Editing Ovulation (section)

==Clinical presentation==
{{further|Concealed ovulation|Fertility  awareness|Mittelschmerz}}
The start of ovulation may be detected by signs that are not readily discernible other than to the ovulating female herself, thus humans are said to have a [[concealed ovulation]].<ref>{{Cite web |last1=Smith |first1=Yolanda |last2=Pharm |first2=B. |date=2010-04-27 |title=Ovulation Signs |url=https://www.news-medical.net/health/Ovulation-Signs.aspx |access-date=2023-05-22 |website=News-Medical.net |language=en}}</ref> In many animal species there are distinctive signals indicating the period when the female is fertile. Several explanations have been proposed to explain concealed ovulation in humans.

Females near ovulation experience changes in the [[Cervix#Cervical mucus|cervical mucus]], and in [[basal body temperature]]. Furthermore, many females experience secondary fertility signs including [[Mittelschmerz]] (pain associated with ovulation) and a heightened sense of [[olfaction|smell]], and can sense the precise moment of ovulation.<ref name="pmid12853171">{{cite journal | vauthors = Navarrete-Palacios E, Hudson R, Reyes-Guerrero G, Guevara-Guzmán R | title = Lower olfactory threshold during the ovulatory phase of the menstrual cycle | journal = Biological Psychology | volume = 63 | issue = 3 | pages = 269–79 | date = July 2003 | pmid = 12853171 | doi = 10.1016/S0301-0511(03)00076-0 | s2cid = 46065468 | doi-access = free }}</ref><ref>{{cite book|editor=Beckmann, Charles R.B.|title=Obstetrics and Gynecology|publisher=Lippincott Williams & Wilkins|year=2010|isbn=9780781788076|pages=306–307|url=https://books.google.com/books?id=0flWgd3OJLEC&pg=PA306|access-date=2013-11-09}}</ref> However, midcycle pain may also not be due to Mittelschmerz, but due to other factors such as cysts, endometriosis, sexually transmitted infections, or an ectopic pregnancy.<ref>{{Cite web|title=Ovulation Pain: Symptoms, Causes & Pain Relief|url=https://my.clevelandclinic.org/health/diseases/9134-ovulation-pain-mittelschmerz|access-date=2021-07-29|website=Cleveland Clinic}}</ref> Other possible signs of ovulation include tender breasts, bloating, and cramps, although these symptoms are not a guarantee that ovulation is taking place.<ref>{{Cite web|title=Am I Ovulating? How to Spot the Signs|url=https://www.webmd.com/baby/am-i-ovulating|access-date=2021-07-29|website=WebMD|language=en}}</ref><ref>{{Cite web|date=2020-06-18|title=Ovulation cramps: Symptoms and what they mean for fertility|url=https://www.medicalnewstoday.com/articles/ovulation-cramps|access-date=2021-07-29|website=www.medicalnewstoday.com|language=en}}</ref>

Many females experience heightened sexual desire in the several days immediately before ovulation.<ref name="pmid15216427">{{cite journal | vauthors = Bullivant SB, Sellergren SA, Stern K, Spencer NA, Jacob S, Mennella JA, McClintock MK | title = Women's sexual experience during the menstrual cycle: identification of the sexual phase by noninvasive measurement of luteinizing hormone | journal = Journal of Sex Research | volume = 41 | issue = 1 | pages = 82–93 | date = February 2004 | pmid = 15216427 | doi = 10.1080/00224490409552216 | s2cid = 40401379 }}</ref> One study concluded that females subtly improve their facial  attractiveness during ovulation.<ref>{{cite journal |vauthors=Roberts S, Havlicek J, Flegr J, Hruskova M, Little A, Jones B, Perrett D, Petrie M | title =  Female facial attractiveness increases during the fertile phase of the menstrual cycle | journal = Proc Biol Sci | volume = 271  | issue  = Suppl 5:S | pages = 270–2 | date=August 2004 | pmid =  15503991 | doi = 10.1098/rsbl.2004.0174 | pmc=1810066}}</ref>

[[File:Pregnancy chance by day near ovulation.jpg|thumb|Chance of [[human fertilization|fertilization]] by day relative to ovulation<ref name="DunsonBaird1999">{{cite journal | vauthors = Dunson DB, Baird DD, Wilcox AJ, [[Clarice Weinberg|Weinberg CR]] | title = Day-specific probabilities of clinical pregnancy based on two studies with imperfect measures of ovulation | journal = Human Reproduction | volume = 14 | issue = 7 | pages = 1835–9 | date = July 1999 | pmid = 10402400 | doi = 10.1093/humrep/14.7.1835 | doi-access = free }}</ref>]]
Symptoms related to the onset of ovulation, the moment of ovulation and the body's process of beginning and ending the menstrual cycle vary in intensity with each female but are fundamentally the same. The charting of such symptoms &mdash; primarily basal body temperature, mittelschmerz and cervical position &mdash; is referred to as the sympto-thermal method of fertility awareness, which allow auto-diagnosis by a female of her state of ovulation. Once training has been given by a suitable authority, fertility charts can be completed on a cycle-by-cycle basis to show ovulation. This gives the possibility of using the data to predict fertility for natural contraception and pregnancy planning.

Urine levels of the [[hormone]] pregnanediol 3-glucuronide of over 5 μg/mL has been used to confirm ovulation. This test has a 100% specificity over 107 women.<ref>{{Cite journal |last1=Ecochard |first1=R. |last2=Leiva |first2=R. |last3=Bouchard |first3=T. |last4=Boehringer |first4=H. |last5=Direito |first5=A. |last6=Mariani |first6=A. |last7=Fehring |first7=R. |date=2013-10-01 |title=Use of urinary pregnanediol 3-glucuronide to confirm ovulation |url=https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1492&context=nursing_fac |journal=Steroids |language=en |volume=78 |issue=10 |pages=1035–1040 |doi=10.1016/j.steroids.2013.06.006 |pmid=23831784 |s2cid=20604171 |issn=0039-128X}}</ref>