Do Women Know When They Ovulate? The Research Answers (Episode 541)

Full Transcript: Episode 541

Lisa Hendrickson-Jack: Today I’m sharing a brand new FAMM Research Series episode on a very important topic. Do you know when you ovulate? And if you’re a women’s health practitioner, do your clients know when they ovulate? So what we’re going to be talking about today — we’re going to delve into a really interesting study. The title of the study is Accuracy of Perception of Ovulation Day in Women Trying to Conceive. And this study just tested this assumption. It tested the assumption of the women in the study. So basically, are we accurate when we are estimating our ovulation day, or are we totally out to lunch? What does the research have to say? So without further ado, let’s go ahead and jump into today’s research study.

So I am really keen to talk about today’s research study because I think this kind of research is really important and really helpful, especially in the field of fertility awareness. So the reason why the researchers were looking into this question is because when you dive into the research and when you learn about the scientific basis behind the fertility awareness method and all of the things that we talk about on this podcast, you start to realize that there is a specific window of fertility. And when women know about this window, when they know how to accurately identify their fertile days, it can significantly increase the time to pregnancy. And what the research shows us is that when women are timing sex accurately within this six-day window — so the five days leading up to ovulation day and ovulation day itself — it significantly reduces time to pregnancy overall. And I would argue that for couples who are having fertility issues, it would truncate the time that it would take to determine that there is something wrong, because if you know that you’re timing sex correctly, we can then be referring to a fertility specialist or for additional screening within, you know, six months, as opposed to the traditional twelve months or more if you’ve been trying. And again, because if you’re not conceiving within that time and you know you’re timing sex correctly, then it does tell us, okay, we need to look deeper to see what’s going on.

So with that said, how many women are actually aware of when they are ovulating, and how many women are accurately identifying their fertile window? Now, as a listener of this podcast, you’re much more likely to have it right in the sense that you have taken a specific interest in this topic. You have learned a little bit about it. If you’ve listened to a few episodes, specifically the episodes where we talk about timing sex and optimizing your chances of pregnancy, you know the important role that cervical mucus plays. So at least you know what to look for. And of course, if you’re charting your cycles, that can take it to a whole other level. But even so, I would still agree with the results of this study that we’re going to talk about — I do think that a lot of women overestimate their fertility awareness knowledge. And I think without knowing it, a lot of women subscribe to rhythm method thinking. And so we’ll get into exactly what I mean by that.

I want to tell you a little bit about the study as we get into it. So what the researchers did is they recruited 330 women. And one of the things that they did to recruit them is they had women who were specifically trying to conceive seeking out information from a particular website. And so one thing that I’ll say about the study is that these women were already trying to conceive and likely already seeking information about their fertility. So I would say that compared to the average woman who may not even be there yet in terms of her thinking — maybe she’s not at all even trying or even thinking about trying to conceive — this cohort of women theoretically should have the highest fertility awareness knowledge, because they’re actively trying to conceive and they’re also actively seeking out information about their fertility. So in some ways I don’t think that this represents the average person. If you were to just grab a thousand women off the street, I feel like this group, because they are all actively trying to conceive, probably has a little bit better fertility knowledge than the average woman. But either way, they had 330 women in the study, the average time that these women had been trying to conceive was about eight months without success at this point. And what they did is they had these women estimate when they thought that they ovulated, and they compared that against the LH testing that they did. So throughout the study, they would test the LH levels, identify the LH surge, and they would identify the day of ovulation as the day following the LH surge.

And for those of you who are in the weeds with me and have listened to some of our previous FAMM research episodes where I go in much deeper into this topic of LH testing and how accurate is it — basically just pointing out that there are limitations to some of these ways that we’re testing — the study did not further confirm ovulation with basal body temperature or progesterone testing or anything like that. So they are determining the day of ovulation as being the day following the LH surge. And again, when we’re looking at research studies, I do think it’s important for the researchers to choose things — it’s done is better than perfect. So it is important to choose these markers and make decisions so that you can actually get the data out there. But it is worth noting that the LH surge does not confirm ovulation. Instead, it tells us when ovulation is likely to happen. So it’s helpful to know how they identified ovulation in the study. But with that said, it’s still giving us a fairly accurate picture of when ovulation is happening for these women in a general sense.

A few other pieces of information about how they selected participants. So in order to be included, the women had to be between 18 and 45 years of age at the time that they were recruiting. They were not selected if they were still breastfeeding. And their shortest cycle needed to be 22 days, longest cycle needed to be 39 days in the past six months, and they needed at least three normal cycles since they discontinued hormonal contraceptives. So just to give you a sense, they are intentionally choosing women whose cycles are mostly falling within the normal range and not immediately in some sort of transition period — whether it’s immediately after birth or immediately after coming off contraceptives — that would potentially skew the results.

All right, so let’s talk about the results of the study. So what the researchers found was that only 13 women — so 12.7% of the participants — correctly predicted their day of ovulation. So only 12.7% actually had the exact day that they defined in the study based on the LH test. And what’s interesting even about that number is that 62% of the women who got it right were also using ovulation tests. So there was such a small number of women who got it exactly right, and of that, a huge percentage of those women were actually using ovulation tests compared to those who weren’t.

Overall, only 56% of the women who were studied estimated their day of ovulation correctly to within a margin of two days. So based on the day of ovulation that they calculated using the LH tests, only 56% of women either identified the correct day or within two days of that day. And again, that is interesting given that these women had been trying to conceive for an average of eight months prior to doing this, and they also had a keen interest in learning more about their cycles.

Something else that they found in the study was that day 14 and day 15, unsurprisingly, were the most common responses for the estimated day of ovulation. So overall, women were most likely to identify day 14 or day 15 as their day of ovulation.

I’ll share a couple other interesting data points. The average menstrual cycle length that they measured for the participants in the study was 29 days. And that was actually in line with the average menstrual cycle length that was reported by the women who were in the study. But the actual range of cycle lengths was 22 to 54 days. And to me that makes sense, because I’ve just observed so many menstrual cycle charts over the years. And there are always women that have certain cycle irregularities or different situations that would cause a longer or shorter cycle to be reported. But what was interesting about that was that the actual reports from the women who were in the study — they defined the range of 24 to 37 days. So even though the actual range was 22 to 54 days based on the data that they collected, the women in the study really underestimated the range and obviously overestimated this kind of day 14 ovulation scenario.

So I would say that this is not surprising at all, but it is helpful information to consider for yourself and also for your clients if you work with women in this way. And I guess the overarching point here is that we tend to — because we’ve just been conditioned — we’ve been conditioned to think that cycles are always 28 days, that ovulation always happens on day 14. And so we’re looking for that to happen, we’re expecting it. And that can skew our interpretation of the data. When you are expecting ovulation to take place around day 14, if you see a temp rise — even if it’s because you drank alcohol the night before — you may be tempted to assign meaning to those fluctuations that happen to occur around that time that are not true based on what’s actually happening in your cycle. And this is something I’ve seen a lot. This is something I talk about with all of my clients and practitioners, because we’re so conditioned to look at our cycle based on what we’ve been told — that template — we do tend to misinterpret the actual events that are taking place. And so that’s huge. That’s something to be aware of for yourself. And when you’re working with clients, you just never want to assume that they’ve got this. Even if they’ve been charting for a while, you always want to verify. It’s like trust, but verify — and ensure that you get a good sense of their true understanding of what’s happening in their cycle.

There were a couple other data points that I want to share with you. Over the course of this study, 130 women conceived. So I’ll read the stats and then we can talk about it. The pregnancy rate was 17% for the first cycle. By the third cycle, 33% of the women in the study had become pregnant. And by cycle six, 42% had become pregnant. So that’s huge. Because as I mentioned a couple of times before, the average time that these women were trying to conceive was eight months prior to being part of the study. And so in the course of the study — I’m sure that due to the different testing and things like that, the women gained a more accurate knowledge of what was happening with their cycles — but just by helping these women define when ovulation is truly happening, a huge percentage of these women conceived.

And one of the things that the researchers noted toward the end of the study is that obviously, knowing how to identify accurately when the fertile window is going to increase the odds of pregnancy overall. And there are other research studies that have found that when women are doing what we refer to in the fertility awareness world as fertility-focused intercourse — so that’s like the scientific term for timing sex based on what’s actually happening in your cycle accurately — when you’re having that fertility-focused intercourse, timing sex correctly, it does tend to shorten the time to pregnancy overall.

Another thing that I thought was really interesting: none of the women believed that they ovulated earlier than day nine or later than day 25. And given that the longest cycle length was 54 days — in a 54-day cycle, if we’re assuming a 12-day luteal phase, that would be a day 42 ovulation. And that’s pretty significantly off. And that definitely speaks to our kind of lack of understanding of how the cycle works, and especially our lack of understanding of how the follicular phase works. And so the follicular phase is the term for the period of time between your actual menstrual period and your ovulation. And that first half of the cycle is the most variable. That is, if you’re having a 54-day cycle versus a 28-day cycle, the difference is that follicular phase and when you’re ovulating in that cycle.

And even it’s making me think of — recently I posted something on social media — it was something to this effect of understanding when you’re ovulating in the cycle, knowing how to identify your fertile days based on your cervical mucus. And I had this comment, and it was, you know, you’re wrong, you don’t understand how the cycle works, women ovulate multiple times a cycle, I have ovulated three times in one cycle. And you know, I do get those kinds of comments every now and then. But again, it’s unfortunate because this is where we’re at in terms of our education. These misconceptions and myths about how the cycle works are very present. Ovulation only happens once per cycle, but you can have multiple patches of mucus. And I’m sure that there are articles out there that would tell you that you’re ovulating multiple times — again, because this is how deep the lack of understanding and knowledge truly is.

It’s a symptom of the fact that none of us are taught anything about our bodies. And most of us who really know about fertility awareness and about this knowledge that we’re talking about today, most of us have stumbled upon it in our own lives somehow and then taken it upon ourselves to self-educate or seek training so that we can specialize in this. It’s just not a thing that your average person knows anything about. And as a women’s health practitioner — so for our practitioners who are listening — keep that in mind when you’re working with clients, that you could fully have clients in your purview who you think have a decent knowledge of what’s going on. Maybe they’re using ovulation strips and they have some sense of what’s going on with ovulation. But again, these myths are really prevalent.

And anytime I teach these classes that I’ve taught over these years, anytime I’m teaching group classes and I’m talking about — you know, you can only ovulate once per cycle, and this is the window, and I’ve got the scientific evidence — it’s not just something I’m saying out of my neck, I can provide the resources and the sources for all of this information that’s been studied. So again, it’s not just my opinion, this is how our bodies work. But there’s always someone who pipes up: what I heard about this woman who was pregnant and she got pregnant again, and she was carrying two babies of different ages, and all that kind of stuff. And again, that’s another myth. You can have a pregnancy with twins and have one of the twins be a smaller size because of developmental issues. It does not mean that they are different ages, because that’s impossible for human beings. Again, there’s research there. I’ll link my previous episode — episode 546 of the podcast — where I talk about this exact question: can you ovulate more than once, and can you get pregnant when you’re already pregnant? And I shared a bunch of research. So if you’re wanting to dive into that, feel free to dive into the archives there.

But again, these myths are really, really prevalent and they have an impact in a variety of different ways. They cause women to have sex around day 14 and think, okay, I’m good for this cycle, even if they’re ovulating on day 25. And they also cause women to potentially make mistakes when it comes to using the method for birth control. Or it causes women to totally dismiss the validity of fertility awareness out of hand, because it’s like, well, you’re saying it’s six days, but I know that you’re wrong because I know women can ovulate more than once. So it’s really important for us to recognize not just the data that’s coming out in this particular study that we’re talking about, but also thinking about the implications of this — how this could impact our clients, how this could impact our own actions and our own understanding of the cycle.

It seems so easy and basic, but we are creatures of habit and we are definitely subject to whatever our kind of subconscious thoughts are. So even if you have some of these ideas — and I call it the rhythm method thinking kind of mindset — we all are subject to that to some extent. And so it’s really important to identify it and start to see how it could be impacting our behavior, our actions.

So one last piece of data that I want to share. The researchers concluded that based on the women’s estimate of their ovulation day, only about 55% of the women in the study would have targeted sex on a day when pregnancy was actually possible. So again, it’s not bad — if you think about it overall, this group of women was pretty knowledgeable, again because they had already been trying for quite some time. So I think compared to the general population, certainly this group was a little bit more knowledgeable. But even so, that means that fully 45% of the women who had been on average trying to get pregnant for eight months already were not having sex on a day where pregnancy would have been possible, based on the day that the researchers identified ovulation to happen via LH testing. So that’s huge. And it also explains why there was such a significant pregnancy rate with no other interventions. It was literally just changing the timing. Huge, really, really important — and certainly this should be a wake-up call for any women’s health practitioners who work in the area of fertility.

So jumping back to the day 14 ovulation assumption for a minute — in this particular study, only 19.6% of the women in the study actually ovulated on day 14 or day 15 of their cycle. And on average, the actual ovulation date was about two days later than what they had estimated. I always find those stats to be really important to mention on air when I’m talking about this topic — how few women actually ovulate on day 14 in the menstrual cycle. It was like one in five, right? One in five women ovulated on either day 14 or 15. They didn’t even include only day 14 — they even gave that two-day window. But it means that 80% of the women in the study didn’t ovulate on day 14. And so if that’s what we’re doing — if we’re just having no information, no one’s taught us anything about our cycles, and we’re just told that cycles are 28 days and ovulation is always happening on day 14 — and most women out there are just running around having sex on day 14 because they think that’s what they should be doing — but literally 80% of women are not ovulating on that day according to this study. That’s huge.

And just one thing to go back to: in this study, they excluded women who were in those transitional phases or whose cycles were more irregular, whose cycles were regularly longer than 39 days. Interestingly, even though they excluded women who reported that their cycles were longer than 39 days, there were still women in the study whose cycles wound up being 54 days. And the study itself shows that the women whose cycles were longer were underestimating how long they were. I think that all of it just kind of fits together to show us how much our bias causes us to incorrectly perceive the data that’s in front of our faces.

And just — it’s funny, because this is what I always talk about with clients. It’s like, you think you know what’s going on, but then if you start tracking it, you’re going to see what’s actually going on. And what’s actually going on is going to be different from what you thought it was. And you think you’re going to remember that day that you saw this thing or whatever, but if you don’t write it down, then when you think back to it, you’re actually not going to remember. So even just tracking what’s going on is going to give you a totally different picture than what you thought was going on if you weren’t tracking.

So as we start wrapping up today’s episode, I think there are a couple of key points that have come through. Obviously, we’ve been conditioned to think that our cycles are 28 days with ovulation on day 14. But what this study and many other similar studies show us is that the majority of the time, on average, we’re not ovulating on day 14. And even if you’re tracking your cycle and you occasionally ovulate around day 14 or day 15, in a year it’s not going to be every single cycle. And if you track for a year — if you track approximately 12 cycles — you will find that there will be at least one or two cycles that are a bit shorter than normal and at least one or two cycles that are a bit longer than normal. And if you’re trying to conceive, it’s Murphy’s Law — it might be that cycle that you stop having sex too early and you don’t end up successfully conceiving. And so it plays a huge role. And also, if you’re using the method for birth control, that also plays a huge role — because if you’re having the occasional cycle that’s shorter than what you’re used to, ovulation might be happening earlier occasionally. And if you’re not accounting for that in the rules or the type of method that you’re using and having protected sex in that pre-ovulatory phase, then you could be putting yourself at risk of an unplanned pregnancy.

Another point to summarize: the women in the study were not correctly estimating when they ovulated. On average, they thought that they ovulated two days earlier than they actually did. On average, they thought their cycles were more regular than they actually were. And they didn’t really even fathom when the cycles were outside of that range.

Another important takeaway from the study is that understanding how to correctly identify that fertile window is really key to improving the chances of pregnancy — given that with no other interventions or changes, there was a significant percentage of these women who did successfully conceive over the course of the study, by simply alerting them to when the accurate days of fertility are in their menstrual cycle.

One of the main points that I hope that you take away from today’s episode and our deep dive into this study is that there is a huge opportunity for women’s health professionals to really support their clients to fill this knowledge gap. The average woman still has no real idea how her fertility works and certainly is not experienced in tracking her cycle and identifying her fertility or ovulation window. And with that said, we all know as listeners of this podcast that it’s not rocket science. It’s something that with a few lessons, with a little bit of support over the course of a few cycles — so typically anywhere from two to three cycles of charting with an instructor — that’s usually sufficient to support a woman to understand her cycle, understand how to identify when her fertile days are, help her to confirm ovulation, and help her to start really gaining confidence about charting and then using this knowledge and information to achieve whatever her goals are. So if her goals are to avoid pregnancy or if her goals are to conceive, it’s really attainable. And it’s really rewarding and empowering, because this knowledge really is foundational.

I hope that you enjoyed today’s episode. If you found it valuable, if you can think of someone who would benefit from hearing it, then feel free to share this episode. The share link is fertilityfriday.com/541. And with that said, I hope that you have a wonderful week, weekend, whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.