Is Fertility Awareness Too Difficult? User Behavior, Intention & Effectiveness | Ep. 600

Episode 600

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This is the Fertility Friday podcast, episode number 600.
Today I have what I think is an exciting episode, only because it’s one of the
topics that I love getting into, which is, is fertility awareness too difficult for
women. This is an important episode for you if you are using the method personally.
We’ll talk about a few very important things to consider in order to ensure that
you get the highest efficacy when using fertility awareness -based methods. But this
episode is also important if you are a provider, if you are a woman’s health
professional. It’s really important to face some of the challenges that result in
unintended pregnancy head -on if you want to engage with fertility awareness -based
methods. This study, I find to be so fascinating because it does show a lot of the
trends that I’ve seen working with clients over the years. It does give some insight
into the relationship between how well that user effectiveness number correlates with
your client’s actions and intentions. And it really touches on the complexity of this
topic of either avoiding or trying to conceive.
So before I get into it, let me share a little bit about the study. So the title
of the study is really long. I’ll just read a portion of it, pregnancies,
intentions, and fertility behaviors during use of the Cretan model fertility care
system after initial intention to avoid pregnancy. So that’s a mouthful.
But the Cretan model is a mucus only method with a very detailed charting system,
similar to the detailed charting system that we
method. And so as we’ll talk about in this study, they had several users.
So they gathered nearly 300 users of this method. And in the study,
they had them identify each cycle if their intention was to conceive or to avoid.
They had them track their fertile signs as well as their intercourse.
So they did the study based on a few different criteria. So we’ll get into all of
that. But because this study
avoiding and this is what we’re doing. And quite literally, in the middle of cycle
two or three, you could see an active intercourse on a fertile day and you check
in and say, okay, well, so what’s going on, what’s happening? So the reason that
I’m sharing that is because intentions are not always set in stone and they can
change and shift. And of course, that affects a lot of different things. So what I
really like about this study is that it is looking at a population, a mixed
population, which is always what I worked with. I didn’t ever work with only women
who are trying to conceive or women who are trying to avoid. And even if you think
about it, if a woman is trying to conceive, there might even be a couple of months
where something happens and she has to back off for a bit. So it’s not always set
in stone. It can change. So let’s go ahead and get into it.
So a little bit of detail about the participants of the study, there was just under
300, 296 participants in the study. The average age of the women was 27 years,
and 82 % were Catholic, and 100 % were married or in a long -term relationship,
and 90 % were newer users to the method. So that is an interesting segment of the
population, just to kind of set the stage. So this is interesting. The initial
intention, all couples began intending to avoid pregnancy, but of course there was a
shift over time. So many couples transitioned towards openness or intention to
conceive during the study. So 84 % of the cycles were reported as to be avoiding,
meaning that at the beginning of the cycle, they said, okay, this cycle were
avoiding pregnancy. 10 % were identified as achieving, meaning they set that intention.
And so,
separately. And the male and female intentions matched in 91 % of the cycles.
So I thought that was interesting as well that they tested that. And so most of
the time, they were on the same page. But obviously, just under 10 % of the time,
they did not match up. So again, very interesting. So if we get into the study
results, among the couples who specifically said our intention is to avoid pregnancy.
29 % of cycles include
fluid or being within the boundaries. So in all methods, there is either what would
be called the count of three or a peak plus four. In all methods, there is a
period of time after we are trying to confirm ovulation that you consider fertile.
And so we have the actual days where we would identify fertility with a mucous -only
method that’s based on mucous observations, but we also have this buffer period. And
so in 29 % of the cycles, intercourse took place on a known fertile day.
So if we look at the outcomes then of this study, among those who specifically said
we want to get pregnant, 89 % within 12 months of those couples did achieve a
pregnancy. So nearly 90 % of those who said, okay, we want to conceive. 89 % within
one year did conceive. Now those who said we’re not trying to conceive.
But, as I just said, there was about a third of the cycles where sex did take
place on a day that would be identified as fertile. About 35 % of those couples
conceived within 12 months. So that’s obviously interesting because that’s a pretty
high pregnancy rate. And again, the reason why the study is interesting is because
it’s really looking at not only the outcome, but the attention stated and then the
behavior and looking at when those two things didn’t match up. So when they actually
looked at what would be a true method failure, meaning that if there was no sex
that took place on any fertile days, as outlined in the method, the true method
failure rate was 0 .3%. So it was very, very low. So the true method effectiveness
rate based on the study was very
that you get some of the context. Over half of the couples that were enrolled were
avoiding pregnancy at the beginning of the study as we talked about, but still
stated that they had a desire to conceive within about two years. And if you
remember when I went over the demographics of the study, many of these were younger
couples potentially had recently been married or were becoming married shortly
thereafter. So that’s something to be aware of as well. And this is one of the
reasons why I state that especially if you are a woman’s health professional and
you’re providing fertility awareness services to clients, it’s not just important to
ascertain what they’re saying right now. You also want to get a picture of if
they’re thinking about pregnancy in the future and what their plans are and those
types of things. Because from experience, what I can tell you is that intentions can
change. It’s incredible. And this is something our practitioners experience where at
the beginning of their work with the client, it’s like, okay, she told me that
they’re avoiding and et cetera. And literally a couple months in, things can
completely shift. It doesn’t always happen like that, but it’s certainly a
possibility. And that was reflected in this study. So couples who at the time of
enrollment said that they intended to have a child within a year or two were
significantly more likely to conceive even when they continue to report that they
were avoiding pregnancy. And this is something that the researchers touched on, which
is that there was a certain level of openness to pregnancy to some of these
participants. So That even in itself is an interesting step that the couples who
said we’re avoiding, but we do want to have a child within a year or two, they
were more likely to conceive overall. So another step that I want to point out,
because I found this to be very interesting, and it’s certainly one that makes me
think a little bit more. About 38 % of participants did not record all acts of
intercourse, and that is a problem. And this is something, of course, that comes up
a lot in our training when we’re talking with our practitioners in order to be able
to support your clients and to assess their understanding of the method and to
support them to ensure that if they’re trying to conceive sex is happening at the
right time, if they’re avoiding, that sex is happening at the right time and not
happening during the fertile window, we really do need to request that our clients
are noting when they’re having sex. And also, if they’re using an app or if they’re
using paper charts, what is actually happening? If they’re using protection, that
should be noted. We should be really clear on what’s going on. Not because we’re
nosy, but because in order to support our clients, we really need to know the full
story of what’s going on. And so to me, that was a bit surprising. Such a high
percentage, 38 % of participants did not record all acts of intercourse.
It said, first, 112 couples could not be included in the analysis because we could
not be confident that all intercourse was recorded. You can’t really identify a
correct use number or a failure rate if we’re not even noting when sex occurred or
how that sex took place. Was there a condom used? Was there withdrawal used?
What was going on? And so if we don’t that data, it makes it difficult to actually
come to accurate scientific communication.
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So what are the implications of this? And getting back to the initial question at
the top of the episode is fertility awareness too complicated? So there’s a few
things I want to share. And of course, I just want to say I’m sharing from my
perspective. Now, I do not teach a mucous only method after working with over a
thousand clients and especially working in groups For many years, I did group
coaching programs for clients, so I’m working with multiple clients at a time. I can
share some of the observations that I’ve seen and some of the, I suppose, wisdom or
knowledge that I’ve gained. We really have to look at this, not just as a black
and white, these are the rules, this is the method. We have to take into
consideration our clients and their motivations, their fears, their level of
understanding in order to really set them up for success. So when I first learned
fertility awareness, as I’ve shared many times, I was very young. I was in my late
teens when I first discovered the method. And as a young woman in my late teens,
early 20s, I had a very black and white, I would say somewhat immature understanding
of the complexity of this question of, am I trying to conceive or avoid? So in my
early 20s, I really thought that this was black and white, that everybody on earth
would be either a zero or a 10. One of the things that we talk about a lot in
our programs is the intention scale. Where are you on the attention scale? If
someone says that they’re a zero, they may be motivated to terminate a pregnancy
because they’re saying, zero, I’m not open to it at all. If somebody is a 10 on
that intention scale, they are likely actively trying and may be pregnant right now.
And so I often used to think that this was very black and white, but over the
years and using this tool with clients and having these discussions, I would say
that although there are some clients that are certainly on either end, the vast
majority of people are somewhere in the middle, even if that just means there are
one or a two, maybe because they wouldn’t terminate, but a lot of clients find
themselves in the middle. Some of you listening might be thinking, what? How is that
possible? How could someone be in the middle? But if you work with enough clients,
you will realize that most people are not necessarily at the very ends of the
spectrum, especially when you define what that would mean. And so that is something
to take into consideration. And we have to be able to talk about it and unpack it.
And we also have to recognize, as I’ve said already, that this is not something
that you do once and then you move off from it. And you also have to take into
consideration.
All of these things have to be taken into consideration. And one thing, if we look
at the data and research on fertility awareness -based methods, if we look at the
efficacy, typically fertility awareness -based methods that are mucous -only typically
have lower effectiveness. There are a lot of different studies on the Creighton
method in particular, some showing very high efficacy. And so what’s interesting about
this study is that the actual pregnancy rates, we’re a bit higher. The study gives
us a lot of nuance on that, showing that, like I said, a third of couples who
stated explicitly that they were avoiding, we’re still having sex on days that were
identified as fertile. So we kind of see what was going on, but we do see this
higher pregnancy rate. And so as practitioners, what do we do with that information?
So for myself, one of the things I love to do, obviously, is I love to go
directly to the research and look at the methods that consistently show the highest
efficacy, and this is something I’ve talked about many times. So the double -check
symptom thermal method, the method that includes mucus observations, as well as a
cross -check with mucus and temperature to confirm ovulation. So identifying that
fertile window, identifying with two measures, not just mucus, but temperature and
mucus to confirm ovulation, but also using two methods to open, two ways to open
the window. So yes, we look at mucus to open the window, but we also rely on a
last infertile day calculation. And when we look at these double check symptom
thermal methods that employ that strategy and create a very well -defined fertile
window that actually gives a bit more of a buffer so that the user is far less
likely to be having sex a little too close to ovulation, which is really the issue
with fertility awareness -based methods. The effectiveness is based on how well you
are managing the pre -ovulatory
that pre -ovulatory phase. And so when we look at that factor, one of the reasons
that the pre -ovulatory double -check symptomothermal methods have higher efficacy rates,
both absolute efficacy rates, but also typical use efficacy rates,
is because a lot of that confusion and gray area is totally removed by giving the
users a little bit more structure for how they manage that pre -ovulatory phase. And
so as an instructor who’s now been in this field for over two decades, I would say
that that is the key. We can talk about intention and we can talk about how we
feel, how open we are to pregnancy. But ultimately, your effectiveness isn’t based on
your feelings. It’s based on your actions. And it is possible to be a little bit
ambivalent and to be a little bit more open to pregnancy. But if you have a really
strong system, if you
is still possible to then take the appropriate action and to have these conversations
with your partner so that you decide how you’re going to do this. And this is one
of the key important aspects of success when using fertility awareness -based methods
in order to set your clients up for success. So again, the study is really
interesting because it does show this nature of human behavior, which I’ve seen over
the years. And when you’re working with clients, I think you do have to recognize
that sometimes you will see achieving behaviors in clients who are explicitly saying
that they are avoiding pregnancy. And so my role is not to be punitive. I don’t
judge. I don’t do any of those kinds of things. I always consider that my role is
just to provide that education and to provide the structure and information and
evidence so that I can really set my clients up for success. My role, the way I
see it, is I want you to understand how the method works and I want you to be
look
Does that ever mean that there’s a day that you’re unsure? No, of course. There may
be days that you’re unsure. There may be days where you see mucus and you’re unsure
of what you’re actually seeing and all of those kinds of things. But you also have
to know what to do on a day that you’re unsure. You can be unsure and that makes
it a fertile day or at least a potentially fertile day, a day that we would have
to consider potentially fertile. So we actually have structure to handle some of
those feelings that you may have or some of those uncertainties that you may see,
the key is the structure. The key is the structure so that there’s still no gray
area. So again, with this paper going back to that data,
having one third of participants, having sex on days that are identified as fertile,
having 35 % of couples who said at the onset, okay, we are avoiding pregnancy to
actually have a pregnancy. But also
or the method efficacy, and the user failure rates or the user efficacy. And so as
practitioners, it is a really big responsibility. This is why I always say that it’s
essential for practitioners to receive training and fertility awareness.
Charting your own cycles is not sufficient to be teaching others. It’s just not
because you have to be able to not only understand your own cycle. You have to
understand what to do in a wide variety of situations that you have never seen
before. And that is why training is really important. And you also have to
understand the user psychology and to have a structure and a system to be able to
equip your clients to be effective in their method. And this is something that comes
with training. It comes with experience. And it comes with having a structure around
how to support clients. And for many women who are using the method personally, they
have come to their own kind of conclusion of how they’re going to use the method
personally. And if you have used the method and you’ve been successful, you probably
have some unsaid rules, some things that you do that you didn’t necessarily define
that have allowed you to be successful. You have some assumptions about how others
may be using the method. And you likely when you have a client and you’re seeing
them do certain things that you wouldn’t do, we’ve had many practitioners. They’re
kind of like, this is crazy. I’m shocked. Right. They’re surprised because their
clients are taking risks or just doing actions or having sex on certain days when
they personally are thinking, I would never do that. I don’t understand. And this is
again why it’s important to have training so that you can set your clients up for
your success because your clients are not you. Some of us are very, very
conservative and take a whole bunch of extra steps beyond the method to ensure
efficacy. And some of us are a lot more open and a lot more open to risk in
different areas and are willing to take different actions. And so what I always say
is I’m here for all of it. I don’t think I’ve seen everything possible, but I’ve
seen a lot. And so I’m prepared for it. And I have ways to support clients
regardless of how conservative they are naturally or how open they are naturally and
how likely they are to take risks. There’s ways to support clients regardless of
where they are on that spectrum. And there’s ways to encourage them and support
them. And the other thing, too, is that a big piece of it is to really understand
where your client is at. And I think one of the most challenging things for some
of our practitioners are clients who are literally not one or the other, who are
literally in the like, I’m open to it, whatever. Like, it’s kind of like hard for
some of our brains to be like, how is this possible for this person not to be one
on one side or the other side of this issue? One last thing that I’ll say about
fertility awareness -based methods is that it really does give women and couples the
ability to plan ahead. And I think that’s one of my favorite things about this
method. This is one of the reasons why I’m so passionate to equip clients to use
this method and feel very confident about it, because it really does give you
options that hormonal methods don’t necessarily give you. So let me give you an
example of why I say that. So with fertility awareness -based methods, they are
possible to use very effectively. And like I said, the double -checked symptomto
Thermal Method and the research consistently shows the highest efficacy method efficacy
as well as user efficacy. Like typical use numbers are quite high with the double
check symptomothermal method when we’re not just relying on one marker, but we’re
relying on mucus and temperature. And like I said, the last and fertile day
calculation in these double check methods. So we can really support our clients to
have a high typical use efficacy so that user failure is less likely to happen.
But in that context, you have a woman who is cycling naturally. She has the
opportunity to chart and see what’s happening in her cycle. And if we are seeing
some cycle irregularities or abnormalities and she’s actively avoiding, but she’s
charting, we’re able to intervene and support her and see in real time how those
interventions are taking effect. And so I’ve supported hundreds of clients to go
through this stage if they’re coming off the pill. Those first cycles tend to be a
little bit irregular as the body normalizes, but we can really support her and also
have a strong focus on preconception nutrition. So while you’re still avoiding
pregnancy, you’re able to really zone in and support hormonal balance,
support menstrual cycle, normalization, build up those nutrient stores preconception all
while you’re still using the method to avoid pregnancy.
is there’s just so much potential there. You’re still avoiding, but you have this
wonderful runway to normalize your cycle and to build up your preconception nutrient
stores, to learn and be educated about how your body works, to understand fertility
awareness. And also to have your partner jump in on the preconception nutrition as
well so that we can support his sperm health, your egg quality, your body, your
nutrient stores, all these things. So I absolutely love this window of time. It is
just such a wonderful opportunity. And so for these couples, then, when they’re doing
that, by the time they’re ready to try to conceive, oftentimes the cycle is in a
much better place than it was before. And of course, they may have been actively
working on their preconception and nutrition during that time. Now contrast that to
the birth control pill. Now, what I always say is that A woman, her, and a man.
So anybody, really. But your intention can switch on a dime. You can go from, and
one of the examples I often give is if you have, I’ve worked with many young
couples and let’s say they’re getting married in the fall or something like that. So
it’s like I’m avoiding, I’m avoiding, I’m avoiding. But literally that month, that
day that the wedding takes place, all of a sudden now we’re like 100%. Like I’m 10
out of 10 on the intention scale. I’m ready to try, and I want a baby right now.
And it can go, it can shift like that in a day. It can shift very quickly. And
so if you’ve been using fertility awareness, you’ve been prepping your body, for
example, as I shared in that example. So now your cycles are in line and all these
things. So when you’re ready, like your body’s already ready, right? Your mind can
switch. You can go from I’m avoiding to conceiving overnight and your body’s there
for it. It’s ready. but for someone who’s been on hormonal contraception, their heart
can shift.
the method that works best for the user. But over the years, I’ve certainly found,
especially I’ve worked with a lot of women who are avoiding pregnancy, who are
terrified of an unplanned pregnancy. So I’m far more comfortable teaching the highest
efficacy method so that they can have the structure they need to succeed. But as
you can see, there’s just such an incredible potential here to support clients. But
the key is that when you’re working with clients in a professional way, you need to
feel good about the method that you’re teaching and you need to feel like you’re
equipping your clients to be successful, right? And so that’s why I always go back
to the research and look at which methods are most effective. So hopefully this
episode has been interesting to you and has shed some light on some of the
different aspects of fertility awareness charting. And if I go back to that original
question, is fertility awareness too difficult. It isn’t too difficult. We just need
the right system, structure, and instruction. We just need that clarity and we need
to get to that place where we can be really black and white. It’s a day, a
fertile day or not. And to have those conversations about intention and discuss how
your intention, I mean, if you’re not talking about it, sure, that means you could
be taking risks and there can be that subconscious motivation. But if we put it
there we have these discussions and acknowledge that we have maybe, although I’m not
wanting to get pregnant right now, like there’s a part of me that wishes I could
be pregnant right now. If we can talk that out, then we can really divide out
those emotions from your actions and you can still be effective at avoiding until
you’re really ready to start trying. So hopefully this episode has been helpful to
you. It has been insightful, made you think a little bit. And also to get into the
weeds a little bit, the nuances related to
when they’re working with us.
So with that said, I hope you have a wonderful weekend whenever you’re tuning into
the show. And of course, as always, until next time, be well and happy charting.
Thank you for listening. If you enjoyed today’s show, please share it with a friend.
You’ll find the show notes page over at fertility friday .com slash 600.
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