Cycle monitoring

During the so-called cycle monitoring, the doctor examines the female monthly cycle. By performing various examinations, the following can be established:

• whether the woman’s hormone cycle is normal,
• whether an ovarian follicle is growing,
• whether the woman is ovulating,
• whether the woman’s endometrium is preparing for the implantation of a fertilised egg, and
• when ovulation takes place.

What is the purpose of cycle monitoring?

Cycle monitoring serves several purposes. The doctor can, for example, discover information on the cause of a couple’s involuntary childlessness and work together with them to find a suitable treatment.
Should the couple want to conceive a child naturally, cycle monitoring will tell the doctor what the optimal window for conception would be – i.e. the days on which they should have sexual intercourse.
Cycle monitoring can also be helpful for insemination with in-vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). This tells the doctor exactly when insemination can be done or eggs can be removed for assisted fertilisation. In this case, ovulation is usually triggered by hormone treatment. This makes for better planning and also increases the chances of a successful pregnancy.

When is cycle monitoring carried out?

Cycle monitoring is part of the diagnostic procedure for involuntary childlessness. In particular, for women whose cycle is irregular, periodic tests using ultrasound and laboratory analysis make it possible to determine whether a follicle is growing or if there is a problem with egg maturation. Follicular growth is also monitored in assisted fertilisation.

What happens during cycle monitoring?

Depending on the reason for cycle monitoring, the doctor will monitor one monthly menstrual cycle of the woman. In addition, more ultrasound and hormone tests are conducted:

1. The first examination is usually between the third and fifth day of the cycle. At the same time, the doctor checks the woman’s hormone levels. At this point, the blood levels of hormones that are responsible for or may interfere with egg maturation are of particular interest. This includes follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid hormones, the stress hormone prolactin and the so-called “male” hormones (androgens). It is also possible to estimate the egg reserves by measuring the anti-Müller hormone (AMH). In addition, the woman’s ovaries and womb are examined using ultrasound.
   
   
2. The second examination is usually between the 10th and 12th day of the cycle, shortly before the expected ovulation. Once again, the doctor checks the woman’s hormone levels. An ultrasound examination reveals whether a follicle has actually matured, whether the endometrium has developed and its thickness, and whether the cervix is already open so that the sperm can easily pass through to the womb.
   
   
3. In the third examination, about a week after ovulation, hormone levels are once again checked – in particular progesterone levels (yellow body hormone). Progesterone plays an important role in the implantation of the embryo in the endometrium, amongst other things.

Should the woman’s menstrual cycle be longer or very irregular, further examinations are conducted – mostly in the space of a few days. A cycle examination can also be done over several cycles, if necessary.

Possible use of hormonal stimulation

Should the doctor establish via cycle monitoring that no follicle has grown or there is no ovulation, hormone treatment is usually recommended. This facilitates egg maturation and induces ovulation. In addition, the implantation phase can be supported through administration of progesterone. This treatment, in conjunction with sexual intercourse at the optimal point in time or insemination, is often sufficient to lead to conception. For cycle monitoring in hormone-stimulated cycles, your doctor will then plan the examinations aligned with this treatment together with you.