Mid cycle pelvic pain (Mittelschmerz), regular menses withmoliminia (headache, bloating, cramping, and emotionallability) and some dysmenorrhea at intervals of 28-32 days are often good indicators of ovulation.
The rhythm method can be used when cycles are regular (28-32days), by estimating ovulation between days 8 and 19 of each cycle.
The basal body temperature (BBT), plotted by daily checking the temperature in the morning before getting out of bed, after at least 6 hours of sleep. A rise in BBT between 0.3 and 0.9 °C coincides with ovulation.
The Billing method relies on changes in cervical mucus which occur within 48h of ovulation, with the mucus becoming thick, tacky, and losing its crystalline fernlike pattern once dry, with a softer cervix detected by vaginal exam.
Some women can also report breast tenderness around the time of ovulation.
More sophisticated methods of ovulation detection also exist, such as ovulation predictor kits, serum progesterone levels and ultrasonography.
Luteinizing hormone (LH) circulating in blood leads to ovulation. A rise in urine LH in parallel to circulating LH can be detected by ovulation predictor kits (OPK). These indicate an imminent ovulation within 10-12h after the peak of LH, and the ovum released would live about 72h.
Serum progesterone assay performed in the mid-luteal phase (third week of the cycle) can confirm ovulation with progesterone levels of 3 ng/mL or greater.
Moreover, ultrasound findings such as disappearance or change in a developing follicle along with fluid in the cul-de-sac are a sign of oocyte release.
The use of an endometrial biopsy (EMB) near the end of the luteal phase can provide reassurance of an adequate maturational effect on the endometrial lining, thus confirming ovulation.
Finally, the only absolute documentation of release of an oocyte is pregnancy.
by Dr. Joe Feghali