NFPS-852 Fertility File 20

‘Understanding Our Fertility‘

Once love and marriage inevitably led to babies. Now reproductive technologies offer us an overwhelming range of services and statistics to help us make our decisions.

But how informed are these decisions and how much do we lack basic information about fertility and ways it may be controlled or damaged?

This seminar explores the central role of fertility awareness education as a basis for understanding reproductive health.

Fertility control - Family planning choices on offer.

Fertility Awareness - To achieve or avoid pregnancy.

Fertility monitoring - Future technologies

How fertile are we? - Is there a right time to have a child?

Wishes, plans and excuses - Do couples really plan their families?

UNDERSTANDING OUR FERTILITY
a presentation at

Dr Cecilia Pyper & Jane Knight

Saturday 13^th April, 1996

Couples who understand about fertility are in a stronger position to make informed decisions about how they wish to manage their reproductive health. For example fertility education is used to help a couple:

Achieve a pregnancy, especially if they are having difficulty conceiving.

Understand how each method of family planning works, how the method will fail if not used correctly, and how soon fertility returns when the method is discontinued.

Avoid getting pregnant by using a natural method of family planning.

Understand that a woman who is fully breast-feeding her baby has significantly reduced fertility.

Understand that fertility declines as women age and couples reduce their chances of having a family if they postpone having children for too long.

Understand that sexually transmitted diseases may cause infertility.

Understand male sub-fertility and infertility.

Research has shown that the timing of sexual intercourse in relation to ovulation strongly influences the chance of conception. Conception only occurs during a six day interval that ends on the estimated day of ovulation and falls to zero 24 hours after ovulation. Research has also confirmed that women are able to accurately identify the fertile time by observation of the alterations in cervical secretions and recording the rise in basal body or waking temperature.

Research on the levels of hormone metabolites in the urine has shown they are accurate in predicting the time of ovulation. This has led on to the development of a new method of contraception using simple urine tests which are read by a small hand held monitor to indicate the days when a woman can enjoy making love without using contraceptives. The device is currently on trial in three European countries including UK.

In Europe an increasing number of couples are choosing natural family planning for ideological reasons, wanting a method of family planning that is both "gadget" and "chemical" free. Research has shown that natural methods of family planning are very effective at preventing pregnancy, provided couples are taught by experienced teachers and are sufficiently motivated to keep to the guidelines. Until recently many of these couples gained information from friends or books and had no formal instruction. Many family planning clinics now include natural family planning teaching alongside other methods of family planning.

All user-dependent methods such as the pill, natural family planning, diaphragm or condoms, rely on couples making decisions whether to use the method or not. Many couples are ambivalent about using family planning methods as well as being ambivalent about whether or when they want to have children. If starting a family means putting your career on hold, cementing your relationship, permanently changing your way of life, in other words turning your world upside down, how does anyone decide the right time, or is risk taking behaviour a way that many couples get around to having their family?

Couples who understand their fertility are in a stronger position to make informed decisions about their family planning dilemmas, and to understand the likelihood of their risk taking behaviour leading to a pregnancy.

SCIENTIFIC REFERENCES
REFERENCES TO RESEARCH PAPERS ON FERTILITY AWARENESS AND NFP
1.	Clubb, E.M. Knight, J.	'Fertility' -Fertility awareness and natural family planning. (David & Charles, third edition ISBN 0 7153 0424 0) 1996
2.	Howie, P.	‘Natural regulation of fertility‘, British Medical Bulletin, Vol 49. No 1, ppl82-199 1993
3.	Graham, Gosling, France.	‘An evaluation of teaching cervical mucus symptoms to ovulating infertile women‘, Australian and New Zealand Journal of Obstetrics and Gynaecology 1983
4.	Clubb, E.M., Pyper, C.M. Knight, J.	‘A pilot study on teaching natural family planning in general practice‘ NFP-Current knowledge and new strategies for the 1990‘s. Part one supplement to the American Journal of Obstetrics and Gynecology. 1990
5.	Vessey, Martin, Smith Yeates,	Oxford, FPA study ‘Return of fertility after discontinuance of oral contraceptives - influence of age and parity‘, British Journal of Family Planning, 1986,Volll,ppl20-40
6.	Germain A., Holmes K., Piot P., Wasserheit J.,	Reproductive Tract Infection - Global Impact and priorities for women's health. Part III Sexual behaviour as a risk factor for sexually transmitted diseases. Written by Aral S. International Women's Health Coalition. NY ISBN 0-306-44241-8
7.	Collins, W.P., Branch, C. et al.	‘Biochemical indices of the fertile period in women‘, International Journal of Fertility, 1981 26 (3), pp 196-202
8.	Perez, A., Labbok, M. Queenan, J.	‘Clinical study of the lactational amenorrhoea method for family planning‘, Lancet 1992,339,pp968-70
9.	Consensus Statement.	‘Breast-feeding as a Family Planning Method‘, Lancet Nov, 1988, ppl204-5
10.	Gross, B.	‘Breastfeeding and the return of fertility‘ Endocrine Unit, Department of Medicine, Westmead Centre, NSW, Australia, 1983
11.	Flynn, Docker, Morris, Lynch Roberts.	‘The reliability of women‘s subjective assessment of the fertile period, relative to urinary gonadotrophins and follicular ultrasonic measurements during the menstrual cycle‘, Research in Family Planning 1983
13.	Weinberg Wilcox.	‘Using the ratio of urinary oestrogen and progesterone metabolites to estimate day of ovulation‘, Statistics in medicine, lO,pp255-66.
14.	Wilcox A., Weinberg C., Baird D.,	‘Timing of sexual intercourse in relation to ovulation. Effects on probability of conception, survival of the pregnancy and sex of the baby.‘ The New England Journal of Medicine, Volume 333, No. 23 Dec. 7^th 1995.
15.	Frank-Herman, P, Freundl, et al.	‘Effectiveness and acceptability of the sympto-thermal method of natural family planning in Germany‘, American Journal of Obstetrics and Gynecology. 1991,165, pp 2052-4
16.	Freely, Maureen, Pyper, Celia.	Pandora‘s Clock (Cedar Press, 1994)

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