Taking Charge of Your Fertility Read online

  My negative gynecological experiences gradually led to an interest in women’s health that evolved into a real passion. It was that passion that ultimately compelled me to interview for a position as a health educator at a women’s clinic—a disastrous experience that in hindsight provided the final catalyst for my decision to pursue fertility education as a career.

  While I sat in the waiting room anticipating my interview with the clinic director, my eyes wandered, glancing over the all-too-familiar paraphernalia of all women’s clinics: posters warning against spreading sexually transmitted infections, charts comparing methods of birth control (with their inherent side effects and risks in tiny print), and plastic models of the female reproductive system.

  I remember being suddenly struck with the futility of my situation. Here I was, applying to be a health educator in a women’s clinic, with absolutely no training in the field. What was I thinking? While fidgeting, I noticed a brochure about classes on the Fertility Awareness Method that were available at the clinic. I could not believe that this supposedly reputable clinic seemed to be teaching the discredited Rhythm Method. I was in a dilemma. Should I risk losing this coveted position by expressing my dismay, or should I keep my mouth shut to get the job?

  In the end, I would have felt dishonest if I said nothing. My heart skipped a beat when the clinic director called my name. The pressure was on. The director was cordial, but I barely gave her a moment to introduce herself before I blurted out, “I don’t understand why you teach Rhythm here. Everybody knows it doesn’t work!”

  “Oh really? We teach what?” she inquired with obvious surprise. “I noticed your brochure here about the Fertility Awareness Method. Isn’t that the same thing?” I muttered shyly. She looked a bit irritated and responded, “Actually, Toni, your lack of knowledge about such an important facet of women’s health wouldn’t bode well at our clinic.”

  Needless to say, I didn’t get the job. But that embarrassing experience years ago helped transform my perspective about women’s health care. After swallowing my pride, I took the clinic’s class on Fertility Awareness—and was amazed. What I learned is that not only was it possible for me to take control of my cycles, but I no longer needed to feel uncertain about various secretions, pains, and symptoms. I could finally understand the subtle changes I experienced every month. I could place my menstrual cycle in the context of my overall health—both physiological and psychological. And best of all? No more unnecessary trips to the gynecologist.

  By taking just a couple of minutes a day, I was able to utilize a highly effective method of natural birth control in which I could accurately determine those days of my cycle when I was potentially fertile. On the flip side, if I wanted to get pregnant, I could avoid the guessing game so many couples play by learning precisely when to time intercourse. I could also identify problems for myself that could potentially impede my getting pregnant. And the fact is, so can you.

  Probably the best thing to come out of my years using the Fertility Awareness Method was the privilege I felt in being so knowledgeable about a fundamental part of being a woman. I no longer questioned when I would get my period. I always knew (including when I’d get what would turn out to be my very last one!). I knew what to expect physically and emotionally at different times in my cycle. I also gained confidence in a way that was reflected in other areas of my life.

  Your menstrual cycle is not something that should be shrouded in mystery. By the time you reach the end of this book, I hope that you will also experience the liberation of feeling in control of your body. Beyond its practical value in giving you the tools to avoid or achieve pregnancy naturally and to take control of your gynecological health, this information about your cycle and body will empower you with numerous facets of self-knowledge that you rightly deserve.

  CHAPTER 1

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

  How often have you heard that a menstrual cycle should be 28 days and that ovulation usually occurs on Day 14? This is a myth, pure and simple. And yet it’s so routinely accepted that, sadly, it’s responsible for countless unplanned pregnancies. Furthermore, it prevents many couples who hope for a pregnancy from attaining one. Much of this fallacy is a legacy of the obsolete Rhythm Method, which falsely assumes that individual women have cycle lengths that, if not precisely 28 days, are reliably consistent over time. The result is that it is nothing more than a flawed statistical prediction using a mathematical formula based on the average of past cycles to predict future fertility.

  In reality, cycles vary among women and often within each woman herself. Keep in mind, though, that normal cycle lengths are generally 21 to 35 days. The myth of Day 14 can affect individuals in the most astounding ways, as you can see by this story some religious clients of mine told me decades ago:

  Ilene and Mick were virgins when they got married on May 21. They wanted to start a family soon after their wedding, so they had their joint medical insurance start on May 15. When they discovered that Ilene had gotten pregnant on their honeymoon, they were pleasantly surprised that it happened so fast. Imagine their shock when the insurance company refused to cover the pregnancy and delivery, claiming that since her last period started on April 19, she must have gotten pregnant about three weeks before the wedding.

  “That’s impossible,” she insisted, “we were both virgins until our wedding day.” She tried to explain to them that her cycles had become quite long and irregular since she started jogging and dieting in order to be a “picturesque bride.”

  The insurance company wouldn’t hear of it. They adhered to the frequently used pregnancy wheel, the calculating device that doctors rely on to determine a woman’s due date (see A Typical Pregnancy Wheel of the color insert). It’s based on the assumption that ovulation always occurs on Day 14. Ilene lamented, “We were sunk. How does one prove virginity in a courtroom? And why should it be anyone else’s business?”

  Needless to say, the Day 14 myth had very expensive consequences for Ilene and Mick. The only consolation they took from their experience was the fact that their son was born just when they expected, three weeks after the insurance company’s due date! He was, in the words of Ilene, “worth all the trouble anyway.”

  Luckily, with advances in our understanding of human reproduction, we now have a highly accurate and effective method of identifying the woman’s fertile phase: the Fertility Awareness Method (FAM). Fertility Awareness is simply a means of understanding human reproduction. It’s based on the observation and charting of scientifically proven fertility signs that determine whether or not a woman is fertile on any given day. The three primary fertility signs are cervical fluid, waking temperature, and cervical position (this last one being an additional sign that simply corroborates the first two). FAM is an empowering method of both natural birth control and pregnancy achievement, as well as an excellent tool for assessing gynecological problems and understanding your body.

  WHY THE FERTILITY AWARENESS METHOD IS NOT BETTER KNOWN

  As you read in the introduction, probably the greatest resistance to the acceptance of FAM has been its dubious misassociation with the Rhythm Method. Furthermore, because natural methods of birth control are often practiced by people morally opposed to artificial methods, FAM tends to be falsely perceived as only being used by such individuals. But, in fact, women from all over the world have been drawn to FAM simply because it’s free of the chemicals associated with hormonal methods such as the pill. Just as important, it minimizes the frequency with which they might have to choose preventive methods that are unpleasant, impractical, or lacking in spontaneity. Many of these people tend to be oriented toward leading a natural and health-conscious life in other ways besides taking control of their fertility and reproduction.

  It’s true that many religious people have discovered the benefits of Fertility Awareness, though they may technically practice Natural Family Planning (NFP). The primary distinction between FAM and
NFP is that those who use NFP choose to abstain rather than use barrier methods of contraception during the woman’s fertile phase. But regardless of the differing values that often divide users of FAM and NFP, all are drawn by the desire for a natural method of effective contraception.

  FAM’s Conspicuous Absence from Medical School

  Still, if FAM has so many benefits as both a method of birth control and an aid to getting pregnant, why, then, is it not better known? One of the most crucial and mystifying reasons that people have rarely heard of it is that doctors are still seldom taught a comprehensive version of this scientific method in medical school. It’s amazing to think that women who practice the Fertility Awareness Method are often more knowledgeable about their own fertility than gynecologists who are trained to be experts in female physiology!*

  Years ago, when I taught at a women’s clinic, the entire staff except one doctor took my seminar to use FAM as a method of contraception. One day, the one who had never attended pulled me aside and whispered, “Toni, I’ll be honest with you. I don’t refer my patients to your classes.” “Oh really, why is that?” I casually asked, trying not to act surprised. “I got pregnant using your method and haven’t trusted it since,” she replied. “You’re kidding! Did you take a class elsewhere, and what rules did you use?” I inquired. “What do you mean, what rules?” she asked. “You know . . . did you observe the rules for both waking temperature and cervical fluid or just one of them?” She looked at me totally confused, as if she had no clue what I was asking her. It was then that I grasped just how widespread ignorance of Fertility Awareness was in the medical community. Even among many doctors, I realized, Fertility Awareness still meant looking at past cycles to predict future fertility.

  What is especially remarkable about the glaring omission of Fertility Awareness education from medical school curricula is the fact that the method’s effectiveness is based on purely biological principles, all discussed in greater detail in Chapter 4. They include the functions of numerous hormones, such as FSH, estrogen, luteinizing hormone, and progesterone, all of which have been scientifically proven. And because the Fertility Awareness Method is useful not only for birth control and getting pregnant, but for promoting gynecological health in general, it’s even more surprising that this information is not part of a complete medical education.

  Indeed, FAM can be a vital aid to doctors and their patients in diagnosing a number of conditions, including:

  •anovulation (lack of ovulation)

  •late ovulation

  •short luteal phases (the phase after ovulation)

  •infertile cervical fluid

  •hormonal imbalances (such as polycystic ovarian syndrome, or PCOS)

  •insufficient progesterone levels

  •occurrence of miscarriages

  Another advantage of charting fertility signs is that it facilitates diagnosis of gynecological problems. Women who chart are so aware of what is normal for them that they can help their clinician determine irregularities based on their own cycles. Examples of potential gynecological problems that can be more easily diagnosed through daily charting include:

  •irregular or unusual bleeding

  •vaginal infections

  •urinary tract infections

  •cervical anomalies

  •breast lumps

  •premenstrual syndrome

  •miscalculated date of conception

  By not being taught FAM, doctors are denied an excellent tool with which they could better counsel their female patients. Moreover, this can often result in unnecessary, invasive, and frequently expensive tests to diagnose an apparent menstrual problem. Of course, if women were taught how to chart for their fertility-related health, they would not need to visit their doctor nearly as often, and substantial numbers of needless medical procedures could be avoided.

  As the previous list should make clear, charting would reveal a myriad of potential impediments to pregnancy, ranging from the woman’s not ovulating to her simply not producing the cervical fluid necessary for conception. It may even show that this woman is consistently getting pregnant but having repeated miscarriages of which neither she nor her doctor had been aware. And for those seeking to prevent pregnancy, charting eliminates the anxiety so many feel as they run off to the store or their gynecologist for expensive and inconvenient pregnancy tests. Women who chart know if they are pregnant just by observing their waking temps, and thus they can eliminate that recurrent doubt while awaiting the arrival of a “late period.”

  Politics, Profit, and Natural Contraception

  Another reason this method is not better known or promoted for birth control is that it’s not profitable for either physicians or pharmaceutical companies such as those that produce hormonal methods like the pill or IUDs. In other words, beyond the initial investment in a thermometer and perhaps a book, class, or app, there is no further cost to those using FAM. Compare this to the cost of the pill, for example, which is at least several hundred dollars a year.

  Given the profitability of so many other contraceptive methods, is it any wonder that FAM is not promoted more enthusiastically by the medical community? It’s no secret that great sums of money are spent to present the pill as a contraceptive panacea, but what is often overlooked is the bias with which various pharmaceutical companies distort the effectiveness and validity of other birth control methods, particularly Fertility Awareness.

  Corporate literature that summarizes the various contraceptives for public consumption is consistently filled with blatant inaccuracies, such as one pamphlet entitled “Contraception: The Choice Is Yours,” which claims that “Natural Family Planning is based on the fact that fertilization is most likely to occur just before, during, and just after ovulation.” This would almost make sense, except for the minor detail that fertilization cannot take place without an egg present, so it would be no small feat for fertilization to take place before the egg is released!

  Of course, more important than any individual misrepresentation is the overall way FAM and NFP are portrayed. This particular pamphlet was typical in that its “Natural Family Planning” heading was followed by a supposed clarification in parentheses, which as you might guess was simply “the Rhythm Method.”

  Aside from birth control, it’s also fairly apparent that for those people and companies involved in providing the high-tech reproductive treatments that have given hope to so many, there is little incentive in promoting a virtually free system of knowledge that could obviate the need for their services. While these reproductive technologies are often a clear necessity, you will learn throughout this book why they are not needed for many couples, when education alone could help them achieve their dreams.

  The Language of “Palatability”

  Finally, FAM is not better known because it suffers the misfortune of being a method that many, especially in the media, refer to as “unpalatable.” Why is this?

  We had a doctor on the Seattle news who produced medical stories every week. I had approached him about the possibility of doing a feature on the Fertility Awareness Method a number of times over the years, but he was always noncommittal while still acknowledging that he sincerely believed the method was effective. I could never grasp why he felt it wouldn’t be suitable for the news until he finally admitted that he felt the subject was simply unpalatable for the general public.

  Perhaps his concern was about the term used for one of the three fertility signs: “cervical mucus.” Maybe if it were referred to as something less graphic, he would find it suitable for the evening news. No sooner had I written him with the suggestion to use the phrase “cervical fluid” instead when he called to tell me he thought the change in vocabulary was just the modification necessary to make FAM acceptable for the news. Within a few weeks, he ran an informative story about Fertility Awareness.

  It took that experience to make me realize how powerful language can be in the acceptance of FAM. Since that news feature years ag
o, I have found that people are infinitely more attentive to and interested in FAM when the more neutral term “cervical fluid” is used instead of “cervical mucus.” Perhaps the increased acceptability of that terminology is less puzzling when you consider that the woman’s cervical fluid is analogous to the man’s seminal fluid. One would never refer to seminal fluid as seminal mucus, and yet the purpose of the fluid in both the man and woman is comparable: to nourish and provide a medium in which the sperm can travel.

  Of course, the media are extensions of our culture, and tend to promote a sanitized, unrealistic view of human physical processes. The purpose of FAM, however, is to enlighten people with a clear and empowering knowledge of their bodies’ functions. Thus, if coining a term such as “cervical fluid” makes that task easier, so be it.

  WHY SOME DOCTORS FAMILIAR WITH THE FERTILITY AWARENESS METHOD DO NOT INFORM THEIR PATIENTS

  Many doctors know that FAM is a scientifically validated, natural method of effective birth control, pregnancy achievement, and health awareness, but they may still cite various reasons why they don’t recommend it to their patients. Some say that women can’t be bothered to learn it because it’s complicated and difficult to use, requires high intelligence in order to apply it, and takes too much time to learn and practice. But for the vast majority of women, I believe that these assertions are simply not valid.

  Actually, FAM is fairly simple and easy, once you learn its basic principles. (Most will be able to learn those principles in this book. Others may want to take a class, where a certified instructor can typically teach a comprehensive course in several sessions.) The method is no different from many life skills, such as learning to drive a car. It may seem intimidating at first, until a little practice gives you the confidence you need.