In this article, I’m dive into some basics of fertility and reproduction:
- Understanding the menstrual cycle
- The basics of the Two Week Wait
- What is implantation and when does it occur?
- Can you do any testing during the implantation window?
- How can you support implantation?
- Learn about tools that help understand conception
- Understanding the menstrual cycle
The menstrual cycle is a month-long process where your body prepares and releases an egg during ovulation and prepares the body for a possible pregnancy. It’s controlled by four main cycle hormones; follicle stimulating hormone (FSH), estrogen, luteinizing hormone (LH), and progesterone.
There are two main phases of your cycle, the follicular phase and the luteal phase. These phases are separated by the release of the egg. During the follicular phase, your body recruits and prepares an egg for release. First, FSH stimulates the ovary to produce follicles. In each follicle is an egg. Then FSH helps the ovary choose the dominant follicle, which contains the egg that will mature and be released that cycle.
As the follicles are growing and one becomes dominant, the ovary starts producing estrogen. Estrogen is one of the hormones that helps prepare the uterus for pregnancy by thickening the uterine lining. Since estrogen levels start to rise as you get closer and closer to ovulation, an initial rise in estrogen signals the opening of your fertile window, the few days each month when intercourse or insemination is most likely to result in conception.
Once estrogen reaches a high level, this signals your brain that the egg is ready to ovulate. The brain then sends a surge of LH to the ovary that ruptures the follicle and triggers it to release the egg. A surge in LH is predictive of ovulation. Since ovulation occurs about 12 to 36 hours after an LH surge, ovulation occurs, and then the egg is released.
But as we know, your cycle isn’t over after ovulation. Then we enter the luteal phase. During the luteal phase, the egg travels to the fallopian tube where it will hopefully be fertilized by sperm and then will make its way to the uterus in hopes of starting a pregnancy. While this is happening, the empty follicle on the ovary starts producing progesterone.
Progesterone is the hormone that stabilizes that thickened uterine lining and makes it sticky enough so that a fertilized egg can successfully implant and a pregnancy could begin. If the egg isn’t fertilized or doesn’t implant, then your progesterone levels drop and your period begins.
What is the two week wait?
If you’re trying to get pregnant, you may have heard the term two week wait, or TWW for short. It’s not always everyone’s favorite term. The two week wait refers to the period of time between an LH surge or a positive ovulation test and when you’re able to take a pregnancy test. As you probably guessed, there’s about a two week or 14-day period between ovulation and when your next period should arrive, or if you’re pregnant, this is also considered a missed period.
The two week wait is often a dreaded term for those trying to conceive, as it is quite literally a two week wait in which it’s difficult to know what exactly is going on in your body. With a little more knowledge of your cycle, you can have a better idea of what usually happens during the two weeks between ovulation and taking a pregnancy test.
What is implantation and when does it occur?
As we now know, the part of your cycle after ovulation is just as important as the part before it. After ovulation occurs, an egg can be fertilized by sperm and then travel down to the uterus. Once it’s in the uterus, the next step is for the embryo to attach to the uterine wall. This is called implantation, it marks the moment a pregnancy begins.
It typically takes a fertilized egg about seven to 10 days to implant after ovulation. These four days are referred to as the implantation window when implantation and getting pregnant is actually possible. As you may have guessed, the implantation window falls right in the middle of the infamous two week wait. This means that understanding implantation can help you better understand what goes on during those fourteen days.
Can you do any testing during the implantation window?
Yes. Progesterone is the hormone produced after ovulation that prepares the uterus for implantation and pregnancy. Progesterone is required for implantation and must be elevated for the entire seven to 10 day implantation window in order for you to have the best possible chance at implantation and pregnancy.
You can get a progesterone blood test from your doctor, but while this test can confirm if you’ve ovulated, a measurement taken at a single point in time doesn’t tell you anything about whether or not your levels remained elevated for the entire implantation window. That’s where PdG comes in.
PdG is a marker of progesterone found in urine and it’s elevated when progesterone is elevated. I recommend Proov tests to all of my patients who are tracking PdG and ovulation. Proov has a unique testing method to measure PdG during the implantation window to confirm successful ovulation. High PdG levels during these four days can really help increase your chances of getting pregnant.
I was recently part of a clinical study where we compared women with low PdG after ovulation against women with high PdG after ovulation. The results were mind-blowing. Women with high PdG levels during the implantation window were 75% more likely to get pregnant. On the other hand, when PdG levels were low, the rate of first trimester miscarriage was almost 90%. Therefore, having good PdG levels during implantation if you’re trying to get pregnant is so critical to your success.
How can you support implantation?
All of the information about implantation and progesterone is great, but what exactly are you supposed to do with that? The best way to support implantation is to support progesterone production.
The same clinical study from earlier also found that have you have low PdG levels after ovulation there were simple medications that would increase PdG levels and pregnancy rates. These included ovulation induction medications like Clomid and Letrozole. Progesterone supplementation after ovulation also improved low PdG levels and pregnancy rates.
If you’re getting low PdG results or your PdG levels drop before the end of the implantation window, please share your results with your doctor and ask about supporting ovulation with these medications.
There are also other ways you can support progesterone production naturally. Herbal supplements like Proov Pro can help support your natural progesterone production. It contains Vitex, also known as chaste berry, and maca root. These herbs help support the ovary to produce progesterone. It also contains Ashwagandha, which helps regulate cortisol levels, which in turn helps the ovary make progesterone.
You can explore lifestyle changes. Simple things like not microwaving food in plastic and doing less intense exercise after ovulation can help you produce a healthy amount of progesterone. Diet changes are a great option as well. Diets rich in leafy greens like spinach, kale, and swiss chard have tons of B vitamins that are the building blocks of progesterone. Beans, lentils, and sweet potatoes are also excellent foods to help support progesterone production.
Finally, eating a tablespoon each of sunflower seeds and sesame seeds after ovulation can support progesterone levels as well. If you eat the seeds raw, they contain high amounts of zinc, vitamin E, lignans, and selenium that help build progesterone and reduce excess estrogen.
Thanks for joining me tonight. Please look out for our next show. Have a good night.
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