With the recent discussions about pregnancy and birth control, I thought I’d give a little glimpse into the day-to-day life of someone who uses no artificial contraception and has a healthy and enjoyable sex life. Just a few things to get out the way early, this post is going to get pretty clinical, and probably NSFW, as we’ll be discussing the female reproductive system in detail. I’d also like to put it out there that my husband and I are Catholics, so we use FAM/NFP for religious reasons on top of its other benefits. If you’re not Catholic, or indeed religious at all, don’t worry - I’m not here to proselytize, but it is somewhat relevant that I am approaching NFP/FAM from a position that artificial contraception in all forms, as well as male orgasm outside of the wife’s vagina, is improper for married Catholics.

So! Onto business! What is NFP/FAM, anyways? NFP stands for Natural Family Planning, and FAM stands for Fertility Awareness Method, but they both mean the same thing; the usage of the knowledge of your own cycle to either achieve or avoid pregnancy without the assistance of any imposed change onto the body or the sex act. No pills, plastic, latex, heavy metals, scalpels, or needles involved. I’ll use both acronyms interchangeably, but I learned about it as NFP, so that is more comfortable to me. In addition, I believe “NFP” has the connotation of being specifically Catholic - I’m not sure why, it’s not like the actual method changes. You can get good information through Google with either acronym.

Why use FAM over more the widespread artificial methods to avoid pregnancy? The benefits are myriad, but I’ll hit a few of the major ones that should be applicable to most women. Firstly and most importantly, FAM teaches and empowers you with regard to your own body. Now, I know that sentence sounds awfully feminist, but I also know that, if you’re like me, your education on your own reproductive system was woefully inadequate, talked about quickly and possibly shamefully, with the note that you’ll bleed roughly once a month, and something about a cervix. No discussion of odd cycles, non-menstrual cervical fluid, what different types of pain might mean, and why we bleed once a month, or how this relates at all to what the body’s doing for the other 80% of the month! Frankly pathetic. So, women are taught to pop a pill, and our problems will disappear. Doctors treat the female fertility cycle as something to be controlled and doped into submission, or assume that women are uninterested in why these symptoms are there over the mindless, easy means to “make them go away.”

Okay, sorry, bit of a rant there. Other reasons to use NFP: it’s free, and I don’t mean insurance-style free, I mean, once you buy the thermometer, it’s freeeeeeeeeeee for all the time you use it. There are zero side effects: no bloating, no weird appetite, no drop in libido, no chance of a bit of copper stabbing you in the uterus or getting stuck, nothing. This also means you can stop at any time, for any reason! Every day is essentially a risk vs reward assessment: “There’s an X% chance that if I have sex today, I’ll get pregnant. Do I want to take that chance?” And then you answer how you see fit. The same knowledge can be used to help you avoid pregnancy, or to get pregnant, with zero change in what you’re doing (except maybe more sex if you’re trying to get pregnant). Also, an unexpected benefit is that it encourages communication and understanding between partners and flourishes best in the context of a stable, committed, intimate relationship. Lastly, any change in your cycle will be immediately known to you, rather than masked. Early knowledge of these changes can help you identify and discuss accurately the potential of illness or other problems with a trusted gynecologist.

Is FAM effective? I’m sure some of you have at least heard the term “Vatican roulette” with regards to early forms of NFP. We’ve all heard the joke, “What do you call a guy who pulls out? A father.” Haha, very funny. But in reality, if used accurately, FAM has an effectiveness that is equal to or surpasses most artificial contraception out there. The reason it’s often chided is that it is more difficult to learn, understand, and use correctly than artificial methods of avoiding pregnancy. There is an upfront cost of time and money, and an ongoing cost in commitment and dedication. The other major drawback is simply a biological fact: women are most receptive to sex and most easily aroused when they are most fertile. If you’re unwilling to use another method during this period, it can be somewhat frustrating, both for you and your partner. On the other hand, I choose to view it as a beautiful way to cultivate my own attraction and attractiveness during the other times of the month, because I am more than my hormones.

Now that I’ve done 850 words of ranting and raving without actually talking about how to utilize NFP, I suppose I can get into the meat of things. In essence, the female reproductive cycle is split into three phases. The first is the follecular phase, or the pre-ovulation phase. This is when the ovary prepares an egg for release. It is characterized by a high amount of follicle-stimulating hormone (FSH), and a gradual increase in oestrogen. Once the egg reaches maturity, fueled by these two hormones, it triggers a sudden spike in luteinizing hormone, which triggers the release of the egg, and a rise in progesterone to further facilitate the development of the uterine lining. Now that the egg is released, one of two things can happen: you can have a period, or you can get pregnant. This phase is called the luteal phase. As the egg kicks around, the follicle from which it came (now known as the corpus luteum) gradually puts out lower and lower levels of oestrogen and progesterone. Once these levels are low enough, the body decides that pregnancy isn’t going to happen, and you have a period, while another follicle is recruited to start the whole thing over again. Therefore, the most fertile days, once accounting for sperm lifespan in non-hostile cervical fluid (there’s a phrase for the quote book), are the 4-5 days leading up to ovulation and the day of ovulation.

Okay, that’s nice and all, but how does a woman actually go about figuring out when she’s fertile? There are three major signs of fertility that can be easily tracked, and a couple others than can be used as a more secure backup.

  1. Cervical mucus: The vagina is a naturally acidic (PH < 7) place and fairly hostile to sperm, which is carried in an alkaline (PH > 7) fluid. The closer to ovulation the woman is, the more the vagina accommodates sperm, PH-wise. The consistency and amount of mucus or fluid produces is also a good indicator. Right after menstruation, there is typically very little mucus, and it's thick and often opaque - a bit like school paste. As you progress, you get slightly thinner, and sort-of opaque, maybe like lotion or coconut oil. The mucus ideal for conception is stretchy, clear, abundant, and sticky - think raw egg white. If you're on any fertility/NFP forums and you see "EWCM" = egg white cervical mucus. Then after the fertility window, you cycle back down until you undergo menstruation again. Here is a SFW photo showing the different types of mucus. You test mucus... ahem, exactly how you would think. Wash your hands first!

  2. Basal body temperature: The human body temperature varies throughout the day based on the last time we ate or drank, how long we've been awake, the weather outside, etc. In order to minimize these variables, NFP uses the basal body temp (the lowest body temp, which happens during long periods of sleep). At the time of ovulation, due to the spike of hormones, this temperature will increase by about a half-to-whole degree F (quarter-to-half degree C). You get this with a special BBT thermometer (regular do-i-have-a-fever ones aren't sensitive enough) and taking your temperature the MOMENT you wake up and recording it. Note, this tells you when ovulation has already occurred, so it's not terribly useful for predicting ovulation until you get the hang of tracking it.

  3. Cervical position: As I mentioned in point 1, the vagina is typically pretty hostile to semen. The cervix changes position throughout the cycle and becomes softer and opens slightly to accommodate semen during ovulation. Here is a handy dandy picture to show what I’m talking about. During non-fertile times, the cervix will be high/far (difficult to reach), and will be hard, like the tip of your nose. As ovulation nears, the cervix will lower slightly, open a little, and grow softer, feeling more like your earlobe. Again, you test this exactly how you might think. (Clean hands!) This is probably the most difficult to really get a feel for (ha).

  4. LH Tracking: You can also buy a packet of strips every month that test for the surge of lutenizing hormone that correlates with ovulation. These work the exact same way as a pregnancy test - via urine sampling. The only trick here is that generally you don’t want to use the first morning urine; if your LH surge starts in the afternoon, you’d miss it! So for these tests, you test about the same time every day, any time after about 10AM.

You'll see lots of "methods" thrown around (Billings, Marquette, etc) - they're all just combinations of these four tracking methods. My recommendation is to download the very excellent app Kindara on the mobile device of your choice. Not only does it have all the tracking tools you could possibly want, but you can also post your charts (anonymously) to other users, who can then help you interpret it until you get the hang of reading your own chart. It comes with a Bluetooth-enabled fancy-pants thermometer called Wink but I use a regular BBT thermometer just fine. The only benefit of getting Wink is that you don't have to fumble with typing anything in at the crack of dawn, as it auto-syncs.

This has turned into an absolute novel, but if you want more information, you can pick up the very excellent and non-religious book ”Taking Charge of Your Fertility” which goes into even more detail. I also enjoyed ”The Sinner’s Guide to NFP” but it’s a specifically Catholic book, so it understandably might not appeal to non-Catholics or non-Christians.

I am also familiar with lactational amenorrhea method (LAM) as a means to space births, but I’ve already ranted for far too long. But I can say that I did not ovulate for a full year after my son was born because I co-slept, wore him in a sling, and breastfed on demand for nutrition and comfort throughout the first year.

If anyone has any questions about my personal experience with either NFP or LAM, please feel free to ask!