At the middle of the menstrual cycle, an ovary releases (ovulates) a mature egg, which the fallopian tube picks up—one end of the tube is right next to the ovary. The tube moves the egg back towards the uterus.
If sexual intercourse occurs around this time, the sperm swim through the lower opening to the uterus (cervix). They travel though the uterine cavity to the tubal openings and into each tube. Fertilization occurs in the outer third of the tube containing the egg.
Fertilized or not, the egg reaches the uterus about 4–5 days after ovulation. If healthy, a fertilized egg now contains 100–200 cells (and is now called a blastocyst). It imbeds into the uterine lining (endometrium).
If fertilization does not occur or the embryo is not viable, the uterine lining sheds about one week later (the menstrual period).
Hormones and ovulation
Hormones from the pituitary gland at the base of the brain control ovulation. Follicle-stimulating hormone (FSH) prompts an egg to grow and mature. Ovulation does not occur in alternating ovaries in alternating months. Usually, just one egg matures at a time, randomly in either ovary.
A cycle is from the start of one menstrual period to the next. When the egg is mature at the middle of the cycle, the pituitary gland releases luteinizing hormone (LH), called the “LH surge.” This prompts the egg to enter into final maturation and to be released. The actual release of the egg is what we refer to as ovulation.
Timing of intercourse
About 40 hours after the LH surge, the ovary releases an egg. It will need to encounter sperm within about 12 hours to successfully be fertilized. Sperm can live in the female reproductive tract for several days. Therefore, intercourse that occurs anywhere from 3 days before and up to about 12 hours after ovulation can result in fertilization.
However, if a woman is trying to conceive, we recommend intercourse on the day of the LH surge as well as the next day. You can detect LH surges with over-the-counter (OTC) ovulation predictor kits that test the urine for the presence of LH hormone.
If a woman does not wish to conceive and is sexually active with a man, she must use a form of contraception.
Barrier methods include diaphragms and condoms, which are usually more effective when used with contraceptive foam.
Hormonal methods include birth control pills, Depo-Provera shots, contraceptive implants, and vaginal rings. The active ingredient in all of these methods is the hormone progesterone. It inhibits development of the uterine lining. It also keeps cervical mucus in a state that is not likely to allow sperm to pass from the vagina into the uterus and up into the tubes.
Intrauterine devices (IUDs) disrupt the development of the uterine lining, preventing implantation. They may also contain progesterone.
Eggs: A limited resource
Women are born with millions of eggs. For unknown reasons, most of these eggs die before they ever have a chance to mature and ovulate. About 1,000 eggs die for every egg that matures and is released.
In reproductive-age women, about 5–25 eggs are present in each cycle. These “finalists” can respond to FSH and mature. As it turns out, however, humans have natural mechanisms that keep all but one of these finalists from growing, which means only one egg will be ovulated, except in the case of fraternal twins and triplets.
Very few eggs remain at menopause, which occurs on average at age 51. Remaining eggs no longer respond to FSH. Menopause is the absolute end of the reproductive years. However, women typically lose the ability to conceive in their early 40s, about 5–10 years before ovulation and menstruation finally ends.
Many resources are available for women interested in learning more about egg freezing.
For example, The American Society for Reproductive Medicine (ASRM) is a “nationally and internationally recognized leader for multidisciplinary information, education, advocacy and standards in the field of reproductive medicine.” In October of 2012, ASRM announced that it no longer considered egg freezing an experimental procedure. The American College of Obstetricians and Gynecologists also endorses the ASRM decision. The ASRM Reproductive Facts website offers a wealth of information and links to articles about egg freezing.
Additionally, the Pacific Fertility Center website offers an array of information about egg freezing and all aspects of fertility education.Contact PFC to learn more