Natural Methods

The most effective methods of fertility control are those in which sexual intercourse is avoided entirely. Abstinence is defined as a limited period of time in which intercourse is avoided, while celibacy refers to a lifestyle decision in which an individual chooses to avoid intercourse for a longer time interval, which may be lifelong in some cases.

Fertility awareness methods are those in which sexually active individuals avoid unprotected intercourse during the

"fertile period," which is defined as the time in each cycle that ovulation is estimated to occur. Since the ovum survives for about 48 hours after ovulation and sperm can survive in the fallopian tubes for up to five days, the length of the fertile period is about seven days in most women. Couples who practice the fertility awareness method use a barrier method of contraception with intercourse during the fertile period and no method for the remainder of the cycle. In the "natural family planning" technique, a variant of fertility awareness, intercourse is avoided entirely during the fertile period and mechanical contraceptive methods are not used at any time in the cycle. The latter approach generally is endorsed by religious groups who object to the use of other birth-control methods, which they consider to be "artificial" in nature.

Four techniques, which can be used alone or in combination, are used to estimate the fertile period.

• The calendar method, in which previous menstrual cycling patterns are charted and from which future ovulatory patterns may be predicted. This method is comparatively inaccurate, as factors such as stress or illness can affect the time of ovulation and thereby shorten or lengthen a given cycle. In addition, many women have such variable cycle lengths that the estimated duration of the fertile period can be as long as two weeks.

• The basal body charting or temperature method, which is based upon the fact that a woman's basal temperature will increase by 0.5° to 1.0°F twelve to twenty-four hours after ovulation and will remain elevated until the next menstrual period. Women using this method are expected to check their temperature each morning upon arising until the temperature rise has been confirmed. Once two days have passed after the temperature rise, the fertile period is considered to be completed, and unprotected intercourse can resume until the next menstrual period.

• The cervical mucus method, also called the "Billings" or "ovulation" method, which relies upon the fact that a woman's cervical mucus becomes copious and watery in the few days before ovulation. The presence of characteristic mucus at the vaginal opening is a sign of impending ovulation and, hence, defines the existence of the fertile period.

• The sympto-thermal method uses a combination of two or more of the above techniques. The use of the cervical mucus to signal the beginning of the fertile period and the basal body temperature rise to predict its completion is the most accurate of the fertility awareness methods.

The effectiveness of the fertility awareness methods depends upon the couple's consistency of use and ability to avoid unprotected intercourse during the fertile period. When practiced correctly and consistently, the sympto-thermal method has a failure rate as low as two failures per one hundred women per year, while for the typical use failure rate for all methods of periodic abstinence is twenty pregnancies per one hundred women per year.

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