Fertility Awareness PDF Print E-mail
Written by Dr. Rehan Zaidi   
Trying to have children can turn out to be a very beautiful and sometimes very trying situation. For those who have had difficulties getting pregnant, even repeated trips to the doctor's office may not have provided them with any real understanding of the natural process of fertility. Instead couples may find themselves being directed to intrusive interventions that may be right for some, but perhaps too early for others. Below are some important tips that all couples should know if trying to conceive so they may maximize their chances of getting pregnant naturally.

1. Mittleschmerz  

It is important to understand the peculiar pain of mittelshmerz, an obviously German word for pain in the middle of the cycle. The value of staying in touch with our bodies cannot be emphasized enough and it allows for us to know the state of our wellbeing without having to be told by laboratory tests. Many women often can feel a sharp pain somewhere in the middle of their period but may not pay any attention to it. This pain is felt to different degrees by women and actually corresponds to the time when the ovaries are releasing a fully developed egg into the fallopian tubes, ie ovulation. It is felt on one side of the abdomen or the other, over the approximate area of where the ovaries may be, approximately one hand width lateral to the umbilicus.  

2. Basal Body Temperature

The temperature of the body throughout the month can be charted by women as a method to discover when they have ovulated. The most accurate way to do this is by keep an oral thermometer right beside the bed and taking temperature first thing each morning. The more regular the schedule of sleeping and waking can be will allow less variables to affect the reading since subtle temperature changes happen and are affected by to many causes, such as circadian rhythm. Therefore, a women who is charting should attempt to wake up at approximately the same time daily and immediately place the thermometer into her mouth with as little movement as possible.  

  • What she will find is that her temperature will dip slightly just prior to ovulation, then increases after ovulation (0.4-1.0°F). This higher temperature will then remain high for the rest of the cycle. She is fertile at the point the temperature change occurs.
  •  Observe any special circumstances, such as a "double peak" in temperature which can happen under stress or illness

3. Cervical Mucus   This is another natural and easy to use method that can be observed at home. It confirms ovulation (the day that her egg is released) by evaluating cervical mucus. The best way to get a handle on the subtle changes of cervical mucus, it is recommended that one make a chart of mucus characteristics. This should preferably be done for one month of abstinence to precisely note all differences.  

  • After the period is finished and the flow has stopped, but before ovulation, is when she is not fertile. These are called dry days although there always is some mucus. During this non-fertile stage the mucus is thick, cloudy and sticky. Think of the mucous as almost too viscous to allow sperm to traverse easily through it to reach the egg.
 
  • During her ovulation is considered the "peak period", which is three days on either side of the day she ovulates. During this time she is most fertile and the mucus will start off as sticky, and then gradually becomes creamier and slipperier. At its peak it will have a thin, clear and stringy consistency, almost like egg white. The way to test for this is if the mucus is stretched in between 2 fingers, a thin strand approximately 6cm/2.5 inches or greater will result.
 
  • This mucus will last for just about two days then it will begin to get thicker and stickier. These are the  post-peak days, also known as the luteal phase. This is when PMS symptoms will begin to make an appearance and she is now again non-fertile ® The mucus will remain on the thicker, sticky side until your period starts.

Method of evaluating cervical mucus:

Method A) An inserted finger that collects some discharge can provide enough mucus for a simple self evaluation. Performed twice a day and charted immediately after so not to forget is the best way to determine the mucus change.

Method B) If the above is not convenient then it even be done by taking a look at your toilet paper about twice a day. After wiping during a regular trip to the washroom simply evaluate any residue collected by the methods

Creating a chart:

Adapted from “The Fertility Sourcebook”, by M. Sara Rosenthal

Creating a chart will make it easy for you to look back and precisely know what is happening with respect to your fertility. It is much better than trying to make a mental note and then thinking back without surety. Using the coding method below you can combine numbers to get an accurate picture.

a) A number coding system to describe the consistency of the mucus can be such as the following;  0=dry; 1=damp, but not lubricated; 2=wet, but not lubricated; 3=shiny, but not lubricated; 4=damp and lubricated; 5=wet and lubricated; 6=shiny and lubricated.

b) The finger test again can be made into a code to describe the consistency. For example: 7=sticky; 8=tacky; 9=stretchy; 10=pasty; 11=gummy or glue-like.

Adding the numbers will allow you get the most accurate picture of the peak fertility period. Mucus that is a 5 on the first reading and 9 on the second is your peak mucus, while a 5 and 10 would represent your cycle past your peak mucus days.

c) Also Use a coding system to observe the color of the mucus. For example, B=brown; W=white or cloudy; C=clear; T=transparent; Y=yellowish or off-white; R=red or pink (your menstrual flow).

What if there is no Mucus?

This may be a potential cause for more intervention. Without cervical mucus, sperm can't survive or be transported to the fallopian tubes to fertilize the egg. The mucus also has the important role of nourishing and protecting the sperm. With healthy mucus secretion sperm can survive anywhere from three to five days in the women’s body. If there are no mucosal changes then it may be a sign that you are not ovulating, have a hormone deficiency, or need to checked by your physician for further investigation.

4. Cervical Changes

Another useful observation that will allow her to get more in touch with her body is by doing self examinations of the cervix. Below are the changes that correspond to different stages of fertility.

  • After menstruation she will commonly find the cervix is slightly firm, closed and tilted backwards towards the rectum. This is a period of non-fertility.
  • As estrogen levels rise the cervix becomes softer, partially open and straight.
  • Then, around her ovulation the cervix changes again to become very soft, very open and tilted almost vertically. This change corresponds to the stringy cervical mucus period and is during the window of fertility.
  • After ovulation until menstruation again the cervix goes back to becoming more firm, closed and tilted backwards.
  • During menstruation many fertility books will mention that it is also fertile time. The reason is largely precautionary only for those with shorter cycle because sometimes sperm may be able to survive until ovulation. 

5. The Safe Zone

Figure out the days of the month that she is fertile and when she is not. These are the days to focus on for couples trying to conceive or the days to avoid for those using natural family planning methods. Note, however, that this method gives an over-estimate of the number of fertile days. The way to determine this "safe zone" therefore is the following: 

  • Track last 6 cycles that she has had
  • Subtract 18 days from shortest cycle (ex. 26-18 = 8)
  • Subtract 11 days from longest cycle (ex. 32-11 = 21)
  • Between these days is when she is most FERTILE (from days 8-21)

The Crux

The above methods are natural and easy ways for women to get in touch with their own bodies and being in more control by being in the know. Although often times other medical interventions are necessary, it is best to avoid invasive procedures when one has the option. Understanding fertility is a safe and health way to increase any couple's chances of getting pregnant.

 
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