Holistic and Free Fertility

AKA Natural Conception Methods and Natural Birth Control Methods. This is a 2 part series, and the link to the birth control part is here.

Published 18 August 2021

If you want an empowering birth, but you’re not currently pregnant, we have some tips and ideas to help you look at your conception journey in a holistic and healthy way.

Fertility Awareness for Conception 

If you have been using Fertility Awareness in the past, you can seamlessly switch from avoiding pregnancy (TTA) to trying to conceive (TTC). It takes you no extra learning, and can get you months ahead with health knowledge. If experiencing trouble conceiving, you can see a Doctor after one year of trying, OR 6 months or less of trying with Fertility Awareness. AND you will know if you actually ovulate, what days to test hormone levels, and whether you have healthy progesterone levels before you ever set foot in a doctors office.
All perfect for someone who wants to be unassisted and holistic in their approach to fertility

Fertility Awareness

So what is Fertility Awareness, if you’ve never heard of or used it before?
Fertility Awareness Methods (FAM) are ways to observe, track, and interpret a woman’s fertility bio markers in real time to help you know when your fertile days are. This allows you to avoid OR achieve pregnancy without the use of unnatural birth control methods.
If you’re wanting to know about FAM for avoiding pregnancy, skip back to our other article - here.

Fertility awareness based methods (FAM/FABMs) rely on two important and non-negotiable  things.

Interpretation of Fertility Signals + Rules.

Fertility Signals are biomarkers that you can use to determine potential levels of fertility on any given day. 

Some of these include

• Period bleeding

• Cervical fluid

• LH surges (observed with "ovulation sticks")

• Cervical os (cervical opening)

• Basal Body Temperature (BBT)

You can also chart secondary signs such as

• Nipple tenderness

• Spotting

• Breakthrough bleeds

• Cramps

• Nausea 

• Libido

• Mood

• Progesterone levels

• Mittelschmerz (ovulation pain)

(But these secondary signs are not counted as official markers, only as helpful or interesting)

You can observe these Fertility Signals in different ways 

• Basal Thermometer

• Visual

• Tests

• Ultrasounds

• Feel/Sensation (vaginal, on fingers etc)

• Observation of your body and how *you* feel

• And then recording them on a paper chart or in a charting app

Each fertility awareness method has rules for interpreting biomarkers, and then a set of rules for avoiding pregnancy and another set for helping you to achieve pregnancy based on your interpretations.

These rules are based on some important facts about a woman’s cycle.

Female Menstrual Cycle and Conception

• (jump down to image of female anatomy of the uterus and cervix)

• Ovulation is the main event of a cycle, not a period. Periods only happen because of ovulation.  Hormones work together to grow an egg to maturity during the “follicular phase”. The egg is released from its follicle in the ovaries by a surge in estrogen and luteinizing hormone (LH). After the egg is released, the eggshell, as it were, “corpus luteum” produces progesterone. If the egg is not fertilised, it doesn’t produce HCG, and so the corpus luteum stops making progesterone. It is this stopping of progesterone that causes the uterine lining to shed as your period, and the cycle starts again. (Skip down to image overview of cycle)

• Cycle day 1 is the first day of period bleeding (not spotting) and the cycle ends when period bleeding starts again

• A true period is bleeding that follows the 10-16 days, known as a luteal phase, after ovulation. Any other bleeding is simply random breakthrough bleeding/spotting. 

• A lack of bleeding is not a period, and should not be considered that your period has “skipped” or “ missed” and will come again in a month.

• If your period is “late” or “missing” it means that actually your ovulation is late or delayed. Once you ovulate, your period will come 10-16 days after.

• Delayed ovulation is quite common for many health or stress related reasons.

• A woman only has only one ovulation event per cycle. She may release 1-2 eggs, but only within the same 24hrs. You cannot ovulate twice in one cycle.  

• An egg only lives for up to 24hrs, making max 48hrs that fertilization can occur. 

• However, a man’s sperm can survive in a woman’s body in optimal conditions for up to 7 days (though the average is less than 5.) This makes the fertile window for conception 7 days.

• A healthy adult male can release between 40 million and 1.2 billion sperm cells in a single ejaculation.

• Outside the body, sperm die in a few seconds, to a few hours depending on what they are exposed to and how fast the semen dries up. Heat and additives like chlorine in a hot tub, or soap in a bath kill them very quickly.

• For most of the cycle, the woman’s body and hormones produce cervical fluid that is acidic and hostile to sperm. But leading up to ovulation, it creates cervical fluid that perfectly nourishes and transports sperm. Sperm are fragile, but fast.

• Sperm can be transported through the cervix to the uterus in mere seconds, so if you’re avoiding pregnancy, do not let any sperm at the vulva or inside the vagina. Once inside the uterus, the sperm travel to the fallopian tubes where the egg is making it’s way from the ovaries to the uterus.

• Only one spermatozoa (sperm) needs to reach and connect with the egg.

• Once the sperm and the egg connect, they merge (conception) and travel together to the uterus where they implant. (Skip to image of egg travelling)  It takes 6-12 days for the fertilized egg to travel. The implantation is considered the beginning of pregnancy in medical circles, due to things like IVF, but others consider pregnancy/life to begin from the time of conception.

• The egg creates cells that will eventually become the placenta.  After the egg implants, more rapid changes happen to the fertilised egg, and to the mothers body. It is these future placenta cells, burrowed into the uterine wall, that produce Human chorionic gonadotropin (HCG). After about 3 days the level of HCG is high enough to test positive on an at home pregnancy test.

• In an ectopic pregnancy, the egg burrows into somewhere that is not the uterus, such as the fallopian tubes. It still creates HCG, but it cannot grow safely outside the uterus and cannot continue. https://www.bellybelly.com.au/pregnancy/ectopic-pregnancy/ 

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Importance of Progesterone

• The HCG sends signals to the corpus luteum to continue to make progesterone past the 16 day normal life span of the corpus luteum. Progesterone is important for sustaining the lining of the uterus and keeping the baby.

• This is one reason why I believe some early pregnancies are lost at about 4 weeks, known as a “chemical pregnancy” - due to low progesterone. The other reasons are usually developmental. 

• At about 12 weeks (12w) gestation, the placenta takes over progesterone production.

• If the placenta did not attach or grow properly due to a defect or abnormality, then a miscarriage may occur anytime before or just after 12w. 

• Noticing if you have a short luteal phase and low progesterone before you conceive will help you come up with a plan to nourish, encourage, and support your body.

• At the end of pregnancy, once your baby’s lungs are fully developed, they send a signal to the placenta, the placenta in turn lowers progesterone production and sends a quick surge of estrogen to the woman’s body to initiate labour.

• This is one reason why you can have nausea, diarrhea, mood swings etc at the end of pregnancy. Because of the sudden hormonal changes as everything shifts into the next phase.

• Your body and baby work together your whole pregnancy and right through labour and birth!

How To Conceive

• First, decide when you want to conceive. Is it now? Or are you happy to wait a few months and work on your health? Maybe you have already been trying for a while and want to pinpoint any issues?

• If you want to start right away, you will need to use maths for the first cycle while you learn your fertility signals. In an average 28 day cycle with presumed ovulation on day 14, your 7 day fertility window up to day 14, and 2 days after will be from cycle day 7-16. You just have sex daily or every other day (D/EOD) in this time frame. The rest of the month, only when you feel like it.

• If you have a longer cycle than 28 days, you must add those days to the fertile window. So if your cycle is 30 days long, you must have sex D/EOD from cycle day 9 until 18.

• Once you know your fertility signals, depending which ones you track, you can have sex daily/EOD until you know ovulation day such as positive LH, and then have sex again on ovulation day, and one after for luck.

• If you are charting Basal temperature (BBT), then have sex daily/EOD until a temp rise is sustained for 3 days ( T+3).

• If you are charting cervical fluid, have sex daily/EOD once you see cervical fluid until peak day, that is, the last day of cervical fluid before it dries up again. And have sex one more time on the dry day to be sure.

• See images at bottom of article and also the resources at this link to help you visualise the different types of cervical fluid

• A popular plan using OPKs and cycle math is called the "Sperm Meets Egg Plan"(SMEP) This article has a great overview https://themonarchmommy.com/2015/11/04/increasing-the-odds-of-conception-smep/ 

Conception Tips

• Get the book "Taking Charge of Your Fertility by Toni Weschler" (TCOYF). It teaches you everything about the female cycle, and how to use a sympto-thermal method of Fertility Awareness to conceive (or to avoid pregnancy). It is considered the Bible of fertility Awareness in many circles, and if you only buy one book, get this one. It explains so much more than I can in this article.

• If you are trying to conceive, do not think that you need to lay around with your legs in the air for 30mins. Just have a quick cuddle, then clean up as usual. All that falls out is empty semen fluid. The sperm have travelled inside to the uterus already. And you can rest assured that any sperm that didn’t make it that fast probably weren’t healthy enough for a beautiful baby anyway.

• When a woman orgasms, the walls of the vagina and uterus contract strongly. It is believed that having the woman orgasm just before or just after the release of sperm into her vagina will cause the contractions to help move the sperm along the cervical fluid pathway and into the uterus efficiently.

• Sperm live inside the female body for 3-7 days. The egg only lives for 12-24hrs. This means that wherever possible, do not try to wait until ovulation day by LH or BBT. always try to have sperm waiting already ready for the egg. This is why it is suggested to have sex every second day leading up to ovulation. This will increase your chances from 10% to 20% or more

• Sperm live inside the male’s body for up to 80 days. However new sperm are produced daily. There is no reason to think that a period of time without sex/ejaculation will kill the sperm stored, and equally there is no reason to believe that daily intercourse will drain him dry. So you can have sex daily, twice daily, or every second day, and it will not hurt your swimmer’s health. The only case where it is beneficial to wait is if your male partner has been tested and definitely has low sperm count and motility. In which case, improving his nutrition, avoiding known sperm killers, and having sex every second day will be your plan.

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Tips For HIM

• Male fertility is just as important as the female’s. Men can often have stressful jobs or work with tight clothing or toxic chemicals that kill off sperm count.

• One of the first things you should do if experiencing difficulty in conception is not just to look at your own cycles, especially if they are already regular, but to look at the man’s health and risk factors. 

• Men will benefit from a healthy diet and taking supplements such as zinc for at least 3 months prior to conception.

• If you experience any difficulty in conception, or you suspect issues with the male, please get that checked out first with a simple semen analysis. Sometimes you may have to get a specific referral and appointment. Other states may allow for out of pocket private clinical tests. Either way, it is far less invasive for the man to ejaculate privately into a specimen cup than it is for a woman to undergo transvaginal ultrasounds or surgery to check her tubes. In my mind, semen analysis should be one of your first medical checks, if you need to consider that route.

• I saw an anecdote recently in a Facebook group where they had been trying to conceive for a year, and were now consulting a doctor. He asked of course about the woman’s cycles. Finally the husband mentioned that as a baby an accident had crushed one of his testicles - would that affect anything? A semen analysis showed ZERO sperm. Now they are needing to run tests to see if there is anything they can find, and fix. They could have saved themselves 3-12 months of stress by getting something they *knew* could be an issue, checked out at the start.

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After the Pill

• If you are trying to conceive after you have been on hormonal birth control, it can take a few months to a year to start to have regular ovulatory cycles. You may also have health issues or side effects from the pill to combat.

• If this is you, you may want to take a few months to work on your health before TTC. You may also find that your cervical fluid takes a while to come into obvious fertile and non fertile phases and amounts.

• This can be frustrating to work with but you're  not alone. 

• Read "Beyond The Pill by Jolene Brighten"

Pregnancy

The goal of all this observing fertility signs and having sex of course has been pregnancy. So how will you know when you're pregnant?

Testing

• We know that implantation happens approximately 6-12dpo, with 84% by 8-10dpo. 

• And we know that it takes about 3 days for HCG to be observed on a home pregnancy test (HPT)

• That means if you are happy to see false (or real) negatives, or very faint lines, that you have to squint to see, you can start testing daily with first morning urine or afternoon after a 3hr hold at 8dpo. 

• If you would rather wait for an obvious line/positive test, its best to wait until the day of your expected period or about 14dpo

• It is very easy to question every feeling, every niggle, any nausea, tender breasts etc as being early pregnancy symptoms. I want to say that while a few women have obvious pregnancy symptoms, most women do not, and won't until about 6 weeks.

• This is mainly because all the same things that make you "feel" pregnant are caused by progesterone, the hormone responsible for PMS. Nearly every “implantation” symptom or early pregnancy symptom like tender breasts, cramping, are caused by progesterone and not HCG. And these progesterone symptoms can change from cycle to cycle depending on a lot of other factors, so don't get false hopes up because a symptom is unusual for you. You can be hyper aware and may forget that you had the same symptoms 3 cycles ago.

• Even things like “implantation bleeding” are possible myths  

• Long story short, remember this: if you are pregnant enough for pregnancy signs and symptoms (in your body or on your chart), then you are pregnant enough to get a positive pregnancy test.

Now what?

Negative?

Negative tests suck. Sometimes it might just be that you’re testing too early. This site has some really cool statistics on the rates of false negative tests based on DPO. As they say “You’re not out til Aunt Flo shows.” https://www.countdowntopregnancy.com/pregnancy-test  

But sometimes it’s negative after negative and then your period does show up. Sit with the heart break. It’s okay to be upset that this cycle wasn’t working out. Take it easy and have a plan for self care on your period to support both body and mind.

You can take a few minutes to review your chart and see if you potentially missed a fertile day, but otherwise don’t stress and overthink it. Just because you didn’t drink your special tea one day or you didn’t orgasm on ovulation day or you broke a mirror during the week are not reasons you didn’t conceive. Take heart, read through the fertility affirmations on this other page, eat chocolate,  and breathe. You’re not alone on this journey. Your time, your baby, will come!

Positive?!

Yay! Congrats on those double lines! You’re pregnant! This is exciting and now there’s lots to do. Plan how to tell your hubby, and family, and friends. Eat a healthy pregnancy diet. Buy all the baby items. Plan an empowered birth. And get excited and stressed over and over until baby comes. So you’d better go get started on those!

But first, don’t put away your chart just yet. You’ve got one thing to use it for first: calculating gestation and due date.

Figuring out gestation/due date

Typically, due dates are calculated based on an average 28 day cycle with day 14 ovulation and a term pregnancy of 40 weeks.

First, (quickly), I don't believe in “Due Dates”. No one can ever know exactly when the baby will come. Only 5% of babies actually are born at exactly 40 weeks. Term pregnancy is between 37-42 weeks, and you are not officially post-dates until 42w+1. This means that I do not believe in calculating due dates, but rather gestation, which is infinitely more important to know, so you know when baby is viable if you have preterm labour, and you can prepare roughly for your “due month”.

Calculating: The medical profession uses Naegle’s Rule to count forward 280 days/40 weeks from last menstrual period (LMP). However if your cycle is longer than 28 days, you will need to subtract that number. If your cycle is 33 days long, you will count forward 280, then subtracting 5 from 280, to count 275 forward. You can also use online calculators like this one, which is my favourite because it has the options for ovulation/conception date too. 

https://perinatology.com/calculators/Due-Date.htm 

Calculating gestation from ovulation is wayyyyyy more accurate than counting from LMP, especially in longer or irregular cycles. If you have been using FAM, find your peak day/Temp Shift/ovulation day and count forward 266 days. You can enter the date in the calculator above, or, simply to find gestation quickly, conception/ovulation day is 2 weeks gestation. You can never be any less pregnant than 2 weeks (which sounds hilarious really!)  because they base gestation on LMP. So when you get a positive test/late period you’re usually about 4 weeks pregnant, or 14 days past ovulation (14DPO)

Fundal height
As the baby grows in the uterus, the uterus expands (image) from 60 grams to 1000 grams of muscle. The top of the uterus is called the fundus and you can measure it to get an estimated gestation of the baby. There are articles online that tell you how to do this. You cannot measure before 12 weeks gestation as the baby is tucked deep behind your pubic bone. At about 20w, the fundus is reaching your bellybutton.

At the end of pregnancy, the fundus is very strong, and is actually what contracts and does the pushing to get baby out for you! Sometimes you may even experience the Fetal Ejection Reflex!

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Book and resource recommendations

I hope this article has been helpful. Please reach out and let me know if you have resources you think would be helpful for other women.

BOOKS

• It Starts With The Egg by Rebecca Fett

• Taking Charge of Your Fertility by Toni Weschler 

• The Fifth Vital Sign by Lisa Hendrickson-Jack

• Period Repair Manual by Lara Briden

• Beyond the Pill by Jolene Brighten

• Real Food For Pregnancy: The Science and Wisdom of optimal Prenatal Nutrition by Lily Nichols

• Nourishing traditions by Sally Fallon https://nourishingtraditions.com/ 

PODCAST 

• https://fertilityfriday.com/ by Lisa Hendrickson-Jack

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FACEBOOK SUPPORT GROUP

• The biggest Fertility Awareness group on Facebook. It has sister groups accessed through the main one for specifically TTC, infertility, and loss https://www.facebook.com/groups/FertilityAwareness.BirthControl/ 

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WEBSITES

• (aimed more at FAM for birth control but helps you learn about your body which can be easily converted from TTA to TTC) https://fertilityawarenessmethodofbirthcontrol.com

• Charting app website has tips on how to chart https://kindara.zendesk.com/hc/en-us/articles/206633810-How-to-Draw-a-Coverline

• Website with handy implantation statistics and cycle info https://www.avawomen.com/avaworld/implantation-symptoms/

• Positive test statistics https://www.countdowntopregnancy.com/pregnancy-test