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Fertility Therapies
   ขั้นตอนการใช้เทคนิค
   ช่วยในการตั้งครรภ์ใน
   สตรีที่มีบุตรยาก

 
Ovulation Induction
   การกระตุ้นให้เกิดไข่ตก

  การใช้ยาช่วยกระตุ้นให้เกิด
  การตกไข่ สำหรับผู้มีบุตรยาก


Artificial 
   insemination

   การใช้สเปิร์มฉีดเข้าใน
   มดลูกหรือท่อรังไข่


Assisted  
  Reproductive   
  Technology. ART
  เทคนิควิธีการผสมเทียม
  - IVF
  - GIFT
  - ZIFT
  - ICSI

วิธีการทำการทดสอบ
   การตั้งครรภ์

   HCG Preganacy test

วิธีการทดสอบหาวันไข่ตก
   สำหรับผู้มีบุตรยาก

   LH Ovulation test

Sample Basal Body  
  Temperature Chart 
  (BBT)
  ตัวอย่างตารางวัดอุณหภูมิเพื่อ
  หาวันไข่ตก



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Web Manager







 Fertility Therapies       

Your Guide: Anna Peris, PharmD. -Stadtlanders' Clinical Fertility Specialist 

เป็นขั้นตอนการใช้เทคนิคพิเศษทางการแพทย์มาช่วยในการตั้งครรภ์ โดยจะ
เป็นขบวนการหลังจากได้พยายามทำขบวนการขั้นต้นมาแล้วไม่ได้ผล เช่น
การวัดอุณหภูมิหลังตื่นนอนในตอนเช้า การตรวจหาฮอร์โมน LH เพื่อหาวัน
ไข่ตกก็แล้ว แพทย์ก็จะเริ่มพิจารณาในขบวนการนี้ต่อไป เพื่อช่วยให้มีการ
ตั้งครรภ์ เรารวมเรียกขบวนการนี่ว่า
Assisted Reproductive Technology (ART: GIFT, ZIFT, ICSI, and IVF)


If you've reached this point, you and your partner have probably tried all the
"basic" methods to enhance your chances of becoming pregnant. You've been monitoring your cervical mucus secretions, measuring your basal body 
temperature (BBT), and perhaps even testing your urine to predict ovulation. 
Despite persistent attempts with these simple strategies, you have yet to 
achieve a pregnancy. At this point, your doctor may have suggested one of 
several fertility therapies to maximize your chances of getting pregnant. If you 
feel confused and overwhelmed with the options available to you, don't worry, 
we are here to help! -Anna 


Introduction to Fertility Treatments 

Fertility treatments don't have to be as complex as they may initially sound. 
Millions of couples go through these treatments every year. And although it is frustrating, the most important thing you can do for yourself is to gain as much knowledge as possible regarding each treatment option. You need to feel comfortable with every step of the process and know what to expect from a 
medical, emotional, and financial standpoint. 
The purpose of this primer is to give you basic information that you need about 
fertility treatments in general. Continue to follow the links for each individual 
treatment option to learn more in depth material such as indications, side effects, 
and success rates. Remember, the more you know, the better you'll feel. 

In general, fertility treatments fall into one of three categories: 
ขั้นตอนการใช่เทคนิคเข้ามาช่วยในการตั้งครรภ์ จะมี 3 ขั้นตอนขึ้นอยู่กับว่า
การใช่ขั้นตอนแรกแล้วยังไม่ได้ผล ก็จะขยับไปในขั้นต่อไป จนถึงขั้นใช้วิธี
การผสมเทียมเป็นขั้นตอนสุดท้าย ดังนี้
Ovulation Induction (OI) 
   กระตุ้นให้เกิดการตกไข่
Artificial Insemination (AI and IUI) 
  การใช้สเปิร์มฉีดเข้าในมดลูกหรือท่อรังไข่
Assisted Reproductive Technology (ART: GIFT, ZIFT, ICSI, and IVF)
  ขบวนการใช้เทคนิคผสมเทียมช่วยให้เกิดการตั้งครรภ์ 


The purpose of ovulation induction is exactly what the name says - inducing the woman to ovulate. This is done with either a pill or injectable medications. 
Ovulation induction
is appropriate for certain women, depending on their 
diagnosis - it's not right for everyone. It usually works the best for couples where 
the woman can't get pregnant because she doesn't ovulate regularly or 
consistently. In some cases, a little pill may be all that is needed to do the trick 
(for more information on fertility medication, see At The Pharmacy). 

The answer is not always so simple however. Some couples may be more 
suitable candidates for artificial insemination or AI. AI means taking a purified specimen of the male partner's sperm and injecting it into the female partner's reproductive tract. In many cases, this may facilitate fertilization if a couple is 
unable to get pregnant. AI is certainly more involved than ovulation induction - it requires an outpatient procedure and monitoring the woman's response to 
potent fertility medications. 

The most complex fertility procedures are grouped under the name ART, which stands for Assisted Reproductive Technology. There are several different kinds 
of ART procedures, including IVF, GIFT, ZIFT, and ICSI. The basic concept 
behind ART is that involves taking the egg out of the female body in order to 
assist the process of fertilization. The simplest ART procedure, IVF has been 
around for over 20 years. Although it is still being perfected, modern medicine 
has come a long way. In many cases, the ART procedures have helped hopeful couples have many children. 

ART, or any of the other fertility treatments should be approached with careful consideration. Although these therapies provide exciting possibilities, it is 
important to understand what each one entails. Fertility treatments utilize potent medications and require a significant emotional and financial commitment from 
each partner. Learn the most you can about your options, and ask many 
questions. It is critical to have all the information you need up front, before you 
initiate therapy. 

 

 

 

 

 Ovulation Induction      


Discussions question
"I have one child and shortly after his birth i became pregnent again. I had a miscarriage during my third month. since ..."
-Talk About It



Ovulation induction is a very common term that you may encounter in your 
journey through fertility treatments. Basically, this term refers to the use of 
medications to stimulate your body to produce one or more eggs. Ovulation 
induction may be necessary in women who do not ovulate consistently, but want 
to have a child. There are many reasons why women do not ovulate regularly - polycystic ovarian syndrome (PCOS), excessive exercise, and 
hyperprolactinemia are just a few examples. One important prerequisite for a 
woman to participate in ovulation induction is that she must have good quality 
eggs remaining in her ovaries. This procedure is of no use to women who have ovarian failure or eggs of poor quality. 

Ovulation induction can be as simple as taking a daily pill or more complicated, 
like injecting fertility medications and seeing your specialist daily for necessary monitoring. The simplest form of ovulation induction involves taking clomiphene. Clomiphene is a small tablet that must be taken on specified days of the cycle. 
It is relatively inexpensive and has very few side effects. If taken correctly, clomiphene can be very effective in inducing ovulation. As many as 50-80% of women who take clomiphene will ovulate, however only about half of these will achieve a pregnancy. 

In some cases, a woman may need a little extra help in getting her body to 
produce eggs. Remember, not everyone is the same and therefore not every 
woman will necessarily respond to clomiphene. More potent medications, known 
as the gonadotropins, are available for more intensive ovulation induction. Gonadotropins are injectable medications that are made up of a combination of follicle stimulating hormone (FSH) and luteinizing hormone (LH) or just FSH alone. These hormones can be very helpful in getting a woman to produce and release
her eggs. Because these medications are so potent, you will be required to visit 
your specialist's office frequently to get appropriate monitoring and guidance. 
This can include bloodwork, ultrasounds, or just verbal counseling in regards to dosing and injection techniques. Close contact with your healthcare team will 
ensure that you get the best outcome from the treatment and also help prevent potential side effects from the therapy. 

For some women, ovulation induction with medications will not be enough to 
achieve pregnancy. Even if the medications work, there may be other reasons 
that prevent the couple from becoming pregnant - for example, a low sperm 
count. For couples where ovulation induction is unsuccessful in producing a pregnancy, one of many ART procedures may be advised as the next path to parenthood. 

For the ART procedures, injectable gonadotropin medications are also used to stimulate the woman's ovaries to produce multiple eggs. However, when medications are used in preparation for an ART procedure, the process is no 
longer called ovulation induction, but rather controlled ovarian hyperstimulation 
or COH. The only difference between the 2 procedures is that in COH, the woman 
is never actually "allowed" to ovulate - rather, her eggs are retrieved from the 
ovaries immediately prior to the anticipated time of ovulation (in the case of IVF) 
and fertilized outside of the body, in a laboratory. In ovulation induction, however, ovulation is desirable since a natural pregnancy is being attempted. COH 
requires extensive monitoring and follow-up since it involves the use of 
injectable gonadotropins. 

The success of ovulation induction in achieving a pregnancy is highly variable. 
It depends on your diagnosis, age, the medication being used, and numerous 
other factors. Therefore, it is important that you speak with your specialist 
regarding your anticipated rate of success with a chosen treatment.

หลักเกณฑ์ในการกระตุ้นให้มีการตกไข่ 
สิ่งสำคัญที่สุดคือรังไข่ ยังทำงานอยู่คือยังมี "ไข่" และสามารถสร้างฮอร์โมนเพศได้ สตรีที่สมควรได้รับการกระตุ้นและชักนำให้ไข่ตกได้แก่  1. สตรีที่มีความผิดปกติของฮอร์โมน เช่น 1.1 มีความผิดปกติที่ระดับส่งการบริเวณสมองส่วน Hypothalamus ซึ่งมักเกี่ยวข้องกับความเครียด น้ำหนักตัวที่มากหรือน้อยเกินไป 1.2 มีความผิดปกติที่ระดับสั่งการ บริเวณต่อมใต้สมอง เช่น มีเนื้องอกของต่อมใต้สมอง2. สตรีที่มีความผิดปกติในเรื่องของการตกไข่ คือ "ไข่" ไม่ตก  กระตุ้นไข่และชักนำให้ไข่ตกมี 3 แนวทางด้วยกันแนวทางที่ 1 กระตุ้นที่ระบบสั่งการในสมอง แนวทางที่ 2 กระตุ้นที่รังไข่โดยตรงแนวทางที่ 3 ใช้ทั้งสองแนวทางร่วมกัน

ข้อมูลเพิ่มเติมเกี่ยวกับการใช้ยากระตุ้นให้เกิดการตกไข่ (ภาษาไทย) 

 

 

 

 Artificial insemination - AI      

AI and IUI
Discussions 
Suffering from blocked fallopian tubes
"Hi,
I am 27 and my husband and I have been trying to have a baby for 2 years now.
 No luck! In that time I have had ma..."
-Talk About It



As a couple dealing with infertility, you may be faced with various options in your journey to become loving parents. Artificial insemination or AI is just one of those options that may be considered prior to attempting more involved treatments, 
such as IVF. AI is typically recommended for the treatment of infertility due to: 
mild to moderate male factor infertility 
"unexplained" infertility 
cervical mucus insufficiency 
hostile cervical mucus 
various structural abnormalities in the woman 
Many couples are presented with the AI option after a trial of clomiphene is unsuccessful. 
AI is a relatively simple procedure that involves injecting a sample of specially treated sperm from the male partner into the female partner's reproductive tract. 
For most couples, AI is performed with the husband's sperm. However, when the husband's ejaculate contains few or no live sperm, the couple may consider undergoing more advanced procedures including IVF, ICSI, or donor sperm insemination. 

It's important to note that AI is a general term - there are actually several different types of AI, and they are named for the location of sperm insemination into the female. The types of AI are intracervical (in the cervical canal), intrauterine (in the uterine cavity), intrafollicular (in the ovarian follicle) or intratubal (in the fallopian 
tubes). Therefore, AI merely describes a procedure where a qualified 
reproductive specialist injects sperm into the female reproductive tract. The 
different types of AI are recommended based on your diagnosis and probability 
of success with each method. 

Of the four different types of AI, intrauterine insemination (IUI) is the most 
commonly used form. It is very useful if the cause of infertility is insufficient or 
hostile cervical mucus or low sperm count or motility. The reason for this is IUI 
allows sperm to bypass the cervix without encountering "unfriendly" cervical 
mucus which could "inactivate" the sperm. The reason that IUI is helpful for low 
sperm count or motility is based upon the knowledge that only about 1% of the 
total numbers of sperm deposited into the vagina at ejaculation will find their way 
into the upper female genital tract. IUI places the healthiest sperm into the female genital tract to increase the likelihood that one of those sperm will fertilize an egg. 

IUI is a relatively quick procedure that takes place in the clinic office. It is 
performed by passing a sterile catheter containing the sperm through the cervix 
and into the uterine cavity. The sperm are then injected directly into the uterus. Usually the insemination itself causes little if any discomfort. Following the insemination procedure, you will likely be asked to remain lying down with your 
hips elevated for about 45 minutes. 

Although IUI is relatively uncomplicated, and less invasive than IVF, one disadvantage associated with IUI is that it does not allow the doctor to evaluate whether or not fertilization is capable of taking place. With IVF/ET, fertilization 
can be confirmed since it takes place outside of the body, in a lab. With IUI, 
however, fertilization still takes place within the body, much like a natural cycle. Although IUI is more natural, it is unknown whether or not the sperm actually 
fertilizes the egg to make an embryo (unless the woman gets pregnant after 
the first IUI cycle). Therefore, if you repeatedly are unsuccessful in achieving pregnancy following IUI, consider discussing the IVF option with your healthcare team. 

The pregnancy rates for IUI treatment cycles average about 15-20% per cycle 
when IUI is performed for the correct indications. If all other conditions affecting 
fertility are thought to be normal or adequately treated, then a reasonable length 
of treatment with IUI is about three to six treatment cycles. If you and your partner 
are unable to achieve pregnancy by the end of this course of treatment, then 
speak with your doctors about other options available to you. Perhaps a reassessment of your diagnosis should be made since some other factor may 
be present which has been unrecognized and inadequately treated. 

 

 

 

 

    

 Assisted Reproductive Technology. ART      

ART stands for Assisted Reproductive Technology. ART procedures include 
IVF, GIFT, ZIFT, and ICSI. ART procedures generally involve taking the egg out 
of the female body in order to assist the process of fertilization. The simplest 
ART procedure, In Vitro fertilization -IVF
has been around for over 20 years and is perhaps the most commonly 
recognized ART of all procedures. I have developed a seperate section on IVF and will focus our discussion here on GIFT, ZIFT, and ICSI. -Anna 


ZIFT
Depending on your diagnosis, your doctor may discuss the option of performing zygote intrafallopian transfer (ZIFT) instead of conventional IVF. ZIFT may be recommended if the husband has severe male factor infertility or if there has 
been difficulty confirming fertilization with past procedures
. ZIFT has the advantages of allowing fertilization to be confirmed and it has demonstrated 
higher success rates than IVF when used for the appropriate indications. 

ZIFT nothing more than a variation of traditional IVF. With ZIFT, the fertilized egg that is transferred back into the woman is allowed to divide only to the 2-cell 
stage, instead of the 4 or 8 cell stage as with conventional IVF.This fertilized egg at the 2-cell stage is called a "zygote". 

Like IVF, ZIFT involves ovarian stimulation, monitoring, and egg retrieval, 
followed by sperm processing and fertilization in the laboratory. Another slight difference between IVF and ZIFT (besides the stage of the transferred embryo) 
is the location where the embryos are placed in the woman's body. With IVF, the embryos are placed directly in the uterus. With ZIFT, however, the zygotes are placed directly into the fallopian tube. Therefore, a criterion for performing ZIFT 
is that the female partner has at least one open and functioning fallopian tube. 

One disadvantage with ZIFT is that the transfer of the zygote must be performed through a laparoscope. This involves a surgical incision, whereas with IVF, the fertilized eggs are transferred through the vagina without the need for any 
incisions. Although laparoscopy is a minor surgical procedure, it still adds to the complexity, risk, and cost of the entire process. 


GIFT
Gamete intrafallopian transfer (GIFT) was developing in 1984 as a variation of in vitro fertilization (IVF). Your doctor may recommend GIFT if your diagnosis is unexplained infertility infertility due to 
immunological factors endometriosis selected cases of male infertility tubal infertility 
A requirement for the procedure is that the female partner having at least one 
open (patent) fallopian tube. GIFT is sometimes selected based on a couple's religious beliefs that prohibit conception outside the body. 
GIFT is not much different than IVF. The main difference is that with GIFT, fertilization occurs naturally within the female partner's body instead of in the laboratory as with IVF. GIFT involves ovarian stimulation, and egg retrieval like IVF, but with GIFT, sperm and eggs are placed directly into the woman's fallopian tubes to foster fertilization. The following steps outline what you can expect when undergoing GIFT: 

Step 1: Ovarian Stimulation and Monitoring 
This step is exactly the same as in IVF. In order to maximize the chances of success, the physician will prescribe fertility medications (such us Humegon? or Fertinex?) to stimulate the woman to produce more than one follicle and egg. 
HCG (Profasi? or Novarel?) is then typically given to stimulate the release of the eggs from the follicles and time the egg retrieval step. 

Step 2: Egg Retrieval and Sperm Processing 
This step also mirrors the process in IVF. The eggs are removed from the 
woman and examined under a microscope to evaluate maturity before they are combined with sperm. The male semen sample has been collected, evaluated, and sperm processing performed prior to the next step. 

Step 3: Gamete Transfer 
Once the physician has determined the eggs are ready for transfer, the selected sperm and eggs are placed together in a catheter. These sperm and eggs are called gametes. In IVF, these gametes would be united in the laboratory by an experienced embryologist, however this does NOT happen with GIFT. With GIFT, the gametes are injected into the fallopian tube using a special catheter (laparoscope). Within the fallopian tube, fertilization will hopefully occur naturally. Unlike IVF in which actual fertilization is observed and confirmed in the laboratory, GIFT does not allow visual confirmation of fertilization. If fertilization occurs, the developing embryos remain in the fallopian tube and then move to the uterus for the natural implantation process. 

For selected cases of infertility, GIFT may have a higher success rate than IVF. This may be due to the fact that GIFT more closely mimics natural conception as compared to IVF. Specifically, the egg is fertilized in the fallopian tube rather than
 in the laboratory. In some cases, however, GIFT may not offer additional advantages to IVF, but may in fact add to the cost of therapy. Therefore, discuss with your specialist if you are a good candidate for this procedure. 

 


Intracytoplasmic Sperm Injection (ICSI) 
Intracytoplasmic sperm injection, or ICSI, was developed to treat couples who previously had a very poor probability of achieving fertilization due to the male partner's extremely low numbers of viable sperm.This treatment, when combined with in vitro fertilization, allows these couples a more favorable probability of achieving conception. ICSI has replaced the two previously developed micromanipulation techniques of partial zona dissection, or PZD, and subzonal insertion, or SUZI, because of the overall higher fertilization rates achieved with ICSI. ICSI has revolutionized treatment for severe male factor infertility because 
the procedure requires only one healthy sperm to potentially achieve fertilization. 

A variety of sperm problems can account for male infertility. Sperm can be completely absent in the ejaculate, a condition known as azoospermia. Men with low concentrations of sperm in the ejaculate have a condition known as oligospermia. Poor motility, or a condition called asthenospermia, occurs when 
the sperm do not have the forward swimming motion sufficient to make the 
journey from the ejaculation site in the female's vagina, though the reproductive tract, to unite with the egg in the fallopian tube. Men whose sperm have an increased percentage of abnormal shapes and forms have a diagnosis of teratospermia. Other sperm problems that prevent fertilization are abnormalities 
in the series of steps required for fertilization, such as the sperm's ability to bind and penetrate the cytoplasm of the egg. 

Male factor infertility may be caused by blockages, varicoceles, or abnormalities of the ejaculatory ducts causing low or no sperm in the ejaculate. Men who have had a severe injury to their male reproductive organs, some neurological disorders, or surgery (including vasectomy), may have an absence of sperm in 
the ejaculate. Men who have had radiation and chemotherapy treatments for cancer, may have low or no sperm present in the ejaculate. Men who have provided semen samples prior to undergoing cancer treatments and major surgeries of their reproductive organs are candidates for ICSI due to the limited number of sperm available to achieve conception with ART procedures. 

ICSI may be a recommended treatment option for all of these infertile men. 

Steps One: Ovulation Stimulation and Monitoring
The same process used in the other ART procedures to induce ovulation is 
used with ICSI. 

Step Two: Sperm Extraction
Semen samples can be obtained through masturbation. If any viable sperm can be obtained from this type of semen sample, procedures to extract sperm will not be used. The sperm sample will be evaluated and processed to select only the healthy, viable sperm for the fertilization procedure. 

When there is an absence of sperm in the ejaculate, surgical extraction procedures are performed. 

One procedure called microsurgical epididymal sperm aspiration, or MESA, is used when sperm are unable to move through the genital tract due to uncorrectable blockage, congenital absence of the vas deferens or seminal vesicles. Aspiration is accomplished with MESA, usually performed as an outpatient procedure, when sperm are extracted directly from the epididymis. Epididymal sperm are typically not fully motile, which means they cannot swim through the female tract to reach the egg for fertilization. These sperm do contain the right genetic material, nucleus and chromosomes, to produce normal babies. These sperm can be used with IVF or ZIFT, assisted reproductive technology procedures that place the sperm in direct contact with the egg. 

Sperm can also be aspirated from the testicles in a surgical procedure called testicular sperm aspiration, or TESA. These sperm are also typically not motile and mature, but do contain the normal genetic material to produce normal babies.. 

Step Three: Egg Retrieval 
This step is the same as in the other ART procedures. 


Step Four: Micromanipulation and Fertilization with ICSI

Specially trained embryologists and andrologists use micromani-
pulation techniques with the aid of microscopic instruments to enhance the chances for fertilization. In the laboratory, extra steps are taken with the eggs to remove the cumulus cells that support the surrounding oocyte, or egg. This 
allows they embryologist and/or physician to visualize the oocyte's maturity 
and suitability to undergo the ICSI procedure. 

The semen sample is prepared, yielding as many viable sperm as possible. 
The goal is to locate as many viable, healthy sperm as the number of selected eggs. While transfer of multiple successfully fertilized eggs increases the probability of success, ICSI has been proven successful with only one viable sperm and one viable egg that are able to fertilize. 

Once an embryo is fertilized, it is transferred back into the woman by injection into the uterus, as with IVF. 

Success Rates 
Definitive statistics have not yet been published by the Registry of Assisted Reproductive Technology. Preliminary success rates reported by various practices that offer ICSI range from 15% to 35% deliveries per egg retrieval. 

The American Society of Reproductive Medicine Fact Sheet on ICSI published 
in December of 1996 states expected egg fertilization rates of 50% and cleavage rates of 80% or more, but only 15% to 20% of egg retrievals produce a delivery in well selected couples. This Fact Sheet also states that perinatal outcomes 
studies in Europe suggest that although multiple pregnancies are common in 
ICSI, there is to date no evidence of increased incidence of birth defects with this procedure. 



Your Guide: Anna Peris, PharmD. -Stadtlanders' Fertility Specialist 



 

Sample Basal Body Temperature Chart (BBT)
Charting your BBTs is really pretty easy. Basically, what you are doing is taking your temperature first thing each day and plotting the temperature on a chart. What you are looking for is to see a shift of at least .4 degrees Fahrenheit after ovulation making your chart biphasic (showing low temperatures before ovulation in the follicular phase, and higher ones after ovulation in the luteal phase).

  1. Take your temperature first thing in the morning before you get out of bed or even speak -- leave your thermometer at your bedside within easy reach so you don’t have to move much to get it. If you use a glass thermometer, make sure you shake it down before going to bed.
  2. Try to take the temperature at as close to the same time each day as possible -- set an alarm if you need to. Staying within a half hour either side of your average time is a good idea because your temp can vary with the time (i.e., if you usually take your temperature at 6 a.m., it is OK to take your BBT between 5:30-6:30, but the closer to 6 the better). The normal variation is by up to .2 degrees per hour -- lower if you take your temperature early, higher if you take it late.
  3. It is best to take your BBT after a minimum of 5 hours sleep, and at least 3 in a row is preferable.
  4. You can take your temperature orally, vaginally, or rectally -- just stay with the same method for the entire cycle.
  5. You should try to place the thermometer the same way each day (same location of your mouth, same depth vaginally and rectally).
  6. Plot your temperature on your chart each day, but refrain from reading too much into it until the cycle is done.
  7. Some women, not all, have a temperature drop when they ovulate. If you see this drop, it is a good idea to have sex in case you are ovulating.
  8. What you are looking for is a temperature shift of at least .4 degrees over a 48-hour period to indicate ovulation. This shift should be above the highest temperatures in the previous six days, allowing one temperature to be thrown out as inaccurate (fluke, illness). Perhaps the best way to explain this is to show an example.

    In the image above, the seven BBTs before ovulation are 97.2, 97.3, 97.8, 97.4, 97.2, 97.3, 97.0 then it jumps to 97.7 and then 98. Ovulation most likely occurred on the day with the 97.0 and you can comfortably draw a coverline at 97.6. You just ignore the 97.8 on day 10.
  9. After you see a temperature shift for at least three days, or at the end of your cycle, you can draw a coverline between your follicular phase and luteal phase temperatures. With luck, it is easy to see a clear shift and draw your line between the highest follicular phase BBT and the lowest luteal phase BBT as in the sample above. The main reason for drawing this line is just to clearly delineate that your chart is biphasic.
  10. Look at the chart at the end of the month to analyze what happened.
  11. Chart for a few months and look for patterns.
  12. If your temperature stays up for 18 days or more after ovulation, you should test for pregnancy.

One thing to note is that women with ovulatory cycles but with irregular cycle lengths, the greatest variation from cycle to cycle should be in the follicular phase. The luteal phase should be relatively constant (within 1-2 days). So if one has a cycle that ranges from 28-34 days, and a luteal phase of 14 days, ovulation would occur somewhere between days 14-20 -- not the middle of a cycle, not day 14 . . . This is the biggest mistake women with long cycles make when trying to conceive.


Frequently Asked Questions

Basal Body Temperature Questions

Q: What will my BBTchart tell me?

A: The goal is to find out if you are ovulating and help you time intercourse. If you see a definite biphasic chart, that’s a good sign. You can also tell whether your luteal phase is long enough if your temperatures are up for at least 12 days after ovulation.

Q: How long should my temperature stay up after ovulation?

Ideally, 14 days. Some doctors say anything over 10 days is acceptable, but it really makes sense to test for luteal phase defect if one typically shows 12 days or less of high temperatures. You can test for luteal phase defect with a serum progesterone level and/or an endometrial biopsy. Many doctors will want to see two cycles of low progesterone or out of phase biopsies before making a definite luteal phase defect diagnosis.

Q: My temperature dropped for a day in the luteal phase, does that mean this cycle is a bust?

A: Not unless it stays down. Some people have a short drop that may go well below the coverline that is a secondary estrogen surge (which may be accompanied by mucus).

Q: How long should I chart before seeing a doctor if I suspect infertility?

A: Good question! If your cycles are irregular, you shouldn’t waste time on BBTs alone -- see a doctor and find out what may be causing the irregularity. If you do have normal-length cycles and decide to start charting, you only need to wait about 3 months to establish a problem and seek help. For example, if you have a 28-day cycle, but ovulate on day 18, and that happens 2-3 months in a row, you should see your doctor. Otherwise it depends on your age and urgency. It’s not a bad idea for everyone to get preconception advice and bloodwork -- test for immunities to rubella, chicken box, fifth disease, also test for anemia and thyroid function at a minimum.

Q: What are average BBTs?

A: The average range of BBTs is between 97.0-97.7 before ovulation and 97.7-99.0 after ovulation. Ideally, a woman’s temperature will not bounce around more than .5 degrees in the follicular phase and will stay above the coverline during the luteal phase.

Q: My BBTs are lower/higher than average, what does this mean?

A: Either case warrants checking your thyroid. Low BBTs are often a sign of hypothyroid which can cause some fertility and pregnancy problems. Excessively high temperatures may indicate hyperthyroid.

Q: I did and ovulation predictor kit, how long after the positive should my BBT rise?

A: You should ovulate 12-48 hours after the positive ovulation predictor test, and your BBTs should go up within 48 hours of ovulating. It can take up to 4-5 days to see the rise, but ideally you see it within 3.

Q: My chart looks more like the Rocky Mountains than anything else, what does that mean?

A: Most likely a) you are not taking your BBTs consistently or sleep erratically, b) you are taking your BBTs orally and you sleep with your mouth open, or c) you are not ovulating. If being more consistent, or switching to taking your BBTs vaginally or rectally, doesn’t help, you should go to the doctor to have your hormone levels checked out and see what may be causing your anovulation.

Q: How late in a cycle can one ovulate?

A: It is possible to ovulate very late in a cycle -- there is not any day limit -- so a long cycle doesn’t mean there is no hope. Long cycles do, however, reduce opportunities to get pregnant and warrant looking into. It is also a good idea to have at least one cycle every 3 months, brought on by medication if needed, so that the uterine lining does not become too thick.

Q: Can I tell I am pregnant from a BBT chart?

A: You are most likely pregnant if your BBTs stay up for 18 or more days after ovulation. It is also common to see a triphasic chart, a second shift sometime during the luteal phase, when pregnancy is achieved.

Q: Do I really need BBT thermometer, or will a fever thermometer do?

A: A BBT thermometer is more reliable and more accurate. In glass thermometers, fever ones are only accurate to .2 degrees Fahrenheit. You really need it to be accurate to .1 degrees. The main plus of the digital BBT over a fever BBT thermometer is speed. The BBT digital is more accurate for some people, and it only takes 30-60 seconds, which can matter if you are waiting to go to the bathroom first thing in the morning. The digital ones are harder to break and remember the temperature for you if you don’t want to chart it immediately.

   

  
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