Using Fertility Awareness-Based Methods To Conceive (Episode 554)

Full Transcript: Episode 554

Lisa Hendrickson-Jack: This is the Fertility Friday Podcast, episode number 554. Today I’m sharing another brand new episode in my FAMM Research Series, and today I’m sharing a bit of a unique study. It is a qualitative study. For those of you who’ve tuned in to previous FAMM Research Series episodes, you know qualitative research studies are a little bit different — because instead of focusing on straight numbers and data, they’re focusing on typically the experiences of their participants in their own words. I really enjoy it when I find qualitative studies on topics of interest so that we can dig into what women are actually saying about the things that are going on in their lives. In many ways, qualitative studies validate our feelings, our hunches, and our qualitative experiences — our description and experience of things that have happened in our lives. So without further ado, let’s go ahead and jump into today’s study.

This study is actually based on women’s experiences of fertility awareness-based methods. I’ll say from the get-go that the sample size is really small. As a fertility awareness educator who’s been in the field for quite a long time, I think there’s certainly opportunity in the future to gather data from far more women to share their experiences. But with that said, I have never seen a study like this. It is called a pilot study. The title is “A Pilot Qualitative Case Study of Women’s Experiences with Fertility Awareness-Based Methods.” In this study, they’re interviewing two women specifically about their personal experience using fertility awareness, and certain themes emerged which we’ll go through today. Interestingly, even though the sample size is small, I have certainly seen very similar themes working with women over the years. Even small, published case study research is very useful — and it should be a jumping off point for larger studies to validate those initial findings.

Why did these researchers decide to do this study? In their words, little is known about women’s journey of using fertility awareness-based methods to achieve pregnancy. They go on to say it’s essential that healthcare providers understand women’s experiences and perceptions of using a variety of FABMs to achieve pregnancy during this special and important period of time. The women in this case study were specifically using FABMs with the intent of achieving a pregnancy — they were actively trying to conceive. The researchers were wanting to elicit this data to make recommendations for how providers could improve their care.

Another reason they chose this topic: statistically, we’re seeing an increase in couples trying to achieve pregnancy. They cite a CDC 2019 statistic that 12.1% of women aged 15 to 44 in the United States have difficulty getting pregnant or carrying a pregnancy to term — right in line with the broader statistic that about 15%, or about one in six couples, struggle with fertility challenges or take longer than average to conceive. Fertility awareness-based methods can improve the chances for many couples. This question came up on a recent FAMM practitioner call: does fertility awareness on its own — just tracking the cycle, understanding the fertile window, and timing sex correctly — improve the chance of conception? Interestingly, there are a number of research studies designed specifically for couples who’ve been trying to conceive unsuccessfully for a year or more, where the intervention is teaching them to use FABMs to time sex based on the actual fertile window rather than what’s assumed. In those studies, there’s always an improvement in conception rates. Simply timing correctly does improve chances. Of course this isn’t the case for all couples — fertility challenges are multifactorial — but it is something to consider.

They asked open-ended questions to figure out the pros, the cons, what women liked, what they didn’t, and their experience with their chosen method. Questions included: “Tell me a story of how you and your partner came to the decision to start a family. What influenced you in selecting your fertility tracking method? How did your decision to follow this path impact your fertility journey?” They did this through face-to-face virtual interviews. Through a thorough assessment of the data, five themes emerged.

Theme 1: Having a sense of control. This generally comes up with fertility awareness-based methods. Our conventional healthcare system takes control away in many ways — you go to the practitioner, they have the answers, they tell you what to do, and the power lies with them rather than with you. Having a sense of control allowed these women to track their bodies, understand what was happening, and reorient themselves to a position of greater authority. They became participants in this process rather than simply passengers. One participant said: “Rather than just feeling like months were going by and I wasn’t getting pregnant, I think I felt like I had more of a sense of why that might be — like maybe I didn’t ovulate that month, or we didn’t have intercourse at the right time. I feel like it helped me understand what was happening with my body more.” Instead of feeling lost in the process, they could actually see what was happening — ovulation happened later, or timing was off — and the process was somewhat demystified.

Theme 2: Experimenting with different methods. Many people assume there is one fertility awareness method that everybody follows. That’s not the case. We’re looking at fertility awareness-based methods that include mucus-only methods, symptothermal methods, sympto-hormonal methods, basal body temperature-only options, calendar-based options, and more. When looking at a vast group of women, there are many different reasons why someone might choose one method over another. This is something we always address in FAMM: we all come into fertility awareness with personal biases, knowing what we’ve used and what’s worked for us. But ultimately the best FABM is the one that works for your clients. In this study, some women found temperature tracking overwhelming and selected a predominantly mucus-only approach, or vice versa. That’s very common among women navigating FABMs whether for conception or avoidance.

Theme 3: Overcoming self-doubt. Through this process, as these women learned more, they also experienced periods of uncertainty. Especially when trying to conceive, you’re charting, understanding your cycle better, timing sex with ovulation. But if you don’t conceive in the first or second or third cycle, of course it raises the question: is this working? These conflicted feelings of self-doubt are very natural and very common. One of the most challenging things about fertility is that you just don’t know exactly which cycle conception is going to take place. What helped these women, interestingly, was having a better, clearer way to identify ovulation. They started using LH strips within the context of their charting protocols, and they reported that this helped them feel more certainty — potentially because it helped them better identify their ovulatory window.

I thought this was interesting because one of the themes that emerged was that BBT was challenging — so women opted for a method that didn’t predominantly rely on it. Many women find BBT to be a helpful definitive sign, but many women struggle with the mucus sign unless they’re using a method with a really detailed mucus charting system. So it makes sense that if you’re relying on mucus but the method doesn’t provide a thorough charting protocol, adding LH strips would help you feel more confident. It’s always better to have two signs versus one — whether it’s mucus and temperature, mucus and an LH strip, or temperature and cervical position. Having two signs allows you to cross-reference and feel far more confident in what’s actually happening. One participant said: “Even though I felt kind of sure, I was like, I might as well, a few days after I end my cycle, just use the strips to see what’s happening. I was testing every day and I felt very confident in those strips — more confident than with checking my cervical mucus, probably because it was quantifiable.”

Their experience was that a method providing more clarity, more structure, and more consistency helped them feel confident. There’s the self-doubt of knowing how to confirm ovulation and feeling confident in your observations — and then there’s the self-doubt that can come from the process of not conceiving. In terms of supporting clients to feel confident in their observations, knowing definitively which days are fertile and which are not and being able to confirm ovulation — that comes from using a very detailed and specific cervical mucus tracking system. We can pretty much define any type of discharge with the method we teach in FAMM. We also use LH testing when appropriate, basal body temperature, and other secondary signs. Secondary signs — whether breast tenderness or other things experienced around ovulation or before the period — in conjunction with the main fertile signs we’re tracking can be extremely helpful, especially at the beginning. All of this supporting data helps overcome the doubt in observations so that clients can feel confident they’re doing it right, tracking correctly, and identifying ovulation. Adding that additional data is not a surprise as a tool for confidence.

Theme 4: Enduring pressure. These women were enduring pressure from husbands, friends, family, or themselves — mostly around the general pressure to have a child. Comments like “Are you guys going to have a baby?” or “What’s taking so long?” They didn’t specify this pressure was related to their choice of FABMs specifically; it was more the pressure to conceive in general. Something I’ve observed in practice is that you might assume women face a lot of pushback from partners about a method like this — but I’ve actually found the opposite in most cases. Partners tend to understand the reasons women are choosing these methods, because typically there’s a specific problem that fertility awareness is allowing them to overcome. Whether it’s negative experiences with hormonal contraceptives, wanting a more natural approach, or concerns about hormonal imbalances — these women typically have very clear reasons for their choice. It is a different way of doing things, and you can receive pushback from healthcare providers and others. But partners are overwhelmingly supportive in my experience — though of course that’s not universal, and there are women who can’t use the method if their partner isn’t willing to participate. One participant’s quote related to this pressure: “Towards the end of the year before I got pregnant, I was starting to get kind of depressed about it. Why aren’t I getting pregnant? Everyone around me was getting pregnant and I remember it being very hard.”

Theme 5: Lack of guidance from healthcare providers. The study found that each woman made strong statements regarding the lack of guidance from healthcare providers regarding natural methods specifically. Women felt they were on their own journey of choosing fertility methods and that healthcare providers did not provide guidance on how to use natural methods. The researchers identified a significant hole in the information and support given in this area. Their proposed solution is to get healthcare providers to provide better information about FABMs. Now — and I’ll call out my own cynicism here — it would be ideal if healthcare providers in traditional medical settings were providing this information, but the reality is that they’re not. The reason is that this simply isn’t taught in medical school. Even in alternative care options — naturopathic, chiropractic — FABMs are not taught in depth. Some functional providers may be more aware and supportive, but not necessarily educated about these methods to the degree they should be.

I’m not going to hold my breath that healthcare providers are going to do a 180 and suddenly support women in these methods. I don’t think that’s where we are in the medical model right now. I do know there are people working toward that aim. My friend and colleague Dr. Marguerite Duane founded FACTS — the Fertility Awareness Collaborative to Teach the Science — and she’s been one of the most prominent faces in the medical field focused specifically on training medical students, because that’s where you’re most likely to have an impact. But ultimately, I think the broader solution to this lack of awareness is to educate women themselves as much as possible — not depending on the healthcare setting to change and provide these alternatives.

One of the reasons I feel that way is that fertility awareness-based methods go directly in the opposite direction of the allopathic approach. The medical approach looks to reduce symptoms in the fastest way possible, typically through drugs and procedures, not necessarily looking at root causes. In the case of fertility challenges specifically, the medical system uses a variety of procedures and medications to override the natural reproductive cycle — creating cycles with hormones, providing estrogen to build the lining, trigger shots to induce ovulation, progesterone to build the lining further, extracting and fertilizing eggs. They’re taking control of the cycle. Whereas FABMs are designed to allow the body to do its thing, to learn what the body is doing, and to modify our actions so they’re in line with what the body was already doing. And when we take it to the next level, as we teach our FAMM practitioners, we’re then working to improve and optimize that natural process — improving egg quality, sperm quality, mucus production, hormone balance — so we can more naturally encourage the body toward what it was going to do anyway and remove obstacles we may have inadvertently created through ineffective dietary or lifestyle factors.

I always find these qualitative studies to be interesting and insightful in a different way. They legitimize the voices and experiences of women — they put it in print, in a published study, where we can look at it more scientifically. Instead of feeling like our experiences are just in a silo and no one really cares about them, the more these qualitative studies are done, the more we can see that there’s a pattern, there’s a structure — these women’s experiences are valid. They help us understand what’s working, what the holes are, what some of the challenges are that women are overcoming in order to find success with FABMs.

Researchers also pointed out that other studies on FABMs often highlight the relationship aspect — that many couples report improved communication and relationship quality when they start charting, because the method by nature requires couples to communicate about the fertile window, make plans, have strategies. That didn’t come up as a specific theme in this study, potentially because of the way questions were asked or the specific focus on women trying to conceive. But it is a common theme in the literature.

One reminder I often share with our FAMM practitioners: when you’re in a room full of people who are passionate about and educated in fertility awareness, it can start to feel like everybody knows this. But the reality is that it is not common knowledge. Although I’ve been in this field for over two decades, have written books, teach practitioners, and have spent years teaching clients one-on-one and in group programs — I am under no misconception that this is common knowledge. As soon as I step out into my regular life and someone asks me what I do, it’s consistently something people have never heard of. The average person has still not heard of fertility awareness. The average woman trying to get pregnant may have heard of ovulation tests, but she doesn’t necessarily know about fertility awareness-based methods for optimizing her chances of conception. And many of the 100 million women on hormonal contraceptives have never heard of this concept of a reliable, up-to-99.4%-effective, non-hormonal birth control option.

Count yourself lucky to be in the small percentage of women who are aware of FABMs — but remember, we still have a long way to go. If you’re a women’s health professional and you decide to educate your clients and raise awareness in this area — that’s what our FAMM practitioners are doing — you really are part of the solution.