January 13, 2022
By Joseph Rall
Like Father, Like Son: A Physician’s Experience with FABMs
Editor’s Note: This compelling interview with a couple that has used several fertility awareness-based methods (FABMs) of family planning highlights many of the advantages of using these modern methods. The unique story begins with a physician who learned about FABMs from his father, also a physician. The son then taught his wife about the method, which they used initially to avoid and, later, to achieve pregnancy. Along the way, they learned there’s a method for every season of one’s reproductive life.
A Father’s Legacy
Tim* was just a high school sophomore when he got home from football practice and found a few new faces in his living room. His parents were teaching a young couple the Sympto-Thermal Method, a fertility awareness-based method taught by the Couple-to-Couple League (CCL). His father, a family physician, has been involved with the organization for many years. Little did Tim know that he would one day follow in his father’s footsteps as a physician and utilize FABMs in his marriage as well.
Tim’s wife, Beth, was unfamiliar with FABMs until her husband introduced them to her while they were preparing for marriage. Beth quickly developed a strong appreciation for fertility awareness. Upon doing more research, she learned about some of the unwanted side effects of traditional hormonal contraceptives. According to the American College of Obstetricians and Gynecologists (ACOG), the most common side effects of hormonal birth control are headache, nausea, breast tenderness, and breakthrough bleeding, depending on the type of contraception. Additionally, combined estrogen-progesterone contraceptives come with an increased risk of venous thromboembolism or blood clots. Although avoidance of side effects is important to Beth, this is just one benefit she has gained from charting.
Benefits of Charting
Early in their marriage, Tim and Beth utilized the Sympto-Thermal Method to prevent pregnancy while he was in medical school. This method utilizes charting of cervical mucus and basal body temperature (BBT) to identify the fertile window. Not only were they successful in their family planning efforts but they experienced several other benefits as well. For instance, the daily temperature checks provided an opportunity for an emotional check-in at the beginning of each day. Both husband and wife felt this daily practice, along with other aspects of charting, improved their communication. They are not alone in this, as research shows FABMs improve communication and outcomes related to marriage.
One study found that 74% of men and 64% of women felt the Sympto-Thermal Method “helped to improve their relationship,” while less than 10% felt use of natural family planning (NFP) had harmed their relationship. Most women (53%) and men (63%) felt using NFP actually improved their sex life. Additionally, some studies have reported markedly decreased divorce rates among couples who practice fertility awareness, although some of these studies are limited by confounding variables such as religiosity.
Beth has found charting to be an invaluable tool to monitor her health. She noticed that her basal body temperature was often near the lower limit of normal. This led to some investigation into her thyroid function. She also noticed the length of her luteal phase was on the lower end of normal, a possible sign that she was experiencing low progesterone. Through a discussion with her physician and several lab tests, she discovered that treatment was not necessary. Beth did feel, however, that charting gave her more insight into what was happening with her body, enabling her to be proactively engaged in pursuing health. As an active participant, she had peace of mind knowing her body was functioning well as she and Tim shifted from a desire to prevent pregnancy to the goal of achieving pregnancy.
Adaptability for Changing Circumstances
Tim and Beth were successful in achieving pregnancy, and Beth gave birth to a boy. Although the postpartum period has been a time of transition, FABMs have helped her navigate the uncertainty. During the postpartum period, breastfeeding often suppresses a woman’s normal cycling. As a result, some external biomarkers of the fertile window become uncoupled from ovulation, making it difficult to rely on certain methods to avoid or delay pregnancy. To combat this challenge, the couple switched from the Sympto-Thermal Method to the Marquette Model, which utilizes monitoring of urinary hormones and cervical mucus to identify the fertile window. Beth states she is once again confident in her knowledge of what is going on with her body, and enjoys empowering other women to use FABMs to do the same.
The opportunity to interview Beth and Tim highlighted several insights:
- These evidence-based FABMs are trusted by people from all walks of life, including many physicians.
- Charting enables a woman to be proactive regarding not just her fertility but also her overall pursuit of health.
- Compelling evidence supports the positive impact of fertility awareness on relationships.
* Names have been changed for privacy. Quotes were used with permission.
 Combined Hormonal Birth Control: Pill, Patch, and Ring | ACOG.” Home | ACOG, https://www.acog.org/womens-health/faqs/combined-hormonal-birth-control-pill-patch-ring. Accessed 25 Oct. 2021.
 van Vlijmen EF, Veeger NJ, Middeldorp S, Hamulyák K, Prins MH, Büller HR, Meijer K. Thrombotic risk during oral contraceptive use and pregnancy in women with factor V Leiden or prothrombin mutation: a rational approach to contraception. Blood. 2011 Aug 25;118(8):2055-61; quiz 2375. doi: 10.1182/blood-2011-03-345678. Epub 2011 Jun 9. PMID: 21659542.
 Keenan L, Kerr T, Duane M, Van Gundy K. Systematic Review of Hormonal Contraception and Risk of Venous Thrombosis. Linacre Q. 2018;85(4):470-477. doi:10.1177/0024363918816683.
 Unseld M, Rötzer E, Weigl R, Masel EK, Manhart MD. Use of Natural Family Planning (NFP) and Its Effect on Couple Relationships and Sexual Satisfaction: A Multi-Country Survey of NFP Users from US and Europe. Frontiers in Public Health. Published online March 13, 2017. doi:10.3389/fpubh.2017.00042.
 Rhomberg W, Rhomberg M, Weissenbach H. Natural Family Planning as a Family Binding Tool: A Survey Report. Catholic Social Science Review. Published online 2013:63-70. doi:10.5840/cssr2013186.
ABOUT THE AUTHOR
Joseph Rall is a fourth-year medical student at Ohio University Heritage College of Osteopathic Medicine. During medical school, he participated in the FACTS Ambassador program and enrolled in the FACTS elective. He looks forward to pursuing FEMM training in the future and is applying to family medicine residency programs.