The Fertility Awareness Method

fertility-awareness

While a man is fertile every day of the month, a woman is fertile for only six days of her cycle - the five days leading up to and including ovulation (because sperm can survive for five days) and for one day following ovulation (because the egg only survives for one day). This is important to know if you are trying to get pregnant OR are trying to avoid getting pregnant.  The fertility awareness method is an incredibly powerful, empowering and successful approach to birth control and fertility - in fact, when used correctly, it can be as effective as the birth control pill.

 

The fertility awareness method (or FAM) is different than the “rhythm” method of birth control that relied solely on the days of the calendar.  Instead, it considers three physiological signs: waking body temperature, cervical fluid or fertile mucous, and cervical changes. Before discussing these in more detail, let’s take a closer look at the intricacies of your menstrual cycle:


The Fertility Awareness Method- A method of predicting fertile and infertile times within your cycle, based on the monitoring of your ovulation.

 

Understanding your cycle

Every healthy cycle is the sum of three phases.

  1. The follicular phase: Day 1 of your period to ovulation. This phase can last anywhere from seven to 21 days.

    1. The pituitary gland releases follicle stimulating hormone (FSH) during this phase to both push you closer to ovulation (by stimulating the growth of the ovarian follicles), as well as to stimulate the release of estrogen from your ovaries.  During this phase, estrogen (estradiol, in particular) is slowly building, and your body is preparing to release an egg. Estradiol’s main job is to grow and thicken the uterine lining in preparation for a baby. The more estradiol you have, the thicker your uterine lining - and the heavier your period will be (if you do not conceive).  It also stimulates a vaginal discharge called fertile mucous - more on that in a little bit.

  2. Ovulation: Lasts one day.  

    1. Luteinizing hormone (LH) is released by the pituitary which triggers the ovarian follicle to swell and rupture, releasing the egg.  LH, FSH, and Estradiol are at their peak at ovulation.

  3. Luteal phase: 10 to 16 days following ovulation, and leading up to your next period.

    1. After ovulation, the emptied ovarian follicle restructures itself into a temporary endocrine gland called the corpus luteum which is responsible for secreting progesterone.  Progesterone’s biggest job is to hold and nourish a pregnancy. It also counter-balances estrogen: where estrogen thickens the uterine lining, progesterone thins it (in preparation for shedding, if there is no conception). It also has many other benefits including: reducing inflammation, promoting sleep and calming the nervous system.  At the end of the luteal phase, the corpus luteum shrinks and progesterone drops - this stimulates your uterus to shed its lining.

    2. One of the worst things about hormonal birth control is that it robs you of all of the beneficial effects of progesterone.  This is why the Fertility Awareness Method can be such a powerful tool not only for fertility but for birth control too.

 

One thing to note is that every woman's cycle will vary, based on the length of days between your first day of your period and your ovulation day.  A healthy menstrual cycle, on average, can be anywhere from 21 to 35 days, with 28 days being the average.


How you can predict ovulation

  1. Waking body temperature (also called Basal Body Temperature - or BBT) is the cardinal sign for FAM.

    1. Another handy effect of progesterone is that it slightly raises body temperature.  Prior to ovulation, your average BBT is between 97.0F and 97.7F (36.1C and 36.6C). After ovulation, your BBT will increase by about 0.5F (0.3C) and will stay that way until you get your period.  A few consecutive days of that small, but significant increase in temperature is enough to know for certain that you ovulated and cannot become pregnant for the rest of that cycle.

    2. How to measure: Temperature is taken daily, first thing in the morning before any movement. This should be taken approximately same time each day. The reason for this is because temperature tends to rise throughout the day. The best way to take the temperature is orally, under the tongue, with with a digital thermometer or glass thermometer. If you choose, a fertility thermometer maybe more accurate than a standard fever thermometer.

    3. While waking body temperature is very helpful in determining when ovulation has taken place, it isn’t as helpful in predicting your “safe days” leading up to ovulation.  That’s where cervical fluid or fertile mucus comes in.

  2. Cervical fluid or fertile mucus

    1. Cervical fluid or fertile mucus is the sign of ovulation that occurs before ovulation.  It is a unique type of vaginal discharge that looks and feels just like raw egg white.  It is clear, stretchy and slippery. You will see it on the toilet paper after you wipe or feel it at your vaginal opening.

    2. While cervical fluid is most obvious in the days leading up to ovulation, you will see it anytime you have high estrogen compared to progesterone.  For example, you can see it early in your cycle if you have too much estrogen. You can even see it after ovulation if you do not make enough progesterone.  Therefore, you may see fertile mucus more than once in your cycle, but it does not mean that you ovulated more than once. This is why, when using FAM, it is important to leverage all three signs of fertility and not use one in isolation.

    3. How to measure: You will begin checking cervical fluid the day after menstruation. Throughout the day ask yourself: “ What is my vaginal sensation?”. On the way to the bathroom, perform Kegels (contractions of the pelvic floor) so that you can check cervical fluid, be sure to do this at least 3 times a day. You can check cervical fluid by checking the fluid at the opening of the vagina, with a tissue or fingers.

  3. Cervical position

    1. This sign is optional

    2. Throughout your cycle, your cervix shape will change. During the most fertile phase in your cycle, the cervix will drop further into the vaginal canal, with a wider opening to allow sperm into the uterus. During the non-fertile phase, the cervix will be up higher (about one finger length) and have a more narrow or closed opening into the uterus.

    3. How to measure: Check daily after your last day of menstruation. Wash your hands with soap. The most convenient position is a squatting position, and inserting your index finger into your vagina. Using your index finger you will want to check:

      1. Softness (firm, medium or soft)-  If you push on the tip of your nose with your finger this would be considered medium softness.

      2. Height (low, midway or high)- how far can you insert your finger?

      3. Opening (closed, partly open, open)

      4. Wetness (same as the cervical fluid).


 

How to track your cycle

  1. Manual- you can look up various charts on Google or use a regular calendar.

  2. Use an app- this will be more user friendly some apps ideal for FAM

    1. MyFlo

    2. Kindara 

  3. Daysy Fertility Monitor - predicts your “safe days” using a computer algorithm using data from 5 million cycles of thousands of women to analysis your temperature to predict fertility.  It is more costly but involves the least amount of work.

Remember - you will ALWAYS know your body better than any app or computer system - so do your best to stay in tune with the changing rhythms of your body


How to understand your tracked results

Ovulation will be depicted by a spike in temperature, a wet cervical fluid, and high, soft cervix. This will be your most fertile point. Depending if you are using FAM for birth control or pregnancy planning you will have sex according to fertile or infertile phases.

 

4 FAM rules for infertile phase:

  1. First 5 days rule: you are generally safe the first 5 days of the menstrual cycle if you had an obvious temperature shift about 12 to 16 days before. (You ovulated in your last cycle)

  2. Dry Day Rule: You are generally safe the evening of every dry day

  3. Temperature Shift Rule: you are safe the evening of the 3rd consecutive day of your temperature is above coverline (your coverline is determined by observing the highest temperature between your last day of your period and the highest of the previous 6 days. When you temperature rises at least 2-tenths of a degree, go back and count the last 6 temperatures before the rise. The coverline will be 1 tenth of a degree higher than the cluster of 6 temperatures.)

  4. Peak Day Rule: you are safe the evening of the 4th consecutive day after your peak day (your peak day is the last day of cervical wetness)

 

When trying to get pregnant you should have sex every day that you have wet cervical fluid or vaginal sensation through to the day you have a temperature rise. The more likely you time sex to your peak day more likely you are to conceive.


Why use FAM outside of birth control or other conception methods

 

FAM is a great way for women to be in tune with their bodies. It brings awareness to signs that your body is giving you depending on hormonal changes. By tracking when you ovulate, and on which day of your cycle you are able to determine predominant hormones acting within your body. For example let’s say you have a 35 day cycle. By normal standards, a 28 day cycle is a good length and a 35 day cycle would be too long. However, we need to focus on more than just the full length of the cycle. In one cycle, if you ovulate on day 30, this would tell you that you have a lengthy estrogenic luteal phase, followed by a shortened follicular phase. This means that progesterone is not maintaining the uterine lining and is shedding prematurely. In contrast, if you have a 35 day cycle with ovulation occurring on day 18, this shows a standard length in the follicular phase (12-16 days).

 

FAM can also help determine the best day to perform breast self-exams. Throughout your cycle there may be cyclical lumps. Using FAM, you can determine that day 7 of your cycle is a hormonally optimal day for self examination as the breasts are less likely to have lumps, and less susceptible to breast tenderness in relation to progesterone release.

 

There are many options to fertility and birth control available to women today outside of the traditional birth control pill offered by most medical professionals.  FAM is an incredibly empowering option for women - not only for family planning, but for discovering the natural flow of their bodies and developing a deeper connection from within.


 

kristin dahl