Taking Charge of Your Fertility

by Toni Weschler

  To see how you would record these conditions, see the two charts below.

  Watery cervical fluid

  No slippery eggwhite-quality cervical fluid observed

  PATCHES OF WET CERVICAL FLUID INTERSPERSED OVER LONG CYCLES

  Whether you are trying to avoid pregnancy or to get pregnant, if you have highly irregular or long cycles interspersed with patches of slippery or stretchy cervical fluid, you might consider being checked for medical conditions such as PCOS or thyroid issues. However, such a pattern could be a result of nothing more than intense stress, as seen on Samantha’s chart below.

  Regardless, during the various phases in your life in which ovulation occurs less frequently, your body may go through episodes of trying to ovulate before it actually does. Eventually, after weeks or months of experiencing “false starts” in the form of patches of cervical fluid, you should be able to verify that ovulation finally occurred by the arrival of a thermal shift.

  For women using FAM for birth control, this transitional pattern can be frustrating in that those patches need to be treated as fertile, and the symptothermal rules require you to abstain or use barriers during all those patches, adding a buffer zone after each one. If this is your pattern, you can apply the Patch Rule.

  Samantha’s chart. A stress cycle. Samantha is getting her master’s degree in social work in an incredibly difficult program that has caused her to be continually stressed out. In addition, she hasn’t been eating well, so she’s lost a lot of weight and has stopped ovulating. This chart actually starts on Day 41, since her prior chart only went to Day 40, and she hasn’t had a period since Day 1 of that chart. Whenever she notices a patch of cervical fluid, she marks the last day with a PA for “patch.”

  She finally started seeing the light at the end of the tunnel when school was over and she had to just apply some finishing touches on her dissertation. Sure enough, after handing it in, she started noticing that her next patch of cervical fluid evolved into eggwhite for a couple days, after which she had a thermal shift on Day 69 of her cycle. However, her luteal phase was short because it was the first time since she ovulated in a couple months, so her body was still adjusting.

  WET CERVICAL FLUID WELL AFTER OVULATION

  After ovulation, there is a second smaller surge of estrogen well into the luteal phase, which occasionally causes a day or two of wet cervical fluid. This often coincides with a temporary drop in temperatures. It is not an indication of returning fertility. So those avoiding pregnancy need not be concerned, assuming the Temperature Shift and Peak Day rules have clearly shown that ovulation has already taken place. But if you’re not sure, don’t take risks.

  Wet cervical fluid mid-luteal phase

  WET SENSATION OR EGGWHITE BEFORE MENSTRUATION

  Having a very wet, watery sensation, or even a slippery eggwhite-quality substance, about a day or two before your period is absolutely normal. It’s merely an indication that the corpus luteum has started to disintegrate, as it does before menstruation.

  The first part that typically flows out when progesterone drops is the water that composed some of the endometrial lining. This watery substance should not be confused with fertile-quality cervical fluid. It has no bearing on your fertility. By definition, if it comes out just before your period and after you have established that you are in your infertile phase, then you are indeed not fertile that day.

  Lubricative secretion or feeling a day or so before period

  INFECTION MASKING CERVICAL FLUID

  Vaginal infections produce many aggravations, including their ability to mask cervical fluid. What typically differentiates most infections from healthy cervical fluid is that infections usually have at least one of the following unpleasant symptoms:

  1.True discharge, which is perhaps gray, green, foamy, or even like cottage cheese

  2.Itching or irritation such as stinging

  3.An offensive or unusual odor

  4.Discoloration of the vagina, such as redness

  5.Potential swelling of the vagina and vaginal opening

  If you suspect that you have an infection, you should record a question mark in the Cervical Fluid Description row. It is imperative that you abstain from intercourse during the time you get treated in order to allow your body a chance to heal, and to prevent passing it back and forth between you and your partner. If nothing else, it can be extremely painful to have sex when you have an infection!

  Vaginal infection

  WET CERVICAL FLUID FOUND AT THE CERVIX BUT NOT AT THE VAGINAL OPENING

  Women who check their cervical fluid at the cervix may notice that it sometimes seems wetter or more abundant than what they simultaneously observe at the vaginal opening. This is logical, since it can take a few hours for the cervical fluid to trickle down.

  Remember to keep in mind that if you check internally, you will always have at least a slight moisture or film on your finger that should not be confused with cervical fluid. Simply wave your finger in the air for a few seconds. If the dampness dissipates, then you know it was probably only the moisture from your vagina itself.

  If you find a slight, white filmy substance on your finger but your vaginal sensation is dry, you may then consider that day a dry day. This is because women will usually have vaginal cell slough internally even when it appears as if they are dry externally. This would still be considered low fertility. See Appendix G for more about internal checking.

  Discrepancy in cervical fluid. Note that cervical fluid that is wetter at the cervix than externally, as well as any film-like substance, can be recorded in the Cervical Fluid Description row. But the shading you record in the Cervical Fluid row should reflect what you observe at the external vaginal opening. You may prefer to use the master chart at the back of the book that is labeled in the bottom right-hand corner “Birth Control (Internal and External).”

  HIGH TEMPERATURES DURING PERIOD

  It is fairly common for women to experience several days of high temperatures during their period. This is usually the result of residual progesterone from the last cycle or fluctuating hormones during menstruation.

  Draw a dotted line from the last high temperature to the normal low temperature. The high temperatures will probably be above the coverline, but you can simply disregard them by using the Rule of Thumb (click here). In addition, remember that it is only the last 6 temps before your thermal shift that are relevant for drawing a coverline, as you can see by the 6 highlighted temps below.

  High temps during period due to residual progesterone

  HIGHER- OR LOWER-THAN-AVERAGE WAKING TEMPERATURES

  One of the most obvious symptoms of a possible thyroid issue is a pattern of very high or low waking temperatures. (Most preovulatory temperatures range between 97.0 and 97.7 degrees and postovulatory range between 97.8 and up.) Some clinicians believe that any consistent pattern of preovulatory temps below 97.3 should be tested. If you find that you have any of the combination of symptoms below, at a minimum, you should have your thyroid checked.*

  Be aware that getting a correct diagnosis for thyroid issues can be elusive, as seen here. Tests often come back “normal” when in reality, your thyroid is still not functioning optimally. That is why it is imperative that you see a doctor who specializes in thyroid issues.

  Hyperthyroidism, or excessively high thyroid activity:

  •high waking temperatures (preovulatory temps 98.4 and above)

  •short cycles

  •scant menses

  •short luteal phases

  •possible milk in breasts without nursing

  •infertility

  Hypothyroidism, or low thyroid function:

  •low waking temperatures (preovulatory temps)

  •anovulatory cycles (with no thermal shift)

  •long cycles

  •heavy or long menses

  •prolonged phases of less-fertile quality cervical fluid

  •short luteal phases

  •unexpla
ined infertility or miscarriage

  The charts below show how each of these conditions might look.

  Possible hyperthyroid temperatures (high thyroid activity). Zooey suspected she may be hyperthyroid because her waking temperatures before ovulation are higher than normal (hovering around 98), she has short luteal phases of less than 10 days, her cycles are short and she has extremely light periods.

  Possible hypothyroid temperatures (low thyroid function). Molly suspected she may be hypothyroid because her waking temperatures are lower than normal (often in the 96s), she rarely ovulates (as reflected by a lack of thermal shifts), she has long cycles and her periods (which are not technically periods since she doesn’t usually ovulate 2 weeks prior) are long and heavy.

  AMBIGUOUS THERMAL SHIFTS

  Occasionally, you may have charts in which the temperature patterns are not obvious, so it may be more difficult to draw the coverline. Below are a few examples. Appendix H, on Tricky Coverlines, clarifies these types as well as several more.

  TEMPERATURE DIP BEFORE THE RISE

  You may be one of the few lucky women who tend to have a temperature pattern in which you see a conspicuous dip before your thermal shift. Or you may only occasionally notice this pattern. Either way, it is believed that it usually occurs on the day of ovulation and is the result of high levels of estrogen pushing your temperatures down.

  For those avoiding pregnancy, the dip does not affect your adherence to the preovulatory rules of contraception. For those trying to get pregnant, this would be an excellent day to time intercourse (assuming, of course, your cervical fluid is fertile that day). Regardless, you should continue having intercourse through to the day of the thermal shift.

  Temperature dip. Note the plunge in temperature well below other preovulatory temps, often indicative of ovulation.

  TEMPERATURE BELOW COVERLINE WELL AFTER OVULATION

  After ovulation (during the luteal phase), there is a second smaller surge of estrogen, which may cause a temporary drop in temperature and often coincides with a day or two of wet cervical fluid. There’s no need to be confused, though, because it is not an indication of returning fertility. The egg is already dead and gone by then.

  Temperature drop mid-luteal phase

  DROP IN TEMPERATURE DAY BEFORE PERIOD BEGINS

  Occasionally, you may notice an obvious drop in temperature the day before you get your period. While this is less common than when it occurs the day of menstruation itself, it is still considered part of the luteal phase (this sudden premenstrual drop is caused by the disintegration of the corpus luteum).

  Regardless, Day 1 of the new cycle starts the first day of bleeding itself and not on the day of the drop in temps. So the luteal phase length is determined by the first day of the mid-cycle thermal shift through to and including the last day before the red menstrual flow.

  Drop in temp before period. Note that Sandie’s luteal phase is 14 days long because it goes from Day 16 through to and including Day 29, despite the fact there was a temperature drop on that day. Day 1 of the new cycle begins with the bleeding on the following day.

  FEWER THAN 10 DAYS OF HIGH TEMPERATURES ABOVE THE COVERLINE

  If you have consistently fewer than 10 days of postovulatory high temperatures above the coverline, it may indicate one of two things:

  1.You have a luteal phase deficiency, as seen in Morgan’s chart below.

  2.Your temps may take a few days to reflect ovulation, as seen in Christy’s chart below.

  The way to resolve the ambiguity is to identify your Peak Day before the rise in temperature, since ovulation usually takes place within a day or two of that day. If there is a large discrepancy between the Peak Day and the thermal shift, you can probably assume your temperature takes several days to increase following ovulation.

  Alas, the only way to definitively confirm whether your temps are lagging following ovulation is through ultrasound, but this would obviously be impractical. Still, if you find that you have this pattern, it might be worth it to follow those few days around ovulation one time with ultrasound to learn how long your body takes to increase temps in response to progesterone.

  If you do indeed have a luteal phase deficiency, click here, whether you are trying to avoid or get pregnant.

  If you are using FAM for birth control, your cervix on Peak plus 4 (not 3) may clarify your fertility status that day. If it is firm, low, and closed, you may decide to use just those two signs, and not your thermal shift. But you should understand that you may be taking a slightly greater risk in such a situation.

  Morgan’s Chart. Short luteal phase. Note that Morgan’s temperatures are probably an indication of a true short luteal phase (9 days in this case), because the shift coincides with her cervical fluid. She most likely ovulated about Day 15 on this chart, since ovulation usually occurs about the day of, or the day after, the Peak Day.

  Christy’s Chart. Probably normal luteal phase. By contrast, Christy’s chart shows that ovulation probably occurred earlier than the temperature reflected, because the Peak Day of cervical fluid was on Day 15, but the thermal shift wasn’t until Day 21. Thus it appears her body takes a few days to respond to the postovulatory progesterone, and she therefore probably does not really have a short luteal phase.

  18 OR MORE HIGH TEMPERATURES AFTER OVULATION

  If you have 18 or more consecutive high temperatures above the coverline with no sign of a period, it’s almost always an indication of pregnancy. The sustained high temperatures are due to the corpus luteum continuing to live and release progesterone beyond its typical 12-to-16-day life span. In fact, in many pregnant women, the pattern of high temperatures even increases to a third level caused by the additional progesterone in their body, as seen in the Triphasic Pregnancy Pattern chart below.

  You should also remember that most women will have a consistent luteal phase (the time from ovulation to menstruation). So, for example, if your own luteal phase is typically about 13 days, and your temperature remains high for 16 days, there is a good chance that you are pregnant. The point is to determine if your temperatures are staying high longer than what is normal for you.

  Another less likely reason for 18 high temperatures is an ovarian cyst, either from LUFS (luteinized unruptured follicle syndrome), or a corpus luteum cyst. In both cases the corpus luteum may continue to live beyond the normal 12 to 16 days—even when the woman isn’t pregnant. If this should happen, the temperature would continue to remain high due to the progesterone that is still being emitted from the persistent corpus luteum. Of course, if the progesterone doesn’t drop, the uterine lining is not shed during menstruation, which is why it could appear as if you were pregnant.

  You may also notice light spotting and mild pain about the time your period is due. A positive pregnancy blood test will likely rule out an ovarian cyst, but if your test is negative and you continue to have high temps, a manual exam and ultrasound of the uterus may be warranted to see if you have one. If it turns out that you do, the good news is that they usually dissipate on their own. Chapter 8 covers ovarian cysts in greater detail.

  High temps reflecting pregnancy

  TWO LEVELS OF HIGH TEMPERATURES AFTER OVULATION (TRIPHASIC PATTERN)

  As mentioned on the previous page, many women who get pregnant develop a triphasic pattern of temperatures. It is thought to be the result of additional progesterone circulating in the woman’s body, which increases about the time of implantation of the egg, about a week after fertilization.

  Triphasic pregnancy pattern

  DROPPING TEMPERATURES AFTER EITHER 18 HIGH TEMPERATURES OR A POSITIVE PREGNANCY TEST

  If you begin to experience dropping temperatures after you have confirmed that you are pregnant through either 18 high temperatures or a pregnancy test, you should contact your doctor as soon as possible. The plummeting temps are often a strong indication that you are in danger of having a miscarriage. In healthy pregnancies, your postovulatory temps will almost always remain hi
gh for at least the first trimester of your pregnancy due to the continued effects of progesterone.

  Spotting, on the other hand, is not necessarily a signal of impending miscarriage, and indeed, many women notice normal implantation spotting in the week to 10 days following ovulation (click here). However, any significant bleeding beyond that should be checked by your physician.

  Signs of a potential miscarriage

  CERVIX THAT CAN’T BE FOUND

  Although at times you may think your cervix has migrated out your ear, surprisingly, it is still there. When a woman is approaching ovulation, her cervix often rises so high that it feels inaccessible. If this is the case, trust your body. If you have been able to feel it before, it probably means that you are just very fertile during times that you can’t feel it. In such a case, simply record a question mark in the Cervix row on the days you can’t actually find it.

  Missing cervix

  CERVIX THAT NEVER FULLY CLOSES

  Women who have delivered a child vaginally will have a cervix that never completely closes during the infertile phase. On infertile days, rather than feeling a small dimple, it feels more like a slightly open horizontal slit. The trick is to learn how to differentiate between the subtle changes in the cervical opening as ovulation approaches.

  Partially open cervix

  BUMPS ON THE SURFACE OF THE CERVIX

  You may notice bumps that feel like hard granules of sand just under the skin of the cervix. They are called nabothian cysts, and are caused by skin cells that clog fluid-producing glands near the cervical surface. Usually considered harmless, they tend to disappear on their own. Still, you may want to have a clinician confirm your suspicion the first time you feel one. Some women notice that they come and go with the cycle. Of course, a woman would probably never realize she even had them unless she checked her cervix.