrual cycles may resume. Suppression of ovulation is more likely when suckling occurs more frequently. The production of prolactin in response to suckling is important to maintaining lactational amenorrhea. On average, women who are fully breastfeeding whose infants suckle frequently experience a return of menstruation at fourteen and a half months postpartum. There is a wide range of response among individual breastfeeding women, however, with some experiencing return of menstruation at two months and others remaining amenorrheic for up to 42 months postpartum.
The word "menstruation" is etymologically related to "moon". The terms "menstruation" and "menses" are derived from the Latin mensis (month), which in turn relates to the Greek mene (moon) and to the roots of the English words month and moon.
Some authors believe that, historically, women in traditional societies without nightlighting ovulated with the full moon and menstruated with the new moon, and one author documents the controversial attempts to use the association to improve the rhythm method of regulating conception.
Some studies in both humans and other animals have found that artificial light at night does influence the menstrual cycle in humans and the estrus cycle in mice (cycles are more regular in the absence of artificial light at night). It has also been suggested that bright light exposure in the morning promotes more regular cycles. One author has suggested that sensitivity of women's cycles to nightlighting is caused by nutritional deficiencies of certain vitamins and minerals.
A meta-analysis of studies from 1996 showed no correlation between the human menstrual cycle and the lunar cycle. Dogon villagers did not have electric lighting and spent most nights outdoors, talking and sleeping; so they were an ideal population for detecting a lunar influence; none, however, was found.
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Fertility awareness (FA) refers to a set of practices used to determine the fertile and infertile phases of a woman's menstrual cycle. Fertility awareness methods may be used to avoid pregnancy, to achieve pregnancy, or as a way to monitor gynecological health.
Methods of identifying infertile days have been known since antiquity, but scientific knowledge gained during the past century has increased the number and variety of methods.
Systems of fertility awareness rely on observation of changes in one or more of the primary fertility signs (basal body temperature, cervical mucus, and cervical position), tracking menstrual cycle length and identifying the fertile window based on this information, or both. Other signs may also be observed: these include breast tenderness and mittelschmerz (ovulation pains), urine analysis strips known as ovulation predictor kits (OPKs), and microscopic examination of saliva or cervical fluid. Also available are computerized fertility monitors.
Symptoms-based methods involve tracking one or more of the three primary fertility signs - basal body temperature, cervical mucus, and cervical position. Systems relying exclusively on cervical mucus include the Billings Ovulation Method, The Ovulation Method, the Creighton Model, and the Two-Day Method. Symptothermal methods combine observations of basal body temperature (BBT), cervical mucus, and sometimes cervical position. Calendar-based methods rely on tracking a woman's cycle and identifying her fertile window based on the lengths of her cycles. The best known of these methods is the Standard Days Method. The Calendar-Rhythm method is also considered a calendar-based method though it is not well defined and has many different meanings to different people.
Systems of fertility awareness may be referred to as fertility awareness-based methods (FAB methods); the term Fertility Awareness Method (FAM) refers specifically to the system taught by Toni Weschler. The term "natural family planning" (NFP) is sometimes used to refer to any use of FA methods. However, ][, which are: the Lactational amenorrhea method, and periodic abstinence during fertile times. A method of FA may be used by NFP users to identify these fertile times.
Women who are breastfeeding a child and wish to avoid pregnancy may be able to practice the lactational amenorrhea method (LAM). LAM is distinct from fertility awareness, but because it also does not involve devices or chemicals, it is often presented alongside FA][ as a method of "natural" birth control.
It is not known exactly when it was first discovered that women have predictable periods of fertility and infertility. St. Augustine wrote about periodic abstinence to avoid pregnancy in the year 388 (the Manichaeans attempted to use this method to remain childfree, and Augustine condemned their use of periodic abstinence). One book states that periodic abstinence was recommended "by a few secular thinkers since the mid-nineteenth century," but the dominant force in the twentieth century popularization of fertility awareness-based methods was the Roman Catholic Church.
In 1905 Theodoor Hendrik van de Velde, a Dutch gynecologist, showed that women only ovulate once per menstrual cycle. In the 1920s, Kyusaku Ogino, a Japanese gynecologist, and Hermann Knaus, from Austria, independently discovered that ovulation occurs about fourteen days before the next menstrual period. Ogino used his discovery to develop a formula for use in aiding infertile women to time intercourse to achieve pregnancy. In 1930, John Smulders, Roman Catholic physician from the Netherlands, used this discovery to create a method for avoiding pregnancy. Smulders published his work with the Dutch Roman Catholic medical association, and this was the first formalized system for periodic abstinence — the rhythm method.
In the 1930s, Rev. Wilhelm Hillebrand, a Catholic priest in Germany, developed a system for avoiding pregnancy based on basal body temperature. This temperature method was found to be more effective at helping women avoid pregnancy than calendar-based methods. Over the next few decades, both systems became widely used among Catholic women. Two speeches delivered by Pope Pius XII in 1951 gave the highest form of recognition to the Catholic Church's approval—for couples who needed to avoid pregnancy—of these systems. In the early 1950s, Dr. John Billings discovered the relationship between cervical mucus and fertility while working for the Melbourne Catholic Family Welfare Bureau. Dr. Billings and several other physicians, including his wife, Dr. Evelyn Billings, studied this sign for a number of years, and by the late 1960s had performed clinical trials and begun to set up teaching centers around the world.
While Dr. Billings initially taught both the temperature and mucus signs, they encountered problems in teaching the temperature sign to largely illiterate populations in developing countries. In the 1970s they modified the method to rely on only mucus. The international organization founded by Dr. Billings is now known as the World Organization Ovulation Method Billings (WOOMB).
The first organization to teach a symptothermal method was founded in 1971. John and Sheila Kippley, lay Catholics, joined with Dr. Konald Prem in teaching an observational method that relied on all three signs: temperature, mucus, and also cervical position. Their organization is now called Couple to Couple League International. The next decade saw the founding of other now-large Catholic organizations — Family of the Americas (1977), teaching the Billings method, and the Pope Paul VI Institute (1985), teaching a new mucus-only system called the Creighton Model.
Up until the 1980s, information about fertility awareness was only available from Catholic sources. The first secular teaching organization was the Fertility Awareness Center in New York, founded in 1981. Toni Weschler started teaching in 1982 and published the bestselling book Taking Charge of Your Fertility in 1995. Justisse was founded in 1987 in Edmonton, Canada. These secular organizations all teach symptothermal methods. Although the Catholic organizations are significantly larger than the secular fertility awareness movement, independent secular teachers have become increasingly common throughout the 1990s and 2000s.
Development of fertility awareness methods is ongoing. In the late 1990s, the Institute for Reproductive Health at Georgetown University introduced two new methods. The Two-Day Method, a mucus-only system, and CycleBeads and iCycleBeads (the digital version), based on the Standard Days Method, are designed to be both effective and very simple to teach, learn, and use.
Most menstrual cycles have several days at the beginning that are infertile (pre-ovulatory infertility), a period of fertility, and then several days just before the next menstruation that are infertile (post-ovulatory infertility). The first day of red bleeding is considered day one of the menstrual cycle. Different systems of fertility awareness calculate the fertile period in slightly different ways, using primary fertility signs, cycle history, or both.
The three primary signs of fertility are basal body temperature (BBT), cervical mucus, and cervical position. A woman practicing symptoms-based fertility awareness may choose to observe one sign, two signs, or, all three. Many women experience secondary fertility signs that correlate with certain phases of the menstrual cycle. Examples include abdominal pain and heaviness, back pain, breast tenderness and mittelschmerz (ovulation pains).
This classifies a temperature reading collected when a person first wakes up in the morning (or after their longest sleep period of the day). In women, ovulation will trigger a rise in BBT between 0.3 and 0.9 °C (0.5 and 1.6 °F) that lasts approximately until the next menstruation. This temperature shift may be used to determine the onset of post-ovulatory infertility.
The appearance of cervical mucus and vulvar sensation are generally described together as two ways of observing the same sign. Cervical mucus is produced by the cervix, which connects the uterus to the vaginal canal. Fertile cervical mucus promotes sperm life by decreasing the acidity of the vagina, and also helps guide sperm through the cervix and into the uterus. The production of fertile cervical mucus is caused by the same hormone (estrogen) that prepares a woman's body for ovulation. By observing her cervical mucus, and paying attention to the sensation as it passes the vulva, a woman can detect when her body is gearing up for ovulation, and also when ovulation has passed. When ovulation occurs, estrogen production drops slightly and progesterone starts to rise. The rise in progesterone causes a distinct change in the quantity and quality of mucus observed at the vulva.
The cervix changes position in response to the same hormones that cause cervical mucus to be produced and to dry up. When a woman is in an infertile phase of her cycle, the cervix will be low in the vaginal canal; it will feel firm to the touch (like the tip of a person's nose); and, the os – the opening in the cervix – will be relatively small, or 'closed'. As a woman becomes more fertile, the cervix will rise higher in the vaginal canal; it will become softer to the touch (more like a person's lips); and the os will become more open. After ovulation has occurred, the cervix will revert to its infertile position.
Calendar-based systems determine both pre-ovulatory and post-ovulatory infertility based on cycle history. When used to avoid pregnancy, these systems have higher perfect-use failure rates than symptoms-based systems, but are still comparable to barrier methods such as diaphragms and cervical caps.
Mucus- and temperature-based methods used to determine post-ovulatory infertility, when used to avoid conception, result in very low perfect-use pregnancy rates. However, mucus and temperature systems have certain limitations in determining pre-ovulatory infertility. A temperature record alone provides no guide to fertility or infertility before ovulation occurs. Determination of pre-ovulatory infertility may be done by observing the absence of fertile cervical mucus; however, this results in a higher failure rate than that seen in the period of post-ovulatory infertility. Relying only on mucus observation also means that unprotected sexual intercourse is not allowed during menstruation, since any mucus would be obscured.
Use of certain calendar rules to determine the length of the pre-ovulatory infertile phase allows unprotected intercourse during the first few days of the menstrual cycle, while maintaining a very low risk of pregnancy. With mucus-only methods, there is a possibility of incorrectly identifying mid-cycle or anovulatory bleeding as menstruation. Keeping a BBT chart enables accurate identification of menstruation, when pre-ovulatory calendar rules may be reliably applied. In temperature-only systems, a calendar rule may be relied on alone to determine pre-ovulatory infertility. In symptothermal systems, the calendar rule is cross-checked by mucus records: observation of fertile cervical mucus overrides any calendar-determined infertility.
Calendar rules may set a standard number of days, specifying that (depending on a woman's past cycle lengths) the first three to six days of each menstrual cycle are considered infertile. Or, a calendar rule may require calculation, for example holding that the length of the pre-ovulatory infertile phase is equal to the length of a woman's shortest cycle minus twenty-one days. Rather than being tied to cycle length, a calendar rule may be determined from the cycle day on which a woman observes a thermal shift. One system has the length of the pre-ovulatory infertile phase equal to a woman's earliest historical day of temperature rise minus seven days.
Ovulation predictor kits (OPKs) can detect imminent ovulation from the concentration of lutenizing hormone (LH) in a woman's urine. A positive OPK is usually followed by ovulation within 12–36 hours.
Saliva microscopes, when correctly used, can detect ferning structures in the saliva that precede ovulation. Ferning is usually detected beginning three days before ovulation, and continuing until ovulation has occurred. During this window, ferning structures occur in cervical mucus as well as saliva.
Computerized fertility monitors are available under various brand names. These monitors may use BBT-only systems, they may analyze urine test strips, they may use symptothermal observations, they may monitor the electrical resistance of saliva and vaginal fluids, or a combination of any of these factors.
Fertility awareness has a number of unique characteristics:
By restricting unprotected sexual intercourse to the infertile portion of the menstrual cycle, a woman and her partner can prevent pregnancy. During the fertile portion of the menstrual cycle, the couple may use barrier contraception or abstain from sexual intercourse. Or the couple may attempt to control birth in the opposite sense by timing intercourse to achieve pregnancy.
The effectiveness of fertility awareness, as of most forms of contraception, can be assessed two ways. Perfect use or method effectiveness rates only include people who follow all observational rules, correctly identify the fertile phase, and refrain from unprotected intercourse on days identified as fertile. Actual use, or typical use effectiveness rates are of all women relying on fertility awareness to avoid pregnancy, including those who fail to meet the "perfect use" criteria. Rates are generally presented for the first year of use. Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables.
The failure rate of fertility awareness varies widely depending on the system used to identify fertile days, the instructional method, and the population being studied. Some studies have found actual failure rates of 25% per year or higher. At least one study has found a failure rate of less than 1% per year with continuous intensive coaching and monthly review, and several studies have found actual failure rates of 2-3% per year.
When used correctly and consistently (i.e., perfect use) with ongoing coaching, under study conditions some studies have found some forms of FA to be 99% effective.
From Contraceptive Technology:
Several factors account for typical use effectiveness being lower than perfect use effectiveness:
The most common reason for the lower actual effectiveness is not mistakes on the part of instructors or users, but conscious user non-compliance, i.e., the couple knowing that the woman is likely to be fertile at the time, but engaging in sexual intercourse nonetheless. This is similar to failures of barrier methods, which are primarily caused by non-use of the method.
A study by Barrett and Marshall has shown that random acts of intercourse achieve a 24% pregnancy rate per cycle. That study also found that timed intercourse based on information from a BBT-only method of FA increased pregnancy rates to 31%-68%.
Studies of cervical-mucus methods of fertility awareness have found pregnancy rates of 67%-81% in the first cycle if intercourse occurred on the Peak Day of the mucus sign.
Because of high rates of very early miscarriage (25% of pregnancies are lost within the first six weeks since the woman's last menstrual period, or LMP), the methods used to detect pregnancy may lead to bias in conception rates. Less-sensitive methods will detect lower conception rates, because they miss the conceptions that resulted in early pregnancy loss. A Chinese study of couples practicing random intercourse to achieve pregnancy used very sensitive pregnancy tests to detect pregnancy. It found a 40% conception rate per cycle over the 12-month study period.
Regular menstrual cycles are sometimes taken as evidence that a woman is ovulating normally, and irregular cycles as evidence she is not. However, many women with irregular cycles do ovulate normally, and some with regular cycles are actually annovulatory or have a luteal phase defect. Records of basal body temperatures, especially, but also of cervical mucus and position, can be used to accurately determine if a woman is ovulating, and if the length of the post-ovulatory (luteal) phase of her menstrual cycle is sufficient to sustain a pregnancy.
Fertile cervical mucus is important in creating an environment that allows sperm to pass through the cervix and into the fallopian tubes where they wait for ovulation. Fertility charts can help diagnose hostile cervical mucus, a common cause of infertility. If this condition is diagnosed, some sources suggest taking guaifenesin in the few days before ovulation to thin out the mucus.
Pregnancy tests are not accurate until 1–2 weeks after ovulation. Knowing an estimated date of ovulation can prevent a woman from getting false negative results due to testing too early. Also, 18 consecutive days of elevated temperatures means a woman is almost certainly pregnant.
Estimated ovulation dates from fertility charts are a more accurate method of estimating gestational age than the traditional pregnancy wheel or last menstrual period (LMP) method of tracking menstrual periods.
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The corpus luteum (Latin for "yellow body") (plural corpora lutea) is a temporary endocrine structure in female mammals that is involved in the production of relatively high levels of progesterone and moderate levels of estradiol and inhibin A. It is colored as a result of concentrating carotenoids from the diet and secretes a moderate amount of estrogen to inhibit further release of Gonadotropin-releasing hormone (GnRH) and thus secretion of Luteinizing hormone (LH) and Follicle-stimulating hormone (FSH).
The corpus luteum develops from an ovarian follicle during the luteal phase of the menstrual cycle or estrous cycle, following the release of a secondary oocyte from the follicle during ovulation. The follicle first forms a corpus hemorrhagicum before it becomes a corpus luteum, but the term refers to the visible collection of blood left after rupture of the follicle that secretes progesterone. While the oocyte (later the zygote if fertilization occurs) traverses the Fallopian tube into the uterus, the corpus luteum remains in the ovary.
The corpus luteum is typically very large relative to the size of the ovary; in humans, the size of the structure ranges from under 2 cm to 5 cm in diameter.
Its cells develop from the follicular cells surrounding the ovarian follicle. The follicular theca cells luteinize into small luteal cells, (thecal-lutein cells) and follicular granulosa cells (granulosal-lutein cells), luteinize into large luteal cells forming the corpus luteum. Progesterone is synthesized from cholesterol by both the large and small luteal cells upon luteal maturation. Cholesterol-LDL complexes bind to receptors on the plasma membrane of luteal cells and are internalized. Cholesterol is released and stored within the cell as cholesterol ester. LDL is recycled for further cholesterol transport. Large luteal cells produce more progesterone due to uninhibited/basal levels of PKA activity within the cell. Small luteal cells have LH receptors that regulate PKA activity within the cell. PKA actively phosphorylates StAR (steroidogenic acute regulatory protein) and PBR (peripheral benzodiazepine receptors) to transport cholesterol from the outer mitochondrial membrane to the inner mitochondrial membrane.
The development of the corpus luteum is accompanied by an increase in the level of the steroidogenic enzyme P450scc that converts cholesterol to pregnenolone in the mitochondria. Pregnenolone is then converted to progesterone that is secreted out of the cell and into the blood stream. During the bovine estrous cycle, plasma levels of progesterone increase in parallel to the levels of P450scc and its electron donor adrenodoxin, indicating that progesterone secretion is a result of enhanced expression of P450scc in the corpus luteum.
The mitochondrial P450 system electron transport chain including adrenodoxin reductase and adrenodoxin has been shown to leak electrons leading to the formation of superoxide radical. Apparently to cope with the radicals produced by this system and by enhanced mitochondrial metabolism, the levels of antioxidant enzymes catalase and superoxide dismutase also increase in parallel with the enhanced steroidogenesis in the corpus luteum.
Like the previous theca cells, the theca lutein cells lack the aromatase enzyme that is necessary to produce estrogen, so they can only perform steroidogenesis until formation of androgens. The granulosa lutein cells do have aromatase, and use it to produce estrogens, using the androgens previously synthesized by the theca lutein cells, as the granulosa lutein cells in themselves do not have the 17α-hydroxylase or 17,20 lyase to produce androgens.
Once the corpus luteum regressed the remnant is known as corpus albicans.
The corpus luteum is essential for establishing and maintaining pregnancy in females. The corpus luteum secretes progesterone, which is a steroid hormone responsible for the decidualization of the endometrium (its development) and maintenance, respectively.
If the egg is not fertilized, the corpus luteum stops secreting progesterone and decays (after approximately 14 days in humans). It then degenerates into a corpus albicans, which is a mass of fibrous scar tissue.
The uterine lining sloughs off without progesterone and is expelled through the vagina (in humans and some great apes, which go through a menstrual cycle). In an estrous cycle, the lining degenerates back to normal size.
If the egg is fertilized and implantation occurs, the syncytiotrophoblast (derived from trophoblast) cells of the blastocyst secrete the hormone human chorionic gonadotropin (hCG, or a similar hormone in other species) by day 9 post-fertilization.
Human chorionic gonadotropin signals the corpus luteum to continue progesterone secretion, thereby maintaining the thick lining (endometrium) of the uterus and providing an area rich in blood vessels in which the zygote(s) can develop. From this point on, the corpus luteum is called the corpus luteum graviditatis.
The introduction of prostaglandins at this point causes the degeneration of the corpus luteum and the abortion of the fetus. However, in placental animals such as humans, the placenta eventually takes over progesterone production and the corpus luteum degrades into a corpus albicans without embryo/fetus loss.
Luteal support refers to the administration of medication (generally progestins) for the purpose of increasing the success of implantation and early embryogenesis, thereby complementing the function of the corpus luteum.
The yellow color and name of the corpus luteum, like that of the macula lutea of the retina, is due to its concentration of certain carotenoids, especially lutein. In 1968, a report indicated that beta-carotene was synthesized in laboratory conditions in slices of corpus luteum from cows. However, attempts have been made to replicate these findings, but have not succeeded. The idea is not presently accepted by the scientific community. Rather, the corpus luteum concentrates carotenoids from the diet of the mammal.
Order of changes in ovary
Human ovary with fully developed corpus luteum
Luteinized follicular cyst. H&E stain.
CT of the abdomen showing a ruptured hemorrhagic copus luteal cyst
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A fertility monitor is an electronic device which may use various methods to assist the user with fertility awareness. A fertility monitor may analyze changes in hormone levels in urine, basal body temperature, electrical resistance of saliva and vaginal fluids, or a combination of these methods. These devices may assist in pregnancy achievement.
The Clearblue Easy monitor works by detecting increased levels of luteinizing hormone (LH) in urine collected from disposable urine test sticks. It identifies up to six fertile days per cycle. The manufacturer, Swiss Precision Diagnostics, recommends that it is to be used as a pregnancy achievement aid only.
The Persona monitor is a small hand-held device that reads results from disposable urine test sticks to determine when ovulation is approaching and to detect when ovulation has passed. When the urine sample is inserted into the device, the woman's fertility is indicated by means of a red ("fertile") or green ("less fertile") light on the monitor. Persona was originally produced by Unipath, and is now produced by Swiss Precision Diagnostics. It is available only in Europe.
The OvuSense system consists of a personal Sensor, placed overnight in the vagina, and a Reader onto which data are downloaded each morning. The Reader provides a daily updated chart detailing relative temperature, and at the end of each month a predicted fertile period for the following month and an analysis of ovulation patterns over previous months. Clinical studies presented at ESHRE 2012 and ASRM 2012, based on the methodology described by Freundl et al. 2003 show comparisons between ultrasound folliculometry (taken as gold standard) and oral temperature. Analysis of these trial data allow the calculation of a quality score for OvuSense versus ultrasound folliculometry and other methodologies, as suggested by Freundl et al. 2003 and a daily probability for fecundity based on a scale described by Colombo and Masarotto in 2000
The DuoFertility system consists of a body-worn sensor, a handheld reader, and computer software. The sensor is worn under the arm like a patch, where it automatically collects up to 20,000 temperature readings per day. The collected data is then transferred to the handheld reader, which stores the data and analyzes it to calculate fertility. The reader is then connected to a computer with the DuoFertility software installed, and the software displays more detailed fertility information. The manufacturer, Cambridge Temperature Concepts, claims that the product is as effective as IVF for patients with unexplained infertility or mild-to-moderate male or female factors. It is marketed as a pregnancy achievement aid only.
They take basal body temperature (BBT) and then automatically compare it with its bio-mathematical forecasting software and stored information of all available family planning research (700,000 cycles of other women) - to accurately determine, analyze and display fertile and not fertile days of the individual menstrual cycle. The clinically proven reliability is 99.3%. Additionally Baby-Comp was also designed not only as natural birth control monitor, but also as family planning support for couples with conception difficulties with built-in gender predictor and hormonal imbalances, cycles without ovulation and 'Corpus Luteum' deficiency recognition.
They are manufactured in Germany by VE Valley Electronics GmbH. All devices are tested and CE & ISO-certified medical diagnostic devices. They are also approved as natural contraception / family planning device in Europe and as ovulation predictor in US.
The OvaCue Fertility Monitor is marketed for trying-to-conceive purposes only. It works by measuring the electrolyte composition of saliva to determine approaching ovulation. It is sold with an optional vaginal sensor to retroactively confirm the date ovulation occurred. The manufacturer, Fairhaven Health, claims that this technique has been demonstrated to be 98.3% accurate in predicting ovulation in clinical studies overseen by the National Institute of Health.
Cyclotest Baby and Cyclotest 2 Plus are both sympto-thermal fertility monitors. By measuring basal body temperature (BBT) and menstruation dates it functions as a cyclo-thermic device which can predict fertility with a 97% accuracy.][
As an optional addition to BBT and menstruation dates, extra fertility indicators can be recorded, including cervical mucus observations. When the user observes the sticky, egg type cervical mucus a button can be pressed on the cyclotest to record the timing of that event. Likewise, a positive result from an ovulation predictor kit can be recorded. Both of these events are synonymous with ovulation and are usually observed 24–48 hours prior to ovulation. The optional addition of one of these two fertility indicators allows the device to apply the algorithms of the Symptothermal Method.
Results are displayed on an LCD screen which allows the user to see their entire predicted cycle and this cycle's fertility window. Other functionality includes USB connectivity for the user to download their cycle data. The manufacturer, , claims the Cyclotest 2 Plus has a Pearl Index of 1.0 - 3.0, A study of 207 cycles conducted in 1998 observed that the device requested more abstinence than was necessary at the end of the fertile time in about 12% of the cycles, and thus concluded that more research should be performed on detecting the end of the fertile time. The result of this is therefore a heavier cushion of abstinence at the start of the luteral phase.
Women undergo an electrolyte change about three to four days prior to ovulation that persists for two to three days following ovulation. This change can be observed as ferning patterns in her dried saliva upon microscopic examination. Baby Start, Fertile-Focus, Maybe Baby,Ovulens and Aphrodite Test are products which use this technology.
Basal body temperature is the lowest temperature attained by the body during rest (usually during sleep). It is generally measured immediately after awakening and before any physical activity has been undertaken, although the temperature measured at that time is somewhat higher than the true basal body temperature (see Fig. 1). In women, ovulation causes an increase of one-half to one degree Fahrenheit (one-quarter to one-half degree Celsius) in basal body temperature (BBT); monitoring of BBTs is one way of estimating the day of ovulation. The tendency of a woman to have lower temperatures before ovulation, and higher temperatures afterwards, is known as a biphasic]disambiguation needed[ pattern. Charting of this pattern may be used as a component of fertility awareness.
Reproductive endocrinology and infertility (REI) is a surgical subspecialty of obstetrics and gynecology that trains physicians in reproductive medicine addressing hormonal functioning as it pertains to reproduction as well as the issue of infertility. While most REI specialists primarily focus on the treatment of infertility, reproductive endocrinologists are trained to also evaluate and treat hormonal dysfunctions in females and males outside of infertility. Reproductive endocrinologists have specialty training in obstetrics and gynecology (ob-gyn) before they undergo sub-specialty training (fellowship) in REI.
Reproductive surgery is a related specialty, where a physician in ob-gyn or urology further specializes to operate on anatomical disorders that affect fertility.
Human reproduction is any form of sexual reproduction resulting in the conception of a child, typically involving sexual intercourse between a man and a woman. During sexual intercourse, the interaction between the male and female reproductive systems results in fertilization of the woman's ovum by the man's sperm, which after a gestation period is followed by childbirth. The fertilization of the ovum may nowadays be achieved by artificial insemination methods, which do not involve sexual intercourse.
Menstrual cycle is the cycle of changes that occurs in the uterus and ovary for the purpose of sexual reproduction. It is essential for the production of eggs and for the preparation of the uterus for pregnancy. The menstrual cycle occurs only in fertile female humans and other female primates.
In humans, the length of a menstrual cycle varies greatly among women (ranging from 25 to 35 days), with 28 days designated as the average length. Each cycle can be divided into three phases based on events in the ovary (ovarian cycle) or in the uterus (uterine cycle). The ovarian cycle consists of the follicular phase, ovulation, and luteal phase whereas the uterine cycle is divided into menstruation, proliferative phase, and secretory phase. Both cycles are controlled by the endocrine system and the normal hormonal changes that occur can be interfered with using hormonal contraception to prevent reproduction. Ovulation