What is an FABM?
A fertility awareness based method (FABM) is a method of family planning in which a woman observes external signs that reflect underlying hormonal changes and combines it with an effective set of instructions to help identify times of a woman’s cycle when pregnancy can and cannot occur. Using this information, couples may time sexual intercourse according to their desire to achieve or avoid a pregnancy. FACTS promotes FABMs that have a high quality of evidence according to the SORT Level 1 criteria, as outlined in our 2013 review paper. The information, or charts, gathered from FABMs can also be used to help diagnose and address reproductive health irregularities.
Who is involved in FACTS?
FACTS is a collaborative of medical professionals, educators and supporters committed to educating our healthcare colleagues and clients about fertility and ways to monitor a woman’s cycle for the purposes of family planning and health maintenance. Our success to date is due to the dedication of our members and their willingness to work together to share the best evidence supporting the use of natural or fertility awareness based methods of family planning. We invite you to become a part of our diverse team of people who are passionate about teaching others the “FACTS” about fertility appreciation by joining today.
As a physician, how do I educate women about FABMs in my practice?
The simplest answer is to start incorporating information about FABMs into your list of possible family planning methods as this discussion would normally occur. FACTS has developed a User Guide [link] to provide information to your patients about the different evidence based FABMs. If your patients are interested in learning more, FACTS also has more detailed information about each method available under Patient Care Handouts [link] and websites where they can go to find a teacher locally. Also in development is a Shared Decision Making Tool [link] to guide the conversation about the different methods available, similar to the one available by drug companies for contraception.
As a medical student, how can I learn more about the science behind FABMs?
In medical school, students learn about reproductive physiology, but not necessarily how it applies to fertility awareness based methods. For a brief overview of the science underlying these methods, click here: https://www.youtube.com/watch?v=39E8VEibreY.
You may also invite one of our trained speakers [LINK to book a speaker page] to your school to give the FACTS introductory presentation, entitled: Fertility and Family Planning. If you are interested in learning more information about each of the methods, there is now an elective available through Georgetown University. Finally, for students who want to get more involved in educating their peers, FACTS has created the Student Ambassador Program to help mentor and train future physicians who are interested in learning about FABMs. Stay tuned for more updates from FACTS as we work on rolling out our online elective soon!
Who can be trained to teach FABMs and how much does the training cost?
The prerequisites and training costs vary by method. Please check their websites for the most up-to-date prices.
The Billings Ovulation Method® (BOM) offers in-person and online teacher training at a cost of $575 for an individual or $675 for a couple which prepares them to teach women or couples how to chart their cycles. For more information, go to:
The Creighton Model programs for FertilityCare Practitioners or Instructors cost between $1,900 -$2,500. Creighton Medical Consultant training cost about $2,100. For more details about training requirements, go to:
SymptoPro costs $400 for an individual or $510 for a couple. This base price involves training done completely online with all digital materials that you can print out as needed. For more info:
The Marquette University College of Nursing Natural Family Planning (NFP) teacher training program is a professional to provide professional NFP services. For more info:
What are some resources for teaching patients in Spanish?
The Billings Ovulation Method® (BOM) has educational materials available in Spanish, as well as numerous Spanish speaking teachers in the US, which can be located via their web-site.
Family of the America’s has developed a program to teach a method very similar to the Billings Ovulation Method by comparing a woman’s fertility to the natural fertility of the earth. The program has been translated into a number of different languages including Spanish and has been used effectively to teach women and men with very low health literacy.
SymptoPro and Couple to Couple League offer their materials in Spanish for women or couples interested in learning the sympto-thermal method. There are a limited number of Spanish instructors, depending on your location.
The Marquette web-site also has materials available in Spanish.
Can FABMs be taught in the developing world? Can patients with low health literacy really learn these methods?
A large trial of the Billings Ovulation Method® (BOM) in India by the Indian Council of Medical Research Task Force on NFP (1996) followed 2059 women the majority of whom were illiterate.
In this patient population, the perfect use rate was 1.1 pregnancies per 100 women years, with a typical use unintended pregnancy rate of 10.5 pregnancies per 100 women years.
The World Health Organization conducted a multi-continent study including many uneducated women and found that 94% of the women taught NFP were able to identify their fertile symptoms correctly on the first cycle.
How does a woman check her basal body temperature?
A basal body temperature (BBT) pattern is obtained by taking a woman’s waking temperature at the same time each morning after several hours of uninterrupted sleep. A woman’s BBT is lower prior to ovulation and will rise .4 to .6 degrees Fahrenheit and stay elevated after ovulation. The higher elevated temperature signals the end of the fertile time.
The waking temperature is taken each day at about the same time (it can be taken up to 30 minutes before or after the usual time without considering the temperature disturbed).
Could avoiding intercourse during the fertile time negatively affect relationships?
Despite the challenge of avoiding intercourse during fertile times, surveys of persons using these methods often show that couples have more satisfying sex lives, improved relationships, and feel more respected by their partners and in control of their fertility.
A key factor relates to a couples’ level of emotional maturity and also whether they mutually agree on common goals to achieve or avoid pregnancy. Each FABM addresses this concern.
Many FABMs provide relationship building techniques for couples to use during the fertile time if they are abstaining. Further, every successful relationship requires some self-control and sacrifice, and many couples find that this brief time of discipline helps to strengthen their relationship.
What about using condoms or a barrier?
The overwhelming majority of FABM effectiveness studies involve couples avoiding genital contact during the fertile phase, with a few exceptions. Condoms or barriers are other forms of contraception that some couples choose to use in addition to using an FABM. However, condoms have an effectiveness rate of their own that is lower than evidence based FABMs. Couples who choose to combine methods should expect an effectiveness rate of the less effective method they use.
Is it a challenge for a couple to avoid sexual relations on days they are fertile?
It can be a challenge for a couple to postpone sexual relations when a woman is fertile, especially since her sexual desire is typically highest then and her partner is usually most attracted to her at that time.
That said, a challenge should not necessarily be perceived as negative. With some self-discipline and motivation, anyone can learn to meet challenges and become stronger for it! For instance, the challenge to eat more vegetables or add exercise to a sedentary lifestyle can be difficult but can drastically improve a person’s health and well-being. Likewise, choosing to have sex at certain times and abstaining from it at other times can be a challenge, but it is doable. Not only can this lead to greater self-control, but it may also increase mutual respect and improve intimacy in other areas of the relationship.
Most FABMs incorporate some teaching points on how to manage periodic sexual abstinence, so that it doesn’t become unnecessarily frustrating.
Many people who use FABMs report an unexpected positive outcome from periods of abstinence followed by a long period of infertility. They say that it allows couples to have a “honeymoon” every month since their desire for each other naturally has time to increase.
How do FABMs work if a woman is postpartum and breastfeeding?
Women may use the Lactational Amenorrhea Method (LAM) if they are within 6 months of delivery, have not had a return of menses and are near exclusively breastfeeding. If they meet all 3 criteria, they will have an unintended pregnancy rate of less than 2% LINK.
When a woman no longer meets the above criteria and has not had a return of regular cycles most FABMs will advise relying on the mucus pattern (including observations and sensation). The presence of cervical fluid will give an indication of the return to fertility. “Patches” of mucus may appear before the actual build up to ovulation. Any change from a dry mucus pattern should be presumed “possibly fertile.” Additionally, some women experience a constant mucus pattern during this time. A certified instructor can help the woman to determine what her “unchanging pattern” is and to treat that as if it were her own “dry” pattern. She would then be instructed to consider any change from that as possibly fertile.
Which method is best for perimenopausal or breastfeeding women?
The Billings Ovulation Method® (BOM), Creighton Model, SymptoPro and CCL Sympto-Thermal methods and the Marquette model all provide specific guidelines for women with special situations, such as women who are breastfeeding or are pre-menopausal. It is important for women and couples to work with their trained instructors to ensure they are using their respective method correctly given their reproductive situations.
Specific post-partum instructions will vary by FABM and patients should work with their instructor for guidance with monitoring their return to fertility.
What are some examples of medical and surgical NaProTechnology applications?
Medical consultants trained in NaProTechnology (or “NaPro”) can better diagnose and treat a variety of reproductive and gynecological problems because of what they learn from an individual woman’s Creighton Model charts. These include: premenstrual syndrome, polycystic ovarian disease, repetitive miscarriage, postpartum depression, and more. NaPro can also help detect many of the causes of infertility, including: luteal phase deficiencies, low progesterone levels, inadequate cervical mucus, PCOS, and endometriosis. These diseases can all be detected using the Creighton Model charts as well as targeted hormonal analysis. Once a cause is determined, targeted treatment strategies such as cycle specific hormonal supplementation or even surgery can be implemented. OB/Gyn doctors trained in NaPro Surgery utilize specific surgical techniques to treat underlying pathology that maximize a woman’s chance of conceiving naturally. (For more information, please visit www.naprotechnology.com)
Can FABMs be used if a woman has irregular cycles?
Some NFP methods or FABMs work no matter the cycling pattern of an individual woman. For example, the Billings Ovulation Method® (BOM), Creighton Model, SymptoPro, CCL Sympto-Thermal method and the Marquette model can all be used by women with long or short cycles when discontinuing hormonal contraception, as well as during breastfeeding and during perimenopause. The Standard Days method and the original Calendar Rhythm method however, require regular menstrual cycles because they are based upon a woman’s cycle history.
It should be noted that most modern NFP methods provide information in “real time.” They are based upon a woman’s day-to-day observations where she can make decisions about her fertility based upon those observations.
Trained FABM instructors can provide couples with specific guidelines to learn how to best apply the method to their individual circumstances. It may not necessarily mean extended periods of sexual abstinence, but it may require additional instruction when help is needed.
Can FABMs be used even if the menstrual cycle is affected due to stress?
Yes. Charting can help a woman to see how stress is affecting her cycle and her fertility. For example, if a woman experiences a stressful event or illness in the pre-ovulatory phase, ovulation will typically be delayed, leading to a longer cycle.
If a stressful event or illness occurs in the post-ovulatory phase, this phase may become shorter than normal, and menses will happen earlier than expected. Generally the luteal phase is a set number of days for each woman (between 12-16 days), and longer cycles reflect long follicular phases, which may be due to stress, illness or a number of other factors. Daily observations through charting can help a woman to monitor these effects.