Fertility Awareness: Natural Family Planning (NFP)

What is fertility awareness?

Fertility awareness is a collection of methods using your body’s natural and normal functioning to determine the days of the month you are most likely to get pregnant. It is also called Natural Family Planning (NFP), the Sympto-Thermal Method, the Ovulation Method, or the Billings Method.

Fertility awareness or Natural Family Planning is a method of birth control that does not use any drugs or devices. It combines the calendar/rhythm method, the basal body temperature method, and the cervical mucus method.

The fertility awareness method is used both as a means of preventing pregnancy as well as targeting the most fertile time for getting pregnant.

How does fertility awareness work?

The calendar; basal body temperature; and cervical mucus methods are combined to give you the awareness of when your body is most fertile. As you become familiar with your body’s ovulation and fertile periods, it provides you the opportunity to abstain from sexual intercourse or use a barrier method during that time.

How do you use fertility awareness?

The first objective within fertility awareness is to become familiar with your menstrual cycle and to begin charting your fertility pattern. The average menstrual cycle is between 28 to 32 days, however there are two parts related to your cycle: before ovulation and after ovulation. Here is a glance at an average cycle to give you a gauge for examining your cycle:

Day 1: The first day of your menstrual flow is the beginning of your cycle.

Day 7: By day seven your egg is preparing to be fertilized by sperm.

Days 11-21: (based on 28-day cycle) Hormones in your body cause the egg to be released from the ovary around this time. This process is known as ovulation. The egg travels through the fallopian tube towards the uterus. If sperm penetrates the egg, the fertilized egg will attach to the lining of the uterus and begin to grow. If fertilization does not happen the egg breaks apart.

Day 28: Hormone levels drop around this day causing the lining of the uterus to be shed making up your menstrual flow.

It is important to realize that the first part of the menstrual cycle (before ovulation) is different in every woman and can even change from month to month. The variation usually occurs from 13 to 20 days long. The last half of the cycle is usually more similar for every women, because there are about 14 days from day of ovulation until the start of the next period. This is why women are encouraged to track their cycles and count back 14 days from their LMP to narrow down their most fertile time of the month.

Calendar tracking method: Your past menstrual cycles will work as a guide for estimating your fertile times. In order to track your menstrual cycle and to identify your expected ovulation follow the step by step process below:

Step 1: Plan on tracking your menstrual cycle for 8 to 12 months.

Step 2: Day 1 will be the first day you start menstruation.

Step 3: Pick the longest and shortest of the cycles from your monthly tracking.

Step 4: The first day of your fertility period is determined by subtracting 18 days from the length of your shortest cycle. If 26 days was your shortest menstrual cycle, take 26 and subtract 18 to come up with the number 8. This means that the first day of your fertility window starts on the 8th day of your cycle.

Step 5: The last fertile day is determined by subtracting 11 from the length of your longest cycle. If 32 days was your longest menstrual cycle, take 32 and subtract 11 to reach the number 21. This means that the last day of your fertility period ends on the 21st day of your cycle.

The time in between these is considered your fertility window. In the above example, your fertility period would be from the 8th day of your cycle to the 21st day of your cycle. Your ovulation is expected during this time frame. You cannot get pregnant everyday during this time, but it is sometime during this time frame that pregnancy can occur.

If you are trying to avoid getting pregnant, you need to abstain from sexual intercourse or use a barrier form of birth control during your fertility window. If you are trying to get pregnant, this fertility period would be the targeted time for sexual intercourse.

Basal body temperature method: Your basal body temperature measures a change in the temperature that occurs after ovulation and remains elevated until your next period. By looking at charting from a few cycles, the temperatures can reveal a pattern from which ovulation can be anticipated. The steps below can help you as you begin to track your temperature and identify when you are ovulating.

Step 1: Take your temperature orally each morning before you become active.

Step 2: Use a basal thermometer which recognizes small changes in your temperature. Your body temperature will only rise between 0.4 and 1 degree farenheit when you ovulate. Buy a Basal Thermometer Now.

Step 3: Record you temperature every day on your fertility tracking calendar.

If you record it every day, you will see that prior to ovulation your temperature is rather consistent. As you get closer to ovulation, you may have a slight decline, but it will be followed by a sharp increase after ovulation. The increase in temperature is the sign that ovulation has just occurred. Because the increase happens after you have ovulated, this method is best used by those who have time to track and study their charts for a couple months, to ensure the best chances of conception. Illness, lack of sleep, and alcohol or drug use can affect your temperature and make it difficult to establish an accurate reading.

Cervical mucus method: The consistency of your cervical mucus changes during the menstrual cycle. In the average cycle, there are 3 to 4 dry days following a 5 day menstrual flow.

The mucus wetness increases daily, lasting approximately 9 days until the wettest day. Your mucus is easily recognized at this point. It should be abundant, slippery, clear, and very stretchy. It has been described as egg whites.

Ovulation occurs when you have your peak day of stretchy mucus (within two days). In order to use the cervical mucus method to identify your ovulation follow the few steps noted below:

Step 1: Collect the mucus from the vaginal opening with your fingers by wiping them from front to back.

Step 2: Record it daily on your fertility calendar by making note of the color (yellow, white, clear or cloudy), the consistency (thick, sticky, or stretchy) and the feel (dry, wet, sticky, slippery, stretchy).

Step 3: Ovulation is recorded on the day that your mucus is clearest, slippery and most stretchy.

Do not douche or use spermicides which increase your risk for infection and may wash away or change the appearance of the mucus.

How effective is fertility awareness?

When fertility awareness is used correctly and consistently, it may reach effective rates around 90%. The effectiveness depends on your diligence to track and record your fertility pattern and your commitment to abstaining from sexual intercourse or using a barrier form of birth control during your fertility window.

Typical use, which refers to the average use, shows a failure rate of approximately 25%. If you are committed to tracking and recording your fertility information, you can achieve much higher success rates.

What are the side effects or health risks of fertility awareness?

There are no health risks or side effects associated with fertility awareness.

Is fertility awareness reversible?

Yes. Fertility awareness does not have any effects on the male or female reproductive functioning. Pregnancy is possible immediately following the practice of fertility awareness.

How much does fertility awareness cost?

Fertility awareness is free to inexpensive. Free training sessions are usually available around your community through health centers, pregnancy services, or some churches. Thermometers used to measure basal body temperatures cost between $10 and $15 and are available at local drugstores, grocery stores or supercenters. You may use one of your home calendars to record this information, or you can purchase a fertility awareness chart which cost approximately $8.

What about fertility awareness and sexually transmitted diseases (STD’s)?

Fertility awareness does NOT provide any protection against sexually transmitted diseases.

Are there any other physical signs of ovulation?

Your fertility period may be identified by paying attention to other functions of your body. Fertility and ovulation are sometimes tracked or noticed by women who:

  • Experience a change in the cervix
  • Have a slight one-sided pain in the area of an ovary
  • Softening of the cervix
  • Breast tenderness

 

Fertility awareness is an acceptable means of birth control for couples who have religious concerns related to contraception.

Fertility awareness is also used by couples who are trying to get pregnant. It helps you target your reproductive efforts at the best times to get pregnant.

What are the pros and cons of fertility awareness?

  • The Pros of Fertility Awareness include:
    • Effective when used correctly and consistently
    • No side effects
    • Immediate reversibility
    • Inexpensive or free
    • No devices, no drugs, no prescriptions or office visits
    • Does not contain estrogen which may increase the risk of heart problems
    • Acceptable for couples who have religious concerns related to contraception
    • Effective for couples who are preventing or trying to get pregnant.
  • The Cons of Fertility Awareness include:

    • Requires diligence from both partners
    • Requires periods of abstinence or backup contraception for approximately 1/3 of the month
    • Requires consistent and accurate record keeping
    • More challenging for women with irregular cycles

View and print an Ovulation Calendar, or use our Ovulation Calculator, to better understand your menstruation cycle and ovulation.

Last Updated: 01/2013