Jacqueline’s chart. When Jacqueline developed patches of spotting, sticky, or wet cervical fluid interspersed throughout her dry days, she considered herself fertile until she could identify the Patch Day plus 1, 2, 3, 4. So in this chart the first patch she considered fertile started on Day 54 and continued through until Peak plus 4, or the evening of Day 59. She then considered herself safe all the evenings of the dry days until her next patch on Day 67. Also note that if cycles extend beyond 40 days, you can renumber Day 1 of the chart as 41, as seen above. (Infertile evenings are boxed in red.)
Kirsten’s chart. Patch Rule with Basic Infertile Pattern of sticky days.
When Kirsten developed patches of spotting or wet cervical fluid interspersed throughout her sticky days, she considered herself fertile until she could identify the Patch Day plus 1, 2, 3, 4. So in this chart the first patch she considered fertile started on Day 57 and continued through until Patch plus 4, or the evening of Day 63. She then considered herself safe all the evenings of sticky days until her next patch on Day 71. On Day 72, she marked it as Patch plus 4, and was safe again the night of Day 76. (Infertile evenings are boxed in red.)
Spotting or Bleeding During Anovulatory Phases
As seen in the rule above, when women experience episodes of spotting or bleeding during phases of anovulation, it’s imperative that they treat those particular days as potentially fertile. The bleeding could be the start of hormonal activity preparing for ovulation, or ovulatory spotting itself. Of course, the key to determining true menstruation is the observation of a thermal shift 12 to 16 days prior. But even if you’re not taking your temperature during times of anovulation, you need to keep an eye out for what appears like a Peak Day (or in this case, more specifically, a patch of cervical fluid that culminates in a secretion such as clear, stretchy, or lubricative). For if this is followed by menstrual-like bleeding 12 to 16 days later, you can be fairly certain that the bleeding you are now experiencing is true menstruation.
In any case, deciding when to start Day 1 of a new chart can be somewhat confusing if it’s not clear that what you’re experiencing is true menstrual bleeding. So, you can either choose to start a new chart on Day 1 of each episode of bleeding, or you can keep the same long chart as if you are experiencing one continuous, potentially months-long cycle with intermittent phases of bleeding. The critical point is to be able to identify when the bleeding is a true period.
Basal temperatures, of course, would confirm ovulation if there was a thermal shift 12 to 16 days prior to bleeding. But be aware that when you first resume ovulating after not doing so for months on end, your luteal phases may initially be very short. So, for example, you may have a true Peak Day followed by only 8 days before menses returns. Regardless, once you start observing more and more patches of fertile-quality cervical fluid, you should start taking your waking temperature again, because one of those patches will ultimately lead to ovulation, and a thermal shift will clearly confirm it.
Geraldine’s chart. Geraldine has not ovulated for a few months now, so she is being especially attentive to any patches of cervical fluid she has interspersed during her dry days, and applies the Patch Rule of PA + 4. But one day she notices that her cervical fluid progresses beyond just the short patches that only evolved to creamy for a day or two.
This particular patch, starting on Day 20, culminated in two days of obvious eggwhite followed by a day of light bleeding, the classic sign of ovulatory spotting. Sure enough, her temperature rose the day after that spotting on Day 27, confirming that ovulation most likely took place. However, her Luteal Phase was fairly short this cycle, lasting only 9 days. This is typical for women who have not ovulated for a while. It may take a few cycles for their Luteal Phases to return to a more typical 12–14 days.
Note that Janice likely had a cycle of 80 or even 120 days, but that she chooses to start the chart anew as if it were Day 1 (as opposed to day 41, which you’ve seen earlier). You should do whatever feels comfortable for you.
Checking Your Cervix
As you know, your cervical position is an excellent fertility sign to help corroborate your other signs, especially in situations of ambiguity. It should be firm, low, and closed before you consider yourself safe.*
A Less Conservative Approach
As you read here, when you are experiencing a long phase of anovulation with no thermal shifts, you must consider yourself fertile during any patches of cervical fluid through to the evening of the 4th day past the patch. However, some clinicians believe if the patch is of a non-wet rather than wet-quality cervical fluid, you need only wait until the evening of the 2nd nonwet day beyond your Patch Day (rather than the 4th), as seen in Louisa’s chart, below. The theory is that only two days of non-wet-quality secretions followed by dry is an indication that estrogen levels are not high enough to lead to ovulation and to change the ph of the vagina.
This approach is still considered safe, but if you absolutely can’t risk a pregnancy, you should either wait until the evening of the 4th consecutive non-wet day beyond your Patch Day, or verify that there is no cervical fluid at your cervix before having intercourse.
Olivia’s chart. A less conservative approach.
Olivia established her BIP of dry weeks ago. So she considers herself safe the evening of all dry days. But as soon as she starts to develop any kind of cervical fluid, she essentially “waits and sees.” If she only has a day or two of non-wet (sticky) quality secretions, as on Days 8 & 9, she abstains during those days, but then considers herself safe once again every dry evening after those sticky days. But on Days 15–17, she notices sticky developing again, although this time, she considers herself fertile on those days and applies the Patch plus 4 rule, because there were at least 3 days in a row of sticky.
Finally, on Days 27–29, she has another patch of secretions, which in this case was two days of wet (creamy) and a day of sticky. So she applies the Patch plus 4 rule again, but this time, her last day of wet was actually Day 28, so that is the day she considers her Patch Day when starting the count of 4. Therefore she considered herself safe starting on the evening of Day 32. (Infertile evenings are boxed in red.)
The Difference Between the Peak Day and the Patch Day
The main difference between the two is the following:
1.Peak Days usually occur just before ovulation, and are typically the last day of clear, stretchy, or lubricative cervical fluid or vaginal sensation. (The relevant contraceptive rule is Peak + 3, or PK + 3.)*
2.Patch Days, on the other hand, tend to occur during anovulatory cycles, and are usually the last day of the more fertile-quality patch from the unchanging BIP of cervical fluid, such as a patch of sticky amid unchanging dry days. (The relevant contraceptive rule is Patch + 4, or PA + 4.)
So in essence, with anovulatory cycles, you may have day after day of unchanging cervical fluid interspersed with patches as your body attempts to ovulate. Eventually one of those patches will evolve into the classic pattern of getting wetter, culminating in clear, slippery, or lubricative cervical fluid or vaginal sensation. The trick is to be on the lookout for the patch that signifies that ovulation most likely occurred.
This final patch is handled as a normal Peak Day pattern, assuming a thermal shift confirms it, as discussed in the rules in Chapter 11. In other words, you are again considered safe when you reach both of these conditions:
•the evening of the 3rd consecutive day after your Peak Day
•the evening of the 3rd consecutive day your temperature is above the coverline, as long as the 3rd temp is at least .3 above.
An example of how you would record a cycle with both Patch Days and a Peak Day is seen below.
Sara’s chart. Cervical fluid patches. When Sara traveled to France for the summer, her cycle was thrown off kilter, and thus she actually didn’t ovulate until about Day 67 (note that this chart starts with cycle Day 41). Several times over the summer her body “prepared” to ovulate, but then stopped short, as seen b
y the sporadic patches of cervical fluid in the weeks leading up to her thermal shift. For these patches, she used the Patch Day Rule.
Finally, on days 66 and 67, she experienced eggwhite, and realized that there was a good chance that she was about to actually ovulate, which was confirmed by a thermal shift on day 68. Thus she applies the Peak Day Rule and considers herself safe starting the evening of the 3rd day after both her Peak Day and Thermal Shift. (Infertile evenings are boxed in red.)
A SPECIAL NOTE ON DIFFERENT SITUATIONS OF ANOVULATION
Coming off the Pill and Other Hormonal Birth Control
It can be difficult to switch from the Pill to a natural contraceptive method, since you are used to absolutely regular, albeit artificial, cycles. So naturally, it can be more challenging for you to initially chart your cycles. But once you return to normal cycles, you will be amply rewarded with the knowledge that your body is healthy and free of the chemicals that may have led to various side effects and medical risks.
In any case, when you first come off of artificial hormones, you might notice one of three very different Basic Infertile Patterns:
•an absence of any cervical fluid at all
•continuous fertile-quality cervical fluid that may be either watery or milky
•erratic patches of varying types of cervical fluid
If you are dry day after day, great. Still, you need to be especially attentive to changes in your cycles as you eventually approach ovulation, and follow the two rules in this appendix very carefully. But if you find the other two patterns too ambiguous as your body adjusts to ovulating again, you should abstain or use barrier methods until you see an obvious thermal shift to corroborate ovulation.
Post-Childbirth (Whether or Not You Are Breastfeeding)
One of the most important points to understand regarding the transition to post-partum fertility relates to what is considered fertile-quality cervical fluid. Once your cycles return (as reflected by a thermal shift), any preovulatory cervical fluid is considered fertile, as it was before you became pregnant. The bottom line is that you will need to go back to the four standard rules used for normal cycles discussed in Chapter 11.
Premenopause
Unfortunately, premenopausal women who follow the BIP rules could be at somewhat greater risk of pregnancy than their younger peers. So while it is true that women are definitely less fertile in their 40s, ironically, their cervical fluid can become wet more quickly. Thus, a woman who has a BIP pattern of sticky days may find herself becoming wetter faster than before, when she experienced a more gradual transition over several days. As a result, her body may progress faster toward ovulation than in earlier years. Therefore, premenopausal women may prefer to limit preovulatory intercourse to the evening of dry days only.
As mentioned above, the increased risk could be minimized if you check your cervical position. It should be firm, low, and closed before you consider yourself safe. In addition, and as discussed in Appendix G, checking your cervical fluid internally at the cervix to verify that there is no wet secretion present before having intercourse will also minimize your potentially increased risk.
When Charting Becomes More Challenging: Changes in Your BIP Signaling a Transition
If a different cervical fluid pattern than your first BIP evolves and becomes the same day after day for at least 2 weeks, that now becomes your new Basic Infertile Pattern, from which you must be on the lookout for yet another change. So, for example, if you had been dry day after day for a month or so, then developed a pattern of sticky cervical fluid that lasted at least 2 weeks, that sticky quality would become your new BIP.
You would then be considered safe all of those subsequent evenings of sticky until you observe a more fertile-quality patch (such as creamy), or experience spotting or bleeding. You must then treat those patches as possibly fertile, until you can apply the Patch Rule you learned here. Are we having fun yet?
CONCLUDING REMARKS ON FAM AND ANOVULATORY PHASES
The most important point to remember when experiencing anovulation is to constantly be on the lookout for a Point of Change in cervical fluid, since that could indicate impending ovulation. Ideally, you should continue to take your temperature to confirm that you are not ovulating. In fact, one of the benefits of taking your temps during these times is that if they are wildly erratic, that in itself is a good sign that you are not ovulatory yet. However, if you find this tedious during long months of not seeing a thermal shift, you could choose to wait until you see your cervical fluid evolve to a more fertile quality.
Either way, remember that you always have the benefit of checking your cervical position during times of ambiguity. And while these rules may appear more complex than the standard FAM rules, you may find that they are really fairly simple, especially if you have the same pattern of unchanging cervical fluid or dryness for months at a time.
In any case, you should know that you will usually have ample warning of normal cycles resuming by the buildup of patches of cervical fluid as your body tries to ovulate. And finally, while it may be confusing at times, remember that anovulatory phases will probably be a fairly small part of your reproductive life.
SUMMARY OF RULES WHILE EXPERIENCING ANOVULATION
UNCHANGING DAY RULE
If your 2-week Basic Infertile Pattern (BIP) is dry or essentially the same-quality sticky cervical fluid day after day, you are safe for unprotected intercourse the evening of every dry or unchanging sticky day.
However, if on the next day you have residual semen that masks your cervical fluid, you should note it with a question mark and not consider that day safe. In addition, women with a BIP of wet cervical fluid should not consider themselves infertile until the BIP changes.
PATCH RULE
If your 2-week Basic Infertile Pattern (BIP) is dry or essentially the same-quality sticky cervical fluid day after day, you are safe for unprotected intercourse the evening of every dry or essentially unchanging non-wet day. But as soon as you see a change in your BIP to wet cervical fluid, vaginal sensation, or bleeding, you must consider yourself fertile until the evening of the 4th consecutive non-wet day after your Patch Day.
The Patch Day is the last day of the more fertile-quality patch of cervical fluid or vaginal sensation in your Basic Infertile Pattern.
APPENDIX K
A Brief Look at Gender Selection
If they wish to have a male child let the man take the womb and vulva of a hare and have it dried and pulverized; blend it with wine and let him drink it. Let the woman do the same with the testicles of the hare and let her be with her husband at the end of her menstrual period and she will conceive a male.
—ITALIAN PHYSICIAN TROTULA, IN 1059
Fortunately, the gender selection techniques discussed in this appendix have eliminated the hare. Indeed, in the 1970s, Dr. Landrum Shettles developed a scientifically-based, fairly simple way in which to increase your chances of having a boy or girl. He wrote an informative book called How to Choose the Sex of Your Baby (Broadway, 2006). This appendix adapts a few of its critical points but emphasizes Fertility Awareness principles to help improve your odds. You may wish to read his work for a more thorough coverage of the topic.
While various studies have shown the Shettles method to be quite successful, I must emphasize that its overall effectiveness is still widely disputed in the medical community. I do not profess to be an expert on this subject, but I briefly discuss it here because once you know the fundamental principles of Fertility Awareness, this method of gender selection is relatively easy to apply.
Of course, even the method’s most ardent supporters do not suggest it is anywhere near foolproof. Dr. Shettles himself claimed that it is about 80 to 90% effective for choosing boys, and 75 to 80% effective for choosing girls, when the method rules are followed correctly. The reason for the lower rates for girls is that it is more difficult to appropriately time intercourse when trying for a female.
The most fundamental principl
e on which the Shettles method is based is that sperm determine what sex a baby will be. The male sperm (Y chromosomes) are smaller, lighter, faster, and more fragile than the female sperm (X chromosomes). The female sperm are generally bigger, heavier, slower, and heartier, and thus tend to live longer than the male sperm.* All of this means that if you desire a boy, you should time intercourse as close to ovulation as possible so that the fast, light, male sperm reach their prize first. Likewise, if you prefer a girl, you should time intercourse as far from ovulation as you can while still allowing conception to occur.
The primary evidence on which Shettles based his method is that male sperm generally beat female sperm when put through a racecourse of alkaline, fertile-quality cervical fluid in laboratory containers. Sperm retrieved from the woman’s reproductive tract also confirm that male sperm are faster, but that female sperm are more resilient.
INCREASING YOUR ODDS WITH FERTILITY AWARENESS
Before seeing how FAM specifically fits in with the Shettles method, you should chart at least 3 cycles before attempting gender selection in order to really know your own cycle well. If just starting to chart, it is best to either abstain or use condoms so as not to mask cervical fluid. This will help you to accurately identify its pattern while preventing a pregnancy that wasn’t well-timed for the gender you desire.
One of the reasons to chart a few cycles first is to determine how many days of fertile cervical fluid you typically have. Generally speaking, most women tend to have a fairly consistent number of eggwhite days each cycle. (Those who don’t produce eggwhite will usually produce some type of wet cervical fluid.) You can clearly see that the better you know your cervical fluid pattern, the more you will know how many days of eggwhite you typically have to anticipate your Peak Day. This will allow you to hopefully time sex accurately, and thus conceive the choice of the gender you both desire.
Taking Charge of Your Fertility Page 45