|Working with couples who have infertility problems can be at times the most demanding part of an NFP practice and yet can be one of he most rewarding. The NFP teacher needs to be especially sensitive to the emotional, psychological, and spiritual needs of the couple at this time. For a couple to be fertile, there are a number of factors that should be present. Most people realize that for fertilization to occur, a sperm and an egg are necessary. However, much more is involved.
From the woman’s side, the hormonal balance necessary for ovulation is important. The fallopian tubes must be open and healthy to allow the sperm to reach the egg and for the fertilized egg (i.e., human embryo) to reach the uterus at the proper time. The endometrium must be healthy in that it must last long enough to be present when the developing embryo enters the uterine cavity and be thick enough to supply nourishment to it. Cervical mucus is also a very important component for supporting, filtering, and sustaining the sperm. On the man’s side, there must be an adequate number of healthy sperm to increase the chances that one sperm will be available to fertilize the egg. While a harmonious relationship with a spouse isn’t necessary for fertilization to occur, a child should have two parents, a mother and father, who are married to each other for support and nurturing as the best environment for his or her emotional and physical health. The child – the most vulnerable and weakest person in the equation – has a right to a mother an father who are married to each other.
A little over 15% of couples have problems getting pregnant. About half of these will get pregnant within 2 years without treatment. For those couples with persistent infertility, a cause will be found in 85-90% with about half eventually achieving pregnancy with conventional (conservative) treatment – without IVF. Untreated infertility will yield a pregnancy rate of around 20%.
The peak fertility range for a woman is from 17-28 years of age and decreases rapidly after the age of 35. In fact, a woman over 45 who has unprotected intercourse is less likely to get pregnant than a woman in her 20s on oral hormonal contraception. This fact is significant because many couples are postponing childbearing until their 30s.
Infertility can be assessed in two ways:
The first is a couple who have been unable to conceive within 1 year of engaging in random acts of unprotected intercourse. Second, because of the rapid drop in a woman’s fertility after the age of 35, the time frame in assessing infertility after that age is decreased to 6 months.
For a couple practicing NFP, who know when they are fertile, if they have not conceived after 6 months of focused intercourse during the fertile time, they are also considered infertile. This is based on studies that show 98% of couples of normal fertility will conceive within 6 months of focused intercourse, most of them within the first 3 months.
Infertility can be further divided into primary and secondary. In primary infertility, the woman has never taken a pregnancy to viability. In secondary infertility, the woman has delivered one or more children and is now having difficulty in becoming pregnant.
Observing and charting natural biological signs of fertility can be of great benefit for the couple who has infertility problems. First of all the NFP chart can indicate why the couple might be having infertility problems.
A monophasic chart (i.e., one with no temperature shift) or a chart with no ClearBlue fertility monitor Peak (i.e., LH surge) might indicate that the woman is not ovulating. A ClearBlue chart that shows no High days might also indicate that there are low levels of estrogen being manufactured by the ovaries and, thus, poor follicular development.
Since a fertilized egg takes from 6-9 days to travel the length of the fallopian tubes, reach the uterine cavity and implant, a luteal phase of less than 9 days could result in infertility. A NFP cart that shows less than a 9-day post-peak or post-temperature shift phase could indicate a luteal phase deficiency.
The NFP chart could also reveal a lot about intercourse patterns that have little probability for achieving a pregnancy. If the couple (who is not charting) is following the usual advice of focusing intercourse around the 10-14th day of the cycle, but the woman is not ovulating at that time because of a short or long cycle, then conception will not occur. Likewise, if a couple is charting and know their fertile window but are not having intercourse during that time or on the optimal two days before ovulation then conception will not be likely.
Charting will also show the quality and quantity of cervical mucus, whether it is present or absent, how long the fertile time lasts, or if peak type mucus (i.e., mucus that is clear, stretchy, and slippery) is present or not. Absence or diminished fertile mucus may be the result of low hormone levels and anovulation or poor ovulation.
If any of these signs last 3 or more cycles, the woman should be referred for medical advice.
Thus, the infertile couple, by observing and charting their fertile signs, can learn and understand more about the days of fertility and infertility. They can have a better idea if the woman is ovulating or not. They can see if they are having intercourse at the appropriate time. They can know that the best chance of conceiving is by having intercourse at the time of greatest quality and quantity of cervical mucus and on the high and peak days indicated by the ClearBlue Easy Fertility monitor.
NFP is invaluable in infertility workups. Forty percent of infertility is due to the wife's reproductive system, 40% to the husband's, and 20% is due to a combination of both. Physicians who do infertility workups will essentially want to know whether the woman is ovulating, whether she has good cervical mucus, and whether the passage for the sperm to get to the egg is open. They also need to know whether the husband has adequate sperm.
There are some advantages of using NFP for medical management infertility. If the couple learns how to chart their fertility signs (e.g., using the Marquette method) then the physician will know better when to draw some hormone tests such as FSH, LH, Prolactin and thyroid tests. With the Clearplan Easy fertility monitor the physician will know when ovulation is actually occurring so serum progesterone levels can be drawn at the appropriate time.
If the woman has to go on a fertility drug to induce ovulation, her mucus can be observed and if it is not adequate mucus enhancers such as Humabid and Ampicillin can be used to thin the mucus starting 5 days before ovulation. Time is not wasted and accurate information is obtained with monitoring temperature, cervical mucus and urinary hormones with the ClearBlue fertility monitor.