Taking Charge of Your Fertility

by Toni Weschler

  If your last day of slippery eggwhite is on a Monday, but you still have one more day of lubricative vaginal sensation (or spotting) on Tuesday, your Peak Day is Tuesday!

  2. You are considered safe after 6 o’clock on the evening of the 3rd consecutive day following the Peak Day. Draw a vertical line between Days 2 and 3 to indicate that you are safe from the 3rd evening on. (Note that you are still considered infertile even if you have sticky days after you’ve drawn the vertical line.) Some of you may have noticed that in previous editions of this book, the Peak Day Rule said that you were only safe the evening of the 4th consecutive day after your Peak Day. But I’ve decided to modify the rule because a consensus has developed that Peak plus 3 can be used without any compromise in contraceptive efficacy as long as it is corroborated by the Thermal Shift Rule here.

  3. If you have a cervical fluid pattern in which you have a day of creamy after your last day of slippery eggwhite or vaginal sensation (most women have nothing or sticky), your Peak Day is still considered that last day of eggwhite.

  However, if you don’t have an obvious thermal shift by the second morning after the last eggwhite day, or your creamy days continue, you should be conservative and consider the last creamy day that you have as your Peak Day.

  4. Usually, any wetness will dry up until the next cycle, but if wet cervical fluid or vaginal sensations reappear during the 3-day count, or even later, as in Heather’s and Susan’s two charts below, wait until the wetness ends to reestablish the Peak Day. Begin the count over again. This type of pattern is sometimes referred to as a “split peak” or “double peak” and is often caused by stress, illness, or PCOS, as discussed here. While these split and double peaks can be confusing, a thermal shift will clarify the picture and allow you to determine whether ovulation has actually occurred. You’ll learn about the Thermal Shift Rule on the next page.

  Heather’s Chart. Split peaks. Heather produced fertile-quality cervical fluid starting on Day 14, but caught the flu from someone at work. It appeared that her Peak Day was Day 18, but after only a couple days, she started producing wet cervical fluid again, so she had to start the count over. Her true Peak Day was then Day 22, after which she counted 1,2,3 and considered herself safe starting on the evening of Day 25.

  Susan’s Chart. Double peaks. Susan started developing fertile-quality cervical fluid on Day 10, but the stress of producing a huge book delayed her ovulation. It appeared that her Peak Day was Day 13, but she started developing wetness again on Day 20, with a Peak on Day 22. So she didn’t consider herself safe until ovulation was confirmed by the Thermal Shift Rule on Day 25.

  4.THERMAL SHIFT RULE

  You are safe the evening of the 3rd consecutive high temp past your Peak Day, as long as that 3rd temp is at least 3/10ths above the coverline.

  Nina’s chart. Temperature Shift Rule. Note that Nina had a thermal shift on Day 18, so she drew the appropriate coverline 1/10th of a degree above the highest of her prior 6 temps. She then recorded 1, 2, 3 in the Temp Count row and started her infertile phase the evening of Day 20, after 3 consecutive high temperatures above the coverline.

  The Coverline and Your Thermal Shift

  You may want to review how to draw the coverline here. The following guidelines assume that you have already internalized that information.

  1. Once you have identified your Peak Day, you are considered infertile starting at 6:00 p.m. the 3rd consecutive night that your temperature remains above the coverline, as long as that 3rd temp is at least 3/10ths above the coverline. Record the 1, 2, 3 in the Temp Count row of your chart. Draw a vertical line between Days 2 and 3 of high temps to indicate that you are safe from the 3rd evening on, as seen in Sara’s chart above. If the 3rd temp is not at least three-tenths above the coverline, you need to wait an extra day.

  2. If a temperature falls on or below the coverline during the 3-day count, you must start the count over once it has risen above the line (I know, I know, boo, hiss). However, you don’t have to draw the coverline again.

  3. If you are sick, you should not consider yourself safe until you have recorded 3 consecutive normal temps above the coverline without having a “fever. (See the Illness section in Chapter 7).

  You should review the Rule of Thumb to see how to handle outlying preovulatory temps caused by such factors as alcohol consumption, lack of sleep, and fever. Remember that the resulting temps can be discounted, but in order to determine your coverline, you must count back 6 low temps, not including the days eliminated. Also remember to watch for any possible temp rise due to taking readings affected by Daylight Saving Time or travel to another time zone. (For a further discussion on how to handle ambiguous thermal shifts, click here.)

  If you notice that your temp has risen either higher than normal or earlier than you would expect, pay close attention and don’t assume it’s already your thermal shift. Ovulation is virtually always preceded by a buildup of wet cervical fluid and changes in the cervix. If you didn’t observe those changes, it’s highly unlikely that you’ve already ovulated.

  A Word About Vaginal Infections

  Almost all women will experience vaginal infections at some point in their lives. True infections will usually cause symptoms that can mask cervical fluid. For this reason, you should abstain from intercourse during an infection, since the signs may be too ambiguous to be reliable. Regardless, even if the ouch factor doesn’t dissuade you, you should abstain anyway to allow your body a chance to heal and to avoid passing the infection back and forth. (For a more detailed description of true vaginal infections, click here.)

  A Word About Your Cervical Position

  As discussed in Chapter 6, the changes in your cervix can also help you determine if you are fertile. However, it’s considered an optional sign since it’s generally used only to corroborate the changes in cervical fluid and temps. For this reason, I don’t present specific rules about the changes in your cervix, but if you do observe it as one of your fertility signs, it should be firm, closed, and low before you consider yourself safe.

  A Word of Caution About Ovulation Predictor Kits and Other Fertility Monitoring Devices

  With the continuing proliferation of ovulation predictor kits and related devices that are designed to interpret your fertility signs, you may be tempted to rely solely on them as a form of birth control. Don’t! The kits are designed for women trying to get pregnant, and reflect when ovulation is imminent, but generally only tell you so a day or 2 beforehand. And since sperm can live for up to 5 days, such technologies have no contraceptive value.

  Finally, most of the other devices, such as those fertility monitors that rely on salivary ferning tests, are useful ways to corroborate the information that you have learned in this chapter, but they are simply not reliable enough to use by themselves. I discuss these products more extensively here.

  BARRIER METHODS OF BIRTH CONTROL THAT CAN BE USED DURING THE FERTILE PHASE

  Because the fertile phase is the only time in the cycle in which you can possibly get pregnant, this is the time when abstinence is necessary if you’re determined to avoid a pregnancy. In fact, since you produce slippery cervical fluid during your fertile phase, any barrier that sits over the cervix could get dislodged more easily. Finally, if a condom is going to fail, this is the time it would really matter!

  Keep in mind that anytime you use a barrier, you risk masking your cervical fluid, so the next day needs to be marked with a “?” in the Cervical Fluid column.

  However, if you would still like the option of having intercourse during those fertile days while maintaining minimal risk, I would at least encourage you to simultaneously use two of the following methods, especially during your eggwhite days:

  Condom

  Diaphragm

  Cervical cap

  Contraceptive sponge

  Vaginal spermicide

  PUTTING IT ALL TOGETHER

  The Peak Day usually occurs one or two days before the thermal shift. Women for wh
om it typically occurs two days before have an interesting advantage in that cervical fluid often dries up quickly the day after the Peak Day, and thus those women can usually predict their temperature shift the following day.

  In addition, note that before ovulation, the cervical fluid is the crucial fertility sign to observe, because it’s the one that reflects the high estrogen levels indicating the impending release of the egg. But after ovulation, the temperature is the most important fertility sign, because it confirms that ovulation has indeed occurred.

  The rules that apply post ovulation will often work in harmony with each other, so that the 3rd evening of high temps will coincide with the 3rd evening after the Peak Day. (If it helps, you can remember this as the Rule of the 3s!).

  However:

  1.If there is a discrepancy between the two postovulatory rules, always wait until both signs indicate infertility to be most conservative (i.e., until the evening after the vertical line farthest to the right). This ensures that all the signs have coincided before you consider yourself infertile.

  2.If in doubt, don’t take the chance! If your fertility signs don’t make sense in any given cycle, it’s not worth risking an unplanned pregnancy.

  The rest of this chapter summarizes the rules that you have learned in this chapter, and will show you how they would typically appear on your chart.

  SUMMARY OF THE FOUR FAM RULES

  The basic biological principles are italicized below each respective rule.

  1.FIRST 5 DAYS RULE

  You are safe the first 5 days of the menstrual cycle if you had an obvious thermal shift about 12 to 16 days before.

  For most women, the combined risk of ovulation occurring on Day 10 or earlier and sperm living long enough to fertilize the egg is remote.

  2.DRY DAY RULE

  Before ovulation, you are safe the evening of every dry day. But the next day is considered potentially fertile if there is residual semen that could be masking your cervical fluid.

  Sperm cannot survive in a dry vaginal environment, and the lack of cervical fluid indicates that estrogen levels are too low for ovulation to occur.

  3.PEAK DAY RULE

  You are safe the evening of the 3rd consecutive day after your Peak Day, the last day of eggwhite or lubricative vaginal sensation.

  The last day of eggwhite or lubricative vaginal sensation indicates the imminence of ovulation, while allowing 3 days for drying up ensures that any eggs released are already gone, and that the return of a dry vaginal environment is inhospitable to sperm survival.

  4.THERMAL SHIFT RULE

  You are safe the evening of the 3rd consecutive high temp past your Peak Day, as long as that 3rd temp is at least 3/10ths above the coverline.

  The rise in temperature due to the release of progesterone indicates that ovulation has occurred, and waiting 3 days allows for the remote possibility of 2 or more eggs being released over a 24-hour period, with each one living a full day.

  A CAUTIONARY NOTE

  These rules are a very effective form of contraception if they are consistently and correctly followed. However, you should understand the relative risks of natural birth control, discussed in Appendix D, before relying on what you have learned in these last few pages.

  Of course, while this box is a useful summary, you must clearly understand all the guidelines for each rule described in this chapter before using FAM for birth control. It’s also crucial that you don’t consider yourself safe unless all the rules indicate that you’re infertile. If you have any doubts, don’t take the risk.

  Finally, if you’d like to practice a more conservative version of these rules in order to obtain an even lower risk of pregnancy (by dropping the annual method failure rate from 2% to under 1%), see the note here.

  CHAPTER 12

  Shortcuts: Minimum Charting with Maximum Reliability

  For those of you who just skipped ahead to this page, don’t even think of using the guidelines in this chapter until you fully understand the rules in Chapter 11 and have already applied them for several cycles!

  Although the Fertility Awareness Method is really very simple once you’ve learned it, even experienced users don’t necessarily want to chart every day to achieve maximum reliability. With a little experience under your belt, so to speak, you can limit charting to only about a third of the cycle and still attain all the information necessary to apply this method, without compromising contraceptive efficacy.

  The reason you can have peace of mind using the shortcuts explained on these pages is that once you have ovulated, your body won’t release an egg again until the following cycle. So once you’ve identified when the egg is dead and gone, it’s unnecessary to continue charting until your next period.

  I recommend, though, that you chart without using shortcuts because it’s easier to do it every day than to have to think about where you are in your cycle. As you’ve seen, charting is also about much more than just detecting when you can and can’t get pregnant. And finally, by charting your complete cycle, you will often benefit from one of its most practical aspects: being warned often hours before you get your period by the drop in temps that most women experience on the first day of the flow.

  However, if you have at least several months’ experience in the standard rules of charting and you would now prefer to take shortcuts, you can use the modified guidelines discussed below. Again, this is because contraceptive efficacy won’t be compromised as long as both your fertility signs have confirmed that ovulation has already occurred for that particular cycle.

  CERVICAL FLUID

  You obviously never have to check your cervical fluid during your period. In fact, there is no point in checking while menstruating since the bleeding will mask it. And once you’ve established the first safe day under the Peak Day Rule, you needn’t chart your cervical fluid again until your next cycle. (See Kati’s chart below.)

  Kati’s chart. The Peak Day Rule with Minimal charting. Once Kati established that she was past her Peak Day, which in this case was on Day 11, it’s likely that she had already ovulated and would therefore not have to continue charting her cervical fluid until the next cycle. She therefore considered herself safe starting on Day 14. However, for maximum contraceptive efficacy, see below!

  A cautionary note: If you intend to rely on the shortcut version of the Peak Day Rule, it’s crucial that you establish that ovulation has passed by also observing three high temps above the coverline. This is because you may have a delayed ovulation in which your cervical fluid could mislead you into thinking you had already ovulated. If you were no longer charting that cycle, you would perhaps not notice the return of fertile cervical fluid.

  By observing a true thermal shift, your chances of being misled in this way are virtually eliminated. Still, you should continue to check your cervical fluid throughout the cycle if the accuracy of your temps could have been compromised due to illness or other factors. As always, be conservative.

  WAKING TEMPERATURE

  It’s unnecessary to take your temps during your period, since these temps may be somewhat high or erratic anyway. In addition, once you’ve established the occurrence of a thermal shift by counting at least three high temps above the coverline (with the third temp being at least three-tenths above the coverline), you needn’t take them again until your period from the next cycle is over, as seen in the chart below.

  Colleen’s chart. Temperature Shift Rule with minimal charting. Once Colleen recorded her 3rd high temperature above the coverline by Day 14, she no longer needed to chart her temperature until the next cycle because she already established that ovulation had passed.

  CERVICAL POSITION

  As you know from earlier discussions, the position of the cervix is considered an optional fertility sign. This means that it’s not necessary to check the cervix in order for the method to be effective. However, the cervical position is an excellent way to cross-check the other two signs if there is ever a discrepancy between t
hem.

  Since checking the cervix is not truly necessary, there are two shortcuts you could take at this point. You could choose not to observe the cervix at all, or you could merely check the cervix about a week per cycle. The time to start checking it would be the 1st day you notice wet-quality cervical fluid, continuing to check through to the 3rd day of your thermal shift. However, to use this shortcut, you may need to chart the cervix for several cycles to be able to detect the subtle changes that occur with it, as seen in Sarah’s chart below.

  Sarah’s chart. Observing the cervix with minimal charting. Because Sarah wanted to chart the minimal number of days necessary while still being as conservative as possible, she recorded her cervical position to verify that ovulation had passed. Note that already by Day 12, her cervix had reverted to its infertile state of low, closed, and firm.

  A NOTE ON THE PREOVULATORY RULES

  It should be obvious that if you choose to use these shortcuts, the preovulatory rules still apply. Thus, you can assume you’re infertile only during the first 5 days of your cycle if you meet the criteria of the First 5 Days Rule, which state that you must have had an obvious thermal shift 12 to 16 days before, and that you don’t have premenopausal symptoms. In addition, you must always follow the Dry Day Rule, and therefore must begin to chart no later than Day 6.

  THE FALLACY OF THE I-JUST-KNOW-WHEN-I’M-FERTILE MENTALITY

  A word of warning about taking shortcuts: Once you decide not to chart every day, it can be very tempting to slack off, either charting less than recommended or stopping altogether, convincing yourself that you just know when you’re fertile. I cringe when any woman claims this.