When you finally get down to trying to make a baby after years of trying to avoid a baby, it can be surprising to realize there are still a lot of questions about how to go about it!  One question I get a lot in the clinic is what exactly is the best way to time insemination?  The very short answer is with egg-white cervical mucus.  But if you still have questions, read on…

The best criteria is to follow the egg-white cervical mucus (EWCM).   Thin watery mucus is also a fertile mucus, which sometimes precedes the EWCM.  Some people only get the watery kind, some people do not notice either.  Sperm can live up to 5 days in EWCM.  This is important, because the sperm have to swim up into place and be ready to meet the egg before ovulation.  This is why libido spikes and EWCM comes before ovulation, which is the release of the egg from the follicle.  The EWCM has nice spindles that are lubricate– sperm find this a really easy roadway to travel along.  The EWCM also protects the sperm from the harsher pH in the rest of the vagina.  It is both their highway and the travel inn!  Ideally, the person receiving the sperm is also orgasming…the contractions of the vaginal wall can help push the sperm along, and help elevate the cervix, essentially opening the door to the uterus.

What about BBT (basal body temperature) charts and pee strips?

BBT charting is an easy and useful at-home method for confirming that ovulation is occuring.  A biphasic chart can rule out lack of ovulation as a barrier to conception.  The only other way to know for sure that you are releasing eggs is through ultrasound monitoring of the ovaries throughout the cycle, confirming maturation of antral follicles into a lead follicle and the release of a matured egg.  

With a BBT chart, you can only know that ovulation occurred after the fertile window has passed, since ovulation happens just before the rise in temperature. BBT charts can also be useful for monitoring improvements in fertility that come with lifestyle changes.  As a chart becomes more bi-phasic, looking more and more like a clear stair-step, you can be sure that your chances of conceiving are increasing.    

A BBT chart in concert with observing EWCM is ideal, since it is possible to get EWCM without ovulating.  To recap: EWCM is best for timing insemination, but the BBT chart is confirming that there will actually be an egg for the sperm to meet.

BBT charting is not complicated, but to be accurate does need to adhere to some basic guidelines.  Here is a blogpost that lays out the particulars of how to do it: (coming soon)

LH surges cannot confirm ovulation, but rather show that your body is attempting it.  In this way they are like EWCM.  The darkening line on the pee strips gives you warning to get down to pleasure because ovulation is (assumed to be) coming soon.  The window for ovulation can be anywhere from 12-36 hours after the LH surge.  This means you should be having sex or inseminating when the OPK strips are at their darkest, as ovulation is imminent.  Ideally this coincides with watery or stretchy mucus, but if it doesn’t, it is still best to time with the EWCM because this gives the sperm the best chance at getting where it needs to go and surviving until it is time to meet the egg.  For this reason, I think the simplest guidance is always to follow the fertile mucus.   

When is fertile mucus not a guide to time insemination?

It is possible to have an anovulatory cycle. Some people can go months without ovulating, and may bleed without ever occurring. During this time the body will try ovulate, increasing estrogen and LH. This could lead to intermittent periods of egg-white cervical mucus and intermittently or consistently high OPK strips. This is where the BBT chart will help you to know what is actually happening in the ovaries. If this is your situation, it is absolutely vital to work with an acupuncturist and herbalist who specializes in fertility. Traditional East Asian medicine has been treating this situation effectively for millennia.