It is well-accepted that transvaginal ultrasound is the “gold standard” when it comes to monitoring the different stages of your monthly cycle. A transvaginal ultrasound is a relatively simple procedure – while you lay on your back, the ultrasound technician inserts a probe, called a transducer, into your vaginal cavity. The probe sends out sound waves that bounce off of your ovaries and uterus (and other internal organs), which are then received by a computer and turned into a picture that you can see on a screen. Because transvaginal ultrasound actually allows you to see your ovaries, you can measure the size of your follicles, identify when the dominant follicle is selected, and see when the egg is released from the ovary into the Fallopian tube. In a nutshell, having daily transvaginal ultrasounds would be the most accurate way to pinpoint the most fertile days in your cycle.
Unfortunately, it is neither convenient nor economically feasible to rely on transvaginal ultrasounds as a tool for ovulation prediction. If only there was a home device that could provide the same type of information with a high degree of accuracy…
Turns out there is! The OvaCue Fertility Monitor is designed to provide you with precisely this type of information. Demonstrated to be 98% accurate at predicting ovulation in government-funded studies, the OvaCue relies upon saliva and cervical mucus sampling to identify your peak fertile days each month, as well as your ovulation date. Thousands of women use the OvaCue each day to help them predict when ovulation will occur, and time intercourse accordingly for trying-to-conceive purposes.
While we could talk all day about the accuracy of the OvaCue, it would be so much more powerful if we could show you how closely the OvaCue’s daily fertility indicators correspond with the results from transvaginal ultrasounds.
Now if only we could find someone willing to use the OvaCue on a daily basis while simultaneously visiting a gynecological clinic for regular transvaginal ultrasounds….
Enter Fairhaven Health’s own Sarah. You may know Sarah from the OvaCue Blog at OvaCue.com, or as “FertilityChartingWithSarah” at OvaGraph.com. Sarah is an OvaCue Specialist Extraordinaire here at Fairhaven Health, and a very good sport. We were somehow able to convince Sarah to have regular vaginal ultrasounds and provide us with those results to compare with her daily OvaCue readings.
Here’s how the OvaCue Challenge went down, in Sarah’s own words.
Cycle Day 2 (Second Day of Menstruation)
Ultrasound: When I first stepped into the office, I had no idea what to expect. I’d never had a reason to get a vaginal ultrasound in the past. As intimidating as the vaginal probe was, it actually wasn’t that bad… a bit uncomfortable, yes, but that was to be expected.
We began the first vaginal ultrasound on CD (cycle day) 2. It’s important to have the first ultrasounds between CD 1-5 to get a baseline measurement for the size of your uterus, cervix, endometrial lining, and follicles in both the left and right ovaries. First, the ultrasound tech took a measurement of my cervix and uterus to ensure that they were in the “normal” range. Next, we took a closer look at my endometrial lining. (See picture CD 2 – Endo Lining) The endometrial lining has what they called a trilaminar appearance, which basically just looks like three lines. At first, it was hard for me to see the endometrial lining, but as I continued to go in for ultrasounds it became easier to see because the lining builds up throughout your follicular phase, making the lines more distinct and clear. Next, we measured the follicles in both my right and left ovaries. There were quite a few follicles in each ovary but we only measured the largest follicle in each ovary. The largest follicle on my left ovary measured 0.56cm by 0.51cm (See picture CD 2 – Left Ovary) and the largest follicle on my right ovary measured 0.58cm by 0.38cm. (See picture CD 2 – Right Ovary) I thought the follicles looked large, but was informed that they would get up to 2.0-2.4cm just before ovulation occurred!
OvaCue: I began use of my OvaCue the morning of CD 2 with the oral sensor. The oral sensor tracks trends in your saliva that correspond with the maturation of the dominant follicle, allowing the monitor to populate a fertile window up to 7 days in advance. At this point in my cycle, the monitor indicated that I was ‘Not Fertile’.
Cycle Day 8
Ultrasound: I’ve tracked my cycles for the last couple years so I’m very familiar with when I ovulate (typically on CD 13, 14, or 15). Luckily, this information helped us determine the most important days to come in for the ultrasounds. We wanted to get a couple of ultrasounds in just before ovulation occurred so I could see how big my follicles grew. Unfortunately, with the timing of my cycle, we ran into a long weekend where my doctor was out of town. The ultrasound tech was able to pop in on CD 8 to get a quick measurement so I had a bit more data to go off of! Unfortunately, we weren’t able to get pictures for this ultrasound. We measured the biggest follicle in my left ovary at 0.99cm by 0.78cm.
OvaCue: The OvaCue had detected my ‘cue peak’ trend on CD 4, 5, and 6 – which populated my fertile window of light blue to dark blue days (the shades indicating the fertility status – the darker the blue, the higher your fertility). The ‘cue peak’ trend coincides with the maturation of the dominant follicle and on average, women ovulate about 5-7 days from the ‘cue peak’ trend. Based on the data collected from the oral sensor, the monitor predicted ovulation to occur on CD 13. I began taking vaginal readings on CD 4. Once you incorporate the vaginal sensor, it will refine the fertile window as necessary and confirm ovulation. For example, if ovulation ends up occurring later than the original prediction made by the oral sensor, it will continue to bump out your fertile window until it can confirm ovulation with the pink box.
Cycle Day 11
Ultrasound: My next ultrasound appointment was on CD 11. This time around, I was finally able to decipher the three different lines, or sections, of the endometrial lining as it was a bit thicker than the previous ultrasounds. (See picture CD 11 – Endo Lining) Next, we moved on to my ovaries. We first looked at my left ovary. Since my follicles all had grown in size, it made it easier to try and get a count of how many there were. It’s difficult to see in the picture, because we had to keep adjusting the angle of the vaginal probe to see all follicles – but we counted about 7 follicles in my left ovary. (See picture CD 11 – Left Ovary Follicles) It was amazing to see the multiple follicles so clearly, all of which had grown since the last ultrasound. The largest follicle we could find was 1.00cm by 0.61cm. (See picture CD 11 – Left Ovary) We then moved over to my right follicle – this time counting about 10 follicles! (See picture CD 11 – Right Ovary Follicles) We measured the largest follicle on my right ovary and to my surprise; it was much larger, measuring 1.29 cm by 1.32cm. (See picture CD 11 – Right Ovary)
But wait! During the previous ultrasound, on CD 8 my left ovary had the biggest follicle – how is that possible? My doctor explained to me that up until ovulation occurs, every single follicle is racing to become the dominant follicle. Each day, a different follicle may be the leader. Now, at some point, a dominant follicle is selected, but the other follicles (and the dominant follicle itself) don’t actually know that and are still in the race to become the biggest follicle. It’s not until ovulation actually takes place that most of the follicles give up and die. Even more interesting, women with PCOS tend to see follicles grow and shrink throughout the cycle, making it very hard to predict if and when ovulation is going to take place. Now that I have this image in my head, I can’t help but picture my follicles fighting and racing each other every month! Fun fact: Your body selects about the same total number of follicles each cycle to enter the race. This is because your body naturally rations out follicles each month to be sure that you have enough to last throughout your childbearing years.
OvaCue: At this point in my cycle, I began to closely monitor my vaginal readings. As ovulation approaches, we expect to see declining vaginal readings. My vaginal readings began to slowly drop on CD 9. Therefore, at this point in my cycle, I considered myself to be in my most fertile window.
Cycle Day 14
Ultrasound: I was extremely excited and anxious for this ultrasound. I had not yet seen the OvaCue confirm ovulation with a pink box, so I was expecting to see a HUGE follicle during the ultrasound. Again, we started the ultrasound by looking at my endometrial lining. (See picture CD 14 – Endo Lining) We were able to zoom in and get a great photo of the trilaminar appearance! (See picture CD 14 – Endo Close) Are you bored with the endometrial lining? I promise, you’ll have an AH-HA moment here soon – I didn’t realize the importance until after ovulation! Again, we started with the left ovary, and still counted about 7 follicles overall. (See picture CD 14 – Left Ovary Follicles) Next, we measured the largest follicle on the left side, which had shrunk since the last ultrasound! It measured at 0.58cm by 0.54cm. At this point, it was clear that ovulation was not going to take place from my left ovary this time around. We moved over to my right ovary and were able to count about 7 follicles (about 3 less than the previous ultrasound – they must have given up!). (See picture CD 14 – Right Ovary Follicles) We measured the largest follicle to be 1.86cm by 1.56cm! (See picture CD 14 – Right Ovary) It was evident that ovulation would be occurring soon.
OvaCue: As I mentioned before, the oral sensor had predicted ovulation for CD 13. At this point, my vaginal readings were still on the decline. Once ovulation occurs, we’ll see a vaginal rise, which causes the monitor to populate the pink box. But, because my vaginal readings were still declining, I knew that ovulation had not yet occurred. (The reading from this night was actually the lowest vaginal reading I had received during the cycle, making it my most fertile day!)
Cycle Day 15
Ultrasound: Unfortunately, CD 15 fell on a national holiday, so the clinic was closed and I was not able to get in for an ultrasound.
OvaCue: When I took my vaginal reading in the evening on CD 15, the monitor detected a rise and populated a pink box – ovulation confirmed! This was not a big surprise. Based on my very low reading the day before, and the size of my follicle in the last ultrasound, I was expecting to see a pink box appear. I went to bed wondering what the next day’s ultrasound would show.
Cycle Day 16
And now for the moment of truth! As I just mentioned, ovulation was confirmed with the OvaCue on CD 15 (about 9 PM). I arrived at my doctor’s office first thing the next morning. The 3D vaginal ultrasound machine that we had been using was booked for the day by actual patients, so we had to settle for using the older ultrasound machine, which is why the pictures look a bit different. We looked immediately at my right ovary, and quickly identified a collapsed follicle. It was evident that the egg had been released from the follicle, and that ovulation had occurred! The best way to describe the appearance of the follicle is that it went from looking like a normal circular basketball to a deflated one.
We then looked briefly at the corpus luteum and moved on to the endometrial lining. I’m sure I’ve bored you with all these endometrial lining pictures, without really providing information about the significance of what you were seeing. It wasn’t until this moment that even I realized the importance of it! Over the course of my follicular phase, as we were watching my follicles grow, we were also watching my endometrial lining grow and thicken. As ovulation was approaching, the three distinct “lines” in the lining became clearer and more distinct (they are very thin just after menstruation because you shed them). But, now that ovulation had occurred, we could clearly see that in half of the area where the three “lines” had been very visible, the lines were now fuzzy and the distinction between the lines was fading. According to my doctor, the trilaminar appearance of the endometrial lining begins to disappear at the time of ovulation, when your body switches from estrogen dominance to progesterone dominance.
How exciting! Seeing the pictures of the collapsed follicle and the disappearing trilaminar endometrial lining confirmed what my OvaCue had told me the night before – ovulation had occurred sometime during the previous 24 hours!
OvaCue: As I expected, my vaginal reading on CD 16 was relatively high. Once ovulation is confirmed with the OvaCue, we expect to see continued elevated vaginal readings for the rest of the cycle, indicating that progesterone dominance has taken hold and that ovulation was successful.
Summarizing the OvaCue Challenge
While this experience was absolutely fascinating in that I was able to actually watch the entire ovulatory process via the ultrasounds, I am so happy that I don’t have to make several trips to my doctor’s office each and every month to be able to predict ovulation. Thank goodness for my Ovacue! By using the OvaCue Fertility Monitor, with both the oral and vaginal sensor, I am confident in my ability to accurately identify the most fertile days in my cycle, and confirm the day ovulation occurs.