The Garden of Fertility: A Guide to Charting Your Fertility Signals to Prevent or Achieve Pregnancy--Naturally--and to Gauge Your Reproductive Health - Softcover

IN JUNIOR-HIGH BIOLOGY ABOUT THIRTY years ago, I looked under the microscope my teacher offered and struggled to figure out how the stuff on the slide was relevant to me. I’d just begun to menstruate, and I wanted to know how my body worked. I wondered if other girls had strong cramps and what they did to ease them. I wondered if menstruating meant that if I had sex, I could get pregnant any day. Or was it just a few days each month? If it was just a few days, which days were they?

Once I became sexually active, I got a diaphragm and then a cervical cap. I asked a doctor and a midwife if they knew a way I could learn to tell when I was fertile. Each of them shook their heads.

A Tangle

Years later, my boyfriend and I drove toward a cabin out of town to celebrate my birthday. “I’ve got another yeast infection,” I said quietly.

“Well that’s lousy,” he said.

The lousiness wasn’t that I was sick, but that we wouldn’t be able to make love. Already that year I’d had several yeast infections because of irritation from the spermicide I used with my cervical cap.

How do I get out of here? I wondered. Out of feeling like my birthday celebration is only about sex, out of birth control that makes me sick?

Sex, fertility, love. Like the burning in my groin, they made a tangle too hot to touch.

Learning to Chart

Once I heard about Fertility Awareness (FA), also called Natural Family Planning (NFP), I decided to learn it. FA is based on a woman’s daily charting of her waking temperature and cervical fluid. With Fertility Awareness, a woman can tell when she’s fertile and infertile. To avoid pregnancy, couples postpone intercourse or use a barrier method on fertile days. To conceive, they know the best time to try.

Fertility Awareness is not the same as the (unreliable) Rhythm Method, which determines fertility by the patterns ofprevious cycles. FA gauges fertility as the woman’s daily chart evolves. According to numerous studies, when its rules are followed, Fertility Awareness is virtually as effective as the Pill.

Through books and classes about Fertility Awareness, I finally learned the vocabulary of my menstrual cycle, the functions of different hormones, and how to determine when I am fertile and infertile. As I started to observe and record my fertility signals, I began to experience explosions of awe: I had never conceived or tried to, but from charting I could see bona fide proof of my fertility. My cycles had often been erratic, and now (from knowing when I ovulated), I could predict when my period would come. I was with a new man while I learned the method, and his interest in the method helped both of us appreciate my femaleness.

Brooke, my partner, realized that ever since he was a teenager, he’d woken every morning and asked, When was the last time I had intercourse? And, Do I feel like masturbating? (Based on surveys of men who’ve taken my classes, this is a pretty typical way for a man to start his day.) Once I started charting, Brooke had a new waking question: Is Katie fertile? (Other men report wondering, What’s my partner’s temperature?) As awareness of fertility patterns emerged, my feminine rhythm gently took the lead in Brooke’s and my relating.

I began to see that the rhythm of masculine sexuality is essentially on all the time—essentially, men are fertile all the time. Meanwhile, because women are fertile, on average, only one-third of each cycle, feminine cycles seem to invite periodic rest from sexual intercourse.

Despite my feminist perspective, I came of age expecting that I should be available for sex all the time. I remember one three- or four-month period when I was physically able and wanting to have sex every day. Surely, I thought, my boyfriend and I would stay together if I could keep this up. Now, I wonder how my access to artificial birth control contributed to such thinking.

Indeed, sterilization, the Pill, Depo-Provera, the IUD, the diaphragm, the cervical cap, and condoms give women in heterosexual relationships the option of having fewer children than earlier generations. These methods allow choice about the course of our lives. However, artificial birth control is usually distributed without substantial information about how our bodies or the methods work.

I began to wonder what price we pay when we don’t know this basic information about ourselves.

Charting my fertility signals, I felt more connected to myself, and to other women who understood their own cycles. Taking my temperature and observing my cervical fluid felt like rituals for contacting a rhythm larger than my own. Brooke and I found ourselves supported by the rhythm my charts offered. Why hadn’t we learned this method before?

Trying to Become a Fertility Awareness Teacher

Because of my passion for the method, I began writing a story about its availability in northern New Mexico. One of the people I called was the director of a Natural Family Planning clinic at an Albuquerque hospital. When the woman said she would be offering a course to train people to teach the method, I asked for an application.

“I could send you one,” she said, “but I couldn’t accept you.”

I was stunned. “Why?” I asked.

“Because you’re single and you have genital contact.” If I was celibate or married, then her program could accept me.

This was spring 1997.

I wanted to understand this clinic’s policy, which is common among Catholic programs wherein medical information is taught effectively and woven with moral messages. I wanted to understand why Fertility Awareness isn’t more available, especially in secular communities. And I wanted the name of someone who could train me to teach the method. Indeed, the NFP clinic’s policy raised numerous questions and propelled me on to a tour of conversations. I spoke with the director of medical affairs for Planned Parenthood, nurse practitioners in women’s clinics, the medical journalist Nona Aguilar, and Suzannah Doyle, who wrote about the method for Our Bodies, Ourselves.

One of the first people I called was Kara Anderson, then Planned Parenthood’s director of medical affairs. She explained that their practitioners rarely have more than twenty minutes with each client. “Most of the people who come to us have been sexually active for six months—without any birth control,” Anderson said. “Our practitioners give each woman as much as they can.”

If a Planned Parenthood client asks to learn Fertility Awareness (which is unusual), she’s usually referred elsewhere—often to a teacher affiliated with a Catholic organization. “To learn this method well,” Anderson said, “a woman needs to be in close touch with a teacher for three or four months. In many areas, Catholic organizations provide the method’s only teachers. We simply don’t have staff or finances available to offer it on a large scale, given the limited number of women who request it.”

Anderson then succinctly articulated that Fertility Awareness can “enhance people’s self-awareness, self-esteem, and communication skills. And these are things we want for all women.”

I began to see that while learning Fertility Awareness is time intensive, once a woman owns a thermometer and knows the method, there’s nothing to purchase again. I began to wonder how classes could be administered for a wide variety of people from a range of backgrounds.

My next call was to Laurie Holmes, a certified nurse-midwife who often dispenses birth control. “I’ve seen too many unwanted pregnancies with Fertility Awareness to feel entirely comfortable endorsing it,” she said. “I bring it up, but people need time to learn it and stay with the daily charting. I think you need to be open to failure if you use it. I also find that people don’t want abstinence.”

I told Laurie, who, like most health-care practitioners, is not trained to use or teach FA, about the first woman I met who used it. She’d had two abortions by the time she was twenty-one, then vowed never again to have an unwanted pregnancy. After her second abortion, she chose FA for birth control; and 115 cycles later, she hadn’t conceived again.

This woman taught herself the method from reading a book; and, indeed, it took her several months before she felt confident enough to engage in sexual intercourse. Now, though, this woman says, “I know when I’m fertile, and when I’m not. Artificial birth control feels too risky to me.” After her abortions, learning how to read her cycles was a rite of passage.

Laurie Holmes found it exceptional that a woman would have the discipline to take her temperature every morning through her childbearing years.

I began to wonder if Fertility Awareness is not taught as well in the women’s community as it is among Catholics (certainly it’s less available) and how this might figure into practitioners’ lack of faith in the method and people’s capacity to commit to daily charting. Are the teaching methods, commitments, and self-control expressed in the Catholic community not available to others? Does the spiritual foundation that Catholic programs provide increase users’ efficacy with the method?

The Couple to Couple League (CCL), one of several Catholic organizations dedicated to teaching Natural Family Planning, has 22,000 subscribers to its newsletter, Family Foundations. Founded in 1971, the CCL is staffed primarily by volunteers who perceive teaching as service; and it’s therefore able to offer classes at a nominal fee. Indeed, the CCL is one of several groups that admirably meets the needs of practicing Catholics. Its publications include chart reviews, discussions of men’s involvement with charting, the effects of breast-feeding on fertility, descriptions of the effects of various drugs on fertility signals, what to expect when coming off the Pill—and numerous prescriptions for living a moral life.

Currently, over 700 volunteer couples teach NFP through the CCL. These teachers are required to sign a principle statement advocating, for example, marriage and breast-feeding, and rejecting abortion, premarital sex, and homosexual behavior. While I appreciate the CCL’s clear outlaying of their beliefs, their programs speak primarily to married, practicing Catholics who are open to the possibility of a child. Their literature is extensive (and available in Spanish); their teachers have been uniformly kind and generous—even while knowing I’m not Christian or married; and I often find beauty in their presentation of charting in a spiritual context. Alas, I’m not in concert with their basic tenet that there are a limited number of right and true ways to behave when it comes to sex and fertility. Learning Natural Family Planning through the CCL is not for everyone.

When I called Nona Aguilar, author of The New No-Pill, No-Risk Birth Control (Simon & Schuster, 1986), I described my frustration that I was not acceptable to the training program at the Albuquerque clinic. “Well,” she said, respectfully, “I agree with that policy.”

I leaned back in my chair. “Okay,” I said. “I don’t understand this. Please explain.”

“Properly used,” she began, “sex is about emotional and psychological union. In our culture, artificial birth control—which feminists have strongly advocated—has made sex a recreational activity. Sex certainly can be recreational, but its potential is to be transcendent. Sex is the life-bearing force of humankind. When lovemaking is recreational, it’s a little like being color-blind during sunset over the Grand Canyon. Union becomes harder to experience, and that’s a loss.”

With Natural Family Planning, Aguilar continued, “issues of control and communication—which naturally arise in a sexual relationship—are strongly brought to the fore. The method can help support that exploration.” And the container of marriage, she insisted, the commitment of marriage, supports the exploration.

Aguilar’s thoughts stirred me deeply and encouraged me to revere Fertility Awareness more than before. Our conversations also strengthened my desire for classes that teach people how our bodies work and that offer opportunity for individuals to differentiate between their personal values around sexual issues and the prohibitions suggested by society. Properly trained, I felt that I could teach such classes, despite my not being celibate, despite my never having felt moved to marry.

Finally, I called the Boston Women’s Health Book Collective. By then I doubted if I would ever meet someone who could or would train me to teach Fertility Awareness. I was given the number of Suzannah Doyle, who wrote about the method for the last several editions of Our Bodies, Ourselves.

Suzannah suggested that charting speaks to a tradition when women were in charge of their own health care. She impressed upon me that charts could be used to gauge gynecological health. She explained that Fertility Awareness teachers usually tell their clients that they have choices during their fertile phases: they can use barrier methods to prevent pregnancy, postpone intercourse, or enjoy sexual expression that doesn’t include genital-genital contact. (She prefers to suggest that couples who don’t want to conceive “postpone” intercourse—rather than abstain from it—during the woman’s fertile phase.) “In any case,” Doyle said, “since women are fertile only one third of their cycle, using birth control for two thirds of it—when a woman is naturally infertile—is a waste.”

Doyle also confirmed that most of the scientists who’ve done research in this field have been male Catholic MDs. Until the 1980s, Fertility Awareness was only available from a Catholic perspective; when Doyle began learning FA, she couldn’t have gotten the information she wanted from a women’s clinic, either. Since then, a small number of nonreligious teachers (who usually learned the method through Catholic organizations) have offered classes throughout North America.

Now, the Fertility Awareness community is often divided between those who are pro-choice and pro-life. “I call myself pre-choice,” Doyle said. “If people—including teenagers—know their fertility signals, they’re more likely to make informed, responsible choices about sex.” She also emphasized that each perspective serves a purpose and meets the needs of different populations.

Suzannah gave me the name of Wendy VanDilla, a colleague who could train me to teach Fertility Awareness. She also gave me her library on the subject, as she had moved on to a new career in music. I studied with Wendy, read voraciously, and attended a CCL workshop with Donna and Bill Taylor, internationally recognized authorities on lactational amenorrhea. I started teaching at the Santa Fe Community College, then began offering classes at Women’s Health Services (WHS), an MD-staffed clinic founded in 1972 in Santa Fe. WHS is one of only a few secular, not-for-profit clinics in the country that offers classes in Fertility Awareness.

Using Charts to Gauge Gynecological Health

Later in 1997, because of menstrual irregularities, I went to see Dagmar Ehling, DOM (doctor of Oriental medicine), the author of The Chinese Herbalist’s Handbook. I’d just begun teaching Fertility Awareness and brought my charts to her office. To my great jo...