Secondary Fertility

Some women experience “multiple follicular stimulation”, a condition in which more than one follicle is selected during the course of a cycle. Multiple follicular stimulation can occur if the dominant follicle does not mature or rupture as expected (perhaps due to a timing issue with the secretion of luteinizing hormone or some other hormone imbalance). As a result, the egg is not released and fertilization cannot occur. The body will often recognize that there is a problem with the first follicle and will attempt to address the situation by selecting a second follicle 3-5 days later. For trying-to-conceive women, recognizing the selection of this second follicle is important, as it will result in ovulation occurring later than expected. Multiple follicular stimulation occurs frequently in women with Polycystic Ovarian Syndrome (PCOS), but can also occur in women with no particular fertility issue.

The OvaCue can help you determine if you are experiencing multiple follicular stimulation, or “secondary fertility.” In the case of secondary fertility, the graph of the oral and vaginal readings will look similar to the graph below. Notice that there are two Cue Peaks in the oral readings, the first occurring on Cycle Day 5 and the second occurring on Cycle Day 10. The second Cue Peak indicates that a second follicle was selected during the cycle, perhaps due to a problem with the dominant follicle. Also, notice the “W-like” pattern in the vaginal readings, revealing two Vaginal Rises. In a typical cycle, there will be one Vaginal Rise (indicating the shift from estrogen to progesterone dominance at the time of ovulation), and then the vaginal readings will remain elevated for the rest of the cycle. In the case of secondary fertility, the vaginal readings dip after the initial Vaginal Rise on CD 12, then rise sharply again on CD 16.