In particular, consistent with the well known role of estrogenic mucus in enhancing progressive sperm motility Eriksen et al. Our data provide additional information not available in the World Heath Organization study evaluating the use of vulvar mucus observations in estimating the fertile interval. The European Study of Daily Fecundability is a prospective cohort study conducted to determine the daily probability of conception on each cycle day relative to ovulation for healthy women in their reproductive years.
From to , women were recruited from seven European centres providing services in fertility awareness and natural family planning NFP. Women enrolled were experienced in NFP, married or in a stable heterosexual relationship, 18—40 years of age, had at least one menses after cessation of breastfeeding or delivery if applicable , and were not currently taking hormonal medication or drugs affecting fertility.
In addition, neither partner could have a history of fertility problems, and couples were required not to use barriers or spermicide generally. Additional details on the inclusion and exclusion criteria, the demographics of the cohort, and other study methods and initial results have been published elsewhere Colombo and Masarotto, Women kept daily records of basal body temperature BBT , cervical mucus symptoms and intercourse.
The daily mucus observations were classified according to Table I , ranging from a score of 1 no discharge and dry to 4 transparent, stretchy, slippery.
If a discharge exhibited mixed characteristics, or if a woman observed multiple types of mucus through the course of the day, the highest matching category was chosen to assign the score. A primary goal of this study is to assess directly the extent to which the different levels of the mucus score predict a real difference in the conception probability. In a previous analysis of these data, Dunson et al. Cycles were excluded from the analysis if there were insufficient BBT data to determine the ovulation day, if there were no reported intercourse acts during the fertile interval, or if there was a day within the fertile interval on which intercourse occurred but mucus information was missing.
Out of menstrual cycles of data with pregnancies, cycles remained in the analysis, with pregnancies. For the purposes of this study, pregnancy is defined as either an ongoing pregnancy of at least 60 days from the last menses or a clinically identified spontaneous abortion within 60 days of the last menses.
Modelling and estimation of pregnancy probabilities were carried out using a Bayesian hierarchical modelling approach Dunson, This involves choosing prior distributions for unknown parameters in a statistical model based on previous information and updating this information with the data in the study to obtain posterior distributions, which represent the current state of knowledge about the unknown parameters.
In a cycle where intercourse occurred on more than one day during the fertile period, it is impossible to determine which act resulted in the pregnancy. Following Barrett and Marshall , Wilcox et al. The analyses presented in this article are based on the methods of Dunson and Stanford The significant trend was attributable to a steady increase in the pregnancy probability with each unit increase in the mucus score.
Specifically, the posterior probability of an increase in the pregnancy probability in going from a mucus score of 1 to 2 was 0. The day of lowest fertility was 5 days before ovulation, and the day of highest fertility was 3 days before ovulation. The difference in pregnancy probability between these two days ranged from 0. Thus the gain in pregnancy probability attributable to an increase from the lowest to highest mucus score is generally higher than the gain attributable to having intercourse 3 days before ovulation instead of 5 days before ovulation.
Within the fertile window, the type of mucus observed on the day of intercourse is more predictive of conception than the timing relative to ovulation. Figure 2 shows the distribution of the reported mucus scores according to timing within the fertile interval. On each day, type 4 mucus is the most common, with the largest proportion occurring 2 days before ovulation, which is also the day on which the smallest proportion of cycles had no vaginal discharge type 1 mucus.
It is important to note that each of the days had a substantial proportion of women in each of the mucus categories. Although fewer women reported type 2 mucus and that proportion remained essentially constant across the fertile window, there was a significant difference in the pregnancy probabilities between type 2 mucus and the other categories. These results provide direct evidence that mucus plays a role in fertility that is more important than its previously identified role as a marker of the fertile window of the menstrual cycle.
Previous estimates of pregnancy probabilities on days relative to ovulation did not account for daily observations of the quality of mucus, though researchers have identified increased conception probabilities on days when secretions were observed compared with no secretions Dunson et al. Our study demonstrates that the quality of mucus explains most of the relationship between the pregnancy probability and the timing of intercourse relative to ovulation.
Our results have important clinical implications. Because vulvar observations of cervical mucus predict not only the fertile days of the cycle but also the probabilities of conception within the fertile interval, monitoring of mucus provides additional information not provided by other methods for identifying the fertile interval. In addition, such monitoring is expensive and inconvenient and can miss the beginning of the fertile interval and even the most fertile days.
Many women already rely on their own calculations to predict ovulation, often obtaining estimates different from results of ultrasound or LH detection Gnoth et al.
Hence, monitoring of mucus provides a useful clinical marker of days with high conception probabilities. Thanks also to Allen Wilcox and Donna Baird for their insightful comments. Figure 1. Estimated probability of pregnancy with a single act of intercourse in the fertile interval conditional on mucus observations. Figure 2. Proportion of cycles with each mucus score on each day in the fertile interval.
Pop Stud 23 , — Lancet 1 , — Colombo B and Masarotto G Daily fecundability: first results from a new data base. Demogr Res 3 , 5.
Dorairaj K The modified mucus method in India. After washing your hands, gently place one finger inside of your vagina and gently remove a sample. Or, use toilet paper to retrieve a sample — wiping from front to back. Along with checking for egg white cervical mucus, other factors can help track ovulation, too.
One of the easiest ways is to track your menstrual cycle , which will be easier if you have regular periods. So you may notice egg white cervical mucus between days 11 and 15 of your cycle. These kits are designed to detect the luteinizing hormone which your body releases 24 to 48 hours before ovulation. You can also use these test kits if you have an irregular period.
You can also track ovulation by monitoring your basal body temperature. Body temperature increases by a few degrees right before ovulation. Keep in mind that some medications and conditions can affect the quality of your cervical mucus.
Egg white cervical mucus differs from other types of vaginal discharge. Normal discharge is usually clear to white and watery to thick. On the other hand, discharge accompanied by itching or irritation could indicate a yeast infection. Cottage-cheese discharge can also signal a yeast infection. Some vaginal discharge can be brown, especially at the end of your period.
But brown discharge can also be a sign of uterine or cervical cancer. See a doctor if you have any concerns about your vaginal discharge. Also keep in mind that egg white cervical mucus is odorless. If your discharge has an odor, you may have a yeast or bacterial infection.
Despite your ovaries releasing an egg each month, the wrong consistency of mucus means sperm will have a more difficult time traveling from your vagina to the uterus.
Certain supplements claim the ability to boost cervical mucus production. These claims have been linked to primrose oil, dandelion, marshmallow roots, licorice, and L-arginine.
However, more research is needed to support these claims. Another purported belief is that drinking grapefruit juice a week before ovulation can improve the quantity and quality of cervical mucus. Again, evidence for this is anecdotal, not clinical, and more research is needed. Being that this mucus is necessary for conception you should try to increase the amount you have present. This can be done by preventing dehydration and by using supplements like evening primrose oil.
Typically fertile secretions are wetter, slippery and more stretchy. To maximise the chance of conception, sex should occur on days with optimal mucus quality, regardless of the exact timing relative to ovulation.
Ovulation is the name of the process that happens once in every menstrual cycle when hormone changes trigger an ovary to release an egg. This usually happens 12 to 16 days before your next period starts.
The egg can only be fertilised for up to 24 hours after ovulation. This marks the start of the next menstrual cycle.
While an egg only survives for up to 24 hours, sperm can remain active for up to five days. It may therefore be surprising to learn that a couple can conceive through sexual intercourse four to five days before the egg is released.
Pay close attention, and you may be more likely to get the message. Ovulation tests work by detecting luteinizing hormone LH. Ovulation tests detect the LH surge, allowing you to accurately predict when you will ovulate.
A positive result on an ovulation test means that the woman will most likely become fertile over the next three days — with peak fertility at 36 hours following the LH surge. How do ovulation tests work? At the beginning of the menstrual cycle, the body begins to produce follicle stimulating hormone FSH. FSH facilitates the formation of a follicle on one of the ovaries.
The follicle contains and nurtures the egg. When a follicle has adequately matured, a surge of Luteinizing Hormone LH causes the follicle to burst and release the egg into the fallopian tube — the moment of ovulation. Throughout the menstrual cycle, a small amount of LH is produced — but during the middle of the cycle LH briefly and dramatically increases.
Elevated quantities of luteinizing hormone facilitate ovulation — and OPKs detect this LH surge through anti-LH antibodies contained in the sensitive testing membrane of the test. The LH surge is, alas, very brief — and in order to detect the LH surge, a woman needs to test at the right time of the month — and the right time of day. As LH is produced by the body in the morning, mid-afternoon is considered the ideal time to test. Once the LH surge has been detected, successful fertilization is most likely to take place one to three days following the LH surge — with peak fertility at 36 hours post-LH surge.
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