Director’s Note: In anticipation of World Prematurity Day, we are featuring an interview with a couple whose marriage has weathered endometriosis, miscarriage, preterm birth, and even an ovarian tumor before welcoming their four children into the world. Andrea Velazquez, DO, a FACTS Ambassador and former FACTS elective participant, interviewed Cecelia* and Andrew* and discussed how charting with fertility awareness-based methods (FABMs) facilitates holistic healthcare and provides trained medical professionals with a richer picture of their patients. Working with a trained practitioner and receiving progesterone support during her pregnancy allowed Cecelia to carry subsequent pregnancies to term. Learn more about the important link between progesterone and preterm birth in our CME course.

As a teen, Cecelia recalled having painful periods. Her mother and sister also suffered from painful periods, so Cecelia presumed it was genetic. After seeing her mother’s and sister’s adverse response to birth control, Cecelia’s doctor supported her search for alternative treatment options, but nothing really helped.

Years later, Cecelia learned about fertility awareness-based methods (FABMs) through a young adult group at her church, but it would be some time before she realized their applications could extend beyond family planning to medical management. Cecelia eventually met her now-husband, Andrew,* and the couple successfully used the Sympto-Thermal Method to avoid pregnancy. After a year of marriage, they used the same method to achieve their first pregnancy. However, this pregnancy ended in an early miscarriage and irregular cycles followed, adding to the emotional stress of miscarriage. At that time, a friend recommended they consult a nurse trained as a Creighton NaProTechnology Practitioner. Following that meeting, Andrew and Cecelia switched to charting with the Creighton Method.

“Using Cecelia’s Creighton charts and medical history, a NaPro physician eventually diagnosed her with endometriosis and scheduled Cecelia for a laparoscopy.”

“She reviewed the charts and immediately commented, ‘I am very confident. This is your problem,’” Andrew said, referring to the physician.

The physician also told them they would likely be able to get pregnant quickly after the surgery. As predicted, they conceived during the second cycle after the laparoscopy. Mindful of Cecelia’s history of early miscarriage, the NaPro physician prescribed vaginal progesterone for the first trimester and co-managed the pregnancy with the obstetrician who would deliver their baby. Although this second pregnancy resulted in a preterm birth, the couple was delighted to welcome their first son.

After delivery, Cecelia resumed charting with Creighton to postpone pregnancy. Then, nine months later, the couple decided to try for another baby. However, Cecelia returned to the NaPro physician with her charts and complaints of fatigue, cramping and weight gain. As a first-time mom, she thought these symptoms were normal. Her physician disagreed, having identified some irregularities in her Creighton charts. During the physical exam, the physician was able to palpate a large mass on Cecelia’s right side, and a CT scan identified a 30 cm tumor on Cecelia’s right ovary. Soon after the imaging and shortly after her 30th birthday, Cecelia underwent surgery to remove the tumor, as well as her right ovary and fallopian tube. Cecelia told her family very little about the surgery because she had a grandmother who passed away from ovarian cancer. Fortunately, the tumor was benign, but once again a timely surgical intervention was facilitated by trends identified in her charting.

Unfamiliar with NaPro, the gynecologist/oncologist who removed the tumor warned the couple  they would have difficulty conceiving with a single ovary. Now in their early-30s but still hoping to grow their family, Andrew and Cecelia resumed charting with Creighton with the goal of conceiving. After Cecelia was cleared post-surgery, they became pregnant with their daughter just two months later. Like the first pregnancy, Cecelia received vaginal progesterone in the first trimester, as well as progesterone shots recommended by Cecelia’s physician given the preterm delivery of their son. At 38 weeks, she delivered a healthy baby girl.

“Unfamiliar with NaPro, the gynecologist/oncologist who removed the tumor warned the couple  they would have difficulty conceiving with a single ovary… (However,) they became pregnant with their daughter just two months later.”

Cecelia and Andrew then used Creighton to avoid pregnancy postpartum after their second child. But with only one ovary, they did not wait long to try again. Cecelia and Andrew affectionately call Cecelia’s remaining ovary “leftie” and say that charting also helped them conceive their third child and fourth children. Both pregnancies were also supported with progesterone, and she delivered healthy, term baby boys. Andrew noted that the spacing of their children — each about two years apart — was their intention when charting.

Cecelia has nursed each child for 9 to 12 months and did not experience a return of periods until weaning. Because of this, they are now seeking to learn more about the Marquette Method as they navigate the challenging postpartum time while discerning whether to have more children. Their family has grown leaps and bounds more than they expected was possible given the struggles at the beginning of their marriage with endometriosis, miscarriage, preterm birth, and a benign ovarian tumor.

During the interview, the couple expressed gratitude for the friends who introduced them to the various NFP methods and the doctors who utilized charting to identify underlying reproductive health issues, prescribe progesterone support to bring their babies to term, and support them in their family-planning goals. Despite their positive experiences using the methods both to achieve and avoid pregnancy, they did encounter some medical professionals who doubted the effectiveness of the methods.

“The couple expressed gratitude for the friends who introduced them to the various NFP methods and the doctors who utilized charting to identify underlying reproductive health issues.”

Now after many years and several methods, I asked Cecelia and Andrew what they would tell medical professionals about FABMs.

“I think it’s just part of holistic healthcare,” Andrew responded. “It’s more than just…conceiving or not. And there’s lots of information about the whole person that is seen in the charts. [Charting] provides a richer picture of the person you are caring for.”

Cecelia, who felt powerless in her teenage years to find symptom relief, said: “You are owning your femininity. Essentially, I feel like I know my body very well, and that is something I am really proud of. To truly know my body is awesome.”

This was a delightful interview and a wonderful way to end the month in the FACTS elective. Andrew and Cecelia’s story summarizes many of the ways FABMs can benefit a woman throughout her reproductive years: from diagnosing and treating underlying endometriosis to improving fertility, utilizing charting for avoiding or achieving pregnancy based on a couple’s goals, and even for diagnosing a potentially cancerous tumor early. In addition, this couple demonstrates how women can switch between methods based on their needs, as well as the importance of having healthcare professionals who respect their choice to use FABMs altogether.