Fertility Awareness Method
   HOME

TheInfoList



OR:

Fertility awareness (FA) refers to a set of practices used to determine the
fertile Fertility is the capability to produce offspring through reproduction following the onset of sexual maturity. The fertility rate is the average number of children born by a female during her lifetime and is quantified demographically. Fertilit ...
and infertile phases of a woman's
menstrual cycle The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that make pregnancy possible. The ovarian cycle controls the production and release of eggs a ...
. Fertility awareness methods may be used to avoid pregnancy, to achieve pregnancy, or as a way to monitor
gynecological Gynaecology or gynecology (see spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined area ...
health. Methods of identifying infertile days have been known since antiquity, but scientific knowledge gained during the past century has increased the number, variety, and especially accuracy of methods. Systems of fertility awareness rely on observation of changes in one or more of the primary fertility signs ( basal body temperature, cervical mucus, and cervical position), tracking menstrual cycle length and identifying the fertile window based on this information, or both. Other signs may also be observed: these include
breast tenderness Breast pain is the symptom of discomfort in either one or both breasts. Pain in both breasts is often described as ''breast tenderness'', is usually associated with the menstrual period and is not serious. Pain that involves only one part of a br ...
and
mittelschmerz ''Mittelschmerz'' (German: "middle pain") is a colloquial term for "ovulation pain" or "midcycle pain". About 20% of women experience mittelschmerz, some every cycle, some intermittently. Signs and symptoms Mittelschmerz is characterized by lo ...
(ovulation pains), urine analysis strips known as ovulation predictor kits (OPKs), and microscopic examination of saliva or cervical fluid. Also available are computerized
fertility monitor Fertility testing is the process by which fertility is assessed, both generally and also to find the "fertile window" in the menstrual cycle. General health affects fertility, and STI testing is an important related field. Women Healthy women ...
s.


Terminology

Symptoms-based methods involve tracking one or more of the three primary fertility signs: basal body temperature, cervical mucus, and cervical position. Systems relying exclusively on cervical mucus include the Billings Ovulation Method, the
Creighton Model The Creighton Model FertilityCare System (Creighton Model'', ''FertilityCare, CrMS) is a form of natural family planning which involves identifying the fertile period during a woman's menstrual cycle. The Creighton Model was developed by Thomas Hi ...
, and the Two-Day Method. Symptothermal methods combine observations of basal body temperature (BBT), cervical mucus, and sometimes cervical position.
Calendar-based methods Calendar-based methods are various methods of estimating a woman's likelihood of fertility, based on a record of the length of previous menstrual cycles. Various methods are known as the Knaus–Ogino method and the rhythm method. The standard days ...
rely on tracking a woman's cycle and identifying her fertile window based on the lengths of her cycles. The best known of these methods is the
Standard Days Method Calendar-based methods are various methods of estimating a woman's likelihood of fertility, based on a record of the length of previous menstrual cycles. Various methods are known as the Knaus–Ogino method and the rhythm method. The standard days ...
. The Calendar-Rhythm method is also considered a calendar-based method, though it is not well defined and has many different meanings to different people. Systems of fertility awareness may be referred to as fertility awareness–based methods (FAB methods); the term Fertility Awareness Method (FAM) refers specifically to the system taught by
Toni Weschler Toni, Toñi or Tóni is a unisex given name. In Spanish, Italian, Croatian and Finnish, it is a masculine given name used as a short form of the names derived from Antonius like Antonio, Ante or Anttoni. In Danish, English, Finnish, Norweg ...
. The term
natural family planning Natural family planning (NFP) comprises the family planning methods approved by the Catholic Church and some Protestant denominations for both achieving and postponing or avoiding pregnancy. In accordance with the Church's teachings regarding s ...
(NFP) is sometimes used to refer to any use of FA methods, the
lactational amenorrhea Lactational amenorrhea, also called postpartum infertility, is the temporary postnatal infertility that occurs when a woman is amenorrheic (not menstruating) and fully breastfeeding. Physiology Hormonal pathways and neuroendocrine control ...
method and periodic
abstinence Abstinence is a self-enforced restraint from indulging in bodily activities that are widely experienced as giving pleasure. Most frequently, the term refers to sexual abstinence, but it can also mean abstinence from alcohol, drugs, food, etc. ...
during fertile times. A method of FA may be used by NFP users to identify these fertile times. Women who are breastfeeding a child and wish to avoid pregnancy may be able to practice the lactational amenorrhea method (LAM). LAM is distinct from fertility awareness, but because it also does not involve contraceptives, it is often presented alongside FA as a method of "natural" birth control. Within the
Catholic Church The Catholic Church, also known as the Roman Catholic Church, is the largest Christian church, with 1.3 billion baptized Catholics worldwide . It is among the world's oldest and largest international institutions, and has played a ...
and some
Protestant Protestantism is a Christian denomination, branch of Christianity that follows the theological tenets of the Reformation, Protestant Reformation, a movement that began seeking to reform the Catholic Church from within in the 16th century agai ...
denominations, the term natural family planning is often used to refer to Fertility Awareness pointing out it is the only method of
family planning Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marita ...
approved by the Church.


History


Development of calendar-based methods

It is not known exactly when it was first discovered that women have predictable periods of fertility and infertility. It is already clearly stated in the Talmud tractate Niddah, that a woman only becomes pregnant in specific periods in the month, which seemingly refers to ovulation. St. Augustine wrote about periodic abstinence to avoid pregnancy in the year 388 (the
Manichaeans Manichaeism (; in New Persian ; ) is a former major religionR. van den Broek, Wouter J. Hanegraaff ''Gnosis and Hermeticism from Antiquity to Modern Times''SUNY Press, 1998 p. 37 founded in the 3rd century AD by the Parthian prophet Mani (AD ...
attempted to use this method to remain
childfree Voluntary childlessness, also called being childfree, describes the voluntary choice to not have children. In most societies and for most of human history, choosing not to have children was both difficult and undesirable. The availability of rel ...
, and Augustine condemned their use of periodic abstinence). One book states that periodic abstinence was recommended ''"by a few secular thinkers since the mid-nineteenth century,"'' but the dominant force in the twentieth century popularization of fertility awareness-based methods was the
Roman Catholic Church The Catholic Church, also known as the Roman Catholic Church, is the largest Christian church, with 1.3 billion baptized Catholics worldwide . It is among the world's oldest and largest international institutions, and has played a ...
. In 1905
Theodoor Hendrik van de Velde Theodoor Hendrik van de Velde (12 February 1873, Leeuwarden – 27 April 1937 near Locarno in a plane crash) was a Dutch physician and gynæcologist who served as director at the Gynæcological Institute in Haarlem. Biography His 1926 book ...
, a Dutch gynecologist showed that women only ovulate once per menstrual cycle. In the 1920s,
Kyusaku Ogino was a Japanese medical doctor specializing in obstetrics and gynecology. His natural father's family name was Nakamura, but Kyusaku was adopted by the Ogino family in 1901. Ogino studied infertility and developed a method to estimate the ferti ...
, a Japanese gynecologist, and Hermann Knaus, from Austria, independently discovered that ovulation occurs about fourteen days before the next menstrual period. Ogino used his discovery to develop a formula for use in aiding infertile women to time intercourse to achieve pregnancy. In 1930, John Smulders, a Roman Catholic physician from the Netherlands, used this discovery to create a method for ''avoiding'' pregnancy. Smulders published his work with the Dutch Roman Catholic medical association, and this was the first formalized system for periodic abstinence: the
rhythm method Calendar-based methods are various methods of estimating a woman's likelihood of fertility, based on a record of the length of previous menstrual cycles. Various methods are known as the Knaus–Ogino method and the rhythm method. The standard days ...
.


Introduction of temperature and cervical mucus signs

In the 1930s, Reverend Wilhelm Hillebrand, a Catholic priest in Germany, developed a system for avoiding pregnancy based on basal body temperature. This temperature method was found to be more effective at helping women avoid pregnancy than were
calendar-based methods Calendar-based methods are various methods of estimating a woman's likelihood of fertility, based on a record of the length of previous menstrual cycles. Various methods are known as the Knaus–Ogino method and the rhythm method. The standard days ...
. Over the next few decades, both systems became widely used among Catholic women. Two speeches delivered by
Pope Pius XII Pope Pius XII ( it, Pio XII), born Eugenio Maria Giuseppe Giovanni Pacelli (; 2 March 18769 October 1958), was head of the Catholic Church and sovereign of the Vatican City State from 2 March 1939 until his death in October 1958. Before his e ...
in 1951 gave the highest form of recognition to the Catholic Church's approval—for couples who needed to avoid pregnancy—of these systems. In the early 1950s, John Billings discovered the relationship between cervical mucus and fertility while working for the Melbourne Catholic Family Welfare Bureau. Billings and several other physicians, including his wife, Dr. Evelyn Billings, studied this sign for a number of years, and by the late 1960s had performed clinical trials and begun to set up teaching centers around the world.


First symptoms-based teaching organizations

While Dr. Billings initially taught both the temperature and mucus signs, they encountered problems in teaching the temperature sign to largely illiterate populations in developing countries. In the 1970s they modified the method to rely on only mucus. The international organization founded by Dr. Billings is now known as the World Organization Ovulation Method Billings (WOOMB). The first organization to teach a symptothermal method was founded in 1971. John and Sheila Kippley, lay Catholics, joined with Dr. Konald Prem in teaching an observational method that relied on all three signs: temperature, mucus, and cervical position. Their organization is now called Couple to Couple League International. The next decade saw the founding of other now-large Catholic organizations, Family of the Americas (1977), teaching the Billings method, and the Pope Paul VI Institute (1985), teaching a new mucus-only system called the Creighton Model. Up until the 1980s, information about fertility awareness was only available from Catholic sources. The first secular teaching organization was the Fertility Awareness Center in New York, founded in 1981. Toni Weschler started teaching in 1982 and published the bestselling book ''Taking Charge of Your Fertility'' in 1995. Justisse was founded in 1987 in Edmonton, Canada. These secular organizations all teach symptothermal methods. Although the Catholic organizations are significantly larger than the secular fertility awareness movement, independent secular teachers have become increasingly common since the 1990s.


Ongoing development

Development of fertility awareness methods is ongoing. In the late 1990s, the Institute for Reproductive Health at
Georgetown University Georgetown University is a private university, private research university in the Georgetown (Washington, D.C.), Georgetown neighborhood of Washington, D.C. Founded by Bishop John Carroll (archbishop of Baltimore), John Carroll in 1789 as Georg ...
introduced two new methods. The Two-Day Method, a mucus-only system, and CycleBeads and iCycleBeads (the digital version), based on the Standard Days Method, are designed to be both effective and simple to teach, learn, and use. In 2019, Urrutia et al. released a study as well as interactive graph over-viewing all studied fertility awareness based methods.
Femtech Femtech (or female technology) is a term applied to a category of software, diagnostics, products, and services that use technology often to focus on women's health. This sector includes fertility solutions, period-tracking apps, pregnancy and nu ...
companies such as Dot and
Natural Cycles Natural Cycles is a mobile app designed to help women track their fertility. The app predicts the days on which a woman is fertility awareness, fertile and may be used for planning pregnancy and contraception. It was developed by scientist Elina Ber ...
have also produced new studies and apps to help women avoid pregnancy.
Natural Cycles Natural Cycles is a mobile app designed to help women track their fertility. The app predicts the days on which a woman is fertility awareness, fertile and may be used for planning pregnancy and contraception. It was developed by scientist Elina Ber ...
is the first app of its kind to receive FDA approval.


Fertility signs

Most menstrual cycles have several days at the beginning that are infertile (pre-ovulatory infertility), a period of fertility, and then several days just before the next menstruation that are infertile (post-ovulatory infertility). The first day of red bleeding is considered day one of the menstrual cycle. Different systems of fertility awareness calculate the fertile period in slightly different ways, using primary fertility signs, cycle history, or both.


Primary fertility signs

The three primary signs of fertility are '' basal body temperature'' (BBT), ''cervical mucus'', and ''cervical position''. A woman practicing symptoms-based fertility awareness may choose to observe one sign, two signs, or all three. Many women experience secondary fertility signs that correlate with certain phases of the menstrual cycle, such as
abdominal pain Abdominal pain, also known as a stomach ache, is a symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than ...
and heaviness,
back pain Back pain is pain felt in the back. It may be classified as neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia (tailbone or sacral pain) based on the segment affected. The lumbar area is the most common area ...
,
breast tenderness Breast pain is the symptom of discomfort in either one or both breasts. Pain in both breasts is often described as ''breast tenderness'', is usually associated with the menstrual period and is not serious. Pain that involves only one part of a br ...
, and
mittelschmerz ''Mittelschmerz'' (German: "middle pain") is a colloquial term for "ovulation pain" or "midcycle pain". About 20% of women experience mittelschmerz, some every cycle, some intermittently. Signs and symptoms Mittelschmerz is characterized by lo ...
(ovulation pains).


Basal body temperature

This usually refers to a temperature reading collected when a person first wakes up in the morning (or after their longest sleep period of the day). The true BBT can only be obtained by continuous temperature monitoring through internally worn temperature sensors. In women,
ovulation Ovulation is the release of eggs from the ovaries. In women, this event occurs when the ovarian follicles rupture and release the secondary oocyte ovarian cells. After ovulation, during the luteal phase, the egg will be available to be fertilized ...
will trigger a rise in BBT between 0.2º and 0.5 °C. (0.5 and 1.°F) that lasts approximately until the next menstruation. This temperature shift may be used to determine the onset of post-ovulatory infertility. (See ref. 30)


Cervical mucus

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 connects the uterus to the vaginal canal. Fertile cervical mucus promotes sperm life by decreasing the acidity of the vagina, and also it helps guide sperm through the cervix and into the uterus. The production of fertile cervical mucus is caused by estrogen, the same hormone 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.


Cervical position

The
cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...
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.


Cycle history

Calendar-based systems determine both pre-ovulatory and post-ovulatory infertility based on cycle history. When used to avoid pregnancy, these systems have higher perfect-use failure rates than symptoms-based systems but are still comparable with barrier methods, such as diaphragms and
cervical cap The cervical cap is a form of barrier contraception. A cervical cap fits over the cervix and blocks sperm from entering the uterus through the external orifice of the uterus, called the ''os''. Terminology The term ''cervical cap'' has been ...
s. Mucus- and temperature-based methods used to determine post-ovulatory infertility, when used to avoid conception, result in very low perfect-use pregnancy rates. However, mucus and temperature systems have certain limitations in determining pre-ovulatory infertility. A temperature record alone provides no guide to fertility or infertility before ovulation occurs. Determination of pre-ovulatory infertility may be done by observing the absence of fertile cervical mucus; however, this results in a higher failure rate than that seen in the period of post-ovulatory infertility. Relying only on mucus observation also means that unprotected sexual intercourse is not allowed during
menstruation Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of hor ...
, since any mucus would be obscured. The use of certain calendar rules to determine the length of the pre-ovulatory infertile phase allows unprotected intercourse during the first few days of the menstrual cycle while maintaining a very low risk of pregnancy.Kippley (2003), pp.108-113 With mucus-only methods, there is a possibility of incorrectly identifying mid-cycle or anovulatory bleeding as menstruation. Keeping a BBT chart enables accurate identification of menstruation, when pre-ovulatory calendar rules may be reliably applied. In temperature-only systems, a calendar rule may be relied on alone to determine pre-ovulatory infertility. In symptothermal systems, the calendar rule is cross-checked by mucus records: observation of fertile cervical mucus overrides any calendar-determined infertility. Calendar rules may set a standard number of days, specifying that (depending on a woman's past cycle lengths) the first three to six days of each menstrual cycle are considered infertile. Or, a calendar rule may require calculation, for example holding that the length of the pre-ovulatory infertile phase is equal to the length of a woman's shortest cycle minus 21 days. Rather than being tied to cycle length, a calendar rule may be determined from the cycle day on which a woman observes a thermal shift. One system has the length of the pre-ovulatory infertile phase equal to a woman's earliest historical day of temperature rise minus seven days.


Other techniques

Ovulation predictor kits (OPKs) can detect imminent ovulation from the concentration of
luteinizing hormone Luteinizing hormone (LH, also known as luteinising hormone, lutropin and sometimes lutrophin) is a hormone produced by gonadotropic cells in the anterior pituitary gland. The production of LH is regulated by gonadotropin-releasing hormone (GnRH) ...
(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. During this window, ferning structures occur in cervical mucus as well as saliva. Computerized fertility monitors, such as Lady-Comp, are available under various brand names. These monitors may use BBT-only systems, they may analyze urine test strips, they may use symptothermal observations, they may monitor the electrical resistance of saliva and vaginal fluids, or a combination of any of these factors. A symptohormonal method of FAM developed at Marquette University uses the ClearBlue Easy fertility monitor to determine the fertile window. The monitor measures estrogen and LH to determine the peak day. This method is also applicable during postpartum, breastfeeding, and perimenopause, and requires less abstinence than other FAM methods. Some couples prefer this method because the monitor reading is objective and is not affected by sleep quality as BBT can be.


Benefits and drawbacks

Fertility awareness has a number of unique characteristics: * FA can be used to monitor reproductive health. Changes in the cycle can alert the user to emerging gynecological problems. FA can also be used to aid in diagnosing known gynecological problems such as infertility. * FA is versatile: it may be used to avoid pregnancy or to aid in conception. * Use of FA can give insight to the workings of women's bodies, and may allow women to take greater control of their own fertility. * Some symptoms-based forms of fertility awareness require observation or touching of cervical mucus, an activity with which some women are not comfortable. Some practitioners prefer to use the term "cervical fluid" to refer to cervical mucus, in an attempt to make the subject more acceptable to these women. * Some drugs, such as decongestants, can change cervical mucus. In women taking these drugs, the mucus sign may not accurately indicate fertility. * Some symptoms-based methods require tracking of basal body temperatures. Because irregular sleep can interfere with the accuracy of basal body temperatures, shift workers and those with very young children, for example, might not be able to use those methods. * FA requires action daily—detailed record keeping. Some may find the time and detail requirements too complicated.


As birth control

By restricting unprotected sexual intercourse to the infertile portion of the menstrual cycle, a woman and her partner can prevent pregnancy. During the fertile portion of the menstrual cycle, the couple may use
barrier contraception Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
or abstain from sexual intercourse.


Advantages

* There are no drug-related side effects to FA. * FA can be free or have a very low up-front cost. Users may employ a coach, use computer software, or buy a chart, calendar, or basal thermometer. The direct costs are low when compared to other methods. * FA can be used with barrier contraception so that intercourse may continue through the fertile period. Unlike barrier use without FA, practicing FA can allow couples to use barrier contraception only when necessary. * FA can be used to immediately switch from pregnancy avoidance to pregnancy planning if the couple decides it is time to plan for conception.


Disadvantages

*Use of a barrier or other backup method is required on fertile days; otherwise the couple must abstain. To reduce pregnancy risk to below 1% per year, there are an average of 13 days where abstinence or backup must be used during each cycle. For women with ''very'' irregular cycles—such as those common during breastfeeding, perimenopause, or with hormonal diseases such as
PCOS Polycystic ovary syndrome, or PCOS, is the most common endocrine disorder in women of reproductive age. The syndrome is named after the characteristic cysts which may form on the ovaries, though it is important to note that this is a sign and no ...
—abstinence or the use of barriers may be required for months at a time. *Typical use effectiveness is lower than most other methods. *Fertility awareness does not protect against
sexually transmitted disease Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and oral ...
.


Effectiveness

The effectiveness of fertility awareness, as of most forms of
contraception Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
, can be assessed two ways. ''Perfect use'' or ''method'' effectiveness rates only include people who follow all observational rules, correctly identify the fertile phase, and refrain from unprotected intercourse on days identified as fertile. ''Actual use'' or ''typical use'' effectiveness rates include all women relying on fertility awareness to avoid pregnancy, including those who fail to meet the "perfect use" criteria. Rates are generally presented for the first year of use. Most commonly, the
Pearl Index The Pearl Index, also called the Pearl rate, is the most common technique used in clinical trials for reporting the effectiveness of a birth control method. It is a very approximate measure of the number of unintended pregnancies in 100 woman-years ...
is used to calculate effectiveness rates, but some studies use
decrement table Decrement tables, also called life table methods, are used to calculate the probability of certain events. Birth control Life table methods are often used to study birth control effectiveness. In this role, they are an alternative to the Pearl Ind ...
s. The failure rate of fertility awareness varies widely depending on the system used to identify fertile days, the instructional method, and the population being studied. Some studies have found actual failure rates of 25% per year or higher. At least one study has found a failure rate of less than 1% per year with continuous intensive coaching and monthly review, and several studies have found actual failure rates of 2%–3% per year. When used correctly and consistently (i.e., with perfect use) with ongoing coaching, under study conditions some studies have found some forms of FA to be 99% effective.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.
From ''Contraceptive Technology'':James Trussell et al. (2000) "Contraceptive effectiveness rates", ''Contraceptive Technology'' — 18th Edition, New York: Ardent Media. On-press. * Post-ovulation methods (i.e., abstaining from intercourse from menstruation until after ovulation) have a method failure rate of 1% per year. * The symptothermal method has a method failure rate of 2% per year. * 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.


Reasons for lower typical-use effectiveness

Several factors account for typical-use effectiveness being lower than perfect-use effectiveness: * conscious user non-compliance with instructions (having unprotected intercourse on a day identified as fertile) * mistakes on the part of those providing instructions on how to use the method (instructor providing incorrect or incomplete information on the rule system) * mistakes on the part of the user (misunderstanding of rules, mistakes in charting) The most common reason for the lower actual effectiveness is not mistakes on the part of instructors or users, but conscious user non-compliance—that is, 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.


To achieve pregnancy


Intercourse timing

A 2015 review found insufficient evidence to draw any conclusions about the effect of timing intercourse on the rate of live births or pregnancies, compared to regular intercourse. 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. Because of high rates of very early
miscarriage Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical lo ...
(25% of pregnancies are lost within the first six weeks since the woman's last menstrual period, or LMP), the methods used to detect pregnancy may lead to bias in conception rates. Less-sensitive methods will detect lower conception rates, because they miss the conceptions that resulted in early pregnancy loss. A Chinese study of couples practicing random intercourse to achieve pregnancy used very sensitive pregnancy tests to detect pregnancy. It found a 40% conception rate per cycle over the 12-month study period. Pregnancy rates for sexual intercourse are also affected by several other factors. Regarding frequency, there are recommendations of sexual intercourse every 1 or 2 days, or every 2 or 3 days. Studies have shown no significant difference between different
sex positions A sex position is a position of the body that people use for sexual intercourse or other sexual activities. Sexual acts are generally described by the positions the participants adopt in order to perform those acts. Though sexual intercourse ge ...
and pregnancy rate, as long as it results in
ejaculation Ejaculation is the discharge of semen (the ''ejaculate''; normally containing sperm) from the male reproductory tract as a result of an orgasm. It is the final stage and natural objective of male sexual stimulation, and an essential componen ...
into the
vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
. Social science research has found that timing intercourse can become a gendered 'chore' in heterosexual married couples trying to conceive, with women tracking their ovulation cycles and dictating to their husbands when they should have sexual intercourse.


Problem diagnosis

Regular menstrual cycles are sometimes 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 anovulatory 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. If this condition is diagnosed, some sources suggest taking
guaifenesin Guaifenesin, also known as glyceryl guaiacolate, is an expectorant medication that aids in the elimination of sputum from the respiratory tract. Chemically it is an ether of guaiacol and glycerine. It is often used in combination with other me ...
in the few days before ovulation to thin out the mucus.


Pregnancy testing and gestational age

Pregnancy test A pregnancy test is used to determine whether a female is pregnant or not. The two primary methods are testing for the female pregnancy hormone (human chorionic gonadotropin (hCG)) in blood or urine using a pregnancy test kit, and scanning with ...
s 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 In obstetrics, gestational age is a measure of the age of a pregnancy which is taken from the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method if available. Suc ...
than the traditional pregnancy wheel or last menstrual period (LMP) method of tracking menstrual periods.Weschler (2002), pp.3-4,155-156, insert p.7


See also

* Billings ovulation method * Creighton Model FertilityCare System *
Fertility monitor Fertility testing is the process by which fertility is assessed, both generally and also to find the "fertile window" in the menstrual cycle. General health affects fertility, and STI testing is an important related field. Women Healthy women ...
*
Lactational amenorrhea method Lactational amenorrhea, also called postpartum infertility, is the temporary postnatal infertility that occurs when a woman is amenorrheic (not menstruating) and fully breastfeeding. Physiology Hormonal pathways and neuroendocrine control ...
*
Kindara Kindara is a femtech company headquartered in Colorado that develops apps that help women identify their fertile window. The products are used for women trying to get pregnant, or women who want to track their menstrual cycle for overall health. ...


References


Further reading

* * {{DEFAULTSORT:Fertility Awareness