Tag: fertility charting

What’s In A Name?: Fertility Awareness (Based) Methods and Natural Family Planning

It’s somewhat embarrassing to admit, but I find it hard to bring fertility awareness up to people in real life who haven’t heard of it before. For me, the awkwardness is their reaction to the name and what they think it entails.

Something about “fertility awareness” evokes something for some folks that is akin to “hippy” or “new age” type of connotations.

On the other end, some folks will think that this term means the calendar method or the rhythm method. This is partially because most people don’t know about the new science of real-time fertility signs. The other reason people think this is because most people who claim to be practicing a fertility awareness method are still doing some kind of bleeding tracking focused method. It’s truly a small percentage of us who are using a evidence-based real-time fertility sign method like Sympto-Hormonal, Sympto-Thermal, or Cervical Mucus only methods.

“Fertility” evokes conception for many folks. It also isn’t the correct word. We can only know if we were truly capable of fertility that cycle retrospectively when a pregnancy occurs, or if the cycle was visibly fertile by counting the luteal phase. I’ve seen a researcher say the correct term might be “fecundity.”

“Awareness” makes me think of some type of campaign. And what does awareness mean?According to the OED, “knowledge or perception of a situation or fact.” This can sound like people are charting with their intuition, but we are not. Fertility awareness modern methods track tangible and measurable fertility signs (cervical mucus, basal body temperature, cervix) or hormone levels.

I also don’t want to tell people that I teach natural family planning. Something about “family planning” makes people assume that the method is only for those who want to conceive, but a part of family planning is avoiding a pregnancy too. Then, there’s the religious connotation. I’m not Catholic, and I don’t just encourage abstinence because of religious compulsion.

Then, there’s the word natural. Natural is an incredibly subjective term. Some folks will see it and think this also means the withdrawal or pull out method. In the context of charting, it does not include withdrawal. According to the OED, one of natural’s meanings is “existing in or caused by nature; not made or caused by humankind.”

With this definition, do urinary hormones methods become “unnatural”? The hormones themselves occur in the human body, but you can only measure them with help from a machine. I’m not arguing against natural family planning including hormone monitors, but I do wonder if it makes sense to use that terminology.

My favorite terminology is “fertility awareness based methods.” Something about the word “based” makes it sound more scientific in my mind. I’ve seen some educators adopt this language to be more inclusive.

I’ve seen Samantha Zipporah talk about “conscious contraception” as a way to classify fertility awareness. I like the term conscious. Something about it sounds more sophisticated than awareness. I’ve seen it used in a few older academic articles. You can read them here and here.

I’ve also seen it called “Natural Fertility Control” or “NFC.” You can read an article with this terminology here. Some people will feel uncomfortable with the term “control.” In some ways, it isn’t control, because there is always a small chance of unintended pregnancy with correct use, and a larger chance of unintended pregnancy with incorrect use. I do think the self-knowledge gives the user a level of control over their choices more than other methods do. After all, with correct use, you will always know when you are possibly fertile, and then can make your decisions accordingly.

What terminology do you like best?

Can I get pregnant on my period?

Many people think that having sex during menstruation cannot lead to pregnancy, but the answer is much more nuanced than that. It is possible to get pregnant during bleeding episodes, some of which may not be menstruation!

Was the bleeding truly menstruation?

Charting evidence-based fertility signs like cervical mucus, basal body temperature, and urinary tests are the best way to determine if you are ovulating. True menstruation should follow about 10-16 days post ovulation as indicated by a temperature shift or positive PdG test.

If you are not charting your cycle with a fertility awareness based method, your bleeding may not really be menstruation. Estrogen breakthrough bleeding may appear very similar to menstruation and is often indistinguishable without charting. This bleeding can be fertile, and pregnancy could result.

Day one of a true menstruation marks the beginning of the cycle.

Day 1 is true menstruation because it followed a proven luteal phase. The current cycle confirms the next bleed will be menstruation because of the positive progesterone tests. This app is Read Your Body.

How long are your cycles? Better yet, approximately when do you usually ovulate?

If your cycles were 26 days or longer for the last year, it is unlikely you will become pregnant with sex during the first five days of the cycle.

Dr. Josef Roetzer monitored 5,807 cycles. He observed only one pregnancy before day 6 of the cycle. Her cycles were 22-27 days long.

Dr. Roetzer estimates that using the first five/six days is 99.8% effective for avoiding pregnancy. It is important to note that all of his cycles monitored had a temperature shift preceding menstruation. If you do not have proof that you ovulated before a bleed, it becomes more likely to conceive during bleeding.

Another way to determine the last infertile day at the beginning of the cycle is to use Dr. Doering’s rule. Dr. Doering subtracted 7 from the earliest first high temperature in the last year. For example, Sarah’s earliest first high temperature was day 13. Day 13 – 7 = Day 6 as the last infertile day of the cycle. This rule is always crosschecked with cervical mucus. Sperm may survive up to 5 days in cervical mucus, and any presence that has not been determined to be infertile through instruction should open the fertile window. The Doering rule is more personalized than automatically assuming the first five/six days are infertile.

In Dr. Frank-Hermann’s double-check sympto-thermal study from 2007, all three method failures were from day 5 intercourse. This study used the first five day rule and Doering rule. This study yielded an efficacy of 99.6%.

So am I safe to have sex during my period? Ask yourself these questions.

  1. Did you confirm ovulation with basal body temperature, PdG strips, or a blood draw in the previous cycle?
  2. Are your cycles longer than 26 days on average? Have you ever had a peak day before day 13 of the cycle?

If the answer to both of those is yes, you can probably have safe sex up to day 5 of your cycle.

If your answer is no, then you have a possibility of pregnancy.

What if I want to be more conservative?

Some methods like Billings, FEMM, and Creighton suggest not having sex during heavy days of bleeding when cervical mucus cannot be observed.

If you have a history of short cycles (less than 26 days) or want to add an extra layer of protection onto the beginning of the cycle, I recommend beginning observing vulva sensation and cervical mucus as soon as your bleeding has lightened enough to no longer need a tampon, cup, or regular pad. If you need only a panty liner or are only experiencing light spotting, you should beginning checking your cervical mucus and sensation throughout the day. At the end of your day, if you have observed no cervical mucus or sensation outside of your determined infertile pattern, this day is safe for sex. (DO NOT DO THIS WITHOUT LEARNING A METHOD. THIS BLOG IS NOT ENOUGH INFORMATION TO AVOID PREGNANCY WITH ALONE).

What if I bleed for more than 5 days?

If your menstruation lasts longer than five days, you should follow the instructions from the paragraph above. It is NOT safe to consider past day 5 automatically available if you are bleeding. You need proof by using cervical mucus or urinary estrogen tests that your fertile window has not yet opened past day 5 of the cycle.

What if I randomly have a short cycle?

Checking cervical mucus is your best back up. Cervical mucus should appear when the fertile window is opening for most charters. Many methods suggest no longer considering menstruation safe once you enter peri-menopause (can occur up to 10 years before menopause) because cycles may shorten at this time. If you notice that your cycles have grown shorter than 26 days, you may want to become more vigilant and stop automatically considering the first 5 days safe.

Conclusion

For the majority of people menstruating, using the first five days of a true menstrual cycle will not result in pregnancy. For a very small percentage, it may. I recommend charting with a real fertility awareness method (Sensiplan, SymptoPro, FEMM, Billings, Marquette, etc) to determine if your bleeding is actually menstruation!

Works Cited

Boetze, Iosef. “Further Evolution of the Sympto-Thermal Methods.” International Review of Natural Family Planning 1 (1977): 139-150.

Raith-Paula, Elisabeth, et al. Natürliche Familienplanung heute. Springer Medizin Verlag Heidelberg, 2008.

An Honest Review of Tempdrop (Revised Review 2021)

Are you looking to simplify your basal body temperature charting routine? Is getting up in the morning just too hard to remember to take your temperature? Read on!

There are currently a few wearable basal body thermometers on the market such as iFertracker, Ava, and Tempdrop. In this blog, I will review the Tempdrop device. If you decide to purchase, use this link and get 10% off the device.

Unboxing Tempdrop!

Tempdrop is a wearable basal body temperature thermometer that came onto the market in 2017. Rather than setting an alarm, you can simply put this thermometer on before bed. You wear it around your upper arm (and it may be worn in a bra as well). It needs 3 hours of sleep to determine your basal body temperature. The device uses an algorithm to find your true temperature, regardless of how many times you have gotten up or whether you had restless sleep this night.

This device is very popular with shift workers, breastfeeding folks, and other people who don’t get a regular amount of sleep and wake up at different times, or just to those who don’t want to set an alarm!

Tempdrop holds 24 hours of data, and it must be synced at least every 24 hours or you will lose previous data. After wearing it for 15 days (as of March 2020), the algorithm will kick in. (If possible you should back up temp with oral basal body temperature for the first 60 days if you are avoiding pregnancy. If not, use a different method of protection). By day 60, the device will only change and make improvements to the last 2 temperatures taken.

Once you wear it, you will need to sync it to an app to see your temperature. Tempdrop has its own app, but I highly recommend using Read Your Body (pictured below) instead! This app is customizable for every method and can be synced to Tempdrop.

My Experience with Tempdrop

Tempdrop is red and oral temperatures are blue! One perk of oral temperatures is that sometimes I can skip taking my temperature, while with Tempdrop you do wear it daily for best results.

I used the Tempdrop device for almost 12 months. I found my oral temps to be more predictable and more steady when observing my own trends over time. I get very steady or repeating temperatures with oral charts most of the time.

However, I am not a shift worker, so I will admit that I do not need Tempdrop like some people may do. I already have to wake up at the same time 5 days a week, and I don’t find it inconvenient to take my temperature on the weekend. My oral temperatures caught my shift earlier than Tempdrop did on two separate occasions. I have seen other people say that Tempdrop catches their shift sooner than oral temperatures, so this is really an individual thing.

I discovered that there were multiple other effective ways of charting without taking my temperature. If you really want to chart in shift work, irregular cycles, postpartum and you do not want to purchase the Tempdrop, I highly recommend considering learning a new method of fertility awareness like the Billings Ovulation Method (click here to learn about working with me) and Marquette method (click here to learn what charting with Marquette is like).

If you are dedicated to using a sympto-thermal method and can’t get accurate temperatures otherwise, and you have tried trouble shooting your routine (vaginal temperatures, pre-warming the thermometer before taking it, using longest stretch of sleep), then Tempdrop may be your best option. You can use my code for 10% off, and I will get a small kickback. Thank you for using my code!

Here is what the device looks like!

Which method of fertility awareness is right for me? A decision making tool

It can be hard to choose the right method for you. In this graphic, I have simplified the main signs, times of intimacy, and efficacies for the four methods that I am most familiar with.

As part of my charting journey, I have personally compared and charted with Billings, sympto-thermal, and Marquette. You can view my charting comparisons here.

The graphic is intentionally simplified. Method rules will vary, particularly if you are using a different protocol of the method or combination of signs. My Marquette example is for monitor-only rules.

Time of day for intimacy is very important to consider as a part of the decision making process. If you and your partner’s schedules don’t mix well, this may sway you towards another method!

Some couple like intimacy to feel spontaneous. If you never want to worry about time of day, Marquette is likely the best method to choose.

On the other hand, if you want your fertile window to be defined by cervical mucus, you may want to sacrifice any time of day sex for the flexibility of opening the fertile window that may come with using alternative evenings of the basic infertile pattern in Billings.

I recommend interviewing an educator and telling them your unique situation before committing to a method.

To find an instructor, I recommend using the Read Your Body Educator directory linked here. You can use it to find an instructor based on the fertility signs you want to chart, your location, price range, and more!

6 Cycle Comparison: Marquette Versus Billings Versus DOT Fertile Windows

Have you ever been curious what your fertile window would look like in multiple methods?

In this blog, I show 6 cycles with various fertility signs and method interpretation including: the sympto-thermal method (Sensiplan rules), Marquette method, the Billings Ovulation Method, and DOT (a calendar method that was recently purchased by Clue app and is a new FDA approved birth control). I chose to include representation for only studied methods of fertility awareness: sympto-thermal, sympto-hormonal, mucus-only, and calendar method.

All charts are from the Read Your Body app, a flexible app for all methods that I highly recommend!

Some things to know before reading:

  • Marquette allows sex any time of day within their rules. My calculation rule lasts until the end of day 7.
  • Sympto-thermal method allows sex any time of day during first 5 days of menstruation, but the first safe day in the luteal phase must be used in the evening. My calculation rule is day 5.
  • Billings Ovulation Method allows sex in the evenings only and on rotated days in the pre-ovulatory time of the cycle. Days of bleeding where mucus cannot be observed are not allowed. However, since you can have sex any time of day post-ovulation with Billings, sometimes cycle day 1 is available if you have sex before bleeding occurs.
  • DOT allows sex any time of day within their rules. It automatically opens my window on day 7.

Cycle 53

Consecutive Fertile Window for Expected Abstinence:

Billings: 8 days

Sympto-thermal: 12 days

Marquette: 12 days

DOT: 12 days

General remarks: This is an extremely standard cycle in length and mucus patch (the average person will have a 5 to 6 day mucus patch when charting). I believe this is a great example of what methods would look like for someone of the average cycle length.

Cycle 54

Consecutive Fertile Window for Expected Abstinence:

Billings: 9 days

Sympto-thermal: 21 days

Marquette: 15 days

DOT: 12 days

General comments: My average coverline is 96.8 to 97.0, so regardless of earlier high temperatures and some illness I felt confident marking this coverline and temperature shift. Due to continous long, clear-ish mucus, my sympto-thermal peak was extremely delayed. Billings is a sensation focused method so I was able to mark my peak at an earlier time and have less expected abstinence.

DOT gave me a very risky day on this one. It is possible I could have been ovulating near the safe day. However, that would have only left 9 to 10 days for implantation and I had spotting, so whether this truly could have ended in pregnancy is up in the air. Even with well-timed sex, pregnancy will not always occur.

Cycle 55

Consecutive Fertile Window for Expected Abstinence:

Billings: 6 days

Sympto-thermal: 12 days

Marquette: 12 days

DOT: 12 days

General comments: This small fertile window in Billings might look scary to some, but it is not possible to get pregnant when the cervical mucus plug is truly closed. I have about one cycle like this every 13 cycles. I was also using the Kegg device during this cycle which is placed internally and reads electrolyte levels to determine the fertile window. It gave me the same 3 day dip for a fertile window, so I feel even more confident that those days were truly dry. I am missing temperatures on this one because my thermometer glitched and would not give me readings on these days. Sex day 1 was allowed because menstruation didn’t start until 5pm.

Cycle 56

Consecutive Fertile Window for Expected Abstinence:

Billings: 8 days

Marquette: 11 days

DOT: 12 days

General Comment: This was an extremely heavy period so I had no period days available in Billings. Even though the other methods gave me available days, I couldn’t have used them due to the pain, so ultimately the other methods didn’t really help out on more safe days.

Cycle 57

Consecutive Fertile Window for Expected Abstinence:

Billings: 10 days

Marquette: 14 days

DOT: 12 days

Cycle 58

Consecutive Fertile Window for Expected Abstinence:

Billings: 9 days

Marquette: 11 days

DOT: 12 days

General Comments: Marquette monitor missed my peak on this cycle. It misses peak on up to 10% of cycles. I relied on meeting LH rules instead of the monitor. Sex day 1 was allowed because menstruation didnt start until 1pm.

Reflecting on What’s Best for Me

I’m currently on cycle 59 charting, and I have tried a ton of methods. Right now, my ideal method is Billings and LH tests as a bonus marker.

While it may appear that Billings gives less safe days in some instances, what is most important to me is having the smallest consecutive fertile window. Having less expected abstinence actually makes me more likely to follow the rules. I was completely unsatisfied with only being allowed period sex in the sympto-thermal method because I have period pain issues. That means that I basically had no safe days at all in reality before ovulation with sympto-thermal.

I originally felt very enthusiastic about Marquette method. However, after 6 cycles of using the Clearblue Fertility Monitor, I realized that it always caught my LH surge after the cheap LH tests. In addition, it missing my peak even once is frustrating for the cost of the product. For that reason, I have decided to stop using the monitor when I run out of tests. I can use a 15 cent LH test and get the period prediction aspect (LH is my most steady indicator).

The DOT app tends to give me a risky cycle whenever I ovulate late and have a shorter luteal phase. I do not rely on this for pregnancy prevention. Overall though, DOT has not given me many risky ways. I use it for long-term period prediction, and it is the most accurate period predictor I’ve ever used for planning months in advance.

What to Consider Before Switching Methods

1. Why are you unsatisfied with your current method? Is it the amount of safe days, or is it the routine that you don’t like?

2. Do you have medical needs that could be addressed by another method?

Sometimes the grass isn’t greener on the other side, but if you are like me and can’t have period sex or don’t want to have period sex, methods like Billings without calculation rules will almost always include more safe days if you are dedicated enough to learn the method and chart it accurately.

Folks in irregular cycles like in postpartum time or with PCOS may benefit from more flexible methods without calculation rules

*DISCLAIMER: DO NOT TRY TO LEARN FROM MY CHARTS. MY CHARTS ARE NOT YOUR CHARTS.

My Experience Becoming a Certified Billings Ovulation Method Teacher

I recently completed my teaching certification for the Billings Ovulation Method through the Billings Ovulation Method Association in the USA (BOMA). This is a cervical mucus / sensation only method that has been taught for over fifty years in over 120 countries.

I began this certification having been quite dissatisfied with my previous certification in the sympto-thermal method. I found the sympto-thermal method inadequate for irregular cycles or postpartum cycles, as well as for any cycles with continous mucus.

This certification 100% cleared up all doubts I had about being able to teach people in these situations! I love that Billing’s motto is “Keep it simple.” Ultimately, this certification gave me the confidence to give up temperature taking as a part of my fertility awareness routine.

First Step:

Before beginning the certification, I took an introductory class with my spouse in the method. This gave me about 6 months to try to apply the principles to my charts before beginning training. I had previously certified in a “Billings-based method” but learned quickly that authentic Billings is a different creature altogether.

I recommend that anyone who is going to train in this method learn to practice it first for at least 6 to 12 cycles under the guidance of an accredited teacher. Joining this program without learning the method first is going to leave you lost on your charts – when you should be confident in your charts before helping others.

Second Step:

The class began in December 2019 and ran through September 2020. We met once a month for approximately an hour (sometimes a little more or less). Inbetween meetings, we were expected to read one to two chapters of material and complete 5 or more worksheets that included chart evaluation and quizzes.

I really appreciated the live classes because my previous certification had no live component. I’m a strong believer that synchronous connection is really important for learning something new.

During class, we were shown PowerPoints and given time to ask questions about the homework. Hearing from long-term accredited teachers about different charting circumstances did wonders for my existing knowledge base. It was incredibly valuable.

Full disclosure: It is important to know that Billings was founded by and is primarily run by Catholics. These meetings often began with prayer or referenced God. Teachers are not required to teach the religious component of the PowerPoint. That means that Billings can be presented in a secular manner. The WOOMB International head organization notably does not include religious elements in their presentation of the method. The science of the method is solid regardless of any ideology attached to it.

Third Step:

The next step after passing an exam on the material was to begin practicum. Practicum is the supervised portion of the certification where you teach 6 to 10 clients minimum in the method while submitting charts and questios to a supervisor selected for you by the organization.

This graphic is how long it took me to finish the practicum portion of the course. Most people take 1.5 to 2 years to finish the program. I went a little faster because I taught larger group classes and had clients lined up before it began.

Practicum was the most enriching part of the experience, and I recommend that anyone who does the training utilize this time to your best advantage. I learned how to help people identify complex basic infertile patterns where they never have dry days. This was not possible in my previous method. I was able to support multiple postpartum women as well as folks with PCOS or who were trying to conceive. I learned so much by meeting with my clients and sending charts to my supervisor.

The follow-ups and classes in Billings are mandatory live meetings (video calling, phone call, or in-person). The follow-ups generally last 15 to 30 minutes depending on the client and how early they are in the process. Follow-ups and classes are required to be live, and this is based on what was done to reach efficacy in the Billings studies. We generally meet with clients seven or more times in the first 6 months, and then every 1 to 3 months. Some people may have more or less follow-ups depending on when they reach autonomy and things like cycle characteristics (postpartum people tend to meet up until the third ovulatory cycle after return of fertility.)

Fourth step:

After having enough clients in different situations (postpartum, trying to conceive, trying to avoid, regular and irregular cycles), I had a final meeting with my supervisor. Before this, I had to compile a document of every client chart. This was a bit laborious as the Billings charts cannot be exported to PDF without losing part of the chart. I had to screenshot segments of the charts and then re-assemble them. This meeting with my supervisor lasted about two hours, and we discussed all of my client charts and any corrections that needed to be made.

Following that, I was recommended for the final step. I recieved a mailed in exam that involved correcting a full paper chart and writing why I made those changes and what mistakes were originally made.

I turned in this exam to two graders. They then met with me and discussed the chart and any necessary corrections. They approved my certification at the end of the meeting.

The Future

Billings Ovulation Method teachers are required to do continuing education to maintain their certification. This is an investment of approximately $300 to $600 every three years. While this is costly, it is really important to attend further training where the teacher can see more advanced charting techniques and learn about health conditions, efficacy, and more!

My Final Thoughts

I would recommend this certification program to anyone who is interested in having an in-depth understanding of cervical mucus charting. The Billings Method teaches about things like the “pockets of shaw” and the cervical mucus crypts. My previous certification did not include close study of the patterns of cervical mucus. This program fundamentally changed my thinking about temperatures always being a necessary part of charting. I ended up dropping temperatures completely after 3 years of using basal body temperature.

Billings allows teachers to order all supplies, including digital materials, for clients. This means I do not have to produce my own materials, and it is super useful for quickly mailing clients what they need.

To make the most of out of this program, I recommend also reading the scientific studies on the side. Unfortunately, the program did not go into a lot of depth on the previous research studies. As someone in academia, I really like understanding all the different correct use and typical use statistics. I’m often questioned about efficacy, and I want to be able to answer people’s questions. If this also describes you, I recommend the following articles:

The Discovery of the Different Types of Cervical Mucus

Use-effectiveness and client satisfaction in six centers teaching the Billings Ovulation Method.

Field trial of billings ovulation method of natural family planning.

A prospective multicentre trial of the ovulation method of natural family planning

A Trial of the Ovulation Method of Family Planning In Tonga

A Response: In Defense of Truth in the Science of the Billings Ovulation Method

Misrepresentation of contraceptive effectiveness rates for fertility awareness methods of family planning

A Dive Into Resting Heart Rate and the Menstrual Cycle

I purchased a Fitbit device close to two years ago, and within months I noticed that my heart rate appeared to be correlating with the phases of my cycle. I’ve been charting resting heart rate since 2018, and I can say with confidence that it has lined up every cycle. This shouldn’t be too surprising because we already know that progesterone causes basal body temperature to rise, but heart rate does not exactly follow that pattern. Heart Rate also rises in response to high estrogen levels in the fertile window.

We have known about the possible connection between heart rate and the menstrual cycle for over a century, but in the last 50 years a few studies have taken a closer look.

Palmero (1991) studied 64 women for 3 consecutive months and created a PMS group versus a non-PMS group. They found that “in the premenstrual phase, PMS group showed significantly higher resting HR levels than NPMS group.”

Moran (2000) followed 26 women and found that “resting-heart rate was significantly higher in both ovulatory (P < 0.01) and luteal (P < 0.01) phases than in the menstrual and follicular phases.”

Shilaih (2017) followed 91 women and found that they “observed a significant increase in pulse rate (PR) during the fertile window compared to the menstrual phase (2.1 beat-per-minute, p < 0.01). Moreover, PR during the mid-luteal phase was also significantly elevated compared to the fertile window (1.8 beat-per-minute, p < 0.01), and the menstrual phase (3.8 beat-per-minute, p < 0.01).”

I want to highlight these last two studies in particular, because many of the other studies have an issue. Marco Altino explains why:

“The great majority of studies looking at HRV and the menstrual cycle collected one single data point during the follicular phase and one single data point during the luteal phase. I don’t have to tell you how little sense that makes, considering the high day to day variability in these parameters.”

This is an excerpt from his blog on heart rate variability in the menstrual cycle. Read the full blog here.

The 2017 study published in Nature by Shilaih, et al found that heart rate may rise up to 5 days before ovulation occurs. This means that heart rate could potentially be a used as a way to time intercourse for conception.

My results are so steady with resting heart rate that I dream of someone using it in a long-term study with other fertility signs. Wouldn’t it be cool if we could avoid pregnancy using heart rate too?

Below is an example of my results with resting heart rate. To convert my heart rate to fit in a fertility awareness app, I use a conversion. Essentially, one heart rate beat = .1 Farenheit change on my temperature scale. A heartbeat of 69 becomes 96.9, 70 becomes 97.0, 71 becomes 97.1 This preserves the original ratio, and it allows me to show the data with other fertility signs. For your own conversion, you may model this. If you have a lower heart beat rate, you can still convert, but you may need to do an additional equation.

My resting heart rate rose during the most fertile days of the cycle. Ovulation most likely occured on Cycle Day 15 or Cycle Day 16 on this chart. In addition, while I have not found evidence of this in the literature, I have observed that I tend to get a one day rise 3 to 4 days before the fertile window opens with cervical mucus. On this chart, that was Cycle Day 6.
A second example. Ovulation most likely occured on Cycle Day 14, 15 or 16. Heart rate rose on Cycle Day 14.

In conclusion, I believe that resting heart rate is a very unique sign to track, especially if you already use a wearable fitness tracker. I will note that a false heart rate rise can be caused by illness, alcohol or food close to bedtime, nightmares, and more! This is not dissimilar to what can obscure a temperature. I hope that in the future more studies are done so that we can see if heart rate can also be used for avoiding pregnancy purposes.

Selected Heart Rate Study Citations

Moran, V. H., Leathard, H. L., & Coley, J. (2000). Cardiovascular functioning during the menstrual cycle. Clinical physiology (Oxford, England), 20(6), 496–504. https://doi.org/10.1046/j.1365-2281.2000.00285.x

Palmero, F., Choliz, M. Resting heart rate (HR) in women with and without premenstrual symptoms (PMS). J Behav Med 14, 125–139 (1991). https://doi.org/10.1007/BF00846175

Shilaih, M., Clerck, V., Falco, L. et al. Pulse Rate Measurement During Sleep Using Wearable Sensors, and its Correlation with the Menstrual Cycle Phases, A Prospective Observational Study. Sci Rep 7, 1294 (2017). https://doi.org/10.1038/s41598-017-01433-9

A Day in the Life of a Billings Ovulation Method User

Have you ever wanted to know what it is like to chart with the Billings Ovulation Method? This blog attempts to give an overview of what it is like for one individual to chart with the Billings Ovulation Method (BOM) over a single cycle. I go through each day of the cycle and explain my overall charting habits. All times are just approximate. I get personal and discuss some challenges I experience with natural family planning. BOM involves tracking sensation felt at the vulva along with the visible appearance of cervical mucus as a person goes about their day to day activities.

Day 1: Record heavy bleeding. Heavy bleeding feels wet. Done! Users are not allowed to use heavier days in the Billings method when avoiding pregnancy. This is a true day one of a cycle because it was preceded by a Billings peak day.

Day 2: Record heavy bleeding. Heavy bleeding feels wet. Done!

Day 3. Record medium bleeding. Medium bleeding feels wet. Done!

Day 4: Very light bleeding. It is now possible to observe my basic infertile pattern of dry.

8am: I feel dry and see a small amount of blood.

10am: I still feel dry.

8pm: I still feel dry. I see no mucus. Sex is allowed in the evening of this day. We use this day.

Day 5: Extremely light bleeding. Technically this day is not allowed for intercourse since I used the day before and Billings method rotates alternative evenings. We use this day anyway #rulebreaker

Day 6: I feel dry. I do not see anything. I record this day as “possibly fertile” since I broke a rule and used the day before. Every day after intercourse gets this white stamp in the pre-ovulatory time of the cycle.

Day 7: My basic infertile pattern of dry is still there! I notice nothing the entire day in the bathroom and my vulva sensation is dry. Sex is allowed in the evening. I consider my evening 8pm because I go to bed around 9pm on average. We use this day.

Day 8: I feel dry all day and see nothing. However, this day is not allowed since Billings alternates days. We skip this day.

Day 9: I feel dry all day and see nothing. However, we do not use this available day because we are both tired. It happens!

Day 10:

9am: I feel a bit moist. I don’t see anything when wiping in the bathroom.

11am: Still feel moist. I do not see anything in the bathroom.

2pm: Still feel moist. I do not see anything.

4pm: Still moist. Nothing seen.

4:45pm: Walking to my car from work. Still moist!

8pm: Overall observation for the day is moist. I record it. The fertile window has opened. This is known as the point of change.

Day 11:

7am: I feel moist as soon as I walk to the bathroom. I see very scant clear mucus on the tissue.

I do not see or feel anything for the rest of the day.

8pm: Overall observation for the day is “moist, clear”

Day 12:

7am: I feel moist, but see nothing.

10am: I feel moist, but see something white.

8pm: The feeling remains the rest of the day. I record “moist, white” for the day.

Day 13:

7am: I feel dry.

11am: I still feel dry.

1pm: I feel wet sensation when walking to my office. This is a change, so I keep that in mind.

I feel damp the rest of the day. I never see anything in the bathroom. I record “wet” as the most fertile sensation that day.

Day 14:

6:30am: I immediately feel moist.

9am: I see long clear strings when wiping in the bathroom.

11am: I have a wet sensation when walking around.

3pm: I walk around my work place. I still feel moist.

5pm: I see clear strings again.

8pm: I record “wet, clear strings” on my chart.

Day 15:

7am: I feel a gush as soon as I wake up. I do not see anything in the bathroom.

9am: I see scant, clear mucus on the tissue when wiping.

11am: I feel very wet walking around my work place.

1pm: I do not see anything on the tissue.

3pm: I do not see anything on the tissue.

5pm: I feel wet sensation while making dinner.

8pm: I record “wet, clear” as my observation for the day.

Day 16:

7am: I do not feel or see anything when waking up.

9am: I still do not feel or see anything.

12pm: I go for a 20 minute walk. When I get back, I feel slippery sensation. I go to the bathroom and see copious amounts of long, clear mucus.

8pm: I felt slippery the rest of the day. I record “slippery, long clear” on the chart.

Day 17:

6am: I feel dry when waking up.

8am: I don’t see anything or feel anything.

11am: I don’t see anything or feel anything.

8pm: The day was nothing felt, nothing seen all day. I record dry. This means yesterday was my peak day because it was a changing and developing pattern ending in slippery followed by an abrupt dry up to no longer wet or slippery.

Day 18 and Day 19:

I have the same experience as day 17. I pay attention all day and observe no mucus or sensation.

Day 20:

Ovulation is expected to be over and the cervical mucus plug has re-closed for the cycle. Sex is available any time for the rest of the cycle until day one of menstruation occurs. I can chart, but it is not necessary to wait until the evening and observations are less important as sex may interfere at any time.

Day 28: I record heavy bleeding and the rules restart.

Real Talk: Diffulties / Obstacles With Billings Not Seen on the Chart

These are things that I find can be difficul in my own personal experience. I know that people in really long cycles or with other irregularities may have different issues than me.

Challenge One: Alternative evenings only can be a struggle, and it seems even harder for me right before the fertile window opens due to my mood at this time of the cycle. This follicular phase is much longer for me than my luteal phase on average, and this means alternative evenings is the rule for most of my cycle. If someone has a partner with a conflicting schedule, this can especially be offputting. I think anyone who is going to practice this method should consider whether this is practical for their lifestyle.

Challenge Two: Expected abstinence in Billings can be hard, and I have fairly short fertile windows on average. I originally practiced sympto-thermal, and I switched to Billings when I realized that overall consecutive abstinence was much less overall (for my own cycle, Billings: 9 days, Sympto-Thermal: 14+ days). I tend to break some rules still, but this is much more suitable for my fertility intentions level than sympto-thermal.

Look out for my next blog on “A Day in the Life of a Marquette User.”

Disclaimer: Do not try to learn how to chart from this post. Everyone has their own unique cycle and this is just an example of charting with Billings in a regular cycle. Please reach out to me if you would like to learn this method with me as your guide. Alternatively, you can find a teacher here.

Perceived Risk Taking and FABM Use: User’s Perspectives

The following data was collected with permission from 255 total FABM users. Select responses that are representative of the data have been included. At the end of this article, I will draw some possible conclusions from the data. The intentions data in this survey were based on this document.

For FABM instructors:  I hope this article helps you think critically about the types of intentions that people have when coming to FABMs.

For Users of FABMs: I hope this article helps you place yourself on the intention scale and make informed choices with your partner.

255 total FABM users took this survey. The questions included: what FABM method was used, how long they had been using a FABM, whether they used phase 1 and phase 3, and reasons for using barrier type methods in the fertile window.

Approximately 62% of respondents were taught by an instructor, while the remaining 38% were self taught users. 85% of people who responded were aware that Phase 1 and Phase 3 are included in the efficacy of the method. 69% used both Phase 1 and Phase 3 for unprotected sex. Out of the 15% who were not aware that Phase 1 and Phase 3 are included in efficacy studies, 76% were self taught.

40% of respondents do NOT abstain in the fertile window. This is across the board from TTA0 to TTW. 60% of respondents do abstain in the fertile window. 

Breakdown of FABM use in 255 respondents

  • Roughly 17% used a single check STM
  • 34% used a sympto hormonal method
  • 29% used a double check method
  • 10% used Billings (primarily sensation mucus method)
  • 8% used Creighton (mucus only)

How long have they used a FABM?

  • 20% less than a year
  • 15.3% one year+
  • 14.5%  two years+
  • 10.2% three years+
  • 7.8% four years+
  • 23.9% five years+
  • 8.2% ten years+

TTA 0: Not taking risks, would take all measures to end a pregnancy

Users who are TTA0 identify themselves as someone who would take all measures necessary to end a pregnancy. 25 survey takers identified themselves as TTA0. 16 of the 25 were self taught using a sympto-thermal method. Only 3 out of 25 who responded used a method other than sympto-thermal. Only 10 abstained in the fertile window. Multiple respondents replied that access to abortion or confidence in barrier method usage was why they chose not to abstain in the fertile window. 

Here is a sample of the overall responses from TTA0:

Why Barriers:

  • I do not believe that abstaining is a healthy choice for consenting adults in a committed relationship. We use a combination of femcap with contragel and “perfect withdrawal” or occasionally femcap with contragel and he completes in my anus. 🙂 We did the math on this combination and are more protected this way than we would be using the pill so we find it acceptable. 
  • Usually on the days where I am THE MOST fertile, we will not have PIV sex, but overall, I trust using condoms as we are good about using them consistently and properly, and also usually use WD as a backup alongside condoms, especially during the weeklong fertile window. 
  • I abstained in the fertile window for 1.5 years. But we’re been using condoms for 5 years and never had a break so I’m developing a trust in them.
  • Years of experience with condoms, proper and careful use of them, and some ability to check for failure/holes. I’m already a TTA0, but abstaining instead of barriers would often give only 6-7 safe days per cycle. (We often use barriers the whole time instead of FAM, technically, due to lazy or unsure charts.)
  • Personally, as TT0, I use protection in phase 1, abstain during the fertile window, UP in phase 3. If I was TT1 I would be ok with condoms in the fertile window.
  • We have excellent barrier usage, I use it with other partners as well so I need to ensure STI protection, and my partners with dicks have been given condoms 101 by me so I know they know what to do
  • I would not feel secure with barriers during the fertile window at all. We conceive far too easily. 
  • I would probably abstain if I didn’t want a pregnancy and was against aborting and also if I lived somewhere with no safe and legal access to abortions.
  • I’m confident in using barriers because my partner respects my body and our intentions. We are TTA0 right now. We don’t see any reason for abstaining because we use barrier methods responsibly. 
  • I feel comfortable using barriers, despite their failure rate being high but will only use condoms and a diaphragm together, not diaphragm alone due to the low failure rate (15% ish). I do tend to avoid intercourse more during my fertile time if possible, but will use two barriers correctly to reduce anxiety or reduce needing emergency contraception if a breakage happens. 

TTA1: Not taking risks, and would possibly give baby up for adoption if pregnancy happened

Only 9 people identified themselves as TTA1. 5 out of 9 still used barriers in the fertile window even though intentions were low.

Why Barriers:

  • Still newish (charting since Jan but stuck on nexplanon which has expired and in that time only had two ovulatory cycles) but I will use days where I’m on my period in phase one if I feel up to it, but I am more comfortable with UP in phase 3.
  • It is literally the ONLY time I have interest in my spouse or can orgasm. Unable to orgasm in Phase 3.
  • I live in a country with great accessibility to emergency contraception as well as to health care to terminate an unwanted pregnancy, so even if my intentionality was lower I would not abstain.

Why Not Barriers:

  • Because we simply can not afford a child

TTA 2: Not taking risks.  Would need some time, maybe counseling. Ultimately keeping the pregnancy.

37 people identified themselves as TTA2.

Why Barriers:

  • I use a double-check and have an abnormal CM pattern that has it almost always starting just after my period. My husband won’t have period sex so it is extremely rare for us to fit in unprotected sex. Even if I tell him we can, he might not trust it because he doesn’t have enough knowledge of FAM. I might have abstained if I used a FABM in college or may have used condoms plus withdrawal. I was a Super Zero, meaning that even having an abortion would have been a burden, as I didn’t have any of my own money or a car. I was still a zero later in life but had more resources.
  • I only use condoms on very low risk days, so if one were to fail, there’d be plenty of time for plan B and/or pregnancy would be fairly unlikely anyways. Peak mucus days I will generally abstain or use outercourse.
  • I generally don’t enjoy sex during my period but my current partner is okay with it so I’ve been doing it more. I tend to ovulate early and rarely have dry days so I generally don’t use that rule. I am planning to use Doering once I have 12 charted cycles (starting over because I’m newly PP). We generally only want to go UP in Phase 3 though.We don’t use barriers but we do use perfect withdrawal during Phase 1 and 2 and sometimes Phase 3. I do not like any barrier method which is why we don’t use them.
  • Because of the doering rule I open my fertile window really early, but most of the time I ovulate later than those early ovulations that set my doering day so I’m ok with going UP until then because it most probably will be far ahead from ovulation. If not I know I’m still safe though.Im doubling up thats what makes me confident enough, I was a TTA0 when I started doing this
  • We don’t rush and always have great communication. And we could be TTA0 and still wouldn’t abstain because we enjoy sex.

Why Not Barriers:

  • Being extra conservative to avoid pregnancy. Not confident in my BIP (yet).
  • Since I’m self taught (charted 7 cycles) I know for sure I’m safe after I confirm ovulation. But my partner and I ALWAYS use condoms anyway and abstain during fertile window. If I were to not use protection, it would only be during luteal phase

TTA3: Not taking risks. “Oh NO how did this happen?! but everything will be okay” Surprise pregnancy would eventually be welcome.

Largest percentage of responses were from this category. 90 people identified themselves as TTA 3.

Why Barriers:

  • I don’t feel safe using phase one without protection (condom) because I am not as confident with my knowledge of the rules for that time (first 5 day, dry day rules, etc) (Self Taught)
  • I would have to be 2 or lower to abstain. We use withdrawal. I’m definitely okay with an oopsie, my partner thinks we need to wait until school is done so about a year from now we can be TTW.
  • No barriers but use withdrawl IF we have sex at all during follicular phase.
  • During the fertile window, we always use condoms and withdrawal. I’m confident in this because I feel that the chances of both the condom and withdrawal failing at the same time are very low. I don’t think my intentions would ever be low enough to abstain.
  • We have never had issues with barriers before. Abstinence for us would have less to do with intentions and more with discomfort caused by barriers / less enjoyable. We’ll never be below TTA2 I think and last time we were I felt safe with condoms too.
  • I’m confident in using barriers because I use perfect withdrawal, my partner and I have very good communication, and we’re a TTA3. My intentions would need to be TTA2 or lower to abstain.

Why Not Barriers:

  • Phase I – Cycle history shows I ovulate later. We could utilize up to day 11, but typically only use up to day 6 or 7. Phase III – confident when confirming ovulation, many months/years of practice including postpartum. No surprise pregnancies!
  • We use a double check method and learned with an instructor, so we feel safer in the 1st phase.
  • N/A my religious views (Catholic) do not allow for using barriers.
  • Barriers don’t feel worth it for us given the added risk of conceiving and less satisfying experience. Better to wait so we can increase effectiveness of method and have a better time during infertile phases.

TTA4: Not taking risks.  Currently content with family size but a surprise pregnancy would be welcome.

59 people identified themselves in this category. On the intentions scale, this is the highest category available before “Trying to Whatever” kicks in.

Why Barriers: 

  • I am confident in using condoms plus withdrawal on fertile days, and lately only use a condom. I am okay with the possibility of the condom breaking at a 4. I would need to be a 0-2 to abstain during the fertile window.
  • Religious. Orthodox Jews abstain during period and one week after, so by that time – around cd12 – I’m usually in my fertile window.
  • I don’t use barriers but use withdrawal during the fertile window. I’m aware of the risk but we did several looks at pre-ejaculate under a microscope and there were no sperm. Partner is very controlled with ejaculating so we are comfortable with our ability to manage the risk
  • We strive for perfect condom use every time and have never had a condom break, so we trust them. If we were lower on the intentions scale, I don’t think we would abstain, but would probably opt for adding extra methods like diaphragm+spermicide and/or withdrawal in addition to condoms.
  • We use withdrawal in the fertile window. Being so high on the TTA scale, we do not worry about any pregnancies resulting from failed withdrawal. Even so, it has worked for 4 years (we did the pre-ejaculate microscope test and there were NO sperm multiple times). I would never fully abstain regardless of intentions. Non Penis in Vagina Sex is always a safe option when done correctly! 

Why Not Barriers:

  • I have a longer cycle,usually 34-36 days so feel fairly confident in using the first part of phase 1. We’re currently pregnant (totally planned) but prior to that when we were TTA, we succeeded in avoiding for 9 cycles (plus 11 months pp without cycles but testing pp with Marquette).

TTW / NTNP: Pregnancy welcome but not activity trying:

29 total responses and only one person in this category used a form of a barrier, everyone else abstained or had sex when they wanted to.

Why Barriers:

  • Haven’t had any failures using withdrawal and since I’m trying to whatever with things now, I don’t mind getting pregnant if withdrawal fails 🙂

Conclusion:

Fertility intentions are not only “I want a baby” or “I do not want a baby.” There is a ton of nuance involved in how the couple feels and decides to behave in the fertile window. Intentions directly effect how someone uses a method. Almost all FABM methods discourage genital contact in the fertile window. However, this does not mean that users will follow this advice. While many users abstain due to religious reasons, others do not abstain due to their own religious beliefs or because they are secular users. With informed choice, fertility awareness users can decide based on their specific intentions what is right for them. Maligning barrier methods as a terrible choice does a disservice to an informed user of a barrier method who has made their decision based on their unique fertility intentions.

As far as I am aware, at least three methods have included barrier method usage in their studies: the Sensiplan Study (2007), the Klaus Billings Study (1979), and at least one Marquette study. The Sensiplan study and the Billings study found that there was not a signficant difference between barrier method usage and abstaining when it comes to failures. Sensiplan found a .2% lowering of efficacy. Users should be aware that incorrect barrier method usage can lead to pregnancy; however, many people are high enough on the intentions scale that this lowering of efficacy may be okay with them.

One of the most ridiculed methods is “withdrawal” or pulling out. However, even this has a place in many people’s family planning intentions, especially those higher on the intention scale or for those who wish to increase diaphragm or condom efficacy. Some people even use withdrawal to attempt to increase efficacy in infertile times of the cycle. There is much misinformation about withdrawal, including accusations of all pre-ejaculatory fluid containing sperm. For a nuanced look at what we know about withdrawal, please read this link. For information about doubling up on barrier methods and efficacy, visit this link.

Shout out to Antonela Vuljan for helping me organize this data!

An Honest Review of Proov PdG Tests

Are you interested in testing your progesterone at home with Proov?

If you decide to purchase, use promocode: CHARTYOURFERTILITY for 30% off the original PdG tests or Proov and Confirm.

Proov tests check levels of the hormone metabolite PdG in the urine. Proov tests are an FDA approved product. People who are ovulating produce the hormone progesterone after ovulation. If you are a fertility awareness charter, you can use these tests to double check that ovulation has occurred along with your other fertility signs. If you are seeking to become pregnant, you can use these tests to help see if your luteal phase is sufficient to support a pregnancy.

Here are a few links on recent studies so that you can be more informed about using this product:

Proov is Clinically Validated

Study on Urinary Hormones and Progesterone

Study on Proov Combined with Fertility Awareness Methods

Study on Combining Proov with Clearblue

I have personally been using Proov since 2019. I can highly recommend this product. Proov has excellent customer service and is continually trying to improve their services and expand product options.

My most common day to get my first positive Proov is approximately 3 to 5 days after a positive LH test. I love having Proov as a crosscheck so that I can have an extra way to confirm ovulation. I like having a ton of data in my fertility awareness routine.

For those trying to conceive, the tests can be used around 7 to 10 days post ovulation (counting from positive LH test). If the tests are positive, this is a good sign that your progesterone is high enough when implantation is most likely to occur on days 7 to 10 post positive LH test.

I used it 7 to 10 days past my first positive LH test to see if my progesterone levels were high enough in the last part of my cycle. Ideally, for conception purposes, you want to see positive Proov tests on days 7 through 10.

These tests are also useful for people with irregular cycles or tough cervical mucus patterns because they can help you know if you have indeed ovulated.

The Proov Insight app can help you read your tests, including PdG, LH tests and the new Multihormone test! It recently updated to include numeric values. This makes the data even more meaningful! Some people struggle reading Proov, and the app is definitely useful for those people.

The app will give you an “ovulation score” based on whether your tests are positive during the days most likely for implantation. This ovulation score can help you plan to improve your health if you notice low PdG levels.

It’s me!
My ovulation score!
PdG levels in the app

I highly recommend trying Proov if you are curious about your progesterone! For now, I have decided to make Proov a permanent part of my fertility awareness routine.

Use promocode CHARTYOURFERTILITY for 30%!