Fertility Awareness Method

The fertility awareness method (FAM) is a form of natural family planning that uses a combination of several separate methods - usually calendar charting, basal body temperature (BBT), cervical mucus, and cervical observation - to predict when a woman will ovulate. This method, also called the Sympto-Thermal Method, can also be used as a method of natural contraception.

The fertility awareness method helps women identify and predict ovulation so they can time their reproductive efforts to coincide with their most fertile days, thereby increasing the likelihood of conceiving. In general, a woman is able to get pregnant for about 5 to 7 days each month. Sperm can live inside a woman's body for 3 to 5 days after intercourse; but after ovulation, an egg is viable for just 24 to 48 hours. You are more likely to conceive if intercourse occurs from 3 days before ovulation until 2 to 3 days after ovulation.

One advantage of FAM is that it is completely natural, with no associated health risks or side effects. Other advantages include its effectiveness if used correctly and consistently (especially for women who have regular menstrual cycles); it can increase a woman's awareness and understanding of her body; and couples using FAM may develop greater communication, cooperation, and responsibility. In addition, the methods can be used to confirm each other; for example, a change in cervical mucus can be confirmed with a change in basal body temperature.

One disadvantage of the FAM is the amount of time and effort required to learn how to use the method correctly - it requires considerable commitment and calculation - and some women say that despite careful tracking and adherence to the method, they simply cannot detect a predictive menstrual pattern.

The fertility awareness method is most effective for women with regular menstrual cycles. Women who have recently given birth, had an abortion or miscarriage, or are breastfeeding or approaching menopause may find it more difficult to chart their fertility because their fertile signs may vary in unpredictable ways due to irregular hormonal fluctuations. This method is also not recommended for couples who have serious reproductive problems or for women with irregular cycles. The following are the most common methods used as part of the fertility awareness method:

Calendar Charting

Calendar charting, also called the rhythm method, involves using past menstrual cycles as a guide to calculate the average number of days in your cycle and estimate your future fertile days.

If we use the first day of menstrual flow as the beginning of the calendar, an egg is maturing and is almost ready to be released from the follicle by day seven of the average cycle. Somewhere between days 11 and 21, hormones in your body cause the egg to be released from the ovary (ovulation) and travel down the fallopian tube towards the uterus. If sperm does not fertilize the egg, it breaks apart. By the 28th day of your cycle your hormone levels drop, which signals the lining of the uterus to be shed as the beginning of your menstrual flow.

The first half of the menstrual cycle, before ovulation, is very different in every woman and can even change from month to month in the same woman. But the last half of the cycle is usually more similar for every woman because there are approximately 14 days from the day of ovulation until the start of the next period. (The average menstrual cycle is between 28 to 32 days.) This is why women are encouraged to count back 14 days from their last period to pinpoint their most fertile time of the month.

To track your fertile days using the calendar method, begin by keeping a written record of your menstrual cycle for 8 to 12 consecutive months, using the first day of menstruation (actual bleeding, not spotting) as Day 1 of your cycle. Once you have recorded your cycle for several months, identify your longest and shortest cycles and subtract 18 from the length of your shortest cycle - this is the first fertile day. Then subtract 11 from the length of your longest cycle - this is your last fertile day. For example, assume your shortest cycle was 26 days and your longest cycle was 31 days. Subtract 18 from 26 to get the first fertile day, Day 8. Subtract 11 from 31 to get Day 20, your last fertile day. Ovulation will occur sometime during this fertility window, between days 8 and 20. To maximize your chances of conceiving, you should have sexual intercourse every day or every other day from your first fertile day to your last fertile day.

As you start each new cycle, add the number of days between your periods to the chart and re-calculate your predictions of fertile times. As your chart grows, cross off the oldest cycles and only consider the past 12 months.

Basal Body Temperature

Monitoring your basal body temperature can help you identify the change in temperature that occurs just before and after ovulation. After charting a few cycles, you will be able to distinguish a pattern in your temperature and anticipate ovulation.

Take your basal temperature orally every morning before you do anything, even get out of bed (even the slightest activity can elevate your temperature), and record it on your fertility tracking calendar. You can also chart it using graph paper to see the pattern more clearly. Use a basal thermometer instead of a conventional fever thermometer; your body temperature will only rise between 0.4 and 1 degree F when you ovulate and a basal thermometer is more sensitive to small changes in your temperature. Your temperature will probably be fairly consistent in the first half of your menstrual cycle; however, as you get closer to ovulation, you may notice a slight drop in temperature followed by a sharp increase, indicating that ovulation has just occurred. The temperature spike occurs within 12 hours of ovulation and it will remain elevated until your next menstrual period begins. Your fertile days are just before the temperature spike, and for the three days following. Keep in mind that illness, lack of sleep, and alcohol or drug use can affect your temperature and make it difficult to establish an accurate reading. To increase your chance of conceiving, you should have sexual intercourse every day or every other day from the ninth day after the start of your menstrual period until three days after your BBT rises.

Cervical Mucus Observation

The cervical mucus method is also called the Billings Method and monitors the amount, appearance, and consistency of cervical mucus in order to anticipate ovulation.

The consistency of your cervical mucus changes during your menstrual cycle. In an average cycle, there are three to four dry days after a five-day menstrual flow. After the dry days, the mucus wetness increases daily, lasting approximately nine days until it becomes abundant, slippery, clear, and very stretchy, similar to egg whites. Ovulation occurs within two days of when your mucus becomes clearest, slippery, and most stretchy.

To monitor your cervical mucus, collect it from the vaginal opening every day with your (clean) fingers by wiping them from front to back, or examine the mucus that collects on your underwear. Record the consistency (thick, sticky, or stretchy), color (clear, white, yellow, cloudy), feel (dry, wet, sticky, slippery, stretchy), and amount of mucus daily on your calendar.

To increase your chances of conceiving, you should have sexual intercourse every day or every other day from the day you notice your cervical mucus becoming clearer and stretchy until it becomes cloudy and sticky.

Do not douche or use spermicides, foams, or jellies as these may wash away or change the appearance and consistency of the mucus. Vaginal infection, the presence of seminal fluid, arousal fluid, lubricants, anovulatory cycles, and using antihistamines can all affect the amount, appearance, and consistency of the mucus.

Cervical Observation

The position of a woman's cervix changes over the course of her menstrual cycle. During menstruation and for the first few days after, the cervix is fairly low and firm like the tip of your nose. As ovulation nears, the cervix begins to move up, becoming more soft, wet, and open; during ovulation, the cervix is at its highest and most open to allow sperm through; and after ovulation, the cervix returns to the firm, low, and closed position.

To observe changes in your cervical position, insert your (clean) middle finger into your vagina and feel your cervix for softness, height, opening, and wetness. A plastic speculum can be helpful in the beginning while you are getting used to finding and feeling your cervix. Check your cervix about the same time of day and in the same position (squatting, sitting on the toilet, or with one leg raised). Record the position and quality of your cervix on your calendar. To increase your chances of conceiving, you should have sexual intercourse every day or every other day from when you notice your cervix become higher and more open until it begins to close and become firm.

Classes on charting fertility patterns are offered by many family planning health centers, church-affiliated instructors, and at Catholic hospitals, often at little or no cost.