February 2005

Jen Crispin


Taking Charge of Fertility

One of the first questions out of the mouth of anyone who knows me well but hasn't seen me in a few days is always, "So, are you pregnant yet?" Something tells me that I have been a little bit too free with the information that I've had the Norplant out and have been thinking about getting pregnant, as this is going to make the whole keeping it a secret until the end of the first trimester thing rather difficult. But in the meantime, I just say that no, we're not, but we're not really trying yet, so it doesn't count. In my mind, trying consists of more than just the occasional bout of unprotected sex, it must involve counting days and charts and possibly messy fluids.

Well after three months of such inquiries, I finally caved. I dragged myself back to Antigone bookstore to pick up that copy of Taking Charge of Your Fertility that I mocked the last time around. I figured whether or not I was ready to be on a first-name basis with my cervical mucous, there would be something in this book to give me a little better idea of how to plan a pregnancy. Of course, the promise to "increase the likelihood of choosing the gender of your baby" had nothing to do with it.

Opening the book, I admit I had some conflicting expectations. While in general I appreciate the idea that paying more attention to my body could yield some real, tangible benefits, I was wary of the smugness that seemed to be characteristic of Fertility Awareness Method (FAM) advocates that I had encountered on various message boards. There also seems to be some confusion between FAM and the Rhythm Method, the latter being universally ridiculed. Not to mention that I do not own a speculum, and have no burning desire to examine my own cervix.

Despite my trepidation, I was an instant convert. Toni Weschler wrote the book in such a way as to disarm all of my skepticisms one by one. From mocking the Rhythm Method in the introduction to the suggestion of the term "cervical fluid" rather than "cervical mucous" (Oh, I know it's just a word, but what a difference it makes!), by the time Weschler started espousing the benefits of taking control of your own reproductive health in chapter two, I was sold. Which is refreshing, as Taking Charge is now only the second book I've been completely happy with since starting this Breeder column -- the first being The Mayo Clinic Guide to a Healthy Pregnancy.

One of the things Weschler does particularly well in this book is her handling of anecdotes. There are just enough to provide concrete examples of the benefits of the methods (and the ignorance of many who dismiss it), but not so many that the book starts feeling more touchy-feely than like any kind of serious medical text. Plus she provides plenty of outrageous stories for reading aloud to your partner or recounting to your friends (the mark of any good book, in my opinion. If it doesn't make you want to read it to other people, it's probably not worth reading.) My personal favorite scandal was a young couple who remained virgins until marriage and then conceived during their honeymoon. Their insurance refused to cover the pregnancy, saying that she must have gotten pregnant before she was added to her husband's policy, as her last period had been a full month before the wedding. Of course, her periods were abnormally long due to her dieting and exercising for the wedding (and more than likely the stress of wedding planning), but the insurance wouldn't take that for an answer. As it turned out, they gave birth to their son at a normal birth rate three week's after the insurance company's due date, supporting their date of conception, but of course it still wasn't covered. Of course, the insurance company probably wouldn't have been persuaded by carefully plotted FAM charts either, but what this anecdote proves to me is that nice young Christian couples really shouldn't have any aversion to suing the living hell out of huge insurance corporations.

What got the couple above into trouble is the antiquated notion that women ovulate on day fourteen of their cycle. This notion is also the basis of the rhythm method -- that simply by counting the days since the first day of your last period, you can determine on which days you are fertile. Of course, even the most regular woman, with a perfect 28-day cycle, will occasionally experience irregularity. So what clues do we have to better predict fertility? FAM uses three primary fertility signs. The first is waking temperature. By measuring your temperature every morning, while still in bed and before doing anything at all, most women will see a thermal shift indicating when ovulation has occurred. Of course, the egg passes quickly if there aren't sperm already present for conception, so for the couple trying to get pregnant, this temperature shift only indicates that their window of fertility has already passed for the month. (Now itís only useful for the waiting game to see if the temperature remains high for more than 12 to 16 days -- indicating that pregnancy has occurred.) So how to know ahead of time? That's where the cervical fluid comes in. Most women will not produce any cervical fluid at all over the majority of the cycle. But several days before ovulation occurs, some stickiness will develop, during to creamy fluid over a few days, and then at peak fertility, the cervical fluid will be slippery and usually stretchy -- providing an ideal environment for the survival of sperm during their wait for the egg. And for those who think that they will have difficulty determining these differences in fluid quality, there are plenty of full color pictures that will make your job a lot easier. There is a nice summary of these signs and a helpful chart here at the book's supplementary website.

The third fertility sign is actually optional in charting your cycle, it is used primarily to verify the information you're getting from the other two signs, especially if a fever masks your temperature or any number of factors make your cervical fluid hard to measure. That third sign is cervical position. Yeah, I know, I don't see myself measuring this either, but it is interesting. During most of a woman's cycle, her cervix remains firm, low and closed, becoming slowly higher, softer, and open at ovulation. Weschler suggests this monthly change as a reason why a certain sexual position that was fantastic the first time you tried it was suddenly painful the next time. Though I wish she would have specified whether that pain was likely from running into a firm, closed cervix or a high, open cervix.

But really, I think that's probably enough talk of cervixes for one day. Once you've got all the signs figured out, it's time to start charting. There are several different chart templates included in the back of the book, for use with either Celsius or Fahrenheit, for trying to obtain pregnancy or birth control, and a few other variations. Even more helpful are the ample examples of charted cycled provided throughout the book. Weschler covers nearly any possible complication that could make your chart hard to read. Also provided are appendixes on special conditions that make FAM a bit more complicated, such as breast-feeding and pre-menopause. Really, Weschler seems to have all her bases covered here, including a stern lecture on the importance of a monogamous relationship and having HIV screening before having unprotected sex with any partner. I'm so impressed with this book that I'm recommending it to every woman I know who is in any kind of a stable relationship.

There is something wonderful about knowing what is going on in your own body. Though I warn you, reading this book may make you want to cause serious physical harm to whoever was in charge of your "menstruation talk" in grade school, as most of these talks seem to have consisted of "Hey, this is messy, but it's natural, and it's gonna happen for the next few decades, so you're going to have to decide between pads or tampons." As for me, I'm happily awaiting my next period and the chance to start my first chart.