By Michal Schonbrun, MPH, CHES
The Fertility Awareness Method (FAM) is an evidence-based tool for gaining body awareness (Body Literacy) and achieving or avoiding pregnancy. It is natural, safe and highly effective when learned and used correctly. Regardless of the goal, the overall purpose of FAM is to: accurately determine when the ‘window of fertility’ opens and closes; confirm that ovulation occurs; and verify that the menstrual cycle is in fact working as it should, in hormonal balance. When a woman knows how to identify her fertility days, pregnancy can be more easily achieved, or it can be avoided through abstinence or the use of other back-up methods.
FAM is often confused with the ineffective rhythm method, which uses calculations based on past cycle lengths to predict fertile days in the present cycle. In contrast, FAM relies on the daily observation of two or three fertility signs or biomarkers, in the present, so it is more accurate and reliable. FAM is also an effective alternative to using hormones or IUD’s during breastfeeding, as these methods can cause staining, prolonged bleeding and other unpleasant side effects.
FAM is based on five scientific facts:
1) The menstrual cycle is controlled by two primary ovarian hormones – estrogen and progesterone, and by two primary pituitary/brain hormones – FSH (Follicle-Stimulating Hormone) and LH (Luteinizing Hormone).
2) These four hormones cause discernable changes in the three fertility signs (described below), which signal the opening and closing of the fertile “window.” Ovulation occurs within this 3-5 day window, which means that identifying the exact day of ovulation is unnecessary because pregnancy is possible any time that the fertile window is “open.”
3) The woman’s egg lives 12-24 hours,
4) Sperm can live for 3-5 days, but only in supportive, fertile-quality secretions, and
5) The first part of the menstrual cycle can vary in terms of number of days ( 1-3 weeks long). This is the time it takes the body to prepare for ovulation. It differs for each person. The second part of the cycle is more “set,” lasting between 10-14 days on average. This is the time in which the body prepares for possible pregnancy.
Simply stated, a woman’s body is programmed to produce specific hormonal changes at certain times in the cycle in order to ensure optimal conditions for potential ovulation and pregnancy.
Fertility Awareness (FA) gives women the tools to easily monitor three fertility signs; the way in which each biomarker changes is relative for each and every woman:
1. Basal Body Temperature (BBT) is the temperature of the body at rest. It is taken upon waking with a special digital (oral) thermometer for one minute. BBT rises after ovulation, 0.2- 0.5 C (up to half of one degree Celsius) and temperatures stay relatively high for nearly two weeks (typically 10-14 days), until the next menses begins. Once this rise is verified, pregnancy is no longer possible.
2. Cervical Secretions or fluids appear throughout the cycle, and signal when we are and are not fertile. For most days of the cycle (regardless of length), secretions are dry, sticky and acidic. In effect, these dry secretions act as natural spermicides which block and immobilize sperm. During the fertile days, which includes ovulation, our secretions become milkier, wetter, and more lubricative, often resembling the consistency of raw egg-white. These wet secretions are alkaline; they nourish the sperm and help them to swim upwards so they can reach and fertilize the egg. Few of us have been taught that these fluids are not only healthy and normal, but are essential for fertility and for conception! Learning one’s unique secretion pattern is like learning a new (body) language. Within a few cycles, anyone can learn to understand their own pattern and become sufficiently ‘fluent’ in identifying their fertile days. Furthermore, when a woman learns to differentiate between her normal secretion changes, she will easily be able to identify any abnormal secretions (e.g., those that indicate a yeast or bacterial infection).
3. Cervical Position and opening (os) also change during the “window” of fertility. When inserting the middle, longest finger deep in the vagina, every woman can feel one, two or three changes. On infertile days, the cervix is lower, closed, and firm when touched. During the fertile days, the cervix moves upwards towards the uterus, and it opens and softens. This allows easy access for sperm on their journey towards the egg. This is the only fertility sign which requires internal checking.
FAM requires checking two out of the three fertility signs, preferably BBT and secretions. The more signs a woman monitors, the more information and effectiveness she gains, plus increased confidence in being able to interpret her fertility chart and apply the method rules.
Charting requires two minutes a day initially. Within 2-3 cycles, most women are able to identify their individual patterns and interpret their fertility signs independently. To reach highest efficacy and confidence, it is recommended to learn FAM with a certified teacher. Theory can be learned from a book but implementing that theory on your own body can be a challenge.
Charting can be a valuable aid for women trying to conceive. Charting can detect anovulation, late ovulation, luteal phase defects, unsuitable secretions, the occurrence of miscarriage, and the likely date of conception. Charting can also alert a woman if her cycle is hormonally balanced. Many women with short or irregular cycles can know exactly if and when they are ovulating in relation to their mikveh date. In many cases, the need for medical tests and treatments can be avoided.
Menstrual cycle and fertility apps are growing in popularity. Before deciding whether to use such an app, and which one to use, it’s important to clarify a number of issues. Please see Michal Schonbrun’s article, 10 Facts Abour Fertility Apps and Devices, for a detailed discussion of this topic.
For more information, contact Michal Schonbrun through her website at https://poriutivit.com/en/home/ .
This article was updated on 25 October, 2021.
