Taking Charge of Your Fertility Read online

  Dedication

  In loving memory of my mother,

  Franzi Toch Weschler,

  whose strength always amazed me.

  Contents

  Dedication

  Acknowledgments

  Preface to the 20th Anniversary Edition

  Introduction

  Part One BREAKING FERTILE GROUND: TOWARD A NEW WAY OF THINKING

  1. Fertility Awareness: What You Should Know and Why You Probably Don’t

  2. Taking Control of Your Reproductive Health

  Part Two REDISCOVERING YOUR CYCLE AND YOUR BODY

  3. There’s More to Your Reproductive Anatomy Than Your Vagina

  4. Finally Making Sense of Your Menstrual Cycle

  5. The Three Primary Fertility Signs

  6. How to Observe and Chart Your Fertility Signs

  Part Three BEING PROACTIVE WITH YOUR HEALTH

  7. Anovulation and Irregular Cycles

  8. Three Prevalent Conditions All Women Should Be Aware Of: Ovarian Cysts, Endometriosis, and PCOS

  9. Natural Ways to Balance Your Hormones

  10. Now That You Know: Preserving Your Future Fertility

  Part Four NATURAL BIRTH CONTROL

  11. Natural Birth Control Without Chemicals or Devices

  12. Shortcuts: Minimum Charting with Maximum Reliability

  Part Five PREGNANCY ACHIEVEMENT

  13. Maximizing Your Chances of Getting Pregnant

  14. Practical Tips Beyond Fertility Awareness

  15. What Next? Tests and Treatments That May Be Necessary to Get Pregnant

  16. Dealing with Miscarriages

  17. Idiopathic Infertility: Some Possible Causes When They’re Not Sure Why

  Part Six BEYOND FERTILITY: PRACTICAL BENEFITS OF CHARTING YOUR CYCLE

  18. Maintaining Your Gynecological Health

  19. Causes of Unusual Bleeding

  20. Appreciating Your Sexuality and Nurturing Your Relationship

  21. Premenstrual Syndrome: You Mean It’s Not All in My Head?

  22. Demystifying Menopause

  23. Enriching Your Self-Esteem Through Knowledge About Your Body

  Epilogue—A History of Progress: Women’s Health and the Missing Piece of the Puzzle

  Color Insert

  APPENDIXES

  BASIC INFORMATION FOR ALL READERS

  A. Troubleshooting Your Cycle: Expecting the Unexpected

  B. Frequently Asked Questions

  C. The Menstrual Cycle: A Summary of Events Through the Use of the Proverbial 28-Day Model

  NATURAL BIRTH CONTROL

  D. The Contraceptive Effectiveness of Natural Birth Control

  E. The Difference Between Natural Methods of Birth Control

  F. Birth Control Rules When You Can Only Chart One Fertility Sign

  G. Checking Cervical Fluid Internally Before Ovulation

  H. Tricky Coverlines

  I. Using FAM While Breastfeeding

  J. Using FAM During Long Cycles and Phases of Anovulation

  PREGNANCY ACHIEVEMENT

  K. A Brief Look at Gender Selection

  L. How to Research Fertility Clinics

  MISCELLANEOUS RESOURCES

  Fertility-Related Resources

  Glossary

  Bibliography

  Index

  Annual Exam Form

  Master Chart Options

  Professional Praise

  Excerpts from Letters to the Author

  About the Author

  Also by Toni Weschler

  Credits

  Copyright

  About the Publisher

  Acknowledgments

  They say women are blessed with the ability to forget the pain of childbirth so they will be able to have more children later. I often wonder whether the same principle applies to the challenges of writing a book of this magnitude. Had another author warned me about what a monumental task it would be, I’m not sure I would have been so insane as to pursue the dream. And even now, revising the book for the third time since the book was first released 20 years ago, I am struck once again with the age-old question: “What were you thinking?”

  But I suppose writers are a deluded bunch, or perhaps their memories are simply fried from their projects! Either way, I’ve come away from writing both the original and revised editions having experienced the gamut of human emotion, from total frustration and burnout to incredible joy and pride. Along the way, as the following list will attest, I’ve had the privilege of being supported by numerous people to whom I owe a debt of gratitude.

  To my wonderful editor at HarperCollins, Emily Krump, for sticking with me during this arduous process and graciously advocating on my behalf. I hope that now that the revision is finally finished, you’ll be able to take pride in your involvement in this incredibly challenging project. And to the wizards in the production department, Heather Finn and Susan Kosko, for putting up with all of my crazy-making instructions to assure that this book is once again as appealing and user-friendly as possible.

  To my literary agent, Joy Harris, who has been with me since the beginning over 20 years ago, as well as to her amazing cohort in crime, Adam Reed, who saved me from myself when I just about had a breakdown trying to convert my original manuscript to one which I could revise on my Mac. He never ceases to amaze me with how professional and responsive he is to my questions. I’ve never worked with anyone else who e-mails me back before I’ve even hit the Send button!

  To the numerous doctors, health practitioners, and professors who had a part in making this book what it is, including Vivien Webb Hanson, M.D., Joan Helmich, Lee Hickok, M.D., Patricia Kato, M.D., Nancy Kenney, Ph.D., Miriam Labbok, M.D., Chris Leininger, M.D., Mark Perloe, M.D., Molly Pessl, B.S.N., Suzanne Poppema, M.D., and especially Rebecca Wynsome, N.D., whom I would like to single out for being especially helpful in this project and providing invaluable professional expertise. And to Thomas W. Hilgers, M.D., for his unparalleled contributions to the field, and for his assistance as I navigated the often confusing world of reproductive health.

  To my medical illustrators, Kate Sweeney and Christine Shafner, for their gorgeous visuals. And to my graphics illustrator, Rosy Aronson, for her beautiful artwork, including the pregnant woman in the color insert. Her incredibly positive attitude made it a pleasure to work with her. And to Sheila Metcalf Tobin, the artist of the lovely vulva and g-spot drawings in the color insert, for beautifully illustrating for women just how unique their bodies are.

  To my medical photographer, Frankie Collins, who had the perfect disposition to be on call every time a cervix model phoned to inform her that their cervix or cervical fluid was at just the right phase to be photographed.

  To the woman whom I ultimately chose for her incredibly photogenic cervix, Deanna Hope, who was so proud of her contribution to the enlightenment of women that she wanted to be mentioned by name.

  To my incredible assistant for the first revised edition, Cricky Kavanaugh, my total godsend, whose intelligence, ingenuity, and attention to detail were surpassed only by her warmth and wonderful sense of humor. I feel privileged that she came into my life, and even though she moved across the country, I hope I’ll have the joy of working with her again one day. Regardless, I hope her young daughter Clara will one day appreciate the many contributions her special mom made to the book.

  To my various university interns I had who helped me maintain a semblance of sanity while working on this revision, including Amy Cronin, Maddie Cunningham, Olivia Eisner, Alana Macy, Anna Rourke, and Lisa Taylor-Swanson. And to Ruby Booras, who I want to single out for helping me come up with the perfect name to replace a rather clunky term in the sexuality chapter
. ’Nuf said.

  To Sheila Cory, Robin Bennett, Kim Aronson, and Ana Carolina Vaz, who all rescued me when they saw that I had that deer-in-the-headlight look. Was it really that obvious?

  To Sarah Bly, who gave me the idea for the “fertile wave.” And to Michal Schonbrun, Ilene Richman, Katie Singer, Geraldine Matus, and Megan Lalonde, all of whom have also contributed immeasurably to the dissemination of FAM into the secular mainstream. And to a new generation of excellent Fertility Awareness instructors who are passionately moving the field forward, including Colleen Flowers, Kati Bicknell, and Hannah Ransom.

  To Kelly Andrews, Ethan Lynette, Suzanne Munson, Sarah Dohman, Whitney Palmerton, Lester Meeks, and Jake Harsoch, all of whom have been a joy to work with. Thank you for welcoming me so warmly!

  To the scores of clients and readers who continue to swell my “Thank You” file with their poignant letters of gratitude for the ways my book has apparently changed their lives. It is this type of appreciation which buoys me when I occasionally feel disheartened by a medical community which has yet to fully grasp the scientific validity and endless benefits of the Fertility Awareness Method. And to those who took the time to write me the most eloquent and touching letters expressing how the book impacted their lives to such an extent that they changed careers—especially to Alyssa Mayer for earning her Ph.D. in public health!

  To my cherished friends who witnessed me go from a fairly gregarious and amiable person to a hermit who rarely came up for air while working on this edition. You helped me maintain a sense of perspective when I kept wondering whether I would ever have a life again. Especially Aud, Cath, Susan, and Sandy.

  To Roger, who more than anyone, has had to peel me off the floor countless times when I thought the end would never arrive, and who sacrificed his personal space by negotiating around stacks of research studies, all manner of women’s health illustrations and copy-edited manuscripts, only to eat on the kitchen bread board lest he disturb any of the color-coded stacks. Without his understanding support for months and months on end—heck, who am I kidding, years on end—I would never have been able to complete this book. So thank you, thank you, thank you.

  To my two older brothers, Lawrence Weschler, whose remarkable literary achievements gave me the inspiration to write this book, and Robert Weschler, for being my own devil’s advocate who kept me constantly on my toes.

  Finally, and most important, to my younger brother, Raymond, without whom I could never have written this book. And even though we often rued the day that we ever started working together on this daunting project over 20 years ago, he was an indispensable editor, researcher, and organizer, as well as an endless source of wit and moral support throughout this undertaking. The fact is that we talked about sharing authorship credit, but he insisted that the book came from my passion and experiences, not his, and ultimately it was written with my voice. Perhaps, but truth be told, Raymond was my co-writer. I am eternally grateful to him for all he’s done, and most especially, for once again agreeing to work with me on this latest edition. In so doing, he showed that despite all the grief we’ve given each other, determined siblings can get things done that no family counselors would’ve ever thought possible!

  The publisher and author do not guarantee the method of birth control or pregnancy achievement described in these pages. As a contraceptive method, it is highly effective, but only when the relevant instructions are strictly followed. Like other effective contraceptive methods, this method is not foolproof, and there is a chance that the method will fail. The ideal way to learn about the Fertility Awareness Method is through a qualified instructor or counselor. In addition, it should be clear that natural methods of contraception do not offer protection of any kind against AIDS and other sexually transmitted diseases.

  This book does not purport to take the place of qualified medical advice and treatment. Thus, any application of the recommendations set forth in the following pages is at the reader’s own risk. Please contact your doctor, a Fertility Awareness instructor, or both whenever appropriate. While every effort has been made to provide the most accurate and updated information, the publisher and author cannot be responsible for any error, omission, or dated material.

  The anecdotes presented in this book are true and accurate. However, except when requested, the names have been changed to maintain anonymity.

  Preface to the 20th Anniversary Edition

  When I first wrote Taking Charge of Your Fertility 20 years ago, women had rarely heard of the concept of charting their menstrual cycles. The idea that they could use the information they gleaned from charting to practice effective natural contraception, maximize their odds of getting pregnant, and finally take charge of their gynecological and sexual health was completely foreign. So my goal was to spark a grassroots movement among women frustrated with the lack of practical information they were taught about their bodies. As I had hoped, the material contained in these pages struck a chord with hundreds of thousands of women.

  In the years since Taking Charge was first released, I’ve been humbled by the effusive reactions women have had toward the book. So many readers have written me personally to say how this information has changed their lives—they’re incredibly excited and encouraged but also often equally frustrated that this information was not shared earlier either in school or during doctor visits.

  Which raises an important key to understanding the book. Through teaching practical knowledge about women’s menstrual cycles, it may have appeared that I was disparaging doctors in the process. So let me set the record straight: Given the obvious demands of physicians’ responsibilities as well as the limited time they can spend with their patients, it would be impossible for any doctor to know the intimate details of your cycle, and that’s especially true if you yourself don’t know them! TCOYF is in large part about learning how to be able to advocate for yourself so you can work with your doctor, for at its heart, this book centers on the concept that knowledge is power.

  It is also important to keep in mind that Taking Charge has been written for women with divergent objectives—those who want to avoid pregnancy and those who want to get pregnant. Because of this, the book is structured to be read both as a whole and as individual chapters when a situation or need arises. As a result, you may find that some key information is repeated. This is to highlight the importance of those topics, but also to ensure readers are fully educated even if they use only a portion of the text. Ultimately, the ability to understand your reproductive and gynecological issues throughout your life is truly empowering.

  My hope is that even if you have read an earlier edition of this book, you will now benefit from this new 20th anniversary edition of Taking Charge. Generally speaking, women’s cycles have remained the same across time, but our understanding of the underlying biology has continued to improve. So, for those who already own an earlier version, you will find numerous additions and modifications throughout, including:

  •an expanded 16-page color insert

  •improved fertility charts

  •a revised and updated chapter on the extensive advances taking place in assisted reproductive technologies (ART)

  •a more detailed sexuality chapter for both you and your partner

  •six new chapters, including:

  ~ Three Prevalent Conditions

  All Women Should Be Aware Of

  ~ Natural Ways to Balance Your Hormones

  ~ Now That You Know: Preserving Your Future Fertility

  ~ Dealing with Miscarriages

  ~ Idiopathic Infertility: Some Possible Causes When They’re Not Sure Why

  ~ Causes of Unusual Bleeding

  The way in which women learn about their bodies and chart their cycles continues to evolve, just as our biological knowledge and reproductive technology do. And so, with this latest edition of Taking Charge, I hope to keep apace of these changes so that each new generation of women will continue to be more educated, more self-aware, and simply
more cycle-savvy than the one before.

  For additional information, forums, and the Taking Charge of Your Fertility charting app, please visit www.tcoyf.com.

  —Toni Weschler, MPH, 2015

  Introduction

  I still cringe when I recall my college years and what ironically led me to pursue the field of fertility education. I can’t count the number of times I ran off to the gynecologist with what I thought was a vaginal infection. Most women will agree that no matter how many times they’ve had a pelvic exam, the experience is usually a drag and sometimes even traumatic. Yet I remember returning, seemingly every month, with the same apparent problem. As usual, I’d be sent home with an unsatisfying assurance that “there’s really nothing there.” So I would leave, feeling like a hypochondriac, only to meekly return when I had what appeared to be the signs of yet another infection.

  Along with my frustration at this recurring problem were the inevitable side effects of the various methods of birth control I tried. If I wasn’t dealing with weight gain and headaches caused by the pill, I was enduring urinary tract infections from the diaphragm or irritation from the sponge. Yet every time I asked the gynecologist for a natural, effective alternative to the dismal selection of birth control methods available, I was cynically informed that the only “natural” method was Rhythm, and everyone knew that that didn’t work. So back to Square One I would go, seeming to have infections all the time and without an acceptable method of birth control.

  It wasn’t until years later, when I took a class called Fertility Awareness, that I realized I was absolutely healthy all of that time. What I had been perceiving as infections was in fact normal cervical fluid, one of the healthy signs of fertility that all women experience as they approach ovulation. But since conversing about one’s vaginal secretions is hardly your typical topic of social chitchat, I had no idea that my experiences were normal, universal, and—perhaps most importantly—cyclical.

  Because of misleading and inadequate health education, women are rarely taught how to distinguish between normal signs of healthy cervical fluid produced every cycle and the signs of a vaginal infection. What are the consequences of such a basic omission in our upbringing and education? In addition to the unnecessary expense, inconvenience, and anxiety that women often experience, such ignorance can also lead to lowered self-esteem and confusion about sexuality.