I plan to have unplanned pregnancies

I see the phrase "unplanned pregnancy" often in the news, and it's always portrayed as a bad thing. Unplanned pregnancy is an argument for better birth control, for access to Plan B, and for abortion rights. Responsible parents plan their pregnancies - they intentionally stop using birth control, and then go out of their way to get pregnant. They avoid long lists of foods, and follow special fertility plans. Responsible parents plan their pregnancies to the month - to optimize their work/family balance, to carefully space their kids evenly, and to plan their child's birthday.

The past few months of learning NFP

NaturalGuy and I have had an interesting few months of learning NFP. I've gotten accustomed to my 7:00 am temperature alarm, and mucus checking has almost become second nature. At night, we takes a quick look at the charts together. The whole process takes less than 5 minutes/day at this point.

How does age affect pregnancy?

For women, age heavily influences fertility. Women are born with all the eggs they will ever have. Over the years, eggs decay in a process called "artresia." This decay occurs even in the healthiest women and is not prevented by birth control or infertility treatments - it is simply the result of age.

As a result of this natural decay of eggs, as women approach their mid to late 30's, they are more likely to have children affected by chromosomal abnormalities (the most common being Down syndrome). The "American Family Physician" article on Down syndrome provides the following graph showing the risk of Down syndrome as a % versus maternal age. As the article notes, from age 20 to 30, the risk of Down syndrome stays relatively stable, although it does increase somewhat. After age 30, the risk increases exponentially each year.

Additionally, women in their mid to late 30's are more likely to have miscarriages. The "Advanced Fertility Center of Chicago" provides the following summary of miscarriage rate by age group:

Maternal age	Pregnancy loss rate
< 30	8%
30-34	12%
35-37	16%
38-39	22%
40-41	33%
42-43	45%
44-46	60%

It is important to note that these rates of miscarriage only apply to pregnancies that have been confirmed by ultrasound, so the actual rate, including pregnancies lost very early on, would be higher.

To see this information interactively, check out the Age and Fertility Calculator.

How does fertility change around ovulation?

Couples seeking to avoid or achieve pregnancy often wonder how likely pregnancy is under a variety of circumstances. Understanding how to risk of pregnancy changes is a key part of natural family planning. Even within the "fertile window" which NFP identifies, the chances of pregnancy vary.

A Comfortable Period

Many women use hormonal contraceptives to control their periods - hormonal contraceptives make bleeding predictable, lighter, shorter, and, with some hormonal contraceptives, less frequent. Some women require hormonal contraceptives to deal with horrendous periods requiring medical treatment, but many healthy women still find their periods to be unpleasant. Returning to natural menstruation requires finding new ways to handle these discomforts.

Containing the Mess

Many women use pads and tampons. It can take a bit of work to find pads and tampons that are comfortable and don't leak. Buy a few of the small packages of different brands to see what you like. Some women use less common period protection:

Health Benefits of Charting

Natural family planning is very education, even if family planning is the furthest thing from your mind! Toni Morrison, author of Taking Charge of Your Fertility, 10th Anniversary Edition: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health, advocates teaching the observational methods of NFP/FAM to young women, in order to empower women to advocate for their health. (She's written a book for middle school and high school girls, Cycle Savvy: The Smart Teen's Guide to the Mysteries of Her Body, which teaches girls to observe the menstrual cycle, but avoids discussion of family planning).

Here's some of the ways charting can help you and your doctor:

1. You will have a great idea of what healthy cervical fluid looks like, and you'll have a much easier time identifying when discharge is unusual or a symptom of an infection.
2. You will be able to identify changes in how heavy or long your period is. Without written records, it can be very difficult to see trends, or to associate those trends with other changes. It's very interesting to see how heavyness/length is effected by medication, weight loss or gain, or dramatic dietary changes.

Hormone confusion: the biology behind stopping the pill

What happens when a woman stops taking hormonal contraception? We've talked about how hormones are effected by hormonal contraception and how hormones regulate the menstrual cycle, but what happens in between?

For the first week after a woman stops taking the combination pill, progesterone and estrogen drop, similar to how they drop during the withdrawal bleeding that occurs during the sugar pill days at the end of the active pills. During the subsequent weeks, as progesterone is no longer artificially increased by the combination pill, FSH and LH restart the natural ovulation cycle.

Some women find that it takes several months to get their period after stopping hormonal contraception. The hormones supplied by the pill leave the body very quickly, but differences between how quickly they leave individual women's bodies may explain short delays. Longer delays can be explained by the body taking time to begin producing normal levels of progesterone and estrogen on its own again. (Levels of estrogen and progesterone are regulated by "negative feedback loops," which means that when they were being supplied by the pill, the body produced less of these two hormones. It takes time for the body to rev back up into production.) Because we can't predict how quickly ovulation will occur after stopping hormonal birth control, it is important to treat this transition time carefully. Even after getting the first post-pill period, it may take several more cycles before the menstrual cycle is regular. In general, women are advised to talk to their doctor if they do not get their period within three months of stopping the pill.

Of particular concern to sexually active women who are discontinuing the pill and starting to use NFP, the transition period is a time when cervical mucus, cervix characteristics, and even temperature may be less reliable. This makes it hard to predict what times are fertile. "The Art of Natural Family Planning," published by the Couple to Couple League, offers special instructions  for this situation. "Taking Charge of Your Fertility," a secular approach to the sympto-thermal method, advises abstaining from intercourse or using barrier methods for the first three cycles after stopping hormonal contraceptives.

My experience with Levora, ie. "The Pill"

During September and October I was taking Levora, ie. "the Pill." I had decided to start hormonal contraception for a mixture of reasons - (1) it seemed like a good way to delay pregnancy, (2) I was curious about whether it would make my migraines less frequent, and (3) my doctor recommended it.

Neither NaturalBoy nor I was that enthusiastic about starting Levora. On my part, I felt like I needed to be on contraceptives because I felt like it was the only responsible thing to do, and that I might "ruin" NaturalBoy's opportunities with an ill-timed pregnancy. NaturalBoy, on the other hand, was very worried about how hormonal contraceptives would effect my health and the health of our future children, but didn't feel he could ask me to stop them since I would be most impacted (physically at least) by pregnancy. This was not an auspicious start by any means.

Great "how to chart" video!

Not all couples using FAM...

Not all couples using FAM...

1. are Catholic, or even religious
2. oppose abortion
3. want 10 kids (or any kids!)
4. have easy pregnancies

NFP and being sick

I've had a terrible cold the past week, so I thought a post about how being sick effects charting would be interesting.

Many women notice that sometimes stress or illness leads to getting their period late. You can generally tell whether your period will be delayed based on when you get sick. If you haven't ovulated yet, getting sick or stressed may delay ovulation, and as a result, your period may be late. If you have ovulated, your period will be right on time (provided you aren't pregnant!). The luteal phase, the time between ovulation and your next period, is a very consistent length and isn't interrupted by minor illness.