By Morgan Wohlgemuth
Editor’s Note: In this patient interview, Morgan Wohlgemuth, a FACTS Elective student, explores the clinical and psychosocial dimensions of fertility awareness-based methods (FABMs) through the experiences of a couple who used these methods across multiple reproductive life events, including family planning, pregnancy loss, infertility, and pregnancy. This article highlights how an understanding of reproductive physiology can support patient empowerment, relationship communication, and informed decision-making. Medical and health professional students interested in learning more about FABMs can explore the FACTS Elective, while clinicians can access the FACTS CME course and Certification Program.
Why Natalie Chose FABMs
For this interview I spoke with good friends of mine, Natalie* and her husband Isaiah.* They are expecting a child, and Natalie is nearing the end of her pregnancy. Their journey with fertility awareness-based methods (FABMs) spans over five years, including pregnancy prevention, trying to conceive, miscarriage, infertility, and their current pregnancy.
Before she got married, Natalie used oral contraceptives for several years. She explained that she wanted to pursue a non-hormonal option after experiencing mood-related side effects with the pill and difficulty remembering to take it daily. During her search, she discovered FABMs and began researching them further. She was particularly surprised to learn that many FABMs have efficacy rates comparable to oral contraceptives when used correctly.
“She wanted to pursue a non-hormonal option after experiencing mood-related side effects with the pill and … was … surprised to learn that many FABMs have efficacy rates comparable to oral contraceptives.”
Natalie chose the sympto-thermal method (STM), which involves tracking basal body temperature (BBT) and cervical mucus every day. These two physiologic markers are influenced by predictable hormonal changes across the ovulatory-menstrual cycle. Cervical mucus changes from an infertile, creamy consistency to a fertile, watery, or egg-white appearance under the influence of rising estrogen, which helps identify the fertile window. BBT rises after ovulation due to progesterone’s thermogenic effect and serves to confirm that ovulation has occurred. Natalie used a Tempdrop armband to measure her basal body temperature overnight, which she found convenient.
“Remembering to take a pill everyday was harder for me than tracking my temperature and mucus,” Natalie said. “It just became so routine that it was just something I did without thinking.”
When couples use STM for pregnancy prevention, they use cervical mucus observations to help identify fertile days and avoid intercourse during that time. If couples wish to remain sexually active during fertile days, condoms may be used.** Natalie expressed appreciation for being able to observe her body’s natural response to ovulation, including increased desire, an experience she did not have while using hormonal birth control. From a medical perspective, this highlights how FABMs promote awareness of normal reproductive physiology rather than suppressing it.
“Natalie expressed appreciation for being able to observe her body’s natural response to ovulation including increased desire, an experience she did not have while using hormonal birth control.”
Natalie described feeling empowered and more in tune with her body while using FABMs. Both she and Isaiah emphasized the positive impact these methods have had on their relationship, particularly through shared responsibility and communication. As Christians, they also reported a deep sense of religious and spiritual satisfaction with this approach. Isaiah acknowledged that FABMs may not be the right choice for everyone. He believes more people should be encouraged to learn about them.
“I would recommend most couples try it, especially if they are married,” Isaiah said. “It has made me feel a lot closer with Natalie.”
His perspective shows the importance of individualized, values-based counseling in clinical practice.
The Role FABMs Played in Natalie’s Family Planning
After their miscarriage, Natalie shared that understanding how her body functioned was reassuring even when pregnancy tests remained negative. Although she struggled to conceive again, she observed fertile cervical mucus and a subsequent rise in her BBT.
“I knew I was ovulating and my mucus was fertile, so I knew everything was working right,” she said.
From a medical standpoint, this demonstrates how fertility charting can serve as a tool not only for family planning but also for assessing ovulatory function and providing reassurance.
Approximately one year after their miscarriage, Natalie knew she was pregnant before missing her period or taking a pregnancy test.
“My temperature just remained high for a couple of days longer than normal, and I knew I was pregnant,” she said.
This observation is consistent with fertility-awareness principles, as sustained progesterone production in early pregnancy prevents the post-ovulatory drop in BBT. This prolonged temperature elevation can serve as an early indicator of pregnancy for women using FABMs and reflects underlying endocrine physiology.
“My temperature just remained high for a couple of days longer than normal, and I knew I was pregnant,” she said … as sustained progesterone production in early pregnancy prevents the post-ovulatory drop in BBT.”
After speaking with this couple, I gained insight into the psychosocial effects of early pregnancy loss and its impact on a relationship. I also learned how a strong understanding of reproductive physiology can provide emotional reassurance and a sense of control during uncertainty. FABMs helped support this couple through their loss by reinforcing Natalie’s confidence in her body’s normal functioning.
The Value of an FABM Education
Through this conversation and the FACTS elective, I learned that the utility of FABMs extends beyond contraception to influence emotional well-being, relationships, and self-understanding. Natalie and Isaiah’s experience illustrates how knowledge of reproductive physiology can foster empowerment, reassurance, and resilience, particularly following pregnancy loss. In this way, FABMs support not only informed family planning but also psychological healing by helping Natalie interpret her body’s signals during a vulnerable time.
This experience also raised an important clinical question for me: How can physicians better integrate fertility-awareness education into routine reproductive health counseling to ensure patients are aware of evidence-based, non-hormonal options? Overall, this interview highlights the importance of patient-centered, values-based reproductive education and demonstrates the potential role of fertility awareness in comprehensive women’s health care.
* Names have been changed to respect the privacy of the interviewees. All information is shared with permission.
**Editor’s note: Some couples who track their cycles with fertility awareness-based methods may choose to use condoms to have intercourse during the fertile window. With this approach, referred to as a fertility awareness combined approach, pregnancy prevention depends on the effectiveness of the condom, rather than the effectiveness of the fertility awareness method. Readers should understand that combining these approaches may result in different pregnancy rates than avoiding intercourse during the fertile window.
ABOUT THE AUTHOR
Morgan Wohlgemuth is a fourth-year medical student at Noorda College of Osteopathic Medicine in Provo, Utah, who plans to practice family medicine with a focus on women’s health and obstetrics. She is passionate about empowering patients to understand and take an active role in their reproductive health. Through the FACTS elective, Morgan explored fertility awareness-based methods to better support patients interested in non-hormonal contraceptives, promote awareness of menstrual cycles, and provide informed, patient-centered care to her community.
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