Taking Charge of Your Fertility
Page 57
For the record, it is likely that the vast majority of women who truly conceived from sex during their period had intercourse at the end of a long menstruation, on Day 6 or after. There is also a definite possibility that what was perceived as sex during menses was actually sex during ovulatory spotting, which they would have realized had they been charting.
* If you are tempted to have sex before 6:00 p.m., click here.
* When clinicians measure a pregnancy by its gestational age, they assume a Day 14 ovulation based on the first day of your last menstrual period. A more accurate approach is to determine the fetal age, which is measured from the day of conception, as ascertained by either the thermal shift, Peak Day, or ultrasound.
* One of the troubling realities of contemporary life is that sperm counts have plunged by about 50% since the 1930s. It’s unclear what is causing this, but some theorize that it may be due to modern environmental toxins.
* It may require discipline to forego having sex on an eggwhite day, knowing that it is the most-fertile-quality cervical fluid. But the principle is to consider the combined fertility of the two of you. If his sperm count is low, it may increase your chances by ensuring that it is high enough on your last day of wetness, since that day is the closest day to ovulation. (Unfortunately, there are no studies that confirm or reject the widespread speculation that couples in which the male has a low sperm count are more likely to conceive if they have sex only every other day.)
* Thankfully the raw egg advice can now be delicately tossed and replaced with a lubricant that was designed specifically to be sperm friendly: Pre-Seed.
* As technology advances, newer tests involving saliva instead of blood are becoming more accurate. If you hate needles, ask your doctor!
† If you are trying to conceive through traditional intercourse and the one progesterone blood test mid-luteal phase reflects low levels, it may be more accurate to get a pooled progesterone test, listed on the next line of the chart.
* Although available over the counter, you should never take DHEA without a prescription and careful monitoring by your clinician.
* Whatever the particular ovulatory drug prescribed, you should be aware that some studies continue to suggest that there may be an increased risk of ovarian cancer if they are used for an extended period of time.
* The one exception is if the donor’s sperm have been tested and are subfertile, in which case your chances of conceiving increase if the sperm are washed prior to insemination.
* There are two other types of ART that are rarely performed anymore. They are:
Zygote Intra-Fallopian Transfer (ZIFT):
In this procedure, the egg is first fertilized with the sperm in a petri dish, and the resulting zygote is returned to the open fallopian tube, after which it continues to naturally travel down to implant in the uterus. Today, it’s almost never used because IVF is considered more effective.
Gamete Intra-Fallopian Transfer (GIFT):
In this procedure, the sperm and eggs are removed artificially, but then inserted back into the fallopian tube and left to fertilize on their own. It’s also considered less effective than IVF and in addition, it’s a more complicated procedure to actually implement. However, it’s still offered as an option to those with religious or moral objections to conception taking place in a petri dish.
* If you’ve heard some outlandish story about how Pergonal has been harvested from the urine of postmenopausal nuns in Italy—for once, ’tis true! As we’ve seen, one of the paradoxical effects of menopause on a woman’s body is to produce massive quantities of FSH as a way of trying to trigger the ovaries to continue to ovulate. Since FSH is needed to induce ovulation in clinically stimulated cycles such as those prepared for procedures such as artificial insemination and IVF, isn’t it logical to use nuns’ urine? You’re probably thinking, “Why didn’t I think of that? Nuns’ urine. Of course.” (For an even more bizarre hormonal source, click here.)
* An extremely effective but controversial use of PGS is for gender selection, as briefly discussed in Appendix K.
* This is especially well advised since until recently, it was assumed this liquid contained little if any urine. But a recent study in the Journal of Sexual Medicine suggests otherwise! See Salama, Samuel, et al. “Nature and Origin of ‘Squirting’ in Female Sexuality,” J. Sex Med 2015, 12:661–666.
* Adapted from Beyond Putting the Toilet Seat Down by Jack York and Brian Krueger.
* To be fair, the results of “Mood and the Menstrual Cycle: A Review of Prospective Data Studies,” Gender Studies 9 (5) (2012): 361–84 was widely misreported in the media to suggest that the study was claiming that PMS itself does not exist, when the real focus was in fact on mood swings. The study does not touch on the physical symptoms associated with this condition.
* This chart is adapted from Dr. Vliet’s comprehensive book Screaming to Be Heard: Hormone Connections Women Suspect and Doctors Still Ignore (2001).
* Hormone therapy was formerly called hormone replacement therapy, or HRT.
* In fact, that’s how Premarin got its name: Pre mar in (pregnant) (mare’s) (urine). Regardless, the use of the words “natural” and “synthetic” can be misleading. “Natural” substances like Premarin are hardly naturally occurring in women, whereas some “synthetic” hormones created in a laboratory, such as 17-beta estradiol, are bioidentical to the compound found in the human body.
* It’s important to note that FAM had been gaining increasing credibility due to the work of many people both within the United States and abroad. In this brief epilogue, though, it’s not really feasible to write a thorough history of all of its “great founders.” Nevertheless, I would like to briefly acknowledge the groundbreaking role of Australian doctors John and Evelyn Billings, whose development of the Billings ovulation method in the 1960s was perhaps the most critical factor in later popularizing the idea that a woman’s body did indeed produce useful and reliable fertility signs.
* Many of the issues discussed in this appendix have potential solutions that I would encourage you to explore in Marilyn Shannon’s Fertility, Cycles, and Nutrition.
* For a more thorough discussion of thyroid conditions, see any one of the following books: The Thyroid Solution by Dr. Ridha Arem (2000), The Thyroid Hormone Breakthrough by Mary Shomon (2006), or Why Do I Still Have Thyroid Symptoms When My Labs Are Normal? by Datis Kharrazian (2010).
* Even the mean average cycle length among fertile women is believed to be 29.5 days, and not 28. This is based on what is thought to be the most extensive study ever done on this topic, by Dr. Rudi F. Vollman, a Swiss gynecologist whose name is synonymous with research in this field.
* “Method effectiveness rates,” as opposed to “failure rates,” are expressed as a positive number showing how many sexually active women would not become pregnant over the course of a year were the method in question used perfectly (correctly, every time). Thus, if a diaphragm manufacturer claims a method effectiveness of 94%, it is another way of saying that over the course of that year, 6% of women using that method are likely to get pregnant, assuming they use it perfectly. It should be noted that while manufacturers certainly prefer to express the positive (94% effective), rather than the negative (6% failure), it is more accurate to discuss contraceptive statistics in terms of failure rates rather than efficacy rates. This is because in the real world, a 6% failure rate does not actually translate into a 94% success rate. Why? Because only about 85% of sexually active women of reproductive age would get pregnant over the course of a year even if they used no method at all. Also, given that women are fertile only a few days per cycle, it is clear that barrier method effectiveness rates will always be overstated. So in this discussion, I will use the more statistically accurate failure rates.
* These data refer specifically to the Sympto-Thermal method, the technical name given for the natural birth control rules detailed in Chapter 11. It involves observing both waking temperature and cervical fluid a
s well as the option of observing cervical position. Generally, other methods of natural birth control only observe waking temperature or cervical fluid. And the Rhythm Method (often referred to as the Calendar Method) doesn’t involve observing any fertility signs.
* One major study in the American Journal of Obstetrics and Gynecology (October 15, 1981, p.) reported without irony that “Couples who stated that they had used the fertile phase of the cycle in an attempt to achieve pregnancy accounted for 9.8% . . . of pregnancies. Since these couples did not give advance notification of their desires to attempt pregnancy, these . . . were attributed to the respective method.” (!) It’s also clear that a significant percent of the other failures, while not trying to get pregnant, were quite happy to take chances during the fertile phase. In fact, this particular article, although quite old, is actually a good and fairly representative example of the numerous studies cited in the medical and scientific journals since then. In this particular report, over a hundred women representing more than 1,600 total cycles of sexual exposure were monitored for contraceptive failure rates in use of the Sympto-Thermal method used in this book. Perhaps the most interesting result reported was that the authors concluded after intensive follow-up interviews that there were no method failures whatsoever!
* There are two exceptions: the first is if you never have dry days after your period, as discussed here. The second is if you have abstained for two weeks to establish your basic infertile pattern (BIP) and have determined that it is the same unchanging non-wet quality, day after day. If so, those days would be treated as if you were dry, as discussed in Appendix J.
* In fact, family planning experts from around the world have determined that there is only a 2% chance of ovulating if you meet the three criteria of the Lactational Amenorrhea Method, or LAM, listed below. (Lactation pertains to the production of milk, and amenorrhea is a lack of menstruation.)
•your menses have not returned
•you are fully or nearly fully breastfeeding
•your baby is less than 6 months old
However, the reason I’ve included LAM only as a footnote under Exclusive Breastfeeding is the fact that the results of their studies were based primarily on women in developing countries, where the type of breastfeeding practiced is typically very different from that of Western societies such as ours. For example, their babies are often continually carried on a sling or a snuggly, reaping the ovulation-suppressing benefits of frequent sips at the breast around-the-clock.
In addition, the babies usually sleep with their mothers, guaranteeing more opportunities for suckling. Of course, this form of breastfeeding excludes scheduled feeds, supplements, pacifiers, bottles, and even pumped milk.
For obvious reasons, few women in industrialized cultures are able to successfully sustain this form of constant togetherness with their babies. Therefore, they usually can’t rely on simply breastfeeding alone as an effective method of birth control.
* While this appendix addresses birth control during phases of anovulation, it should also be used by women with abnormally long cycles, because they share the same issues. The underlying causes of both anovulation and long cycles, and how you deal with them for contraception, remain basically the same.
* Women who have given birth vaginally will have a cervical os (opening) that never closes completely. Instead, it tends to feel like a slightly open horizontal slit. Regardless, new mothers should not be checking their cervix for at least two months or so following childbirth.
* Of course, Peak + 3 applies to women who have also identified a thermal shift to corroborate the Peak Day. If they are only checking cervical fluid, the rule is Peak + 4.
* For simplicity’s sake, for the remainder of this appendix, I will refer to sperm carrying the male Y chromosome as “male sperm,” and sperm carrying the female X chromosome as “female sperm.”
* Obviously, if you have any problems with infertility, it is probably not worth following the guidelines for having a girl.
* Another well-known method of sperm separation, Microsort, was denied FDA approval, and as of this writing is no longer available in the U.S.
* NFP certification programs are much more common than those for FAM because they are usually funded by the Catholic Church.