Fertility-Awareness-Based Methods as a Vital Tool of Restorative Reproductive Medicine
Most people who have heard of Fertility Awareness Based Methods (FABMs) think of them as an ethical way to space pregnancies rather than as a precious tool for overcoming infertility. They were originally created for that purpose, and the general term used at first, natural family planning methods (NFP), reinforced this perspective. In fact, FABMs such as the Billings Ovulation Method, Creighton Model FertilityCare System, or Sympto-thermal Sensiplan, are scientific methods used to monitor and interpret biological signs of female fertility during the menstrual cycle. Because they are used to identify the “fertile window” days when a woman is close to ovulation and can alert clinicians to abnormalities in a woman’s monthly cycle, FABMs are integral to restorative reproductive medicine (RRM) efforts to diagnose the root causes of infertility.
A comprehensive review article by Marguerite Duane, Joseph Stanford, Christina Porucznik, and Pilar Vigil entitled, Fertility Awareness-Based Methods for Women’s Health and Family Planning, published in Frontiers in Medicine does an excellent job pointing out the ways that “physicians can use the information from FABM charts to guide the diagnosis and management of medical conditions and to support or restore healthy function of the reproductive and endocrine systems, using a restorative reproductive medical (RRM) approach.” It is of the first importance to scientifically understand a particular woman’s menstrual cycle if she suffers from subfertility or infertility. The authors pointed to studies that suggest charting using FABMs can lead to the diagnosis of such conditions as polycystic ovarian syndrome, endometriosis, or hypothyroidism, etc. In fact, Duane et al. say informed tracking of the menstrual cycle is increasingly recognized as one of the “vital signs” of health for women by modern medicine.
FABMS or NFP methods are also credited with positively influencing the relationships of married couples, particularly by increasing communication between husbands and wives, and the basic body literacy of women. “One study of over 2500 sympto-thermal users found large majorities of women and men felt NFP improved their relationship and sex-life, and three-fourths of them were satisfied with how often they had sexual intercourse. Fully 95% of women reported using a natural method improved their body literacy.”
There is, however, a major challenge in a shockingly low amount of formal training in FABMs among medical professionals. One study found only 4% of US physicians had received such instruction. Only slightly more, 6%, had accurate knowledge about the perfect and typical use effectiveness of FABMs. Clearly, doctors who know nothing about FABMs are very unlikely to recommend them to their patients even if specifically asked for alternatives to in vitro fertilization (IVF). Fortunately, the article points out, continuing medical education in FABMs is now available from groups like the Billings Method Ovulation Association-USA, Fertility Appreciation Collaborative to Teach the Science (FACTS), Reproductive Health Research Institute (RHRI), NeoFertility, and the St. Paul VI Institute for the Study of Human Reproduction.
Couples who use FABMs to engage in fertility focused intercourse conceive children at much higher rates and more quickly than couples who do not. This simple means of increasing the chances of conception can help many suffering from subfertility. Unfortunately, it is very difficult to do randomized studies comparing RRM and the most common infertility interventions like IVF. Ethically informed couples with a strong moral understanding of the different interventions would not accept to be subjected to a different method than RRM which is “designed to identify and treat root causes of reproductive or hormonal dysfunction to restore the reproductive system to the way it is designed to function.
Duane et al also addressed the recent phenomenon of a huge increase in the number of “fertility apps” for cell phones and other mobile devices that women can use to track their menstrual cycles. They identified over 500 available for download, but the vast majority were “not concordant with evidence-based methods of fertility awareness.” This means there is a clear need to make educated choices regarding the best apps to download. There are even plans by app designers to apply artificial intelligence (AI) to the interpretation of physical signs in future fertility tracking apps.
The conclusion of Duane et al’s overview of FABMs affirms that charting the female menstrual cycle can be immensely helpful in identifying potential abnormalities and lead to an informed differential diagnosis of many female reproductive health problems. This can open up a wider range of options for those seeking to achieve pregnancy or even to postpone it. A key obstacle to success, however, is lack of knowledge of FABMs among physicians. Much more widespread medical education is required, but fortunately this is becoming easier to achieve all the time with more online options for learning becoming available.
Restorative reproductive medicine is an exciting and growing field of medicine. RRM is closely linked to advanced FABMs whose benefits go far beyond helping overcome infertility. Understanding the biological facts expressed in their own cycles empowers women and helps them to have a more holistic approach to reproductive health. This can lead to long-term health improvements as gynecological symptoms are often identified earlier and then treated more frequently and effectively. Given the modern phenomenon of increasing rates of infertility, it is interesting to see the growing importance of FABMs in helping couples diagnose female fertility problems and in achieving the conception of children.
Joseph Meaney received his PhD in bioethics from the Catholic University of the Sacred Heart in Rome. His doctoral program was founded by the late Elio Cardinal Sgreccia and linked to the medical school and Gemelli teaching hospital. His dissertation topic was Conscience and Health Care: A Bioethical Analysis. Dr. Meaney earned his master’s in Latin American studies, focusing on health care in Guatemala, from the University of Texas at Austin. He graduated from the University of Dallas with a BA in history and a concentration in international studies. The Benedict XVI Catholic University in Trujillo, Peru, awarded Dr. Meaney an honorary visiting professorship. The University of Dallas bestowed on him an honorary doctorate in Humane Letters in 2022.