Fertility Awareness

The Menstrual Cycle

Being aware of your menstrual cycle and the changes in your body that happen during this time can be key to helping you plan a pregnancy, or avoid pregnancy. During the menstrual cycle (a total average of 28 days), there are two parts: before ovulation and after ovulation.

  • Day 1 starts with the first day of your period.

  • Usually by Day 7, a woman’s eggs start to prepare to be fertilized by sperm.

  • Between Day 7 and 11, the lining of the uterus (womb) starts to thicken, waiting for a fertilized egg to implant there.

  • Around Day 14 (in a 28-day cycle), hormones cause the egg that is most ripe to be released, a process called ovulation. The egg travels down the fallopian tube towards the uterus. If a sperm unites with the egg here, the egg will attach to the lining of the uterus, and pregnancy occurs.

  • If the egg is not fertilized, it will break apart.

  • Around Day 25 when hormone levels drop, it will be shed from the body with the lining of the uterus as a menstrual period.

The first part of the menstrual cycle is different in every woman, and even can be different from month-to-month in the same woman, varying from 13 to 20 days long. This is the most important part of the cycle to learn about, since this is when ovulation and pregnancy can occur. After ovulation, every woman (unless she has a health problem that affects her periods) will have a period within 14 to 16 days.

Charting Your Fertility Pattern

Knowing when you’re most fertile will help you plan or prevent pregnancy. There are three ways you can keep track of your fertile times. They are:

  • Basal body temperature method - Basal body temperature is your temperature at rest as soon as you awake in the morning. A woman’s basal body temperature rises slightly with ovulation. So by recording this temperature daily for several months you’ll be able to predict your most fertile days.Basal body temperature differs slightly from woman to woman. Anywhere from 96 to 98 degrees orally is average before ovulation. After ovulation most women have an oral temperature between 97 and 99 degrees. The rise in temperature can be a sudden jump or a gradual climb over a few days.Usually a woman’s basal body temperature rises by only 0.4 to 0.8 degrees Fahrenheit. To detect this tiny change, women must use a basal body thermometer. These thermometers are very sensitive. Most pharmacies sell them for around $10. You then record your temperature on a special chart.The rise in temperature doesn’t show exactly when the egg is released. But almost all women have ovulated within three days after their temperatures spike. Body temperature stays at the higher level until your period starts.You are most fertile and most likely to get pregnant:
    • two to three days before your temperature hits the highest point (ovulation), and
    • 12 to 24 hours after ovulation.

    A man’s sperm can live for up to three days in a woman’s body. The sperm can fertilize an egg at any point during that time. So if you have unprotected sex a few days before ovulation there is a chance of becoming pregnant.

    Many things can affect basal body temperature. To get the most useful chart you should take your temperature every morning at about the same time. Things that can alter your temperature include:

    • drinking alcohol the night before
    • smoking cigarettes the night before
    • getting a poor night’s sleep
    • having a fever
    • doing anything in the morning before you take your temperature — including going to the bathroom and talking on the phone
  • Calendar method - This involves keeping a written record of each menstrual cycle on a calendar. The first day of your period is Day 1. Circle Day 1 on the calendar. Do this for eight to 12 months so you know how many days are in your cycle. The length of your cycle may vary from month to month. So write down the total number of days it lasts each time. To find out the first day when you are most fertile, check your list for the cycle with the fewest days. Then subtract 18 from that number. Take this new number and count ahead that many days on the calendar. Draw an X through this date. The X marks the first day you’re likely to be fertile. To find out the last day when you are fertile, subtract 11 days from your longest cycle and draw an X through this date. This method always should be used with other fertility awareness methods, especially if your cycles are not always the same lengths.
  • Cervical mucus method (also known as the ovulation method) - This involves being aware of the changes in your cervical mucus throughout the month. The hormones that control the menstrual cycle also change the kind and amount of mucus you have before and during ovulation. Right after your period, there are usually few days when there is no mucus present or “dry days.” As the egg starts to mature, mucus increases in the vagina, appears at the vaginal opening, and is white or yellow and cloudy and sticky. The greatest amount of mucus appears just before ovulation. During these “wet days” it becomes clear and slippery, like raw egg whites. Sometimes it can be stretched apart. This is when you are most fertile. About four days after the wet days begin the mucus changes again. There will be much less and it becomes sticky and cloudy. You might have a few more dry days before your period returns. Describe changes in your mucus on a calendar. Label the days, “Sticky,” “Dry,” or “Wet.” You are most fertile at the first sign of wetness after your period or a day or two before wetness begins. This method is less reliable for some women. Women who are breastfeeding, taking hormonal contraceptives (like the pill) using feminine hygiene products, have vaginitis or sexually transmitted diseases (STDs), or have had surgery on the cervix should not rely on this method.

To most accurately track your fertility, use a combination of all three methods. This is called the symptothermal method.

Infertility and Fertility

What is infertility?

Infertility is the term health care providers use for women who are unable to get pregnant, and for men who are unable to impregnate a woman, after at least one year of trying.In women, the term is used to describe those who are of normal childbearing age, not those who can’t get pregnant because they are near or past menopause.

Women who are able to get pregnant but who cannot carry a pregnancy to term (birth) may also be considered infertile.

What causes infertility?

Infertility does not have a single cause because successful pregnancy is a multi-step chain of events.Simply described, pregnancy includes the following steps: A woman’s ovaries must be able to release a viable egg, which then must be able to travel down the fallopian tube. The man must be able to ejaculate, and his sperm must be able to travel to the fallopian tube. The sperm and egg must unite to fertilize the egg. The fertilized egg must attach to the inside of a receptive uterus (or implant) and be nurtured by the body to allow the fetus to develop and grow until it is ready for birth.

Problems with any of these steps can lead to infertility.

The cause of infertility can rest in the woman or the man, or can be from unknown factors or a combination of factors. In some cases, environmental factors can contribute to infertility. In other cases, genetic conditions or other health problems are the main cause of infertility.

Female infertility

As explained above, female fertility requires a variety of conditions to be successful. If even one of these conditions is not met, or is not met for the right amount of time, the pregnancy may either not happen or it may end before birth.
Most cases of infertility in women result from problems with ovulation. Some conditions affecting ovulation include premature ovarian failure, in which the ovaries stop functioning before natural menopause, and polycystic ovary syndrome (PCOS), in which the ovaries may not release an egg regularly or may not release a viable, healthy egg. Among women who have PCOS, even when a healthy egg is released and fertilized, the uterus may not be receptive to implantation of a fertilized egg, which results in infertility.

Other causes of infertility might include:

  • Blocked fallopian tubes due to endometriosis, pelvic inflammatory disease, or surgery
  • Physical problems with the uterine wall
  • Uterine fibroids

A woman’s risk for infertility can also be affected by certain lifestyle and environmental factors, including (but not limited to):

  • Age
  • Stress
  • Poor diet
  • Being overweight or underweight
  • Smoking, drugs, and alcohol
  • Medication
  • Environmental toxins
  • Genetic conditions, such as being a carrier of Fragile X syndrome
  • Other health problems, such as sexually transmitted diseases

Male infertility

The male fertility process involves the production of mature sperm and getting the sperm to reach and fertilize the egg. Although it may seem to be a simpler process than female fertility, male fertility also requires many conditions to be met: the ability to have and sustain an erection, having enough sperm, having enough semen to carry the sperm to the egg, and having sperm of the right shape that move in the right way. A problem meeting any of these conditions contributes to infertility.

Like female infertility, male infertility can result from physical problems, such as testes that don’t make enough normal sperm, hormonal problems, and lifestyle or environmental factors, including (but not limited to):

  • Age
  • Stress
  • Exposing the testes to high temperatures, which can affect the ability of the sperm to move and to fertilize an egg. For instance:
    • Cryptorchism is a condition where the testes do not descend into the scrotum. Although it does not usually affect the ability to have and sustain an erection, cryptorchism means that the testes are still inside the body cavity, which has a higher temperature than the external scrotum.
    • Tight underwear—For some men, wearing tight underwear can also increase the temperature of the testes.
  • Smoking, drugs, and alcohol
  • Medications
  • Environmental toxins
  • Genetic conditions, such as Klinefelter syndrome
  • Other health problems

But, in some cases, health care providers cannot determine a cause for infertility in the man or woman. In addition, some known causes of infertility do not have any treatments

How is infertility diagnosed?

Although not getting pregnant is an indication of possible infertility, only a health care provider can provide a diagnosis of infertility. Those who suspect they are infertile should see their health care providers, including:

  • Couples who have been trying to conceive for a year without getting pregnant
  • Women who have experienced menstrual irregularities or who have had endometriosis or uterine fibroids
  • Women who have gotten pregnant but who have had more than one miscarriage or stillbirth
  • Men and women with certain genetic conditions

What are the treatments for infertility?

There are a variety of ways to treat infertility, including:

  • Medication
  • Surgery
  • Intrauterine insemination/artificial insemination (woman is injected with carefully prepared sperm from the husband, partner, or a donor)
  • Assisted reproductive technology (ART), such as in vitro fertilization

Most often, health care providers treat infertility with medication or surgical repair of the reproductive organs. In addition, lifestyle changes may also help alleviate infertility, such as reducing stress, diet modification, stopping use of drugs or alcohol, or reducing the temperature around the testes.

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