How can I test for fertility?

Daniel Chukwuemeka Okwum

Have you been patiently looking forward to a time in your life when your womb will harbour a growing baby, and you are regarded as pregnant?

There is respite! Do not give up, soon your joy will be full!

One important thing you may need to do is  to track your ovulation and be double sure you are actually ovulating. A woman who ovulates is medically fertile and capable of getting pregnant.

Ovulation tracking can help you achieve the following:

• confirm whether you are ovulating or not
• help you make gender choice

1. What is Ovulation tracking?

Also known as follicular tracking, infertility scan and folliculometary, is a sonographic examination aimed at monitoring the development of the eggs in the ovaries until the biggest follicle attains maturity and possibly ruptures, releasing its content in readiness for ultimate fertilization.

2. I'm I really ovulating?

In case you are not sure as to whether you are Ovulating or not, or having irregular menstrual cycle, this serial ultrasound examination might be suggested by your gyna to help you ascertain ovulation. If your follicles are not developing well probably due to PCOS, your gyna may place you on some special medication, possibly from the first day to about day 5 of your menses, to stimulate their growth.

3. How reliable is ovulation tracking?

It is a direct yes or no examination. At the end, it's either you are ovulating or not.

4. How long does it take to track my ovulation?

It takes about six days to undergo. You would be asked to come to the hospital on three alternating days for the examination.

5. On what day of my period I'm I expected to start tracking?

You will be expected to start tracking on the 9th or 10th day, counting from the first day of your last cycle. A serial scan of your ovaries is done with two day interval between the 1st, 2nd and 3rd scans: talking with 9th, 11th and 13th day or 10th, 12th and 14th day, from the first day of your LMP, depending on the number of days in your entire cycle.

Source: Uncle Scan Ultrasound album.

Photo showing a maturing egg in the left ovary.

6. How painful is the examination?

Ovulation tracking is not a painful procedure. You may however experience a mild discomfort when the transducer is introduced into your vagina for the examination. 

7. What preparation do I need to make?

• Ensure it's the 9th or 10th day of your cycle
• Shave the areas of your genital
• Put on a gown from home(optional)
• Empty your bladder just before you go into the ultrasound examination room
• In the changing room, take off your pantes
• If any, put on the examination gown
• Lie with your back on the examination couch
• Bend your knees such that you step on the couch with your feet
• Open up your laps for the examination

8. How is ovulation tracking procedure carried out?

• The sonographer put on his gloves
• spreads a sheet over your elevated laps
• Wears a new condom over the special handheld instrument called transvaginal (TVS) transducer.
• S/he inserts the transducer into your vagina
•  Observes your ovaries and uterus on the screen, taking measurements where necessary
• Issues you a result. Your result could be issued to you after each examination or at once at the end of the serial scans.

9. What parameters determines ovulation?

The eggs in your ovaries and the endometrial plate thickness are evaluated on each of these three days. The sizes of the eggs are measured on each of the days while the appearance and thickness of the endometrium is noted and recorded. Note that as the dominant or bigger follicle develops faster, other ones reduce in size. 

10. When would the dominant follicle rupture?

The dominant follicle having attained between 1.8-3.6cm is expected to rupture on the 13th or 14th day, midway into your cycle. 

11. How does the sonographic ascertain I am ovulating?

1. The dominant follicle ruptures and possibly disappears (successful ovulation)

2. Presence of fluid in potential spaces around the ovaries and uterus

3. Three tiny lines in the endometrium, called trilaminal lines.

4. Your experience

12. What if the dominant follicle does not rupture when it ought to?

Yes, there are cases where the follicles would not rupture, and would keep getting bigger such that it grows beyond the size it is expected to rupture, especially after the day you aught to have ovulated. At this point, the follicle is not likely to rupture anymore. This is referred to as Anovulation, i.e. ovulation could not occur.

Source: Uncle Scan Ultrasound album.

Photo showing a functional ovarian cyst labelled as C.

13. What becomes of the follicle that refused to rupture?

It becomes a functional ovarian cyst which eventually resolves in about two weeks time as you expect your next cycle.

NB: This procedure is carried out with the use of scan machine and ultrasound gel, hence it has no side effect. You may choose to undergo this procedure privately with the help of a reliable sonographer or a sonologist to know your status or consult a gyna.