Question

A 28-year old woman has an appointment with her obstetrical gynecological (OB/GYN) physician, to discuss family planning. She has been trying to have a child for a year without success. The physician reviews her history and does an examination on her and it goes well. She orders labs, as well, in order to see the whole health picture of her client. The physician asks her to chart her menstrual periods.

1. How would she explain ovulation and the optimal time to become pregnant, utilizing a 28-day cycle?

2.How many days before and after can the client become pregnant, during her 28-day cycle?

3. Explain the basal body temperature technique. How accurate is it?

Answer 1

Question 1

Hormonal changes produce alterations in the endometrium and also it dictates the ovulation.Endometrial and ovarian cycles are regulated by the LH and FSH(follicle stimulating hormone) produced by the anterior pituitary, in response to the GnRH(Gonadotropin releasing hormone) released from the hypothalamus.The LH(leutinising hormone) surge is responsible for ovulation.In each cycle, one ovum becomes mature by completing the meoisis and is released from the ovary on alternate sides.In a 28 day cycle ovulation takes place on the 14th day.In other words, ovulation takes place 14 days prior to the next menstruation.During ovulation, the ovum is released by the rupture of graffian follicle.Once the ovum is released it enters the fimbriated end of fallopian tube.The ovum can remain viable for a maximum of 36hours,within which it should be fertilised by the sperm.The sperm, after getting ejaculated ,will remain viable for 3 days or a maximum of 5 days.Hence, for the lady to get pregnant, the intercourse should happen within a time period of 5 days prior to ovulation date and till 3 days after the ovulation date.For a 28 day cycle,it is from 9th day of cycle to 17th day of cycle.Day 1 of the cycle is the date of last menstrual period.During this period, if fertilisation doesn't occur, hormonal changes causes the endometrium to be shed(menstruation)

Question 2

Explained in question 1

Question 3

Basal body temperature is the recording of body temperature after a period of rest. It is done immediately after waking up from a night's sleep.It is seen that there are changes in body temperature in relation to various phases of menstrual cycle.After ovulation,there is a rise of 0.5 to 1 degree Fahrenheit temperature. This temperature rise will sustain till the next menstruation.After menstruation this will fall.It is said that the lowest temperature is recorded 1 day prior to ovulation.

The rise in body temperature occurs because of the effect of the hormone progesterone.Following ovulation, corpus luteum is formed and it releases progesterone ,in order to prepare for pregnancy, if it occurs.This progesterone by its action through the hypothalomo pituitary ovarian axis keeps the temperature high.

By measuring the basal body temperature every day,the woman may be able to predict the time of ovulation. But this method is not accurate because of certain reasons

-It is necessary that the temperature should be measured every day

-It should be measured immediately after waking up

-It may be interfered by environmental factors such as fever due to infections,emotional stressors etc

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