Optimizing Fertility Part II: Analyzing your BBT chart in the follicular phase

In Part I in this series of articles on fertility and traditional Chinese medicine, we discussed the how’s and why’s of basal body temperature (BBT) charting, an incredibly useful tool in identifying potential fertility challenges, and optimizing your reproductive health in preparation for pregnancy.

This following article focuses on BBT chart analysis of the follicular phase (Phase I), addressing some of the patterns that you are likely to see – with diagrams – and ways in which acupuncture and herbal medicine can be used to optimize fertility.

The follicular phase begins on the first day of your period – this is counted as Day-1 of your cycle. This phase is a time of regeneration and replenishment, specifically of blood and yin. The endometrial lining is shedding, while the construction of a new lining is also beginning. Estrogen production increases, along with the growth of follicles and eggs within the ovary. Estrogen stimulates the production of fertile, cervical mucus; and influences the growth and quality of the new endometrial lining, which is vitally important for embryo implantation.

BBT should drop to its “base level” a day or two before the start of period. Base temperature, or starting temperature of the follicular phase, varies from woman to woman, and can also vary slightly from cycle to cycle. The average range for BBT throughout the follicular phase is 97.2° to 97.8°. See Figure 1.0 for an example of an optimal BBT.

If your follicular phase temperature tends to run too low (below 97.2°) (See Figure 1.1), this is a yang deficiency (specifically of the Spleen and Kidney organ systems). Often there are other constitutional symptoms, such as sensitivity to cold, fatigue, weight gain, and edema. The metabolism is typically slow, and sometimes there will be a Western diagnosis of hypothyroidism. Treatment to warm the yang would be applied throughout the cycle.

The length of the follicular phase very often determines the length of the menstrual cycle. It reflects the length of time it takes for a follicle to grow in the ovary and release a mature egg. Unless there are symptoms that point to issues in the luteal phase, the period typically comes around fourteen days post-ovulation. For example, in a woman with a 21-day cycle, the follicular phase is likely seven days; in a woman with a 35-day cycle, the follicular phase is likely twenty-one days. (Note: It is possible for a luteal phase defect to shorten the length of the menstrual cycle – this will be discussed in a future article on Phase II. Your BBT chart will ultimately indicate how long your follicular phase is relative to your luteal phase.)

At the start of the follicular phase, which again begins on Day-1 of your period, the body is losing reserves that must be immediately replenished. The follicular phase is the time in your cycle when the body is working its hardest to replenish blood and yin. If your follicular phase is too long (See Figure 1.2) – longer than fourteen days – this is considered delayed ovulation. There is likely Kidney yin and/or blood deficiencies, and in theses cases, medicinal herbs are often prescribed in conjunction with acupuncture around Day-3 or 4 the cycle. If “advanced maternal age” is a factor (mid-to-late 30’s, and older), there may be what is called a Kidney jing deficiency (i.e., diminished ovarian reserve – if this is a concern, your gynecologist or fertility specialist can do a panel of lab tests to assess your ovarian reserves – discussion of these tests is beyond the scope of this article).

Qi stagnation (e.g., stress) is also a common, compounding factor with delayed ovulation – the smooth flow of qi is necessary for the transition from the follicular phase to the luteal phase, the transition from yin to yang – this is ovulation. In these cases, acupuncture and herbal medicine will also be used to course the qi, address any underlying deficiencies, and essentially help you de-stress so timely ovulation can take place.

If your follicular phase is consistently short (around nine or ten days) (See Figure 1.3), Kidney yin deficiency accompanied by heat is the most likely diagnosis. When yin is severely deficient, heat develops, and this heat can trigger premature ovulation. If eggs are released too soon, they will not be mature, and thus not conducive to fertilization, implantation, and a healthy pregnancy. Acupuncture and herbs will be used to nourish yin and clear heat, and therefore lengthen the follicular phase; treatment should begin around Day-3 or 4 of your cycle.

If your follicular phase temperature is consistently too high (above 97.8°) (See Figure 1.4), there are other considerations. Temperature readings this high imply that there is internal heat that needs to be cleared. Internal heat tends to burn out the yin, leading to scanty or acidic cervical fluids, which are inhospitable to sperm. In addition, the endometrial lining may be too thin or dry to hold a pregnancy. (The length of your follicular phase may be adequate, around fourteen days, or it may be short, as in the cases of yin deficiency with heat.) Treatment would require the use of acupuncture and strong herbs to clear heat and reinforce yin, especially during the first phase of the cycle. Symptoms often accompanying this pattern include feelings of agitation, anxiety, insomnia, and weight loss. The metabolism tends to be high, and sometimes there is a Western diagnosis of hyperthyroidism.

If basal body temperature does not drop in the day or two before the onset of your period (See Figure 1.5), this indicates that there is an internal imbalance – yang is not effectively transforming into yin. This usually indicates the presence of “blood stagnation,” which can lead to the generation of internal heat. Sometimes there is a Western diagnosis of endometriosis. It is important to begin treatment from Day-1 of the cycle using acupuncture and herbs to ensure full discharge of the endometrial lining so a new, healthy endometrial lining can form – this is essential for embryo implantation; underlying imbalances (e.g., blood deficiency leading blood stagnation with heat) will be addressed throughout the cycle.

(Note: If your BBT remains elevated in the day or two before the expected onset of your period, and you skip your period – this very likely indicates pregnancy. See the next article on the luteal phase for discussion.)

Finally, BBT temperatures will fluctuate from day to day, this is normal, but if readings fluctuate more than .3°, this is considered an unstable follicular phase (See Figure 1.6). Lack of sleep, alcohol consumption, or being sick, will all cause your temperature to spike, but if there is a pattern of unexplained sharp spikes and drops, there may be some Liver or Heart fire that needs to be quelled. An unstable follicular phase lends itself to unpredictable ovulation (i.e., irregular periods, potentially from a disorder somewhere along the hypothalamus-pituitary-ovary axis of the endocrine system, a system that is very vulnerable to the effects of stress). Herbs and acupuncture to clear heat and reinforce the yin will be applied during the first phase of the cycle; treatment to “calm the spirit” will be applied throughout the cycle. Cultivating relaxing everyday rituals, such as a mindfulness practice or quiet walks after work, will be helpful (and necessary) over the long term.

In the next article in this series on fertility and reproductive health, we will discuss ovulation in more depth, as well as the luteal phase and some of the patterns that you are likely to see, and ways in which acupuncture and herbal medicine can be used to optimize fertility in this second phase of your cycle.

If you would like to schedule an appointment to discuss your fertility and ways in which acupuncture and herbal medicine can help – here are the ways you can contact me.

Be Well,
Dr. Jules Bogdanski, DAOM L.Ac.