What is Fertility Awareness? Fertility Awareness Method (FAM) is a collection of practices that help a woman know which days of the month she is most likely to get pregnant. A woman can learn when ovulation is coming by observing her own body and and charting physical changes. She can then use this information to avoid or encourage pregnancy. The most effective way to discover YOUR fertile time is to practice all of the techniques described here. Fertility Awareness increases a woman’s understanding of her body and her menstrual cycle. To be effective as birth control, it requires her to abstain from intercourse or to use a barrier method of birth control during the fertile time, approximately one-third of the month.

If you are want to use FAM as a method of birth control or to get pregnant, please seek additional information from the resources listed at the end.

Fertility Awareness is a form of Natural Family Planning. However, the term 'Natural Family Planning' does not always mean the comprehensive approach known as Fertility Awareness Method or FAM.

Fertility Awareness Assumptions • How it Works • Calendar Charting
Cervical Mucus Monitoring • Basal Body Temperature • More Signs
Effectiveness • Advantages • Disadvantages • Further References • PDF

Fertility Awareness relies upon the following assumptions:

• An egg (ovum) can live inside a woman’s body for 12-24 hours. However, in calculating the fertile time we use 48 hours in case more than one egg is released.
• Sperm can live in a woman’s body up to 5 days after intercourse, though more often 2 days. Pregnancy is most likely if intercourse occurs anywhere from 3 days before ovulation until 2-3 days after ovulation.
• Since the exact time of ovulation cannot be predicted, we add 2 to 3 days to the beginning and end.

A woman’s fertile time (“unsafe days” if she wants to prevent pregnancy) is thus about one-third of her cycle.

Pregnancy is prevented by not having sexual intercourse during the unsafe fertile time, or by using a barrier method such as male condom or female condom, cervical cap, or diaphragm. Alternatively, if a woman wants to get pregnant, she can know when is the most likely time.

The more regular a woman's cycle, the more effective FAM is. FAM is most reliable for women with regular menstrual cycles. As a woman becomes more familiar with the signs of ovulation and the pattern of her menstrual cycle, FAM becomes more effective for her.

Calendar Charting

With Calendar Charting a woman uses past menstrual cycles as a guide. She calculates the average number of days in her cycle, and estimates future fertile times. When you know the shortest and longest cycles over several months, you can use a formula to determine an estimate of your fertile time.

Start by keeping a written record of your menstrual cycle for 8-12 consecutive months. Count the first day of menstruation (the first of bleeding) as "Day 1" of your cycle.

Pick your longest and shortest cycles. Subtract 18 from the length of your shortest cycle and note this as the first fertile day. Subtract 11 from the length of your longest cycle and this is the last fertile day.

Example: Count the number of days between Day 1 of one period and Day 1 of the next period.

In this example, the shortest cycle was 26 days and the longest was 31 days. Subtract 18 from 26 to get the first unsafe day, that is Day 8. Subtract 11 from 31 to get Day 20 as the last unsafe day. Therefore, Days 8-20 are the fertile time.

Once you have a record of your cycles, the following table will help you determine your fertile unsafe days.

Using the above chart for another example, if a woman's menstrual record shows her shortest cycle was 25 days and her longest was 30 days, her unsafe fertile days are Day 7 up to and including Day 19, counting from Day 1 as the first day of her period.

Each month add the number of days between periods to the chart and re-calculate your predictions of fertile times. As your chart grows, cross off the oldest cycles and only consider the past 12 months.

Cervical mucus changes consistency during the menstrual cycle and plays a vital role in fertilization of the egg. Present in the days preceding ovulation, fertile cervical mucus aids in drawing sperm up and to the fallopian tubes where fertilization usually takes place. It also helps maintain the survival of sperm inside the woman's body.

In a "typical" cycle, after 5 days of menstruation there are 3-4 "dry" days, then wetness begins with sticky, cloudy, whitish, or yellowish secretions. The wetness increases to the wettest day when mucus is quite distinctive: abundant, clear, very slippery and very stretchy (like egg whites). Ovulation occurs sometime in the 2 days before or up to 2 days after the peak day of stretchy fertile mucus.

To chart your cervical mucus, observe and record your cervical secretions every day on a calendar or chart. Day 1 is the first day of your menstrual period.

Using a plastic speculum for vaginal and cervical self examination, a woman can learn to see the changes in the os (opening to the cervix) and watch it open as ovulation approaches. Within the os, fertile cervical mucus appears clear and shiny. You may collect this mucus from the speculum after you take it out.

Alternatively, to collect the mucus, wipe yourself front to back with your fingers collecting the secretions from your vaginal opening. Look for a sensation of wetness. Note the color (yellow, white, clear or cloudy) and consistency (thick, sticky, stretchy) as well as how it feels (dry, wet, sticky, slippery, stretchy).

When monitoring your mucus, do not douche as it washes away the secretions. Do not use spermicidal gel, foam, cream or suppositories as they can mask or affect your mucus, making it difficult to identify the changes.

Some practitioners warn that during menstruation and the first dry days after menstruation, you should only have intercourse every other day to ensure you do not miss the first signs of increased secretions. You can use male or female condoms to keep semen out of the vagina and to protect yourself from sexually transmitted infections and HIV.

When a woman monitors her Basal Body Temperature (BBT) she can see when ovulation happens after it has occurred. BBT helps identify post-ovulatory infertile (safe) days.

Using an easy-to-read thermometer, take your temperature every morning immediately upon waking and before any activity. Use graph paper so you can see the rise and fall of temperature (see below).

Cervical fluid changes consistency during the menstrual cycle and plays a vital role in fertilization of the egg. Present in the days preceding ovulation, fertile cervical fluid aids in drawing sperm up and to the fallopian tubes where fertilization usually takes place. It also helps maintain the survival of sperm inside the woman’s body.

Immediately before ovulation, the temperature drops briefly. Within 12 hours of ovulation the BBT rises several tenths of a degree and remains up until the next menstrual period. When your temperature stays high for 3 days in a row, the fertile period is over and the safe infertile time begins.

The main drawback of using the BBT method by itself, is that several factors can influence your BBT, including illness, lack of sleep, alcohol or drug use.

Record your temperatures on a chart similar to the one above, along with your cervical fluid and the next technique, cervical observation. Keep a chart of your BBT over a period of 8-12 consecutive months to learn the approximate time in your cycle when you usually ovulate.

Cervical Observation

The position of a woman’s cervix changes over the course of her menstrual cycle. Typically, during and in the first few days after menstruation, the cervix is fairly low and firm like the tip of your nose. When the wet cervical fluid begins to show, the cervix begins to move up, become more soft, wet, and open. During ovulation, the cervix is at its highest and most open. After ovulation, the cervix returns to the firm, low, and closed position.

To observe the changes in cervical position, wash your hands, insert your middle finger, and feel your cervix for softness, height, opening, and wetness. A plastic speculum can be helpful in the beginning while you are getting used to finding and feeling your cervix. Check your cervix about the same time of day and in the same position (squatting, sitting on the toilet, or with one leg raised).

Add to your chart a record of the appearance, softness/firmness, and wetness of the cervix.

More Signs

In addition to the changes described above, other physical changes may occur mid-cycle, around the time of ovulation, including:

• Slight one-sided pain or cramp in the area of an ovary in the lower abdomen
• Spotting
• Breast tenderness

To prevent pregnancy, a woman should abstain from intercourse, or use a barrier method of birth control during her fertile days: 5 days before ovulation through 3 days after ovulation, about one-third of her cycle.

The effectiveness of FAM for birth control varies, depending on the dedication and motivation of the woman and her partner, the length of time she has been using it and the regularity of her menstrual cycle. Combining multiple techniques such as those discussed here for observing fertility increase the effectiveness. Of 100 women who limit vaginal intercourse during their fertile time, between 2 to 20 will become pregnant during the first year. By comparison 60 to 80 women out of 100 who use no birth control will become pregnant.

It is helpful to learn these techniques directly from a qualified instructor if you can find one. Books and websites also have good information.

New technologies such as calculators, computer programs, saliva tests and urine tests are becoming available to the public to help determine fertility. These high tech methods may be especially valuable to women who have had trouble getting pregnant.

Advantages

• No health risks or side effects to the woman.
• Can be used to plan or prevent pregnancy.
• Effective if used correctly and consistently, especially for women who have regular menstrual periods.
• Acceptable for couples with religious concerns about contraception.
• Can increase a woman's awareness and understanding of her body.
• Couples may develop greater communication, cooperation and responsibility.
• For couples who choose not to abstain during the fertile period, use of barrier methods at that time can offer considerable protection against pregnancy.

Disadvantages

• Learning to use the method takes time and effort.
• Requires considerable commitment, calculation and self-control, both by the woman and her partner.

Cycle Beads

Cycle Beads can be a useful tool and a fun way for keeping track of where you are within your own cycle. The beads are color coded. Cycle Beads website has further information on fertility awareness.

Emergency Contraception (The "Morning After" Pill - "Plan B" - "EC")

You can prevent pregnancy after sexual intercourse by taking Emergency Contraception pills (Plan B). Plan B works by giving the body a short burst of synthetic hormones that disrupt the hormone patterns needed for a pregnancy to start. Emergency Contraception is most effective in the first 24-48 hours after unprotected intercourse, but it can work for several days.

To find Emergency Contraception, see ec.princeton.edu. If you already have birth control pills in your possession, this page explains how to use them as emergency contraception.

In Washington State, you can get Plan B directly from your pharmacy. Call ahead to make sure they have it in stock. Some women are buying Plan B in advance (it costs around $35-50) so they will have it on hand if they need it.

• Fertility Awareness Method in PDF
• Understanding Your Menstrual Cycle
• The Garden of Fertility: A Guide to Charting your Fertility Signals to Prevent or Achieve Pregnancy -- Naturally -- and to Gauge your Reproductive Health by Katie Singer. The book describes the changes a woman experiences throughout the menstrual cycle; how to chart your fertility signals (the waking temperature and cervical fluid); how to determine, by fertility charts, when you are fertile and not fertile; how to practice natural birth control that is virtually as effective as the Pill; and when to time intercourse if you want to conceive. It explains how to identify, by your fertility charts, whether you're ovulating, indicating a propensity for thyroid problems, poly-cystic ovarian syndrome, or miscarriage. It tells how to establish and identify unambiguous infertility while breastfeeding, and how to identify that ovulatory cycles are resuming. See www.GardenofFertility.com and www.KatieSinger.com.
• GardenofFertility.com also posts several articles about Fertility Awareness, fabulous photos that show the changes the cervix goes through during a menstrual cycle unless a woman's on the Pill, fertility charts that can be downloaded at no charge, and more. published in 2004.
  
• Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control and Pregnancy Achievement by Toni Weschler. HarperCollins. 1995. Fertility Awareness Method relies on three indicators of fertility. This book teaches them in detail. Natural family planning is achievable with this knowledge and practice. More about it from Amazon.com
• Try Cycle Beads to help you keep track of where you are in your monthly cycle.
• A Cooperative Method of Natural Birth Control by Margaret Nofziger. 112 page booklet. 1992.
• Signs of Fertility: The Personal Science of Natural Birth Control, The Fertility Question, Nutrition and Fertility, A Cooperative Method of Natural Birth Control - 4 excellent resource books by Margaret Nofziger - available at Amazon.com or by calling MND Publishing at 334-569-1984.
• Fertility Awareness Network, PO Box 1190, New York, NY 10009, fan@fertaware.com
  
• Society for Menstrual Cycle Research - a nonprofit organization and multidisciplinary group of women pioneers in understanding the centrality of menstrual cycle research to women's health.
• Our Bodies Ourselves is a wonderful resource for understanding our bodies. New version in 2005.
• Self Exam with your own speculum
• about the Self Help Movement

Want to get pregnant? See...

• Preconception advice for women regarding nutrition and other health factors.
• All about Pregnancy from "Women's Health Matters" in Canada
• For men - temperature affects sperm production. You are more likely to get pregnant during the winter and if the man wears boxer shorts instead of briefs.
• For women - resting for 10 minutes following intrauterine insemination, or traditional sexual intercourse, may improve chances of pregnancy, according to a new study at McGill University. The study is published in the September issue of "Fertility and Sterility."
• Study indicates a nutritional supplement known as FertilityBlend may help previously infertile women conceive, according to the April 2004 issue of Journal of Reproductive Medicine. The supplement contains folic acid; vitamins E, B6 and B12; iron; magnesium; zinc; L-arginine, an essential amino acid, chasteberry, an herb that is thought to optimize ovulation; green tea, and selenium.

March 13, 2009

Feminist Women's Health Center
proud to operate Cedar River Clinics