Ironically, experienced women who have charted for years are the most common subscribers to that way of thinking. But remember, even if your cycles have always been regular and your charts easy to interpret, there’s always the chance that the next cycle will be different from all others. Like any other birth control method that “fails” because of improper use—such as leaving the diaphragm in the drawer—FAM must be used correctly to work.
Simply intuiting when you are or aren’t fertile is not a reliable method of birth control. In fact, it’s no method at all. You need to chart your temperature and cervical fluid, even if it’s for only a third of your cycle. Otherwise, it can be too easy to forget what transpired on any given day. In the end, you may find that charting becomes so ingrained that you won’t even be tempted to take the shortcuts described above.
CHAPTER 13
Maximizing Your Chances of Getting Pregnant
Literature is mostly about having sex and not much about having children; life’s the other way round.
—DAVID LODGE, BRITISH AUTHOR
If you’re like most people trying to get pregnant, you probably remember the years of hassling with birth control and all that that entailed—the diaphragms that flew across the room when you attempted to insert them, the condoms that broke at the peak of lovemaking, or the pill that caused your weight to balloon. In fact, you may even have experienced sleepless nights worrying about whether you had accidentally conceived, even though you consistently used birth control.
Yet here you are, years later, perhaps bemoaning the fact that you spent so much time and energy trying to avoid pregnancy, only to discover that it might not have been so easy to conceive after all. For some couples, getting pregnant may indeed be difficult. But for many, it can be as simple as learning how to optimize their chances of conception by identifying when your combined fertility is at its greatest. Surprisingly, the odds of a typical couple of proven fertility conceiving in any one menstrual cycle is thought to be no higher than about 25%. And for couples in their mid-30s and older, the chances decrease substantially. But you can increase them dramatically by identifying the optimal time to try.
While most would acknowledge the great benefits derived from advances in medical technology, there are also drawbacks. One is that people are often led to believe that the most efficient and only way they will be able to get pregnant is through invasive procedures. Not only is this often wrong, but it can even be counterproductive. Modern methods can ironically impede or delay the very pregnancy they were designed to aid (for example, as mentioned earlier, Clomid tends to dry up cervical fluid, and artificial insemination may be inappropriately timed). Today there are countless ways to diagnose and treat so-called infertility. But if you think you might be facing a fertility problem, FAM should always be your first step in the pursuit of pregnancy, not your last.
When trying to get pregnant, dispense with all the misinformation that well-meaning friends and clinicians seem to perpetuate. If you’ve read this book in sequence, and didn’t sneak a peek at this chapter first, you should already know that there are a number of truths about fertility that directly contradict the myths you’ve heard.
One of my couples illustrated the benefit of knowing you are still fertile even though it would appear that you are well beyond the day of ovulation. Carrie and Jake were extremely demoralized when I met them. They had been trying to get pregnant for nearly two years, after the tragic death of their baby. Since they didn’t have any trouble conceiving the first time, they were perplexed by why it was taking so long to get pregnant again.
In their particular case, what helped them to conceive after those two years was the realization that if Carrie’s temps hadn’t shifted yet, they were still considered fertile. She said that she was almost relieved when her temps were still low on Day 22, because it meant they still had an opportunity to get pregnant that cycle. So, rather than feeling anxious, she felt much more in control. They knew to continue having sex each day that she had wet cervical fluid and the temps remained low. They had intercourse and conceived on Day 22. Sure enough, her temp rose the next day, confirming that they had timed it just right.
FERTILITY TRUTHS
1.A normal cycle is not necessarily 28 days; it ranges from about 21 to 35 days. It varies from woman to woman as well as within individual women.
2.You can ovulate as early as Day 8, and as late as Day 20 or beyond. The point is that most women don’t necessarily ovulate on Day 14.
3.Your most fertile day cannot be determined by your temps. In fact, most women don’t even experience the “temperature dip” that they’ve often been told to look for.
4.You are usually not most fertile the day of the rise in temps, either. In fact, by the time the temperature rises, it’s generally too late—the egg is often already gone.
5.The key to identifying your most fertile phase is through cervical fluid, and not waking temps.
6.You don’t need to stand on your head for half an hour after making love in order to get pregnant! If you are timing intercourse at the most fertile time, the sperm will rapidly swim up through the cervical fluid, regardless of what position you are in.
7.How often you should have intercourse during your fertile phase (for example, every day or every other day) may be a function of the combination of your partner’s sperm count and your cervical fluid. It’s not a hard-and-fast rule that applies to all couples alike.
8.Both men and women are equally likely to have a fertility problem.
WHY SOME WOMEN ARE MORE FERTILE THAN OTHERS
Even being armed with accurate knowledge doesn’t necessarily guarantee a timely pregnancy. If it’s taking longer than you had anticipated, probably the last thing you want to hear are the annoying clichés of young mothers referring to themselves:
“They call me Fertile Myrtle.”
“He just has to look at me and I get pregnant.”
“I’ve gotten pregnant on every method of birth control [yuck, yuck].”
Actually, there are several reasons why some women do indeed tend to be more fertile than others, but that doesn’t diminish the irritation you may rightly feel. In addition to the obvious fact that their reproductive organs are healthy, they may have a long phase of extremely fertile-quality cervical fluid, providing them more opportunities to get pregnant. Also, women with short cycles tend to ovulate more often, which means that they have more fertile days in a given year. But even though these women have a biological head start, you can certainly level the playing field by charting your cycle.
Vanessa and Max were a charming couple who had initially taken my class to avoid pregnancy. After two years of using FAM successfully, they decided it was time to try to get pregnant. But a trip to Mexico delayed their plans by several months while they allowed the malaria medications to dissipate from their bodies. So the first month in which they were able to try was March. Then a little detail looked like it was going to interfere. Max had just had major surgery on a shoulder that had eroded from years of playing basketball. He spent several days in the hospital after the operation.
His first night back home he was in a lot of pain, so he was completely drugged to help him handle it. Vanessa walked in and proudly announced, “Tonight’s the night.” The eggwhite was too obvious to miss. As Max recounted, “Trust me, sex was the furthest thing from my mind. Here I was, with my shoulder and arm taped to my torso to immobilize it, flat on my back, pumped with painkillers, and my wife walks in and says: ‘It’s time. I’m fertile.’ Needless to say, I explained to her that I was hardly in a position to have sex, as it were, when she reminded me that she could take care of everything herself. So with me half out of it, she proceeded to do what was necessary to allow conception to occur. Sure enough, from that one single act of sex that cycle, we conceived our little boy Don.”
You may take a lot longer to get pregnant, of course. The point is that knowing when you are most fertile will expedite the process. If, after 4 t
o 6 cycles of timing intercourse on your most fertile days, you still haven’t gotten pregnant, you should probably pursue diagnostic testing or fertility treatments. (Some couples may want to get a semen analysis even earlier, given how easy it is to do.) This advice probably goes against the common wisdom you’ve always heard of waiting a year. Remember, that advice is for the average couple who doesn’t chart. If you have been timing sex during your fertile phase, and you know that your partner’s sperm analysis is good, then becoming proactive after 4 to 6 cycles only makes sense.
A WORD ABOUT OVULATION PREDICTOR KITS (OPKS)
Before getting to the crux of how FAM can help you get pregnant, I want to say a few words about ovulation predictor kits, because many of you will no doubt use them or have already used them. While they can in fact be quite useful, you should know by now that your own body can provide you with as much valuable information as the kits, with less hassle and certainly less cost. Still, if you do choose to use them (either exclusively or with Fertility Awareness), you should be aware that OPKs can be misleading for the following reasons:
1. The kits test only for the occurrence of the luteinizing hormone (LH) surge that precedes ovulation. They don’t indicate whether the woman has definitively ovulated afterward. In fact, women may occasionally experience a condition called LUFS (luteinized unruptured follicle syndrome) in which they have an LH surge but the egg is never actually released from the ovary. This condition is further discussed here.
2. A woman could miss her LH surge if she is one of those who have surges that last less than 10 hours and she only checks once a day. She could also miss it if she is one of the significant number of women who peak below the threshold that the kits actually test.
3. A woman may experience false LH surges in which she has mini-peaks of LH before the real one, causing her to potentially time intercourse too early for the sperm to survive long enough for the release of the egg. In addition, if the woman has PCOS, her body may continually produce misleading LH surges, not indicative of a true impending ovulation.
4. The kit does not indicate whether the woman has suitable cervical fluid to allow sperm a medium in which to travel to the egg. In addition, by the time the kit does show a surge, the cervical fluid may already be starting to dry up.
5. Their accuracy can be compromised if exposed to excessive heat during delivery and storage.
6. The kits are accurate only if they test a woman’s fertility right around the time of ovulation. This is a very significant point, because often the type of woman who purchases them is one who, by definition, has irregular cycles. Therefore, the typical kit, which has only 5 to 9 days’ worth of tests, will often not have enough to cover the range necessary for her to determine ovulation.
For example, if Bailley has cycles that are between 24 and 40 days, then her ovulation will generally vary between Days 10 and 26, which is a range of 16 days. Since the kits last 9 days at most, it could be a challenge for the woman with irregular cycles to know on what day to begin testing. In a situation like this, women with irregular or long cycles should not start testing their urine until they notice their cervical fluid start to get wet, to be sure to test at the most appropriate time around ovulation.
7. Women with short luteal phases may not realize that the kits instruct them to test for ovulation based on an average-length luteal phase. This may lead a woman to test much earlier than she is actually ovulating. Therefore, the test results may reflect anovulation, when in reality, ovulation has probably just not yet occurred. For example, if Ashlee has cycles that average about 23 days, with a luteal phase of only 8 days, then ovulation would occur about Day 15. But the kits would instruct her to start testing as early as Day 8.
8. Some drugs can invalidate the results of the kit, including:
a)most fertility drugs, especially those that contain FSH, LH, or HCG
b)certain antibiotics containing tetracycline
c)hormone therapy (HT)
9. Women over 40 and approaching menopause can have elevated levels of luteinizing hormone that are not indicative of impending ovulation. A kit should show a surge of only one day. If it shows more than one day, there is an increased chance it is invalid.
10. Finally, you should be aware that if you happen to be pregnant already, the kit would simply imply that you aren’t ovulating. Of course, this is true, but this tells you nothing about your real condition (whereas charting would, as you’ll soon learn). In addition, if you are postpartum or breastfeeding, the kit results may be invalid.
OTHER METHODS OF OVULATION DETECTION
Aside from the standard ovulation predictor kits just discussed, there are several other ways to predict ovulation. Here is a brief description of some of the more widely used devices currently available:
Clearblue Easy Fertility Monitor
This palm-size electronic system works with a standard urine test to monitor your cycle. By analyzing both estrogen and LH within the urine, a computer is able to tell you if you are currently in a low, high, or peak phase of your cycle. If used correctly, it can effectively predict ovulation about one to two days before it occurs, while alerting you several days before that. Certain medical conditions and drugs can compromise its performance, though, so check the company’s website before considering it. The monitor costs about $200, and a box of 30 test sticks is about $50. clearblueeasy.com
OvaCue Fertility Monitor
This device measures the level of electrolytes in your saliva. By placing a sensor on your tongue for a few seconds each morning, a saliva reading registers on a digital screen. The probe is used every day from the first day of your cycle until the computer signals you are within about a week of ovulation. If you are trying to get pregnant, you would then begin having intercourse every day or every other day while continuing to check with a small accompanying vaginal sensor that eventually confirms when ovulation has occurred. The monitor costs about $200–$300, depending on whether you buy the optional vaginal sensor. ovacue.com
OV-Watch Fertility Predictor
This wrist computer looks like a watch, but it’s worn only while sleeping. Its purpose is to detect chloride ions on the surface of the skin. About 6 days before ovulation, chloride ion levels surge, before the estrogen peaks and LH surges. Thus, its advantage is that it predicts ovulation earlier than typical ovulation predictor kits, which only test LH. It costs about $200 for the watch and a two-month supply of sensors, with additional month-packets costing about $40 each. ovwatch.com
Salivary Ferning Tests
Just as your fertile cervical fluid will show a distinct ferning pattern under a microscope (click here to see the page in the color insert), the sodium in your saliva often does the same thing. Although brands vary, these tests generally come with several acrylic slides and a specially designed microscope through which to view the results. Each morning, before doing anything else, you put some saliva on one of the slides by licking it or using your finger. Perhaps not surprising, it’s now widely accepted that there is a high correlation between salivary ferning and the approach of ovulation. Unfortunately, though, it can often be difficult to interpret these slides. Prices vary by company, but they typically cost about $30 for a microscope and several slides.
A BRIEF COMMENT ON THESE OVULATION DETECTION DEVICES
Like OPKs, these technologies may be able to assist you in determining your most fertile days each cycle, but be aware that each one generally has at least a few of the same weaknesses that I noted for the kits. And regardless, while they can do an excellent job of corroborating your charting, most won’t give you the comprehensive information that your own temps and cervical fluid will give you directly every day.
Still, if you would prefer to take a more digital approach to ovulation detection, I would personally recommend the app that complements this book. This is because it’s specifically designed to digitize the information you glean from practicing Fertility Awareness, and it can easily be shared with your doc
tor through e-mail. TCOYF.com
THE ROLE OF FAM IN PREGNANCY ACHIEVEMENT
I wish getting pregnant were always as easy as making love when the mood strikes. Yet for many people, it requires more knowledge than we were typically taught while growing up. And unfortunately, people can be incredibly educated and well-read and still require high-tech procedures to get pregnant. But for a lot of people presumed to have a fertility problem, FAM can help fulfill their desire to get pregnant in numerous ways.
Infertility can have many causes, and FAM allows couples to hone in on them more quickly, thus helping their doctor determine if they require medical intervention. As mentioned before, conventional medical wisdom is for a couple to have intercourse for a full year before seeking help for getting pregnant. But for most people, that advice is an unnecessary waste of time and emotional energy. Using FAM, couples often discover that getting pregnant simply involves optimizing their chances with newfound knowledge about their combined fertility, rather than simply trying whenever. In timing intercourse precisely, one should be able to tell if there is a problem within only a few months of trying.
Eva is a 36-year-old woman who almost never menstruated from the age of 28 on. Naturally, she suspected that it would be a real challenge to get pregnant. A fertility doctor prescribed the ovulatory drug Clomid for 6 months. During that time, although she ovulated, she experienced a number of unpleasant side effects, the most serious being vision problems. In addition, the Clomid exacerbated her problem of poor cervical fluid production. So after several months of frustration on the drug, she decided to discontinue it. In fact, she and her husband, Toby, a physician, were so discouraged with the experience that they welcomed the break from feeling obligated to get pregnant.
One morning, about 4 months after stopping Clomid, she woke up “swimming in eggwhite,” as she recounted. Since she hardly ever ovulated, she rarely experienced such fertile cervical fluid. They knew that if they had any hope of getting pregnant, they had to take advantage of that moment. Sure enough, she conceived that day, without the aid of anything but the knowledge of Fertility Awareness that they both possessed. Little Hugo was born at home 9 months later.
Taking Charge of Your Fertility Page 19