By: Sarah Makarewicz
Editor’s Note: While on the FACTS online elective, Sarah Makarewicz enjoyed learning from a nurse and a medical student who chose the Marquette Model to pursue their fertility goals. Since the elective, Sarah has continued to learn about fertility awareness-based methods (FABMs) and plans to incorporate them in her future practice. Since one of our goals is to increase access to FABM-trained medical professionals and educators, FACTS provides a Physician-Clinician-Educator directory to make it easier for interested FABM users to find instruction and follow up for their preferred method.*
Introduction
Women in medicine sometimes feel as though they must choose between pursuing a successful career or taking time off to have a family. This leads many female physicians, nurses, and other health care professionals to choose contraception in the form of synthetic hormones such as an intrauterine device (IUD) or oral contraceptive pill (OCP). Countless women in healthcare are unaware of fertility awareness-based methods (FABMs), which are effective and natural ways to manage fertility without the use of exogenous hormones that suppress ovulation and also impact health. [1] This article summarizes my interviews with two friends (Clara and Felicia).** They both have careers in healthcare and chose to practice the Marquette Model to achieve their fertility goals.[2]
“Countless women in healthcare are unaware of fertility awareness-based methods (FABMs), which are effective and natural ways to manage fertility without the use of exogenous hormones that suppress ovulation and also impact health.”
Meet Clara: NICU nurse and mother
Clara is a NICU nurse who has been married for three years, and she and her husband have a 14-month-old son. During their engagement, the couple learned about the Marquette Model from his sisters, who use the method to plan their families. Since their wedding in 2021, Clara and her husband have used Marquette to successfully avoid pregnancy, achieve pregnancy, and during the postpartum journey.
The method’s impact on work
As a nurse, Clara finds the Marquette Model very straightforward to use and more reliable during stressful times than cervical mucus observations. Still, she has needed to make some adjustments to be able to use the method during frequent night shifts at the hospital. She explained that “collecting first morning urine was sometimes tricky during overnight shifts,” as she would have to ensure a four-hour hold. Thus, she would avoid using the restroom toward the end of a shift and then test upon arrival home.
Despite needing to be attentive to this hindrance, she never struggled with the morning testing window set by the ClearBlue monitor (typically 5am to 11am). She was able to test each day during her fertile window whether she worked a daytime, evening, or night shift.
Support through challenges
Clara described her postpartum phase as a “bit of a rollercoaster.” The couple was grateful for the support of their Marquette instructor, Louise, and for the resources she provided. Louise helped guide them through the uncertainty of delayed ovulation, spotting, and return of her cycles upon starting their infant on solid foods at 6 months.
Surprised by intimacy through FABMs
Overall, Clara describes her experience using the Marquette Model as challenging but rewarding. She felt the times of required abstinence when trying to avoid pregnancy and the postpartum protocols build mastery and self-discipline, guiding the couple to grow in intimacy in other ways. “Marquette allowed us to take control of our fertility together without medicating my cycle or dampening my hormones,” noted Clara. “My body can undergo its full range of emotions, and my husband can love me intentionally through all of it. This closeness we share wouldn’t be possible without Marquette.”
“She felt the times of required abstinence when trying to avoid pregnancy and the postpartum protocols build mastery and self-discipline… ‘Marquette allowed us to take control of our fertility together without medicating my cycle or dampening my hormones.’”
Meet Felicia: Medical student and wife
Felicia is a second-year medical student and a newlywed. She wanted to avoid pregnancy while in medical school, so she began learning the Billings Ovulation Method six months before the wedding. Yet, with the combined stress of medical school and wedding planning, she struggled to confidently identify her cervical mucus patterns. Given her difficulty charting her cervical mucus, Felicia worried she wouldn’t have a reliable, natural way to avoid pregnancy at the start of her marriage. Unaware of the different types of FABMs, she feared OCPs were her only option to avoid pregnancy but was concerned about their potential side effects.
An FABM for every need
A few weeks prior to her wedding, she was still struggling with the Billings Ovulation Method. I explained that while cervical mucus observations are a reliable method for some women and couples, urinary hormone testing with the Marquette Model is another way to practice natural family planning (NFP). Two weeks after Felicia’s wedding, I forwarded the name of Dr. Stephanie Kafie, a family physician who offers Marquette services through her online NFP clinic in Ontario, Canada. A few weeks later, Felicia and her new husband joined an online Marquette class with Dr Kafie and have been practicing the Marquette Model ever since.
When asked about the first few months of using the method, Felicia explained, “Marquette is so simple. During my fertile window, I wake up in the morning, pee on a stick, put it in the ClearBlue monitor, and chart low/high/peak for the day. It is accurate and objective, which I value as well.”
The best FABM is what works for you!
Felicia appreciates how Marquette offers her husband the ability to participate in practicing NFP. “He did the research on where to buy the ClearBlue monitor and the testing sticks for the best price. I appreciate how he frequently checks our chart on the bathroom door to know where we are in the fertile window.”
To Felicia, learning to use the Marquette Model felt like she had “permission” to focus on her studies for now, and that she and her husband could change their intentions from avoiding to achieving pregnancy when they discerned the time was right for them. This FABM continues to meet their needs during this important transition in their life as a couple. The interview ended with gratitude, “I am thankful for the peace of mind Marquette gives me. It has been transformational for me as a busy medical student and new wife. I’m so thankful to have learned about Marquette!”
“Felicia appreciates how Marquette offers her husband the ability to participate in practicing NFP … and ‘the peace of mind Marquette gives (her). It has been transformational for (her) as a busy medical student and new wife.’”
Insights from a future physician
As a proponent of FABMs, I strongly believe the “best” method is whichever one suits the needs and fertility goals of a particular woman or couple. This is also what FACTS teaches: an appreciation for the various FABMs and what each offers women and couples in their unique circumstances. The ease of use of the Marquette Model is an attractive feature for many couples and especially for young women balancing the demands of a career in healthcare with planning their families. Although the cost of the ClearBlue monitor, the test sticks, and formal instruction can add up, many women choose to invest financially in learning the Marquette Model due to its efficacy, simplicity, and protocols for women in any stage of the reproductive lifespan.
References
[1] Duane M, Stanford JB, Porucznik CA, Vigil P. Fertility Awareness-Based Methods for Women’s Health and Family Planning. Front Med (Lausanne). 2022 May 24;9:858977. doi: 10.3389/fmed.2022.858977. PMID: 35685421; PMCID: PMC9171018
[2] FACTS Factsheet: The Marquette Model. https://www.factsaboutfertility.org/wp-content/uploads/2018/01/MarquettePEH.pdf
* While we ask clinicians, practitioners, and educators to report information accurately in the Physician-Clinician-Educator directory, FACTS does not independently verify listings or specifically endorse any listed practitioner. Please follow the link for more information.
** Names have been changed to respect the privacy of the interviewees. All information is shared with permission.
ABOUT THE AUTHOR
Sarah Makarewicz
Sarah Makarewicz is a fourth-year medical student at the University of Alberta in Edmonton, Alberta, Canada. After attending the FACTS conference in Minneapolis in 2023, she was inspired to join as a medical student FACTS Ambassador. In 2024, she completed the FACTS 4-week medical school elective to gain foundational knowledge of the different FABMs and learn more about their medical applications.
In 2025, she enrolled in the FEMM Medical Management course and hopes to train in the Marquette Model and NeoFertility in the future. Her career aspirations include pursuing family medicine with specialized training in low-risk obstetrics, lactation, and restorative reproductive medicine.
