Calendar Method Vs. OPK? It's All In The Timing...

Question:

So my husband and I are trying for our first child. We've trying for about 3 months with no luck yet. i was thinking of trying the ovulation test but i'm not sure if its worth it. I've read online that they can help but i figure it would never hurt to ask. Do you know much about them and if there worth the money or should i just track my temp every morning.Thanks for the help! S. from Canada

Answer:

Hello S. from Canada,

An ovulation predictor kit (OPK) does not help any more than timing it well. I don't recommend it to my patients. Instead, I recommend the calendar timing method. It goes like this:

CD#1 The day your period starts. Mark you calendar then count each day. For instance the next day is cycle day #2, then cycle day #3 etc.

CD#10 Stop having intercourse. You can have regular intercourse until that day but you have to stop on that day.

CD#13-17 Assuming you have normal regular cycles, this is your fertile period. You should have intercourse each day, only once per day and only one ejaculation per episode. After cycle day #17 you can resume your normal frequency.

Keep in mind that 85% of women under the age of 30 take 8-12 months to achieve pregnancy so you have not yet been trying long enough. Hopefully this method will help.

Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, U.S.A.

Comment: Ok thank you so much for the advice! I'm going to try the calendar method.

36 Year Old With 3 Miscarriages On Prometrim Using OPK : Continue With Calendar Method or Go For An Infertiity Consult?

Question:

Hi, My name is R. I am 36 years old living in Atlanta GA. My husband is 41 we do not have any kids and would like to have a baby.

In the past I have had 3 miscarriages. prior to my miscarriages, I had a hystersalpinogram(sp) when I was in my early 20's unblocking both of my tubes. Recently I had been diagnosed with Pcos and placed on Metformin 750mg 2x a day, although I have always had a regular period lasting only 3 days but it comes like clockwork every 28 days. So now let me bring you up to date. Today 08/15/2010 I had detected my LH surge via clearblue ovulation kit. But last month my doctor recommended the Clearblue ovulation test and prescribed me Prometrium.

I do not understand why I was prescribed the medication and 2 I am confused as to when to take it, the bottle says to take 3 days after ovulation, when is that? I just detected the LH surge so when should I begin taking it? In the meantime, shouldn't me and my husband be having intercourse to try and conceive? The Prometrium is a 30 count, so should I take the medication starting day 3 until its all gone? I am so confused and excited, I have never used the ovulation predictor and so I am surprised that I see this happy face, what should I do next? Beside sit and worry!

Thanks for your answer, I am anxiously awaiting to hear back from you.

Answer:

Dear R. from Georgia.,

I don't know why you have the diagnosis of PCO if you have very regular cycles, but there is a variant of PCO that you would fit into. You would not need to take Metformin, however. Did your doctor check an insulin level or how did he decide to put you on Metformin?

In terms of timing your ovulation, that is good but if you want to save yourself money, since you have such a regular cycle, the calendar method would work just as well. If using the OPK, when it turns positive, you begin intercourse (on that day#, once per day for four consecutive days #only one ejaculation per episode). With the calendar method, mark you calendar on the first day of your period then count each days in sequence. Stop having intercourse on cycle day #10 then on CD#13 begin having intercourse once per day for four consecutive days as explained above. In both cases, start the Prometrium on CD#16 and use it twice per day. Because this will suppress your menses, you will need to do a pregnancy test around CD#30.

You know, I need to emphasize that time is a critical factor in your case. I presume you have been trying for pregnancy for a while, so you & your husband really should see an infertility specialist. Your age, the miscarriages, previously blocked tubes and possible PCO diagnosis all indicate that it may be necessary. The specialist will lead you in the right direction, doing the tests that need to be done before starting an arbitrary treatment plan, and be the most efficient in helping you to get pregnant. Sometimes it may only take doing one Intra Uterine Insemination. With each year, your pregnancy rates are decreasing, even with the highest level of treatment, which is IVF, so don't waste time.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, U.S.A.

Using BBT chart and Ovulation Predictor Kit while on Clomid

Question:

First, thank you for your time. It is awesome that you would offer your advice on line.

I am on Clomid 150mg. I show on my BBT chart that I ovulated on cd 17. My temps stayed above the coverline till 7 DPO and again today on 8 DPO it is still low. All of the research I find says that implantation dip is only a single day, but that my temp should drop of between 10-16 days to start menstruation.

Here is the link to the website where I get my BBT chart. http://www.fertilityfriend.com

Thank you for your time.

Answer:

Thank you for your question, I try to give as good advice that I can considering the limiting factors, which of course include not being able to talk to you at length and in person.

I would not analyze the temperature chart so closely. It is not that accurate. Many factors can influence the temperature. It is only useful to see if there is a rise in the mid-cycle, which is an indirect measurement of the LH surge, indicating ovulation is going to occur. If you are going to continue using the chart, use it only for that indication i.e. timing of intercourse, and nothing else.

Another option, which I think is more accurate but more expensive is the ovulation predictor kit or OPK. However, with this kit you also cannot evaluate the luteal phase. The only way to evaluate the luteal phase is to do an endometrial biopsy. You will need to begin infertility testing for that.

Follow-Up Question:

One more question. My cycles are very irregular I take progestrone to start before the clomid. When do you recommend taking the home pregnancy test?

Thank you for your time.

Follow-Up Answer:

You are going through a lot of effort that is not very efficient.

The way that I do Clomid cycles is I follow my patients using the Ultrasound starting from day # 10 of the Clomid cycle. This allows me to see if the patient is responding to the dose that I prescribed, count how many potential ovulatory follicles there are so that there are not too many, and to time when intercourse should occur. I also use HCG to trigger the ovulation. With this method, the cycle is done more efficiently. I then do a pregnancy test two weeks later. It is programmed. There is no guessing. If your doctor is not doing it this way, then you are probably not seeing the right person or specialist. This is the correct way.

If you don't have a choice, then you have to go by the calendar method which is based on your period. Cycle day # 1 is the day your period starts. Begin intercourse on cycle day # 13-17, once per day, only one ejaculation per day. Do a pregnancy test on cycle day # 28 and repeat on cycle day # 30. If it is positive, then have a blood pregnancy test done on those days.

I hope this helps. Good Luck!

Sincerely,

Edward J. Ramirez, M.D.

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Program

www.montereybayivf.com