Taking Charge of Your Fertility

by Toni Weschler

  However, I suspect there will be some among you who have no philosophical objections to this technology, and who will eventually want to have your own biological children. And for you, freezing your own eggs could be one of the best decisions you ever make.

  CHAPTER 11

  Natural Birth Control Without Chemicals or Devices

  Please note: Before you use Fertility Awareness as a method of birth control, you need to take the appropriate precautions needed to eliminate the risk of AIDS and other sexually transmitted infections (STIs). In particular, I must state what I hope is obvious: As a form of contraception, Fertility Awareness should only be used by those women involved in a monogamous relationship in which neither partner has an STI.

  Contraceptives should be used on every conceivable occasion.

  —SPIKE MILLIGAN

  There are certain clients I will never forget. One particular couple was given my seminar on natural birth control as a wedding gift by the woman’s parents. Although they seemed thoroughly absorbed in the class, I was soon to discover that they had failed to internalize the most fundamental concept of the method. A month after the seminar, I met with them for their follow-up consultation. Everything seemed to go just fine. Her charts looked great. She recorded her fertility signs perfectly.

  But I noticed that even though they had had intercourse throughout her cycle, they didn’t record what method of birth control they used in the Birth Control Method column of the chart. In other words, they didn’t record whether they used condoms or a diaphragm, for example, during her fertile phase. So, as they were getting up to leave, I casually reminded them to be sure to record what contraceptive they use every time they have intercourse during her fertile phase. She gave me a completely puzzled look, quizzically glanced at her husband, then looked back toward me with a blank stare.

  Silence.

  I said, “In other words, every time you have intercourse, just be sure to record whether you specifically chose not to use birth control because you were infertile at the time, or record what method you used while you were fertile.” Again, the glazed-over look.

  And again, more silence.

  “What do you mean, ‘What method’? I thought this was a method of birth control.” The hair stood up on my arms. It was only then that I realized that this couple actually thought that by merely recording her fertility signs, they were using a reliable method of birth control!

  Needless to say, the Fertility Awareness Method is most effective as a contraceptive if you abstain during your fertile phase. If you would rather not postpone intercourse, you can use a barrier method, though you should be aware of the following:

  1.If a barrier method is going to fail, it’s going to fail when you’re in your fertile phase. And all contraceptives have a failure rate.

  2.If you would still like to use a barrier, you can dramatically increase the effectiveness rate by using two methods simultaneously, such as a condom with a diaphragm, sponge, or spermicide.

  3.Using barriers with spermicide during the fertile phase can mask cervical fluid, so if you would still like to have intercourse during that time, see the rules here.

  Ideally, then, the method is most effective when you have intercourse only outside of your fertile phase. And while it may initially seem difficult to do, many users of natural birth control feel that this creates a “dating and honeymoon” effect. In other words, in every cycle there is a phase when the couple finds creative ways to sexually express themselves, knowing that within a week or so, they can resume intercourse again. By choosing to postpone sex rather than using a barrier method during the fertile phase, people often feel they’re living in harmony with their fertility, rather than fighting it.

  Much of this is simply learning to understand how your body works. A way to conceptualize the length of a woman’s fertility is to remember that it’s totally dependent on the man’s fertility. In a vacuum, a woman would be fertile only a maximum of 24 hours, or 48 hours if two or more eggs were released at ovulation. But her fertile phase increases with the viability of both sperm and egg. The only reason a woman is fertile for longer than 24 to 48 hours is because sperm can live up to 5 days.

  In essence, then, the first part of the woman’s fertile phase is determined by the survival of the sperm and the second part by the viability of the egg. When FAM is used for birth control, this typically adds up to about 10 days (including a buffer on each side), during which abstinence or a barrier method of contraception is necessary. This includes a significant safety margin on each side of the fertile phase.*

  OFF THE LEASH reprinted by permission of UFS, Inc.

  The Fertility Awareness Method is not so much about identifying the day of ovulation as it is about answering one simple question: Am I fertile today? And for those women who are lucky enough to have relatively regular cycles between about 21 to 35 days, the question is simply: When have I entered my fertile phase, and when is it over? Again, this is because in order to use FAM as a method of birth control you don’t need to know the exact day you ovulate.

  THE FOUR FAM RULES AT A GLANCE

  Preovulatory Infertile Phase Fertile Phase Postovulatory Infertile Phase

  1) First 5 Days Rule Abstinence or barriers required! 3) Peak Day Rule

  2) Dry Day Rule 4) Thermal Shift Rule

  For most women, the cycle can basically be divided into three parts. Note that the four FAM rules identify the beginning and end of the fertile phase, which is the time that unprotected intercourse can result in pregnancy.

  What follows are the contraceptive rules for using the Fertility Awareness Method with maximum effectiveness. While they may be a bit tricky to internalize on a first reading, they should become fairly intuitive if you’ve understood the basic biological principles presented earlier in the book. I suggest you read this section slowly and several times, as well as carefully review all of Chapter 6. It’s fairly simple, but as with any new process, it requires a little patience.

  To be safe, I also strongly suggest that you chart at least two or three full cycles before relying on these rules for birth control (I can hear the groans already). Or, at a minimum, do not consider yourself safe until after ovulation, when you know that the egg is dead and gone (by using Rules 3 and 4, described later in the chapter).

  This especially applies to women coming off the pill or other hormonal methods, since their bodies may take quite a few months to resume normal ovulatory cycles with clear fertility signs. The peace of mind you’ll gain will be more than worth it. And if you still find you need further clarification, I would encourage you to either take a FAM class, or at least do an in-person, phone, or online consultation with a qualified instructor. Finally, a guiding principle is that if you encounter any ambiguity, be conservative. All four rules should indicate that you are infertile before you consider yourself safe. If in doubt, don’t!

  I strongly encourage you to chart both cervical fluid and temps, and even the optional cervical position sign, to corroborate your observations—the charting of these three signs is technically referred to as the Sympto-Thermal Method. However, if you only chart one sign, see Appendix F for a slightly different set of rules.

  THE FOUR FAM RULES WHEN CHARTING BOTH CERVICAL FLUID AND TEMPS

  Preovulatory Infertile-Phase Rules

  1.FIRST 5 DAYS RULE

  You are safe the first 5 days of the menstrual cycle if you had an obvious thermal shift about 12 to 16 days before.

  Flora’s chart. The First 5 Days Rule. Flora considers herself safe the first 5 days of her cycle, regardless of how many days of bleeding she has (as seen by three variations of her cycles). In each case, she knows that this really is the beginning of a new cycle and not ovulatory bleeding, since she had a thermal shift a couple weeks before.

  The First 5 Days Rule applies to the first 5 days of the cycle, regardless of how many days you actually bleed. But any bleeding after the 5th day of the cycle should be considered fertile, since it could
mask your ability to check cervical fluid.

  By noting an obvious thermal shift 12 to 16 days before you bleed, you have strong evidence that ovulation occurred that previous cycle. This confirms that the bleeding you experience the first 5 days of the new cycle is true menstruation and not ovulatory spotting or unusual bleeding unrelated to menses.

  This rule is effective because the combined risk of ovulation occurring on Day 10 or earlier and sperm living long enough to fertilize the egg is, statistically speaking, very rare. Remember, sperm can generally survive a maximum of 5 days, and even that is only in fertile-quality cervical fluid. Still, the rule should be modified for women who meet any of the following criteria:

  1. If any of your last 12 cycles have been 25 days or shorter, you should assume that only the first 3 days are safe. This extra precaution is taken because of the increased risk of a very early ovulation. If cervical fluid were to develop while you were menstruating, you would be unable to detect it through the blood, and thus sperm could theoretically survive the few days necessary to fertilize the egg. There is some disagreement in the FAM community over the necessity of this conservative guideline, but I would personally recommend it.*

  2. If you did not have a thermal shift or Peak Day about 12 to 16 days before your period, you should assume that it’s probably anovulatory bleeding or something else, and therefore you cannot consider yourself safe!

  3. If you are approaching menopause with such signs as hot flashes and vaginal dryness, you should not rely upon this rule at all. This is because premenopausal women are subject to major hormonal changes that could result in dramatically early ovulations, to say nothing of irregular bleeding that may not even be menses (see Appendix J for how to use the method if you are perimenopausal).

  MESS-FREE SEX DURING YOUR PERIOD

  One of the ways that you can take full advantage of sex during your period without the requisite mess is to use a menstrual cup or similar product. Of course, if your idea of a good time is scrubbing bloody linens, then by all means, skip the suggestions below.

  There are different types of cups that will collect menstrual blood, and most are a wonderful alternative to pads and tampons, regardless of whether or not you use them during sex:

  Menstrual cups: There are scores of these ingenious items available today either at drugstores or on the internet, and all are good for collecting blood. Unfortunately, though, they are not designed to be used during intercourse, because they can get in the way or get dislodged and leak. Still, they are great for sex play because they are made of silicone, so they don’t leave you imbued with that lovely scent of discarded rubber tires.

  Diaphragms: These must be fitted by a clinician, but they then serve double duty during intercourse, as a contraceptive as well as a collector of blood.

  Cervical caps: These must also be fitted by a clinician, though they fit differently than a diaphragm. Some are more comfortable for intercourse than others.

  2.DRY DAY RULE

  Before ovulation, you are safe the evening of every dry day. But the next day is considered potentially fertile if there is residual semen that could be masking your cervical fluid.

  Erika’s chart. Dry Day Rule. Note that Erika is safe the evening of every preovulatory dry day, which in this chart occurs on Days 5 to 12.

  1. Before ovulation, you are safe for unprotected intercourse the evening of every dry day (after 6:00 p.m.).* Dryness is determined by checking throughout the day and observing that no bleeding cervical fluid or wetness is present at any point. But as soon as you observe your Point of Change, even if it is a sticky- or nonwet-quality cervical fluid, you must consider yourself potentially fertile.

  It may surprise you that you must view this type of cervical fluid as potentially fertile before ovulation. It’s true that it’s very difficult for sperm to survive in it. However, the rules are extremely conservative, and take into consideration the fact that a woman may not be able to differentiate between sticky cervical fluid and the beginning phases of the wetter quality.

  In addition, this eliminates the risk of wetter fluid trickling down from the cervix in time to save the few hearty sperm that may have survived. But if you only experience one or two consecutive days of sticky cervical fluid and then revert back to dry days, you are considered safe again the evenings of each dry day.

  To reiterate, then, before ovulation, the only days considered safe are the evenings of those dry days in which there is no cervical fluid present on the tissue when you wipe from front to back. (Note that women will always have a slight dampness or moistness at the vaginal opening, which quickly dissipates from the finger. These days are still considered dry if you have no cervical fluid.)

  2. The day after intercourse is marked with a question mark if semen or spermicide is present, because they can mask the presence of cervical fluid. The evening of a Semen Day is considered fertile since there is no way to prove that such a day is indeed dry. For recording semen, see Mikaela’s chart below. Better yet, for an efficient way to eliminate semen, refer back to SETs.

  Michelle’s chart. When semen masks cervical fluid. Note that Michelle is safe on the evenings of preovulatory dry days, but any day with residual semen must be recorded with a question mark, as she did on Days 6, 8, 10, and 12. These days are considered potentially fertile.

  If, by the end of the day after intercourse, you are dry all day, you are safe for unprotected intercourse again that evening. There are two reasons why you can have peace of mind using the Dry Day Rule before ovulation:

  a.Sperm can’t survive if there’s no cervical fluid present to sustain them. At longest, they will live a few hours. And because the sticky-quality cervical fluid that develops before wetter types is just about as inhospitable to sperm as a completely dry vaginal environment, the risk of conception is low.

  b.If you don’t have cervical fluid, it’s an indication that your ovaries are inactive and your estrogen levels are so low that you’re not near ovulation. Remember that ovulation is preceded by a buildup of wet-quality cervical fluid.

  The above two reasons should reduce fears that you might have regarding the issue of sperm surviving long enough for an egg to be released. To exaggerate the point, even if sperm could live 10 days in ideal conditions and ovulation occurred the day after intercourse, it’s extremely unlikely you would get pregnant if your lovemaking was on a dry day. Of course, this scenario would never happen, but I want to stress the concept that sperm need fertile cervical fluid in order to survive and move.

  Finally, you should realize that because sperm can survive up to 5 days if fertile-quality cervical fluid is present, you absolutely cannot rely on ovulation predictor kits, which give only about one day’s warning of impending ovulation. And just for the record—no, arousal fluid and lubricants don’t provide the necessary environment for sperm survival.

  3. After a couple of cycles of charting, you may notice that immediately after your period ends, you don’t have any dry days. Rather, you have a sticky- or even gummy-quality cervical fluid that starts just after menstruation and continues day after day until you see the change into a wetter quality. Since this could be an indication of cervical inflammation, you should probably have it checked when you first start charting. But, assuming you are healthy, this just means that your Basic Infertile Pattern (BIP) during your infertile phase is sticky rather than dry, as was briefly discussed here.

  If you do indeed have this postmenstrual BIP immediately following your period, you may still be able to apply the Dry Day Rule on those days of sticky cervical fluid, treating the sticky days as if they were dry. Of course, the first sign of wet cervical fluid is your Point of Change and is now considered fertile.

  This exception, though, applies only to those who never experience dry days pre-ovulation. And even then, you should be aware that you are taking a somewhat increased risk in following this modified guideline. Because of this, I suggest that you do not use this modified rule if you’ve had cycle
s of 25 days or less in the last year, and if you do use it, verify that there is no wet cervical fluid at your cervix before having intercourse. (See Appendix G as well as Ashley’s chart below.)

  Ashley’s chart. Basic Infertile Pattern of sticky cervical fluid. After charting a couple of cycles, Ashley notices that her Basic Infertile Pattern is sticky rather than dry immediately following her period. Because this is her preovulatory pattern, she may treat Days 7 to 10 above as if they were dry, and follow the Dry Day Rule. In order to minimize the risk of pregnancy, she verifies that no wet cervical fluid is present at her cervix before having intercourse.

  Postovulatory Infertile-Phase Rules

  3.PEAK DAY RULE

  You are safe the evening of the 3rd consecutive day after your Peak Day, the last day of eggwhite or lubricative vaginal sensation.

  Jessica’s chart. Peak Day Rule. Jessica’s last day of wet vaginal sensation or cervical fluid was Day 19. She marked “PK” (for “Peak”) under it, then recorded 1, 2, 3 on the subsequent days in the Peak Day row. She considered herself safe the 3rd evening after her Peak Day, on Day 22. Note that even though Jessica had sticky cervical fluid on the 3rd day, she is still considered safe as long as wetness does not reappear during the 3-day count.

  1. Identify your Peak Day (the last day of eggwhite or lubricative vaginal sensation, as described here). Mark PK in the Peak Day row below it. Subsequent days should be labeled 1, 2, 3 in that same row, but it’s best to record them only in the evening after having observed your cervical fluid each day. You will know it was the Peak only the following day, when your cervical fluid and lubricative vaginal sensation have already started to dry up.