By Katie Singer
Issue 117, March/April 2003
[Author's note: This article is only an introduction to Fertility Awareness. It does not provide adequate information about using charts to prevent pregnancy. Interested readers should take a class and/or read a comprehensive book, such as Toni Weschler's Taking Charge of Your Fertility. See For More Information at the end of the article.]
When Maria Simmons and Eric Hurley (not their real names) first got together, they didn't use birth control. "I thought I knew when I was fertile," Maria says. "I'd heard that the egg leaves your body with the slippery mucus in the middle of your cycle. And once the egg's gone, you can't get pregnant." Eric figured she knew what she was talking about; "I sure didn"t," he says. The couple's son, Brahm, was conceived within two months. After he was born, Maria and Eric, by then married, considered their options for birth control. Maria had had experience with the Pill and the diaphragm, and she didn't like either. "We weren't comfortable with the , either," Eric says. "So we used condoms. But we didn't like them much. We didn't have much sex."
Their midwife suggested Fertility Awareness (FA), a natural method based on daily charting of a woman's waking temperature and cervical fluid changes.1 Maria was skeptical: "I thought that was how I'd gotten pregnant," she says. "But my midwife had used FA herself for years and insisted the method could work for me, too."
Curious to learn more about her cycle, Maria started charting, and eventually the couple took a class in FA. Eric, who can read Maria's charts as well as she can, says, "Now I have a feeling of responsibility, because I know when Maria's in her fertile phase. We have intercourse only when she's infertile, since we don't want another child now. We're actually enjoying sex more, and I'm glad she's not using the Pill or . They're strong chemicals."
Maria adds, "I didn't want sex for a long time after Brahm was born. Once I could read my charts confidently, I realized that a big part of not wanting sex was that I feared getting pregnant again. Eric often felt unwanted and frustrated during that time, understandably so."
How Fertility Awareness Works
Like the earth's surface, a woman of childbearing age moves through cycles of heating and cooling, which in turn create moistening and drying, which in turn provide a fertile environment for life to evolve. Rocks, glaciers, plants, and animals (including humans) all evolve in concert with these processes. Just as a meteorologist can observe and measure cycles in the earth's surface to determine weather patterns, a woman can observe her daily waking temperature, cervical fluid, and the cervix's changes to gauge her gynecological health and to determine when she can and cannot conceive. According to Leah Morton, an MD with a family practice in Santa Fe, New Mexico, "The first step in being healthy is knowing about yourself and respecting nature. Fertility Awareness provides a way to learn these things."
By the time a female fetus is four months old, she has already produced all the eggs she will ever create in her lifetime. The eggs, which number about 1 million, are each encased in a sac called a follicle. With the onset of menses, a young woman begins a hormonal cycle that typically lasts about one month.
With each new cycle, estrogen causes about a dozen follicles (sacs holding unripe eggs) to mature in one of her ovaries. Besides heightening a woman's sexual desire, estrogen also works to produce cervical fluid, cool her body slightly, and open her cervix. These signals can all be observed by the daily charting of mucus, temperature, and the cervix itself. When a follicle is mature, the egg within it bursts out of the ovary, and the 's finger-like reach out and grab it. The ripe egg then lives at the outer edge of the tube for 12 to 24 hours. This process is called ovulation, and a fertility chart can confirm that it has taken place. It's important to note that being fertile is not the same as ovulating. Ovulation is the release of a ripe egg. A woman is fertile when she produces cervical fluid, which can keep sperm alive for up to five days. If there are sperm in the cervix, or if the couple has intercourse while an egg is alive in a fallopian tube, cervical fluid can carry sperm up through the uterus and the fallopian tube, where they try to fertilize the egg.
After ovulation, whether or not the egg is fertilized, the empty sac remains in the ovary and produces progesterone. This hormone dries up the woman's mucus, warms her body temperature, closes her cervix's opening (the os), and thickens her with blood. If an egg is fertilized, it takes about a week to travel down the fallopian tube before implanting itself in the newly lined uterus. If fertilization does not occur, the egg simply dissolves. Then, 12 to 16 days after ovulation, menstruation occurs and a new cycle begins. Typically, cervical fluid begins to build up a few days after the period ends, becoming tacky, moist, then creamy; it normally peaks at a stretchy, egg-white consistency seven to ten days after the period ends. After the period, any mucus or moist sensation at the vulva signals that the fertile phase has begun. Contrary to what Maria Simmons once thought, the egg does not leave the body via slippery cervical fluid; the mucus is actually a signal that ovulation is about to take place. After ovulation, the mucus has a drier consistency. A woman's waking temperature is typically cooler before ovulation and warmer after ovulation.
If its rules are followed, FA is virtually as effective as the Pill in preventing pregnancy. It has also helped countless couples to conceive. With about two minutes of daily attention, women can observe and chart their fertility signals. Charts can also be used to determine such things as progesterone deficiency, a possible thyroid problem, pregnancy, and miscarriage.
"Unfortunately," says Leah Morton, "most doctors aren't taught FA in medical school. But even if your physician can't interpret your charts, you can still use them to raise questions about your gynecological health and to make more informed decisions about your care."
Using FA While Breastfeeding
While it's easier to learn Fertility Awareness before you conceive, breastfeeding women can also determine whether or not they're fertile by observing their fertility signals. Different kinds of breastfeeding will influence how long it takes for fertility to return postpartum:
Exclusive breastfeeding means giving your baby nothing but milk from your breast; frequent nursing (including at night); pacifying the baby at your breast, rather than with a rubber pacifier; and feeding without a schedule. These behaviors will likely dry up your and also keep you from ovulating or menstruating. Sheila Kippley, co-founder of the Couple to Couple League, a Catholic organization that promotes Natural Family Planning, calls these behaviors "ecological breastfeeding" when the mother also takes a daily nap with the baby, and sleeps with the baby for easy night nursings.
Partial breastfeeding means giving the baby water, formula, and/or a pacifier in addition to nursing. Leaving the baby with sitters, or sleeping through the night without nursing, are also characteristic of partial breastfeeding. Pumped milk is nutritionally sound, but because your baby isn't sucking from the breast, pumping could speed up your return to fertility. (Actually having the baby close to you, as during breastfeeding, creates a hormonal response that affects fertility. Pumping only partially activates this hormonal response.) With partial breastfeeding, fertility can return as quickly as with bottle-feeding (i.e., three to ten weeks postpartum), or as late as three to four months after birth, depending on how much you nurse and whether or not you and your infant take a daily nap or practice the family bed. (I recently heard of a mother who worked full-time, pumped her milk while she worked, nursed her baby frequently in the evenings and at night, practiced the family bed, and did not return to fertile cycles for a year.)
If you are exclusively breastfeeding, you can have intercourse in the first eight weeks after giving birth without risking a new pregnancy. If you continue with exclusive breastfeeding for the baby's first six months, the risk of becoming pregnant is less than 2 percent. After six months, a nursing mother has about a 60 percent chance of ovulating. According to Sheila Kippley, the average return of menstruation for ecologically breastfeeding mothers is between 14 and 15 months; taking a daily nap with your baby and practicing the family bed can indeed delay your return to fertility.
Typically, women who breastfeed exclusively can establish unambiguous infertility - notably dry mucus, dry vaginal sensation, and - within a few months postpartum. Once you observe wet vaginal sensation or cervical fluid, consider yourself alerted that ovulatory cycles are on their way. Of course, a menstrual period (which might or might not be ovulatory at first) also signals that fertility is returning.
A Natural Process
With Fertility Awareness, a woman can be in sync with her own cycles, and couples often experience enhanced communication and intimacy. As Eric Hurley said, "We're finally doing birth control together. It's not all on Maria now. Not just our lovemaking, but our whole relationship feels better for it."
1. Fertility Awareness is also called the Sympto-Thermal Method, Natural Family Planning, or the Ovulation Method. The Sympto-Thermal Method is used by women who chart cervical fluid, temperature changes, and possibly cervix changes. Users of the Billings or Ovulation Method chart only the changes in cervical fluid. FA teachers will inform their clients how to use effectively during fertile phases to avoid pregnancy. Teachers of Natural Family Planning advocate abstinence only during fertile phases for couples avoiding pregnancy. The ineffective Rhythm Method, unlike others cited here, determines fertility by observations of past cycles.
FOR MORE INFORMATION
Ehling, Dagmar, and Katie Singer. "Gauging a Woman's Health by Her Fertility Signals: An Introductory Synthesis of Western and Traditional Chinese Medical Principles" Alternative Therapies (November 1999) or see www.FertilityAwareness.net.
Kippley, John, and Sheila Kippley. The Art of Natural Family Planning , fourth edition. Couple to Couple League, 1996.
Kippley, Sheila Matgen. Breastfeeding and Natural Child Spacing: How Ecological Breastfeeding Spaces Babies , fourth edition. Couple to Couple League, 1999.
Taylor, H. William, et al. "Continuously Recorded Suckling Behaviour and Its Effect on Lactational Amenorrhoea." J. Biosoc. Sci. 31 (1999): 289-310; or see www.faculty.fairfield.edu/htaylor/reprints/99TAYL289.pdf
Weschler, Toni. Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health, revised edition. Quill, 2001.
www.FertilityAwareness.net includes an extensive, annotated bibliography of books and links with fertility-related themes.
www.tcoyf.com includes message boards especially for women who want to conceive.
To find an FA teacher in your area, contact: Fertility Awareness Network, PO Box 1190, New York, NY 10009; 800-597-6267. Send $5.00 for a list of teachers throughout North America who offer classes and private consultations.
The Couple to Couple League, PO Box 111184, Cincinnati, OH 45211-1184; 800-745-8252; www.ccli.org
Katie Singer has taught Fertility Awareness at Services in Santa Fe, New Mexico, since 1997. She is the author of a novel, The Wholeness of . Her book The Garden of Fertility Awareness (forthcoming in 2004 from Avery/Penguin Putnam) focuses on using FA to gauge and strengthen reproductive health.