By: Danielle Dukes
Executive Director’s Note: As we continue our series on infertility, this patient interview sheds light on the struggles, hopes, and valuable lessons learned as couples try to conceive. The interview was conducted by Danielle Dukes as part of the FACTS elective. Now almost a year later, the patient, Mrs. T, has still not conceived, but the lessons she shares are a powerful testament to fertility awareness-based methods (FABMs) that goes beyond what a phone app can predict. For Mrs. T, utilizing a FABM alerted her to the fact that she was ovulating 3 to 5 days later than predicted by the app. With over 100 fertility apps on the market, women seem to have a lot of choices, but most apps are not very accurate at predicting the fertile window. As always, FACTS recommends learning from a trained instructor; check out our Directory to find a physician or educator near you! To increase access to FABM services, consider applying to be listed in our directory if you are a FABM-trained medical professional or educator.
At the time of the interview, Mrs. T, a 36-year-old woman, and her husband had been actively trying to conceive for nine months. Their first two children were born at full term in 2014 and 2015 with no complications and she breastfed them both. She had not been on birth control since 2007 and did not previously have any problems with conception.
Mrs. T and her husband both came from a family of five and always planned to have three kids. After they actively tried to conceive for a few months, Mrs. T became worried because she had not become pregnant. She made an appointment with her OB/GYN physician. Her annual exam and pap smear were both normal, but when she sought guidance from her physician about becoming pregnant, Mrs. T was advised to have sexual relations right after menstruation, as it was likely that her ovulation occurred earlier as she got older. If that didn’t work, she was told to come back after another year.
Infertility is defined as the inability to become pregnant after 12 months of regular intercourse without the use of birth control [1]. As 85% of couples can conceive spontaneously within a 12-month timeframe, it is common practice to wait until a couple has been trying to conceive for at least one year before beginning an infertility evaluation. Despite not having any previous infertility issues, since Mrs. T was now older than 35 years — an infertility work-up could be pursued after six months of trying and failing to get pregnant.
A few more months passed, and Mrs. T still had not conceived. She decided to buy an app to help track her cycle and predict her fertile window. As time went on, she became more frustrated, frequently asking, “What is wrong with me?” Her husband also struggled to understand why they hadn’t conceived yet. He offered to get a semen analysis, but she believed it was most likely her “fault” and decided to postpone the analysis.* She faithfully researched as much as she could online about the different phases of her cycle and how to identify her fertility window. This search led to the purchase of a Clearblue Easy hormone monitoring kit that tracked her LH, or luteinizing hormone levels, which may indicate ovulation is about to occur.
As time went on, she became more frustrated, frequently asking, “What is wrong with me?” Her husband also struggled to understand why they hadn’t conceived yet.*
Shortly after purchasing the urine hormone monitoring kit, Mrs. T recounted a vivid dream in which she was pregnant and filled with so much hope and joy. She awoke in the middle of the night from the dream — a dream that felt so real she found herself cradling her dream baby and walking around the house, unable to fall back to sleep due to sheer excitement.
One month into tracking her urinary hormones, Mrs. T observed that she ovulated 3 to 5 days later than predicted by the phone app. Fueled by hope from her vivid dream, she strongly believed she was pregnant; she was typically never late to start menstruation. However, after a few days of dryness she started menstruation. She remembered a flood of negative emotions, including feeling “like a failure all over again.”
In following her OB/GYN’s advice, they had completely missed her fertile window by trying too early. Still, she remained hopeful and planned to continue using the Clearblue Easy hormone monitoring kit until September. If not pregnant by then, Mrs. T would return to her OB/GYN for an official fertility evaluation to continue pursuing her dream of being an official “family of 5.”
Executive Director’s Note: Not only do FABMs and hormone monitoring allow women to accurately identify their fertile window, but the holistic approach reminds couples that it takes two healthy people. Mrs. T’s husband ultimately went in for a semen analysis, which identified that was also a factor contributing to the couple’s infertility. Mr. T has begun lifestyle modifications and Mrs. T continues tracking her cycles, hormones, and mucus in the hopes that they will conceive soon!
References
[1] Lindsay TJ & Vitrikas KR. “Evaluation and Treatment of Infertility”. Am Fam Physician. 2015 Mar 1; 91(5): 308-314.
ABOUT THE AUTHOR
Danielle Dukes
Danielle Dukes is a fourth-year medical student at Ohio University Heritage College of Osteopathic Medicine with special research interest in the social determinants of health, food insecurity, women and infant health, and mental health issues. Before matriculation into medical school, she obtained a M.S. in biology at Wright State University and a M.B.A. with a focus on Health Care Management at Wright State University.
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