Taking Charge of Your Fertility

by Toni Weschler

  Night-Shift Work

  Working the night shift tends to come with many challenges, not the least of which is when to take your basal temperature. But remember, the definition of a basal temperature is the temp first thing upon awakening, which will not be the morning for those who work nights. (Of course, if your night job is really boring and you sleep through it, you’ve probably got bigger issues than when to take your temps.)

  The general rule in night-shift situations is to still take your temps first thing upon awakening, but the difference is that it should be from your longest, most restful sleep. For many of you, that will be late afternoon or evening.

  If you work various shifts, you may find it more challenging to see a clear pattern of lows and highs. Depending on your work schedule, you may still be able to identify a clear thermal shift for every cycle, but if you cannot, you may still be able to rely on your other fertility signs discussed in this chapter. (Again, see Cervical Fluid Only Rules for how to maximize contraceptive efficacy in such situations.)

  A General Note on Special Circumstances

  While most of you will be able to recognize a thermal shift despite these challenges, you will want to be especially attentive to your cervical fluid as well as to the optional sign of cervical position in order to clearly identify your fertile phase. And regardless, you should never use your temps for contraceptive purposes unless you can see a clear pattern of postovulatory highs above the coverline. If in doubt, don’t rely on FAM for birth control during these times unless you can clearly determine your fertile phase by observing your other signs.

  How Temperature Patterns Predict Length of Cycles

  The beauty of charting temps is that it can give you a sneak preview of how long your cycle will be simply by observing when you have a thermal shift. Remember that once your temps rise, the length of time until your next period will remain pretty consistent from cycle to cycle. So, for example, if you have a fever or a lot of stress during the first part of your cycle, you may experience a delayed ovulation that will be reflected in a late thermal shift. In such a case, you will still be able to count ahead to determine when you will menstruate, even though it will be later than usual.

  Cassandra and Everett were young engaged clients of mine. They both attended college but still lived at home to save money for their future marriage. One weekend, Cassandra’s family went out of town, and they took the opportunity to finally be together without her younger siblings barging in on them.

  A couple of months later, I met with them for their private follow-up consultation. One of the first things that struck me about her charts was that she was having a long cycle with a delayed ovulation. When I asked her whether she was experiencing stress, the two of them glanced at each other and burst into nervous laughter. With a little prodding, I soon discovered that several days after her parents had returned, her mother called Cassandra into her bedroom to inquire what the cap to a whipped-cream can was doing wedged between the mattress and the headboard. At least her charts would prevent her from worrying about a period that was sure to be late that cycle.

  Clara’s charts below help illustrate the point that the preovulatory phase can vary considerably both between women and within any one woman’s pattern from cycle to cycle. The postovulatory phase, while varying somewhat from woman to woman, usually remains fairly constant for each individual woman (plus or minus a day or two).

  25-day cycle

  32-day cycle

  39-day cycle

  Clara’s charts. Temperature charts showing one woman’s cycles of 25, 32, and 39 days. Note that Clara’s preovulatory phase varies in length, but her postovulatory (luteal) phase remains consistent, usually about 14 days.

  CERVICAL POSITION (OPTIONAL SIGN)

  The most challenging fertility sign for most women to master is the cervical position. Of course, it makes sense—after all, how often do you typically slide your finger in your vagina to feel what greets you several inches within? So it may take a few cycles to be able to tell the differences in the cervical qualities of softness, height, and opening.

  As you approach ovulation, your cervix tends to rise, soften, and open. It progresses from feeling firm like the tip of your nose (when not fertile) to feeling soft like your lips as you approach ovulation. Your cervix will lower abruptly when estrogen levels fall and progesterone becomes dominant after ovulation. By simply inserting your clean middle finger, you can detect these subtle changes.

  The cervical position is an optional sign, but it is especially helpful if either of the other primary signs are confusing in any particular cycle. It should never be relied upon alone. The best time to observe dramatic changes are right around ovulation, when the position of the cervix shifts most abruptly.

  Even women who want to chart their cervical position might be initially squeamish about checking it. This is understandable, since it’s probably not something they are accustomed to feeling. Simply breathe slowly and let your body relax. Eventually, you’ll probably find that it can be fascinating to observe how your cervix varies throughout the cycle. And once you become familiar with the various changes, you may want to check your cervix just a week or so per cycle, as discussed in Chapter 12.

  I would encourage you to check your cervix if:

  1.Your temperature patterns do not reflect a completely obvious thermal shift. Your cervix in such cases would provide corroborating evidence of your fertility.

  2.Your cervical fluid observations or temperature readings are not easy to interpret.

  3.You absolutely cannot risk an unplanned pregnancy and want a third sign to confirm infertile days.

  Observing Your Cervix

  When first learning how to check your cervix, one trick that may help give you a baseline is to check for the first time only after ovulation, when your cervix is at its lowest, since it’s easiest to reach then. During the luteal phase, it will usually feel firm, low, and closed. Once you have a point of reference for what it feels like:

  1. Begin checking your cervix at least once a day after menstruation has ended.

  2. Make sure your fingernails are trimmed, and always wash your hands with soap first.

  3. Try to check at about the same time each day. Just after a morning or evening shower is probably the most convenient time. But do not check immediately after a bowel movement because you obviously risk introducing bacteria, and it could cause the cervix to open. And don’t check it the very first thing in the morning because it may be temporarily harder to reach.

  4. The most effective position in which to check is squatting, since this pushes the cervix closest to the vaginal opening. However, some women prefer to check while sitting on the toilet, or putting one leg on the bathtub. Just be consistent about the position you choose, since different positions will change the cervical height.

  5. Use your finger as a convenient gauge. Insert your middle finger and remember the mnemonic SHOW as you observe the following conditions of the cervix:

  Technically, wetness is a quality of the cervical fluid and not of the cervix, but it’s included here because, when checking the cervix, you can’t help but notice whatever secretion is on your finger when you remove it. Just be aware that there will always be something there, and with practice, you will probably start noticing variations depending on where you are in your cycle. (Regardless, though, what you observe when you pull your finger out must not be your main way of checking cervical fluid!)

  6. Note that women who have vaginally delivered children will always have a slightly open cervix. It will feel more oval and is usually shaped like a horizontal grin, so it’s important to focus on the subtle variations throughout the cycle.

  Woman who has never vaginally delivered children

  Woman who has vaginally delivered children

  7. The best time to begin observing cervical changes is when the wet-quality cervical fluid starts to build up in the days before ovulation. You should continue observing at least until
the cervical fluid and cervix abruptly revert back to their infertile quality after ovulation. Cervical changes will become easier to observe with practice.

  8. Don’t be surprised if you notice firm bumps that feel like granules of sand under the skin of your cervix. These are called nabothian cysts, are no big deal, and typically come and go without treatment. (See Nabothian Cysts illustration.)

  9. Obviously, you should not check your cervical position if you have genital sores or vaginal infections.

  10. As mentioned before, once you have learned how your cervix feels during the different phases, you may prefer to scale back to checking daily only for about one week during each cycle, from the first day of fertile-quality cervical fluid through to your thermal shift (see Chapter 12 for shortcuts).

  11. If you find that it’s easier but just as useful to note only one or two of the characteristics of the cervix, focus on those. So, for example, if it’s hard for you to detect the height, but you notice whether it’s open or soft, then just check those two qualities. You might even use a different mnemonic for checking your cervix, such as cervical “OS” (for opening and softness).

  Charting Your Cervix

  1.Use a circle to represent the cervical opening.

  2.The general cervical pattern will look like Isabella’s chart below.

  Isabella’s chart. A typical cervical position pattern. Note that Isabella’s cervix takes a few days to soften, rise, and open, but then immediately closes and drops between Days 20 and 21. This is due to the strong effects of progesterone after ovulation, which in this cycle, probably occurred about Day 20.

  HOW TO DETERMINE THE LENGTH OF YOUR LUTEAL PHASE

  Technically, the luteal phase is defined as the time from ovulation until your next period. The only way that you would be able to know how long it truly lasts is if you happened to have an ultrasound machine in your bedroom to check every day. Short of that, you can still get a good idea of its length by counting from the first day of your thermal shift through to your period, not including the first day of menses itself. To be clear, you count through to the last day before your true period, even if your temps drop a day or more before, and even if you have premenstrual spotting in the days before.

  Luteal phases are typically about 12 to 16 days. If it’s fewer than 10 days, it’s generally considered too short. Likewise, you could theoretically have a luteal phase of normal length but still produce an insufficient amount of progesterone. Either situation may be a problem if you are trying to get pregnant, because both can result in your uterine lining shedding before a fertilized egg has a chance to implant.

  There is one situation in which you might want to modify the way you count the length of your luteal phase: If your thermal shift consistently occurs more than two days after the Peak Day, it probably means that your body reacts slowly to the heat-inducing progesterone released after ovulation. In such a case, it may be more accurate to count the day after the Peak as the first day of the luteal phase rather than waiting to start counting after your thermal shift (see Fewer Than 10 Days of High Temperatures Above the Coverline section).

  SOME CHARTING LOGISTICS WHEN RECORDING BY HAND

  Download the appropriate master chart (for birth control or pregnancy) from www.tcoyf.com. or copy them from the back of the book and enlarge by 125%.

  Record almost everything except temps in fine-point pencil.

  To record cervical fluid or color-coded signs, use a thick marker to fill in the narrow boxes. Have fun exploring a good office supply store with a sample chart in hand to find the best thickness, style, and colors to meet your needs.

  Put a question mark in the column anytime you forgot to observe signs. If your temps fall below 97, write the correct temp just below it and circle that number (so, if your temp was 96.9, record 9 just below the 97, and circle it). Likewise, if your temps rise above 99, write the correct temp just above it and circle that number (so, if your temp was 99.3, record 3 just above the 99, and circle the 3). You can also download a master chart with temps below 97 at tcoyf.com

  If your preovulatory temps tend to be consistently in the 96s or very low 97s, download a master chart with temps below 97 at tcoyf.com.

  If your cycle extends beyond Day 40, cut and tape your charts together (I know, I know, so very yesterday) so that they look like one continuous, long cycle.

  Keep your charts in a notebook with the most recent on top, for easy recording.

  Copy the Annual Physical Exam master form on onto the back of the chart for the cycle in which you get your exam. To easily access your annual exams in the future, you may want to use a little metal clip in the top right corner.

  If you are scanning or faxing your charts to your health practitioner, be sure to put your name on the charts, and send them at high resolution.

  If you would prefer to download a digital master chart or chart your cycles on an app, visit tcoyf.com.

  COMING OFF THE PILL OR OTHER ARTIFICIAL HORMONES

  (INCLUDING ORTHO EVRA PATCH, NUVARING VAGINAL INSERT, IMPLANON ROD IMPLANT, DEPO-PROVERA INJECTION, OR PROGESTIN IUD)

  Women who discontinue hormones are often surprised that their cycles don’t necessarily resume in the manner that they had become accustomed to while on them, especially with the clockwork nature of the pill. But remember that cycles on hormones are artificially induced to be perfect. And ovulation doesn’t necessarily resume immediately after discontinuing them, usually because of the oversuppression of the feedback mechanism of the hypothalamus and pituitary gland.

  Generally speaking, putting women on the pill to “regulate cycles” is counterproductive. So, if you are prescribed the pill for any number of conditions causing irregular cycles, such as PCOS, endometriosis, ovarian cysts, or primary ovarian insufficiency, it usually only masks rather than treats the underlying cause. And once you go off it, your cycles will return to what they were like beforehand.

  In addition, the pill can cause any of the following disruptions for up to several months after discontinuing:

  Temps

  •false high temps

  •temps that seems completely out of sync with cervical fluid

  Cervical Fluid

  •absence of typical ovulatory cervical fluid, leading to an unchanging Basic Infertile Pattern (BIP) even when ovulation does occur

  •continuous seemingly fertile watery or milky cervical fluid

  •erratic patches of varying types of cervical fluid

  Luteal Phase

  •short luteal phase indicating an unsuitable ovulation

  Bleeding

  •heavier and redder bleeding than you became accustomed to while on the pill

  •irregular preovulatory bleeding and spotting in the luteal phase

  •poor menstrual flow following ovulation

  When a woman comes off the pill or other hormones, her cycles will usually revert to the way they were before. However, the length of time it takes varies among women. For some, it’s almost immediate. But for most, there is at least a short delay of a few months, and for others, it could take many months to years (Depo-Provera in particular may delay the return of normal cycles for up to a year or two). This variation is a function of the type and dosage of hormones used, the basic physiology of the woman, and of course, as mentioned above, any underlying conditions that she had before taking it.

  Those who tend to take longer to clear the drug from their systems, and therefore take several months to resume cycling after hormones, are often young or thin (especially those who lost weight while on hormones). Those who were irregular before hormones typically return to their irregular pattern after. In addition, you should be aware that once women do resume natural cycling, they may experience short luteal phases for the first few months. This will usually be reflected in high temps of fewer than 10 days, after the thermal shift.

  Once women discontinue hormones, but before their cycles start showing the classic buildup of fertile-quality cervical fluid, th
ey may notice that it has a somewhat milky quality. Some experience a type that is a combination of both sticky and wet. Still others may discover that their cervical fluid doesn’t attain classic fertile qualities, because the pill can damage the cervical crypts that produce it. For most women though, such abnormalities in their fertility signs will gradually disappear, and they can anticipate returning to cycles similar to what they experienced before starting it.

  It’s clear that when coming off the pill, your observations of your cervical fluid might initially be confusing. And I want to remind you again that any woman who is just starting to chart—or just starting to chart again after being on hormonal contraceptives—should not rely on FAM as their sole method of birth control until they feel confident in being able to interpret their fertility signs.

  For those of you who want to get pregnant after stopping the pill, I would encourage you to wait a few months to be sure the residual hormones are out of your body. Or certainly ask your doctor what they recommend based on the type and dosage you were on.

  PUTTING IT ALL TOGETHER: A SUMMARY

  The time it takes to actually check all three signs is negligible compared to the advantages to be gained. The following, then, is a summary of how to observe and chart the three fertility signs. You might want to bookmark this section for quick reference.

  Observing Your Cervical Fluid

  1.Begin checking cervical fluid the first day after menstruation has ended.

  2.Focus on vaginal sensations throughout the day (such as dry, sticky, wet, or lubricative).

  3.Try to examine your cervical fluid every time you use the toilet, doing Kegels on the way.

  4.Check cervical fluid at least three times a day.