FERTILITY AWARENESS GUIDELINES

The Fertility Awareness Method can be used to avoid pregnancy or to conceive.  This summary is oreiented toward birth control.  The FAM requireds observation of basal body temperature and cervical mucus.

Primary Fertility Signs:
•    cervical mucus changes:  clear, wet, stretchy, stringy, like egg-white.
•    basal body temperature:  around time of ovulation bbt increases 0.3 - 1.0 degree F.
•    cervix changes:  deeper in vagina, softer texture, is open wider.

Important Facts:
•    an egg can be fertilized for 12 to 24 hours after ovulation
•    sperm may be capable of fertilizing and egg up to 5 days when fertile mucus present

Need to distinguish:
•    menstural bleeding
•    dry days:  dry sensation at vaginal opening
•    infertile mucus:  sticky, pasty, crumbly or tacky
•    fertile mucus:  creamy, whitish, wet or clear, stretchy, “egg white”, stringy

Regarding Cervical Mucus:
•    infertile mucus may be present with fertile mucus on overlap days
•    any hint of wetness should be regarded as fertile, even if appearance is not classic
•    fertile mucus may start to be produced in cervix before noticable
•    may find a few wet days at end of cycle, prior to menses, during infertile phase
•    Factors that interfere with observation of mucus:  douching, semen, spermicide, vaginal infections.

Determining Infertile Days:
Cycle has 2 parts:  before ovulation and after ovulation

day 1                        ~ day 14
11111                            *                           day 28
menses                    ovulation
mid-cycle

PreOvulatory (most variable in length)            PostOvulatory (11-16 day least variable)

Each phase has different rules for determining infertile days.  The postovulatory rules are the easiest to observe and more definitely safe.
PostOvulatory:
1.    Thermal Shift Rule
2.    Peak Day Rule
3.    Cervix Closing Rule (optional)

Thermal Shift Rule: 
•    infertile phase begins on eve of 3rd consecutive day of temperatures above baseline (allows for release of 2 eggs 1 day apart)
•    find highest bbt recorded during the 1st 10 days of cycle
•    draw coverline 1/10th degree F above the highest of the 10 temp
•    temperatures must be above this coverline for 3 days in a row (this means you are infertile after a rise in temperature has been maintained for 3 days and cervical mucus signs consistent).

Peak Day Rule:
•    infertile phase begins eve of 4th consecutive day of sticky, pasty, crumbly mucus and/or dry days after the Peak day.
•    Peak Day:  last day of stretchy, wet, fertile mucus
•    Ovulation can occur up to 3 days before or after peak day.
•    Ovulation can be dalayed, it is possible for wet mucus to come and go until the egg is released

PostOvulatory Infertile Days:
•    observe the most conservative to the 2 rules
•    you are infertile after a rise in temparature has maintained for 3 days AND 4 days after the last day of fertile mucus.

Cervix Closing Rule (optional):
•    infertile phase begins on the eve of the 3rd consecutive day of lower closed, firm cervix

Determining PreOvalatory Infertile Days:
1.    Menses rule
2.    Alternate dry day rule
3.    21 day rule (optional)
Unless cycles are short (less than 25 days) or are anovulatory.  During short cycles, fertile mucus may be present during menses and pregnancy could occur.  When ovulation has temporarily ceased, cannot predict when it will resume.  Some causes of anovulation:  illness, recent use of birth control pills, changes in diet or exercise, travel, emotional stress, breast feeding, ovarian cyst, pre-menopause.
Regarding short cycles or Anovulatory cycles:
•    alternate dry rule
•    mucus patch rule

Menses rule:
•    cycles are never less than 25 days AND
•    you have ovualated during previous cycles (observed thermal shift on the last day of fertile mucus)
•    first 5 days of cycle are considered safe/infertile (this is true even if bleeding last only 3 days)

Any type of mucus that appears after menses and before ovulation is considered fertile EXCEPT mucus you can identify as non-changing, infertile mucus.

Alternate Dry Day Rule:
Once menstrural bleeding ends, intercourse can occur the evening of every other dry day.  Need to alternate days because it is difficult to distinguish semen from cervical mucus for up to 24 hours.  Semen will be gone after 24 hours.  If the day after intercourse is dry for the entire day there is no need to abstain that evening - no need to alternate.

Mucus Patch Rule:
If experiencing ANY mucus after a dry day, this is considered fertile.  If mucus is pasty and dry, abstain for 3 dry days after mucus is gone.  If mucus is wet and stretchy, abstain for 4 dry day after the mucus is gone.  Any bleeding is regarded as wet mucus and can be a sign of ovulation.

21 Day Rule (only if cycles are 25-37 days long):
•    Determin the shortest of the 6 most recent consecutive cycles.
•    Subtract 21 from the shortest cycle
•    the remaining number of days, from the onset of menses are safe but be careful
Usually the greatest number of days from ovulation to menses is 16 (11-16).  Sperm can survive 5 days (16 + 5 = 21!)  This does NOT account for a possible earlier-than -usual ovulation (1-5% pregnancy rate).  An unusually early ovulation is difficult to predict.  BEWARE this is a riskier strategy.