Understanding fertility is important for all women. Fertility is defined as the ability to conceive a child (1). Being able to identify the fertile window within the menstrual cycle is important in order to time sex correctly for conception (2). The ability to recognise this fertile period within the menstrual cycle is known as fertility awareness (3). This awareness can be used not only as a way to achieve pregnancy, but as a natural contraception or even as a way to monitor menstrual health. Despite its importance, fertility awareness is often misunderstood (4, 5).

Sadly, in Australia, infertility is common with 1 in 6 couples being affected (4). Infertility is defined as being unable to conceive after 12 months of regular unprotected sex (1). As mentioned, being able to identify the fertile time during the menstrual cycle is key to timing sex correctly when trying to get pregnant (2). However a study has found that even though many women believe they are timing sex within their fertile window, most were found to have a low knowledge of their fertile time (5). Of 204 infertile women attending two IVF clinics in Australia and seeking help with getting pregnant, 68.2% of women thought they had mostly timed sex within their fertile window (5). However, it was found that only 12.7% of those women were accurately pinpointing their fertile time (5). These numbers are despite 86.8% of women having tried to gain more fertility awareness knowledge through various sources, such as information on the internet (5). This indicates that low fertility awareness knowledge could be playing a role in some couples’ infertility and that the sources women are seeking for this information may be of low quality (5).

It is important to seek help from someone who is trained to provide this information in order to ensure accuracy (5). This is one of the roles of Natural Fertility Educators and they could provide an important missing link in the conception journey for couples. GP’s are commonly the first point of contact for couples who are having difficulty conceiving, however most GP’s do not have training in fertility awareness methods and are unable to provide this information (5). Couples are often referred directly to a fertility specialist without first exploring the couple’s knowledge of the fertile window (5).

Getting pregnant is only possible within a short time frame each month and timing sex to coincide with this window is the key to getting pregnant naturally (2). The body produces indicators of fertility in response to the hormonal changes that take place throughout the menstrual cycle (6). There are three main fertility awareness methods used to identify the fertile window: rhythm, mucus & temperature (3).

The rhythm method (also known as the calendar method), is an outdated way of tracking fertility (6). It uses the length of a woman’s previous menstrual cycles to predict the fertile window (7). As the menstrual cycle varies, even for women with a regular menstrual cycle, it is not an accurate indicator of fertility (2). Many fertility tracking apps use this method to calculate its user’s fertile window which is something to be wary of.

The cervical mucus method (also known as the Billings ovulation method), is an accurate way to identify a woman’s fertile window (4). Women make daily observations of their cervical mucus by noting the sensation of the cervical mucus at the vulva (the skin outside of the opening of the vagina) (8). Cervical mucus changes in response to the hormonal changes that occur throughout the woman’s menstrual cycle (8). On average, fertile cervical mucus occurs for 6 days prior to ovulation (4). When fertile cervical mucus is present, it is possible for sperm to survive for up to 5 days (6). Fertile cervical mucus also provides channels for the sperm to safely make their way to the egg (9). Fertile cervical mucus can be identified by the presence of a slippery sensation at the vulva (8). The final day of this sensation is known as the Peak day and the most probable day of ovulation (8,9). The sensation of the cervical mucus outside of the fertile window will be a feeling of either dryness or slight moistness (8). 

The temperature method uses the basal body temperature (BBT) to determine ovulation in retrospect (4). Basal body temperature is the body’s lowest natural temperature which usually happens after a minimum of 6 hours undisturbed sleep (4). When ovulation occurs, the basal body temperature rises by 0.3-0.6°C (6). This occurs because soon after ovulation, when the egg is released from the follicle (the sac where the egg comes from), it transforms into a gland called the corpus luteum (10). The corpus luteum starts to secrete a hormone called progesterone (10). The progesterone then communicates with the part of the brain that controls the body’s temperature (the hypothalamus) and tells it to increase the body’s basal temperature in preparation for possible pregnancy (11). 3 days of temperatures higher than the previous 6 temperatures are needed to confirm ovulation (4). If pregnancy has not occurred, the temperature remains elevated until the next period (4). 

Due to only being able to determine ovulation in retrospect, it is preferable to combine the mucus method with the temperature method (4). This is known as the symptothermal method (4). Practicing this method may be particularly useful for women with irregular menstrual cycles (4).

Whether trying to get pregnant, avoid getting pregnant or monitoring menstrual health, learning fertility awareness provides valuable knowledge and is a way for women to feel empowered about their body.

Every woman deserves access to reliable information about their fertility. Although there is a lot of information available on the internet, learning the cervical mucus method or symptothermal method through a trained teacher, like myself, is important to ensure correct application of the method. For more information or to work with me, visit joeybegent.com.

References

1. Borght, M., & Wyns, C. (2018). Fertility and infertility: Definition and epidemiology. Clinical Biochemistry, 62, 2-10. https://www.sciencedirect.com/science/article/abs/pii/S0009912018302200
2. Wilcox, A. J., Dunsen, D., & Baird, D.D. (2000). The timing of the “fertile window” in the menstrual cycle: day specific estimates from a prospective study. BMJ, 321(1259). https://doi.org/10.1136/bmj.321.7271.1259
3. Hampton, K., & Mazza, D. (2015). Fertility-awareness knowledge, attitudes and practices of women attending general practice. Australian Family Physician, 44(11), 840-845. https://pubmed.ncbi.nlm.nih.gov/26590626/
4. Hampton, K., & Newton, J. (2016). Assisting women to conceive: a clinical update on fertility awareness. Australian Nursing and Midwifery Federation, 24(1). https://pubmed.ncbi.nlm.nih.gov/29236432/
5. Hampton, K., Mazza, D., & Newton, J. (2013). Fertility-awareness knowledge, attitudes, and practices of women seeking fertility assistance. Journal of Advanced Nursing, 69(5), 1076-1084. https://pubmed.ncbi.nlm.nih.gov/22764878/
6. Pallone, S. R., & Bergus, G, R. (2009). Fertility awareness-based methods: another option for family planning. The Journal of the American Board of Family Medicine, 22(2), 147-157. https://www.jabfm.org/content/22/2/147.long
7. World Health Organization and Johns Hopkins Bloomberg School of Public Health. (2018). Family planning a global handbook for providers. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/260156/9780999203705-eng.pdf?sequence=1
8. Billings, E., & Westmore, A. (2011). The Billings Method (9th ed.). Melbourne: Anne O’Donovan Pty Ltd.
9. Odeblad, E. (1994). The discovery of the different types of cervical mucus. Bulletin of the Natural Family Planning Council of Victoria, 21(3), 1-34.
10. Stocco, C., Telleria, C., & Gibbori, G. (2007). The molecular control of corpus luteum formation, function and regression. Endocrine Reviews, 28(1), 117-149. https://doi.org/10.1210/er.2006-0022
11. Steward, K., & Raja, A. (2020). Physiology, ovulation and basal body temperature. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546686/