Friday, March 4, 2011

The Natural Family Planning Post!!!

We are fearfully and wonderfully made. 
Psalm 139:14

I am so grateful to Alison at Matching Moonheads for agreeing to write a guest post about Natural Family Planning! She and her husband are certified NFP teachers for the Archdiocese of Galveston-Houston and have been teaching a sympto-thermal method for two years.

I couldn’t be more excited to write this article about the scientific perspective of natural family planning (NFP). Understanding the science behind NFP and how exquisitely our bodies are designed has had a huge impact on my life. I am passionate about sharing this knowledge with others.

The Basics
All natural family planning (NFP) methods have the same aim: Identify the times when a couple is fertile or infertile in order to know when to achieve or avoid pregnancy. This does not make NFP a method of contraception, since nothing is being done to prevent conception. The sex act is left undisturbed, and the spouses’ bodies are unaltered. A couple decides when to have intercourse based on their desire to postpone or achieve pregnancy.
A male is always fertile, but without the right conditions in the female body, his sperm will die within 20 minutes after completion of intercourse. A woman, on the other hand, cycles between being infertile and fertile all within an approximately month-long period.
Overview of a woman's cycle
(Click image to enlarge)
From the Diocese of Harrisburg, Pennsylvania, Sympto-thermal Method, Dr. Roetzer.

Because males are always fertile and females are only cyclically fertile, NFP methods focus on understanding when a female’s body creates an environment hospitable to sperm, making conception possible. This is done by observing one or both of two measurable and quantifiable secondary characteristics of a woman’s body that occur as a result of the hormones that control her reproductive cycle: her basal body temperature and her cervical fluid discharges. In short: 

  • An increase in cervical fluid indicates cycle onset of fertility.
  • A rise in basal body temperatures (which are correlated with a “drying up” of cervical mucus observations) signal a return to infertility after ovulation.  

Using these two observations together, a complete picture of the fertile window leading up to ovulation and after ovulation can be made.  
Each NFP method has the user identify her cycle peak day from her fluid observations, which is the last day that the most fertile fluid was observed. [Cervical fluid discharges closely resemble nasal mucus and come from similar crypts within the cervix. These fluids are commonly referred to as "cervical mucus," so I will use that term from here on out.] Peak day is the highest statistically likely day of ovulation. (Note that the only way to identify ovulation with 100% certainty is through ultrasound. However, since we are interested in days of fertility or the “fertile window”, not just ovulation, determining ovulation day with 100% certainty is not necessary to use NFP.)  
Identifying the onset of changing fertile mucus and peak day are the cornerstones to almost all NFP methods.  
A woman will ovulate during a 24-hour window of her cycle when follicle stimulating hormone (FSH – not shown on the chart) and luteinizing hormone (LH - green on the chart below) reach sufficient levels. A released egg has only 24 hours of viability; if it is not fertilized by a sperm during that time period, the egg will die and be absorbed back into the system. 
However, the male’s sperm can live up to 5 days, depending on sufficient, good quality cervical mucus. Because of this, the days immediately preceding and the day following ovulation are potential days of fertility. Each NFP method has rules (based on significant research) that dictate how long after peak day abstinence is required for avoiding pregnancy. 

Making Observations
All NFP methods require the woman to make routine observations about her body, in order to apply the rules to achieve or avoid pregnancy. The two main types of NFP are the mucus-only methods, which record mucus observations, and the sympto-thermal methods, which record both basal body temperature and mucus observations. While observing and charting is a highly individual task, it helps to follow standardized rules that ensure the best possible observations. Some NFP methods are more standardized than others, so it is best to pick a method that will suit your needs. Some things to remember when making your observations:

  • When using basal body temperature (BBT) readings, it is important to take your temperature at the same time in the morning before getting out of bed.  BBT data is based on circadian rhythms that are affected by hormones that start flowing in your body before you get out of bed. Data is best compared at the same time every morning when your body is still as close to being asleep as possible, before it starts to “heat up.”
  • It is important to use a basal body thermometer to ensure accuracy, not just any thermometer. Additionally, most thermometers have a “memory recall” button that allows you to take your temperature without needing to write it down right away. This means you barely have to wake up to take your temperature and can easily go back to sleep.
  • Cervical mucus is to be observed every time you void (both before and after) and right before you go to bed. This is as simple as wiping from front to back using a flat sheet of folded toilet tissue and examining what you see. You will be looking for two things: sensation when wiping and characteristics of the mucus. Both are important. A mucus observation that includes any of the following would be considered the most fertile (for identifying peak day): a wet or lubricative feeling when wiping, mucus that is clear or stretchy (think: egg white). Other cloudy, tackier mucus (think: more like tooth paste or pudding) will be less fertile. You will record the most fertile reading of the day on your chart. The NFP method you have chosen will have different ways to classify this and different rules for how to proceed. 
  • In the pre-peak phase of your cycle, it is necessary to get a good mucus reading throughout the day before you can conclude if a day is fertile or infertile. This means that for almost all NFP methods, intercourse in the morning during the pre-peak phase is not advised.
  • It is important to identify true menstruation, which only follows ovulation.  Not all bleeding is menstruation, including bleeding while using the Pill. Mucus observations must be made on days of light bleeding. Couples that are going off of hormonal contraception are advised to practice abstinence during the pre-peak phase for the first few months, in order to properly practice mucus readings and identify peak day (fertile mucus will closely resemble seminal fluid). Often what women think is their period is not, because they have not been ovulating while on the Pill.

There are several other things to keep in mind when making observations, and what I’ve given here is by no means a complete description. It is absolutely necessary to consult an NFP teacher who will be able to explain the details of their method, and who will work with you one-on-one to help you understand your chart and any issues you might have.  

Understanding the Hormones
In order to use NFP, it is not necessary to understand how the careful balance of hormones creates the woman’s reproductive cycle. However, it is interesting information, and it can help identify problems when a woman has irregular cycles and/or is not conceiving when desired. Understanding the balance of these hormones and seeking to correct any imbalance is the basis for NaProTechnology with Dr. Hilgers and the Pope Paul VI Institute, whose mission is the study of reproduction (and avoiding artificial reproductive techniques). 

(Click chart to enlarge)
Note: This is an example cycle. Every woman's body will vary.
The hormones that dominate a woman’s cycle are estrogen (estradiol – blue on the chart) and progesterone (red on the chart). The pre-ovulation/pre-peak phase (also called the “follicular phase”, as this is when a follicle is developing to release an egg), is dominated by estrogen. After menstruation and in the beginning of the cycle, the pituitary gland in the brain will produce follicle stimulating hormone (FSH) that will do just that – stimulate the follicles on the ovaries to start getting ready to mature and release an egg. This developing follicle (shown in the graph) will begin to produce estrogen, which increases the uterine lining, opens the cervix to admit sperm, produces mucus that will aid in transmitting sperm, and depresses the basal body temperature.  
High enough levels of estrogen emanating from the growing follicle on the ovary will eventually signal the pituitary gland to release luteinizing hormone (LH) to trigger ovulation. Incidentally, this is the hormone measured by the Clearblue® Easy Fertility Monitor and ovulation predictor kits.  
In the post-peak phase or “luteal phase”, the burst follicle on the ovary (now called the corpus luteum or “yellow body”) will release progesterone that causes the body to get ready for pregnancy. It will signal the pituitary gland to stop producing FSH (which is why you won’t ovulate beyond a 24-hour window), the cervix will close, mucus will dry up, endometrial lining will increase in preparation for implantation, and basal body temperature will increase. However, after two weeks the corpus luteum will begin to dry up if it has not heard from a fertilized egg to keep producing progesterone. If the woman is not pregnant, progesterone levels will drop, the endometrial lining will slough off, the woman will get her period, and the cycle will start all over.
NFP Resources
This introductory article is by not meant to substitute for real, individual NFP instruction! It is offered only as a introductory resource for those inquiring into NFP. As mentioned, many doctors have been researching and working on natural family planning methods over the last several decades, so there are multiple NFP methods available. There is truly something for everyone in any circumstance. Because NFP requires users to make observations on their own bodies each month, it is a highly individualized method, unlike the rhythm method, which used rules based on the average woman’s cycle. Regular cycles are not a requirement to use NFP.

Following is a list of NFP methods and contacts: 

Billings Ovulation Method – Mucus-only  
Creighton Method (CrMS) – Mucus-only, help for infertile women  
Couple-to-Couple League (CCL) – Sympto-thermal method
Marquette Method – Sympto-thermal method, includes Clearblue Easy monitor  
CEIBA Study, study for couples wanting to learn Creighton 
Additionally, CCL has a home study course available to self-teach, which may be a good resource for those couples looking to learn on their own, or who don’t live near a teacher.  
A final note: NFP has benefits for everyone, not just Catholics. I was not Catholic when I first learned about NFP, but I had accepted that NFP was a powerful pathway to good health, to accepting my femininity, and to respecting my own body’s reproductive and life-giving potential. For me, learning the method led me to discover truths about my body that point to something higher -- namely, what true love and self-giving look like. From there, I was eventually able to understand other universal truths, which cleared up many misconceptions I had about Catholic teaching, and which eventually led to my conversion. 
Thanks again to Alison for this excellent NFP primer! And for those of you interested in hearing from real-life NFP couples, please watch this sweet video made in my own diocese. I am blessed to know several of the couples (and the doctors) in the film. Don't miss the funny outtakes at the end!

**Important follow-up to this post, here.

(Why NFP is not the same as contraception.)



  1. Great, great article! I had the blessing of meeting Alison and her husband a few weeks ago here in Mexico and they are great representatives of a very well prepared, young, in love couple using NFP.

    Congratulations Alison. I will refer a few persons to this articule!

  2. Woo-Hoo! I am going to print this out and read it over the weekend.


  3. Alison, this is fantastic! I love all the charts!!! You did an excellent job. I've linked this to my blog and facebook as I know it will be a help to people!

  4. Thanks guys! You know, technically the progesterone should peak a little earlier to coincide with the BBT rise a little better. Doh! Guess that's what I get for thinking its the best graph ever!

  5. Well, it pretty much sounds like rocket science to me. I never knew so much was going on in my body every month!

    Seriously, though, I am so thankful to have this introduction and look forward to learning more from a NFP teacher! Thank you soooooo much for posting!

  6. This is a great article! Thank you for writing it and sharing it! I love how my body is made and could never choose to mess with it now!

    We used only sympto-thermal for many years. It was a struggle at times since I am borderline hypo-thyroid (My temps are VERY low) and I have a Luteal Phase Defect (my body doesn't make enough progesterone) which made finding a true thermal shift VERY difficult.

    We were SO blessed to learn and we now use Marquette. I'm often disappointed that there's not more information in the NFP community about this method. I was skeptical about how much we could trust the ClearBlue Easy Fertility monitor. However, BECAUSE of my experience with Sympto-thermal and the fact that I'd spent 8 years doing cervical fluid checks and charting, I was amazed at how accurate the monitor was.

    My sister, who has some physical issues that made reading cervical fluid signs difficult (tilted uterus...fibroid tumors) is now using the monitor and Marquette and loves it as well.

    So, I'm a big supporter of ANY NFP method that a couple finds works for them and I look forward to the day there is more information in the NFP community and the scientific community at-large about Marquette (and I'm sure there will be as they have obtained government grants - gasp! - to study). Marquette is the first and only institution that I am aware of that has been granted the funds to do studies on NFP. I was a participant in their monitor-efficacy study in 2009.

    have a great day!!

  7. Michelle, that is so interesting to me, because before this post, I had never even heard of the Marquette method! I learn something new from you ladies every day!!

    And it is stunning that they received government grants. Whoa!

  8. I believe that creighton is also running a study on its efficacy rates - the one in allision's article called ceiba

  9. A friend of mine often claims that NFP will be the "bridge" by which many organically-minded/natural-is-best folks cross into the Church. In fact, in Stevens Point, WI, there is a "hippie" co-op right across the street from the thriving, very-orthodox Catholic parish... because they both cooperate teaching NFP. How beautiful!

  10. Allison, thank you. That is so well-written. I've sent friends to the websites before and it was too much and confusing. This is perfect. Thank you, Leila!

  11. This is Awesome Allison! Thank you for taking the time to put this together.

    Leila: I loved that video!

    K and I have been saying it for awhile, NFP is the best thing we did for our marriage. I wad on bcp when we first got married for "medical" reasons. We all know how well that actually works. Since learning NFP our relationship has grown more than I ever could have imagined.

  12. I just want to second the point about making sure you work with an NFP instructor when switching over to NFP. My husband and I used the Couple to Couple League Home Study Course. We felt like we understood the method pretty well and started using it. We sent in 2 charts and never heard anything back from any personal instructor. During my third chart something looked a little "off". Since no one from CCL ever contacted me about my charts that I sent in, I decided to contact them. They sent me the name of the person who was assigned to my charts, but by that time I had already gotten a positive home pregnancy test.

    Looking back at my charts now it's pretty obvious what went "wrong" to conceive this baby. In hindsight, I'm actually so happy that I was never contacted to review my charts because otherwise I would not be carrying this little miracle. (Yes, we were actually trying to avoid because of a medical issue I had. Luckily this medical issue has not affected the pregnancy at all and has actually brought me out of a bit of depression I was in because of it).

    But if you are REALLY in a dire position where you CAN NOT have a baby right now, I HIGHLY suggest you get someone who has been doing and teaching NFP for a while to review your charts with you.

    Overall NFP has been wonderful for me and my husband and I hightly recommend it. I know God knew exactly what I needed and this baby is going to be AMAZING! I just wanted to get the word out there to make sure you REALLY know what you are doing before you try to just do it all on your own.

  13. Caitlin, excellent reminder, and I love the story you tell on your blog!

    Some readers may remember this story (below), about my friend Melanie who had an amniotic embolism, "died" in childbirth and came back, had a uterine artery severed, had three heart attacks, etc. Well, she is a chastity speaker and she and her husband are an NFP couple (they are in the video above, the lady with the long blond hair and her husband with the vest and tie -- that was before the incident). They have been told by even NFP doctors that she can not have any more babies or it will risk her life. They are using NFP very precisely now, and will be for the rest of their childbearing years. They spoke about it at our recent NFP Valentine's dinner at the diocese. An amazing couple, and it can be done:

  14. Where might a person learn more on the hormonal intricacies of all this?

    I have not been ovulating for about 4 years now, by my reckoning. I started taking temps (basal and daily average) a few months ago and they're wildly erratic.

    Fertility itself is not really an issue at this point, but I would like to glean more info to help doc figure out what is going on with my health. Does someone here know where I might look?

  15. Michelle - Creighton is another great one for those of us with hormonal/thyroid issues. The ClearBlue Easy Fertility Monitor sounds like a great aid too!

    Caitlin... I have a nephew thanks to a similar situation. :) I agree though, it's so important to have an instructor help you when you start out if you are in dire medical need of avoiding pregnancy.

    Great post!

  16. Fantastic post! I just wanted to add that for anyone reading this interested in a non-Catholic NFP option, try the book "Taking Charge of Your Fertility" or try contacting a local midwife. I have used the sympto-thermal method described in TCOYF for 5 years, but am now switching over to the easier-to-implement-but-just-as-accurate Creighton method.

  17. CEIBA is a current study from the University of Utah on the effectiveness of the FertilityCare Creigton Model. As CrMS has be very effective in avoiding a pregnancy over the years, this new study came about because of the new teaching techniques that are used in training the pracitioners/instructors.

    The article was very will written and informative about NFP. I'm currently a Practioner-Intern with the Creighton Model and work at the Pope Paul VI Institue with Dr. Hilgers. As you stated, CrMS is very good for couples with infertility. However, it is for all couples. Also, it would be important to note that only 13% of women do have a dip in their BBT each month. So it is an unrealiable sign for most women to determine your fertility.

    Thanks for the article and I hope this information is beneficial to many women and couples.
    Abigail , FCPI

  18. JP
    Are you positive you are not ovulating through ultrasounds or are you just observing temperature? It is actually an intricate balance/ratio of those hormones in the body (as well as testosterone) that create this thermal shift, so it still may be possible that you are ovulating, just not regularly. Either way, seeing an endocrinologist to get tested for your hormone levels would be a great start. The Creighton method has standardized this so it might be the easiest place to start.
    As far as learning more on your own, I'll have to find some sources and get back to you.

  19. Abigail,
    Actually, although a dip in temperature may signal ovulation, sympto-thermal NFP methods look for the rise that signals it has happened. While some when see a dip due to the peaking estrogen and it may be helpful to identify ovulation, it is not necessary to use given the sympto-thermal rules. Additionally, both sympto-thermal methods that I have learned have rules to accomodate for women who have weak thermal shifts and that data is always used in combination with mucus observations. Many peer-reviewed articles have been published stating the efficiency rates, so these are reliable methods.

  20. Okay, I have to say, I really get frustrated with NFP teaching, mostly because every teacher and manual I have used has skipped right over the breastfeeding issue. This is a huge issue for me, because I breastfeed for 24 months. I do, in fact, use ecological breastfeeding (no pacifiers, no bottles) but my fertility returns between 6 and 10 months. With my second baby, I watched my signs like a hawk. (Sorry to get graphic, but this is an NFP post...) We only had sex once a month (literally, one time each month) during the time when I was most certain that I was not fertile. (Due to dire financial constraints, we cannot get pregnant) Still and all, I managed to conceive when our daughter was eight months old. I have no idea how this happened. So now, during our (seven month old) son's entire life, we've had to be totally abstinent. Completely. I'm sure you can imagine the strain this is putting on us, but that's how serious our financial situation is. My period hasn't returned, but the random signs don't make any sense, and I've given up on the temperature thing since my temps have always been all over the place.

    I really feel that it is unnecessary to have to be entirely abstinent, but really don't know what to do as the only advice I ever get is "just be careful while breastfeeding." Careful didn't work for us. Extremely careful didn't work for us.

    Anyway, sorry to rant. I feel like I can't be the only mother out there with this issue, and with so many Catholic moms being committed to breastfeeding, I can't understand why there is such a lack of help for us.

    Oh, and I have gone to the Marquette website. I'd love to use the Clear Blue Easy monitor because I think it really would work, we just can't afford it at the moment. Have any of you had luck with this during breastfeeding?

    Thanks for this, though. And thanks for being awesome, Leila!

  21. Allison, great job, thanks so much!
    And aside from CEIBA, I am proud to be a part of an ongoing iNEST study on the efficacy of NaPro for achieving and sustaining pregnancy.

    Wanted to add to Abigail's comment about Creighton being for all couples- it is really a great diagnostic tool for ANY woman OR couple. Our NaPro Technology Drs are able to use the information from the charting to address ANY gynecologic women's health issue, such as PCOS, ovarian cysts, premenopausal symptoms, PMS, unusual bleeding, anovulation, etc. etc... many people hear the words "NFP" and assume it can't help them with their problems because they may be young and/or single and not genitally active.

  22. Calah,
    After I finished hitting "publish" I thought (oh I should have discussed the breastfeeding issue, too) and went back to do so and just saw your comment!!
    Creighton is GREAT for breastfeeding!! I have many, many breastfeeding clients, and through the standardization of our system, we are able to help women navigate through those very difficult times both before and after menses return, post-partum - both total AND weaning.

    I'd recommend a Creighton Intro so you can learn more about it.

  23. My husband and I are huge fans of the Creighton Model. We started learning about 6 months before we got married and met with a nurse who is trained in the model. We are now 7 months into our marriage and it is so amazing how it has made us so much closer. Each month we have to decide what is best for our family, whether to try to conceive or not. I love that it is a decision both of us make!

    The Creighton model is easy to follow and really helps you not only monitor your fertility but know your hormone cycles! I like it because you don't have to take a temperature each day and the checking of mucus really becomes second nature after a few months. Plus the model makes sure couples are addressing all parts of sexuality, not just the physical, which is so important in building a strong relationship.

    I found my teacher through FertilityCare.

    Thanks for the great post!

  24. Its OK! And yes, you're definitely right about Creighton having the additional benefit of being a whole woman's health-care practice...that could be its own post! I have a friend who went to a Creighton doctor when she was a teen and got help for PMS and irregular cycles when they noticed a progesterone deficiency. Any other doctor would have just put her on the pill!

  25. Calah - I have to second that Creighton is a great method for breastfeeding moms. It's my understanding that temps mean nothing when you are breastfeeding, so a method that does not rely on temps is a great way to go. And Creighton teachers (as I am sure any great NFP teacher) will help you figure out your charts, correct mistakes etc., so you get that second set of eyes on your charting.

  26. sorry if this is TMI, but like Calah said, it is an NFP post!

    We're using STM right now, but I'm seriously considering switching to Creighton or Marquette as I'm still breastfeeding (only once per day, but I think it's still causing my cycles to be erratic). My only hesitation with Creighton is that my mucous seems really hard to read, and I seem to have so much of it (as in, I almost never have a dry day; my BIP is sticky fluid). I have eggwhite mucous literally for weeks on end.

    I'd love to take a class but due to my husband's work schedule, I really doubt we could find one that fits (he works 'til 7:30pm 4 days a week), and babysitting is almost impossible to find.

    My only hesitation with Marquette is the $200 fertility monitor. I just know I'd make the purchase and then get pregnant the next cycle. :P

    Any thoughts?

  27. Great post Leila! Thank you for posting all of this information Alison! It's a God-send. I'm going to link it on my blog too.

  28. JoAnna-
    I actually purchased the ClearBlue Fertility Monitor to help in conception after 18 months of TTC using the sympto-thermal method with no results (I was later diagnosed with PCOS). It works exactly as it's supposed to! And instead of buying a brand new monitor, I bought a used one from ebay for $80. It was clean, and I found instructions online about how to reset the monitor so the previous woman's information wasn't still saved on the monitor.

    When I had an ultrasound on CD 14, my doc told me I'd be ovulating in 3 days, CD 17. I ended up ovulating on CD 18-19 (the monitor gives you 2 days of peak), had sex then, and got pregnant!

    I'd definitely trust the monitor in helping us to avoid after we have our baby as well. I say give it a try if you're able!

    I'm definitely adding a link to this post on my blog. Thanks for the great introduction to NFP!

  29. JoAnna - Okay I wrote this once, and it got erased lol. Let's try again.

    The Creighton method is great even if you are super mucusy (fun, right?? :)). A Creighton Model Practitioner should be able to work with you to help you identify when your body is fertile. They even special stickers for those who produce a lot of mucus (the yellow stickers :)). Also, there are ways to increase or decrease your mucus production, and a Creighton teacher should be able to share those with you. That's one thing I love about Creighton/NaPro (as others have pointed out too)... they can not only help you monitor your fertility but help improve things too.

  30. Super post! You should get to write the next pamphlet:)

  31. How many days a month (on average) are considered "fertile days," i.e. days when you shouldn't have sex if you want to prevent pregnancy?

  32. Leila, thank you so much for posting this, and Alison, WOW, this is awesome!

    We've been married about 14 years and using the Creighton method, but I have always been curious about CCL though. I really appreciate your information and links!

    P.S. Leila, this is Cathy BB and I'm still praying! Keep up the wonderful work! ;)

  33. I love this! We took the class to learn the Symptothermal method before we got married, and I charted for several years. Now I totally forget how to chart and have no idea how to do it while breastfeeding, but we don't really care that much anymore ;)

    Oh yeah and sperm can definitely live for 5 days in the right conditions. Just ask Leo ;)

  34. Alison - this is AWESOME! It's the perfect summary of the STM class that you teach.

    Leila, thank-you for asking Alison to do this!!!

  35. @Anonymous, it varies from woman to woman but generally is between 3-7 days of abstinence/cycle for couples seeking to postpone/avoid. As others have shared above, however, it's most important to pay attention to one's own body.

  36. This is great, Alison! I loved the video too, Leila!

    Calah, I totally understand where you are coming from, and I love love love the Creighton Model!! I have a very strange constant mucus pattern when I am breastfeeding that results in endless abstinence. :( It was easily figured out with Creighton, and I am so glad we switched! We may purchase the fertility monitor just to be extra sure in the months before I get my cycle back.

    However, we charted using Creighton while I was breastfeeding for 6 cycles following a molar pregnancy, and we had to avoid pregnancy since it would have been dire for my health. It worked perfectly!

    Anonymous, it can be anywhere from 7-12 days at a time on average. However, with Creighton, in my experience, the abstinence days get fewer as you get better at identifying your fertility signs. We had it down to 7 days on the last cycle that we were trying to avoid. :)

  37. OMG, JoAnna: "my mucous seems really hard to read, and I seem to have so much of it (as in, I almost never have a dry day...)"

    I'm not the only one?!? We did Creighton for over 2 yrs and I'm convinced I never truly found my peak day. I just couldn't do it and never felt confident about it. I ALWAYS have mucus!

    Anyone have any ideas on how to figure this out??? Would a different method work better for me???

  38. Nicole, did your instructor help you discern the estrogen related mucus? I have a constant mucus pattern too, but it did vary in color and stretch. I was able to detect the estrogen related mucus, and when that went away that was when I was able to determine my peak day.
    In fact, in my case, my three days of drying up were often yellow baby stickers because they weren't technically dry, but my mucus wasn't estrogen related, and I could tell.

  39. p.s. my practitioner has been instructing for 25 years, and she KNOWS her stuff. She trains new practitioners as well.
    If your practitioner didn't work with you on mucus differentiation, then maybe you need to find a different practitioner? Just a thought. :)

  40. Oh yeah, we definitely worked on mucus differentiation! Never talked about "estrogen related mucus" that a technical term? Don't recognize it. But yes, my mucus did vary in color and stretch. The problem, though, is that it went back & forth so often. I was like, white baby stamps ALL the time. I hardly ever had any green stamps!

    My practitioner has been doing it for ages too. I don't know if it was just me not getting it or what. It was frustrating and very stressful. I've considered trying someone else. She's super nice, but maybe we just weren't understanding each other.

  41. Anon 11:11 here, from way back :) I stopped with the debate-type posts for a while, but I love cycle-related conversations, so I had to jump back in!

    I used hormonal BC off and on in my late teens and early 20s, but didn't like it at all. When I was around 22, I started learning about my cycles, and thought it was the coolest thing ever. I'm 31 now and can't imagine ever going back on hormonal BC. My husband and I used FAM to avoid for years (although I have to be honest and say we used w/d during fertile phases, not abstinence) and are now pregnant with #2, and it was a breeze to conceive. One of my favorite parts about FAM is that I'm never wondering if my period is "late". If I happen to ovulate late one cycle, I still know exactly when to look for my period. There was no wondering, ever. When I was pregnant, I knew exactly when to test. My husband was reluctant at first, but now he'll look at me and say "are you luteal?", which I think is so funny! So, I know we don't follow the exact Catholic NFP rules, but I couldn't not comment because I think this stuff is too cool.

    I was wondering if I could make a request for a future post? I would love to hear the logistics of having 8 kids. Like I said, I'm pregnant with #2 now, and I can't imagine having any more kids. Taking care of my 3 year old through a miserable pregnancy is just about breaking me. I love my kids, and I love being a mom, but I think I'm at my limit. How do you handle laundry? groceries? clutter? changing bed sheets? school lunches? keeping track of what's going on in each one's life? talking to your husband with a moment of peace? who's grown out of what clothes for what season? everything else?

    (I'm SO not saying "you can't possibley provide for so many kids", like I know some people say. I am honestly fascinated by what it takes to run a household with so many kids. And, I really want to hear the logisitics; when I say "how?" I'm not asking about how you lean on God, I want to know literally HOW? lol!)

  42. This is great. I've been telling my baby sitter who is LDS about NFP and she plans on doing it. Maybe she'll start a movement in her church.

    I'm also curious about the breastfeeding issue too. For the past 8 years I was either pregnant or breastfeeding. Now I'm not either but am curious what breastfeeding women do if they never have dry days and have weak temperature shifts. I have to admit I wasn't exactly being a good Catholic during those times when I was breastfeeding.
    P.S. Melanie's story snapped me back to the Church after drifting.

  43. Anon 11:11, it's great to have you back!! And, that's a great idea for a post! I'll see what I can pull together! :)

  44. Nicole,
    I don't know if estrogen related mucus is a technical term, but my practitioner said that what we were trying to figure out since estrogen changes the mucus leading up to ovulation.

    My charts usually only have one or two green stamps at the very end of each cycle. What ended up happening was I could determine the change in my mucus, and that is when I started using the yellow baby stamps followed by solid yellow stamps. I even used the solid yellows for a few days after my period.
    The key was recognizing the change because if I hadn't been able to tell, all the yellow stickers would have been white baby stickers, and I would have had a solid chart of white babies with red at the beginning and one or two green ones at the end.

    Does that make sense?

  45. Yes I'm with anonymous. Id love to read that post!
    Anon, we just had our third Baby in under 4 years. It was difficult to take care of my kids during my rough pregnancies ... I throw up multiple times a day for weeks... but its doable and so worth all the trouble when I see how much my oldest adores her little brothers!

  46. I ditto Calah - on everything she said about pp NFP - its nasty!! How do you not get caught in the pregnant , breastfeeding , pregnant again cycle?
    am also on my 3rd baby in 4 years and switched to MArquette - not that we can afford it but its either that or total abstinence

  47. I hope and pray that every diocese have NFP courses for couples during their marriage prep courses!!!
    My GP doctor, (catholic) hands out NFP phamplets for couples who have been unable to conceive a child. Her comment "works almost every time"!!!

  48. Anon - I have no children, so take what I say with a grain of salt. :) However, the parents I do know with larger families say the arrival of #2 is a HARD phase. When parents have just had #2 they are 1) experiencing multiple children for the first time and 2) their #1 is usually still little. When my twin sister had #3, I was amazed to see how well she adapted so quickly... much easier than with 2. Part of it had to do with the fact that #1 was now getting older and part of it was that she seemed (to me) to really be finding her stride as a parent of multiples. A coworker of mine with 5 is one of the most serene dads... he often reminds the stressed dads with two little ones that they felt that way as well with 2, but now with five, the oldest ones are teens, great companions, and great helpers. All that said, I would be fascinated to read Leila's post because I am still trying to imagine how I will handle just one lol.

  49. Nicole C - when was your last follow-up? Judging from your comment, it seems like you got started on the essential sameness question, but never got to the point of actually implementing the yellow stamps. While navigating through ESQ and yellow stamps, you should be following up at least every 2-4 weeks. Make an appt! No one should have all white baby stickers on their chart! It's a pet peeve of mine especially for infertility clients, who feel any white baby sticker is a mockery (and imagine white babies day after day after day)!

  50. theresa EH, you will love this: For years, our diocese (Phoenix) has required an introduction to NFP course for all engaged couples. But starting a year ago, our wonderful bishop is requiring every engaged couple to take the FULL COURSE of NFP instruction!! Can you believe it? He is awesome!! So far, feedback from couples has been fantastic!

  51. Leila, I'm blushing... I have a growing list of things I didn't know to be grateful for! I assumed NFP was required for Catholic marriage prep EVERYWHERE. Excuse me while I go offer another prayer of gratitude now... =)

  52. TCIE - in fact we did get to the essential sameness question and I was using yellow and yellow baby stamps eventually. I was meeting w/ my FCP, at least by phone, every 4 weeks or so. But I haven't seen her since early fall, but that's just because I gave up and quit charting. Kinda gave up on Creighton altogether.

  53. Nicole and Megan- you're not alone! ME, TOO!!!! Wow. Leila, you're really getting us to put ourselves out there on this post.

    And ANON 11:11, you should check out some of Danya's tips. Here's one of her organization tips-

  54. This entire post/comments has been kind of mind-blowing. I wish Alison could be cloned and speak at every Pre-Cana class! We attended about 13 years ago, and the NFP portion consisted of a movie where cervical mucas was represented by a cartoon character who joked around. It was a terrible introduction to NFP, and we never viewed it as a reasonable option. I mean, seriously, you are going to entrust your fertility to a cervical mucas cartoon?

    This post, as well as the follow-up comments are really eye-opening. Thanks Leila & Alison!

  55. This is a fantastic overview of NFP! Very thorough!

    This is a pet peeve of mine: I would encourage the author Alison and everyone reading this to not use the term “fertilized egg,” as it is not scientifically accurate. There is no such thing as a “fertilized egg.” Once fertilization happens, the new organism (human!) is called a zygote. In the last paragraph under “Understanding the Hormones,” “blastocyst” would be the term you would use instead; the blastocyst secretes HCG to tell the corpus luteum to continue progesterone production. Accurate terminology is so important when discussing the beginning of human life. The term “fertilized egg” also seems to deny the fact that a new member of the human species now exists; I’ve really only heard the term used by those supporting abortion who are trying to downplay the value of that human life.


  56. PLR, you make a great point! Stay tuned....

  57. I'll be starting up with Marquette soon, as soon as I buy the monitor next paycheck. I have very reliable LAM but that is coming to an end. I can't temp (my sleep pattern is erratic) and my cervical mucus is almost always 'fertile' just in varying amounts. I also have some medical issues that make my cycles a little wonky. Marquette will bypass all these issues.

  58. I don't understand why the arrows point both ways on the circle graph. Can you explain?

  59. They're just pointing both ways to span the distance of the cycle they're covering, to show that the entire time between the lines is "menses" or "fertile", etc.

  60. This is a wonderful post! Thank you, Alison & Leila!

    Theresa EH: I went through marriage prep in the Phoenix diocese, and expected that some NFP instruction was a typical requirement. I was really saddened when I found out just how wrong I was. I teach Creighton in Tucson, where there is no requirement at all for NFP instruction for marriage prep within the diocese, so I am right there praying with you!

  61. Megan, Tucson is my hometown and I realize looking back that there are some serious problems in that diocese. It's so different from the Phoenix diocese. I wish Tucson would use Phx as the model for marriage prep. We heard nothing about it when I got married in Tucson.

  62. PS: Megan, I am so glad you are out there and teaching Creighton in Tucson!! I love your site!

  63. Just wanted to say hello and thank you to Alison and Leila! Although not so common, I'm a single girl using NFP to diagnose and treat PCOS. I just had the ovarian wedge resection last summer with Dr. Hilgers in Nebraska and it worked wonders!! SO grateful to NFP and Napro!! :)

  64. Hi PLR! Alison and I have discussed it, and we've agreed to leave the terminology as is. Here's part of our reasoning:

    Since we were discussing ovulation and release of an egg, we didn't want to confuse the reader into thinking that just any egg would send the signal and HCG to keep producing progesterone, but only a fertilized egg. We didn't go into the details of pregnancy or what happens during pregnancy, since that would have created a much longer post. Those points are gone over in NFP classes, but this was just a quick intro.

    Personally, I am and have always been prolife, but I also have used and understood the term "fertilized egg" to mean a new person. "When an egg is fertilized..." to me means "new human life, new person, new baby". But I admit, that's just me.

    Isn't the term zygote also "dehumanizing" even as it is accurate? Blastocyst doesn't tell me that's a human any more than "fertilized egg", and it is more foreign sounding and technical for the lay reader. If we are honest, anything less than "and then the little baby implants" could be seen as dehumanizing.

    It's the think that I find interesting about the term "fetus".... pro-aborts use the term to dehumanize the unborn, and yet we pro-lifers understand that "fetus" means "little one" (literally). So, I think almost any term can be dehumanizing, and yet every one of the terms means a human life, a person.

    Anyway, I am going to leave it as is, because I think it's most clear in the context of this post.

    (And, everyone reading this blog and post will know without doubt that we are 100% pro-life, so there should be absolutely no confusion.)

    Thanks for your input though, and please know we really took it seriously!

  65. For women in Canada, the Serena sympto-thermal method is available (similar to Couple to Couple League in the US with a couple teaching a couple).

  66. Leila, how many of your 8 children were "surprises"?
    (and yes, I've been reading your blog long enough to know you had a "surprise" while still contracepting)

    I'd also like to extend the question to any other mothers (/fathers) of large families that use NFP to avoid pregnancy

  67. Hi Anonymous,

    Actually, the only true surprise was baby number six and let me tell you why:

    We tried for a year and a half to get pregnant with him. After five easy conceptions, we were shocked that month after month we did not conceive. After a year and a half, I just assumed I was too old. We were utterly shocked and thrilled when John surprised us!! We quickly decided to try again a year later, and lost that baby early. Two more planned babies later, we are raising eight.

    Jen at Conversion story may be more the narrative you are looking for? She says they are "bad at NFP" and she has many little ones! :) Everyone loved and welcomed, even if "unplanned".

    The difference between an "unplanned" NFP baby and an "unplanned" PP baby is that the PP baby is almost surely set for termination, while the NFP baby is welcomed in love.

  68. Anon, I'm sure it's my memory (which isn't so hot), but which post did I talk about a pregnancy being unplanned?

  69. Anon, forgive me! I made the PP comment because I thought I was responding to the thread on the Culture War, where we were discussing the Pill's failure rates. Sorry! I didn't mean to be controversial..... just in the wrong conversation! :)

  70. Anon, I never had a surprise pregnancy while still contracepting. I think you may be thinking of the time the condom broke when I was with my husband. We did not get pregnant that time. But the condom definitely broke, with two experienced users! :)

  71. I've been using NFP since May 2003. In that time, I've had five pregnancies. Four were planned (3 births, 1 miscarriage) and 1 was unplanned (miscarriage). During the time of the unplanned pregnancy, I was going through a stressful time (had quit my job w/ a verbally abusive boss and had just started a new one) and was charting rather sloppily. I can't say we were all that surprised when the pregnancy test was positive, even though s/he was 'unplanned'. Still, we were devastated when we lost him/her. S/he was unplanned but not unwanted.

  72. Leila--This is so helpful--such a great resource! I googled NFP Baby days, and you popped up--so since I kind of "know" you, I picked you! We are nursing (pumping because of special needs) and because of those special needs/surgeries it would be extremely hard at this time to conceive but with NFP, at least if we do end up getting pregnant, it is part of God's plan, and with God's plan there must be faith and trust that all will be ok.

    We've been "doing it" on the first day of fertile days after menstrating, which for me is about 6 days after and those fertile days last for about 6 days. It's a hard time to abstain, because it's when I want it most. Anyway I just had to check the "rules" we've been using it on and off for so many years, this is a great resource for a refresher! I guess after reading this, we shouldn't be doing that if we don't want to conceive right now. Oops. That's where the trust comes in. Thank you so much!


  73. Well, I wasn't married until I was almost 41 and hubby was almost 43. We have always been open to life. We hoped and prayed to be able to have children, but I guess it's not God's will for us. I still feel sad about it. I really hoped and prayed to be able to have children. I was diagnosed with endometriosis stage four eight months after getting married at age 41 and had to endure two surgeries. I was seeing an excellent Napro doctor for awhile, but then Hubby told him that we "weren't interested in fertility anymore." which wasn't exactly true - I'm still hoping and praying for a miracle! There are no Napro or Catholic pro-life MDS/GYNs around here. I did have to go see a secular GYN who was very nice, BUT she wanted to put me on Lupron or recommended a hysterectomy due to the endometriosis. She told me because of the endo I am in danger of developing ovarian cancer (All you have to do is mention the "C" word to me and I'm done - months before my first surgery the doctors kept telling me they didn't know if the cysts on my ovaries were Cancer and I'd sit there and cry while praying my rosary begging God and the Blessed Mother to please save my ovaries and fertility. It caused extreme anxiety! You see, my beloved Nana died from colon cancer and it was horrible seeing her suffer like that and wither away.). So now I'm scared of developing ovarian cancer, thanks to this doctor and my mother in law who was a Nurse (I haven't met her yet). Is it true having a hysterectomy is against the Catholic church? Would it be a sin for me to have this surgery for medical reasons? It certainly would not be to prevent new life. That has never been my intention and never will be. This endometriosis causes a lot of pain though, but in reality because I'm 46 now, my cycles are NOT as horrible as they were when I was younger.

    Because I can't have children, I've often wondered why and what God wants me to do. I've wondered - what is my purpose? Well, the other night my husband had this amazing dream where the Blessed Mother told him that I am a "Prayer Warrior for the Unborn and for women who have difficulty having children." I really LOVED LOVED LOVED hearing about this. Also Hubby says the Blessed Mother said in the dream: "Maria, can be very persistent, can't she?" Hearing all this really encouraged me and made me so happy! I really needed to hear this!

    I've just felt so sad over the years wanting a child and trying to do everything I can (within the Catholic Church's teachings) to be able to have one. I've been told by relatives and doctors that I need to be on birth control and try IVF. I told them "No." I was offered by my best friend's neice that she was willing to be a surrogate for me. I had to tell her "No" and explain to her gently why, which was difficult. It is very very difficult to want something so much (Motherhood) and be unable to obtain it. I've apologized to my husband over and over for being unable to give him any children. I've cried buckets over not being able to have any children. I still don't understand why the answer looks to be "No". Maybe I'm supposed to offer up this pain and suffering to save other souls? To help end abortion? Bring souls out of purgatory (Hubby was told in his dream my Dad who died in 2002 was in Purgatory and my suffering was to be used to help Dad reach Heaven!)? Maybe that's why. I don't know.

    All I know is that I will never do anything that will cause me or the hubby to lose our souls and heaven, even if we are never blessed with a child.

    All of you who are blessed to be Mothers - you are very blessed! You all are in my prayers!

    May God Bless us all.

  74. Maria, I am so sorry for your suffering! I have followed your story through the years, and I thought I had told you before that you may definitely have a hysterectomy for medical reasons! Yes, it's entirely licit. My own sister had one for her medical issues. A pathology can be treated, for sure.

    Adoption seems to be the "glaring" answer to your desire for motherhood. I am sure there are many waiting children who would love to be in a family! Please consider it! You could start as a foster mom, even.

    I will pray for you, Maria!

  75. Help! I am struggling with NFP because I am currently breastfeeding an 11 month old and have no sign of menses in the past two years. Does anyone have any advice on how to track fertility while breastfeeding?? - 25 year old mother of two : )

    I am so grateful for experienced mothers letting me know about the motherhood tunnel! It is very hope inspiring. :D

  76. Hi Catholicrose! You should get in touch with an NFP teacher in your diocese (or through Couple to Couple League if you can't find one in your area), and they will be able to walk you through those circumstances. There are special rules for breastfeeding and menopause, which are very helpful and equally effective! :)

    God bless you!

  77. Leila, would you mind if I used some of the information, graphics, and resources in this post on my blog?

    I have been wanting to write a post on how to practice NFP for some time. (My wife and I use NFP and I want the world to know how amazing it is!)

    Please let me know.
    And if you want to check it out, my blog can be found here:

  78. Hi Taylor! I'm the author of this post, but I would be happy if these graphics/information got more use so please do use them! Just please reference my blog/the original source for whatever you use. Thanks!

  79. Taylor, as long as you link back to this post, that would be fine! :)

  80. I just wanted to say I am glad to know I'm not alone. Well, not that it is a fun place to be! But I share the problem of not seeming to have many dry days! I was trained in the Billings Ovulation Method by a Catholic couple (the man was a doctor, too). I went back to meet with them a couple times but never really felt confident in my charting. Never understood when to use the yellow baby. Read the instructions over and over. Bought the hard-to-find book over the internet. Thumbed through that. Just felt helpless. I talked to priests about it. Got completely mixed reactions. Don't live near my teachers anymore. Stopped charting. Recently read about a "2 day Method" of NFP which sounded so much easier... just observe if you are dry... don't worry about the other details. ("Am I dry today? Was I dry yesterday?) WELL I have been monitoring for weeks now and even the days I feel dry I find mucus so I don't think they count as dry days. UGH!! SO FRUSTRATING. Hubby wants kid #2 right away. I want to wait. I don't know how to find a teacher for the 2 day method though it's starting to sound just as hopeless as the others.

  81. This is very good information a really nice blog. keep it up!!!
    family planning orange county

  82. Hi, Leila!

    I found your blog a couple of years ago, loved it, read almost everything, then forgot about it! I was looking through my bookmarks yesterday for something else and found it again. LOVE the post comparing the popes! I feel exactly the same way. =)

    I read your post about NFP and I thought I would write to let you know about another resource you might be interested in if you ever do a follow-up post. I noticed a few comments expressing difficulty with mucus-only methods and some questions about the return of fertility after childbirth while breast-feeding. Also I saw someone refer to ecological breastfeeding as "no bottles or pacifiers", as you probably know, there is a lot more to it than that!

    Anyway, is the website started by John and Sheila Kippley (the founders of The Couple to Couple League) after their forced separation from the Couple to Couple League. They offer full instruction in all of the readily observable signs of fertility including mucus, the cervix and temperatures, so that you can make an informed choice as to which are most helpful to you.. They offer free, downloadable charts and a printable version of the entire manual is downloadable for free from the website (although they ask that you consider a $10 donation, if you are financially able to). Sheila's book Breastfeeding and Natural Child Spacing is an excellent explanation of attachment-style parenting and the ecological breastfeeding that goes with it and the natural infertility it provides. John Kippley's book Sex and the Marriage Covenant is a beautiful, easy to understand explanation of God's plan for marriage.

    The website has tons of great information to deepen your understanding of and appreciation for our God-given gift of fertility and the purpose of marriage.

    God bless you and yours and thank you so much for your uplifting and informative blog!



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