MYTHBUSTER - Spontaneous ovulation

The moment when the egg gets released from the ovary

   I have heard it from different people that "Yeah, yeah, this Fertility Awareness Method sounds very good for contraception, but what about when ovulation happens spontaneously and therefore the egg does get fertilized?".
   The fact is that the ripening of the follicle and the releasing of the mature egg is the result of a very long and complex process. When, at the end of the cycle, the progesterone level drops and bleeding begins, in the brain the hypothalamus starts producing GnRH (Gonadotropin Releasing Hormone) that activates the Pituitary gland. The Pituitary gland releases FSH (Follicle Stimulating Hormone) that travels with the blood circulation to the ovaries where it kicks in the process of ripening the follicles and the eggs inside. The follicles produce estrogen that is responsible for the occurring fertility signs (cervical mucus, changes in the position of the cervix) and for building up the uterine lining. 
   There is continuous connection and communication between the ovaries and the brain via hormones. As the estrogen produced by the ripening follicles (and later the dominant follicle only) reaches a certain level in about 1-2 weeks' time, this will give green light to the Pituitary gland to release LH (Luteinizing Hormone). Ovulation happens 12-24 hours after the LH level peaks, we see this exact moment in the picture above. (The light purple in the background on the left is the ovary, the pink is the protrusive ripe follicle and the red is the egg.)
   We have discussed before that whatever has an effect on the brain (grief, travelling etc.) can influence the hormone production, causing ovulation to occur earlier or later than usual, but this does not happen in a minute. The process is so long and so complex that a long awaited meeting with a loved one, a good sex, a huge orgasm, a big fright, an argument etc. will not cause spontaneous ovulation out of the blue. And in case the process has already started, estrogen level is rising, cervical fluid is being produced, it will show up on the cycle chart immediately and those who use the method for contraception avoid unprotected vaginal intercourse in this period anyway, so an accidental spontaneous ovulation (if such thing exists at all) will not cause unplanned pregnancy!

   I hope we have managed to clear any doubts in this topic. The Natural Family Planning Teachers' Association (where I was trained) does not accept the existence of spontaneous ovulation but the theory could be proven or refuted only if we could examine each and every woman's each and every cycle in the world.
   I leave it up to you to decide if you believe in it or not. Nevertheless, the Fertility Awareness Method is a very effective and safe solution for contraception! 😉

The different types of vaginal bleeding

Human blood as seen through microscope

   I believe it is important to discuss the different types of vaginal bleeding because not everything is menstruation!

1. Spotting: As the name shows, this is not a proper flow but few drops of blood that we can find occasionally in the urine, on the toilet paper or in the panties. Generally it has brownish (old blood) or light pink color or it might make the cervical fluid streaky with red. Spotting can occur for 1-2 days around menstruation, it can also be a result of ovulation or the implantation of a fertilized egg. In every other case or if it lasts more than 2 days it is considered abnormal and should be examined. Abnormal spotting can have various reasons, like insufficient progesterone production, cyst, injured cervix, ectopic pregnancy, miscarriage etc.

2. Menstruation: Menstruation occurs when ovulation is not followed by fertilization and therefore the corpus luteum withers, the progesterone level decreases, the thickened uterine lining sheds and exits through the vagina, causing bleeding. The flow usually lasts for 3-5 days, varies between light and heavy, during which we loose about 25-80 ml of blood. If any aspect is out of the ordinary there might be some problem in the background, it is advised to get it looked into (taking contraceptive pill is not a solution!!)

3. Breakthrough bleeding: We are talking about breakthrough bleeding when, for some reason, ovulation does not happen in a cycle and, due to the lack of progesterone to support it, the uterine lining cannot hold itself and sheds, leaving the body with blood flow. Those who do not chart their cycles often mistake it to be menstruation but that is incorrect. Menstruation is always preceded by ovulation! In case of breakthrough bleeding the cycle does not end yet, new cycle starts with true menstruation.

4. Withdrawal bleeding: When taking contraceptive pills, the blood flow in the 4th week is called (hormone-)withdrawal bleeding. As we already know, the pill shuts the system down completely, stops all the natural hormone production and makes the cycle non existent (that the doctors 'forget' to tell us about, otherwise there would not be such a huge market for it), therefore we obviously cannot talk about menstruation in this case. Bleeding occurs because they withdrew the artificial hormones from the 4th week's pills to make the endometrium shed and exit, imitating menstruation and therefore making women believe that they have normal cycles. (The first versions of the pill provided hormones continuously, not causing any blood flow, but this made women doubtful about the efficacy.)
Many people ask about tricks to make the bleeding happen earlier or later to avoid collision with the vacation or the honeymoon etc, but I believe that those who have been following this blog so far can clearly see that there is no natural way to do that. The only solution is the pill, you will bleed when you take the ones without hormone. But let me ask you this: is it really worth it??

5. Postpartum bleeding: This bleeding occurs postpartum, as the name shows, in case of vaginal birth it can last for weeks but it might stop sooner after Cesarean section. Lot of different aspects together determine when fertility will return but we can talk about menstruation only after ovulation starts happening again. 

+1. Vaginal bleeding in case of abortion or miscarriage: I don't think this category requires too much explanation, these events can also cause extensive, heavy blood flow. It is always advised though to ask the doctor how long is normal and when we might start to suspect some underlying problem. In these cases fertility returns quite soon but there might be changes in the cycles compared to the ones preceding the pregnancy: different length, cervical fluid pattern, different symptoms occurring in certain phases.

   I hope you learnt something useful today, ask questions or share comments on the topic, subscribe with your e-mail address and sign up for the course, it's really worth it! 😉

"Thanks, doc but no, thanks!"

   I hope you will find this article very useful and you will be motivated to start charting your cycles and therefore avoid mistreatment.

  
   We start with the fact that the majority of doctors count with 28 days cycle length and ovulation on the 14th day (or in case of long cycles 14 days luteal phase length), they don't know (?) what cervical fluid is and they are not willing to dig deep to find the source of a problem. Now let's see why this attitude might be dangerous and how Fertility Awareness can help us get the proper treatment:

1. "White flow": Probably the most common misapprehension (I, myself have experienced it several times and heard the same from others also) is when you go to the gynecologist in your fertile window and s/he tells you that "Unfortunately you have some white flow" and immediately writes a prescription for fungicide. This can happen either because s/he is not aware of the existence and function of the cervical fluid and thinks it is a sign of vaginal infection; or because s/he assumes that you have no idea whether it is cervical fluid or vaginal discharge caused by infection, so why even ask, it is easier to prescribe the medicine just to be sure.
       What can you do? You can try saying "Yes, I am fertile right now" after the diagnosis, if s/he understands, then good. If s/he ignores what you said and prescribes the fungicide anyway, you can thank her/him politely but not buy the medicine because you know perfectly well that you do not need it.

2. Blood test on the 21st cycle day: This is also based on the theory of 28-14 cycles. Every hormone has an optimal day within the cycle for getting its level checked. Most of them can be examined in the first few days of the cycle which is not an issue because it is very easy to tell when a cycle starts. The problem is when they call you in on the 21st day to check your progesterone. The progesterone level is the highest on the 7th day post ovulation, if conception did not occur then it starts decreasing after that. We already know that ovulation rarely happens exactly on the 14th day, therefore a blood test on the 21st day (14+7) will show an accurate reading just as rarely and a false result can lead to unnecessary hormone treatments.
       What can you do? In a cycle chart the basal body temperature shows when your ovulation happened (just before the shift) so you will be able to tell which day is the 7th after. This way you will be able to get your progesterone level tested on the correct day and you will always get an accurate reading.

3. Determining the time of conception: This is probably the most dangerous mistake someone can make because it does not affect only you but also the embryo growing inside. When your pregnancy test turns positive and you go to the doctor for the first time, s/he asks the first day of your last period. S/he then adds 14 days to it (the assumed time of ovulation and therefore conception) and based on this s/he checks if your baby is growing at an appropriate pace. But what if your ovulation was late for some reason and it happened, say, on the 21st day? Then the doctor says that the embryo is not growing properly and s/he prescribes some medication or suggests abortion, believing that there is something wrong with the baby and it would probably die soon anyway. When in reality there is nothing wrong at all, only conception happened a week later.
       What can you do? If you are charting your cycles properly then, before you start trying for a baby, it is advisable to find out whether your doctor believes you regarding the day of ovulation. If s/he does then it is an easy case, you can just tell her/him during the first examination exactly when the baby was conceived and s/he will calculate accordingly. If s/he doesn't believe you then the simplest thing you can do is to count back 14 days from the ovulation day and say that that is when your last period started. (One of my friends did this, resulting in a worry-free pregnancy.) S/he will not be able to verify your statement anyway but this way at least, because s/he counts with ovulation on the 14th day, the age of the foetus will be calculated accurately. 

4. "You cannot conceive? Take hormones!": Unfortunately this comes from a personal experience, when, after several months of trying, I was still not pregnant and we visited the doctor to find out what to do. The doctor only asked how many months we have been trying and whether I have any unusual symptoms or complaints and then she immediately prescribed hormone treatment. She told me to take it as advised and keep trying, it will solve the problem, the baby will come. Luckily at that time I had already been charting my cycles and could clearly see that there was nothing wrong with my hormones at all, I had proper ovulation each month, so why take medication to fix something that is not broken?
       What can you do? Again I would say you might try to convince your doctor that you know exactly what is going on in your body and when. If s/he doesn't believe you, then you might want to find another doctor. Naturally I did not take any of the prescribed hormones because they were not necessary. (And to prove this, right after that our first baby conceived without any external 'help'.)

5. Progesterone for bleeding during pregnancy: Again personal experience that when our first baby conceived and I had spotting at the end of the 5th week, we called the doctor that something is wrong. Without asking anything she told us to go to the clinic so she can give me progesterone injection, it will solve the problem. I was shocked that she did not even want to try to figure out the cause of the bleeding, no examination at all, only immediate artificial hormone treatment once again. As we found out later, the spotting was caused by the pregnancy being ectopic (the egg implanted in the Fallopian tube instead of the uterus), so injecting progesterone probably would have made the situation even worse. You could read in the previous blog post how dangerous ectopic pregnancies can be and how important early diagnosis is.
       What can you do? In a case like this it is better to visit another doctor who does not treat blindly but examines first. We, instead of her clinic, went to a nearby hospital where they did not mind the time they spent to figure out the cause of the symptom and do the proper treatment, therefore the situation did not end in tragedy. 

   With all this I do not intend to judge or criticize doctors, I respect them, they have enormous professional knowledge, I, myself have already trusted them with my life once. But they are not omniscient, not unerring, they generalize and average because they do not have the time and capacity to pay special, personal attention to each individual which can cause the above seen mistakes and mistreatment. Let's help them (and ourselves!) by dedicating 2 minutes of our time each day to chart our cycles so we can avoid being falsely diagnosed and treated unnecessarily because, after all, we are the 'suffering' party, not the doctors!
   Feel free to share your experiences or ask your questions in the comment section below, and once again, let's take care of ourselves! 😉

What you need to know about ectopic pregnancy

   Even though today's topic does not have the closest connection to Fertility Awareness I think it is important to talk about it because it happens to more people than we would imagine and cycle-charting can help with the early diagnosis. It is the ectopic pregnancy.

   When the fertilized egg implants not into the thickened uterine lining (endometrium) but some place outside the uterus, it is called ectopic pregnancy. Statistically it occurs in 2% of all pregnancies and it can be fatal for the mother therefore early diagnosis is extremely important. Different types are recognized according to the place of implantation.

   Telltale signs could be vaginal spotting or bleeding, abdominal cramps, even fainting. In any case you must contact your doctor immediately! Unfortunately the embryo has no chance for survival but early diagnosis can reduce the damage caused in the mother's body.
   Treatments can vary depending on how forward the pregnancy is and where the egg implanted. It might be possible that the egg moves forward after getting temporarily stuck in the tube (without actually implanting), in this case a regular ultrasound examination can be enough, no need of intervention, but this is rare. In most of the cases it implants there and starts growing. With an early diagnosis, when the wall of the tube is not affected yet, this can be solved by taking medication that makes the egg die and get absorbed, there will not be permanent damage.
   The problem is that the tube is not very flexible, as the embryo grows it can crack. This time it might still be possible to suck the egg out but the remaining wounds increase the chances of another ectopic pregnancy. Another solution is to remove part of the Fallopian tube that contains the embryo which will decrease the chances of getting pregnant again by 50% because that side will never work properly any more. (However, it is still possible that the egg is released from the ovary towards the stomach and the other side's tube picks it up, so the situation is not that hopeless.)
   In the worst case the wall of the Fallopian tube breaks completely, causing internal bleeding in the abdomen. In this case surgery is immediately needed because it can cost the mother's life if not acted upon. Fertilized eggs implanted elsewhere also cause internal bleeding if they do not get removed in time.
   Risk factors that increase the chance of ectopic pregnancy:
       - previous ectopic pregnancy
       - tubal surgery
       - pelvic inflammatory disease
       - smoking
       - advanced maternal age
       - miscarriage
       - abortion
       - history of infertility
       - intrauterine device

   So, once again, an ectopic pregnancy can be fatal for the mother, early diagnosis is extremely important! Cycle-charting helps in realizing pregnancy at an early stage and therefore noticing the occurrence of abnormal symptoms in which case one must visit the doctor as soon as possible!
   Let's take care of ourselves, Ladies!

Our first angel

   I got married in 2016 and my husband and I agreed that we would like to have babies immediately, so from then on we stopped using condoms. I was naive, I thought that if we decided to have babies and go unprotected then I would get pregnant immediately, or max within 3 months because with the Rhythm Method you can predict your ovulation quite precisely and if you time the intercourse well then it must happen. Or not?

   Not. We had been trying for 6 months unsuccessfully when one of my friends told me about some fertility awareness thing and observing cervical fluid and recommended a Facebook group. I joined the group and I had to realize that till then I had known ridiculously little about how my body and my fertility works. I immediately ordered a book that they recommended in the group and a basal body thermometer and I dived into Fertility Awareness and cycle charting. 
   It might not be surprising that in the 3rd month of charting my cycles our first baby conceived, 9 months after the wedding. You can imagine our happiness, I tested on 3 consecutive days because I was doubtful at first, I thought it might be a false positive. I still had 4 days to go till my (not) expected periods, but I had weird cramps and breast pain and my friend who has 3 kids said they might be early pregnancy symptoms. Seeing the test results we immediately shared the happy news with our family and close friends.
   I knew that the ultrasound would not show anything this early, so we were planning to visit the doctor in the 6th week. Till then I thought of passing time by checking baby clothes and furniture online, it never occurred to me that anything could go wrong. I downloaded a pregnancy tracker app on my phone, I read the articles every day and I drooled over the poppy seed and the sesame seed that showed how big the baby was in those weeks and we took a "belly" photo of the 4th and 5th week that would be made into a slide show by the app at the end of the pregnancy.
   At the end of the 5th week, however, something happened that none of us expected. I started bleeding. Not much, just spotting, but even an inexperienced mummy-to-be would know that vaginal bleeding during pregnancy is not a good sign at all. The friend I mentioned earlier confirmed my suspicions and suggested visiting the doctor immediately. At the hospital the ultrasound technician could not see anything in my uterus and she kept asking me if I was sure I was pregnant, I confirmed it again and again but she didn't want to believe me. The gynecologist was also doubtful so she sent me for a blood test to check the hCG hormone level that verified my statement. She asked to repeat the blood test after 2 days to see if the hormone level doubles, if it does then there might not be any problem after all. I sat home for 2 days wishing it to double. I still had no idea about what was going on. Seeing the second blood test result, the gynecologist sent me back for ultrasound to find that baby because it must exist. It did. Only not where it was supposed to be. They found it implanted into my left Fallopian tube, it was already big enough to stretch the wall of the tube to break-point. I had two options: either getting injections weekly that would induce miscarriage, followed by blood tests, but doubtful if it would work at all, or I go for surgery. I didn't need to think much, I chose surgery. I can't stand needles, I hate blood tests, during the surgery at least I would be asleep, not knowing and not feeling anything and it would be over much faster. I got admitted to the hospital next day around noon, the surgery started at 5 pm.
   It was a laparoscopic procedure. As they informed me afterwards, they were only planning to suck the embryo out of the tube but by that time it was so big that the wall started to break, leaving no choice but to cut that part of the tube out, otherwise there would have been a great chance for it to happen again. Due to this the surgery went longer than they anticipated and they had not put me to sleep well enough, I woke up in between. I felt them working on my belly, I saw the lights, I heard the voices and I could not breathe from the tube in my throat. I remember wishing I would die then and there along with my baby. Of course they put me back to sleep quickly but I did not feel any better even after hours, lying in my hospital bed. My husband told me what happened, that they needed to remove part of the tube and I felt the world end. Not only they tore my first, so awaited baby out of me but they also reduced my chances of getting pregnant again by 50%.
   Eventually though, as the days went by, I realized that my poor baby had no chance at all and at least it did not take me along so I should be glad. My doctor was amazed that I had known about my pregnancy so early, here, in India many times women don't realize that they are expecting even in the 3rd month, therefore those for whom the embryo implants outside the uterus don't get diagnosed in time, their tube breaks causing internal bleeding and unconsciousness, they are taken to the hospital by emergency ambulance and the doctors have to fight for their lives. She almost congratulated me for being so conscious and reading the signs of my body so well, and she thanked me for her first "calm surgery" experience. This was so absurd that eventually it started to make me feel better.
   
   But why have I told you all this? First, because it allows me to finally close this chapter of my life and second, because it might be useful for you. I have been thinking a lot ever since, I believe that everything happens for a reason and if I had not familiarized myself with Fertility Awareness and not started charting my cycles before, I might have not survived, thinking that the spotting was just the beginning of a late period that does not require a visit to the doctor.
   Don't get me wrong, I'm not saying that if you don't chart your cycles then horrible things will happen to you. I believe that, thanks to Fertility Awareness, knowing exactly what was going on in my body and realizing when something was wrong saved my life. But this is my story.

   The next article, following this topic, will be about ectopic pregnancy, chances of occurrence, types, symptoms and treatment, I hope you will find it useful. Share your thoughts or questions in the comment section below. I have not included some details about the doctors' attitude, there will be a separate post about that (not generalizing, only personal experiences).

HISTORY OF FERTILITY AWARENESS - From the Venus of Willendorf to the 19th century

   Now let us travel back in time a bit and see what different cultures thought about reproduction in different eras, when the great discoveries in human anatomy started and whether these newly revealed facts verified or refuted the theories of our ancestors.
   Some parts of this article are to be treated with a sufficient amount of irony. 😉

   When there were only handfuls of people on earth living far away from each other then reproduction was the biggest mystery. Archaeologists say that these people believed being overweight to be the primary sign of female fertility. Proof of this theory could be the statues of the Venus of Schelklingen from around 40,000-35,000 BC or the Venus of Willendorf from 24,000 BC. However, this is all we know about those times.

Venus of Schelklingen

Venus of Willendorf

   The earliest written sources on the topic of family planning are from the ancient Egypt. The KAHUN papyrus from 1900 BC describes methods to avoid or achieve fertilization, the EBERS papyrus from 1552 BC gives advises on pregnancy testing, breastfeeding and finding out the gender of the fetus. It also contains a practical solution for contraception: maintaining the natural acidity of the vagina by the use of tampons soaked in vinegar or lemon juice will kill the sperms.

KAHUN

EBERS

   In India, between 1000-500 BC, the Hindu medical training provided a detailed description about the optimal time for conception: within 12 days after the menstrual bleeding stopped; and choosing the gender of the baby: for a boy the sexual intercourse should be on the even days of the cycle (4th, 6th, 8th, 10th, 12th), for a girl on the odds (5th, 7th, 9th, 11th).
   In ancient Israel women were told to abstain from sex for 7 days after their periods, this way they would get pregnant immediately on the 8th day. The method could work for the majority of women but they did not realize that with short cycles it might just be the recipe of failure for some. To increase the time between two pregnancies they believed in excessive breastfeeding for 2-3 years. These practices can be found in the Jewish community even today.
   The Greeks and Romans did not add anything new to the discoveries discussed above, they even took a step backward. A school of philosophy attributed the Single Seed Theory to Aristotle (384-322 BC). The theory was that the child in the womb developed from the single seed of the man. Later Galen (129-216 AD), a physician to Roman emperors and gladiators, forwarded the Two Seed Theory on the simple observation that a child would look like the maternal side of the family.

Aristotle

   For centuries the general belief remained that menstruation was closely associated with ovulation and therefore being the most fertile time in the cycle. Mistakenly, the rest of the cycle was considered to be infertile. This theory persisted even into the 19th century.
   In the Renaissance started the great discoveries in human anatomy, mostly thanks to the lifelike artworks of Michelangelo, Leonardo da Vinci and Raphael who conducted dissection on human bodies. The drawings of Leonardo da Vinci particularly reawakened the interest in the working of the body, leading to the discovery of circulation and the female reproductive organs (Fallopian tube: Fallopio - 1561; corpus luteum: Coiter - 1573 and de Graaf - 1672).

da Vinci - Dissection of a woman

   The next big step was the improvement of the microscope in 1677 (Leuwenhoek), there was no stopping from then on. In 1765 von Haller concluded that the ruptured follicle transforms into corpus luteum; in 1843 Barry mapped the passage of the sperm from the vagina to the Fallopian tubes; in 1897 Beard realized the importance of the corpus luteum during pregnancy and in 1928 the human ovum was first described by Allen.

   I will write about the 20th century and the development of the Fertility Awareness Method in a separate blog post. If you have not done it already, subscribe with your e-mail address to get notified about new posts. I have a lot more to tell you, so stay tuned! 😉

FERTILITY SIGNS - Cervical position

   Although the cervical position is one of the main fertility signs, many people do not observe it for various reasons. The cervix is the part of the uterus that reaches into the vagina, connecting the two. It looks like a doughnut with a small opening in the middle. To observe it you have reach up inside your vagina to feel it with your fingertips around the same time every day, in the same position (squatting, lying on the bed etc.).
   In 1962 Dr Edward Keefe american gynecologist was the first one who described the changes in the cervical position during the menstrual cycle. He encouraged women to observe it themselves so that they would know when they are fertile and when they are not.
   In the infertile phase of the cycle the uterus has the shape of a pear upside down. The cervix reaches longer into the vagina therefore you feel it being lower, it is firm and dry and the opening in the middle is closed. In the fertile phase, however, due to the increasing level of estrogen the shape of the uterus becomes more apple-like, the cervix moves higher, it becomes softer and wetter. It also opens up to let the cervical fluid flow into the vagina and to let the sperms reach inside the uterus to fertilize the egg. The cervix is highest, softest, wettest and most open at the time of ovulation. After the egg is released, due to the progesterone hormone produced by the developing corpus luteum, the uterus quickly returns to its upside down pear shape, the cervix becomes low, firm, dry and closed once again. (The picture does not show the changes in the shape of the uterus properly.)

   Those who have read the previous article might have noticed that the changes in the cervical position are very much in synch with the changes in the cervical mucus, both can help us determine the fertile phase in the menstrual cycle. Their reaction to estrogen and progesterone are very similar and if you note them in a cycle chart you will see that they create a spectacular curve. This is the reason, however, that many people choose not to observe the cervical position. The basal body temperature and cervical fluid chart is enough to determine the fertile and infertile phases of the cycle. The cervical position serves as double-check to confirm what the mucus has already told us.

   It can also happen that someone wants to observe the changes of the cervix but for some reason she cannot reach it inside the vagina in any position in any phase of the cycle. That is absolutely normal, no need to be worried, in this case she must rely on the cervical fluid to identify the onset of fertility. 

   Checking the cervix can be especially useful for those who are not sure they understood the cervical fluid sign properly or they have issues with the mucus production due to some medication or hormonal imbalance. In this case the cervix along with the temperature will help them determine the fertile phase. 

   With this we have reached the end of our fertility signs. There is a fourth "sign" also but it is not observation, it is simply counting days and analyzing previous data, during the course I explain it in details but here I do not feel it necessary to write a full article about. 

   I hope you have learnt something useful today but I have to tell you that to be able to chart your fertility signs and use the Fertility Awareness Method properly you must learn it from a qualified educator, reading the articles will not be enough! Here, on the blog I speak of things generally, but the method itself is much more complex, it requires more detailed knowledge!

   For the next article I have a lighter topic, I hope you will enjoy, stay with me. 😉

FERTILITY SIGNS - Cervical mucus

   Cervical mucus (CM) is the one fertility sign that everyone comes across at some point, only they have no idea what they see. When you go to the gynecologist in your fertile window s/he will say "You have a bit of a flow" and s/he will immediately prescribe anti-fungus medicine, not knowing (?) that it is absolutely normal. This is that sticky or creamy white discharge that you sometimes find in your panties and this is what sometimes creates slippery feeling when you wipe yourself after peeing. But what is this exactly?

   The cervical mucus or cervical fluid is an alkaline substance containing electrolytes, glucose, amino acids, proteins, enzymes and 90-99% water. It is produced in the cervical crypts in the first half of the cycle due to the increasing level of estrogen. Thanks to gravity it travels from the cervix down through the vagina and can be observed at the vaginal opening. Being alkaline it changes the normally acidic environment of the vagina that would kill the sperms, it nourishes the sperms and creates a path for them to travel towards the uterus while filtering out the deformed ones and this is what can keep the sperms alive up to 5 days in the cervix while waiting for the egg to come. 

   The colour, consistency and amount of the mucus changes during the follicular phase, from yellowish rubbery or sticky through white creamy or milky to opaque stretchy and slippery (like raw eggwhite) and all these are natural and normal! As we are approaching ovulation the mucus becomes more and more stretchy and slippery, providing optimal environment for the sperms to live, feed and travel in. After ovulation due to the progesterone hormone it dries up or returns to the initial sticky or creamy state. It is important to know that prior to ovulation, for the reasons mentioned above, as soon as any type of mucus appears, we are considered fertile, this is the sign that tells us when our fertility begins in the cycle.
   Felix Pouchet was the first to define the cervical fluid in 1847 and in 1954 Dr John Billings described it as the primary sign to indicate potential fertility. Billings, along with his colleagues categorized the different types of cervical mucus and their impact on fertility and developed the Billings Method that determines the fertile phase in the menstrual cycle. 
   Observing cervical fluid is pretty easy for western people: you have to wipe your vaginal opening with a piece of folded toilet paper before and after peeing and check if there is anything on the paper (pee gets absorbed, mucus stays on the surface). Whoever is not experienced in identifying the different version of mucus I encourage them to touch it and take it between the fingers, rub it to see if it is sticky or lotiony or slippery, try to pull it to see if it is stretchy. I know it sounds gross at first, but believe me it is not horrible at all once you get used to it and it provides you with a huge amount of information about your health and fertility. After a couple of weeks it becomes part of the routine of using the toilet and you won't even need to touch it any more because you will be able identify it and note it in the chart by just looking at it.
   Another reason why it is important to observe and chart cervical fluid daily is that everyone has their own mucus pattern during the cycle. Once you get to know yours you can avoid the above mentioned misunderstandings and unnecessary treatments at the doc's but you will also know if something is wrong and should be checked. Natural cervical mucus is odorless, does not cause irritation or any other symptom, the colour can be pale yellowish, white, opaque, or pinkish (in case of spotting) and all this means is that you are fertile at the moment. But if you have dark yellow, brown or greenish, possibly lumpy discharge with a strong, unpleasant smell that often causes irritation at the vulva then it is probably caused by some vaginal infection and you must see your doctor and get it treated!

   In the next post we will talk about the third fertility sign, the cervical position. I hope you found this article useful and I haven't put you off charting, trust me, it's really worth it! 😉

FERTILITY SIGNS - Basal body temperature

   The first fertility sign that we have to discuss is the basal body temperature (BBT) or waking temperature.
   Probably all of you have already learnt in biology class that the normal body temperature of humans is between 36-37 degree Celsius. This, however, keeps changing during the day according to our activity, obviously while we are working out it will be higher, while we are at rest it will be lower. The waking temperature can be taken in the morning when we wake up after at least 3 hours of consecutive sleep. This is the time of the day when it is the lowest. As soon as we get out of bed and start our daily activities it will rise, but we are not talking about big differences, only few tenth or hundredth degree changes.
   The fact that the basal body temperature changes during the menstrual cycle, in the first half it stays in a lower range, in the second half it rises to a higher range was first discovered in 1868 by Dr W.Squires, but he could not figure out the reason behind it.
   Van de Velde was the one who realized the connection between the mid-cycle temperature shift and ovulation in 1904. In 1928 he also figured out that the reason for the higher temperatures is the progesterone hormone produced by the corpus luteum after ovulation. However the field studies and researches took place decades later by Dr John Marshall British neurologist who published the proof of this theory in 1968.
   But why is this an important part of Fertility Awareness? Because the woman who takes her BBT daily and notes it in a chart will be able to differentiate between the pre-ovulatory (follicular) low temperatures and the post-ovulatory (luteal) high temperatures. This will tell her if ovulation happened and she can also estimate its day. It can happen that ovulation does not occur for some reason but the temperature chart will show this, the temperatures will remain low throughout the cycle. Also whoever is trying to conceive can save money on pregnancy tests because the production of progesterone hormone is continuous while expecting a baby, the temperatures will stay high for 9 months.
   The only problem with the basal body temperature is that it is very sensitive, there are numerous factors that can throw it off balance and cause a false reading (bad sleep, consuming alcohol, illness, travelling etc.) If you join a course and learn the Fertility Awareness Method though, you will be able to identify these factors and know what to do about them. Also I have to tell you that the BBT is not taken in the armpits because that place is unreliable when we are talking about so small changes. It has to be taken in the mouth under the tongue, in the vagina or in the rectum (always the same place). There are basal body thermometers available that were developed specially for this cause and show hundredths of degrees compared to the general thermometer that was designed to indicate fever and shows only tenths.
   As I have said it is very useful to chart your waking temperatures but it will tell you only when your fertile phase ends since it rises 1-2 days after ovulation.

   In the next post we will see which sign shows us the onset of fertility and determines the length of the fertile window in the cycle. Stay with me! 😉

The phases of the menstrual cycle

   I have already mentioned before that the cycle is not only about menstruation, now let us see what the different phases of the cycle and their characteristics are.

1. Menstrual phase
   This is the part of the cycle that is the easiest to identify and the most obvious. The fist day of the cycle is the first day of menstrual bleeding. If conception did not happen in the previous cycle then the thickened endometrium sheds and leaves the uterus in form of bleeding through the vagina. This lasts for about 3-5 days with changing intensity during which we normally loose 25-80 ml of blood. We can talk about true menstruation only if it is preceded by ovulation. (I will have a separate post about the different types of bleeding.)

2. Follicular phase
   This part is about the ripening of the follicle and the egg inside. The brain produces FSH (Follicle Stimulating Hormone) which starts the ripening of multiple follicles in both the ovaries but after a few days one (or two) follicle becomes dominant, the others whither and get absorbed. The ripening follicle produces the main hormone of this phase, estrogen, that is responsible for the developing of the secondary female characteristics and the fertility. Estrogen induces multiple procedures in our body that would redound fertilization (more about this later). The length of this phase varies, it can differ from month to month. The reason for this is that the brain plays a central role in the process. Whatever can influence the working of the brain (stress, grief, travelling etc.) can also influence the production of the hormones and therefore the length of this phase.

3. Ovulation phase
   This is the most important part of the cycle in terms of fertility and health as well. Ovulation is when the ripe egg gets released from the ovary and starts its journey in the Fallopian tube towards the uterus. When the amount of estrogen, created by the ripening follicle, reaches a certain level it makes the brain produce LH (Luteinizing Hormone) that will cause the follicle (12-24 hours later) to break and release the egg. The level of this hormone is what ovulation predictor kits can show from urine. The egg lives for 12-24 hours after ovulation and can only be fertilized in the first 6-12 hours. In case there were two dominant follicles, the second egg gets released maximum 24 hours after the first one. The length of this phase is about 3 days, from the LH surge to the death of a possible second egg.

4. Luteal phase
   This part was named after the corpus luteum. When the egg gets released, the broken follicle remaining in the ovary turns into corpus luteum and starts producing the main hormone of this phase: progesterone. Progesterone blocks the production of FSH and estrogen thus preventing the ripening of new eggs. It also prepares the endometrium for a possible implantation. If fertilization has not occurred, the corpus luteum lives for 10-16 days, determining the length of the luteal phase for each woman individually. It is the same number of days in every month (+/- 1 day maximum). As the corpus luteum dies and the production of progesterone suddenly stops, the endometrium sheds and leaves the uterus through the vagina in the form of menstrual bleeding, a new cycle starts. So if you chart your cycles, as soon as ovulation happens you will be able to tell exactly which day your next period will come.

   So these are the phases of the menstrual cycle, I hope you found this article useful, you can ask questions or tell your opinion in the comment section below. In the next posts we will discuss the fertility signs, stay with me! 😉

MYTHBUSTER - About the Fertility Awareness Method

   In today's article we will dispel the misconceptions about the Fertility Awareness Method (FAM).

Myth #1: Fertility Awareness Method is the same as Rhythm Method.
Fact: The Rhythm Method is about guessing and predicting. It is based on the false theory that all cycles are the same, if the previous one was 28 days long then this one will be as well and ovulation always happens in the middle of the cycle. FAM is based purely on biology, it has a strong scientific background. It always concentrates on the current day in the current cycle by the observation of the hormone-induced fertility signs (basal body temperature, cervical fluid, cervix).

Myth #2: Fertility Awareness is not an effective method for contraception.
Fact: As we have discussed before, FAM is backed up by scientific researches, always concentrates on the present. The person who learns to observe and chart her fertility signs on a daily basis will always be able to tell if she is fertile or not on a given day. Based on this information and their family planning intention (whether they want to have a baby or not) she can decide about having sexual intercourse. For those who obey all the rules and abstain from sexual intercourse on the fertile days this method works with a 99.6% efficacy. For those who choose to have protected sex in the fertile window this rate gets reduced to the efficacy of the barrier method (condom, diaphragm, spermicide etc) they use.

Myth #3: Fertility Awareness works only for those who have regular cycles.
Fact: We have seen above that the biggest advantage of FAM is that due to daily observation it always concentrates on the present - the current day in the current cycle. This is why it works for everybody, regardless of age, or situation (coming off hormonal birth control, postpartum, nursing, approaching menopause). The user will always know exactly what is going on in her body and which phase of her cycle she is in. 

Myth #4: Fertility Awareness is only good for achieving or avoiding pregnancy.
Fact: There is a separate post ('The fifth vital sign') already on this blog that confutes this statement in details. The cycle chart (the notes on the daily observations of the fertility signs) provides you with a broad and very detailed picture of your hormone production and reproductive health. It tells you whether everything works properly in your system. If you get to know your own fertility cycle pattern from your charts then you can avoid running to the doctor all the time or taking unnecessary treatments because you will be able to distinguish between normal and abnormal events. You might not use the method for contraception or getting pregnant but still it is very reassuring to have proof in your hand about your body working perfectly. And if something is wrong you can find a solution, you have the time and the opportunity to change your ways and the positive effect will be visible in your upcoming charts.

   I hope that by now you see why Fertility Awareness is good and worth learning. It might take 1-2 cycles for you to gain confidence in charting your fertility signs but the observation itself is not more than 2 minutes daily and the information it gives you is very valuable and useful.
   If you are interested in learning contact me here, in e-mail or on my Facebook page, I guarantee that you will not be disappointed. 😉

MYTHBUSTER - About the Pill

   The next very important topic to cover in the Mythbuster series is the hormonal birth control tablet (the Pill).

Myth #1: The Pill is so effective because it makes your body believe that you are pregnant.
Fact: The pregnancy hormones are different, what the Pill does is it completely shuts down your natural hormone production, creating an artificial menopause state in your body, not to mention the side effects that come with taking it.

Myth #2: While taking the Pill you still have your normal menstruation every month.
Fact: Taking the first, experimental versions of the Pill women did not have bleeding at all which made them worried that they were pregnant. For this reason the manufacturers removed the hormones from the 4th week's tablets therefore inducing 'withdrawal bleeding' to imitate menstruation, hoping this would encourage women to take the Pill. We can talk about true menstruation only if it is preceded by ovulation.

Myth #3: Taking the Pill with regulate your cycles, reduce menstruation cramps, and cure your acne.
Fact: All these problems indicate some underlying health issue which can be cured by changing your lifestyle, your diet, taking certain vitamins or drinking herbal tea. Your body is trying to let you know that something is wrong. Taking the Pill, as we have seen above, shuts down your system therefore not providing a solution, only masking your symptoms. As soon as you stop taking it, your problems will return. 'If the smoke detector went off in your house would you try to locate the fire and put it out or would you wear your headphone, turn up the volume to drown out the sound of the alarm and pretend that the house is not burning down around you?' /Lisa Hendrickson-Jack: The fifth vital sign/

Myth #4: After coming off the Pill your normal cycles will return immediately.
Fact: There are cases when this statement is true but for most women it is a longer process that can take months or even 1-1,5 years. Think about waking up in the morning after a long sleep. There are people whose eyes just pop open and immediately they are up and about but for most of us it takes some time - let it be 5, 10 minutes or half an hour - to reach the point when we can get out of bed and start the day. Same scenario with the natural hormone production after the Pill.

Any comments or questions are welcome in this topic, I hope you found it useful! 😉

MYTHBUSTER - About the cycle and fertility

   The world is full of false information and misunderstanding burnt into the public's mind, so I thought of starting a series where we would discuss these myths in certain topics. The most popular misconceptions are related to the menstrual cycle and the fertility, so we will start with these.

Myth #1: A normal cycle is 28 days long.
Fact: Only a fraction of women have 28 days long cycles. The length of the cycle is totally normal between 24 and 35 days, it can even change from month to month (see in the next paragraph), but doctors usually follow the textbook "norm" and count with 28 days to make it easier.

Myth #2: Ovulation always happens on the 14th day.
Fact: The brain produces the hormones that are responsible for ovulation, therefore stress, travel, grief, illness etc can have an effect on it. Ovulation can happen as early as day 9-10 or as late as day 20-21 or even later, all are perfectly normal. The number of days between ovulation and the next menstruation (luteal phase) is always the same individually, it can last 10-16 days. The length of the cycle always depends on the day of ovulation in that month and the length of the luteal phase of that person. Doctors however count with 14th day's ovulation, following the textbook "norm".

Myth #3: Women can get pregnant on any days of their cycle.
Fact: After ovulation the matured egg lives for 12-24 hours and can be fertilized only in the first 6-12 hours of its life. The sperm can live up to 5 days in nourishing environment (fertile cervical fluid). Taking these factors into account there are only about 6 days in each menstrual cycle when unprotected intercourse can cause pregnancy. 

If you know more myths in this topic or you have comments or questions, use the comment option below, I would love to hear from you! 😉

The fifth vital sign

  More and more people consider the menstrual cycle (with ovulation) to be the fifth vital sign. And it is not only about the bleeding but all the hormonal changes, the maturing of the ovum.
  The cycle is closely related to your overall health, if everything is fine with you, then everything will be OK with your cycle also and vice versa: if there is something wrong with your cycle, most of the times it indicates an underlying health issue.
   Fertility Awareness is not only about contraception or making babies. If you learn to observe the signs that your body sends every day and note them into your chart, it will give you a complete and detailed picture of your health status as well. It can happen that you don't have symptoms but your chart tells you that your thyroid function is low and that is why you are unable to conceive. But this is only one of many examples.
   Fertility Awareness is very useful at any age and any state of life, after all who wouldn't want to avoid going to the doctor?
   Learning this method will give you such knowledge that you will gain control over your own body and confidently make decisions about it. For example you will not freak out and run to the pharmacy for anti-fungus medicines when you go to your gynecologist in your fertile time and s/he says "Unfortunately you have some flow", mistaking your cervical mucus to be a vaginal discharge caused by infection. You will just smile, thank her/him and throw the prescription into the first dustbin. (This is not only my experience, unfortunately most of the doctors are not aware of the things that you can learn here, it is not being taught in college or university.)

   So get an appointment, learn how your body works and gain confidence in your decision making. 😉

What is Fertility Awareness?

If you
- want to know more about your cycle and your fertility,
- are interested in what your returning symptoms mean,
- are trying for a baby and want to optimize your chances,
- are looking for a natural, effective and environment-friendly way to avoid pregnancy,
- are tired of the invasive fertility check-ups,
- want to avoid unnecessary treatments 
then you are at the right place!

   I can teach you everything you need to know about your own body and cycles. You can learn how to recognize your fertility signs, when to have sexual intercourse, maybe even try to choose the gender of your baby.
   
   Whether you are adolescent, adult or approaching menopause, whether you want to achieve or avoid pregnancy, whether you are breastfeeding or coming off the birth control Pill, you will find learning the Symptothermal Method, which is the base of Fertility Awareness, very useful.

   I think this is enough introduction, we will talk more about the topic later! 😉

Blog introduction and teaching

Dear Readers!
   I have created this blog, because I have so many things that I want to share with you related to Fertility Awareness, and my husband says nobody reads long posts on Facebook. I hope you will like it and find it useful!
   If you get interested and want to dive deeper into the topic and learn the Fertility Awareness method, send me an e-mail to timeaagnesvelu@gmail.com, contact me on my Facebook page: Fertility Awareness teaching and consultation - Timea Agnes Velu or message me here at 'Contact me!'.
   I teach mostly via Skype, the basic course is about 4 hours long (for Indians it would be 5-6 hours due to the complete absence of education in schools in the human anatomy and reproduction field). In special cases (adolescent, postpartum, breastfeeding, coming off hormonal birth control, approaching menopause) it takes half an hour extra. I teach everyone individually, therefore the pace is personalized, there is always time to process what you heard or ask questions.
   The course is mainly for women because the base of the method is the observation of fertility signs during the menstrual cycle, but it is always good if the male partner also takes part, it helps with the cooperation. In case of Indians both the partners should attend the course due to the reason mentioned above!

So Ladies (and Gentlemen), let's get started! 😉

Welcome

Hi, my name is Timea Agnes Velu. I was born in 1990 in Budapest, in high school I joined the faculty of biology-chemistry, I have a degree in taking care of babies and children and I studied indology in the university. I got married in 2016 and moved from Hungary to India the same year. We had already been trying for a baby for 6 months when I came across this method, one of my friends told me about it. I immediately fell in love with it, with all the knowledge that it gave me. Within a week I bought my basal body thermometer and a book that I learnt charting from, and dived into the world of Fertility Awareness. After only 3 months of using the method I got pregnant. Unfortunately it was an ectopic pregnancy, I ended up in hospital for surgery. Thanks to charting they could diagnose it quite early, my life was not threatened by it yet, but my left Fallopian tube had to be removed. Few months later my second angel was conceived but that was a biochemical pregnancy, it ended before we could be happy about it. I was devastated, but at least I had proof that this method works if you want a baby. That was when I decided to become a Fertility Awareness educator, I immediately signed up for a teacher course and I passed my final exam on 15th February in 2019. Being a Fertility Awareness teacher I want to assist women to get to know and understand their own cycles and fertility signs which will help them either to achieve or avoid pregnancy or simply to keep an eye on their general and reproductive health. I believe that the best way to succeed is this natural method, based purely on biology, that takes only few minutes a day but provides them with a huge amount of knowledge of their body. By using this method they can avoid taking unnecessary hormone treatments and medication, go under invasive check-ups in order to figure out the reason behind their infertility or get pregnant against their will. Learning about Fertility Awareness can help them confidently make their own decisions about their body and be in control. So, ladies, let’s get charting! 😉