Monday, June 29, 2015
Pregnant perspectives
I recently read a post to Catholic Newlyweds about how worrying about getting pregnant before you consider yourself ready is the least of your worries. Statistically, it’s far more likely that you will struggle with infertility or miscarriage. In fact, 1 in 3 women will experience a miscarriage through their reproductive life. I’ve heard far too many stories of women who deal with reproductive obstacles. I still have a long span of reproductive life in me, even though conceiving this baby was easy, I don’t consider myself exempt.
During my reversion into Catholicism, and especially as I was looking into NFP (they were simultaneously occurring) I was terrified of becoming pregnant. I fully accepted the modern way of thinking that pregnancy was just about the worst thing that could happen to me. It’s a common 20 something thought. I believe it’s also a common 30 something thought to suddenly fear that not getting pregnant could be the worst thing to happen to you. The modern view of reproducing is very dichotomized. Our ovaries are either turned on or turned off – and the choice is ours. But is it really? I would argue it’s an illusion of choice.
Friday, February 27, 2015
Miscontraceptions is on YouTube
Friday, December 19, 2014
NFP - Not just Catholic Birth Control
SHK ponders.
I read a lot of refutes to Natural Family Planning where people pose the question, “Isn’t that still birth control? What’s the difference between charting and popping a pill?”
Labels: catholic, morality, NFP, sex
Friday, February 21, 2014
Sweetening the Pill
Book Review: Sweeteningthe Pill by Holly Grigg-Spall
Or How We Got Hooked
on Hormonal Birth Control
The
medicalization of women’s bodies has a dark and bloody history. Throughout
history, but perhaps most prominently from the Victorian era onward, women have
been subjected to all sorts of poisons and ills to “treat” those processes which indicate good health. Why is it that the very things that make us women, (menstruation,
gestation, ovulation, lactation, birthing, and menopause) have so often been
treated by the medical field as problems to be dealt with? Perhaps because the
medical field has been dominated by men for the past several thousand years, with
the exception of midwifery and “witchcraft,” which in some cultures may have
simply been female herbalists who used spirituality and natural treatments for
common ailments. But most of what we think of in the past two thousand years as
“medicine” has been a male-dominated field. Are hormonal birth control pills a
conspiracy of the patriarchy to oppress women? To reduce and regulate those frightening menstruations, to render women infertile, to blunt the effects of testosterone and
other “raging” hormones, and make women more available sexually? Maybe. Is it a conspiracy of capitalism to make women
buy a drug that they need to take every day, even when they are perfectly
healthy? Just as women need to buy tampons and pads, shavers and creams, moisturizers,
make-up, deodorants, and a hundred other products, just to function daily as a
woman? Maybe that is also true.
These
aren’t my ideas; I came across them in reading Holly Grigg-Spall’s wonderful
work, Sweetening the Pill. Grigg-Spall
is a feminist and writes from a non-religious perspective on the dangers of
hormonal birth control and lauds fertility awareness methods and other non-hormonal
forms of birth control. I found reading this book refreshing and empowering. It
has been sometime since I read truly feminist literature, and I felt as though
reading this helped put me in touch with the broader struggle women face today.
Grigg-Spall
posits that ditching the pill can be an act of rebellion against the
patriarchy, and encourages women to reclaim their bodies and their biology. She
discusses feminist groups in California who meet in circles and use speculums
to observe the changes to their cervixes and mucus throughout their cycles, and
also learn first-hand the many variations of the female body. It is a radical
act of taking gynecological knowledge into their own hands. Most women have never
seen their cervix, or even looked properly at their own genitalia, and this
allows women to familiarize themselves with their own bodies. I loved this
example, although just one of many instances in which Grigg-Spall describes
women reclaiming their biology through self-knowledge and awareness. I love it
because it is a metaphor for NFP or fertility awareness methods of birth
control. These methods are first and foremost about KNOWLEDGE of a woman’s own
body. So many women don’t understand why at certain times of the month they
find a lot of fluid and mucus, and may even think this is abnormal, such as an
infection, and don’t realize it is a sign of healthy fertility! So many PMS symptoms,
risks of miscarriage, hormonal imbalances, PCOS, and other health problems can
be detected from charting a woman’s cycle. Grigg-Spall argues these health problems can be
treated best, not with the magical cure-all pill, but with synthetic hormones
that very closely mimic the ones in our own bodies, which is not the same thing
as what is in most hormonal birth control products.
Right
as I was finishing this book, I attended a talk by Dr. Nolte of the Gianna Center in New York
City. Her talk was on infertility, the bioethical problems of IVF, and the
alternative of NaPro Technology. It
is funny how Dr. Nolte, a conservative Catholic, and Ms. Grigg-Spall, a secular
feminist, agreed on so many things. For one, they both agreed on the use of
synthetic hormones that more closely match real estrogen and progesterone to
treat hormonal problems in women. Too often the pill is used to “treat” these
conditions, when in fact it does nothing to treat the underlying cause of the
hormonal imbalance. Dr. Nolte says she does a full hormonal profile, which
means drawing blood every few days from the woman for a cycle, to see exactly
which hormones are out of balance and in which part of the cycle. Then she will
use the closest thing to the actual hormone that is available, and only administer it during the part of
the cycle it is needed. For example, if a woman is not making enough
progesterone, she will take progesterone supplements, but only AFTER ovulation,
which is when that hormone naturally spikes. To take it over her entire cycle
would actually shut down the cycle and suppress ovulation (which is what some birth
control pills do.) Dr. Nolte has found that women who have undergone this
particular therapy who previously had a very high incidence of miscarriage,
have been able to successfully maintain pregnancy to term, and have even had
their cycles begin self-regulating, increasing natural progesterone and
dispensing with the need to medicate.
Grigg-Spall and Nolte both would agree
that hormonal contraceptive is grossly overprescribed and that most women are
lacking a basic understanding of their own biology. For example most women don’t
know that they are in fact only fertile for 12 to 24 hours a month, with sperm
able to survive for a few hours to 5 days. The length of sperm survival
actually depends on the woman and HER mucus. If she has fertile cervical mucus
that nourish the sperm and allow them to enter the cervix, they can live for
days. But if there is no cervical mucus, the sperm die in a matter of hours in
the acidic vagina. Most people don’t know this! Why isn’t this basic biology
knowledge taught in high school? (Well, I am teaching it in my classroom, but I
can’t vouch for other biology teachers.)
Or
course Dr. Nolte and Ms. Grigg-Spall would have their differences. Grigg-Spall
is still pro-abortion and pro-condom, and favors a form of fertility awareness
that is not kosher in the eyes of the Catholic Church. Ms. Grigg-Spall did not
say much if anything regarding IVF in her book, but one of the downsides to hormonal
contraceptives she did highlight, was the sometimes months or even years it can
take for a woman’s natural cycle to return fully after quitting hormonal contraceptives. Dr. Nolte pointed out that
many women are on hormonal contraceptives for most of their fertile years, and
then when they want to conceive, have difficulty doing so. Part of the problem
though, is lack of patience. A couple may feel their biological clock ticking,
and rather than waiting and taking the time to chart cycles and detect the underlying problem, will go to an infertility specialist, and if they have
the money, they are inevitably offered IVF. One of the main bioethical problems
of IVF, from a Catholic perspective of course, is the creation of extra embryos,
and the subsequent freezing of them. There are millions of embryos in frozen
storage from IVF, and this in the eyes of the Church, is the same as creating
human beings, with souls, and freezing them indefinitely. Big problem.
Moreover, there is low success rate with IVF (around 30%) and this number doesn’t
even account for the women who drop out due to complications before
the IVF process is complete. It is very expensive, and has a high risk of multiple
births. Often if a woman becomes pregnant with more than twins in IVF, she will
be counseled by her doctors to “reduce” the pregnancy, by selecting one of the
fetuses to be terminated for the sake of the other two. So now, after the
heart-break of years of infertility and desperation for pregnancy, the woman is
put through the painful decision of deciding which of her children to
terminate. Dr. Nolte has had a very high success rate with her use of NaPro
Technology, and boasts much higher success rates than IVF, although granted her
process takes longer. She also has very rarely had twins, although it has
happened. In the spirit of honesty, I should note that Dr. Nolte is my OB/GYN,
although I have only just been recently seeing her. So far I have been
extremely happy with her and the Gianna Center clinic. The level of care and
concern was phenomenal. She didn’t just treat my reproductive system, but takes
into account the whole individual. It was the first time I had an OB/GYN ask me
about my diet, exercise, vitamins, etc. It was the first time I had an OB/GYN
screen me for PMS and other hormonal problems. These are the things you would
expect from your gynecologist, but usually all they are checking for is STDs and cancer and then they ask
you what method of birth control you are using.
But I digress. Even though Dr.
Nolte and Ms. Grigg-Spall may not see eye to eye on the sanctity of the embryo,
I think they have a surprising amount of common ground and if women came
together over fertility awareness, instead of arguing over our differences,
much good could be accomplished. For example, I think both women would agree
that fertility awareness could be taught in a high school biology curriculum.
They might disagree on some of the details, but the basics of biology, the
hormonal, mucus, temperature, and cervical shifts over a woman’s cycle, should
and can be taught to young women (and men.) They both agree that hormonal
contraceptives are over-prescribed and often have undesirable side effects such
as depression and loss of libido.
My only major critique of Sweetening the Pill is a lack of
citation for her scientific facts. Most of her science, to the best of my
understanding and from what I have read in other sources, seems accurate. But
it would strengthen her arguments if she bothered to properly footnote her
statistics and facts with references to peer reviewed science journal articles,
or at least something. She does reference many other books, most by fellow
feminist authors, and she gives those books proper credit. She also has a list
of recommended reading and resources in the back. Still, there is nothing like
a good-old footnote to support your point if someone calls into question the
integrity of this or that fact. Furthermore, I think she could have discussed
IVF and infertility treatment and the modern process of birthing as yet other
ways women’s bodies have been medicalized. But in her defense, the thrust of
this book is the use of hormonal contraceptives and the effect on the bodies of
women, and some topics she touches upon, such as menstruation, she does not
have time to delve into in this slim book.
As for my own personal experiences,
like Ms. Grigg-Spall and millions of women, I went on hormonal contraceptives at
a young age. I was 17. Unlike Ms. Grigg-Spall who was put on the pill by her
mother, almost as a rite of passage into womanhood, I chose the pill for
myself, against my parents’ wishes. I was on it for nearly four years. During
that time I experienced weight-gain and depression. I don’t personally
attribute my depression to the pill, as I was going through many life-crises at
that time, but Grigg-Spall recalls many anecdotal cases, particularly with
Yasmin/Yaz, of women suffering from depression and lack of energy while on
hormonal contraceptives. She claims that doctors and the medical industry don’t
take these complaints seriously, but dismiss them, putting the blame on the
women, not on the drug. There must be something else wrong with them, it can’t
be the drug they are on, even though so many report mood changes when going on
the pill, and then that fog lifts once they go off. But no, it couldn’t be
the pill! Grigg-Spall seems to indicate that this dismissal of women’s reports
of emotional side-effects, is yet another way the medical industry is silencing
women and delegitimizing their experiences. It was Grigg-Spall’s own struggles with
depression on Yasmin/Yaz and her subsequent recovery after eliminating hormonal
birth control that prompted her to write this book. How many of my friends have suffered
similarly? I don’t know. Although almost all my female friends have been on
hormonal contraceptives at some point in their life, it is something we sadly
don’t talk about. I do know that I had one friend become hospitalized from a
blood clot that was partly a complication from her birth control pill. I also
had a friend who always had very regular periods her entire life, experience
loss of her menstrual cycle after using the morning-after pill. Her entire
cycle shut-down and she went months without a period. Her doctor finaly had to
put her on hormonal contraceptives just to restore her cycle. It was never the
same after she used the morning-after pill.
Maybe what we need is some sort of Wikipedia
space for women to report out about these side effects and document them
publicly. There are many online forums where women gripe about this or that
hormonal contraceptive and the side-effects they are experiencing. We need to
make our voices form a collective and get these numbers to the FDA. Too many women bear
their suffering in silence and alone, thinking it is just them, it must be a
problem with their body, not the drug.
As an exciting development, just as
I was writing this, several friends shared with me
that Ricki Lake is teaming up with Abby Epstein to make a film documentary
based on Sweetening the Pill. Awesome! I think a documentary by
Ricki Lake will reach a wider audience than Grigg-Spall’s book alone. Women
need to not be afraid to take on Big Pharma, and challenge what the ads claim
is “natural, safe, and effective.” That fine print, those warning labels, need
to be given a face and voice. Even if the percentage of women experiencing
these side-effects is small (which it probably isn’t) with over 80% of women
taking birth control pill at some point in their lifetime, we need to take
these side-effects very seriously, and ask ourselves, is it worth it? Is this
truly the best and healthiest way for women to prevent pregnancy? I hope Ms.
Lake’s documentary will include alternatives, such as fertility awareness methods.
Labels: book, contraception, feminism, NFP, prolife
Thursday, February 20, 2014
Sinner's Guide to Natural Family Planning
Book Review: TheSinner’s Guide to Natural Family Planning by Simcha Fisher
I was
feeling blue about NFP when I picked up Fisher’s Sinner’s Guide to Natural Family Planning. Everything I read
previously, and the testimonies from couples I had heard on my Engaged
Encounter retreat, sang nothing but high praises about how using NFP drew them
closer together as a couple and fostered marital bliss. But I had difficulty
charting using the Creighton method my first month of marriage and felt
frustrated at the number of days of abstinence, and even had an argument with
my husband over our choice of NFP. I needed advice from someone in the
trenches, from a married woman who had been there, and tried NFP for many
years, and knew that it can be difficult. I needed reassurance that I wasn’t a
failure for having problems in the first month or two of trying it and
encourage me to continue with practical advice. Sadly, I have few married
Catholic friends who could speak to me from this perspective, so Simcha Fisher
became my stand-in for a friend in this book.
The
book reads like a casual but intimate conversation with a dear friend, who isn’t
afraid to bare all and tell you about her own struggles with NFP, while
consoling you with very useful and heart-warming advice. She does so in a way that
is non-condescending or judgmental, but she meets you where you are with
kindness, a smile, and gentle jokes to make you laugh at yourself and realize
you aren’t alone.
The
slim book (124 pages) is broken into three parts. I read it in one sitting, as
I was so desperately needing the help. The parts are: “NFP and Your Spiritual
Life,” “NFP and the Rest of the World,” and “NFP in the Trenches.” Although the
first part is titled “NFP and Your Spiritual Life,” for me, the real gems of
spiritual advice came in Part III. Because in this part Fisher spoke concretely
of how this spirituality plays out in your relationship with your spouse.
Fisher ties in practicing NFP to love and Love, the Love we encounter from God
who is Love. She makes a witty comment that NFP is called “natural” because it
reveals to us our human nature, which is fallen. When practicing NFP we may see
our weaknesses, and if we don’t practice NFP with love and cooperate with God’s
grace, we can use this system to even hurt our spouses. If women berate their
husbands for getting frisky in the bedroom when it is the wrong time of the
month, and do not acknowledge that their husbands are simply in love, attracted
to their wives, and have a need for affection, it can result in a hurtful
comment, or pushing away an opportunity for expressed love. If husbands leave
the full burden of charting NFP to the wives, and do little to understand or
take part in sharing the responsibility, the woman may become bitter and
resentful, losing motivation to chart and communicate about it. These things
have been known to happen. Fisher, in both serious and light-hearted ways,
always draws the reader back to foundation of love that is really the basis for
the whole system, no matter what method of NFP you chose. If it is not done in
love, no matter how scientifically accurate your method is, you may wind up
damaging your relationship through this type of family planning.
Sometimes
we have very practical questions about NFP that the Church does not answer for
us. Just as unmarried couples practicing chastity may as, “How far is too far?”
and there is not a completely black and white answer, married couples may
wonder, “Just what can we do on fertile days, if trying to avoid pregnancy?” “Is
this or that act okay?” Fisher deals with these and other gray areas well, she
counsels us that we are adults, and the Church left this undefined for a
reason. Because what is considered loving expression of affection, and what
each couple can handle within the boundaries of chastity will vary from couple
to couple. Some couples may choose to sleep together naked during periods of
abstinence to still feel bonded sexually, but that may simply be too
uncomfortable or inviting trouble for another couple. Fisher emphasizes
communication between spouses and a strong prayer life as the solution to
possible moral quandaries that may arise. From the big questions of, is now a
good time to get pregnant? To how to please your spouse and make him or her
happy in bed, to whether or not your are comfortable with certain actions, all
can be brought before the Lord in prayer, and discussed with your spouse in
loving conversations of mutual respect, and this will be the foundation for
your answers.
Perhaps
what was most refreshing for me about the book was simply the fact that it is for Sinners. There is an acknowledgment
that we aren’t perfect, we may not like or even hate NFP at times, and we may
not always adhere to it perfectly, and we may not have holy sex lives (just
that phrase makes me laugh a little), but it is okay to laugh at ourselves
sometimes and pick ourselves up and try again. Confession, conversation,
openness in communication and revisiting questions with our spouses, and a
prayer, will give us the graces necessary to find the moral compass to guide us
in our sex lives and family planning.
Thank
you Simcha Fisher for the kind advice and picking me up during a low point and
giving me the courage to confront my sins and keep trying to do the right
thing, knowing that I am not alone in this journey. Thank you for the reminder
to do all things in love, most especially that which we call “love-making” and
all the complicated conversations and decisions that act entails!
Mrs. Fisher asks if you're using the right method of NFP
My current method of birth control, wearing a hideously ugly scarf, is working pretty well for me right now, so I'm not going to change that up.
Labels: NFP
Friday, February 07, 2014
Miscontraception
Cassie Wilson gets funding from Kickstarter to create a documentary about women's fertility and charting. I'm excited to see this!
https://www.kickstarter.com/projects/1893202271/miscontraception
https://www.kickstarter.com/projects/1893202271/miscontraception
Labels: NFP
Giving Up Creighton
I plan to write more on my NFP experiences, when I have had more of them. I still new to this, and for me, the jury is still out.
Yesterday I decided to stop using the Creighton Model of natural family planning. I grew frustrated with the tedium of it. There were so many directions you had to follow and understand. It puts a burden on the woman to check for mucus by folding toilet paper into several layers of flat squares and wiping before and after every urination, bowel movement, shower, swimming, etc. You have to "bear down" and do a series of Kegel exercises to eliminate seminal fluid after-sex, and you are also supposed to do this at the end of the day before bed. Yeah sure, all this is less onerous than getting pregnant, and so far, I have not gotten pregnant. But I also had trouble reading mucus some days and misinterpreted possibly some non-fertile days for fertile.
The problem with the Creighton Model, is that it relies on only one sign, although it is perhaps the best sign, for fertility. But if you miss and forget to wipe and register the three observations (sensation, color, consistency/finger-check) EVERY time, my instructor said it invalidates the process, because sometimes the fertile mucus only appears once a day, so if you missed it, you could risk confusing fertile and nonfertile days. I found this discouraging, because sometimes, well, you just really have to go, especially if you are teacher and had to hold it for two 80 minute blocks of teaching. Sometimes you are just two damn tired at night.
But more significantly, I had trouble interpreting the mucus, despite three classes and being a biology teacher. My confusion led to my getting blood tested three times last cycle for progesterone levels. I was very upset at having to take time out of my busy schedule to go get blood drawn, when I am a healthy individual.
Finally, maybe I am not good at following simple directions, but I kept messing up the chart. I put the letters before the number, not after, causing my instructor to cross them out and rewrite everything. I put "D" for dry, instead of "0", again causing her to correct my chart. I forgot to record sensation, most days, when I felt it wasn't necessary. I used the wrong color stickers multiple times.
I guess I make a pretty bad student. But after my class yesterday my teacher asked in frustration "Are you taking this seriously?" It was then I decided to give up. If I can't learn it after three classes, then it is not for me. I went to a class last week on the sympto-thermal method offered by the New York Archdiocese and the Couple-to-Couple league. I think taking my temperature at the same time each morning is easier than this militant attention to mucus. STM still relies on mucus observations, but it is more casual, something you just make a mental note of as you go about your day. There was no strictness about how often you wipe. I know STM isn't for everyone. Some people don't have regular sleep patterns that allow them to take their temp at the same time everyday. Some people don't have regular temperature patterns for some reason. But I am hoping it works for me. I did track for one cycle before marriage, and I saw the typical rise in temperature one would expect. So I hope this method works for me, because I won't use contraception, and the only other alternatives are to look into the Marquette Method or 2-day Method, or some other form of tracking.
Yesterday I decided to stop using the Creighton Model of natural family planning. I grew frustrated with the tedium of it. There were so many directions you had to follow and understand. It puts a burden on the woman to check for mucus by folding toilet paper into several layers of flat squares and wiping before and after every urination, bowel movement, shower, swimming, etc. You have to "bear down" and do a series of Kegel exercises to eliminate seminal fluid after-sex, and you are also supposed to do this at the end of the day before bed. Yeah sure, all this is less onerous than getting pregnant, and so far, I have not gotten pregnant. But I also had trouble reading mucus some days and misinterpreted possibly some non-fertile days for fertile.
The problem with the Creighton Model, is that it relies on only one sign, although it is perhaps the best sign, for fertility. But if you miss and forget to wipe and register the three observations (sensation, color, consistency/finger-check) EVERY time, my instructor said it invalidates the process, because sometimes the fertile mucus only appears once a day, so if you missed it, you could risk confusing fertile and nonfertile days. I found this discouraging, because sometimes, well, you just really have to go, especially if you are teacher and had to hold it for two 80 minute blocks of teaching. Sometimes you are just two damn tired at night.
But more significantly, I had trouble interpreting the mucus, despite three classes and being a biology teacher. My confusion led to my getting blood tested three times last cycle for progesterone levels. I was very upset at having to take time out of my busy schedule to go get blood drawn, when I am a healthy individual.
Finally, maybe I am not good at following simple directions, but I kept messing up the chart. I put the letters before the number, not after, causing my instructor to cross them out and rewrite everything. I put "D" for dry, instead of "0", again causing her to correct my chart. I forgot to record sensation, most days, when I felt it wasn't necessary. I used the wrong color stickers multiple times.
I guess I make a pretty bad student. But after my class yesterday my teacher asked in frustration "Are you taking this seriously?" It was then I decided to give up. If I can't learn it after three classes, then it is not for me. I went to a class last week on the sympto-thermal method offered by the New York Archdiocese and the Couple-to-Couple league. I think taking my temperature at the same time each morning is easier than this militant attention to mucus. STM still relies on mucus observations, but it is more casual, something you just make a mental note of as you go about your day. There was no strictness about how often you wipe. I know STM isn't for everyone. Some people don't have regular sleep patterns that allow them to take their temp at the same time everyday. Some people don't have regular temperature patterns for some reason. But I am hoping it works for me. I did track for one cycle before marriage, and I saw the typical rise in temperature one would expect. So I hope this method works for me, because I won't use contraception, and the only other alternatives are to look into the Marquette Method or 2-day Method, or some other form of tracking.
Labels: NFP
Saturday, February 01, 2014
Teaching Fertility Awareness in High School
Learning about fertility awareness has convinced me that this needs to be taught in high school. For one thing, I believe it would reduce the number of abortions. I teach the basics of the menstrual cycle in the high school where I work, even though it is NOT part of the curriculum, because I believe women (and men) should know more about what is going on in their bodies. Most of them understand the basics, but when I start showing them charts of hormones and mention the role of the pituitary and corpus luteum, I can tell that they have no idea what I am talking about and they are hearing this information for the first time. The class suddenly gets very quiet and pays close attention, because they care about this topic. Many of them are probably sexually active, or will be before they graduate high school. As much as I would rather they wait until marriage, I would also rather that they are more informed about their risk-taking behavior. If a teenage girl knows that it is her "fertile" time, or around ovulation, because she has been taught to notice certain changes in her body, there is a good chance she will be less likely to have sex, and certainly unprotected sex, during that time.
I haven't forgotten my promise from November to cover natural family planning in more detail. I hope to cover this topic a bit more in the coming month. I was a bit busy with entering the institution of marriage in December.
I haven't forgotten my promise from November to cover natural family planning in more detail. I hope to cover this topic a bit more in the coming month. I was a bit busy with entering the institution of marriage in December.
Labels: education, NFP, prolife
Tuesday, December 03, 2013
As a counterbalance to Justine's seriousness
I present this comic from "Mary is my homegirl", entitled "When someone I don't know well ask for my opinion on birth control".
Labels: contraception, humor, NFP
Tuesday, November 26, 2013
Fertility Awareness Products
On first learning about NFP, some might complain that it takes work, and there is a risk of being inaccurate. Isn't there an app or some sort of wrist-band you can strap on that just tells you if you are fertile or not? Isn't there some sort of easier way? Well technology is enhancing all areas of our lives, why not fertility awareness?
A couple of interesting products I have come across, but have not bought or tested, so this is no endorsement, but I simply wanted to point them out as worthy of notice.
1) OV-Watch Fertility Predictor
Website: http://www.ovwatch.com/
A couple of interesting products I have come across, but have not bought or tested, so this is no endorsement, but I simply wanted to point them out as worthy of notice.
1) OV-Watch Fertility Predictor
Website: http://www.ovwatch.com/
To quote the vendors: "OV-Watch is a clinically proven, patented fertility predictor that helps women determine their most fertile time of month. It is a wrist-mounted, bio-sensing medical device that tracks a woman’s individual body chemistry to find the 4 crucial days before ovulation."
Yes, it is like a digital watch you wear at night while you are sleeping. It monitors the chloride ions, which surge in the days preceding ovulation due to hormonal changes.
Pros: Can help you conceive! Seems like it is easy to use!
Cons: Costs well over $100, and has to be refilled with monthly sensors that cost about $40 a month. Cheaper if bought in bulk.
**Warning: The makers of OV-Watch state, "OV-Watch® is not intended for contraception and should not be used by
women who are monitoring their cycles for the purpose of avoiding
pregnancy." ***
2) Fertility Microscopes:
Ovuscope
And also there are various similar products on Amazon.com.
This is basically a fancy magnifying glass or mini-microscope. It is based on the premise that a woman's saliva crystallizes and forms fern-like patterns, only around the time of the month she is most fertile, with maximum "ferning" occurring when she ovulates. This is again due to the surge in chloride ions due to rising estrogen levels. Other times of the month the saliva just dries up in irregular forms with no noticeable patterns.
If you work in a place with access to microscopes, there is no need to purchase this product. I tested the concept by spitting on a slide at the time of the month when I predicted that I was ovulating and checked to see the pattern. I got the following images I took through my iPhone. I learned the technique of holding the iPhone camera up to the eyepiece from my students who were too lazy to draw what they saw under the microscope. I have to saw, the image quality is pretty good!
3) Kindara - Fertility Tracker App for iPhone
This product I have been using for several months now, and switched from the free to the pay version about a month ago, although I haven't noticed many differences in the upgrade. (Which is a good thing for those using the free version!)
This app is both sophisticated and user-friendly. You can use up to three different indicators to track fertility (BBT, mucus, and cervical checks). You can also add in your own additional customizable data. You can input as little or as much information as you want. It predicts your fertile window and your next period start date. It is easy to use if you are new to Natural Family Planning. However, I wouldn't use this app in place of doing your research and reading the literature on NFP and taking a class with a trained instructor.
This product I have been using for several months now, and switched from the free to the pay version about a month ago, although I haven't noticed many differences in the upgrade. (Which is a good thing for those using the free version!)
This app is both sophisticated and user-friendly. You can use up to three different indicators to track fertility (BBT, mucus, and cervical checks). You can also add in your own additional customizable data. You can input as little or as much information as you want. It predicts your fertile window and your next period start date. It is easy to use if you are new to Natural Family Planning. However, I wouldn't use this app in place of doing your research and reading the literature on NFP and taking a class with a trained instructor.
Monday, November 25, 2013
Article Review: NFP Effectivness to Avoid Pregnancy
Article #1:
The effectiveness of a fertility awareness based method to
avoid pregnancy in relation to a couple’s sexual behaviour
during the
fertile time: a prospective longitudinal study
Hum. Reprod. (2007) 22 (5): 1310-1319. doi: 10.1093/humrep/dem003
Link to free access of article:
Summary (Excerpted
from abstract with some modifications)
A study was conducted in Germany with a cohort of 900 women who
charted data from 17,638 menstrual cycles using a version of the sympto-thermal
method to avoid pregnancy. The symptom-thermal method uses a daily temperature
readings, cervical discharge, and optional cervix checks. The results showed 99.4%
effectiveness when used “perfectly” (no unprotected sex during the fertile
window) and showed 98.2% effectiveness when used “imperfectly” (some sexual
relations took place during the fertile period.)
Some Background Information
Warning, biology primer, please skip this if you already know basic
human sexual biology: Men are, generally speaking, always fertile from
the time they hit puberty, although fertility does decline with age. Women
however, are infertile most of the time, with a limited window during which
conception takes place. Obviously, for conception to take place, the egg (ovum)
needs to be released from the ovary (ovulation), and usually this only happens
once a cycle. The egg usually only lives for about 12 hours, and then dies if
it is not fertilized. So technically speaking, the fertility window is a matter
of hours, not days. However, sperm can live for days in the woman’s
reproductive tract! Say sexual intercourse occurs two days before ovulation,
the sperm is actually nourished and aided by the woman’s mucus in this time to
survive and reach the egg. Thus although 48 hours passed between intercourse and
ovulation, a woman may well become pregnant. In fact the most fertile time in a
woman’s cycle is the few days preceding ovulation,
and the chance of pregnancy rapidly declines once ovulation occurs. Thus it is
not simply enough to find out when a woman ovulations, but to plan for, or
avoid, pregnancy, a couple should ideally be able to forecast and predict about
when ovulation will occur. However, the old-school biology textbook notion of a
28 day cycle with ovulation on day 14, is far from the reality of most women.
Thus simply counting days after the commencement of a new cycle is ineffective
at planning and avoiding pregnancies. (This is the old rhythm method that is
rightfully discredited.) /biology primer
The symptom-thermal
method (STM) is based on two primary signs of fertility in a woman: basal
body temperature and mucus discharge. For most women there is a spike in
temperature on the day of ovulation, and the body temperature will remain
raised until the end of the cycle. There will also be an increase in mucus in
the days approaching ovulation, typically with the maximum discharge associated
with the day of ovulation. (Of course this is ascertained only after the mucus
has decreased again.) The reality of this method is slightly more complicated,
and can involve also cervical checks and other changes a woman may notice.
Please do not use this summary an effective way to learn
STM! In fact one of the keys to success in this study, the authors claimed, was
the excellent quality of the teachers and distributed materials that were used
in training women and couples in STM. Usually women and couples are taught this
method together in a series of classes with an instructor. In the case of this
research the instructors were the only ones to know the identity of the
participants of the study, and had to form a relationship of trust with
participants in order to facilitate honesty and consistency in report back data
of a very personal nature, including details of sexual intimacy.
Key Points & Highlights
I am going to use this section to point out what was most
interesting or relevant to me. I will not be summarizing the full methods of
the research. If you want to dig that deep, I encourage you to refer to the
original article using the above link.
First of all, when I read this article I was fairly new to
NFP and what was meant by the symptom-thermal method (STM). What constitutes
STM can vary by region and teacher as well. The method used in this study is
nicely summed up by the following graphic:
I am finding that the main way different NFP methods differ,
is in how one identifies the “fertile” time. The median length of the fertile
time by the above calculations was 13 days a cycle. With all women in the study
having an average cycle length between 22 and 35 days, 13 days may seem like a
long time to abstinent. This is a legitimate criticism of the method. In fact,
as I will demonstrate in my discussion of another paper, 13 fertile days is
very conservative window. By that I mean that the probability of getting
pregnant outside that window is in fact extremely low (0.4%), and some couples
may choose to engage in some intelligent risk-taking by having intercourse on
the “edges” of this fertile window.
In fact that is precisely what some couples in this study
did. Those couples engaging in
unprotected sex during the “fertile” time had pregnancy rates of around 7.5%.
One could make the point that this is a nearly 19 fold increase, however one
would expect the pregnancy rate to in fact be much higher if couples are
engaging in sexual intercourse when a woman is “fertile.” 7.5% is shockingly
low, and the authors of the paper attribute it to the fact that couples,
although failing to adhere to the advice of abstaining from unprotected sex
during the fertile window, are still using their knowledge of fertility
awareness to avoid the few most fertile days of a woman’s cycle.
Interestingly, there was no significant difference in unintended
pregnancies in those couples choosing to use barrier methods of contraception
during the “fertile” window and those choosing abstinence.
Conclusions and
Contentions
The high success rate of avoiding unintended pregnancies is
remarkable. The pregnancy rate was 0.4 (per 100 women) for those adhering to
the guidelines, and 1.8 (per 100 women) overall, including those using the
method imperfectly over the course of a 13 cycle (approximately one year)
period.
How does this compare to other forms of birth control? Well,
I did what most teenage girls across America would do (although I am no longer
a teenager) and went to PlannedParenthood.org for some reliable information on
birth control. When I clicked a link labeled “Effectiveness of birth control” I
was sent to the following graphic:
Oh no! According to Planned Parenthood, it looks like “Fertility-Awareness
Based Methods” like STM are only 75% effect at birth control! That is no good!
However, when you click the link for “Fertility-Awareness Based Methods” it
lists out a variety of methods, including STM, which it does state as having a
less than 1% (0.4%) failure rate. So why do they lump it at the bottom with
spermicide? Maybe because they include it with the “Calendar” method which is
simply based on counting days, and other less efficient methods. Planned
Parenthood is also quick to point out that “If you have unprotected sex on a
day that you may be fertile, emergency contraception is a good option.” I’ll
try to bite my tongue here, but let me just say that Planned Parenthood, in
spite of its non-profit status, is a money-making institution, and so there is
perhaps a vested interest in listing FAB methods at the bottom of the
birth-control totem pole.
Planned Parenthood states that if you always use a condom, it will result in an average of 2 pregnancies
per 100 women (proper use), and if not always used properly and consistently,
will result in 18 pregnancies per 100 women. Compare those stats to the 0.4%
and 1.8% of STM.
What about the pill? Again, Planned Parenthood states that 1
out of 100 women who always take the
pill every day for an entire year, will become pregnant, and for women who don’t
always take the pill everyday as they are supposed to, the number is 9 out of
100. Again, STM wins.
And the best part is, STM is of virtually no cost to the
woman. There is an upfront investment in taking the time to learn the material,
and ideally attend a few classes with a trained professional. It does not
suppress a woman’s fertility, as synthetic hormones do, and has no side effects,
so the very month a woman and her partner change their mind about their desires
to conceive, they can use the same knowledge that helped them to avoid
pregnancy, to now achieve it. There are no side-effects, and there is nothing
you have to buy and keep handy in order to have sex. (Actually, it does require
investing in a thermometer, but these are relatively inexpensive, less than the
cost of condoms over a year! Plus you can use the thermometer when you are
feeling sick and wondering if you have fever!)
What about the fact that
you have a possibly long (13 day median) period of time in which you must
abstain from (at least unprotected) intercourse? This is a valid point, and one
I am still struggling with. It should be noted that the drop out rate from dissatisfaction
was 9.2 per 100 women per 13 cycles (year). This rate is low, and not all women
left for dissatisfaction with the method. Some left because of a “desire to
achieve a pregnancy (8%); separation from partner (2%); medical reasons (4%) and
most frequently (22%) because they wished to discontinue participating in the
study, although they wished to continue to use the STM.” One critique I have is
that the above percentages only add up to 36% and I would like to see a data
table of the other reasons women gave for exiting the study.
I am still wondering if
the 13 day median of a fertility is too conservative. No woman is fertile for 13 days, it is
impossible! The egg only lives for 12 hours, and sperm can realistically live
at longest for 5 days in a woman, and this is a very small percentage that can
live that long. So why the 13 day window? Because of the nature of forecasting
a woman’s day of ovulation. There is some natural variability in cycle length,
and outside factors and also impact a woman’s cycle, such as illness. So the
large window is to minimize the risk of pregnancy due to this variability.
However, my guess is, and I haven’t been tracking my own signs long enough to
know, that for some women they can learn their own biomarkers well enough, and
may have stable enough cycles, to reasonably reduce that window further. The
researchers had to define a wide window of fertility to accommodate the
diversity of cycle types, and variability for even one woman. But my feeling is
that not all women need to be as conservative, and after learning the method
and their own bodies, may be able to make some well-informed calculated risks,
narrowing the abstinence/fertility window. I am certainly not recommending this
and don’t mean to undermine the sound counseling of trained professional NFP
teachers. These are simply my own conjectures.
The next paper I comment
on will discuss be a large demographic study on the daily fertility rates of
women to examine this question of the fertility window more deeply.
