February 26, 2020
By Rachel Engle, MD
Editor’s Note: This interview with a couple is part of our series that highlights the reality of using fertility awareness based methods (FABMs), including benefits as well as challenges of the various methods. Dr. Rachel Engle, a family medicine resident, conducted the interview as part of the FACTS two-week online elective with Dr. Marguerite Duane, executive director and co-founder of FACTS. The couple’s different choices in family planning illustrate the various approaches many couples utilize as they navigate the different phases of the reproductive years.
BOMA-USA Medical Seminar Series
Our colleagues at BOMA-USA are hosting an online medical seminar series every Sunday in March 2020, featuring Dr. Mary Martin, an Ob-Gyn physician who presented at our FACTS Conference in Dallas. If you are a medical professional, student or educator interested in learning more about the Billings Ovulation Method and its applications in practice, click here for more information.
As part of the FACTS elective, I had the opportunity to interview Mr. and Mrs. W, a pleasant couple married for twenty-eight years who used both oral contraceptives (OCPs) and natural family planning (NFP) to space out their four children. We discussed their experience within a medical context, and I believe many couples will be able to relate to their trials and triumphs in the area of fertility.
From Barrier Methods to OCPs to FABMs
Mr. and Mrs. W met at a restaurant about thirty years ago and, after a year of restaurant hopping, they were five pounds heavier and happily engaged! Although they used barrier methods to prevent pregnancy during their engagement, Mrs. W asked her doctor for a prescription of OCPs once married. She explained that back then, all her friends would go on OCPs after getting married, almost as a ‘rite of passage.’ The couple agreed had they taken an NFP course as part of their premarital classes, they would have been interested; at that time, neither had heard of the concept.
One year after OCP use, Mrs. W’s cousin suffered a stroke and became permanently paralyzed at the age of 22. Since her cousin had been on ‘the pill,’ they decided not to refill the medication. The couple was concerned about the potential risk of developing blood clots while on the pill. They also noticed Mrs. W became unusually irritable and moody during the year she was on OCPs. That strain on their marriage eased after she stopped the medication.
One year later, they had their oldest daughter. Since Mrs. W was the breadwinner for the family at that time, she had to return to work, and pumped to maintain breastmilk production. Using both barrier methods and the Lactational Amenorrhea Method (LAM), they were able to space out their first and second children by about a year and a half. After the second child, Mrs. W started a part-time job and was able to breastfeed much more consistently. It was not for another two years that she became pregnant with another child.
Facing the Unexpected Together
The couple’s views about LAM and barrier methods were generally positive and, up to this point, there was little reason to need a ‘perfect’ method. The family was growing, Mr. W’s business had taken off, and there was relative peace in the home. Yet, their perspective and goals changed after their third child was born with congenital defects. The baby needed major heart and hip surgeries during the first year of life, which meant Mrs. W had to stop working and take the child to therapy three times a week for three years. During this time, they became serious about finding a method that was highly reliable. For the couple, this entailed a combination of cervical mucus monitoring and LAM. They were guided by a family friend who had learned to chart the menstrual cycle for personal use. Along with charting, Mrs. W breastfed the baby for two and a half years.
After the third year, the couple agreed to have another child. They tracked the cervical mucus and had frequent intercourse. Yet, despite their attempts, they had three additional years of infertility. Mrs. W was almost 40 years old and felt she would not be able to have any more children, and raised her concerns to an Ob-Gyn physician familiar with FABMs. Using NaProTechnology, her physician diagnosed progesterone deficiency and prescribed vaginal progesterone supplementation. Within one cycle, she was pregnant with her fourth child!
When asked how they would counsel couples regarding fertility, both quickly agreed to two take-home points:
- Choosing each method has to be intentional and practical for their needs at the time. Breastfeeding and working a full-time job did not provide the same efficacy as breastfeeding exclusively after their third child.
- They felt it is important to find a balance between the science of technology and the art of family dynamics. Science provides answers and solutions about fertility issues, but the family’s needs dictate which method(s) to use, as well as the timing.
Insights from a Physician
As a physician, I was impressed with this couple’s diligence in pursuing different methods to meet their needs. Their story highlights some of the concerns and benefits of different fertility approaches, including side effects from birth control, the effectiveness of LAM with consistent use, and the benefits of progesterone supplementation in the right setting. I believe it’s possible their infertile period was a reflection of the stress the family experienced when their child had significant medical problems. I feel fortunate to have learned from their experience, and I hope others can learn that each couple may approach their fertility in unique ways at the various stages of life.
Editor’s Note: In 2019, Dr. Marguerite Duane was one of the authors of a meta-analysis[i] titled, “Systematic Review of Hormonal Contraception and Risk of Venous Thrombosis.” The research supports what other studies have found: compared to nonusers, users of hormonal contraception have an increased risk of venous thrombosis (blood clots), which may increase the risk of stroke. The 2006 article,[ii] “Hormones and Cardiovascular Health in Women,” discusses cardiovascular risk in the context of hormonal contraception and conditions like polycystic ovary syndrome (PCOS). It provides an extensive list of references as well as a thorough discussion that includes both conclusive and conflicting data, some of which is still being studied.
[i] Keenan, Lynn, et al. “Systematic Review of Hormonal Contraception and Risk of Venous Thrombosis – Lynn Keenan, Tyson Kerr, Marguerite Duane, Karl Van Gundy, 2018.” SAGE Journals, 3 Jan. 2019, journals.sagepub.com/doi/abs/10.1177/0024363918816683.
[ii] “Hormones and Cardiovascular Health in Women.” OUP Academic, Oxford University Press, 28 June 2006, academic.oup.com/humupd/article/12/5/483/780557
Author Bio: Rachel Engle, MD is a resident physician of family medicine at Via Christi in Wichita, KS. She has enjoyed the FACTS elective and hopes to train as an international medical fellow with special focus on women’s health.
Our NEW 2020
Beyond our core webinars, FACTS is pleased to present a series of new webinars this year — one offered each month through June 2020! These bonus presentations reflect current research and topics of growing interest in the field of fertility awareness.
Registration is now OPEN for these 1-hour webinars. To REGISTER, click on the dates below.
Evaluating Female Interest for Health Monitoring and Family Planning | Tuesday, March 24th, 8:30 pm EST
What Can Be Learned from Millions of App Records | Tuesday, April 28th, 8:30 pm EST
What’s New with Fertility Tracking Apps? | Tuesday, May 26th, 8:30 pm EST
Chart Neo & the Visual Fertility Advisor | Tuesday, June 23rd, 8:30 pm EST
Join Us for Our Core Webinars and Earn CME Credit!
Below are the webinars we offer every month.
To REGISTER, click on the dates below, then share and invite a colleague!
The Female Cycle as the 5th Vital Sign
This presentation highlights the health of the female cycle and how the fertility awareness chart can aid in the diagnosis and management of common women’s health concerns.
Wednesday, March 18th, 12:30 pm EST
Tuesday, April 7th, 8:00 pm EST
FABMs for Achieving & Avoiding Pregnancy
This presentation focuses on the use of FABMs to achieve pregnancy. It includes a case in which FABM charts assisted to diagnose and treat infertility. Evidence-based FABMs and their effectiveness rates to prevent pregnancy are also discussed.
Monday, March 9th, 7:00pm EST
Monday, April 27th, 1:00pm EST
The Signs of the Female Cycle Explained
Designed for a general audience, topics of this presentation include the science of charting a woman’s cycle, the benefits of using FABMs to monitor health, and how to choose a method that may be best for you!
Monday, March 2nd, 12:00 pm EST
The Science Behind Fertility Awareness
Our flagship presentation, Fertility & Family Planning, reviews the latest research and science supporting FABMs and their effectiveness to prevent and achieve pregnancy.
Monday, March 30th, 5:00 pm EST
Thursday, May 21st, 1:00 pm EST