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Let’s Talk About Fertility | Catholic Life

Let’s Talk About Fertility

I have a nice long post sitting around about Fertility Awareness/NFP and how it requires a lot of work/abstinence. But over the past few years I have become aware of the fact that others have a very different view of this than I do. It has also been 3-5 years since I was reading NFP studies and I am beginning to realize that I don’t remember as much as I’d like to think I do. So, this is a call for help.

In your experience, how many days in a typical cycle would you identify as fertile for the purpose of avoiding pregnancy? And by “identify as fertile” I mean abstain from sex on the day in question, not which days you’d guess were actually fertile once you were looking back on the completed chart after the cycle was over.

The second request is for you to provide studies that show how effective your method is for avoiding conception.

For instance, CCL cites a study that indicates a 99.6% method effectiveness for avoiding pregnancy. And when you look at the actual study you see that there was an average of 13 days per cycle that were identified as fertile and required abstinence.

Based on my understanding of NFP, there are 6 days per cycle that could really be fertile (sperm life + egg life), and an additional 3 days (to account for the possibility of double ovulation and to confirm that it was indeed ovulation– not merely a disturbance in temperature or cervical fluid building up to ovulation but then stopping without ovulation). That means that unless one is either counting on lower fertility (for instance, assuming that a woman will only have a few days of fertile cervical fluid so the sperm could only survive 2-3 days) or else taking chances with not really confirming ovulation, the minimum number of days a (blessedly healthy) woman can expect to identify as fertile is 9.

I recently re-read through the instruction manual for the method that Josh and I learned while engaged (the Cross-Check Method: think STM flirts with Marquette) with the goal of figuring out the least amount of abstinence possible for a healthy woman who was seriously determined to avoid pregnancy. After playing around with the various rules, the shortest that I could come up with was 10 days. A quick review of our practice charts (theoretical, not my body’s data) revealed that the shortest was, in fact, 10 days.

And I am just focusing in on the shortest possible length of time. I know quite well that for many women there will be many months where they must abstain for much longer if they are truly serious about avoiding conception.

So, help me out here. Does your experience or training indicate something else? Please, please, please do direct me to studies. At this point I am thinking that a week of abstinence may get many women a 90-95% method effectiveness rate for avoiding pregnancy, but I just can’t see how it would take less than 9 days to get to 99%.

What am I missing? I don’t want to be ignorant and say silly things in future posts. :-)

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20 Responses to “Let’s Talk About Fertility”

  1. Michelle 02. Jun, 2011 at 8:11 pm #

    I’ll have to take some time and do some digging. I’ve used STM, variation of CrM and we used Marquette between babies #4 and 5. By far I love Marquette as it’s required the least amount of abstinence for avoiding…but…for studies…you’ll have to be patient with me! :) Maybe I’ll get to it this weekend!!

    • Rae 03. Jun, 2011 at 4:30 am #

      Thanks so much!

      I remember reading some of Marquette’s stuff which was really great (I think they also used Creighton studies as well since that was the base they developed off of?) that found a 97-99 method effectiveness for avoiding pregnancy. But I had assumed that when they said “your fertile window will be longer than 6 days due to the variability of the natural markers” they meant something like 3 days longer. Based on what you’ve seen (either your experience or training charts or friends or whatever) would you say that that is an accurate assumption, or do you think that many women can use it successfully with only considering 6-7 days as “fertile?” And I’m totally ignorant here because I haven’t taken MM directly, only had it filtered through another class.

      And, for the record, I don’t consider 9 days to be at all long or unreasonable. I just keep encountering people who seem to think that a week is the standard amount of abstinence required for NFP which they expect to be 99% effective for avoiding pregnancy.

  2. MyFeminineMind 02. Jun, 2011 at 8:21 pm #

    Looking at the two Creighton charts that I can go by, both months there were 10 days of abstinence during my fertile time. And I think with my sympto-thermal charts, it was 9 or 10 days. As far as effectiveness goes, the 5th edition (2001) of Fertility Appreciation Creighton Model has this to say, “There have been five major effectiveness studies of CREIGHTON MODEL System over the last several years. In these studies, the method effectiveness (as a means to avoid pregnancy) has ranged from 98.7 to 99.9 percent. If one takes into account teaching, using and/or human error, the use effectiveness (as a means to avoid pregnancy) ranged from 94.6 to 97.9 percent. Both of these effectiveness rating are equal to or better than birth control pills or other drugs and devices.” The citation for the study they give: Hilgers, T. W. and Stanford, J.: “The Use Effectiveness to Avoid Pregnancy of Creighton Model NaProEducation Technology: A Meta-Analysis of Prospective Studies,” J. Repro. Med. 43: 495-5022, June, 1998.

    • Rae 03. Jun, 2011 at 4:31 am #

      Thanks!

      • Joselyn 31. Jul, 2014 at 4:06 pm #

        something about your understanding and kolenwdge of NFP.First and foremost, there is not only one method of NFP, there are at least three very popular methods Creighton, Billings, and Symto-thermal. And then within those there are other things you can do to customize the method to your own body i.e. adding in other checks to see where you are in your cycle or tweaks to accommodate your own unique body.Second, a good instructor follows up with every couple for a time (when I took the intro Creighton course I believe it was a year) to provide time for the couple/individual to ask questions about their own charts and charting practices.It’s hardly one size fits all. It’s providing methods to learn about your own unique body and fertility information that is not simply limited to fertility but your entire reproductive health that can be used to identify problems like PCOS, endometriosis, PMDD, ovarian/cervical cancer as well as being used to gauged most accurately when a child was conceived.Ponder this why do doctors (rightly) reject a birth spacing method that presumes a 28-day menstrual cycle while still clinging to the practice of estimating conception dates based on last menstrual day and a 28-day cycle? Moms who use NFP know what day they ovulated on and thus know possibly to the day or at least within a few days time span when their child was conceived, whether they have a 25 day cycle or a 60 day cycle?

  3. MyFeminineMind 02. Jun, 2011 at 8:39 pm #

    Okay I can’t help myself. I am curious about what you mean by “a lot” of abstinence. Because…um…well…when I’m naturally infertile due to lactational amenorrhea, it seems we average once a week, which would be about 4 times a month. But when I am fertile and we are seeking to avoid pregnancy, well..um..we have sex…more than that. Like maybe 8ish times a month? So I guess we abstain for 10 days at a time, but we also have sex more. And I guess according to polls, NFP couples have more sex than contracepting couples. So perhaps “a lot of abstinence is relative? :)

    • Rae 03. Jun, 2011 at 4:38 am #

      I’ll post more about it, but basically I think that many people seem to be under the impression that a woman can just know when she is fertile, and that she is only fertile for 6 days, so NFP requires 6 days of abstinence to be effective. So by “a lot” more work/abstinence I meant that in my understanding, all of the studies that actually show 99% effectiveness require careful observation/charting for the majority of the month + abstaining for at least 10 days each cycle. And if one wants less work in observing/charting, one has to abstain longer.

      I’m mostly concerned about newly married/young couples who seem to have incorrect assumptions about NFP. I totally agree with you that both abstinence and the work of fertility observation are relative. Since I am interested in fertility, charting daily and assuming two weeks of abstinence would be no big deal. But apparently it is light years away from what others would ever consider to be NFP.

  4. Kathleen 03. Jun, 2011 at 4:16 am #

    You’ve quoted everything I could give you already. :) Can’t wait to read it.

  5. Rae 03. Jun, 2011 at 4:42 am #

    Oh c’mon. You could at least tell me that in your experience as an instructor women only need to meditate on the concept of fertility for five minutes each month and abstain for 3 days and they will have a 100% user effectiveness for avoiding pregnancy. 😉

  6. Katarina 03. Jun, 2011 at 10:34 am #

    Ive only used NFP postpartum so can only tell you my experience with that background – we have def had more than the 10 – 13 days of abstinence . What i have discovered with the NFP methods in the pp transition to fertility is the amount of abstinence can be unnerving
    Unfortunately with the exception of Marquette

    There are studies on the effciacy of this method on their site http://nfp.marquette.edu/

    • Rae 04. Jun, 2011 at 4:13 am #

      Thank you for our comment. I wish that more people would talk openly about this. I think that many young newly married women are hugely ignorant about the reality that seriously avoiding pregnancy postpartum may involve several months of abstinence. Of course there is great variation in how different women’s bodies respond, but the reality is shocking to those who think that NFP=a little abstinence here and there + babies perfectly timed as you like.

  7. Rebecca @ The Road Home 03. Jun, 2011 at 11:16 am #

    I can only speak from our experience (not studies, sorry :( ) that yes, it’s more like 9 – 10 days of abstaining, and careful charting each day, and that is with a regular length cycle. Though, the best part, IMHO, of STM is that once you’ve ovulated, you’re days are all OK days until the next cycle starts. No need to worry about dry days or every other day (I don’t know if Creighton or Marquette work this way or not, so that may just be a good thing about all NFP.)

    • Rae 04. Jun, 2011 at 4:15 am #

      Haha, yes. :-)

      • Martin 31. Jul, 2014 at 7:19 am #

        If they took each other’s virginity and nheetir have slept with anyone else then HIV was contracted in some other way by one partner by IV drug use or some other obscure way. Blood transfusions were once a cause, but now blood is checked and that is extremely rare. Of course one partner could be lying about their virginity and monogamy. Of course if one had HIV he or she could give it to their partner by having unprotected sex. The odds of this ever happening are extremely slim. Most states require a blood test for HIV if the couple applies for a marriage license.

  8. TMI 08. Jun, 2011 at 10:34 pm #

    The comments and stats are a little depressing to me. Only 9 days?? Now I am feeling extra sorry for myself, boohoo. We had one instance in one single cycle of an abnormally but ultra super early upward temp. shift and now we have, like, 3 weeks of abstinence until the Phase III all-clear (according to STM Rule #whatever–sorry I can’t remember). I couldn’t believe that O was possible on cd8 but anecdotal evidence from other NFPers in some online forum indicated that other women have indeed conceived from intercourse as early as cd3. Huge bummer.

    Unless I am missing something here and if anyone wants to correct me, my husband will thank you!

    • Rae 10. Jun, 2011 at 10:01 am #

      The only thing that I can come up with that might help you is that, because our bodies change, old cycles are not relevant forever. I am not an NFP instructor, so you should ignore everything I say unless you want to precisely what you don’t want when it comes to abstinence and pregnancy;-), but I think it is somewhat standard to consider the past 12 cycles when making cycle-based calculations.

      You might also consider the circumstances surrounding the month in which your body had the odd cycle–not only that month, but the few months before. If you can figure out a probable cause, and if that cause is not currently relevant and you have not ovulated early in the past 12 cycles… maybe… talk to a legit instructor? :-)

      9 or 10 days was what I could come up with as the absolute minimum (well, unless you were going for ultrasounds every day?). I don’t think that it is at all realistic for any woman all of the time, or for many women ever.

      I’m guessing you’re thinking of the Doering rule (earliest temperature shift minus 7 = first fertile day) but there are so many rules that can make Phase I non-existent in practice. All it takes is one 22-day cycle and a woman should assume that fertility starts on day 1 in the future. And, let’s be real, how many women have cramps or heavy bleeding or whatever that makes sex not work during the first few days of the cycle, even if it is “allowed?” So yes, lots more than 10 days of abstinence. And let’s not even talk about adding in abstinence for liturgical reasons and life circumstances such as traveling!

      I guess I should post something about the other side as well. Here I was working on starting to counter the (apparently common?) misunderstanding that a week of abstinence is standard for serious NFP.

    • Motoshi 31. Jul, 2014 at 1:20 pm #

      ~N, my wife started tkniag the pill when we got married. After a couple years she started gaining weight, had acne problems, pain in her joints, eczema, roseacea and hair loss. Her OBGYN told her it was side effects of the pill so he switched her to a lighter dose. That didn’t clear things up so she quit tkniag it altogether. After a month she still had most of the symptoms and she went to see her regular physician. After running through the symptoms her doc suggested a wonder drug that would clear them all up: the pill. She refused and within a few months most of the problems had gone away. About a year after that she went back to her OBGYN. She still had the eczema and roseacea, plus her allergies had gotten much worse. The OBGYN she saw that day (not her regular one) suggested she go back on the pill to clear all that up. In addition, she’d been on the pill in her early teenage years. It was prescribed at various times to treat heavy bleeding, and irregular cycle, cramps and rapid weight loss. She was taken off the pill or switched to a different dose because, according to her doctors, it caused her heavy bleeding, irregular cycle, cramps and rapid weight loss. So, at various times and by various doctors, she was told that it both caused and cured each and every one of her symptoms (amusingly, the one thing it didn’t do was keep her from getting pregnant). Yes, I realize this is also anecdotal, but if you gather enough anecdotes they end up becoming statistics.

    • Diana 19. Feb, 2015 at 12:25 pm #

      Dear N, I’d like to weigh in regards to 1flesh pmoiotrng NFP to minors. I teach the Creighton Method. In the past 6 months alone six teens have approached me for instruction; four with their mothers, two on their own. They wanted help for heavy bleeding/painful periods, extreme PMS, migraine headaches, recurrent cysts. They were taught to chart their cycles. The chart is like a preliminary diagnostic tool as certain patterns and biomarkers help reveal what may be the cause of their problem. The chart allows us to target the cycle perfectly for blood draws to investigate any possible hormone imbalance. If there is an imbalance the teen continues to chart so the treatment (bio-identical hormones) can be targeted to the right part of the cycle to bring it back into it’s proper balance, which in turn resolves the symptoms. My teen clients have found resolutions to their problems when nothing else helped. This is a new approach to women’s health, and teens need it too.

  9. Katarina 09. Jun, 2011 at 1:00 am #

    tmi – no need to be depressed – i have a baby to show for ovulation on cd 10 after a 9 day cycle so for us phase i & Phase II are totally a no go area

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