Introduction To FAM – Fertility Awareness Method

Overall Goal Of Fertility Awareness

Fertility Awareness is an educational process in which one learns how their body, cycles, and fertility actually work.  As a tool, it gives us vital information about our hormonal health.  As a method, it is used to determine the fertile and infertile days of the menstrual cycle, with one of three primary goals: 1) overall body awareness and knowledge that your cycle is healthy and hormonally-balanced, 2) planning a pregnancy, or 3) avoiding or postponing a pregnancy.   

Fertility Awareness Is “Body Literacy”

It is a tool for reading/knowing your body signs (biomarkers) and it is based on scientific principles:

1. The menstrual cycle is controlled primarily by two primary ovarian hormones – estrogen and progesterone. Estrogen dominates the first part of the cycle and progesterone the latter. These hormones are activated by two other pituitary hormones – FSH (follicle stimulating hormone) and LH (luteinizing hormone).
2. During the cycle (from bleed to next bleed), the body produces three observable biomarkers that signal fertile and infertile days and impending ovulation.  These signs are: basal body temperature, cervical secretions, and cervical position.
3. When ovulation occurs, the egg is only viable for 12-24 hours. If a second egg is released in one cycle (as in the case of fraternal twins), it will be released within 24 hours of the first egg.
4. Sperm can live in fertile-quality secretions for 3-5 days.  
5. The corpus luteum (the remnant of the follicle in the ovary, after ovulation occurs) secretes progesterone, which prepares the body for  pregnancy. It inhibits follicular development and thickens the lining of the uterus, until the following cycle. Its lifespan is typically 10-14 days, or two weeks  on average.

Clarification Of Different Natural Contraception Methods

Fertility Awareness Method (FAM)

FAM refers to a proven, evidence-based method used for preventing and achieving pregnancy, naturally.  FAM is one of many variations of the Sympto-Thermal Method (STM). FAM/STM divides the menstrual cycle into three separate parts- infertile, fertile and infertile, because we are only fertile for a limited number of days.  The method involves daily monitoring of one’s fertility signs, which in turn enables anyone to identify the fertile and infertile days of their cycle.

FAM is an observational method, not a calculation method,  like the ineffective rhythm/calendar method.  Our reproductive hormones control when and how these signs shift, so a person can know on a daily basis if and when they are fertile.  For contraception, some schools of STMs encourage abstinence during the fertile days. FAM enables free choice. 

Since FAM is not a stand-alone method, many couples choose to use two back-up methods (e.g. condoms and spermicide, or diaphragms with a natural gel) during the fertile days. Once ovulation is over, no additional methods are necessary and a couple can enjoy an average of 10-12 days of sexual freedom with a very high rate of effectiveness.  

Fertility Apps and Devices 

Most menstrual cycle apps are “period trackers” which allow for charting various aspects of the cycle.  Some apps and devices are marketed as “fertility predictors.”  Others are categorized as FABM’s- fertility awareness-based methods, although they are not actually full methods of contraception. 

Some apps and devices that predict fertile and infertile days are actually “hi-tech” versions of the antiquated Rhythm Method of fertility planning  because they use algorithms or mathematical calculations (based on past cycle lengths) to predict present cycle length and fertile and infertile days.  In order to achieve high efficacy, these methods can require many days of abstinence or allow sexual intimacy with the use of other back-up methods e.g. condoms, barriers, and spermicides. 

Effectiveness Of FAM

While the theoretical effectiveness of FAM, like most methods of contraception, is 98-99% (perfect use), the more important rate is actual/typical effectiveness, which is another way of  referring to “imperfect use”.  Typical user effectiveness is always lower than the theoretical rate because it tells us how “forgiving” or “unforgiving” a method is under “real-life” conditions,  i.e. not every couple uses a method correctly and consistently, as prescribed. 

FAM is very effective among serious, motivated and conscientious users, and it can be very unforgiving among imperfect users.  Statistically-speaking, typical users may experience a failure rate as high as 10-20% during the first year of use (meaning 10-20 out of 100 users may have an accidental pregnancy).

Among conscientious and motivated users/couples, failure rates are very low and effectiveness can reach over 95%.  This largely depends on how the method was learned (by a book, a friend or a certified teacher) and what couples choose to do during their fertile days.  If couples abstain during fertile days and only have intercourse after ovulation, user effectiveness approaches 100%.

The biggest predictors of higher vs lower effectiveness of FAM are:

• The ability to accurately determine the fertile window of the cycle.
• The number of backup contraceptive methods that a couple uses during the fertile days.
• The degree of skill and experience that users have with those back-up methods. It is important to remember that because FAM divides the cycle into three parts, the risk of an unplanned pregnancy differs in each part.

The Three Fertility Signs

1. Basal Body Temperature (BBT) is the waking temperature of the body at rest. The temperature is taken orally for approximately one minute with a special digital thermometer.  Charting temperatures throughout the cycle confirms that ovulation has occurred and that you are no longer fertile. Basal temperature rises after ovulation and remains high until the next menstrual period.
2. Cervical Secretions (CS) are natural secretions produced in the cervix and are typically seen as either dry or wet panty stains.  Our hormones directly affect the type and quality of secretions we observe.  When learned from a certified teacher,  a  person learns their own “body language,” how to accurately describe, chart and interpret their secretions – as a way to know when pregnancy is possible, i.e. when they are and are not fertile.  Fertile secretions nourish and support sperm whereas infertile secretions are inhospitable to sperm. 
3. Cervical Position (CP) refers to the relative change in height, sensation, and degree of openness of the “os,” the opening of the cervix. The cervix is positioned between the uterus and the vagina. Because it involves inserting a finger into the vagina, it is an optional fertility sign.  Only during the fertile window can sperm actually enter the reproductive tract and attempt to fertilize the egg (waiting in the fallopian tube).

Misconceptions About FAM

1. It is another variation of the Rhythm/Calendar Method.
2. It is unreliable and ineffective.
3. It is only suitable for women with clock-work cycles.
4. One must be highly educated to understand and use it properly.
5. It is related to astrology or astrological calculations.

Charting One’s Cycle Can Reveal Many Normal And Abnormal Situations

1. Anovulation (non-ovulation)
2. Early or late ovulation 
3. Luteal phase defects        
4. Infertile secretions    
5. Hormonal imbalances
6. Insufficient progesterone   
7. Confirmed miscarriage
8. Confirmed pregnancy 

Fertility Charting Aids The Diagnosis Of Gynecological Problems

Charting one’s fertility signs can help facilitate the diagnosis of gynecological problems. People who chart regularly know what is/is not normal for them and thus can engage in self-care and seek help from their clinician if and when irregularities or unusual symptoms occur. 

Examples of problems that can be more easily diagnosed through daily charting:

1. Irregular bleeding (bleeding not related to menstruation)
2. Yeast and other infections of the vagina and cervix
3. Cervical anomalies
4. Symptoms related to premenstrual tension (PMT/PMS)
5. Normal vs. abnormal breast tissue nodularity and sensitivity
6. Confirmation of pregnancy and the likely date of conception
7. Hormonal imbalances like PCOS-(Polycystic-ovarian syndrome)
8. Thyroid issues (usually hypo or underactive)

Advantages Of FAM

1. It is a natural, safe, and effective method of contraception (requiring less than two minutes a day during the learning phase). It is also an ideal planning tool for achieving pregnancy.  
2. It enables a deeper and more connected relationship to one’s body, cycles, sexuality, and health.
3. It promotes healthful body awareness & responsibility for self-care.
4. It is consonant with religious practice and lifestyle.
5. It reduces dependence on other methods
6. It facilitates gynecological and fertility diagnosis.
7. It can enhance communication between partners.
8. It encourages partner participation in sexuality and fertility-related decision-making. 
9. It can empower couples who are determined and motivated to manage their fertility naturally, while gaining peace of mind and self-confidence in the process.
10.  In some cases, it can eliminate the need for invasive infertility treatments like IVF.

Disadvantages Of FAM

1. It typically requires time to learn (7-10 hours, depending on the goal) over  2-3 cycles/months of charting before implementing with confidence.
2. It requires discipline, particularly during the first few months or learning phase.
3. It requires personal responsibility, motivation, commitment and partner support. 
4. For contraception, it requires two additional backup methods during the fertile days, e.g. spermicides with condoms or withdrawal, or a diaphragm with a natural (non-chemical) gel.  FAM is not a “stand-alone” method during all days of the cycle.

Typical Characteristics Of FAM Users

1. Those frustrated with side-effects/inconveniences of Pills and IUDs. 
2. Those wanting to use a truly natural method that doesn’t interfere with natural hormones, libido or mental health (headaches, mood swings, depression)
3. Religious couples who desire a safe and halachically acceptable alternative to conventional methods
4. Breastfeeding moms who want a natural approach for managing their fertility needs.
5. Women with irregular cycles who want to achieve pregnancy and/or seek approaches in natural medicine to balance their hormones and health.
6. Couples desiring a method that promotes shared responsibility for fertility
7. Women desiring greater body awareness, connection, and control.