Monday, January 11, 2010

How To Use LH Tests

We've established that identifying ovulation is the key to NFP success, but how do we go about doing that? Other methods of NFP recommend tracking all sorts of things like basal body temperature, the position of the cervix, quality of cervical mucus, etc. My advice is to use whatever information is helpful to you. I could never remember to take my temperature, found it really tricky to ascertain just what my cervix was up to, and the nursing woman may not have any cervical mucus(prolactin dries it up). I can attest to the fact that, so long as I was pumping milk for Jack, I had no physical indicators of fertility and had to rely solely on tests. These tests. The ones I ordered off Amazon. There is also the Clear Blue Easy ovulation monitor(which I've used), but it's expensive and it requires the presence of a regular cycle. With the tests I use now, you can test at anytime, with or without a cycle of any kind, even right after having a baby.
They come with handy instructions printed on each little test. Hold the stick in the urine stream for five seconds, or collect a urine sample in a disposable cup and follow the instructions on the test.

Interpreting the results of the test strip can take some getting used so, since it's a little different than using a pregnancy test. In the above picture, the strip on the top is negative for LH. The strip on the bottom is positive for LH. A positive LH test means that the LH Surge has begun and I will ovulate within 24-72 hours. Now that my cycles have normalized, my LH Surge lasts about 24 hours. While I was still nursing Matteas, my LH Surge was sometimes as long as 72 hours. That meant that I might not ovulate until three days after getting a positive LH test.
And now, a close-up. Here's how it works: the pink line on the right(the one closest to the green strip with the letters 'LH' on it)is the "control line." That line shows up no matter what, even if all you do is dip the strip in water. It's for comparison.

The line that's really important is the one next to the control line, the one to the left of the control line. Depending on when in your cycle you test, you may or may not see this line show up. It's mere presence doesn't indicate a positive test; it needs to be darker than or as dark as the control line. If you did one of these tests everyday after your period, you'd most likely see something like this:

Day 7: control line only(negative LH test)

Day 8: control line only(negative LH test)

Day 9: control line only(negative LH test)

Day 10: control line only(negative LH test)

Day 11: control line and very faint test line(negative LH test)

Day 12: control line and faint test line, test line a little stronger than day 11(negative LH test)

Day 13: control line and very dark test line, test line being as dark as or darker than control line(this is a positive LH test)

Day 14: control line and very dark test line, test line being as dark as or darker than control line(still positive)

Day 15: control line and test line growing faint, test line no longer as dark as control line(negative LH test)

That's just a possibility; you may only get one positive test and the test line may fade gradually or rapidly. It will seem confusing at first, but you'll get used to it.

Some Things I Recommend
Keep a calendar. Write everything down. Symptoms, lack of symptoms, when you have sex, any possible symptoms of ovulation. Even if your husband looks extra cute, write that down. You might think nothing of it at the time, but if a few weeks down the road you get a positive pregnancy test, looking back over your notes you will say "Ohhhhh...."

So you've established a positive LH Surge, what now?

The 72-hour Method
For the beginner, I recommend that you continue testing until you get a negative LH test. Since the length of the LH Surge can vary(especially if you're breastfeeding), I recommend testing every 12 hours(once in the morning and once at night) after the first positive test. Next, it's time for some math. Numbers vary on the lifespan of an egg, and range from 12-48 hours. I like to use 48 hours so my bases are covered. Once you get a negative LH test(after establishing your LH Surge), start counting. Assume that you're going to ovulate for 48 hours. So if you get a positive LH test on Monday morning and a negative LH test on Tuesday morning, assume you're ovulating from Tuesday morning until Thursday morning. Then I like to add a 24 hour buffer, just to be safe, meaning don't have sex until Friday morning. I know women who cut it a little closer and haven't gotten pregnant, but it depends on how comfortable you are taking a risk. If you are absolutely committed to avoiding pregnancy(whatever your reason), I recommend using the 72-hour method described above. I've been using it for two years with 100% success.

Test regularly at the same time of dayFeel free to do additional tests in between, but try maintaining a regular testing time(first thing in the morning is generally easiest).

Investigate more than one method of NFP
A friend of mine identified ovulation and further, that she was pregnant using the Basal Body Temperature method. I like my tests, she likes her thermometer. Find something you feel comfortable using.

I've read this whole blog, and I'm still confused
E-mail me! I've spent years researching reproductive health and would be more than happy to share anything I've learned with you. Whether you are a veteran NFP user, just starting out, or simply have questions for a friend, I believe that sharing information is key to NFP success. My e-mail address is tirzahmounsey@gmail.com

The "Abnormal" Cycle

Once you get the hang of it, NFP is actually very easy to use with a normal 28-day cycle. However, my desire to practice NFP was due to the fact that I had tiny babies(three months and six months, respectively) and felt that my body wasn't ready to sustain another pregnancy yet. Most women I talk to have some kind of hormonal variable(breastfeeding being the most common) which affects the length and predictability of their cycles, making it more difficult to track ovulation. Jack had difficulty breastfeeding, so for six months I used a breast pump and fed him by bottle. I ovulated when he was three months old and it took another five months after that for me to have normal cycles. While I was still pumping, my cycles varied in length; one was 62 days long, with ovulation occurring on day 51. Fun times. Here's why:

Prolactin is a hormone produced by breastfeeding. It keeps estrogen levels low. The rise and fall of estrogen levels is what dictates menstrual cycles. Some women I know nurse on-demand, co-sleep, and otherwise do everything you're "supposed" to do to keep prolactin levels high and naturally prolong nursing-induced infertility, and lots of them get pregnant. Don't assume you're infertile just because you're breastfeeding. With Jack, I was pumping and not producing enough prolactin to ward off my cycle. Matteas was a champion nurser and I still got my cycle back when he was 6 months old. You never can tell.

There are lots of different philosophies on the most effective way to avoid pregnancy. I would like to state that the following information is what I found to be most effective for me. What works for you may be something different; if you have other tricks up your sleeve, by all means, share!

In a nutshell, here's my NFP routine: abstain from sex beginning on Day 1 of my cycle until three days after I ovulate. During a normal cycle, this works out to 17 consecutive days of abstinence and 11 days of being "in the clear(able to have sex without getting pregnant)." The keen observer may note that the ratio is weighted in favor of NOT having sex, to which I can only respond: quality, not quantity. Moving on...

On Having Sex Prior to Ovulation
The short answer is: don't do it. Certain methods(like Billings) of NFP claim that, when certain indicators are present, you can have sex prior to ovulation without getting pregnant. The reasoning behind this is that sperm can only survive for a few hours unless conditions are sperm-friendly. Sperm need an alkaline environment to survive, and the pH of a woman's vagina is typically very acidic. Vaginal pH shifts to alkaline prior to and during ovulation to allow sperm to survive for as long as possible. Theoretically, vaginal pH is too acidic for sperm to survive for the first 2-3 days immediately following menstruation. The theory is that even if you have sex on these days(which would correspond to approximately days 7-9 of your cycle) the sperm will not survive long enough to reach the uterus. In my experience, this is not the case. I know several women(myself included) who have become pregnant while using NFP: in every case, pregnancy resulted from having sex prior to ovulation.

On Having Sex During Menstruation
Again, the short answer is: don't do it.
Blood is very alkaline, making it possible to get pregnant if you have sex during your period. Sperm can survive just fine in blood, and once they reach a fallopian tube vaginal pH is no longer a factor. Further, prostaglandins in semen can trigger early ovulation. I know this because of Matteas; he is what we call our Six Day baby. Here comes too much information: we had sex on Day 5 of my cycle, while light spotting was still present. Six days later I had an appointment with my OB/GYN for a regular checkup. Upon examining me, she told me I was ovulating. That moment. On Day 11 of my cycle. I suspected as much, but I always appreciate professional confirmation. This tells me two things: sex during menstruation can indeed trigger early ovulation, and; sperm can survive just fine for at least 6 days.

So the bottom line is, for the greatest possible accuracy maintain complete abstinence until after ovulation.

Which brings me to my next topic: how do you know when you've ovulated?

Tuesday, December 1, 2009

The 28-day Cycle

It can be challenging to successfully use NFP even when a regular 28-day cycle is present, but a basic understanding of how things work under "normal" circumstances is helpful even if you're not there yet. Someday you will be. In the most basic terms, here's what happens: bleeding starts, shedding the lining of the uterus so a new one can be "built." This usually takes about a week, sometimes a little less. On day 14, an egg is released from an ovary. If conception does not take place, the egg dies within 24 hours and 14 days later bleeding occurs, starting the next cycle. NFP involves the observation of fertility indicators and either abstaining from sex to avoid pregnancy or using that information to achieve pregnancy.

In greater detail:

The Follicular Phase
Day 1
This is the first day of menstruation, the day you count all other days from. Normally, a woman's period lasts from 4-7 days. During this time, the body is producing Follicle Stimulating Hormone(FSH), which does exactly what it sounds like: it stimulates follicles(eggs) on an ovary. Every woman has two ovaries, but ovulation generally takes place on only one ovary at a time. During this time(bleeding), estrogen levels are at a steady low and don't fluctuate much. This is important to know if you are taking any kind of medication which affects estrogen levels(or even eating a lot of soy, which raises estrogen levels) because it will impact your cycle. On the last day of bleeding, estrogen levels begin to rise. They continue rising until they are high enough to trigger the release of Leutenizing Hormone(LH), an event called the LH Surge(the most important piece of information in NFP). The LH Surge can last 24-72 hours, and triggers ovulation. This is significant because the LH Surge can be detected using a simple at-home urine test and, in my opinion, is one of the only fool-proof indications of what your hormones are doing.

Let me stress: the LH Surge is NOT the same thing as ovulation, it precedes and triggers ovulation. These hormonal reactions are fast and sensitive; they change hourly. Once estrogen levels are high enough to trigger an LH Surge, there is no going back. The LH Surge proceeds until high enough levels of LH are reached to trigger ovulation. Within an hour of LH peaking, levels of LH begin to drop off and ovulation occurs. The decline of LH after a confirmed peak indicates ovulation has begun.

The Luteal Phase
(the portion of the menstrual cycle which begins with ovulation and ends with Day 1 of the next cycle, usually 14 days after ovulation)

Day 14(usually)
Ovulation occurs. An egg is released from an ovary and is viable for roughly 24 hours. If conception does not occur, the egg dies, estrogen levels decline and in 14 days another menstrual cycle begins.

So that's what normally happens. For more in-depth information, go here.

Monday, November 30, 2009

An Introduction

Hello, friends! My hope for this blog is that it will be a place people can come for information and support about Natural Family Planning. As any of you who have tried it know, it can be a tricky business and my own experience with NFP has been challenging to say the least. If you are uncomfortable with very explicit anatomical information, this blog is not for you. If, on the other hand, you are in search of as much information as possible, read on.

There are lots of reasons for using NFP. While some couples use it in order to conceive, my application of NFP has been entirely to avoid pregnancy. I am not a fertility expert and would probably be of little help to someone who is struggling to GET pregnant. Infertility is simply not within the scope of my experience.

I decided to start this blog because I have encountered a staggering amount of misinformation regarding fertility, especially fertility and breastfeeding. One of my major frustrations with much of the current literature on NFP is that it assumes a woman is having regular 28-day cycles and is not breastfeeding; in my experience, most women who desire to avoid becoming pregnant look into NFP because they have a young breastfeeding infant and therefore their cycles are often irregular and difficult to track. I was one of those women. Jack decided he really didn't want to breastfeed, so I pumped. When he was three months old, I ovulated. I know that some women would be open to the idea of having babies that close together, but I wasn't one of them. The reasons for avoiding pregnancy vary from couple to couple and are a private decision. What I will NOT do on this blog is discuss the moral validity of avoiding pregnancy. This blog is not a space for moral debate, just information and support. For obvious reasons I will allow anonymous comments but you can also feel free to e-mail me directly. If you e-mail an interesting question I may address it in a blog post, but I WILL NOT use your name unless you specifically tell me that's okay. I know it's a hard subject to talk about and you might think twice about leaving a comment, but I want to encourage dialogue here. I have had some invaluable conversations with some amazing women which contributed to my understanding of how NFP works and how to make it work for me, an understanding which would be far less rich without those conversations. Sharing has been a powerful tool in my journey to understanding NFP, and I want to welcome everyone's voice in this conversation.

I've decided to start with a brief overview of basic fertility and then move into discussing issues outside of what I'd call "basic" fertility, which I feel is where the greatest lack of information is. I'll start that in my next post, but in the meantime I'd welcome any questions anyone would like addressed. I might not know the answer, but I'm a relentless researcher and would be happy to provide that support for you. Don't be shy!