Tuesday, April 9, 2013

Thank you, Taking Charge of Your Fertility

Occasionally, you read something that is such a revelation to you that you feel like an idiot for not knowing it before. Over the past two weeks, I have had that experience in reading Taking Charge of Your Fertility, by Toni Weschler.

Maybe other women already know and understand much of the information in this book; that would be awesome. But for ladies like me who somehow missed the boat on an in-depth understanding of the menstrual cycle and how women's fertility really works (despite gobs of knowledge about pregnancy, birth, and breastfeeding and a mother who was very open about body/reproductive knowledge), here are some intellectual hors d'oeuvres.

  • The 28-day cycle is a myth that impacts a variety of women's health care standards. Menstrual cycles are as individual as fingerprints. By keeping track of key fertility signs, you can get to know your own cycle.
  • Women typically release one egg a month, occasionally two. That egg is viable for a very short window of time, about 24 hours. Men produce hundreds of millions of sperm every day. It is entirely possible to know when you are fertile (ie, could become pregnant) and when you are not. 
  • The time between menses and ovulation is variable. It could change every month based on what's going on in your life. If you are sick, stressed, travelling, or exercising vigorously, ovulation could be delayed.
  • The time between ovulation and your next menses, or the luteal phase, is generally not variable month-to-month for a given woman. A luteal phase averages between 12 and 16 days between women generally. If your luteal phase is 13 days, then it may occasionally be 14 or occasionally 12, but will not vary beyond that. 
  • If you are keeping track of your key fertility signs and know when you ovulated and how long your own luteal phase is, then you will actually know if your period is "late" or not. Let's say your period starts on April 1. You get sick a week later, and then you are really stressed out from school. You notice that you don't ovulate till around April 25. You know that your own luteal phase is 15 days. So, you are not surprised when your period doesn't show up until May 10--giving you a 40-day cycle that is completely normal.
Wow. Whether you are trying to achieve or avoid pregnancy, that knowledge of when your period will come is wonderful. In the example above, a woman who is not keeping track of her fertility signs may have been really excited, expecting that she's achieved a pregnancy she wanted. When her period finally arrives so "late", she and her husband might feel disappointed. Another woman with that same 40-day cycle who is not keeping track of her fertility could have purchased several pregnancy tests in a fit of paranoia that she's become pregnant when she was not quite ready. When her period arrives, she will feel relief--but will be just as susceptible to pregnancy paranoia the next time ovulation is delayed for some reason.

You can only really know when to expect your period if you know when you ovulated and how long your own personal luteal phase is. If you're trying to get pregnant, you can only know when to time your baby-makin' if you know when you're going to ovulate (And guess what? Ovulation predictor kits* don't necessarily help with that). Toni shares stories of couples trying to get pregnant who had been very diligent about making time for love about two weeks after the woman's period (based on the the mythical 28-day cycle), but who had not achieved a pregnancy. If a woman ovulated at day 11, then they would have missed the ball! Or if a woman ovulated frequently at day 20, they would have been too early! Toni points out that a couple could make love twice a week for a year and not get pregnant because they are missing when the woman ovulates every single time. Such a couple might think they have fertility problems, when actually they just don't know enough about the woman's cycle. Toni also talks about how many fertility treatments are timed based on the 28-day cycle and the problems and misfires and expense that can subsequently result.

Oh and speaking of 28-day cycle problems, guess what else is based off of it? PREGNANCY DUE DATES. If a woman's last period started February 1, her due date will be calculated from February 14, according to the 28-day cycle. But if her ovulation was very delayed and she didn't ovulate until February 28, that means her due date is off by two weeks. That means that if her care provider insists she is induced at 40 weeks, she could actually be getting induced at 38 weeks. What if that baby naturally would have gestated till 42 weeks? Then baby has been born a month early, and will suffer for it. Every day in the womb makes a difference. How many "failed" inductions that resulted in C-sections were inductions that didn't work because they were actually happening at 36, 37, or 38 weeks?

Toni also talks at length about the inequality of manufactured birth control, how it is essentially all geared toward the woman; how even though women are the ones who are only fertile a couple days a month, we are the ones expected to live with all of the horrible side effects of birth control. As another incentive for reading the book, let's just say that Toni has a little parody of the IUD called the IPD, and it is so vindicating and hilarious.

Basically, when women are actively keeping track of their fertility signs (waking temp, cervical fluid, and cervical position), and timing unprotected intercourse for when she's infertile (which is the majority of the time), then Fertility Awareness is a completely free method of birth control that is just as reliable as condoms. That is, if you are using the Fertility Awareness Method taught in the book with exactness, you have a 2% chance of getting pregnant. Using condoms with exactness, you also have a 2% chance of getting pregnant.

I ponder at length about lost body-knowledge. I have been aware of our culture's lost knowledge about birth and breastfeeding for a while, and now I realize we have also lost knowledge about the most basic elements of the menstrual cycle. A woman's body is not just this mysterious, unknowable thing that has to be reigned in with drugs and devices! We can and should know our own bodies and our own cycles.

I realize I didn't even attempt to explain what the key fertility signs are or what they indicate (though I was fascinated to learn about how the cervix changes position cyclically with ovulation!) That is because this is a complex topic, and I don't want anyone to be tempted to run off and try to use FAM as birth control with a couple fun facts. These are hors d'oeuvres. Please, go to the library or a bookstore and sit yourself down for the main course. It will give you the most nourishing and delicious self-knowledge you have ever consumed.

*You may view all of this with skepticism, thinking of someone you know who got pregnant unintentionally while using "natural" birth control. Likely, they were using an ovulation predictor kit, which doesn't give enough warning before ovulation; the Rhythm method, which is based off the 28-day cycle and does not require a woman to keep track of her own fertility signs; or the Billings method, which only monitors cervical fluid and is thus incomplete and prone to slip-ups. Toni's Fertility Awareness Method is rigorous, detailed, and very individualized, and again, has the same clinical effectiveness as condoms for contraceptive purposes. Don't knock it till you've tried it.


  1. "If you're trying to get pregnant, you can only know when to time your baby-makin' if you know when you're going to ovulate"

    Doesn't that take all the fun out of it?

    But in all seriousness, I think this is really cool. Natural birth control is something I have wanted to try for a long time. I am kind of bummed by the fact that I have been on harmones for the majority of my adult life, and feel pretty bad about all of the fish I have probably hermaphrodicized. However, as you pointed out, you have be be pretty aware of your cycle at all times, and follow the ques in the book with exactness in order for the method to work. I had kind of concluded that experimenting with natural birth control was something I was going to wait to do until after graduation and a job, you know, in case I am not so great at mastering the method.

    But now I know what book to get when I am going down that path!

  2. This is interesting. I've never ever had regular periods and was on birth control on and off since I was 18. I noticed off birth control nothing happened, but on birth control I had my period. I wonder if she throws in hormones into the mix because the body's chemistry is so sensitive that one thing chemically wrong can throw it all off. I'm afraid it is going to be super hard for me to get pregnant if the time ever comes. Thanks for the book recommendation. Like Nicki, I will check it out when I'm ready.

  3. Love this book, and have been tracking my fertility since 2008 (I have recorded proof!) Of course, I had breaks from it during my 2 pregnancies. I now use the fertility friend app on my tablet. I do not forsee myself ever going back to any other form of birth control, especially since i personally believe it was the birth control pill, which i had bee on for 4 years previous, that caused me to not get pregnant for one year WHILE TRACKING my cycles and timing things perfectly. Something was definitely messed up. I got pregnant on our first cycle trying with my second kid. I attribute this to using natural birth control. Breastfeeding also causes me to not ovulate for about a year, so that helps a lot with preventing pregnancy too.
    I feel very empowered to know so much about my body's cycles. I don't recommend this method to everyone for birth control, but I DO recommend it to every woman, just so they can know their own bodies! When I learned how to do this, I was mad that I didn't learn it in school or from my mom or doctor.

  4. Yes! I think we are going to try NFP. We got pregnant with Atticus doing some version of the rhythm method, and I found out later when I started really tracking that my cycles were not the "standard" -- so I'm excited to get to know my body a little better! (still not ovulating yet so haven't began tracking). Tallulah was conceived after my first cycle (Atticus and Tim went out of town for a few days when he was about 20 months old and so we didn't nurse for three days, or I might not have ovulated until later!) I like knowing my "natural" baby spacing. We'll see what happens this time around, we want to wait a little longer.

  5. I was going to comment and say pretty much the same thing Aleatha said. Instead I'll just say, "DITTO!" I hated being on birth control. It turned me into someone I didn't recognize, and it made me lazy, in terms of understanding how my body worked and what made me tick (very easy to do, when everything is on auto-pilot and you can always blame mood swings on the hormones). I love understanding my own body. I've been following this book's principles for a year and I will NEVER go back.

  6. I'll have to check this out. Although I don't plan on any more kids, it's funny how it works. I told my doc over and over again that I have a 32 day cycle. They told me no. When I calculated my due dates with a 32 day cycle rather than 28 day my kids came 100% on due date. lol. Funny how that works. I would not use this, no matter how much for birth control though. Although it may work for some, I wouldn't trust condoms either! Lorelai we call our little miracle baby. Wyatt was still nursing 100%, so nursing was out the window as a birth control, AND Chris was coming home from Iraq, I told him that I was due to start the day after his arrival so he better be on time if he wanted a nice welcome home...but the day after he got home I didn't start. Then a week later I peed on a stick and sure enough...there was proof that Lorelai had beaten the odds. (Which also btw, not using any special early detection methods, we knew we were pregnant both times WAY before we were supposed to. Curious how that works too.) Maybe this book would enlighten me. She was planned, we knew we wanted to get pregnant again when he got back, we were both just surprised that it happened the day he got back. I am really curious to hear what she says about IUDs. I have one right now and hate it. In fact, I have thoughts on how it is really working in my body vs how they say it works. I have about one more year left on it and then we are deciding if we want to make things permanent or not. But I will not get another IUD. But down and dirty, planning or not, I'm not saying that everyone has the ability to do this, but when trying to get pregnant why not just have sex once a day every day. Men's body's can keep up. And if you're trying to have a baby you'd better love each other enough to want to touch every day. I guess my love life is just such that I don't see the big deal in "planning" when to have sex. If you have sex all the time, it'll happen eventually. Maybe it'll take a couple of years because of birth control hangover or something, but unless there is actually a reason (like actual infertility issues for the man or woman), being totally crude, just crawl into bed and show each other how much you love each other every night. Ahh...such wonderful hard work ;)

    Things like this also highlight the "comic" about when you are high school they preach that you can pretty much get pregnant by touching. Then somewhere around 25 there is a science to making it happen. When did it go from "never touch or you'll get pregnant" to "we need to touch this second or we won't be able to get pregnant again for a month!" Interesting to me I guess. Not really funny.