Infertility/Fertility/Menstrual Cycle issues


Good evening Edward,

I am writing to you from the UK.

I am 27, with three children; difficult pregnancies and labors; Group Strep B, etc. There is a history of PCOS going back as far as my great gran.

I have been tracking my periods for some time now as mine have always been irregular.

From August last year they started out as a Cycle of 30 days and have increased to this month a Cycle of 40 days.
As you can imagine, this made tracking ovulation very difficult.
So, I started keeping track of my temperature changes and cervical mucus, and recently Mittleshmirtz pains.

I ovulated, according to my BBT and M.Pains on the 17th Jan- but all the online calculators have told me that this makes my luteal phase a length of 21 days, as my next period is due on the 7th Feb, which is abnormally long.

I've just undergone testing for progesterone levels and they came back satisfactory. The next is FSH levels on the the third day of my next cycle.

My question here is, how reliable are Mittleschmirtz? I had intercourse on the Tuesday and Thursday before I felt these pains on the friday... was this the right timing? Or was that just a warning?

I hope all this made sense.

Kind regards,


Hello Kate from the U.K.,

Because "Mittleschmertz" is a subjective finding, it is not a reliable means to time intercourse or use to get pregnant.  Certainly there are women that can tell when they are ovulating but that is not universally true and I think that some women can convince themselves that it is what they feel.

Based on the fact that you have irregular menstrual cycles, it is likely that you have PCO, which is an ovarian dysfunction.  In that case it is not just ovulation that is the problem but the entire hormonal milieu is probably off.  My recommendation would be to consider ovulation induction to correct the ovary and help you to achieve pregnancy.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  I now provide personalized fee for service consultations/advice/direction via email and payable via Pay Pal.  If interested, contact me via my email at  This service will allow you to have your own personal on-demand infertility expert  


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Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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