By: Saewon Chun, MD
Meet Rachel
While on the FACTS elective in fertility awareness, I interviewed Rachel,* who shared her journey to becoming a user of fertility awareness-based methods (FABMs). She has always been independent and someone who takes the initiative, seeking autonomy and ways to continually improve her life. During the COVID-19 pandemic, Rachel was looking for lifestyle changes that could improve her overall health, and she adopted intermittent fasting and a low-carbohydrate diet. She wished to join an online community of like-minded people to learn more about healthy lifestyles and gauge if she was headed in the right direction. While searching, she came across the book by Toni Weschler titled, “Taking Charge of Your Fertility” and decided to read it, feeling drawn to the idea of taking more ownership of herself.
“Rachel was looking for lifestyle changes that could improve her overall health, and … she came across the book by Toni Weschler titled, ‘Taking Charge of Your Fertility.’”
As a teenage girl, she was taught by her mother to keep track of her menses. Since her cycle has always been regular, she had few questions about the female cycle and never encountered situations that led to a major concern. The book introduced her to a modified version of the Sympto-Thermal Method, which was eye-opening in helping her learn more about the signs of her body, including cervical mucus and temperature changes. When she got engaged, Rachel began planning ahead for a new stage in life, hoping to incorporate this method to conceive soon after marriage.
Finding the Right Fit
Despite her motivation, she noticed limitations in the method outlined in the book. Rachel was troubled by the complicated ways of identifying temperature shifts and felt apprehensive by the lack of scientific evidence supporting the author’s method. Thus, she started searching for FABMs that offer standardization and trained instructors. She considered formal training in the Sympto-Thermal Method, but given that it is considered conservative for the postpartum period, Rachel considered the Marquette Model or the Billings Ovulation Method in hopes of continuing with a single method throughout her fertile years.
Rachel eventually decided to pursue the Billings Ovulation Method for two reasons. First, the Billings Method has been around for decades. With its relatively longer history, there are more published studies and more users, suggesting the method’s efficacy. Second, the simplicity of the Billings Method seemed to limit potential errors in accurately tracking her fertility cycle. One of the drawbacks of Weschler’s book was that cervical mucus needed to be categorized into specific types, but the Billings Method did not involve such rigid categorizations. Instead, the method allowed users to freely record their bodily signs by choosing their own descriptions rather than using predefined labels.
“Rachel eventually decided to pursue the Billings Ovulation Method for two reasons… There are more published studies and more users, suggesting the method’s efficacy… (and) the simplicity of the Billings Method seemed to limit potential errors in accurately tracking her fertility cycle.”
The Billings Ovulation Method Met their Needs
While taking the FABM elective course, the Billings Ovulation Method came across to me as a legacy method that provided the foundation for methods developed later. My understanding was that other methods, such as the Creighton Model, the Sympto-Thermal Method, and the Marquette Model, provided additional measures that would allow for double confirmation and therefore higher accuracy rates to predict the fertile window. However, Rachel mentioned that having additional measures may not always correlate with higher accuracy. An additional predictor variable with lower accuracy may in fact hinder the accuracy of the overall outcome data. She felt more comfortable using only cervical mucus as the proven measurement to understand her cycle.
She was able to easily find an online instructor certified to provide training in the Billings Method. Rachel and her fiancé—now her husband—attended a total of three sessions. These sessions naturally opened up conversations about family planning, fostering joint effort and responsibility. Rachel noted that what they learned about ovulation was significant and had a positive impact on their marriage. She shared an episode when she faced extreme stress and mood swings during the postpartum phase. It was her husband who reminded her of the hormonal imbalances during ovulation, providing reassurance and comfort, and preventing unnecessary frustrations or conflict in their relationship.
“These sessions naturally opened up conversations about family planning, fostering joint effort and responsibility. Rachel noted that what they learned about ovulation was significant and had a positive impact on their marriage.”
Today, Rachel is the mother of two beautiful children. She appreciates FABMs for how they expanded her knowledge and played a role in forming her family. She has shared her cycle charts with her book club members, as they could help someone seeking to take ownership of her fertility cycles. As we approached the end of the interview, Rachel suggested the possibility of there being a greater number of FABM users than perceived, as it is not something we openly discuss often. It was a pleasure speaking with Rachel and learning about her journey of exploring different FABM methods through independent research and informed decision making.
* A fictitious name was used to respect the privacy of the interviewee. All information is shared with permission.
ABOUT THE AUTHOR
Saewon Chun, MD
Saewon Chun, MD is a first-year resident in psychiatry at Arrowhead Regional Medical Center in San Bernardino County, CA. She completed her undergraduate education at Harvard College in Cambridge, MA and earned her medical degree at California University of Science and Medicine in Colton, CA. Dr. Chun is interested in women’s mental health and providing culturally-competent care. She enrolled in the FACTS elective to gain an understanding of natural family planning methods, which could be relevant to her future patient population experiencing psychological distress associated with infertility.
Inspired by what you read?
You can support the ongoing work of FACTS here. To connect with a member of our team, please email development@factsaboutfertility.org. Interested in becoming an individual or organizational member? You can learn more and register here. To discuss with a member of our team, please email membership@factsaboutfertility.org.
