This might surprise you, but your period is not  the main event of your menstrual cycle. Yes, managing your monthlies takes some attention (especially if you suffer during this time), but it's actually ovulation that determines if, when,  and how  your period shows up - and it's a far more complex process than most people realise. Ovulation occurs when one of your ovaries releases an egg. Women of reproductive age should ovulate every month, but a lot needs to go right for that to happen. It actually takes around 100 days for an egg to fully mature - so the one you release this month began its journey more than three months ago. During that time, you have the opportunity to either support or potentially disrupt the development of the egg and its chances of being released successfully. What Is Anovulation? Anovulation or lack of ovulation, is surprisingly common and can happen for various reasons. The intricate hormonal symphony that controls ovulation is highly sensitive to disruption. So, depending on what’s going on in your life or with your health, you might occasionally skip ovulation. That’s normal from time to time , but when it happens regularly, things can start to go haywire, and not just for your periods. Chronic anovulation will affect your overall health and well-being, too. Why Do We Need to Ovulate? The obvious reason is, of course, to get pregnant. But even if you're not trying to conceive, ovulation brings with it a whole host of other benefits: To maintain a healthy and regular menstrual cycle - Ovulation is key to cycle regularity. Without it, cycles can become erratic or disappear altogether. Irregular menstrual cycles come with a whole host of unwanted symptoms. To produce the hormone progesterone in the luteal phase (the second half of your cycle) - If you don’t ovulate, you won't make Progesterone. This hormone is important for mood stability, sleep quality, and has a calming effect, reducing anxiety. It's important for inflammation control, pregnancy, and reduces heavy periods. We also need Progesterone to make Testosterone. Metabolic health - Ovulation and the associated hormonal fluctuations of oestrogen and progesterone support insulin sensitivity and regulate metabolism and appetite. Bone health - Both oestrogen and progesterone help protect against bone loss and support bone density.  Cardiovascular health - Ovulatory cycles are linked to better heart health, with women having a longer reproductive lifespan and regular ovulatory cycles having a reduced risk of heart disease. Brain health - The production of hormones like oestrogen and progesterone at ovulation also support mood, memory, and cognitive function. Libido - Ovulation usually boosts libido - your body’s way of encouraging reproduction, but also a sign of hormonal harmony. Why Tracking Ovulation Matters Understanding your menstrual cycle and knowing when you ovulate can help you avoid pregnancy or  pinpoint your fertile window when trying to conceive (TTC). But it’s important to track it the right way. Cycle tracking apps are popular, but most of them calculate ovulation based on the average menstrual cycle length. This method isn’t reliable because your ovulation can’t be confirmed just by knowing when your period starts. A Quick Overview of the Menstrual Cycle The menstrual cycle can be broken down into four main phases: Follicular Phase  – before ovulation Ovulatory Phase  – ovulation itself Luteal Phase  – after ovulation Menstrual Phase  – your period For this post, I’m going to focus on the follicular  and luteal  phases, since the other two are wrapped up within these. The Follicular Phase  The follicular phase begins on day one of your period  and lasts until ovulation. This phase is the final stage of follicular development, as these follicles have a much longer lifespan and take 100 days to mature in total.  During this time, your ovaries respond to a pituitary hormone called FSH (follicle-stimulating hormone)  by producing follicles - small fluid-filled sacs. As these follicles grow, one becomes dominant. This is the follicle that will release an egg during ovulation, and it also becomes the primary source of oestrogen (Estradiol)  production. Oestrogen is the queen bee  of hormones. When it’s produced at healthy levels it boosts serotonin and dopamine production, making you feel pretty fabulous. It thickens the uterine lining and stimulates the production of fertile cervical mucus . It also increases libido in the lead-up to ovulation. Clever, right? The dominant hormone at your most fertile time makes you feel sexier and  creates nature’s ultimate lube. Just before ovulation, oestrogen peaks. In the presence of rising levels of oestrogen, FSH triggers a surge in another pituitary hormone— LH (luteinizing hormone) . LH surges around 24–36 hours before ovulation , triggering the release of the egg. Once this happens, oestrogen drops, and you transition into the luteal phase . The length of your follicular phase can vary, lasting anything from 7 to 21 days.  The Luteal Phase After the egg is released, the leftover follicle on your ovary becomes a temporary structure called the corpus luteum . This glandular structure now starts producing progesterone . Progesterone brings a more calming vibe compared to oestrogen. You might feel less energetic, less social,  more inclined to slow down, and your appetite may increase. Sex drive takes a back seat, and your cervical mucus will shift, becoming thicker and less watery, maybe even disappearing altogether. Progesterone supports the uterine lining, making it nutrient-rich and ready to welcome a fertilised egg. It also plays a critical role in embryo implantation  and will continue to support early pregnancy until the placenta  takes over hormone production. If no fertilised egg implants, both oestrogen and progesterone levels will drop around 10–14 days after ovulation . This hormonal decline triggers the shedding of the uterine lining- aka your period. And then the whole cycle starts again. The Luteal phase should last from 10-14 days. If any longer than this, you may not have ovulated. If shorter, you may have still ovulated, but this will be classed as a short luteal phase and you won't make enough progesterone - this can impact fertility and also menstrual health.  Can I Still Have a Period If I Don’t Ovulate? Yes - but it's technically not a true period. What you may experience is a breakthrough bleed , where the endometrial lining sheds without ovulation. This is what's happening when taking the combined oral contraceptive pill (COCP) , as this prevents ovulation but still allows for a withdrawal bleed during the pill-free days. Why Might I Not Be Ovulating? Ovulation relies on a delicate hormonal balance. Disruptions to this system can be caused by: Stress Low or high body weight Blood sugar imbalances Inflammation or illness Disordered eating Medications Sleep disruption, shift work, or travel And of course, pregnancy These factors can delay or prevent ovulation altogether, especially if they're ongoing. How do I know when I am ovulating and which tests to use? A combination of methods is often most effective. Here are several ways to track your fertile window  and confirm if you're ovulating: 1. Ovulation Predictor Kits (OPKs) These test for a rise in luteinizing hormone (LH)  in urine, which peaks 24–36 hours before ovulation. However, they need to be timed well and are less reliable for women with PCOS , as LH may be persistently elevated. Tip:  Watch for fertile signs like cervical mucus before beginning OPK testing and then use these tests daily until you see a clear change of colour or smiley face (depending on the brand) on the test strip indicator confirming the day of ovulation. 2. Basal Body Temperature (BBT) Charting Your BBT  increases after ovulation due to a rise in progesterone . Using a BBT thermometer: Take your temperature first thing each morning (before moving or getting up). Track it daily from day 1 of your cycle . This is the first day of your period with full blood flow (spotting doesn't count). A temperature shift mid-cycle suggests ovulation has occurred. You should see a biphasic pattern with a rise in temperature of around 0.2C in the 3 days following ovulation. This rise in temperature should remain consistent for around 10 days. Note:  Illness, alcohol, or irregular sleep can affect readings. Apps or wearable devices can help automate the process. 3. Fertility Awareness Method (FAM) FAM combines BBT tracking  with cervical mucus observation  and sometimes cervical position checks . Fertile mucus  is clear, slippery, and egg-white-like - your body’s natural sign that ovulation is near. Cervical position may also rise and soften around ovulation. Fertile mucus is capable of keeping sperm in a prime position for up to 5 days. With this in mind, you are most fertile on the days leading up to ovulation, when this mucus is present, on the day of ovulation, and for 1-2 days following ovulation. This equates to around 6 days in total. When learned correctly and with practice, FAM is highly effective.   This method is not for everyone, as tracking your BBT can be stressful, particularly if you are TTC.  4. Hormone Blood Testing To confirm ovulation via blood work,  progesterone levels need to be tested  7 days after suspected ovulation  (Ovulation + 7). You will need to use a combination of the above methods to time this right.  For deeper insights, I always test FSH, LH, and oestrogen between days 2–3 of your cycle . This helps identify issues with the start of your cycle that could be impacting your ovulation.  In perimenopause or PCOS, hormone testing can be trickier - it's best to work with a fertility-awareness practitioner or fertility nutritionist  to support you with this.  Tip: Day 21 progesterone test - most GPs, when testing progesterone, will standardly do this on day 21 of your menstrual cycle. This is only accurate if you are having a textbook 28-day cycle and ovulating on day 14. As we know cycle length and time of ovulation can vary. 5. Follicle Monitoring Scans Ultrasound scans can confirm ovulation by visualising the developing and released follicle. This method is used in clinical settings - ideal during fertility treatment or when investigating irregular cycles , but not practical for monthly self-monitoring. What’s the Best Way to Track Ovulation? If budget allows, wearable digital devices that monitor temperature (like Oura Ring or Tempdrop ) offer convenient and accurate ovulation tracking. Otherwise, the best method is a combined approach : Observe cervical mucus to pinpoint your fertile window (remember this is around 6 days) Use OPKs  at the onset of your fertile window  (when fertile mucus is noticeable) to identify the day of ovulation. Confirm ovulation with BBT  and/or blood tests . Working with a practitioner to help you with it is generally needed in the early stages. If your cycles are irregular or absent , ovulation may be infrequent or missing. You should always consult with your GP if you are experiencing symptoms of anovulation in order to rule out any conditions that may require medical treatment. Also don't forget to consider a potential pregnancy. If you would like nutritional support with optimising your ovulation and your menstrual cycles please get in touch. References: Wang, Y.X., Arvizu, M., Rich-Edwards, J.W., Stuart, J.J., Manson, J.E., Missmer, S.A., Pan, A. and Chavarro, J.E., 2020.  Menstrual cycle regularity and length across the reproductive lifespan and risk of premature mortality: prospective cohort study. BMJ , 371, p.m3464. Available at:  https://pubmed.ncbi.nlm.nih.gov/32998909/  [Accessed 9 May 2025]. Briden, L., 2017.   Period Repair Manual: Natural Treatment for Better Hormones and Better Periods . 2nd ed. GreenPeak Publishing.​ Reed, B.G. and Carr, B.R., 2018.  The normal menstrual cycle and the control of ovulation. In: K.R. Feingold, S.F. Ahmed, B. Anawalt, et al., eds. Endotext  [online]. South Dartmouth (MA): MDText.com , Inc. Available at:  https://www.ncbi.nlm.nih.gov/books/NBK279054/  [Accessed 9 May 2025].​ Femometer, n.d. 5 Basic Things You Should Know about BBT Charting . [online] Femometer. Available at:  https://www.femometer.com/Blog/5-Basic-Things-You-Should-Know-about-BBT-Charting  [Accessed 9 May 2025].

Have you been referred for IVF without fully understanding why you are unable to conceive?  I understand; time is of the essence, and you don’t want to miss the window of opportunity, but what if there were a way you could improve your chances of conception before heading down the Assisted Reproductive Therapy (ART) route?  I’ve been working with couples to support their fertility health for the last seven years, meeting them at various stages of their journey. The majority come to me after having already gone through fertility treatment, sometimes multiple rounds, without success.  Almost every couple I see at this point has had clinical tests that merely scratch the surface. They've been given no reason as to why they are struggling to conceive and are often feeling very lost as to where to turn next.  What are the success rates of IVF?  Infertility affects around 1 in 7 couples in the UK. A significant number of these couples will either be referred for, or will choose to undergo Assisted Reproductive Therapy (ART). Thanks to advances in fertility treatment, success rates for IVF and ICSI are higher than ever before. However, the national average remains around 31%, with the highest pregnancy rates at 41%, seen in women aged 18 to 34. Source: HFEA How much does IVF Cost? Eligibility for NHS-funded fertility treatment is strict, and varies depending on your local Integrated Care Board (ICB), but age and body weight are often primary factors. The cost of private treatment also varies, typically starting at around £2,500 per cycle at the lower end of the scale, however, this doesn’t cover all your treatment. Additional medical investigations, medications, and consultations all need to be added, and depending on your clinic of choice, the total can end up being closer to £10,000. This is the kind of figure I often hear from clients in my clinic, and a primary reason as to why they are looking for alternative support. My IVF Story  Sophie Skardon, Nutritional and Herbal Therapist specialising in Reproductive health. My own experience with IVF was relatively straightforward. I was fortunate to have some inside knowledge, having qualified as a Nutritional Therapist two years prior, and was well-versed in research and preparation before undergoing any kind of medical procedure. My partner at the time had been previously diagnosed with suboptimal fertility and was upfront about the likelihood of needing medical assistance to conceive. We’d been in a relationship for six years, not actively trying to conceive but also not using contraception. It became clear that natural conception wasn’t happening, and we reached a point where we were ready to take it seriously. I wasn’t willing to begin fertility treatment without a dedicated preconception period for both of us. I had already been preparing my body for some time, and my partner agreed to a three-month detox. This included eliminating alcohol, adopting a supplement routine, and making major dietary changes. The results were remarkable. By the time of our egg collection, his sperm count had significantly improved, along with motility and morphology. So much so that ICSI was no longer required. Out of the eight eggs collected, four fertilised, and one developed into a viable blastocyst suitable for freezing. And guess what? We were successful! At my seven-week scan, a strong heartbeat was already visible and we went on to have a healthy little baby boy. I know how fortunate we were, and after working with many couples, I truly appreciate just how rare this outcome is.  "It was my own experience that lead to me where I am today and my passion for helping others on this journey" The Most Common Scenario My experience with fertility treatment is rarely a shared one, and this is partially because very few people know what goes into prepping their body for IVF; and why would they? Preconception advice is seldom given, and when it is, it’s generally lacking in depth.  By the time couples have come to me, they’ve often been through the wringer. They’ve spent 12–24 months trying to conceive, sometimes enduring multiple failed rounds of IVF. They’ve had minimal fertility investigations, are exhausted from endless hospital visits, and are emotionally drained by the heartbreak and financial strain. Does this sound familiar?  It shouldn’t have to be this way! IVF can be a powerful tool, but it shouldn’t be the first  step. If only every couple referred for fertility treatment were offered proper preconception care, comprehensive testing, and evidence-based guidance to optimise their health beforehand. Imagine how much time, energy and disappointment this could save! The basic concept of assisted reproductive technology (ART) is to bypass some of the hurdles to natural conception. This can be incredibly helpful for multiple reasons, but there are a many things IVF and ICSI can’t do. Before embarking on your first or next round of treatment, consider the following factors in order to maximise your chances to success.   These are the things I wish all couples knew before starting IVF IVF and ICSI treatment can control your cycle, collect multiple oocytes (eggs), and make life a whole lot easier for sperm to get to those eggs, but it can’t do the following:  Improve Egg Quality  - Egg quality is influenced by a number of factors; including age, hormones, lifestyle, stress, inflammation, and nutritional status. Some gynaecological conditions can also impact egg quality; PCOS and Endometriosis, for instance. It take 100 days for an egg to fully mature, this is a critical time for chromosomal development. Supporting your health during this time has been shown to positively impact egg quality. Sperm Quality  - IVF can't improve this and so optimising sperm parameters before treatment is essential. Spermatogenesis (sperm production) takes from 72-76 days, implementing positive nutrition and lifestyle changes during this time can enhance the quality of the genetic material within sperm cells and improve your chances of fertilisation and a successful pregnancy. Genetics  -  Genetic mutations or chromosomal abnormalities can affect fertility outcomes and miscarriage risk. These aren't commonly explored in standard IVF workups. In some cases this needs to be investigated. The Reproductive Microbiome  - A healthy vaginal, seminal and gut microbiome supports implantation and early pregnancy. Imbalances can contribute to inflammation or infection, which may impact sperm and egg quality and also increase the risk of miscarriage. IVF doesn’t help to address this. Nutrient Levels  – Fertility clinics very rarely test nutrient levels.  Folate, Vitamin D, Iron, and B12 are vital for egg and sperm health, ovulation, hormone balance, and embryo development. A simple blood test can identify nutrient deficiencies and give you an opportunity to fix this prior to pregnancy. Miscarriage Risk  – Fertility treatment can provide hormonal support to prevent this, but miscarriage is often multifactorial. Some of the things I have already mentioned, i.e, microbiome health, genetics, and sperm and egg quality, also need to be addressed to reduce the risk of miscarriage. Thyroid Health - Thyroid hormone imbalance and the presence of Thyroid Antibodies has been shown to affect pregnancy outcomes. A full thyroid panel should be included in a comprehensive blood test to rule this out. So what's the solution?  Get started on this journey well before IVF is even suggested. OK, so you might not get access to all the tests you want on the NHS unless you’ve been trying to conceive (TTC) for over 12 months, but you can still take matters into your own hands. If you’re not conceiving after 6 months of trying, I’d suggest working with a fertility adviser or fertility nutritionist who can help identify what might be getting in the way. Assessing your nutrient intake, addressing lifestyle and stress factors, and gaining insight into your cycle and ovulation patterns are all great starting points. Private testing is also an option. While sometimes costly, it can highlight areas that need support and, in some cases, lead to a fertility strategy that doesn’t involve medical treatment. Remember IVF can’t fix egg or sperm quality. That’s why it’s so important to optimise your health beforehand  to improve your chances of success. Reproductive health doesn’t exist in isolation; it's intricately linked to every system in your body. Focusing on your overall health in the four months prior to conception has been shown to positively influence egg and sperm quality, improve pregnancy outcomes, and even benefit your child’s health throughout their lifetime. Source: Fertility and Sterility, 2022 . 4 month is also the ideal window for addressing hormonal imbalances and supporting a healthy reproductive microbiome. You may still need medical intervention, but here’s the thing: whether you’re eligible for NHS treatment or paying privately, you’ll want to do everything you can to give yourself the best chance the first time around . If you’d like to find out more about how I can help you investigate your fertility and prime your body for a healthy pregnancy, please get in touch. Sophie Skardon, Registered Nutritional and Herbal Therapist specialising in reproductive health.