Taking Charge of Your Fertility

by Toni Weschler

  In any case, the body’s response to conception is truly amazing. If you were to become pregnant, the embryo would be lost if the endometrium began to disintegrate and were shed in the form of menstruation, as it usually is, cycle after cycle. So the pregnant body has a means of preventing that from happening. As soon as the fertilized egg burrows into the lining, it starts releasing a pregnancy hormone, HCG (human chorionic gonadotropin), which sends a message back to the corpus luteum left behind on the ovarian wall. HCG signals the corpus luteum to remain alive beyond its usual maximum of 16 days, continuing to release progesterone long enough to sustain the nourishing lining. After a few months, the placenta takes over, not only maintaining the endometrium, but providing all the oxygen and nutrients the fetus needs to thrive.

  One of the reasons for “false negative” pregnancy tests is that the test is often done too soon, before the egg has had a chance to implant and start releasing HCG, or before the HCG has had time to reach a high-enough level to be detected in the urine or bloodstream. Of course, the occurrence of such misleading results could be decreased if women charted their cycles and could identify for themselves when ovulation, and therefore implantation, most likely took place.

  I hope the last few pages have convinced you that your menstrual cycle is anything but boring, but is in fact an amazing orchestration of biological events. Far from being only about menstruation, it is a continual hormonal chorus working together toward the ultimate goal of releasing and nurturing a healthy egg. And, as you will see in the next chapter, your body gives you conspicuous signs to help you understand on a daily basis what is transpiring within.

  CHAPTER 5

  The Three Primary Fertility Signs

  I was completely ignorant of this bodily change every cycle. Boy, what my mother never told me. In fact, I learned about love and baby making from a neighbor boy’s declaration that a man puts his penis in a woman’s “china.”

  —KELLEY HEIL, a first-edition TCOYF reader

  Ask a typical woman whether she is aware that her body is a walking biological computer containing the most enlightening information about her fertility, and you’re likely to be met with a blank stare. But the truth is, all women of reproductive age can easily learn how to observe and chart the three primary fertility signs that their bodies produce. This information can then be used to tell them numerous things about their cycle, the most obvious being whether they can or can’t get pregnant on any given day.

  As you know, the three primary fertility signs virtually all ovulating women produce are:

  1.cervical fluid

  2.waking temperature

  3.cervical position

  But before you learn about each sign individually, you should take a look at the key charting terms in the box that follows.

  CERVICAL FLUID

  One of the first things that may strike you when you start charting is that there is a distinct pattern of cervical fluid throughout your cycle. In fact, most women comment that before they learned how to chart, they often noticed mysterious secretions that seemed to come out at arbitrary times, but found it “gross” and confusing, never realizing that it served a purpose and followed an obvious pattern.

  KEY CHARTING TERMS FREQUENTLY USED IN THE BOOK

  You should review the list of definitions below. It’s basically a cheat sheet for charting that will help you to internalize the rest of the book.

  Secretions Cervical fluid, unless mentioned otherwise.

  Sticky Cervical fluid that has a non-wet consistency such as pasty or gummy and causes a dry or sticky vaginal sensation.

  Creamy Refers to any type of transitional and fertile wet cervical fluid on the continuum between sticky and eggwhite. It can include numerous types that you may experience yourself, including but certainly not limited to a type that resembles hand cream.

  Eggwhite Eggwhite-quality cervical fluid, which is defined as either stretchy, clear, or lubricative. Note that “eggwhite” always includes the concept of lubricative vaginal sensation, as well. It is the most fertile quality.

  Basic Infertile Pattern Unchanging dryness or sticky (non-wet) cervical fluid that women experience immediately after menstruation, or for an extended time when not ovulating.

  Point of Change The point in the cycle when the Basic Infertile Pattern transitions to a more fertile state, either from dry to sticky (non-wet), or from sticky to creamy (wet).

  Temps Basal body temperatures (BBT), which are waking temperatures, or temperatures first thing upon awakening.

  Thermal shift The rise in waking temperatures that divides the preovulatory low temperatures from the postovulatory high temperatures on an ovulatory chart.

  Biphasic chart A temperature chart that reflects ovulation because it shows two levels of temperatures: a pattern of relatively low temps in the preovulatory phase followed by higher temps in the postovulatory phase for about 12 to 16 days.

  And, if you are like most women when they learn how to observe their fertility signs, the second thing you may experience is a sense of frustration and even anger when you realize how little you understood your body before. No, you were probably not experiencing recurring vaginal infections all the time. No, you were not dirty and in need of douching away the “discharge.” In fact, the beauty of charting your cervical fluid is that you will be able to discern once and for all what is absolutely normal from the symptomatic discharge that results from a true vaginal infection. For this reason, I would suggest you never again use the “d-word” to describe your healthy cervical fluid. After all, we don’t refer to men’s healthy semen as “discharge.”

  Cervical fluid is to the woman what seminal fluid is to the man. Since men are always fertile, they produce seminal fluid every day. Women, on the other hand, are fertile only a few days around ovulation, and therefore produce the substance necessary for sperm nourishment and mobility only during that time. It’s fairly intuitive. Sperm require a medium in which to live, move, and thrive—otherwise they will quickly die. Once the sperm travel from the penis to the vagina, they need an analogous substance to sustain them. But the only time it’s crucial for sperm to survive is around the time the egg is released. This is why women produce the substance that resembles semen for only a few days per cycle.

  Ultimately, cervical fluid has several key functions. It provides an alkaline medium to protect the sperm from the otherwise acidic vagina, it nourishes the sperm, it acts as a filtering mechanism, and perhaps most important, it serves as a medium in which the sperm can move.

  In a nutshell, a woman’s cervical fluid starts to develop and resemble a man’s seminal fluid in a very predictable way. As she gets closer to ovulation, she usually sees a pattern of increasing wetness. But each cycle may be different, with the main point being that the secretions become ever more fertile as she approaches ovulation. So, for example, after her period and directly under the influence of rising estrogen, her cervical fluid will develop more fertile characteristics. The Continuum of Cervical Fluid from Sticky to Creamy to Eggwhite table below shows an example of how a woman’s shows an example of how a woman’s cervical fluid might develop. But keep in mind that this is only to help you recognize your own particular cyclical patterns.

  Dry

  Right after your period, you may have a dry vaginal sensation and observe nothing near the vaginal opening. Or you may notice a slight moisture, similar to the way it would feel if you touched the inside of your cheek for a second. Your finger would have a dampness on it that would evaporate within a few seconds. This is the way the vaginal opening typically feels when there is no cervical fluid.

  After perhaps a few days of this dryness, you will notice a Point of Change that occurs as estrogen starts to rise, indicating that you are now starting to approach ovulation. It is the first time that you notice cervical fluid after your period ends. For some it may occur on Day 6, for others maybe Day 11. Each woman is different, which is why it’s so important to learn how your own body res
ponds to estrogen.

  Sticky

  What exactly it looks and feels like is unique to you, but the important point is that you will notice some type of cervical fluid. Perhaps it’s sticky, like the paste you used in grade school. Or it might be flaky. Occasionally, it may even resemble drying rubber cement in that it’s somewhat rubbery and “springy,” but the main point is that it’s not really wet. And while this particular type of cervical fluid is not likely conducive to sperm survival, for contraceptive purposes, it must be considered possibly fertile if found before ovulation.

  Creamy

  The next type of cervical fluid you may notice for several days is a wetter type. Some may describe it as creamy or lotion-like. It may tend to feel rather cold at the vaginal opening, just as hand lotion itself feels cool to the touch. It may even stretch up to ¾ inch, but it will break. The most important point about this type of cervical fluid is that it’s wet, but not yet the quality of the next and most fertile type. Because it comes between sticky and the most fertile, slippery quality described next, it’s considered a transitional type of secretion.

  Eggwhite

  The final and most fertile cervical fluid is also the most easy to identify because it often resembles raw eggwhite. Its most obvious characteristics are that it usually stretches at least 1 inch, or is clear, or causes a lubricative vaginal sensation (the ability to stretch is called spinnbarkeit, or spin for short). In fact, just memorize “stretchy, clear, or lubricative”—make it your mantra.

  It may also be partially streaked, and it could be yellow-, pink-, or red-tinged, all indicating the presence of possible ovulatory bleeding. When you stretch it, it won’t break. In addition, it could be so watery that you can’t actually see anything, but can only feel the slipperiness as a vaginal sensation. Finally, and as many of you will have already noticed, it will often leave a fairly symmetrical circle of fluid on your underwear due to its high water content. Regardless, the crucial determinant of this quality cervical fluid is the wet and lubricative vaginal sensation you usually feel, whether or not you can actually see anything.*

  WHAT’S THE DEAL WITH CREAMY?

  There are so many personal variations of cervical fluid that what you may experience does not necessarily fit any of the descriptions in the opposite table. The important point is for you to internalize the concept of a pattern from dry to wet. If you are ovulating, your cervical fluid after your period ends will evolve from dry or sticky to wetter and more slippery as you approach ovulation. The point is that almost all women experience a transition from dryer to wetter.

  Thus, I’ve chosen the word “creamy” to describe the category of wetness in between sticky and eggwhite, since so many women experience it. But you may prefer to use a different term that is more descriptive of what you yourself observe. Maybe you would rather think of it as just “wettish” or “transitional.” That’s fine; whatever works for you!

  Again, the most important feature of this extremely fertile cervical fluid is its slippery quality. You may even notice that the lubricative vaginal sensation that usually accompanies it continues a day or two beyond the actual presence of the stretchy or clear cervical fluid itself. That sensation indicates that you are still extremely fertile. Of course, vaginal sensation should not be confused with sexual lubrication. Vaginal sensation is something you simply feel throughout the day, or notice while wiping, without actually observing anything. In the end, quality is more important than quantity when evaluating the fertility of cervical fluid. Regardless, the way all of these types of secretions are recorded can be seen in the chart below.

  Alyssa’s chart. A typical cervical fluid pattern. There is usually a gradual progression from dry to sticky to wetter types, seen here in 2 days each of sticky, creamy, and eggwhite. Also notice that the vaginal sensation generally corresponds with the cervical fluid (“lube” is used to signify a lubricative sensation at the vaginal opening). Finally, observe how Alyssa records Day 1 of the new menses on the same chart before repeating it again on a new chart. Every cycle is clearly delineated with a vertical closing line. This cycle was 30 days.

  After estrogen levels peak, the cervical fluid changes abruptly, often within a few hours. This is due to the sudden drop in estrogen, combined with the surge of progesterone as the egg is about to be released. After ovulation, the non-fertile cervical fluid forms a thick sticky plug that impedes sperm penetration. In addition, the acidic vaginal environment destroys the sperm that aren’t trapped in the plug.

  In other words, it may take up to a week for the fertile-quality cervical fluid to build up, but then it will usually dry up in less than a day. This sudden drying of the cervical fluid is the best way to know that estrogen has plummeted and that progesterone has taken over. The lack of wet cervical fluid typically lasts the duration of the cycle.

  Finally, in the day or so before menstruation, women may occasionally notice a very wet, watery sensation, which in some women feels like watery eggwhite. This is thought to be due to the drop in progesterone that precedes the disintegration of the lining of the uterus. The first part of the uterine lining to flow out is typically water, hence the very wet sensation. Obviously, this wet fluid immediately preceding menstruation does not indicate a fertile time, since the egg will have disintegrated about two weeks before.

  One way to envision the changes in your cervical fluid is through the image of a wave, which gradually builds higher and higher until it abruptly crashes down. Though our hormones aren’t quite so dramatic, the analogy still holds. Note in the graphic below how the phases of cervical fluid buildup and subsequent decrease are not symmetrical.

  A trick to help you identify the actual quality of the cervical fluid and vaginal sensation is to notice what it feels like to run tissue across your vaginal lips. Does it feel dry, impeding movement? Is it smooth? Or does it simply glide across? When you are dry or sticky, the tissue won’t pass across your vaginal lips smoothly. But as you approach ovulation, your cervical fluid gets progressively more lubricative, and thus the tissue should glide easily.

  Knowing What’s What

  One of the saddest examples of a woman not being taught the nature of normal cervical fluid was a client I had years ago.

  Brandy was a young woman who attended my class after having been on the pill for six years. Prior to my seminar she endured a completely unnecessary diagnostic test—all because she had never learned how to understand the amazing signs her body produces every cycle.

  Brandy noticed that every now and then, when she had a bowel movement, she would feel a slippery substance when she used the toilet paper. She became quite concerned that perhaps something was wrong with her intestinal tract, because she noticed it only after using the bathroom, and only periodically. The doctor suggested she have a colonoscopy to rule out inflammatory bowel disease or polyps. But why?

  Brandy was experiencing the absolutely normal and common occurrence of fertile eggwhite flowing from the vagina. Since that type is so slippery and profuse, it can easily be spread to the rectum with tissue paper. Of course, it’s no wonder she noticed this slippery substance only every now and then, since she produced eggwhite only around ovulation.

  This is not to suggest that colonoscopies are unwarranted. In fact, as part of taking charge of your overall health, you should get one every 5 to 10 years starting at age 50. But my hunch is that if you are reading this book, you are not 50 yet. In addition, if you were taught the ins and outs of slippery cervical fluid, as it were, you would know to specifically be looking for signs of it, especially when bearing down on the toilet.

  The stories of women like Brandy having unnecessary and anxiety-producing tests is one of the things that motivates me to educate women about the simple signs their own bodies tell them about their reproductive health. This is not to say that women don’t occasionally have genuine infections or other problems and medical concerns. The point is simply that women should be taught what is normal so that they can better dete
ct disorders in themselves.

  You should also be aware that there are certain factors that can potentially mask cervical fluid, such as:

  •douching

  •vaginal infections

  •seminal fluid

  •arousal fluid

  •spermicides and lubricants

  •antihistamines (which can dry it)

  In addition, women with an unchanging gummy, rubber cement, or wet type of secretion that continues for weeks or longer may have cervicitis or cervical erosion. Neither of these conditions is serious, but they should be treated, if for no other reason than that it makes it easier to accurately observe your cervical fluid.

  Finally, women often wonder how cervical fluid differs from seminal fluid and arousal fluid. The latter two are much thinner and typically dry quicker on your finger, whereas cervical fluid tends to remain until you wash it off. I discuss this in greater detail in the following chapter. Of course, once again, because you have three fertility signs to rely on, you can have the peace of mind of knowing that you can still interpret your fertility by cross-checking the other two signs if there is any ambiguity.

  © Steinberg/The New Yorker Collection/www.cartoonbank.com

  WAKING (BASAL BODY) TEMPERATURE

  Perhaps the easiest sign to observe is the waking temperature, for the simple reason that it is usually very graphic and objective. Many women who have charted their fertility for a few months find that it becomes a fun challenge to predict the day their temps will shift.

  A woman’s preovulatory waking temps typically range from about 97.0 to 97.7 degrees Fahrenheit, with postovulatory temps rising to about 97.8 and higher. After ovulation, they will usually stay elevated until her next period, about 12 to 16 days later. If she were to become pregnant, they would remain high throughout much of her pregnancy, gradually dropping a few months before childbirth.