FACTS Men’s Health Series
A Dynamic Duo Takes on the Sympto-Thermal Method
By Conor Bradley
Editor’s Note: As we near the end of National Men’s Health Month, we are featuring the experiences of an engaged couple who discovered fertility awareness-based methods during medical school, decided together which one was best for them, and adapted to their individual roles in the process. Conor Bradley, a former participant of the FACTS elective, interviewed the couple, Jeff and Jackie*. If you, or someone you know, is interested in learning more about FABMs and how to decide which method to use, please join us for our upcoming webinar, The Facts About Fertility Explained on July 12th at 7pm ET.
Jeff and Jackie, two medical students who are engaged, recently learned to use the Symptothermal method (STM) over the course of several months. They first heard about fertility awareness-based methods (FABMs) during their first year of medical school, from a faculty member who gave an extra-curricular talk on campus. Jeff and Jackie chose to use STM because they had heard it was best for avoiding pregnancy— a priority as they progressed through their residencies and professional careers. They had considered using the Creighton Method, but were looking for a method with cervical mucus and an additional biomarker.
Now that they have learned the STM through Couple to Couple League, they appreciate the insight that tracking both cervical mucus and temperature gives into their health. Jackie said she has learned a lot about her body: she can see how estrogen changes her cervical mucus and the rise in her basal body temperature (BBT) gives evidence that her progesterone is rising. She appreciates the beauty of being able to have insight into both phases of her cycle through the use of the STM. Jeff and Jackie are now able to see consistent cycles suggesting ovulation, which is promising to them as they hope to have children in the future. Still, the couple is aware that doctors often start having families later than other couples and are at a higher risk for having fertility issues. According to a 2016 survey published by Stentz et al. in the Journal of Women’s Health, as many as one in four female physicians have issues with fertility— double the national average [1]. They are glad they are collecting data about Jackie’s cycle now, so that if any issues arise when trying to have a family, there will be plenty of diagnostic information available.
“She appreciates the beauty of being able to have insight into both phases of her cycle through the use of the sympto-thermal method.”
Jeff and Jackie’s biggest challenge using STM has been recording Jackie’s BBT, or first morning temperature. Her schedule is difficult as a medical student, and she knows it will continue to get harder as a resident. The two decided to invest in a device called TempDropTM, a device worn around the upper arm that measures a woman’s temperature multiple times throughout the night. It cost about $120 and allowed them to download the associated mobile application, which provided them a convenient place to chart their observations on the go. However, since the effectiveness of STM is based on the BBT measurements, more studies are needed to specifically evaluate the effectiveness of STM in achieving or avoiding pregnancy with wearable devices, such as the TempDropTM .
The closure of the fertile window in STM is generated from studies using a standardized methodology of recording a woman’s temperature with an oral probe upon awakening, which is congruent with the definition of BBT in other studies: “The lowest natural, non-pathologic body temperature recorded after a period of rest.” [2] The TempDropTM device, however, records temperature at the upper arm and generates a woman’s baseline temperature by recording and subsequently averaging hundreds of data points over a three to four hour period during rest. Despite this, Shilaih et al. demonstrated in 2018 that these devices have promise. They studied 437 cycles from 136 women using TempDropTM and urinary luteinizing hormone (LH) test strips— considered an indicator of ovulation. When the researchers applied STM rules that define evidence for ovulation (three days of temperature rise 0.5 to 1.0 degrees Fahrenheit higher than the previous six days), they found 357 of 437 cycles (82%) showed a three-over-six temperature rise. Additionally, 86% of these temperature shifts (307 of 357) occurred on ovulation day or later (as per the LH strips). Interestingly, researchers identified one advantage of wearable temperature devices: temperature readings were shown to be resistant to lifestyle factors, such as alcohol, eating before bed, and having sex, factors that have been shown to affect BBT readings in other studies [3].
Jackie found that learning STM was great but challenging at times. Even as medical students, Jeff and Jackie found themselves having to relearn the rules and check with each other about charting correctly. They expressed gratitude for each other’s support. Jeff recognizes his main role is to help Jackie chart, since Jackie is the one who has to collect her biomarkers. Being able to work together with their fertility has brought them closer as a couple and made them appreciate each other’s reproductive health. This bond that Jeff and Jackie demonstrate could contribute to the overall health of their relationship in the long term. Fehring and Manhart’s 2021 study of 2,550 women demonstrated that ever-use of NFP yielded 58% lower odds for divorce or separation when compared with women with ever-use of other forms of birth control. They note, however, that factors like frequent church attendance were also associated with lower divorce or separation rate, which may confound the risk found in the study. [4]
“Being able to work together with their fertility has brought them closer as a couple and made them appreciate each other’s reproductive health.”
*All names have been changed to respect the privacy of the interviewees, and all information is shared with permission.
References
[1] Stentz NC, Griffith KA, Perkins E, Jones RD, Jagsi R. Fertility and childbearing among American female physicians. J Womens Health (Larchmt). 2016;25(10):1059-1065. doi: 10.1089/jwh.2015.5638.
[2] Steward K, Raja A. Physiology, Ovulation and Basal Body Temperature. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 22, 2021.
[3] Shilaih M, Goodale BM, Falco L, Kübler F, De Clerck V, Leeners B. Modern fertility awareness methods: wrist wearables capture the changes in temperature associated with the menstrual cycle. Biosci Rep. 2018;38(6):BSR20171279. doi:10.1042/BSR20171279
[4] Fehring RJ, Manhart MD. Natural Family Planning and Marital Chastity: The Effects of Periodic Abstinence on Marital Relationships. Linacre Q. 2021 Feb;88(1):42-55. doi: 10.1177/0024363920930875.
ABOUT THE AUTHOR
Conor Bradley
Conor Bradley graduated from Thomas Jefferson University’s Sidney Kimmel Medical College in Philadelphia in 2022 and from the University of Notre Dame in 2017. He is a Family Medicine Resident at Jefferson Abington Hospital, just outside of Philadelphia. His interests include care of the underserved, preventative medicine, FABMs, and sports medicine. He looks forward to contributing to FABM research and patient care in the future.
