Wednesday, June 15, 2011

Fertility Awareness Method

About a month and a half ago, one of my readers, Carla, asked me to write about my preferred method of birth control, the Fertility Awareness Method, or Natural Family Planning.  She posted my explanation on her blog

And nooooow I'm posting it here!  It's long.  It uses the words "cervical," "sperm," and "ovulation."  It's once again, long.  And it's me, JessicaMayLords, talking about birth control (including which methods I've used in the past).  If that grosses you out, then don't read on.  You should know that I don't write anything on this blog that I would be embarrassed to have my mom and mom-in-law read.  So I'm not going to be inappropriate, but to be truly informative, I can't NOT use the word penis.  Do we understand each other?


So, if I haven't scared you, and if you have ever wanted to know a LOT about FAM, then read away....

When Carla asked me to shed some light on the Fertility Awareness Method, I was more than happy to shed some light on this often misunderstood form of birth control. Most people that I’ve talked to don’t know about the Fertility Awareness Method, and out of those that have heard of it, few understand it.  The Fertility Awareness Method, or Natural Family Planning (FAM or NFP; FAM is the term typically used by people who prefer natural birth control, and Natural Family Planning is often used by those who are Catholic or abstain from birth control for religious reasons) are NOT to be confused with the “Rhythm Method” from your mother’s generation.  The true FAM is not simply a calendar-based form of birth control; instead, it uses several indicators to determine ovulation.

The FAM can seem daunting when first used – and there is a learning curve.  I highly recommend buying “Taking Charge of Your Fertility” by Toni Weschler.  It’s about $13, which is about as inexpensive as a month’s worth of the cheapest birth control pill out there at the moment.  The nice thing is, it will last you a lot longer than a month!

In “Taking Charge of Your Fertility,” Toni supplies her readers with SO MUCH INFORMATION.  I learned things about my body and my fertility that I had never heard of before; did you know that an EARTHQUAKE can throw off your cycle?  I thankfully read that before we had a 6.5 earthquake in California; when my cycle length that month was 42 days, I wasn’t nervous about being pregnant.  I knew that the earthquake could have affected my cycle, and I realized that I had ovulated about ten days later than normal.

So what is it??
So by now you’re probably wondering, what exactly is the FAM?  Well, like I said, the FAM works by using several indictors to determine when a woman’s body ovulates.  The most commonly used methods are tracking your cycle days, your basal body temperature, and your cervical fluid/mucus.  I know, cervical mucus is a really gross sounding term, but it can let you know when you are fertile and when you are not. 
Cycle Days
Let’s start with your cycle days.  The first day of your cycle is the first day that you bleed.  If you are just spotting a little bit, it’s best to count the first day that you need to actually wear a light pad.  If you just wipe yourself and see a scant trace of blood, but don’t need a pad, then that’s not your first day, that’s spotting. 

Most medical professionals go by the “Day 14 is when you ovulate” theory, since this is the “average” that the medical community has accepted (the Day 14 average is what is used to determine pregnancy due dates as well, FYI).  HOWEVER, you should never assume that you ovulate on Day 14.  Some ovulate before, some ovulate after, some have an irregular cycle and their ovulation changes (ding, ding, ding!  That’s me!).  I personally know that I ovulate, on average, anywhere from Day 19 to Day 30 (occasionally I have really long cycles; my average is 35 days), with my average ovulation day being Day 23.  If I was just going by the calendar/rhythm method (assuming Day 14 as ovulation), there’s a good chance I’d be pregnant now.   Once you have tracked a few cycles, you have a good idea as to which of your days are fertile. 

It would be wonderful if you just had to worry about your fertility – after all, if a woman ovulates only once a cycle, and usually releases just one egg, and that egg only lives for 12-24 hours…. That means you can only get pregnant within one 24 hour day a cycle, right??? WRONG.  Because sperm are like tiny microscopic superheroes; they can live 5-6 days in a woman’s reproductive system after ejaculation.  And men release approximately 300 million sperm per ejaculation.

I told you there were like little microscopic superheroes.

So.  If an egg can last for 24 hours, and occasionally a woman releases two eggs, we’ll figure that a woman is fertile for 48 hours.  However, the superhero sperm increase this fertile window to 7-8 days.  This means that you could have sex on Day 10 and get pregnant on Day 15.

Weird, eh?

 If you want to add a buffer (I do!) then your fertile window is about 10 days per month.  But how do you know when you’ve ovulated?

Basal Body Temperature
First, check you basal body temperature.  This is taken every morning before you get out of bed.  It’s important to take it right about the same time every morning, within an hour.  Your temperature before ovulation will be lower than it is after ovulation.  For instance, my pre-ovulatory temperature is usually about 97.7-97.9.  After ovulation, my temperate is usually 98.4-98.6.  When my tempature spikes from low to high, I know I’ve ovulated. It’s important to chart this temperature change daily, especially when you are just starting the FAM.  I highly recommend using  I chart my temps using Fertility Friend, and it shows me when I’ve ovulated in a cycle, and keeps track of my averages.  It’s a free service as well!  You can choose to get a membership, which runs about $10-15 a month, depending on which package you choose.  Membership gives you a bit more perks, but I currently use the free version.  The basal body thermometer I use takes my temp in ten seconds, so I barely have to open my eyes in the morning, which is excellent; it also remembers the last temperature taken, so I can chart later that day.

Cervical Fluid
Another indicator of fertility is your cervical mucus/fluid.  During your unfertile days, you will experience dry, tacky, or crumbly cervical mucus.  Your mucus changes throughout your cycle.  When you get closer to ovulation, it will become wetter, or creamier.  When you are experiencing fertile cervical mucus, it will have a similar consistency to eggwhites.  You can even stretch it between your fingers.  This is the perfect consistency for sperm to live in; it’s their favorite.  Dry cervical mucus is their kryptonite.  The pH is wrong, and they can’t swim like superheroes when they don’t have anything to swim in.

Combining it all
Tracking your days, your temperature, and your cervical mucus will tell you when (and if) you are ovulating.  Since you don’t know your ovulation day until you’ve already ovulated, it’s CRITICAL that you chart for several months before determining “Safe Days.”  Since I know I haven’t ovulated before Day 19 in a year and a half, and I know that sperm can live for 5-6 days, I know that I’m safe to have unprotected sex from Day 1 to Day 13.  It’s possible I may not ovulate until Day 23, or later, but I don’t want to risk pregnancy.

Once I have ovulated (let’s say, on Day 19) then I need to continue taking my temperature.  Once I have had three temperatures that are high, I am “Safe” the night of the third day.  I will occasionally wait until the night of the fourth day of a high temperature, just to be on the safe side.

When you are in your fertile window, you can choose a number of possibilities to protect against pregnancy. You can abstain from vaginal sex (other types of intimacy that don’t bring sperm in contact with the vagina are fine), you can use a barrier method such as a condom, diaphragm, cervical cap, etc, or you can use the withdrawal method.

What to use in your fertile window
I have abstained, used condoms or a diaphragm, and used the withdrawal method.  Each method has its pros and cons.  I abstained from sex until I was married, so while I’m familiar with abstaining, I certainly don’t love it.  You can find other ways besides vaginal sex to be intimate, however. 

My husband and I have used condoms, but we don’t like them very much.  However, when used perfectly, they have a 98% effectiveness rate.  When used typically (imperfectly) they have an 82% effectiveness rate.  This means that if 100 couples use condoms perfectly for a full year, 2 of those couples will become pregnant.  If 100 couples use condoms imperfectly for a full year, 18 couples will come pregnant.  Condoms are relatively inexpensive, which makes this barrier method good for a budget; it’s also easy to have one on you and be discrete.  Condoms do offer protection against STD/STIs.

We’ve also used a diaphragm.  While I found the diaphragm allows a better sensation during sex, it can be difficult to put in, and your partner may feel it inside your vagina.  A diaphragm requires spermicide to work, which is a gel/cream/jelly that has a chemical in it that kills sperm when they come in contact with it.  When used perfectly, it has an effectiveness of 94%.  When used typically, it has an effectiveness of 88%.  My diaphragm was free through Title X funds because we were low income at the time – I believe they are normally around $65 for the diaphragm, and spermicide usually costs about $1 per use. Diaphragms do not protect against STD/STIs.

The withdrawal method has gotten a bad rap.  In Sex Ed, I heard the joke (as I’m sure many of you have as well), “What do you call people who use the withdrawal method?” “Parents.” 

Ba dump bah.

HOWEVER.  New studies show that pre-coital fluid (the small amount of fluid that comes out of the penis before ejaculation occurs) does NOT have sperm in it as previously thought.  If a man has ejaculated within two hours of intercourse, and hasn’t gone to the bathroom since then, he may still have living sperm in his urethra.  If he hasn’t ejaculated in the last two hours, or he’s gone to the bathroom since them, sperm should not be present in his urethra or pre-coital fluid.  Withdrawal can be tricky however; the body’s natural tendency is to thrust inwards during ejaculation, not to pull out.  Because of this, the withdrawal method is best used when a couple has been having monogamous sex for a while, when they trust one another, and when they (especially the man!) knows his own body and when he is about to ejaculate.  When used perfectly, the effectiveness rate for the withdrawal method is 96%, almost as good as using a condom.  When used imperfectly, the effectiveness rate is 73%.  The withdrawal method does NOT protect again STD/STIs.

The FAM is not as effective at preventing pregnancy as hormonal methods.  When used perfectly every time, it can reach effectiveness rates of 98%, which is just a bit less than birth control pills.  However, with typical use (meaning, imperfectly), it has about a 75% effectiveness rate.  This means that if the FAM is used perfectly every time, 2 couples out of 100 will become pregnant within a year of use.  If it is used typically (imperfectly), 25 out of 100 couples will become pregnant in a year.

This is where I get a little judge-y.  I don’t understand how someone could use the FAM imperfectly. If you know you aren’t on hormones, and that the only think preventing pregnancy is you being smart and prepared… why would you take a chance??  I have no idea.  I have used the FAM for over a year and a half now, and I’ve never been pregnant.  However, I’m very diligent with my birth control.  
The Fertility Awareness Method is best used by couples in a long-term, monogamous relationship... which to me, means marriage.  The more your partner is invested in your relationship, and the more committed he is to NOT getting you pregnant, the better your odds will be; someone who doesn't plan on staying with you as long may not be as understanding of you requiring condoms on day and nothing the next.

Why I use it
Okay.  That was a LOT of information, most of it quite technical.  So why do I use the Fertility Awareness Method?  I LOVE not being on hormones.  I have been on two birth control pills so far.  One made me feel crazy – I had terrible mood swings, I cried all the time, and it gave me high blood pressure, which led to panic attacks.  I switched from that pill to another pill.  The second pill I really liked, actually.  I could predict my period to a 3 hour window, it made my cycles that regular.  Not only that, but it cleared up my skin really nicely (I even had a guy friend ask what skin products I used!).  However, it was known to cause blood clots in some women.  After a few friends who were using it developed blood clots, and a friend of a friend died from a blood clot attributed to this birth control pill, I became concerned and my family members asked me to get off the pill, as it was worrying them. 

I decided that I’d try the FAM and use a diaphragm or condom on “Unsafe Days.”  My husband and I hate condoms, but we used them… for a while.  The diaphragm wasn’t bad… but it wasn’t great.  My husband could feel it when we were being intimate, and it was difficult to get in at times.  For a while we were just abstinent during my “Unsafe Days” but THAT isn’t very fun.  We switched to the withdrawal method after I researched it quite a bit and found that it’s actually a pretty good method – if used correctly, just as good (if not better) than a diaphragm. 

I like the FAM because I don’t have to be on hormones, and I don’t have to pop a pill every day.  Now that I know when I’m likely to ovulate, I only take my temperature about 10 days out of the month, and I’m aware of my cervical mucus without having to actually check it (just look at toilet paper after you wipe, and you have a good idea).  Since I have an irregular cycle, the FAM is a bit more difficult for me than it is for those with a regular cycle.  I am okay with the difficulty, however; it’s worth it to me to be in touch with my body and to use a more natural form of birth control.  I would recommend the FAM to anyone who wants a natural form of birth control, who is willing to take a few months using barrier methods every time they have intercourse in order to establish a “usual” cycle, and who wouldn’t be crushed if they get pregnant.  My husband and I are excited for children in the future, but we’re not ready at the moment.  With the FAM, I won’t need to go off hormones before trying to get pregnant; because I know when I ovulate, I’m more likely to have a better chance to conceive, because I know exactly when I’m fertile.  If you use the FAM correctly every time, and if you’re willing to learn a bit and buy the “Taking Charge of Your Fertility” book, I think this is a great method!

If you have any questions about the Fertility Awareness Method, please feel free to email me at jessicamaylords at gmail dot com or leave a comment.


  1. Right up my alley. :)
    One update (this just in!): Most medical professionals are now advising AGAINST using spermicide because it can cause lesions on the inside of the vagina canal for some females. These irritations are not only painful, they also make STI transmission more likely.

  2. Yeah, I'm not into spermicide. The "patches" that you can use gave me an infection, they have SO MUCH spermicide since they're pretty much made to be like those breath strips. And the gel is really hard to find, and I didn't like how it felt. And the little suppository bombs felt GROSS. I can definitely understand how it could cause lesions.

  3. Just a quick comment -- it's actually better to check your cervical mucous by wiping and looking BEFORE and after you go to the bathroom, because if it was there (fertile mucous, that is) before you just might be gone after.

  4. Hi Anonymous. :-) Thanks for that clarification, you're totally right, I messed that part up. Wipe, then pee. Thanks for the correction!