Dr. Julie Lamb, MD, FACOG debunks the biggest ovulation myths

Knowing your body’s ovulation patterns can tell you a lot about your reproductive health and chances of conceiving. Quick recap: Ovulation happens when your ovary releases an egg for possible fertilization by sperm.

But tracking your ovulation is not always the most intuitive process.

We recently turned to Dr. Julie Lamb, MD, FACOG, a reproductive endocrinologist at Pacific Northwest Fertility and a member of the Modern Fertility Medical Advisory Board, to demystify the most confusing aspects of ovulation and explain the common misconceptions about getting pregnant. Read on for answers to the following questions:

• Do you always ovulate on the same day of your cycle?

• If you bleed from your vagina, does that mean you definitely ovulated?

• Can you only get pregnant the day or two around ovulation?

• Do ovulation tests always confirm that you’ve ovulated?

• If you get a positive ovulation test result, does that mean getting pregnant will be easy?

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First, a refresher: Ovulation is the phase of your cycle when hormones relay chemical signals between your brain and your ovaries to let your body know when to release an egg. Estrogen rises in your body, which triggers a rise in luteinizing hormone (LH). This is a time of *peak* fertility. The five days leading up to and the day of ovulation are considered your “fertile window”: when chances are highest for conception.

A common misconception is that all uterus owners ovulate at the same time each cycle, approximately on day 14. However, “normal” cycles vary widely and each person’s day of ovulation is unique.

Dr. Lamb says that, according to one study, 95% of uterus owners had cycles lasting 20-40.4 days, rather than the “textbook” 28-day cycle.

Ovulation predictor kits (aka OPKs) can help you pinpoint your own ovulation timeline outside this common estimate. For example, Dr. Lamb says, “If you have a 35-day cycle, you may ovulate later in your cycle… and that’s where the ovulation predictor kit comes in. It helps you figure out when in your cycle you’re ovulating so you can better time sex or insemination around that, if you’re trying to conceive.”

Reproductive health conditions such as polycystic ovary syndrome (PCOS) can also impact when and if you’re ovulating. Many uterus owners don’t even realize they have this very common endocrine disorder until they’ve started trying to conceive and experience difficulties, Dr. Lamb says. (One in 10 people with ovaries are diagnosed with PCOS.)

“Some people with PCOS don’t ovulate on a regular basis and instead have breakthrough bleeding,” continues Dr. Lamb. She also explains that their ovaries may also be unable to release eggs. Ovulation tests are especially helpful in this situation because you can detect your LH surge to determine if you’re ovulating.

You may need to seek medical attention from a reproductive endocrinologist to help you on your path to pregnancy if you’re using ovulation tests and don’t see your LH levels increase.

It may seem counterintuitive, but vaginal bleeding doesn’t necessarily mean that an egg was released during ovulation (without being fertilized and implanted). Dr. Lamb explains that cycles can be “anovulatory,” which means ovulation doesn’t occur — even when there’s vaginal bleeding.

This can happen in a few different scenarios:

1. Withdrawal bleeding during your placebo week if you take oral contraceptives. (Note: This is not a true period.)

2. Having uterine lining that is too thick — a common symptom of PCOS — and experiencing light or heavy breakthrough bleeding as a result.

3. Having polyps, fibroids, or cervical lesions.

4. Spotting during the early stages of pregnancy.

Hormonal birth control that stops or lessens menstruation can sometimes make it difficult to tell if you’re still ovulating. Dr. Lamb says that if you’re on hormonal birth control, you might not ovulate, and sometimes you may ovulate but not experience any bleeding. (This can happen on lower-dose hormonal birth control like IUDs, which don’t suppress ovulation but do prevent buildup of the uterine lining — therefore preventing you from getting a period.)

To figure out what’s going on with your cycle while on this kind of birth control, Dr. Lamb suggests using an ovulation test or asking your doctor to perform an ultrasound to check if you’re ovulating.

If you have a regular cycle but notice that you consistently spot on certain days before your period — for example, if your cycle is 36 days long but you often spot on day 19 — then Dr. Lamb suggests visiting your OB-GYN to find out if the bleeding relates to ovulation or to another issue, such as polyps or a hormonal imbalance, which could impact fertility.

Your “fertile window” is actually quite long: up to five days before ovulation, as well as on the day of ovulation itself. So, six days total. “Pregnancies occur when you have sperm waiting for the egg,” Dr. Lamb says, and sperm can live in the reproductive tract for up to five days. (Though Dr. Lamb says that the quality of sperm — such as whether it has been frozen or has low motility or concentration — can result in different timelines.) When sperm is waiting for the egg, then the egg can be fertilized in 12-24 hours, and most people report conceiving after intercourse that took place three days prior to ovulation.Dr. Lamb says you’re most fertile the day of and the day after your luteinizing hormone (LH) surge —  the surge of LH in your body that prompts the ovary to release an egg during ovulation. This is a big reason why ovulation tests are so useful — with an ovulation test, you can detect your LH surge more easily and better time intercourse or fertility treatments.“Your body releases an egg about 24-48 hours after your LH surge,” says Dr. Lamb. “I tell patients to make sure to start timing intercourse a couple days before they expect their LH surge, so there’s sperm there when the egg is released… you don’t want to wait until your ovulation test is positive to have intercourse for the very first time that month.”

Technically, ovulation tests can’t “confirm” ovulation — but they can detect LH surges in your body. By helping you track when these LH surges occur, ovulation tests allow you to effectively plan intercourse or intrauterine insemination (IUI) during your fertile window.

In terms of when to start incorporating OPKs into your pregnancy journey, Dr. Lamb says there is no right or wrong answer. It solely depends on the patient and when they choose to start exploring.

Some tests track LH at low, high, and peak levels to more effectively detect the two days you’re most likely to get pregnant. We recommend testing in the afternoons to catch your surge — just try to avoid drinking liquids beforehand so your urine isn’t diluted.

However, one study proved that 1 in 10 uterus owners have LH surges that ovulation tests can’t detect because they’re below the “average” LH surge level. So, if you don’t test positive for an LH surge, that doesn’t necessarily mean you aren’t ovulating. If you still feel uncertain, talk to your doctor about an ultrasound or blood work to confirm ovulation.

Many factors influence a person’s fertility, so ovulation alone does not guarantee that someone will conceive easily. For one, Dr. Lamb says that age and genetics impact the quality and quantity of eggs released during ovulation. “I want people to learn about how fertility changes with age and for that topic to be part of our culture and for people to talk about it,” Dr. Lamb says.  

Some factors (beyond ovulation) that influence fertility are uterine cavity issues (like polyps or fibroids) and tubal functioning (aka blockages in your fallopian tubes). Blockages can be caused by things like endometriosis or various infections.

A partner or donor’s sperm quantity, quality, mobility, and morphology (meaning the shape of the sperm) can also impact your ability to conceive.

What if you’re not ovulating? Dr. Lamb says some reproductive health conditions that impact your menstrual cycle tend to run in families. For example, if uterus owners in your family dealt with things like early menopause, PCOS, or autoimmune issues, that may “warrant investigating early on when you’re trying to conceive,” Dr. Lamb says. Thyroid conditions can also affect your cycle.

If you’re 35 and older, conditions like diminished ovarian reserve — or a lower egg supply than anticipated for your age — may also impact the frequency of your cycle and your chances of conception. (If you’re 35 or younger, Dr. Lamb says that the quality of your eggs matters more than the number of eggs you have.)

If you’re over 35 and have tried to conceive for six months to a year, then Dr. Lamb suggests reaching out to a reproductive endocrinologist for guidance.Watch our full convo with Dr. Julie Lamb below and read more about different types of ovulation tests, what’s happening with your body during ovulation, and reasons for tracking ovulation.

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Current version

July 28, 2020

Written by

Rachel Sanoff

Fact checked by

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