Fertility Awareness Method (FAM)

Back in April 2004, I heard about this book called Taking Charge of Your Fertility (TCOYF). Basically, it explains the changes that a woman's body goes through during her cycle each month, and how she can observe these changes in order to achieve or prevent pregnancy. I was on the birth control pill at the time and wasn't liking it - I didn't like being on medication, I didn't like not knowing what it was doing to my cycle, and it definitely affected my libido - not good when you're newly married! So Val and I discussed the possibility of trying FAM as birth control instead, and decided to give it a try.

A quick overview of FAM - a woman's cycle consists of 2 phases. The first phase is the preovulatory phase, which begins with menstruation and lasts until she ovulates. Then she is in her postovulatory phase (or luteal phase), and that lasts until her next period (and cycle) starts. Typically, the length of menstruation and luteal phase are essentially the same each cycle. So if a woman's period lasts 4 days, and her luteal phase is 13 days long, that will basically be the same in each cycle. However, the length of her preovulatory phase can vary greatly, as her body gets ready to ovulate. If she is sick, stressed, travelling, or has any other disturbance, her body may delay ovulation until it is ready to support a potential pregnancy. The average length of the preovulatory phase is 14 days (from the start of menstruation), and the average length of the luteal phase is 14 days, leading to the typical 28 day cycle. However, these are just averages and most woman will vary from these numbers somewhat.

During the preovulatory phase, as the body gets ready to ovulate, the basal body temperature (measured immediately upon waking after at least 3 hours of sleep) is low because of the estrogen in the system. As the levels of estrogen increase, the body starts to produce cervical fluid. This cervical fluid provides a medium for the sperm to live in while travelling to and waiting for the egg to be released. Initially, sticky cervical fluid is noticed. Then a more creamy and wet cervical fluid appears, and finally an egg-white like quality, lubricative cervical fluid is produced in the day(s) leading up to ovulation. This egg-white cervical fluid is the most fertile, allowing sperm to survive for up to 5 days. However, both sticky and creamy cervical fluid can also support sperm, so the observation of any of these fluids indicate fertility and impending ovulation.

Once ovulation occurs, the body produces progesterone to support a fertilized egg. The increased levels of progesterone, as well as the drop is estrogen levels, stops cervical fluid from being produced. As well, it produces an noticeable increase in the basal body temperature. These higher temperatures will last until the next cycle starts, and drop back down to low levels during a woman's period when the amount of progesterone produced decreases.

By paying attention to these two signs, a woman can determine when she is fertile and infertile, and take the appropriate steps to either achieve or prevent pregnancy. After her period has stopped, she looks for cervical fluid to indicate fertility. She also tracks her temperatures, watching for them to increase to indicate ovulation. Once her temperatures jump at least 0.2 degrees above the highest temperature recorded during her preovulatory phase and stay there for 3 days, and she also notices the absence of her highest-quality cervical fluid for at least 4 days, she knows she has ovulated.

It is possible for the body to attempt to ovulate multiple times before it finally does. The appearance and disappearance of cervical fluid, without an accompanied temperature shift, indicate that the body tried to ovulate but didn't. Only an increase in temperature confirms that body actually did ovulate, and it can only do that once per cycle.

It's also possible that a woman won't ovulate at all during a particular cycle - this is called an annovulatory cycle. Basically, no increase in temperature is observed before her next period arrives, and so there would have been no opportunity to get pregnant that cycle.

FAM is great because you can really learn about your body and cycle, and also learn about potential problems that may arise when you're trying to conceive. If a woman is consistently having annovulatory cycles, and so not ovulating, she will obviously have trouble getting pregnant. She may not know this if she is not charting, as her body may still produce cervical fluid and even get ready to ovulate (which would potentially result in a positive ovulation predictor kit (OPK) test). Without also charting her temperatures, she would not know for sure whether she is actually ovulating or not. As well, the length of the luteal phase and the level of progesterone (reflected in the degree of the temperature shift) can also indicate potential problems with conceiving. If the luteal phase is too short (usually it needs to be at least 10-12 days long), then a fertilized egg may not have enough time to implant before the next period starts, thereby preventing the pregnancy from "sticking". As well, if the levels of progesterone aren't high enough (which are sometimes indicated by temperatures that drop back down to lower levels during the luteal phase), it may not support a fertilized egg and again, the pregnancy is prevented.

Thus, a woman with a 28 day cycle may be trying to get pregnant by having intercourse on day 14 (when she thinks she ovulates), but if she actually ovulates on day 19, and then only has an 9 day luteal phase, she is 1) much less likely to conceive 5 days before she ovulates, and 2) unlikely to support a pregnancy if she did conceive because her luteal phase is too short. Only by charting would she be able to determine when is the best time to try to conceive, and also if she should be taking any supplements of medication to try to extend her luteal phase to a reasonable length.

Anyways, I guess that wasn't exactly brief, but it gives a basic overview of FAM. We used FAM to avoid for 33 cycles. During that time, I learned a lot about my body and felt very comfortable with our contraception. I found out that my luteal phase is a bit short (10-11 days), so I started taking vitamin B6 supplements to help support that. It was also great to know pretty much the day that my period would arrive, since once I observed ovulation, I knew it would arrive 10-11 days later. And it took us just one cycle (we were lucky!) to conceive - we timed everything correctly, and I got my BFP (big fat positive!) at only 10 days past ovulation (10dpo). In fact, by knowing that my luteal phase rarely went beyond 11 days, I would have known I was pregnant without a pregnancy test if my period hadn't arrived by 14dpo, because it has never been that long before. But I wasn't patient enough to wait that long :)

So that's my experience with FAM. I really think it is a great thing for a woman to do, as she learns so much about her body, regardless of whether she wants to conceive or avoid. It's natural and informative, and gives a better chance at conception when trying to get pregnant.