Using Ovulation Tests for Family Planning
Curious about different methods of family planning and whether ovulation tests may be helpful in achieving your goals? OBGYN Dr. Mare explains how ovulation tests can be used to either achieve or avoid pregnancy.
There are so many ways to go about planning to start your family. The traditional method of family planning is the one that employs some sort of birth control — whether that be pills, an IUD or another option — until a person desires pregnancy, at which point they would discontinue using it. For some women, however, birth control is not what they may want for various reasons. For these women, natural family planning using fertility awareness methods (FAMs) are the next best way to plan for a pregnancy.
While fertility awareness methods are most often used to help with achieving pregnancy, they can also be used to help prevent pregnancy when it’s not the right time. There are several different methods under the FAM umbrella that all work by predicting when ovulation will occur.
Fertility awareness is based on our knowledge that a woman can only get pregnant by having unprotected intercourse during the fertile window. So, if FAMs are being used to get pregnant, you want to have intercourse during that window. If FAMs are being used to prevent pregnancy, then unprotected intercourse would be avoided during that time (or a barrier method would need to be used). When used correctly all the time (aka perfect use), FAMs are up to 99% effective at preventing pregnancy. However, in real life, where these methods aren’t always used exactly as directed (aka typical use), effectiveness can drop as low as 76%.
FAMs can be great for people who want to avoid clinical interventions (like hormones, devices, or procedures) and are willing to put in a little time and effort to understand and control their fertility. They can also be very cheap depending on the method you use. There are a few different ways to use fertility awareness including:
Tracking basal body temperature (BBT): a person’s body temperature rises about 0.5–1 degrees F (0.3–0.6 degrees Celsius) at the beginning of the luteal phase (i.e. the second half of their cycle, after ovulation). Since this rise happens after ovulation has already occurred, BBT is not considered a reliable contraceptive method when used alone. However, tracking the BBT rise for several months can help someone predict when they might ovulate in upcoming cycles.
Monitoring cervical mucus: we know cervical mucus changes throughout the menstrual cycle in response to estrogen and progesterone. Mucus increases in amount when a person is approaching ovulation or is ovulating. Cervical mucus that looks like egg whites usually suggests that ovulation has occurred within the last day or is about to occur soon. In contrast, thicker, clumpier mucus usually means ovulation has already occurred.
Tracking your menstrual cycle: using an app or a calendar. There are several sub-categories here including the rhythm or standard days methods.
Tracking your ovulation: this is the one we’ll be delving into today. This method depends on ovulation predictor kits (OPKs) which use urine to monitor for a spike in luteinizing hormone (LH). LH usually spikes somewhere within 24 hours before ovulation. See this previous piece to learn more about how they work.
OPKs for family planning
So how can you use OPKs for family planning? They can be used both for avoiding or achieving pregnancy.
In terms of avoiding pregnancy, OPKs can sometimes fall short because the results may not give enough advance warning to avoid the entire fertile period. For many people, the LH surge doesn’t happen until some time into the fertile window, so an OPK won’t become positive until then. This increases the risk of failure (pregnancy) if someone has unprotected intercourse in the time between when the fertile window begins and when the surge happens. However, this limitation can be mitigated by combining OPKs with one or more of the other FAMs (i.e., monitoring BBT or cervical mucus).
When trying to achieve pregnancy, there’s a little more leeway — intercourse even before an ovulation test is positive is encouraged because we know the fertile window usually starts before the LH surge.
For both avoiding and achieving pregnancy, tracking your ovulation with an OPK will improve after you’ve done it a few times — usually three to six months — as this allows you to become more familiar with your cycle, which in turn means you can better predict when your fertile window is.
The main drawback to using FAMs for family planning is that they do not protect against sexually transmitted infections (STIs). Barrier methods are recommended for those who may be concerned about that risk. In addition, some FAMs are not as effective if a person’s menstrual cycles aren’t regular or in the immediate postpartum period.
Finally, it’s important to realize that for these methods to be most successful, you must be willing and able to use them exactly as directed each time. If that seems like it will become too much of a hassle for you, this may not be the right option for you. You can always talk to your doctor about what other methods might be better suited to your lifestyle.
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