Fertility Awareness–Based Methods - Birth Control and Fertility Helper

It can be difficult for many women to find and utilize nonhormonal options when it comes to fertility. This includes women who want to become pregnant but also those who are looking to avoid pregnancy. With many women and couples having misconceptions regarding the fertile period of a woman’s cycle, it is more advantageous to educate women on their fertile signs for greater chances of either conception or avoidance of conception.[1]

There’s a stigma regarding fertility awareness methods (FAM), possibly due to the inefficacious “rhythm method.” This method, first introduced in the 1920s, was the first fertility awareness–based method of birth control.[2] Although many women relied on this method and swore by its use, the rate of unplanned pregnancies was calculated at 15–18%.[2] The driving factor here was the reliance on data from past menstrual cycles to calculate future fertile days. As well, the rule stated that days 12–19 of the menstrual cycle were “fertile days;”[2] however, this wouldn’t be reliable for women with short or long cycles.

Since this time, many other methods have been introduced, one of the most effective and accurate being the symptothermal method (STM), with a pregnancy rate of only 0.4% when used properly as a method of birth control.[2] The STM incorporates three major aspects of understanding fertility: changes in basal body temperature, characteristics and presence of cervical fluid, and cycle tracking with symptom monitoring. In using this method on a regular basis, not only is it a means of nonhormonal birth control but it can also assist couples who are trying to conceive. Current guidelines recommend that couples wishing to conceive engage in intercourse optimally every other day. But we now know that this may not be accurate.[3] Knowing when a woman is most fertile and modifying sexual timing could improve a couple’s chances of conceiving.

Understanding your Cervical Fluid

The discharge or fluid experienced throughout the menstrual cycle has a purpose and changes in consistency for good reason. Cervical fluid has several key functions: First, it’s alkaline in nature, meaning that it provides the proper pH to protect sperm from the otherwise acidic vagina.[4] It also serves as a medium for sperm movement.[3] You may notice several different types or characteristics of cervical or vaginal fluid throughout the menstrual cycle.

First, understand the difference between cervical fluid and vaginal discharge. Discharge is more wet or creamy, whereas cervical mucous or fluid is more jelly-like. Most days, you should be able to detect a slight moisture around or inside the vagina, indicative of the natural discharge. The mucous membranes within the vaginal canal produce this natural lubrication to keep tissues moist and healthy, as well as to prevent infections. You can insert a clean finger to check for this, and you will notice that upon reexposure of that finger to air, the moisture evaporates within a few seconds.[4] In terms of fertility, this type of discharge is considered “dry.” Upon wiping with tissue, you should also notice a dry feeling, especially when compared to subsequent wet or slippery fluid days. Fertility on “dry fluid” days is considered extremely low.[4]

Cervical fluid is more apparent as estrogen levels begin to rise after menses. As we get closer to ovulation, cervical fluid becomes more noticeable and it changes in texture between the postmenstrual dry days and ovulation. This transition fluid can appear in many different forms. What’s important to note is that fertility becomes enhanced during these days. A sticky fluid may be more paste-like or rubbery in nature. It’s not truly wet or slippery, nor will it stretch the same way as your most-fertile fluid. Although not optimal for sperm survival, this fluid still indicates the possibility of being fertile.[4] A creamy fluid is much wetter. Some women may even experience a sensation of leaking water. If held between two fingers, this type of discharge should break apart when plying your fingers apart. If you notice that, in addition to feeling wet, the fluid is slippery when wiping with tissue, this is more indicative of your fertile cervical fluid. Regardless of slipperiness, fertility is increased when experiencing a creamy type fluid. In one study that tracked the use of the STM, the highest probability of conception occurred on the peak mucus day (egg-white or clear stretchy jelly) for both fertile and subfertile couples.[3] This peak-mucus day is considered the last day of this egg-white fluid and indicates the day of ovulation.

Recording Basal Body Temperature (BBT)

BBT is also known as waking temperature: Oral or axillary temperature is taken first thing in the morning upon waking, but before getting out of bed or moving around. It’s important to experience at least 3–6 consecutive hours of sleep the night before, and avoid alcohol consumption the night before; otherwise, temperatures may be altered, and your recordings will not be as accurate.[4] Due to changes in hormone levels, temperatures are lowest in the preovulatory phase, then rise after ovulation and stay elevated by about 0.2–0.6° until menses starts again. A woman is assumed to have ovulated after observing three consecutive days of temperature elevation, and therefore pregnancy is avoided by abstaining from intercourse until 3–4 days after the rise in BBT is observed.[2] All subsequent days until the next menses are considered infertile days.[2] Temperatures should be taken and recorded daily, looking for overall trends throughout the cycle. A single rise in temperature from one day to the next does not indicate ovulation alone, but instead, the whole chart needs to be considered. This can take some practice; some women opt for hand-charting or use computer spreadsheets to track and chart their temperatures. Many others use cycle-monitoring apps which log your temperatures and chart them for you within the app.

Keep in mind that BBT alone is a poor predictor of ovulation. First of all, many factors can interfere in temperature readings, including the consumption of alcoholic beverages, poor sleep quality, and waking during the night. Secondly, some women will ovulate without a clear rise in BBT, making it harder to track ovulation.[3] The other issue is that BBT alone doesn’t predict ovulation far enough in advance to identify all potential fertile days in a given cycle.[2] It is for this reason that combining BBT with cervical-fluid monitoring is a more accurate way of calculating fertile days.[1] It’s also more appropriate for women with short or long cycles, where ovulation doesn’t occur on a regular day 14.[3]

Calculating the Fertile Window

When calculating the fertile window, keep in mind that an ovum can only survive for roughly 24 hours. Sperm, on the other hand, can live in cervical fluid for 3–5 days. This is why a woman can be fertile for as long as 6 days before ovulation and for about 3 days postovulation. Studies have calculated the highest pregnancy probability beginning 5 days before ovulation and ending on the estimated ovulation day. The peak day for fertility has been shown as the last day with the best “egg-white”–quality mucus, meaning that it is slippery, clear, wet, and stretchy.[3] Understanding these variations and a woman’s individual cycle can have huge implications on whether a woman conceives or not. A woman with a 32-day cycle, which is longer but still considered normal, may actually be ovulating closer to day 18. If trying to conceive, counting on a day 14 ovulation, and therefore timing intercourse accordingly, she may have completely missed her most fertile days, under the assumption that she is no longer fertile by day 15. In some situations, couples who may have considered themselves infertile, due to the inability to conceive for several months to a year, may actually be able to conceive but have been unable to due to improper timing of intercourse. Alternatively, this method may help other women or couples avoid pregnancy by understanding her dry days versus wet days and avoiding unprotected intercourse during the 8–9 days (approximately) of her fertile window.

Understanding your body and getting intimate with your menstrual cycles is the first step in taking control of your fertility. Although the FAM may not be for everyone, it can be at least helpful in understanding your body’s response at each stage in your cycle, from the postmenstruation to preovulatory discharge changes to the ovulatory “fertile” window. Even regardless if a woman is looking to prevent or promote conception, knowing when she ovulates can also help solve hormonal imbalances. For example, ovulating too early may indicate poor egg quality, which can lead to relatively lower estrogen levels. Ovulating much later can lead to luteal-phase defects (and potentially lower progesterone), which comes with symptoms of early spotting and periods that come too frequently.

Most importantly, we need to get over the stigma of “natural birth control” methods. There are definitely methods, such as the rhythm method, that have a poor track record and have not been as successful as a means of birth control. However, FAMs take into consideration several different factors and have much higher success rates, both in preventing and in promoting conception (depending on how the results are used).