|First Pregancy Wheel use
|Failure rates (per year)
||Dependent Regnancy Wheel upon strict user adherence to methodology
||no side effects, can aid pregnancy achievement
|Weight Pegnancy Wheel gain
Fertility Awareness (FA) is the practice of observing one or more of a woman’s primary fertility signs Oregnancy Wheel to determine the fertile and infertile phases of her cycle. Pergnancy Wheel Depending on their goals, couples may choose to time unprotected sexual intercourse Pregnacny Wheel so that it falls during the infertile phase (to avoid pregnancy) or the fertile phase (to achieve it). The term Fertility Awareness Method (FAM) is sometimes used.
The term natural family planning (NFP) is sometimes used to describe any use of FA methods. However, this term specifically refers to a set of several birth control methods approved by the Roman Catholic Church, one branch of which includes methods of FA. Although the physical methods used in this branch of NFP and the methods used in FA are identical, natural family planning as practiced by Catholics involves additional behavior restrictions defined by their religious beliefs. These restrictions are not specific to the practice of fertility awareness.
- 1 Methods and Characteristics
- 1.1 Benefits
- 1.2 Related Practices
- 2 Avoiding pregnancy with FA
- 2.1 Birth Control Effectiveness in General
- 2.2 Effectiveness of Fertility Awareness
- 3 Achieving pregnancy with FA
- 3.1 Timing intercourse
- 3.2 Helping diagnose problems
- 3.3 Testing for pregnancy and estimating gestational age
- 4 Scientific Basis
- 5 Observational Methods
- 6 References
- 7 Footnotes
- 8 External links
Methods and Characteristics
There are three primary fertility signs that may be used to practice FA:
- Basal body temperature (BBT)
- Cervical mucus (Systems relying exclusively on cervical mucus include the Billings Ovulation Method, the Creighton Model, and the Two-Day Method.)
- Cervical position (No studies have been conducted of women relying exclusively on cervical observations, though one such method has been suggested.)
- Sympto-thermo Methods combine observations of BBT, cervical mucus, and sometimes cervical position.
FA is unique in that it is the only family planning method that:
- can have no possible side effects. (Some FA methods encourage internal observation of the cervix or cervical mucus - the insertion of fingers into the vagina for these observations might change the vaginal environment.)
- can be free, depending on whether or not the couple chooses to use photocopied charts, a basal thermometer, special calendars, special computer software, or other paraphernalia.
- uses no chemicals and may use no physical devices.
- can be practiced in accord with moral beliefs of Catholics and adherents of various other religious sects.
- can be used both to avoid pregnancy and to conceive a child.
- can be used to track reproductive health in general, and aid in the diagnosis of gynecological health and/or fertility problems
FA can be used by all women throughout their reproductive life, regardless of whether a woman is approaching menopause, is breastfeeding, or experiencing irregular cycles for other reasons. While not a contraindication to use, avoiding pregnancy with FA may be more difficult for women not having regular cycles.
Less popularCalendar Method or the Knaus-Ogino Method (named after Hermann Knaus and Kyusaku Ogino), which relies solely on counting days in order to estimate the onset of a woman's fertile period. Because of its lower accuracy, many FA teachers consider calendar rhythm to have been obsolete for at least 20 years, and no longer teach it. Also, women who are breastfeeding a child and wish to avoid pregnancy may be able to practice the Lactational Amenorrhea Method (LAM), or a stricter version known as Ecological Breastfeeding. These methods are not FA, but because they also do not involve devices or chemicals, they are often presented alongside FA as a method of birth control.
and less accurate than fertility awareness methods is the Rhythm Method,
Avoiding pregnancy with FA
Like the Pill and other non-barrier contraceptives, FA offers no protection against sexually transmitted diseases. FA methods do require regular, consistent effort to determine when a couple's chance of fertility is low. For many women, the times of high fertility coincide with the time of highest libido. The "scheduling" of sex required can be inconvenient for partners who do not live together and are unwilling to abstain or use non-procreative forms of sex when they are able to spend time together. For these reasons, other methods are more popular than FA among large sections of society.
FA can be combined with other forms of birth control, such as condoms. Many couples will use a "back-up" method during the fertile phase, instead of abstaining from intercourse. Couples seeking maximum effectiveness might use their "back-up" method during the infertile phase, and abstain from intercourse during the fertile phase.
Avoiding pregnancy by use of FA requires couples to refrain from engaging in unprotected sexual intercourse for at least 8-10 days each cycle. Achieving the highest effectiveness rates can require an even longer period of refraining, though it is rare for couples to need to do so for more than two weeks. Despite this requirement, even FA users who practice abstinence during the fertile period have intercourse about as often as users of other birth control methods.
Birth Control Effectiveness in General
The effectiveness of FA, as of artificial forms of contraception, can be assessed two ways: method effectiveness and actual effectiveness. The method effectiveness is the proportion of couples correctly and consistently using the method who do not become pregnant. Actual effectiveness is the proportion of couples who intended that method as their sole form of birth control and do not become pregnant; it includes couples who sometimes use the method incorrectly, or sometimes not at all. Effectiveness rates are generally presented per one year of use.
For all forms of contraception, actual effectiveness is lower than method effectiveness, due to several factors:
- mistakes on the part of those providing instructions on how to use the method
- mistakes on the part of the method's users
- conscious user non-compliance with method.
For instance, someone using oral forms of hormonal birth control might be given incorrect information by a health care provider as to the frequency of intake, or by mistake not take the pill one day, or simply not bother to go to the pharmacy on time to renew the prescription.
Effectiveness of Fertility Awareness
The highest effectiveness rates of FA (when used to avoid pregnancy) are found in couples that received instruction from an experienced teacher. Many couples learn FA from one of the comprehensive books on the subject, often in conjunction with online support forums, but this is thought to result in higher actual failure rates. If the intent is to avoid pregnancy, learning solely from passive online material is not recommended.
When used correctly and consistently, studies have shown some forms of FA to be 99% effective, the same as oral contraceptives.
From Contraceptive Technology :
- Post-ovulation methods (i.e. abstaining from intercourse from menstruation until after ovulation) have a method failure rate of 1% per year.
- The symptothermo method has a method failure rate of 2% per year.
- The cervical mucus-only methods have a method failure rate of 3% per year.
- Calendar rhythm has a method failure rate of 9% per year.
- The Standard Days Method has a method failure rate of 5% per year.
For all fertility awareness methods, actual effectiveness can be significantly lower than method effectiveness - some studies have found actual failure rates of 25% per year or higher. Actual failure rates vary widely depending on the population being studied and the teaching method - at least one study has found an actual failure rate of less than 1% per year, and several studies have found actual failure rates of 2-3% per year.
The most common reason for the lower actual effectiveness is not mistakes on the part of instructors or users, but conscious user non-compliance, i.e., the couple knowing that the woman is likely to be fertile at the time, but engaging in sexual intercourse nonetheless. This is similar to failures of barrier methods, which are primarily caused by non-use of the method.
Achieving pregnancy with FA
A study by Barrett and Marshall has shown that random acts of intercourse achieve a 24% pregnancy rate per cycle. That study also found that timed intercourse based on information from a BBT-only method of FA increased pregnancy rates to 31%-68%.
Studies of cervical-mucus methods of fertility awareness have found pregnancy rates of 67%-81% in the first cycle if intercourse occurred on the Peak Day of the mucus sign.
Helping diagnose problems
Regular menstrual cycles are often taken as evidence that a woman is ovulating normally, and irregular cycles as evidence she is not. However, many women with irregular cycles do ovulate normally, and some with regular cycles are actually annovulatory or have a luteal phase defect. Records of basal body temperatures, especially, but also of cervical mucus and position, can be used to accurately determine if a woman is ovulating, and if the length of the post-ovulatory (luteal) phase of her menstrual cycle is sufficient to sustain a pregnancy.
Fertile cervical mucus is important in creating an environment that allows sperm to pass through the cervix and into the fallopian tubes where they wait for ovulation. Fertility charts can help diagnose hostile cervical mucus, a common cause of infertility.
Testing for pregnancy and estimating gestational age
Pregnancy tests are not accurate until 1-2 weeks after ovulation. Knowing an estimated date of ovulation can prevent a woman from getting false negative results due to testing too early. Also, 18 consecutive days of elevated temperatures means a woman is almost certainly pregnant.
Estimated ovulation dates from fertility charts are a more accurate method of estimating gestational age than the traditional pregnancy wheel or last menstrual period (LMP) method of tracking menstrual periods.
Ova die if not fertilized within 24 hours of ovulation. Ovulation can be detected through changes in basal body temperatures, cervical mucus, and/or cervical position. Once ovulation has passed, conception is not possible for the remainder of the menstrual cycle. Spermatozoa are able to fertilize an ovum for a period of up to five days after they have been ejaculated. If no fertile cervical mucus is present, the acidic environment of the vagina usually results in a dramatically shorter sperm life. Intercourse that occurs more than five days before ovulation will not result in pregnancy. Intercourse that occurs in the presence of cervical mucus, and/or right before the temperature shift is most likely to result in pregnancy. Most women experience fertile cervical mucus and cervical position changes five or more days before ovulation occurs, giving them sufficient notice to avoid or plan intercourse (depending on their pregnancy intentions).
This description is an overview only. Couples wishing to use Fertility Awareness to avoid or encourage pregnancy should seek instruction from an experienced teacher.
The three primary fertility signs are basal body temperature (BBT), cervical mucus, and cervical position. A woman practicing fertility awareness may choose to observe one sign, two signs, or, all three.
Basal body temperature is a person’s temperature taken when they first wake up in the morning (or after their longest sleep period of the day). In women, ovulation will trigger a rise in BBT between 0.3 and 0.9C (0.5 and 1.6°F) that lasts approximately until the next menstruation. Sixty percent of the time, ovulation happens the day before the temperature rise. The other forty percent of the time, ovulation may happen a few days in either direction.
The appearance of cervical mucus and vulvar sensation are generally described together as two ways of observing the same sign. Cervical mucus is produced by the cervix, which separates the uterus from the vaginal canal. Cervical mucus is a heterogeneous mixture of different types of mucus, several of which have specialized functions. Some of its functions are similar to those of semen - cervical mucus promotes sperm life by decreasing the acidity of the vagina and providing nourishment to the sperm. One type of mucus has a structure that helps guide sperm into the cervix and then the uterus. The production of fertile cervical mucus is caused by the same hormone (estrogen) that prepares a woman’s body for ovulation. By observing her cervical mucus, and paying attention to the sensation as it passes the vulva, a woman can detect when her body is gearing up for ovulation, and also when ovulation has passed. When ovulation occurs, estrogen production drops slightly and progesterone starts to rise. The rise in progesterone causes a distinct change in the quantity and quality of mucus observed at the vulva. Each of the methods of fertility awareness observes and interprets this occurrence differently, and uses different rules to determine the onset of fertility and post-ovulatory infertility.
The cervix changes position in response to the same hormones that cause cervical mucus to be produced and to dry up. When a woman is in an infertile phase of her cycle, the cervix will be low in the vaginal canal; it will feel firm to the touch (like the tip of a person’s nose); and, the os – the opening in the cervix – will be relatively small, or ‘closed’. As a woman becomes more fertile, the cervix will rise higher in the vaginal canal; it will become softer to the touch (more like a person’s lips); and the os will become more open. After ovulation has occurred, the cervix will revert to its infertile position.
There are other techniques for detecting ovulation. Unlike the three primary signs described above, these other methods are not considered sufficiently accurate to avoid pregnancy. They are often used by couples seeking to conceive.
Ovulation Predictor Kits (OPKs) can detect imminent ovulation from the concentration of lutenizing hormone (LH) in a woman’s urine. A positive OPK is usually followed by ovulation within 12-36 hours.
Saliva microscopes, when correctly used, can detect ferning structures in the saliva that precede ovulation. Ferning is usually detected beginning three days before ovulation, and continuing until ovulation has occurred.
Fertility monitors are available under various brand names. These monitors use a combination of the calendar method, OPKs, and sometimes computerized interpretation of BBTs. Though the manufacturers claim high effectiveness rates for avoiding pregnancy, independent studies show failure rates comparable to the calendar method.
Many women experience secondary fertility signs that correlate loosely with ovulation. Examples include breast tenderness and mittelschmerz (ovulation pains).
- Garden of Fertility by Katie Singer.
- Taking Charge of Your Fertility by Toni Weschler.
- The Art of Natural Family Planning by John and Sheila Kippley.
- ^ Note: FAM refers specifically to the set of symto-thermo rules published in Toni Weschler's book Taking Charge of Your Fertility.
- ^ Weschler, Toni (2002). Taking Charge of Your Fertility, Revised Edition, New York: HarperCollins, p.52. ISBN 0-06-093764-5.
- ^ John F. Kippley and Sheila K. Kippley (1996). The Art of Natural Family Planning. Cincinnati, OH: Couple to Couple League International, p.82. ISBN 0-926412-13-2.
- ^ Taking Charge of Your Fertility, pp.3-4
- ^ Susan B. Bullivant, Sarah A. Sellergren, Kathleen Stern, et al (February 2004). "Women's sexual experience during the menstrual cycle: identification of the sexual phase by noninvasive measurement of luteinizing hormone". Journal of Sex Research 41 (1): 82-93 (in online article, see pp.14-15,18-22). PMID 15216427.
- ^ Sinai I, Arévalo M (2006). "It's all in the timing: coital frequency and fertility awareness-based methods of family planning.". J Biosoc Sci 38 (6): 763-77. PMID 17029661.
- ^ Ecochard, R.; Pinguet, F.; Ecochard, I.; De Gouvello, R.; Guy, M.; and Huy, F. (1998) "Analysis of natural family planning failures. In 7007 cycles of use", Fertilite Contraception Sexualite 26(4):291-6
- ^ Hilgers T.W. and Stanford J.B. (1998) "Creighton Model NaProEducation Technology for avoiding pregnancy. Use effectiveness", Journal of Reproductive Medicine 43(6):495-502
- ^ a b Evaluation of the Effectiveness of a Natural Fertility Regulation Programme in China: Shao-Zhen Qian, et al. Reproduction and Contraception (English edition), in press 2000.
- ^ a b Howard, M.P. and Stanford, J.B. (1999) "Pregnancy probabilities during use of the Creighton Model Fertility Care System", Archives of Family Medicine 8(5):391-402
- ^ James Trussell et al. (2000) "Contraceptive effectiveness rates", Contraceptive Technology — 18th Edition, New York: Ardent Media. On-press.
- ^ Wade ME, McCarthy P, Braunstein GD, et al (October 1981). "A randomized prospective study of the use-effectivness of two methods of natural family planning". American journal of obstetrics and gynecology 141 (4): 368-376. PMID 7025639.
- ^ Medina JE, Cifuentes A, Abernathy JR, et al (December 1980). "Comparative evaluation of two methods of natural family planning in Colombia". American journal of obstetrics and gynecology 138 (8): 1142-1147. PMID 7446621.
- ^ Marshall J (August 1976). "Cervical-mucus and basal body-temperature method of regulating births: field trial". Lancet 2 (7980): 282-283. PMID 59854.
- ^ Frank-Herrmann P, Freundl G, Baur S, et al (December 1991). "Effectiveness and acceptability of the sympto-thermal method of natural family planning in Germany". American journal of obstetrics and gynecology 165 (6 Pt 2): 2052-2054. PMID 1755469.
- ^ Clubb EM, Pyper CM, Knight J (1991). "A pilot study on teaching natural family planning (NFP) in general practice". Proceedings of the Conference at Georgetown University, Washington, DC.
- ^ a b (December 1993) "European Natural Family Planning Study Groups. Prospective European multi-center study of natural family planning (1989-1992): interim results". Advances in Contraception 9 (4): 269-283. PMID 8147240.
- ^ Frank-Herrmann P, Freundl G, Gnoth C, et al (June-September 1997). "Natural family planning with and without barrier method use in the fertile phase: efficacy in relation to sexual behavior: a German prospective long-term study". Advances in Contraception 13 (2-3): 179-189. PMID 9288336.
- ^ Ryder, R.E. "Natural family planning": effective birth control supported by the Catholic Church. BMJ. 1993 Sep 18;307(6906):723-6. PMID 8401097
- ^ Hilgers T, Daly K, Prebil A, Hilgers S (Oct 1992). "Cumulative pregnancy rates in patients with apparently normal fertility and fertility-focused intercourse.". J Reprod Med 37 (10): 864-6. PMID 1479570.
- ^ Ellington, Joanna (2004). Sperm Transport to the Fallopian Tubes. Frequently Asked Questions with Dr. E. INGfertility Inc. Retrieved on 2006-08-13.
- ^ Weschler, p.316
- ^ Weschler, pp.3-4,155-156, insert p.7
- ^ James B. Brown (2005). Physiology of Ovulation. Ovarian Activity and Fertility and the Billings Ovulation Method. Ovulation Method Research and Reference Centre of Australia.
- Justisse - An online educational resource. Lists FA teachers trained by Geraldine Matus, director of the Justisse Center. Based in Edmonton, Alberta, Canada.
- Sister Zeus - A women's guide to synergistic fertility management.
For teachers who teach FA in the context of the Catholic belief system as natural family planning; see natural family planning - external links. Many of these classes are geared towards married Catholic couples, and include religious content.
- BeAMommy.com - For women trying to conceive; PC, cell phone and PDA fertility tools.
- PERIMON - Period monitoring software, available in English and German.
- PalmNFP - Software for the Palm handheld device.
||Condom, Diaphragm, Shield, Cap, Sponge, Spermicide
||Combined: COCP ('the Pill'), Patch, Nuvaring
Progestogen only: POP mini-pill, Depo Provera, Norplant, Implanon
||Ormeloxifene (a.k.a. Centchroman)
||IUD, IUS (progesterone)
||Emergency contraception • Abortion: Surgical, Medical, Herbal/Drug
||Tubal ligation, Vasectomy, Essure
||Natural: Coitus interruptus, Fertility awareness, Rhythm Method, Lactational
Avoiding vaginal intercourse: Anal sex, Oral sex, Outercourse, Masturbation, Abstinence
Categories: Articles with unsourced statements | Periodic abstinence