Taking Charge of Your Fertility

by Toni Weschler

  TIMING INTERCOURSE FOR A BOY

  Have intercourse on your Peak Day, as well as the following day.

  If you would like, you can initially have intercourse in the first part of the cycle, but only on dry days. Once you start to have any cervical fluid, you should abstain in order to minimize the risk of conceiving a girl. Then, have intercourse on what you perceive will be your Peak Day as well as the day after.

  Remember that, ideally, you are trying to time sex as close to ovulation as possible. Dr. Shettles says that you should try to time intercourse for the day of ovulation itself, but, in reality, it makes more sense to time for the Peak Day, which is often the day before. This is because by the time ovulation occurs, the cervical fluid will have frequently dried up already, thus dramatically reducing the possibility of conception for either gender. In any case, without the use of ultrasound, there is no practical way to truly know which precise day you are ovulating.

  Audrey’s chart. Timing intercourse for a boy. Audrey has two daughters and decided that it would be kind of fun to try to time intercourse for a boy. She’s been charting her cycles for a couple years for birth control, and knows that she typically has about 3 days of eggwhite every cycle.

  Knowing that when timing for a boy, you want to have sex as close to ovulation as possible, she chose to abstain as soon as she started getting any cervical fluid, waiting for her presumed Peak Day as well as the next day to have sex. By postponing sex until her 3rd day of eggwhite, she made sure to time intercourse as close to ovulation as possible. As you can see by the positive pregnancy test on Day 18 of her Luteal Phase, she became pregnant that cycle with a boy.

  TIMING INTERCOURSE FOR A GIRL

  Have intercourse several days before your Peak Day, but preferably not closer than 2 days before.

  It may take a little more patience and perseverance to try to conceive a girl, because the timing is trickier. You’ll want to have intercourse far enough away from ovulation to ensure that mostly female sperm remain, but close enough to still allow a conception to occur. As with trying for a boy, the better you know your cervical fluid pattern, the more likely you’ll be able to time sex correctly.

  The key is to time intercourse from 4 to 2 days before your Peak Day. What this means, practically speaking, is that you should first try 4 days before you anticipate the Peak Day. However, if that fourth day is no wetter than sticky, you should initially try the third day before. If that doesn’t work, try a day closer the following cycle. But for the first few cycles, do not have sex any closer than 2 days before you expect your Peak Day.

  If you have gone several cycles without conceiving, you may decide to try intercourse on what you estimate to be only 1 day before your Peak Day. The fact is that yes, you will increase the odds of conceiving, but your odds of conceiving a boy also go up. You can now see why it’s harder to time for a girl!

  Zoey’s chart. Timing intercourse for a girl. Zoey would like to try to time intercourse to conceive a girl, but she realizes that it will be harder to try for a girl than a boy, because she will need to have intercourse as far away from ovulation as possible while still being close enough to actually conceive. So after charting for a year as a method of birth control, she is aware that she typically has a couple days of creamy before several days of eggwhite every cycle.

  She and her husband decide that with this cycle, they will only have intercourse on the first couple days that she develops any wetness at all (in this case, creamy), and then not again until she is well after ovulation. She conceived a girl that cycle. But had she not, they would have tried to time sex the next cycle one day closer, by maybe trying for the 1st day of eggwhite but then abstaining until well after ovulation.

  Remember, the point is to try to have intercourse as far from ovulation as you can and still have conception occur. After the cutoff date, you should abstain from intercourse or use barriers until you are outside your fertile phase. If you continued to have sex right up through ovulation, you would dramatically increase the chances of conceiving a boy.*

  CONCLUDING REMARKS ON USING FAM AND THE SHETTLES METHOD

  The guidelines presented here may increase your odds of conceiving the gender of your choice. However, I should emphasize again that even Shettles’s most ardent supporters acknowledge that they are far from foolproof. Thus, if you are someone who would be greatly disappointed by the birth of your second choice, you should seriously reflect on the potential outcomes before trying to conceive.

  A BRIEF LOOK AT THE HIGH-TECH ALTERNATIVES

  Although the Shettles method of gender selection is the one that most logically complements the principles you have learned from FAM, there are at least two other high-tech methods you should be aware of. The Ericsson method of gender selection uses specialized instruments to pass sperm through a blood-protein solution, thereby separating them into groups of male and female. Proponents of this method say it has selection success rates of over 70%, and it is currently available at about 50 fertility clinics throughout the U.S.*

  Finally, and as you read in Chapter 15, preimplantation genetic diagnosis (PGD) has become widely used as a way of selecting those embryos for IVF that are most likely to result in healthy babies. The sex of such embryos is easily observed with PGD, and thus not surprisingly, it has become a controversial technique of highly effective gender selection. Of course, the trade-off is that it comes with the emotional, physical, and financial costs associated with all hightech fertility procedures.

  APPENDIX L

  How to Research Fertility Clinics

  The very fact that you’ve read this book means that you are already well ahead of most, because you’ve learned how to chart your cycles. This alone will allow you to help your doctor in diagnosing and ultimately treating a potential fertility issue, but of course, if you decide to work with a specialized fertility clinic, there are still several ways you can increase the odds of choosing one that’s best for you.

  Get a referral

  The two best ways to get a personal recommendation are from a health professional such as your primary care doctor, or from a friend or relative who has successfully used a particular clinic. They both have their advantages. Health professionals tend to know the reputation of doctors among their peers. But happy patients can often explain why they recommend a particular doctor or clinic, whether it is their bedside manner, ability to adequately convey the whole process without being brusque or patronizing, or their utilization and knowledge of the most cutting-edge techniques.

  Ideally, it would be best to get a referral from a satisfied former patient, then run the name by your own clinician or other health professional who would have inside knowledge in the field. And of course, use the internet to research people’s satisfaction with the clinic you are considering.

  Don’t fall for exaggerated statistics

  One of the most frustrating aspects of researching fertility clinics is understanding the success statistics that each clinic claims. There are a myriad of reasons why a clinic may appear to be highly successful. For example, there is a huge difference between “pregnancy rates” and “take home baby rates.” The percent of women who get pregnant at any given clinic is worth knowing, but the most important stat is what percent of their patients ultimately delivered a healthy baby.

  In addition, if a clinic only accepts women under 35, for example, their success rates may appear much more impressive than a clinic that is actually more cutting edge, but doesn’t put an age limit on whom they accept. Given the complexity of the various factors that determine success, I would encourage you to visit the two websites below for the most reliable success rates of various clinics:

  sart.org

  fertilitysuccessrates.com

  Learn whether the clinic profits from performing certain procedures over others

  As you’re likely aware, there’s often an inherent conflict of interest for medical professionals who may choose to order more tests and treatments than are
necessary, simply because it’s more lucrative for them. Of course, I don’t mean to paint a broad brush across the profession, since the majority of doctors are ethical and caring clinicians who want the best for you.

  Still, you should try to determine early on how they ultimately make their money. For example, physicians in teaching facilities are often salaried, so there is no incentive to order unnecessary expensive tests or procedures. In any case, and as discussed in Chapter 15, you should always discuss ahead of time which tests and procedures they are recommending, and whether their utility justifies their costs.

  Trust your gut

  You hear this adage all the time, and for good reason. If the answer were always emblazoned across the sky, there’d be no question. But, alas, with something as profoundly intimate as who you will ultimately trust to help you achieve your dream of having a child, your gut feeling is often your best barometer.

  If every time you go to the clinic, you feel like a number, or feel that you are only given a few minutes with your doctor, or you don’t understand why the clinician is ordering a particular procedure, consider finding another facility. In the end, your path to becoming a mom should be as stress-free as reasonably possible, and that starts with which clinic you ultimately choose to help you.

  Fertility-Related Resources

  The organizations listed below should be able to help you locate a Fertility Awareness instructor in your area. The information taught by FAM and NFP providers are similar, but you should be aware that NFP instruction often comes with a religious orientation that you may or may not appreciate, and as you’ll recall, NFP prohibits barriers during the fertile phase. Regardless of whether you are trying to practice natural birth control or to get pregnant, I would encourage you to find organizations that teach the Sympto-Thermal Method as taught in this book, which involves the observation of both waking temperatures and cervical fluid.

  In addition, if you have been inspired by what you have learned in this book and would like to become an instructor yourself, the organizations on the next page can refer you to certification programs. And for those of you who would like to pursue disseminating Fertility Awareness information as a career, I would encourage you to consider a degree in either nursing or public health.

  COMMUNITY ORGANIZATIONS

  All of those listed below may be able to point you in the right direction for FAM/NFP classes:

  Family planning clinics

  Hospital education departments

  Public health departments

  University health clinics

  Women’s clinics

  Catholic churches and dioceses

  FERTILITY AWARENESS METHOD (FAM) PROVIDERS

  Because there are not as many FAM instructors as there are for NFP, you might want to contact the following organizations for their lists of qualified instructors who teach classes as well as offer private office and phone consultations.*

  Association of Fertility Awareness Practitioners (AFAP)

  FertilityAwarenessProfessionals.org

  The Association of Fertility Awareness Professionals (AFAP) supports professionals in the field of Fertility Awareness as well as those looking for high-quality, non-religious Fertility Awareness instruction. AFAP maintains a list of member educators on their website, provides information to those interested in becoming Fertility Awareness Educators themselves, and is the only international membership organization devoted to advancing the field of secular Fertility Awareness.

  NATURAL FAMILY PLANNING (NFP) PROVIDERS

  The following organizations have an extensive list of NFP providers, listed by type of instruction.

  United States Conference of Catholic Bishops

  3211 Fourth Street NE

  Washington DC 20017

  (202) 541-3000 usccb.org

  (search “NFP providers” on their home page)

  Serena Canada

  151 Holland Avenue

  Ottawa, Ontario K1Y 0Y2 Canada

  (613) 728-6536

  (888) 373-7362

  serena.ca

  CONTRACEPTIVE RESOURCES

  Planned Parenthood Federation of America

  810 Seventh Ave.

  New York, NY 10019

  Phone: (212) 541-7800

  plannedparenthood.org

  An excellent organization with local clinics throughout the United States. Covers all facets of women’s health—not just contraception.

  Emergency Contraceptive Hotline

  Phone: 888-NOT-2-LATE (888-668-2528)

  not-2-late.com

  If you think you might have accidentally gotten pregnant, you can now get emergency contraception through your local pharmacist without a prescription. It consists of taking two pills 12 hours apart. They need to be taken as soon as possible after sex, and no later than 5 days after.

  FERTILITY RESOURCES AND SUPPORT

  RESOLVE: The National Infertility Association

  7918 Jones Branch Road, Suite 300

  McLean, VA 22102

  Phone: (703) 556-7172

  resolve.org

  If you are facing fertility problems and would like to be part of an organized community dealing with similar issues, I particularly recommend contacting this wonderful organization. It has local chapters throughout the United States and provides support groups, education, and monthly meetings, among other services.

  Infertility Awareness Association of Canada, Inc.

  475 Dumont, Suite 201

  Dorval QC H9S 5W2 Canada

  (800) 263-2929

  (514) 633-4494

  http://iaac.ca/en

  IAAC is a national Canadian organization, providing educational material, support, and assistance to individuals and couples.

  SOME WEBSITES OF NOTE

  There are countless websites devoted to FAM, NFP, fertility, and women’s health issues in general. Unfortunately, web pages have a tendency to suddenly disappear, and thus I have chosen to list only a handful of the most useful ones that I think are most likely to exist well after this book has been published.

  tcoyf.com

  The official site of Taking Charge of Your Fertility.

  cyclesavvy.com

  The official site of the author’s book for teen girls, entitled Cycle Savvy: The Smart Teen’s Guide to the Mysteries of Her Body.

  justisse.ca

  A Canadian site that focuses on body literacy through FAM and holistic health care.

  fertilityuk.org

  An excellent British site on Fertility Awareness education.

  irh.org

  The Institute for Reproductive Health, which promotes natural contraceptive methods throughout the world.

  womenshealth.gov

  Official site of the National Women’s Health Information Center.

  medlineplus.gov

  An extensive source of all types of medical information from the National Library of Medicine at the National Institutes of Health.

  pubmed.com

  A search engine for abstracts to thousands of articles in medical scholarly journals.

  mum.org

  Official home of the Museum of Menstruation and Women’s Health.

  natural-fertility-info.com

  Excellent website for learning about all facets of natural fertility treatments.

  fairhavenhealth.com

  One of the best websites for ordering all fertility-related supplements and products, and the site with whom I have partnered to distribute the app that accompanies this book.

  Glossary

  Abstinence: Avoidance of intercourse. To avoid pregnancy using Natural Family Planning (NFP), abstinence from intercourse includes avoiding all genital contact during the fertile phase of the cycle.

  Adenomyosis: A condition in which the endometrial tissue penetrates the muscular walls of the tissue, causing severe menstrual cramps and heavy periods.

  Adhesion: Fibrous tissue that abnormally binds organs or other body parts. It is usually the result of inflamm
ation or abnormal healing of a surgical wound.

  AI: See Artificial insemination.

  Amenorrhea: Prolonged absence of menstruation. Causes include stress, fatigue, psychological disturbance, obesity, weight loss, anorexia nervosa, hormonal contraceptives, and medical disorders.

  AMH: See Antimullerian Hormone.

  Amniocentesis: Puncture of the fluid sac surrounding the fetus through the abdominal wall and uterus to obtain a sample of the amniotic fluid for testing. The procedure, performed around the sixteenth week of pregnancy, can be used to identify various birth defects.

  Androgens: Male sex hormones, responsible for the development of male secondary sex characteristics including facial hair and a deep voice. Most androgens, including the principal one, testosterone, are produced in the testes. Small amounts of androgens are also produced in a woman’s ovaries and adrenal glands.

  Anovulation: The absence of ovulation.

  Anovulatory bleeding: Bleeding that appears to be like a period, but is technically not because ovulation did not occur 12 to 16 days before it began. It is usually caused by a drop in estrogen that triggers the shedding of the uterine lining (estrogen withdrawal bleeding) or an excess amount of estrogen that causes so much growth in the uterine lining that it can no longer support itself (estrogen breakthrough bleeding).

  Anovulatory (Anovular) cycle: A cycle in which ovulation does not occur.

  Antimullerian Hormone (AMH) Test: A test for the quantity of hormone secreted by pre-antral follicles, which gives a good idea of a woman’s remaining egg supply.

  Antral Follicle Count: An ultrasound test done to determine the number of immature resting (antral) follicles in a woman’s ovaries. The results can be used to estimate a woman’s ovarian reserve, or how many years of fertility she has left before going through meno pause. In addition, it can help determine her expected response to ovarian-stimulating drugs that are used with in vitro fertilization.