The underpinning of Fertility Awareness is self-empowerment through knowledge of our menstrual cycle. My initial interest was sparked by reading Taking Charge of Your Fertility (TCOYF) by Toni Weschler, MPH. TCOYF is a life-changing book, and I have probably given it as a gift and loaned it out more than any other book I’ve ever read.
Readers of TCOYF come away with two principles: (1) Fertility Awareness Method is a reliable way to prevent pregnancy without hormonal contraceptives, and (2) fertility “problems” can often be solved simply by using FAM, without resorting to invasive treatments or hormonal methods. Through daily charting of basal body temperature, cervical fluid and cervical position, the vast majority of us can figure out when we ovulate. When we know our ovulation patterns, we can time sex accordingly, depending on the outcome that we want. To prevent pregnancy, we either abstain or use a barrier method during fertile days; to get pregnant, we time intercourse as close to ovulation as possible. This is a broad-brush overview – TCOYF provides all the specifics.
Please note that Fertilty Awareness is an umbrella term that encompasses Natural Family Planning. The main difference between the two is that practitioners of NFP use abstinence and non-intercourse forms of sexual connection during a woman's fertile phase instead of barrier contraception. NFP is the only form of family plannning endorsed by the Catholic Church, so organizations promoting NFP tend to be guided by Catholic theology and practice.
Following are a few personal insights that I would like to share:
I find FAM a compelling method for birth control for a number of reasons. First of all, just as I appreciate being aware of whether I am hungry or need to go to the bathroom, I like to know what’s going on with my ovaries. I took birth control pills for several years in part because I had painful cramps and long periods. Then, about six years ago, I read a fascinating article in The New Yorker magazine by Malcom Gladwell called "John Rock’s Error." The article chronicles the efforts of the inventor of the Pill, a devout Catholic, to have hormonal contraception sanctioned by the Catholic Church. It explains that the monthly "period" that we experience while taking the Pill was contrived so that the Pill would appear more natural to the Church authorities and, ostensibly, to women. But it serves no function.
It was shocking to learn that the "period" I’d been having while taking birth control pills for years was optional. In fact, the bleeding that we experience while on the pill isn’t a period at all! Clinically speaking, it is "withdrawal bleeding" that appears as our uterine lining breaks down in response to the withdrawal of the progestin in the Pill.
Though I'm sure I had read or heard it countless times before, it wasn't until I read Gladwell's article that I truly understood how the Pill works – that it prevents pregnancy by suppressing ovulation. A few years down the road, beginning to ponder my future fertility and conscious of my desire to conceive within the next several years, I read TCOYF. I found myself desperate to know whether, left to its own devices (or lack thereof, in this case), my body would ovulate.
Though my husband and I were not yet trying to conceive, I was ready to lift the veil that the Pill had cast over my ovarian function. How was it that I – with a Harvard degree in women’s studies, no less – could be so clueless about whether and how my body would experience this basic female bodily function?
When I told my young, hip gynecologist in Los Angeles of my plans to use the sympto-thermal method (the name given to FAM for use during comparison testing of birth control methods), she said, “Well, what I tell my patients is that you really shouldn’t use the rhythm method unless you’re prepared to have a baby.” I thanked her politely, threw away my pills, and began charting. I was appalled that a board-certified OB/GYN could be so clueless about Fertility Awareness Method. Had she been taught – or sought – even minimal information, she would have known that FAM is completely different from the rhythm method. FAM is based on rigorous charting and analysis. The rhythm method, which instructs women to abstain on and around Day 14, is based on the asinine assumption that all women ovulate on the fourteenth day after they start their period. Feeling empowered by my new knowledge and confident in the many benefits of using FAM, I transferred my care to a midwifery practice and came to my first appointment armed with my first few months of charts.
FAM and Achieving Pregnancy
I love Fertility Awareness charting, but it takes on a special significance when making a baby is on the horizon – even at the very edge of the horizon. When I reached the time in my cycle when ovulation was imminent, I looked forward to taking my temp each morning to see whether, in fact, I had ovulated. Once ovulation was confirmed, I loved imagining my husband’s sperm on their way to meet my egg. And when I started bleeding about a week after my temps confirmed I was pregnant, charting helped me confirm that I was experiencing an early miscarriage and left me a tangible remembrance of my precious, fleeting first pregnancy. With my second pregnancy, charting my elevated temps for a month after the rise in temperature first indicated pregnancy gave me extra reassurance.
One critical benefit of FAM for anyone who has cycles that are not 28 days long (most of us!) is that pinpointing the day of ovulation allows for accurate pregnancy dating. The standard convention for calculating the date of conception is to add 14 days to the start of your last menstrual period. This can result in serious miscalculations of fetal age and, in a worst case scenario, lead to premature labor induction. Think about it - if you have a 42-day cycle instead of a 30-day cycle, your "due date" could be as much as two weeks off. With FAM, you will know your date of conception, since sperm must fertilize an egg within 24 hours after ovulation. In my case, I had very long, 40-day cycles prior to my second pregnancy. When asked by providers to give my last menstrual period (LMP) in order to date my pregnancy, I wrote on the form, “irregular cycles – date of conception 5/12/04.” If I had simply followed directions and listed 4/20/04 as my last menstrual period, I shudder to think how much time and effort would have gone into determining why my baby was too small.
On a practical note, I found it helpful to use ovulation predictor kits in conjunction with basic charting, as suggested by TCOYF. The kits test for the surge in Luteinizing Hormone (LH) that triggers ovulation, so they can be useful in confirming that ovulation is, indeed, approaching. The Fertility Shop sells LH strip tests in bulk. Lacking fancy packaging, these aren’t as pretty or easy to read as the commercial tests like Clear Plan Easy, but the cost savings is worth it. (The Fertility Shop also sells cheap pregnancy strip tests and other, more sophisticated ovulation prediction devices.)
Adding ovulation predictor tests to the mix, my daily FAM routine was the following:
Take basal body temperature first thing upon awakening (You will need a basal thermometer, which is the same as a regular thermometer but measures temps in tenths of degrees. You can find these at most drug stores.)
Check for changes in cervical fluid and position
Ovulation Predictor Kit (LH surge test) from midway through my cycle or whenever the consistency of my cervical fluid was eggwhite or stretchy
Confirm ovulation with elevated temps within a couple of days of the positive LH surge
Record all of the above on my chart
One final note on ovulation prediction: Thanks to pregnancy and nursing, I haven’t had my period in over 2.5 years. Next time I am using FAM for either pregnancy avoidance or to conceive, I will probably purchase or rent an Ovacue fertility monitor. These devices predict ovulation several days in advance by measuring the electrolytes in your saliva; a vaginal sensor corroborates ovulation by measuring electrolyte changes in your cervical fluid.
FAM and Sexuality Education
I increasingly believe that the key component lacking in sex education – whether comprehensive or abstinence-only – is fertility awareness. In their haste to prevent unwanted pregnancies and sexually transmitted diseases, sex educators have lost sight of the purpose of sex. Let’s face it – biologically speaking, sex is for making babies. Yes, it has some other benefits, too, in addition to making babies – and yes, it can be beautiful when shared by people who have neither the goal nor the equipment for making babies together.
Supporters of sex education in America today are divided into two camps – those who endorse abstinence-only education and those who endorse comprehensive sex education. Both ideologies are inherently flawed in that their core narratives are scare tactics and guilt trips. Abstinence-only education, by design, focuses on “protecting” virginity and promoting the idea that sex outside of marriage is dangerous. Comprehensive sex ed offers a menu of safer sex methods, again stressing “protection” from the consequences of sex.
None of these messages sufficiently motivates teens to either abstain from sex or use contraception, and some may cause teens to internalize harmful or destructive ideas about their developing sexuality (Sexuality is not normal or natural, but dangerous. I have to protect myself from myself.). Messages about sexuality should give teens credit for being able to think for themselves.
What if girls and boys both internalized the message that since sex is the cornerstone of the miracle of creating new life, it makes sense to wait to have sex (or at least use a very conservative version of FAM to be sure that you aren’t in a fertile phase) unless you’re really ready to take responsibility for a baby? If you’re going to have sex anyway, isn’t it better to really understand what kind of birth control device or pill or charting you’re using?
And what if each and every girl who got her period was taught how to use FAM to understand her menstrual cycles and, as a result, gained appreciation and reverence for her newfound gift of fertility? The lynchpin of creating fertility awareness in teens is inverting the dominant approach to menarche in our society, which is to largely ignore this vital event in a young woman’s life. Instead of cloaking the onset of menstruation in shame and secrecy, we should take our cues from the rituals and celebrations found in other cultures and help girls to celebrate the unfolding of their body’s miraculous new ability to create new life.
Practicing fertility awareness has led me to the inescapable conclusion that every pregnancy is a miracle. Let’s face it – it is hard to get pregnant. In order to get pregnant, everything from the egg to the sperm to the stars must be in the right place at the right time. And even if you time sex to coincide with ovulation, the chances of becoming pregnant and then sustaining a healthy pregnancy are around 25%, according to TCOYF. Despite what we see in the movies, where a one-night-stand inevitably results in the birth of a child, most unwanted pregnancies in real life are the result of having lots and lots of unprotected sex over time.
What if a positive link between sex and fertility, surrounded with messages of responsibility and care, could replace or supplement our existing sexuality education? Perhaps if people – including teens – who are in the market for pregnancy-free sex were armed with fertility awareness, they would take fewer risks with whatever contraception they aspire to use, or at least have the sense to abstain during the woman’s fertile time. Confronting the biological purpose of sex through awareness of a woman’s cycle – rather than reliance on devices or hormonal methods that fall prey to imperfect design and use – seems like a welcome corrective to the current no-strings-attached culture of sex in modern society.
There are several medically legitimate reasons that hormonal contraceptives may be desirable for individual women, such as painful or long periods. Sometimes the Pill is prescribed as a treatment for infertility. If you take a Pill that causes you to bleed monthly, be sure that this is your choice. Know your options. While some women do feel more comfortable having a monthly faux period, there are newer continuous, low-dose contraceptives out there that allow women to go for months without bleeding. Depending on your particular medical situation, this may amount to a purely cosmetic decision. Or perhaps not – Gladwell’s article details the findings of a researcher documenting the costs of the Pill’s monthly placebo week:
“In a paper in the February [2000] issue of the journal Obstetricsand Gynecology, [Sulak] and her colleagues documented something that will come as no surprise to most women on the Pill: during the placebo week, the number of users experiencing pelvic pain, bloating, and swelling more than triples, breast tenderness more than doubles, and headaches increase by almost fifty per cent. In other words, some women on the Pill continue to experience the kinds of side effects associated with normal menstruation.”
The first Pill to be commercially marketed to be taken continuously for several weeks at a time was called Seasonale. After reading Gladwell’s article, and prior to Seasonale’s release, I asked my gynecologist for a Pill that I could take for three-month intervals. She prescribed Yasmin, a monophasic 21-day active, 7-day placebo pill, and it worked perfectly. (Please note that this strategy does not work all for Pills – you must consult with an ob/gyn or midwife.) Also, be aware that the creators of Seasonale have recently released Seasonique, a variation on the same theme. Research your options. Empower yourself with information.
Fertility Awareness Resources
Taking Charge of Your Fertility by Toni Weschler, has an associated website Ovusoft, a computer program for daily charting that aids in identifying the thermal shift. The website features a cycle gallery, enabling you to compare and contrast your cycle with others in various categories (Anovulatory Charts, Just-after-the-Pill Charts, Short Luteal Phase Charts, etc.).
The Garden of Fertility by Katie Singer is a book (and website) paralleling Taking Charge of Your Fertility, but with a more naturalistic and holistic slant. The highlight for me is Singer’s discussion of the impact of artificial lighting on the menstrual cycle – she reviews research and provides instructions for “resetting” your cycle and triggering ovulation using night-lighting (the truth is sometimes stranger than fiction!). A fascinating experiment to explore before taking any high-octane fertility drugs, to be sure…
Katie Singer also has an excellent biobilography on fertility awareness.
The Fertility Awareness Center is a resource center for fertility awareness. The director, Ilene Richman, teaches classes and offers private fertility counseling. She strongly recommends taking classes or arranging for private advising prior to using FAM for birth control, as it is "highly unforgiving," i.e., a mistake can mean accidental pregnancy. I agree that classes and consultations are a good idea as a general rule. Without a doubt, we must thoroughly understand the FAM rules that we are using, and we must always err on the side of caution when applying the rules. Having said that…if it’s not possible to find an FAM teacher for financial or logistical reasons, I would not despair. Taking charge of my own learning, while fully appreciating the wondrous gift of fertility and the responsibility it entails, was something I found tremendously empowering. Keep in mind that if you do not choose to find a FA teacher, do seek out support from friends practicing FAM or use the internet to find support. As with anything outside the mainstream, practicing FAM can be a tad lonely at times (especially if your husband or partner is skeptical).
The Fertility Shop is a place to purchase FAM supplies, such as urine test strips for LH (ovulation) and hCG (pregnancy). Much cheaper than drugstore prices.
Zetek makes the OvaCue fertility monitor, which seems to be the most reliable and well-thought-out product of its kind on the market.
Getting Pregnantby Neils Lauersen, MD, PhD & Colette Bouchez. This book is written for a mainstream medical audience, but it is full of information on environmental, diet and other factors affecting fertility, as well as thorough coverage of existing fertility testing and technology. If you have been trying to conceive using FAM for several cycles and feel you may have a medical problem, or if you have had a miscarriage and want to learn more prior to trying again, I recommend this book.
Breastfeeding and Natural Child Spacingby Sheila Kippley, published by the Couple to Couple League, a Catholic organization that promotes Natural Family Planning. It is not possible to rely on FAM for birth control while nursing if your periods have not yet returned, since it is possible to ovulate and conceive without ever having a period. (If you have had experience evaluating cervical fluid, you may notice your body gearing up to ovulate, and you can begin taking your temps in the morning, but this is no guarantee.) Still, by following the guidelines for “ecological breastfeeding” in Breastfeeding and Natural Child Spacing, you can delay the return of your fertility. Learn more from Journeymama...
Justisse is a Canadian organization with an extensive website promoting fertility awareness, as well as their particular brand of fertility education ("body literacy"): Our goal is to teach every woman how to independently observe, chart and interpret her menstrual cycle events. They market Justisse-specific materials for women practicing FAM – including a kit for personal use without classes or instruction, but with contact information for consultations if necessary – and offer courses certification as a Justisse Holistic Reproductive Health Practitioner. Despite their focus on branding, their approach is innovative and well-packaged, and I would recommend a visit to their website.
