Family Planning

Natural Family Planning (NFP) and Fertility Awareness Methods (FAMs)

There appears to be a mutual agreement among the major religions that "natural family planning," which uses a combination of observational methods to determine the most fertile time period of a woman’s reproductive cycle, is a good choice for birth control. Other forms of birth control, such as, birth control pills, Depo Provera, the Intrauterine Device (IUD), and permanent sterilization, which are not considered to be "natural" are not considered acceptable by some faiths, such as the Roman Catholic Church.

Although "natural forms of birth control" can be effective, the ovulatory and menstrual cycles of women can be highly unpredictable which can lead to unwanted pregnancy.

How Effective Is Birth Control?

The effectiveness of any form of birth control can be measured or described based on its "perfect use" or "typical use."

"Perfect use" describes the effectiveness of the form of birth control when used correctly and consistently as directed. "Typical use" describes the effectiveness of the birth control with actual use by the patient (which includes the correct and incorrect use). The best way to reduce the risk of unintended pregnancy is to use effective birth control, correctly and consistently. The following list of effectiveness is available from the Centers for Disease Control and Prevention (CDC) as a downloadable pdf file. You are encourage to go directly to their website for more information at http://www.cdc.gov/reproductivehealth

Natural Family Planning (NFP)

Natural Family Planning (NFP) is categorized under a group of contraceptive methods also known as Fertility Awareness methods (FAMs) which relays on the observation of a number of natural body functions to include the Ovulation Method (calendar/rhythm), Sympto-Thermal (basal body temperature) Method, and the Billings (cervical mucus) Method.

Fertility Awareness methods (FAMs) are used not only as a means of preventing pregnancy by abstaining from having sexual intercourse or use of a barrier method to prevent conception or it can be used to predict the most fertile time of the month in order to plan for pregnancy.

How Do You Use Natural Family Planning (NFP) or the Fertility Awareness Methods (FAMs)?

Ovulation (Calendar/Rhythm) Method
- Based on a 28 day cycle:
  - Day 1: is the first day of the menstrual cycle or period
  - Day 14: optimal day of ovulation
  - Day 28: if pregnancy does not occur, start of next menstrual cycle
- Based on a 30 day cycle:
  - is the first day of the menstrual cycle or period
  - Day 16: optimal day of ovulation
  - Day 30: if pregnancy does not occur, start of next menstrual cycle
- Based on a 35 day cycle:
  - is the first day of the menstrual cycle or period
  - Day 21: optimal day of ovulation
  - Day 35: if pregnancy does not occur, start of next menstrual cycle
- *Key points to understand regarding the ovulation method:
  1. Ovulation cycles often irregular and can fluctuate based on stress, weight changes, medications, and natural hormonal fluctuations.
  2. The optimal date of ovulation is relative; however, the first day of menstruation following ovulation is generally 14 days regardless of the time interval between one period and the next.
  3. The optimal range of fertility is dependent on the survivability of the male sperm, which averages 3 to 5 days in the female reproductive tract.
- In order to track your menstrual cycle and determine the optimal window of ovulation, the following is recommended:
  1. Document your menstrual cycles for 3-12 months.
  2. Day 1 will be the first day of your period.
  3. Relative confirmation of your optimal day of ovulation is determined by reviewing when you had intercourse the previous month rather than the upcoming month. To determine this, based on the first day of your period, count back on your calendar 14 days.
  4. The recommended days of sexual intercourse in order to get pregnant should be from days 12-16 based on an expected 28 day cycle; 14-18 days based on an expected 30 day cycle; and 19-23 day cycle based on 35 day cycles. If attempting to avoid pregnancy, the aforementioned days of optimal ovulation should be avoided or barrier methods should be used to avoid getting pregnant.
  5. Luteinizing Hormone (LH) which peaks approximately 12 hours before ovulation can be measured indirectly by using urine LH tests which can be purchased in the drugstore or dollar store for as low as $1.
Sympto-Thermal (Basal body temperature) Method
1. During the menstrual and ovulation cycles, the natural (basal) body temperature of the female body will fluctuate, will increase after ovulation and remain elevated until the next menstrual period.
2. Based on the pattern of temperature fluctuation over a number of months, the estimated date of ovulation can be calculated.
3. The general steps for determining the date of ovulation are as followed:
  1. Using a basal thermometer, take your oral temperature each morning immediately after getting out of bed. (Your body temperature will change by only a few tenths of a degree Fahrenheit)
  2. Record this temperature and note slight changes in your temperature.
  3. As you approach the date of ovulation, you will notice a sharp consistent increase after ovulation. The increase in temperature is a sign of ovulation.
  4. Since the basal temperature increase occurs AFTER ovulation has occurred, it is best to use this method of a gauge of when ovulation is estimated to occur.
  5. Changes in behavior or events such as infection, drug use, lack of sleep or travel can affect basal temperature.
Billings (Cervical Mucus) Method
- 1. Cervical mucus is constantly being produced and the consistency of this natural discharge changes during the menstrual cycle.
  2. The mucus is generally thick following menstruation and becomes to thin out as ovulation approaches.
  3. Within 1-2 days of ovulation, the consistency of the mucus is thin, almost transparent, elastic or stretchy.
  4. In order to calculate the consistency of the mucus, the following is recommended:
    1. Collect a small amount of mucus from the vaginal opening using your fingers
    2. Record the characteristics of this mucus on your fertility calendar.
    3. Ovulation will occur within 24-48 hours of when the mucus is most transparent, slippery and stretchy.
- *The combination of all three methods maximizes the effectiveness of preventing pregnancy or maximizes the probability of getting pregnant. Since sperm can live in the female reproductive tract for up to 5 days, abstinence should be practiced for at least 5 days before ovulation and 5 days following ovulation. If pregnancy is desired, intercourse should occur every day following the end of menstruation or as often as possible, especially during the documented range of expected ovulation.
- FAM or NFP when followed correctly has an estimated effectiveness of approximately 90%. Unfortunately, due to the natural variations in physical signs of approaching ovulation, this form of birth control or conception preparation is not 100% effective.
- Failure to follow the signs by these methods decreases your chance of successful birth control to approximately 20-25%, which is less effective with simple withdrawal method of the male partner before ejaculation or condom use. Due to its high rate of failure (10x higher) as compared to other forms of birth control, it is exceptionally important that you not deviate from the recommended protocol since the risk of unwanted pregnancy will significantly increase.

What are the benefits and side effects or potential complications associated with (NFP) or the Fertility Awareness Methods (FAMs)?

Since NFP and FAMs are based on observation of natural physical signs of the body, there are no side effects or risk associated with this form of birth control or desired conception. If the protocol fails, pregnancy is the outcome.

The cost of NFP/FAMs are nominal. Ovulation calendars are available as free app for both Android and iPhones. Basal body thermometers cost approximately $15 at the drugstore. LH kits are also available at the drugstore and dollar stores for as low as $1 per test. Classes for this type of reproductive education are available online, at the office of your OBGYN or free through our ministry.

NFP/FAMs are safe, require no hormones and do not affect the ovulation or menstrual cycle, they are not as effective as a form of birth control as other options and do not prevent the spread of sexually transmitted diseases. They are also highly dependent on the couple following the protocol very carefully and avoiding having sex during the days when ovulation is most likely to occur or during the period where viable sperm may be able to lead to conception.

Reversible Birth Control

There are a number of hormonal and non-hormonal types of birth control which include the following:

Oral Contraceptive Pills
Subdermal Patch (Ortho Evra, Xulane)
Intravaginal Ring (Nuvaring)
Depo Provera Injectable
Nexplanon
Non-hormonal Intrauterine Devices (Paragard)
Hormonal Intrauterine Devices (Mirena, Skyla)

The best way to reduce the risk of unintended pregnancy among women who are sexually active is to use effective birth control correctly and consistently. Among reversible methods of birth control, intrauterine contraception and the contraceptive implant remain highly effective for years once correctly in place. The effectiveness of the contraceptive shot, pills, patch and ring, and barrier and fertility awareness-based methods, depends on correct and consistent use—so these methods have lower effectiveness with typical use.

For each method of birth control, effectiveness with typical use is provided below. We present this as the percent of women who experience an unintended pregnancy within the first year of typical use (also known as the failure rate).

Please go the following Center for Disease Control pdf links for more information on the effectiveness of FAMs, reversible and permanent sterilization: