Taking Charge of Your Fertility

by Toni Weschler

  COMING FULL CIRCLE

  Although I wrote Taking Charge with a clear vision of educating all women of reproductive age, the success of the first edition was primarily due to the large majority of readers who were seeking to conceive. Initially, I was puzzled as to why this was, because before I wrote it, my own seminars were still much more popular with those seeking to avoid pregnancy. In retrospect, I realize now that the very title of this book often misleads people into thinking that it’s strictly about getting pregnant.

  Regardless, I find it fascinating that the continuing advances in high-tech reproductive technologies are perhaps most responsible for popularizing Fertility Awareness in general. This is because as increasingly more couples muster the financial and emotional resources to try high-tech reproductive options, they often discover that FAM should be the first step they take in their efforts to conceive, before they begin the invasive tests and procedures that drain so much of their money and energy. My vision is still to transform FAM into a body of knowledge that is a basic component of all sex education, but if it takes the determination of those struggling with infertility to propel it into broader society, then so be it.

  I hope Fertility Awareness will eventually bring the women’s health revolution full circle, and that its growing popularity may one day result in its being seen as important as the technological advances and grassroots movements that have already come before it. This is because, as so many women are now learning, FAM is a truly liberating tool for understanding and maintaining basic reproductive health, and can function as such from an adolescent girl’s first period to her last one, nearly 40 years later. In fact, as the decades have passed, a growing critical mass of women have finally discovered that it is arguably the most empowering information that women can be taught about the miraculous workings of their own bodies.

  I feel privileged to play a role in the dissemination of such important and edifying knowledge, in large part because I have come to realize that if FAM continues to grow in popularity in the years ahead, it may one day be seen as the logical culmination of what has, in fact, been a series of women’s health movements, from the first demands for access to contraceptives to the relatively recent and increasing interest in finding natural alternatives for menopausal symptoms.

  And, yes, there is a certain irony in the fact that women considering high-tech procedures for getting pregnant would be the group that is most responsible for bringing Fertility Awareness into the mainstream, for as you’ve learned in this book, the practice of using FAM to chart your cycles generally involves little technology. Still, because of the age we live in, it’s increasingly popular to use computerized charting programs and apps such as the one I helped develop to complement this book, available at www.tcoyf.com.

  It’s still too early to tell, but these digital charts may yet serve as another crucial catalyst in the growth of Fertility Awareness education, as it one day becomes commonplace for women to e-mail them to their doctors on the day before an office visit. And unlike today, virtually every physician would be darn sure that they’re familiar with FAM’s basic medical principles, in part because if they weren’t, they would know less than your average teenage girl.

  Color Insert

  The Three Primary Fertility Signs

  The chart and pictures below reflect the three primary fertility signs of one woman’s cycle, which in this case was 30 days in length. These photos were taken on Days 12, 17, and 20.

  As she approaches ovulation around Day 17, increasing levels of estrogen keep her temperatures down while causing her cervical fluid to become progressively wetter and her cervix to become soft, high, and open. But almost immediately after ovulation, the newly released progesterone causes her temps to rise, her cervical fluid to dry up, and her cervix to revert back to firm, low, and closed.

  You can see that in the middle picture of her cervix, the cervical fluid was removed so as not to obscure the visibility of the opening. Also note that photos are unable to reflect the height of the cervix, but it does reveal an obvious difference in its angle after ovulation.

  WAKING TEMPERATURE

  CERVICAL FLUID

  CERVICAL POSITION

  Photographs by Frankie Collins

  Healthy Variations of Cervical Fluid

  Most women tend to be dry for a few days after menstruation, but as they approach ovulation, their cervical fluid becomes increasingly wet and copious. The quality of cervical fluid is on a continuum from dryer and less fertile to wetter and more fertile as ovulation approaches.

  Each woman has her own unique pattern. The above photographs show just some examples of what women may experience. A woman’s Peak Day of fertility is the last day she experiences either eggwhite-quality cervical fluid (stretchy, clear, or lubricative) or a lubricative vaginal sensation.

  Photographs by Frankie Collins

  Seeing the Forest Through the Trees

  Note the obvious pattern of thermal shifts indicating ovulation in three of the author’s charts, placed side-by-side. Even though there are a few temperatures that are out-of-line or even missing, you can clearly see a pattern of lows before ovulation (blue), and highs after ovulation (pink).

  The Ferning of Fertile Cervical Fluid

  When viewed under a microscope, the stretchy eggwhite secretions in the picture below on the left look like a beautiful ferning pattern conducive to sperm motility. The drier, sticky types of cervical fluid on the right don’t have that magical appearance.

  The Most Fertile-Quality Cervical Fluid

  Fertile eggwhite-type cervical fluid exudes from this woman’s open cervix right before ovulation.

  Stretching the Concept of Perfect Timing

  To see how the cervical fluid below contributed to the conception of this little guy, see his story here.

  Photographs of cervical fluid and baby by Bruce Bobman

  The Beauty of Reproductive Biology

  The Life of an Ovum

  In the illustration below, a tiny egg within the ovary slowly develops its own follicle (red). After completely maturing, it’s released from the follicle left behind on the ovarian wall, in the most significant event of the menstrual cycle: ovulation. In most cases, the just-released egg (blue) will continue on its journey, being swept into the fallopian tube by its outer fimbriae.

  The follicular material left behind in the ovary will soon form the corpus luteum (yellow), which omits progesterone. If fertilization does not occur, it will die within 12–16 days, causing progesterone levels to plummet, and menstruation to follow.

  However, if intercourse occurs in the short fertile phase surrounding ovulation, the sperm may meet the newly released egg within the tube, where fertilization would take place. If this happens, the fertilized egg, now a zygote, continues the journey, becoming a blastocyst that implants in the lining of the uterus about a week later.

  Ovulation photographs by Erlandsen/Magney: Color Atlas of Histology, 1992

  The Delicate Fimbriae of the Fallopian Tubes

  Contrary to what you would imagine, the opening of the fallopian tubes, called fimbriae, are remarkably ruffled, allowing them to sweep the miniscule egg into the narrow tubes.

  “Fallopian Tube” © Science Source® a division of Photo Researchers, Inc.

  The Moment of Ovulation Magically Captured on Camera

  Don’t be squeamish! In one of the most amazing photos ever taken of such a biological event, a doctor just happened to capture the moment of ovulation while operating on one of his patients. As you can see, the egg seeps out from its surrounding follicle on the surface of the ovary.

  “Ovulation” printed with permission from J. Donnez

  The Journey Continues

  No, that’s not an egg resting on vaginal lips. It’s the ovum as it is swept through the fallopian tube, waiting to either be fertilized by sperm or reabsorbed by the body if conception does not occur.

  Photograph by Lennart Nilsson, A Child Is Born, Dell Publishin
g Company

  A Typical Pregnancy Wheel

  This is one of scores of calculating devices that you will find in virtually all fertility clinics. They are considered indispensable in determining a woman’s due date. However, they are often inaccurate, since they assume that women ovulate on Day 14, regardless of when they really do.

  This particular wheel is set for a woman whose 1st day of her last period was January 1st, and thus ovulation was assumed to have occurred on January 14th. In reality, she could have easily ovulated several days earlier or weeks later, as is seen in the charts here.

  “Pregnancy Wheel” printed with special permission from FairHaven Health, LLC

  A Triphasic Pregnancy Chart

  When a woman becomes pregnant, her temperature pattern may evolve into three levels, as can be seen by the three colors below. The second level is the result of the progesterone released after ovulation, while the third level is thought to be the result of the pregnancy hormone HCG, which circulates after implantation. Note that this woman ovulated about Day 21, not Day 14, as seen by the fact that her thermal shift didn’t occur until Day 22.

  Hormone graph by Kate Sweeney

  Ovulation in Context . . .

  Note that the length of the phase before ovulation can vary widely, as seen at the bottom of the graphic. But the phase after ovulation is almost always 12–16 days. Within individual women, the postovulatory phase is remarkably consistent, usually not varying more than a day or so.

  . . . And How Fertility Awareness Helps You Track It

  The only way to determine the precise day of ovulation is through serial ultrasound, in which a woman’s ovaries are followed for several consecutive days. Realistically, of course, that’s not practical nor affordable for most. But given the various ways to corroborate observations of your body and cycles, it’s also generally not necessary. The graphic below simply highlights the average days, relative to ovulation, in which you might expect to see or use any of them.

  Peak Day (Most Fertile Day)

  The chances of conception are limited to about 6 days per cycle, with the most fertile day occurring on the Peak Day, the last day of clear or stretchy lubricative cervical fluid or vaginal sensation.

  Thermal Shift

  The waking temperature shift most often occurs within a couple days of ovulation, and usually confirms that an egg has been released.

  “Fertile Days” with Buffer for Natural Birth Control

  What makes the Fertility Awareness Method effective is that the rules add a buffer of a few days on both sides of your fertile phase.

  Ovulation Predictor Kits (OPKs)

  These urine tests identify when LH peaks, which in turn should trigger an egg to be released within 24-36 hours.

  Fertility Monitors

  These type of tests measure not only your LH, but the estrogen rise that occurs prior to your LH peak, so they are able to reflect increasing fertility up to four day earlier than OPKs.

  Implantation Spotting

  When the fertilized egg implants in the uterine lining, it may cause a slight amount of bleeding.

  Beginning of Triphasic Temps Pattern

  When the fertilized egg implants in the uterine lining, it may cause a third more subtle rise in temperatures.

  Pregnancy Tests

  All pregnancy tests measure hCG (the hormone released after the fertilized egg implants in uterus). There are two types of pregnancy tests.

  Quantitative blood tests are more sensitive and reflect exactly how much hCG you are producing, which will usually double every 48–72 hours. Qualitative urine tests, on the other hand, answer only one question: Are you pregnant?

  Pregnancy Likely Based on Thermal Shift

  If you have 18 conspicuous normal temps above the coverline, it is usually an indication that you probably conceived.

  Endometriosis

  This is a mysterious condition in which the cells that typically line the uterus implant instead in other locations within the pelvis. Women with only a mild case may experience debilitating symptoms, while others with it throughout their pelvic cavity may be totally unaware that they even have it. This illustration shows you some of the various locations where endometriosis can be found in the pelvis.

  “Endometriosis (Beyond the Basics)” reproduced with permission from UpToDate. Copyright © 2015

  Identifying Endometriosis Through Charting

  Three of the most common symptoms of this condition are heavy bleeding, intense menstrual cramps, and deep pain during intercourse. By keeping track of these and other symptoms, you can better help your clinician determine what testing to do in order to make a diagnosis.

  Polycystic Ovarian Syndrome (PCOS)

  This is a serious metabolic condition caused in large part by hormonal imbalances, including excessive insulin. It is surprisingly common, and is characterized by irregular or anovulatory cycles, as well as more serious medical conditions. One of the classic diagnostic signs is the “String of Pearls” seen below, which are cysts that encircle the ovary and can be seen during ultrasound.

  Reprinted with permission from William Herring, MD, FACR. Learning Radiology

  Identifying PCOS Through Charting

  Note how this woman has cycles that range from about 38–143 days, as recorded on the top of the chart. This particular cycle was 39 days, and she had numerous patches of wet cervical fluid before she finally ovulated about Day 28. You can see that she also had ovulatory spotting on that day, which is a more common phenomenon in women with long cycles.

  Fibroids

  By the time a woman is 40, there’s a good chance that she will have developed at least one fibroid somewhere on her uterus. As seen below, they are benign growths that vary from the size of a pebble to that of a melon. There may be one large one or a cluster of smaller ones. Some form stalks that connect them to various parts of the uterus, some grow on the inside or outside, and still others grow deep within the muscle itself.

  While most women will never even be aware that they have them, others may experience long and heavy periods, urinary or bowel issues, pelvic pain, and an enlarged abdomen, among other symptoms.

  Fibroids used to be one of the most common reasons for hysterectomies, but today, there are many more options available for those women who experience serious symptoms, depending on whether or not they would still like to have children.

  “Where Fibroids Grow” © The StayWell Company

  Identifying potential fibroid symptoms through charting

  Some of the symptoms that women may experience with fibroids are debilitating cramps during their periods, frequent urination from the fibroid pressing against their bladders, pelvic pressure in general, and pain during sex. Any one of these symptoms alone would not necessarily make you think you had fibroids, but together, they may help your doctor with a diagnosis.

  Identifying Sources of Unusual Bleeding

  It’s very possible that at some point in your life, you may experience unusual vaginal bleeding. This is generally considered any bleeding other than menstruation, which occurs about 12–16 days after ovulation. There are basically two different types: bleeding that results from organic causes, as seen in the illustration below, and dysfunctional uterine bleeding (DUB), which is caused by a hormonal imbalance.

  Some sources of organic bleeding include various fibroids and polyps, which because of their physical nature are often more easily diagnosed. However, bleeding caused by endometriosis can often be very difficult to diagnose due to the microscopic cells that it deposits outside of the uterus.

  Dysfunctional uterine bleeding is, by definition, caused by hormonal disturbances, and is therefore more likely to cause menstrual irregularity such as exceedingly short or long cycles, in addition to anovulation. Some examples of conditions that are caused by DUB include PCOS and thyroid issues.

  In any case, any menstrual bleeding that is severe or causes debilitating discomfort is not normal and should be diagnosed by a c
linician.

  © Dreamstime.com LLC

  Color-Coding Rows for Noting Conditions Such as Unusual Bleeding and Secondary Fertility Signs

  As you can see below, you can record any unusual bleeding as well as various secondary fertility signs such as ovulatory pain. Signs for PMS, including irritability or feeling bloated, can be recorded using colors to make your chart more graphic.

  In addition, you may want to record when you exercise, as well as when you perform a breast self-exam, which should always be done on Day 7 of your cycle. Simply circle the BSE after doing it.

  Finding the Elusive G-Spot

  One of the most hotly debated subjects in the field of human sexuality is the question of whether or not there is such a thing as a G-spot. Paradoxically, what isn’t really disputed is where it resides. Assuming it does exist, it is located about an inch or two inside the vagina on the upper wall close to the pubic bone.

  Perhaps part of the mystery lies in the extent to which some women find that area pleasurable. Some feel absolutely nothing, while others, when rubbed there, are able to actually ejaculate in much the same way that men do.

  The illustration below shows two fingers stroking the G-spot in a “come hither” motion, which is typically harder to achieve during regular intercourse.

  © 2015 Sheila Metcalf Tobin.