Fertility Awareness Methods

fertility awareness methods

WHAT IS FERTILITY?

This is the ability to conceive and bear offspring.

Fertility Awareness is a collection of practice which enables a woman to know when she is most likely to get pregnant,. A woman can understand when she will ovulate by observing her own body and charting physical changes. In a layman terms, it is the ability of a woman to tell the time her menstrual cycle is likely to start and end. (The fertile time is when she can become pregnant). It is also referred to periodic abstinence or natural family planning.

 Methods of Fertility Awareness

1.      Calendar/Rhythm: this involves the use of calendar to keep track of menstrual cycles in other to know when it will start and end with the aim of knowing once fertile time.

This method uses the assumption that

       - Ovulation occurs every 14 days.

       - Sperm has a life span of 2-3days

       - Ovum has a life span of 24 hours.

This method is easy but extra care is needed in women with irregular menses, in this case the girl is advised to add three day forward and three days backward to the supposed ovulation time which is day 13, 14 and 15 and then abstain or indulge in sexual intercourse  from day 11-17 after her monthly period depending on whether she wants to get pregnant or avoid pregnancy.  

2. Keep track based method involves keeping track of the menstrual cycle to identify the start and end of the fertile time.

3. Symptoms based methods depends on having signs of fertility.

4. Cervical secretion: when a woman sees or feels cervical recreation, she may be fertile. She may feel just a little vaginal wetness.

5. Basal body temperature (B.B.T): A woman’s resting body temperature goes up slightly after the release of an egg (ovulation) when she could become pregnant. Her temperature stays higher until the beginning of her next monthly bleeding.

These methods work primarily by helping a woman know when she could become pregnant. The couple prevents pregnancy by avoiding unprotected sex during these fertile days usually by abstaining or by using condoms or a diaphragm.

 Some couples use spermicidal or withdrawal methods, but these are among the least effective methods.

According to a global handbook for providers, effectiveness depends on the user; Risk of pregnancy is when couples have sex on the fertile days without using any method.

1.     Commonly used, in the first year about 25 pregnancies in per 100 women using period abstinence. (How these women identified their fertile time is not known). Pregnancy rate for most of the specific fertility awareness methods as commonly used are not available.

2.     Pregnancy rates with consistence and correct use vary for different types of fertility awareness methods. (See table below).

3.     In general abstaining during fertile time is more effective than using another method during fertile times.

Table.1.1: Calendar Based Method

Method	Pregnancies per 100 women over the first year
Calendar –based method
Standard days method	5
Calendar rhythm method	9
Symptoms –based method

Table 1.2: basal body temperature (BBT)

Today method	4
Basal body temperature(BBT) method	1
Ovulation method	3
Symptothermal method	2

            Benefits of Fertility Awareness Methods

1.     Have no side effects.

2.     Do not require procedures and usually do not require supplies.

3.     Help woman learn about their bodies and fertility

4.     Allow some couple to adhere to their religious or cultural norms about contraception.

5.     Can be used to identify fertile days by both women who want to become pregnant and women who want to avoid pregnancy.

         

   Fertility Awareness method for Women with HIV

Women who are infected with HIV, have AIDS and are on antiretroviral (ARV) therapy, they can safely use fertility awareness methods.

These women should use condoms along with fertility methods. When used consistently and correctly, condoms help prevent transmission of HIV and other STLs. Condoms also provide extra contraceptive protection for women or ARV therapy who cannot use calendar based methods.

All women can use calendar based methods, no medical conditions prevent the use of these methods, but some condition can make them harder to ensure effectively. Caution means that additional or special counseling may be needed to ensure correct use of the method. Delay means that use of particular fertility awareness should delay until the condition is evaluated or corrected. Give the woman another method to sue unit she can start the calendar based method.

In the following situations use caution with calendar based methods, menstrual cycle has just started or has become less frequent or stopped due to advance in age. (Menstrual cycle irregularities are common in young women in the first several years after their first monthly bleeding and in older women who are approaching menopause identifying the fertile time may be difficult).

 In this situations, delay starting calendar based methods. Recently gave birth or breast feeding mother should delay until they have had at least three menstrual cycles and the cycles are regular again).( For several months after regular cycles have returned use with caution) irregular vaginal bleeding.

In the following situations delay or use caution with calendar based methods. Taking any mood altering drugs such as anti-anxiety therapies may delay ovulation, long term user of certain antibiotics, or long term user of any nonsteroidal anti-inflammatory drug (such as aspirin, ibuprofen, or paracetamol). These drugs may delay ovulation.

Providing calendar- based methods

When to start: A woman or couple usually can begin using calendar based method at any time, give patient who cannot start immediately another method to sue until they can start.

Table.1.3:Use of Symptoms Based Method

Woman’s situation	When to start
Having regular menstrual cycle	No need to wait until the start of the next monthly bleeding
No monthly bleeding	Delay calendar based methods until monthly bleeding returns
After childbirth (whether or not breast feeding)	Delay the standard based method until she has had at least 3 menstrual cycles and the last one was 26-23 days long.

All women can sue symptoms based methods. These methods are not affected by any medical condition, although some condition makes it difficult to sue effectively. Caution means that addition or special counseling may be needed to correct use of the method. 

Providing Symptoms Based Methods

Once trained, a woman or couple can begin using symptoms based methods at any time. Women not using a hormonal method can practice monitoring their fertility signs before they start using symptoms based methods.

Table. 1.4 HOW TO USE SYMPTOMS METHOD

Woman’s situation	When to start
Having regular menstrual cycle	Any time of the month no need to wait until the start of the next monthly bleeding
No monthly bleeding	Delay calendar based method until monthly bleeding returns
After childbirth (whether or not breast feeding)	She can start symptom based methods once normal recreation. Have returned.

Two day method: if a woman has a vagina infection or another condition that changes cervical mucus, the two day method will be difficult to use.

Check for secretion: The woman  should check for cervical secretion every afternoon and/or evening, on fingers underwear, tissue paper or by sensation in or around the vagina. As soon as she notices any secretion of any type, color, or consistency. She considers herself fertile that day and the following day.

Avoid sex or sue another method on fertile day: the couple should avoid sex or uses condoms or a diaphragm on each day with secretions and on each day following the day with secretion. They can also use withdrawal or spermicidal but these are less effective.

Resume unprotected sex after 2 dry days: the couple can have unprotected sex again after the woman has had two dry days (days without secretions of any type) in a row.

Basal body temperature (BBT) method: If a woman has a fever or other changes in body temperature, the BBT method will be difficult to use.

Take body temperature: the woman takes her body temperature at the same time each morning before she gets out of bed and before she eats anything. She records her temperature on a special graph. She watches for her temperature to raise slightly 0.2 to 0.5 (0.5 to 1.0 f). Just after ovulation (usually about midway through the menstrual cycles).

Avoid sex or use another method until three days after the temperature rises: the couple should avoid vaginal sex or uses condoms or a diaphragm from the first day of the first day of monthly bleeding until three days after the woman’s temperature has risen above her first temperature.

Resume unprotected sex until next monthly period begins: The couple can have unprotected sex on the 4^th day and until her next monthly period begins.