Fertility FAQs

This page contains Frequently Asked Questions (FAQs) related to fertility, fertility awareness, birth control, and conception. If you have a question which isn't listed here, feel free to ask by sending an e-mail to faq@tcoyf.com.

Fertility and Cycles

The Three Primary Fertility Signs

Ovulation

Fertility Awareness Method

The Pill and Fertility Awareness

Birth Control

Pregnancy Achievement

Ovulation Predictor Kits and Pregnancy Tests

Fertility and Cycles

1. What percent of a woman's cycle is fertile?

The answer to this question is somewhat tricky. The general answer is that most women are fertile for only a few days per cycle. However, there are several factors to consider:

1. The woman's egg can only live up to 24 hours. Two or more eggs may be released over a maximum of 24 hours. So, in a vacuum, a woman is only fertile for about a day or two. But the man's sperm can live up to 5 days, so the combined fertility of the two individuals is about a week.
2. For a couple trying to get pregnant, the woman's fertile phase is as long as she has fertile quality cervical fluid, up through ovulation. That might be several days, or as few as one.
3. For a couple trying to prevent pregnancy, FAM adds a buffer zone of a few days to assure that an unplanned pregnancy does not occur. This usually results in about 7-10 days being considered fertile per cycle.

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2. Can a woman get pregnant during her period?

The answer lies in the wording of the question. More precisely, it is essentially impossible for a woman to get pregnant during her period, but on rare occasions it is possible for a woman to get pregnant from intercourse during her period. Since sperm can live for five days, a couple could have sex near the end of the woman's period, and the sperm could then live long enough to fertilize an egg several days later, if the woman had a very early ovulation. (Conception is more likely in these cases if intercourse occurs at the end of a 6- or 7-day menstruation.) It's also possible that women who think they got pregnant from intercourse during their period were actually having sex during ovulatory spotting.

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3. Can you be pregnant and still have your period?

It's fairly unusual to be pregnant and still have a normal period. This is because the very thing that causes women to menstruate is the drop in progesterone that occurs only if fertilization does not happen. If a woman were pregnant, her progesterone levels would remain high, thus preventing her from having a period. Of course, there are times when pregnant women do indeed bleed, but by definition, these bleeding episodes are not true menstrual periods:

1. Implantation spotting: This is usually brownish spotting that occurs in some women about a week or two following fertilization. It is due to the egg implanting in the uterine lining, causing a small amount of the lining to be shed.
2. Bleeding due to hormonal shifts occurring with pregnancy: In this case, it may be perfectly normal, or it may signal a potential problem requiring a physician’s observation.

Then there are the cases where the opposite occurs, in which a woman actually thinks she is pregnant when she really is not. The most common cause of this is when women have a delayed ovulation, which causes them to menstruate later than usual, often leading them to think that they are pregnant because their period is late.

Regardless the easiest way to determine why you are or are not bleeding is to chart your waking temperature. Once you do so, you will probably find that it provides so much valuable information that you’ll wonder how you got by while being so unaware.

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4. How long can a human egg survive?

Most ova probably survive about six to twelve hours after ovulation. However, for the purposes of contraception, you must count on a 24-hour survival period, plus an additional 24 hours in case there is a multiple ovulation.

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5. How does the Pill work?

In essence, the Pill works by tricking the body into thinking it’s already pregnant. It does this by manipulating the normal hormonal feedback system. The end result is that the body doesn’t release the hormones necessary to stimulate the ovary to release an egg.

As a back-up, every other facet of the woman’s reproductive system is also altered. The uterine lining is prevented from producing a suitable environment for egg implantation, and the cervical fluid doesn’t develop the fertile quality necessary for sperm survival.

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The Three Primary Fertility Signs

6. Do I have to wake up every day at the same time in order to take my temperature?

No, although you should try to be as consistent as possible. In general, waking temperatures tend to creep up about two-tenths of a degree for every extra hour you sleep in. Thus, if you take it substantially later than usual, it may result in a reading that is outside the range of your usual pattern. If you wake up earlier than usual, you should take your temperature upon awakening, so long as you have had at least 3 hours of consecutive sleep.

Regardless, an occasional aberrant temperature can easily be dealt with by following the Rule of Thumb. You should also be aware that if taking your temperature feels like a burden, you can in fact take it for only about a third of the cycle without sacrificing contraceptive efficacy, as described in Chapter 10 of Taking Charge of Your Fertility.

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7. How can temperatures be relied upon if I sometimes get a fever?

There may be several factors, from fever to alcohol to lack of sleep, that could affect your waking temperature. Yet this doesn’t compromise your ability to rely on them while charting, because you ultimately want to identify a pattern of low and high temperatures, rather than focusing on individual ones. Outlying temperatures can be effectively dealt with by using the Rule of Thumb, which usually allows you to ignore them in interpreting your chart. In addition, you will always be able to rely on your other two signs to cross-check your fertility in situations such as these.

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8. What does it mean if I don't see a thermal shift but I have very regular, 28-day cycles?

It can mean one of several things: First, you may be ovulating, but you may be one of the few women whose temperatures do not reflect the heat-inducing progesterone produced following ovulation. Second, you may indeed be having a thermal shift, but are not drawing the coverline correctly in order to accurately interpret your charts Third, and finally, you may not be ovulating altogether, although this is not that likely, since women with extremely regular cycles usually do ovulate.

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9. Is it worth checking my cervical position?

Although it is not necessary to check your cervix in order to practice FAM effectively, I urge you to learn how to do so. At a minimum, I think you should practice checking in the days leading up to and just past ovulation, for the first few cycles that you're learning the method. Once you recognize how your cervical position reflects your fertility, you will always be able to use it as a cross check whenever you find the slightest ambiguity in your other two fertility signs.

The bottom line is that complete familiarity with the changes in your cervix will greatly increase the confidence with which you observe your fertility and overall gynecological health. And since it only takes seconds a day to check, my attitude is that for those few relevant days per cycle, you should just do it!

A distinct but closely related question is whether those women using FAM for contracption should ever check their cervical fluid at the cervical tip. The short answer is that it isn't necessary to do so, although if you want to be even more conservative than the FAM rules require, or if you simply want to know your cervical fluid status ahead of time, it certainly couldn't hurt (Remember that the cervical fluid you normally check at the vaginal opening might have taken several hours to trickle down from the cervical tip). Finally, checking this way may provide some couples with more time for unprotected sex.

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Ovulation

10. Do women always ovulate on Day 14 of their cycle?

No! The day of ovulation can vary among women as well as within each individual woman. However, once a woman ovulates, the time between ovulation and her menstruation is very consistent, almost always between 12 and 16 days. Within most individual women, this length of time generally doesn’t change by more than a day or two. In other words, if there is going to be variation in the cycle, it is the first preovulatory phase that may vary. The second (postovulatory) phase generally remains constant.

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11. Can you "feel" ovulation happen?

The most obvious outward sign of impending ovulation is increasing wet and slippery cervical fluid. In fact, it can be so abundant that women notice a string of cervical fluid literally hang down when they are using the toilet (Bon appetite, by the way). If a woman notices this, she should assume that ovulation is about to happen within a day or two. This is what is referred to as a primary fertility sign.

Some women are lucky enough to notice other signs on a regular basis, all of which are very helpful in being able to further understand their cycles. These signs are referred to as secondary fertility signs, because they do not necessarily occur in all women, or in every cycle in individual women. Yet they are still very practical for giving women additional information to identify their fertile and infertile phases.

Secondary signs as ovulation approaches may include:

• Mid-cycle spotting
• Pain or achiness near the ovaries and uterus (called "mittelschmerz")
• Increased sexual feelings
• Fuller vaginal lips
• Abdominal bloating
• Water retention
• Increased energy level
• Heightened sense of vision, smell and taste
• Increased sensitivity in breasts and skin
• Breast tenderness

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12. Do women feel more sexual around ovulation?

Many women do. Because estrogen peaks around ovulation, women typically experience a wet, slippery sensation due to the fertile cervical fluid they produce. This cervical fluid feels similar to sexual lubrication, and can therefore be experienced as a sexual feeling. A woman who practices FAM needn’t worry about confusing the two, because cervical fluid is checked periodically throughout the day, and not when she is sexually aroused.

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13. Does ovulation occur when my cervical fluid is most abundant, or afterwards?

This is actually a very interesting question, because the answer is not intuitive. Every single woman has one day in her cycle that is more fertile than any other day, but that day is not usually the day she ovulates! How can that be? Generally speaking, your most fertile day is considered the last day that you produce fertile quality cervical fluid or have a wet vaginal sensation for any given cycle. It is called the "Peak Day," because it denotes your peak day of fertility. But this day usually occurs a day or two before you ovulate, or occasionally on the day of ovulation itself (Unfortunately, the only way to know precisely when you ovulate would be to have an ultrasound every month—not a very practical solution).

One of the obvious drawbacks of charting the Peak Day is that you will only be able to determine it in retrospect, on the following day. This is because you can only recognize it after your cervical fluid and vaginal sensation have already begun to dry up. This concept should become intuitive fairly quickly, though. Also be aware that the Peak Day is not necessarily the day of the greatest quantity of cervical fluid. In fact, the longest stretch or greatest amount could occur a day or two before your Peak Day.

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14. How soon after childbirth will I start ovulating? Can I expect the same cycle as before?

Women who don't breastfeed find that their cycles resume very quickly — as early as 4-10 weeks after childbirth. But, if you meet the following 3 criteria, then your chances of ovulating are only about 2%:

• Your menses have not returned.
• You are fully or nearly fully breastfeeding.
• Your baby is less than six months old.

If you wanted to have a safe and natural method of contraception during these first 6 months, you could use the Lactational Amenorrhea Method (LAM), as described in TCOYF.

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Fertility Awareness Method

15. Is FAM a good method for everybody?

No, not as a method of birth control. It is only appropriate for those women who have the discipline to learn the method well, and then to follow the rules once they have internalized them. In addition, it is only recommended for monogamous couples, given the danger of AIDS and other STDs.

However, as a method of pregnancy achievement, it is highly advised as the first step that every couple should take to maximize their chances of conception, and to determine if there may be anything impeding their ability to get pregnant. In addition, Fertility Awareness can be very effective in helping couples plan the timing of their baby’s birth.

FAM is also highly beneficial for all cycling women who simply want to educate themselves about their own bodies. So even if you have no interest in using the method for avoiding or achieving pregnancy, it is an empowering means of taking control of your gynecological health.

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16. Is FAM better for someone avoiding pregnancy or for someone trying to get pregnant?

I personally think a more appropriate question should be: what women would not benefit from charting her cycle? The Fertility Awareness Method (FAM) is an incredibly liberating and effective method of understanding your fertility on a day-to-day basis, whether or not you need contraception or an aid to pregnancy achievement. It also happens to be a wonderful tool for maintaining your gynecological health.

As an empowering method of natural birth control, women from all over the world have been drawn to FAM simply because it is free of the chemicals associated with hormonal methods such as the Pill. Just as importantly, it allows them to minimize the time that they need to use the chemicals and hardware that makes other methods unpleasant, impractical, or unspontaneous.

And as an aid to pregnancy achievement, the Fertility Awareness Method should always be the first step in the pursuit of pregnancy. When trying to get pregnant, dispense with all the misinformation well-meaning friends and clinicians seem to perpetuate. Charting your cycle will allow you to finally take control and understand not only when you are most fertile in any given cycle, but what impediments you may have to achieving pregnancy.

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The Pill and Fertility Awareness

17. Is it safe to start trying to get pregnant right after stopping The Pill?

It used to be that women were encouraged to wait several cycles before trying to conceive following the use of the Pill. But nowadays, many physicians suggest trying shortly after discontinuing it, since some speculate there is a higher chance of conceiving within the first few months after stopping.

When a woman comes off the Pill or other hormones, her cycles will usually revert back to the way they were before. However, the length of time it takes varies among women. For some, it is almost immediate. But for most, there is at least a short delay. And for others, it could take many months. This variation is a function of the type and dosage of hormones used, as well as the basic physiology of the woman.

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Birth Control

18. How many days do you have to abstain when using the Fertility Awareness Method for birth control?

You never have to abstain when using the Fertility Awareness Method. This is different than Natural Family Planning, which does require abstinence during the fertile phase. However, if you do have intercourse when you are potentially fertile, you must use a barrier method of contraception. The fertile phase will vary, but in practice this means that the average couple would have to use barriers about 8-10 days per cycle. The average cycle is 27-31 days, and thus for the typical couple, barriers (or abstinence) would be required for about 30% of the cycle.

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Pregnancy Achievement

19. What are your chances of conceiving in any given cycle?

It is believed that the average fertile couple has about a 25% chance of conceiving for any given cycle, depending on their age, frequency of intercourse, and numerous other factors. Of course, if couples are taught precisely when to time intercourse based on when the woman is most fertile, those odds can be greatly increased.

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20. Are there sexual positions that can increase chances for conception?

In other words, should you stand on your head and face East for half an hour after intercourse? The answer is no. But there are a number of things that you can do to increase your chances of conception. For the average woman, you would certainly want to avoid straddling over your partner, since this could cause his sperm to leak out of you (as it’s prone to do anyway at the most inopportune times, like when you are standing in line at the grocery store wearing a cute little skirt and no stockings). But I digress.

Any position in which his sperm is not likely to leak out would be best. If possible, it couldn’t hurt to put a pillow under your hips following intercourse so that your cervix basically rests in the pool of semen for a few minutes in order to allow the sperm time to swim up through the cervix. But don’t use a large pillow, or you may sabotage your efforts, since the sperm may then puddle behind your cervix. Not a good place to be when trying to reach that egg.

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21. Will lying still after making love improve your chance of conception?

Although no definitive studies appear to have been done, there is considerable speculation that the best position for intercourse is the traditional missionary position. This allows for deepest penetration, and will thus deposit the sperm closest to the cervix, where the sperm need to pass through.

Some clinicians also believe that if the man’s sperm count is marginal, or the woman’s cervical fluid is not that fertile (ie. if her cervical fluid is not very slippery or wet), it may be advantageous to remain horizontal for up to half an hour after intercourse. The theory is that this will help assure the sperm time to travel up through the cervix to the fallopian tubes, where conception occurs.

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22. What does implantation bleeding look like?

Not all women experience implantation bleeding, but if they do, it is usually light spotting that is typically brownish, and appears about 7-10 days after conception. It is caused by the egg burrowing into the uterine lining.

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23. What is secondary infertility?

Secondary infertility simply means problems getting pregnant or sustaining pregnancy in a woman who has had a child previously. In some ways, women describe it as painful as primary infertility, because:

1. The causes of infertility are even more mysterious, since they have had a child before.
2. They don’t usually have the support and empathy of others dealing with primary infertility, or even friends and family, because they are presumed to not have a fertility problem.
3. They don’t know how to explain to their child that she or he may not have a sibling.

One of the most important factors to remember for those who can’t understand why they are unable to achieve a pregnancy as easily as their first child is that, by definition, they are older now, and fertility diminishes with age. Furthermore, they may have always been of lower fertility, but had a lucky break the first time they had a child. Either way, secondary infertility can be extremely painful, but for most, is finally resolved with the birth of another child.

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24. Can douching affect your ability to conceive?

Yes. By all means, do not douche when trying to get pregnant! For that matter, women really should never douche, since it alters the normal acidity of the vagina and is not usually necessary. It can also adversely change the normal Ph balance and can ironically lead to vaginal infections and Pelvic Inflammatory Disease (PID.)

In addition, douching alters the vaginal environment to such an extent that sperm usually can’t survive. It may cause inflammations or allergic reactions which can kill sperm or impair sperm survival. And finally, it may wash away the very cervical fluid that sperm need to get through the cervix to the egg. Other than those little details, douching's no problem!

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25. Can orgasm affect your ability to conceive?

Generally speaking, probably not. But interestingly enough, female orgasms usually increase the quantity and flow of the natural alkaline secretions that occur around ovulation. And the orgasmic contractions may help transport sperm into the cervix, where cervical crypts produce fertile quality cervical fluid. In the end, though, female orgasm is helpful, but by no means critical.

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26. Can excessively low weight prevent you from getting pregnant, even if you have regular 28-day cycles?

Low weight is typically only a problem if it is preventing you from ovulating. The average woman should have a minimum of about 20% body fat to maintain normal ovulatory cycles. The main purpose of the fat is to store enough estrogen to allow your body to pass over a threshold necessary to release an egg.

Experiencing regular "periods" doesn’t guarantee that you are ovulating, but it usually does imply it. Still, it’s possible to bleed without actually releasing an egg. The easiest way to determine if you are indeed ovulating is to take your waking temperature every morning to determine if you have a conspicuous pattern of low temperatures before ovulation and high temperatures after ovulation.

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Ovulation Predictor Kits and Pregnancy Tests

27. Why does my ovulation kit indicate that I am ovulating, but my BBT doesn't have a rise at the same time?

This experience is completely normal and to be expected. The ovulation kits predict impending ovulation by detecting the surge of a hormone called, LH, or luteinizing hormone. This hormone is the very catalyst that thrusts the egg out of the ovary during ovulation. The temperature shift indicates that ovulation has already occurred. Once you ovulate, the leftover follicle (the corpus luteum) that encased the egg in the ovary starts producing progesterone, a heat-inducing hormone.

It is the progesterone that causes a thermal shift, or temperature rise in your body, usually a day or two after you ovulate. So in essence, you would expect to see about a two or three day delay from the LH surge to your thermal shift. The order is: LH, ovulation, and then thermal shift. But keep in mind that it is possible to have an LH surge, and still not actually ovulate. If this happens, you temperature will not rise to a sustained higher level.

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