A wise man once said: Before you can hope to change things, you must first understand the way things are. Since beginning almost forty years ago as a fertility awareness or natural family planning (NFP) instructor, as well as consulting with thousands of women for a large NFP provider over the past thirteen years, it has become increasingly apparent that the “health” of women’s and men’s fertility has been compromised.
Couples are concerned because they are unable to have babies or they become frustrated when practicing NFP to avoid a pregnancy, because their fertility cycles are so irregular and the times of abstinence are inordinately long. It is correspondingly commonplace for women to suffer from premenstrual syndrome (PMS), polycystic ovarian syndrome (PCOS), ovarian cysts, heavy periods, endometriosis, menstrual cramps, acne and absence of periods. Men, too, share in this burden of fertility issues. Even a cursory review of comments taken from the scientific literature supports this observation:
• “Polycystic Ovarian Syndrome is the most common endocrine disorder among women of reproductive age.”1
• “PCOS has been known to be associated with irregular periods, infertility, increased pregnancy complications . . .”2
• “Endometriosis is a common gynecological condition affecting 10-15% of the female population.”3
• “Endometriosis is a chronic inflammatory disease, which is especially found in women with subfertility problems with an incidence of up to 30%.”4
• “The prevalence of endometriosis was 47% (104/221 women) in infertile women with normal ovulation and normospermic (normal sperm) partners.”5
• “An estimated 7 million American couples per year seek infertility care in the United States. A male factor contributes to 50% of cases. . .”6
It stands to reason that infertility in men and women nowadays is the result of our fast-paced, stressful culture, highly processed foods with inadequate nutrition and the long-term use of the pill for both birth control purposes and/or for most of those familiar, but abnormal fertility-related problems that cause women so much anxiety. Consider what direct damage the pill can do to women’s fertility: by changing the nature of the mucus-producing cells located in the cervix, thus affecting the proper type of mucus production critical for sperm migration and the ability to conceive,7 by depleting women’s bodies of several B vitamins (riboflavin, B6, B12 and folate), vitamin E and Coenzyme Q10,8 vitamin C, magnesium and zinc,9 all of which are necessary for healthy fertility, and by damaging the beneficial gut flora.10 These adverse changes do not include the well-known myriad of mild-to-severe health side effects such as a 40 percent increase in breast cancer in women who have not had a full-term pregnancy,11 stroke or even death. Men’s fertility is also affected by their exposure to toxic elements in the environment, including cell phone radiation.12,13
Healthy fertility is at a premium, it seems; more and more couples are faced with the sadness and concern that comes with the inability to conceive.
Indeed, infertility is widespread. Nonetheless, rather than leave couples stranded with their fertility concerns, this article will provide an overview of natural strategies to address these challenges, strategies that are consistent with the work of Weston A. Price, the Weston A. Price Foundation and my own experience. In order to accomplish this, however, it is essential to understand what healthy fertility is, so that readers will be better able to judge what constitutes unhealthy fertility. So let’s start with some fundamentals of human fertility and the techniques by which couples can monitor their own fertility.
Human Fertility
Anyone who is somewhat familiar with the inner workings of the human reproductive system must stand in awe of its intricacy and complexity, undoubtedly due to the Creator’s perfect design. From the time of puberty to old age, for example, a man’s reproductive system is capable of producing sperm (part of this perfect design), which means he is essentially fertile for many decades. On the other hand, the Creator’s design of a woman’s fertility manifests as waxing and waning cycles beginning at menarche (the onset of menses). A woman is born with all the immature ova or eggs (inside her ovaries) she will ever have, quite the opposite of a man’s capacity to produce sperm continuously from puberty onward.
The Female Cycle
Approximately once per month, one (or more) ova develop inside specialized sacs called follicles in the ovaries (see Figure 1). During this maturation process the follicle(s) also produces estrogen—the female hormone responsible for building up a nutrient-rich uterine ‘bed’ or lining for a possible fertilized egg to implant and for activating specialized cells in the cervical canal to produce mucus—a fluid necessary for promoting fertility. As time passes and the release of the egg (ovulation) becomes imminent, increasing estrogen production liquefies the mucus, making it more hospitable to sperm life.
To know whether ovulation is likely to occur, women observe a changing, developing pattern of mucus culminating in pronounced slippery or lubricative or watery, runny (very wet) sensations at the vulva, detected while moving about throughout the day or when wiping at bathroom visits. (“Fertility Cycle” example with mucus descriptions, page 33.) Women may also notice visible strings or eggwhite discharge during this time—another sign of higher estrogen production. The presence of this type of visible discharge is not, of itself, indicative of impending ovulation unless it appears as part of a changing pattern of mucus sensations over several days. Note in the same chart how the pattern of sensations and visible mucus changes from moist, thicker and sticky (less fertile) to wet, slippery and stringy (more fertile).
When the egg ruptures out of the ovary (ovulation), finger-like projections on the Fallopian tube capture the egg, permitting it to journey toward the uterus. If sperm are present, conception can occur in the outer one-third of the Fallopian tube, but only within twelve to twenty-four hours, as the egg survives for only twelve to twenty-four hours at most. At this same time a dramatic shift in hormone production occurs. The now-empty follicle (referred to as a corpus luteum) initiates a surge in progesterone production (the second important female hormone), which counteracts the effects caused by rising estrogen. Progesterone activates special areas in the vaginal walls (the Pockets of Shaw) that cause a dramatic drying-up sensation at the vulva and also turns off any further follicular development (and release of additional eggs) in that cycle. The changing pattern of mucus leading up to slippery sensations, followed by a dramatic drying-up sensation confirms the ovulatory event. Another substantial confirmation of ovulation is progesterone’s ability to warm the body, causing a rise in a woman’s waking (basal) temperature of roughly 0.4°F or more.
By monitoring the mucus and temperature signs, couples can then interpret these observations to apply rules for avoiding pregnancy that mirror the effectiveness the pill delivers, but without any health risks. In addition to knowledge of the fertile and infertile windows during the cycle, simple daily observations of the mucus and temperature signs provide an abundance of valuable information such as early detection of pregnancy, accurate due date calculations, insufficient thyroid function, progesterone deficiency, inadequate mucus quality and medication effects.
Fertility awareness becomes a special tool to open up conversations between the couple that otherwise might not take place—conversations like: “Is the time right for us to try to conceive?”; “We discussed before that we have an important reason to avoid pregnancy for the time being; we should avoid sexual relations during your fertile time. Do you still agree with this decision?”; “Honey, I noticed your cycle this time shows signs of progesterone deficiency. No wonder your PMS has skyrocketed. Let’s take a look at what can be done naturally to remedy this.”
These outward fertility signs have been known for over fifty years although refinements in the last thirty to forty years have improved the efficacy of modern NFP. When couples consider using NFP, they should be aware that modern NFP is a far-cry from the older calendar rhythm—the Model T of natural methods for family planning. Calendar rhythm uses previous historical cycle length data to “predict” the fertile and infertile times in future cycles. Quite obviously, this Model T method of family planning does not take into account the woman’s current fertility signs; therefore, it is highly ineffective for women who have variable cycle lengths. Couples, too, should be aware that many physicians lack knowledge in distinguishing the Model T version from the modern NFP version.
Both the mucus and temperature signs are important indicators for couples who wish to practice a natural method of family planning. To recognize their fertile and infertile times some NFP methods employ the mucus and temperature signs together (called sympto-thermal method) while others focus solely on one of these signs, typically the mucus sign (called the mucus-only method). A third sign, changes in the cervix, can also be monitored.
A Healthy Fertility Cycle
To appreciate what a healthy fertility cycle is like, take note of the following example, although others exist. (Fertility Cycle, page 33) On this chart a non-pregnant woman recorded her daily basal (waking) temperatures and brief descriptions of her mucus sensations (what she felt or sensed) and mucus characteristics (what she saw). A “P” was recorded on the last day of her slippery or very wet mucus sensations to denote Peak Day—most frequently the day of ovulation.
She also recorded her days of menstrual flow, the marker used to determine the start of a new cycle, and documented the length of her luteal phase (between ovulation and the next menstrual period, fourteen days for this cycle)—the number of days of higher temperatures (sympto-thermal NFP method)14 before the return of her next menstrual period. Mucus-Only NFP Methods determine luteal phase length by counting days after Peak Day before the return of the menstrual period.15 In this example both ways yield the same result; in other examples, they may not. Healthy luteal phases can be anywhere from twelve to sixteen days in length. In addition, the strength of the luteal phase may play a role in establishing the health of the cycle itself. “Strength” refers to whether the temperatures after Peak Day reach at least 0.4°F above the previous level and remain that high or higher until the end of the cycle (when menstruation returns). The temperatures rose around Peak Day and remained high for the duration of the cycle until menses returned. Temperatures under the influence of estrogen, during the first half of the cycle, are lower. Further, the overall level of the temperature pattern may indicate the strength of thyroid function; around 97.8° to 98.2° prior to ovulation and above 98.2° after ovulation are good. This cycle illustrates a healthy thyroid function.
Lastly, the overall pattern of mucus descriptions demonstrates that ovulation will occur (and has, in fact, occurred) as the woman observed several days of a changing pattern of mucus ending in slippery or very wet sensations, followed by a dramatic change in her sensation. Consider the fact that these descriptions of mucus communicate exactly what the woman observed. Had she recorded her mucus in a letter format to denote, for instance: “m” for damp, moist, or sticky sensations; “t” for tacky; “w” for wet; “sl” for slippery; “s” for stretchy, the exact pattern of mucus would have been more difficult to ascertain. Thus, descriptions enable the identification of an individual pattern. Patterns can be fertile or infertile, depending on the type, as not all vaginal discharges are signs of fertility. Proper instruction assists women in distinguishing infertile discharge patterns from mucus patterns that are signs of fertility. See the “Fascinating Fertility Facts” sidebar, page 36, for additional information.
Characteristics of an Unhealthy Fertility Cycle
Over the past twenty years I have noticed a striking increase in one or more of the following cycle traits I consider to be unhealthy:
• Poor quality mucus patterns, that is a limited number of days of mucus leading up to Peak Day; lack of a changing, developing pattern which would indicate a lack of impending ovulation.
• Long cycles of more than thirty-five to forty days.
• Short luteal phases of ten days or less—a sign of progesterone inadequacy, which means that the follicle didn’t mature correctly; this can cause miscarriage or inability to sustain pregnancy.
• Overall low basal temperatures—indicator for less-than-ideal thyroid function; low temperatures like 97.4° or below prior to Peak Day (ovulation) could cause problems with conception in some women, while in others it may not.
• Pre- and post-menstrual spotting—one or more days of light brown or light red spotting before the actual menstrual flow begins, or after the flow has ended.
• Erratic luteal phase temperatures that do not remain consistently high, but dip down to or below pre-ovulatory levels.
Likewise, other personal health issues directly related to hormonal imbalances have increased: PMS, PCOS, infertility, postpartum depression, anxiety, adrenal stress, under or overactive thyroid and others. No wonder women are concerned! Their overall lifestyle is adversely affected, and their ability to conceive or sustain a pregnancy is compromised.
In Pursuit of Healthy Fertility Naturally In addition to long-term use of the pill, which has deleterious effects on women’s hormonal balance, gut flora and well-being, other modern factors that contribute to unhealthy cycles include inadequate nutrition and toxicity.
Nutritional deficiency results from inadequate intake of nutrient-dense foods containing the essential fertility vitamins (A, D, E, K) and many important minerals such as magnesium, calcium, iodine and others. In his travels around the globe Dr. Weston Price found that primitive (not ignorant) peoples knew this maxim well. They knew it so well that these cultures required a special period of eating “sacred” foods high in nutrients, including organ meats, certain types of seafood, fish eggs, pastured butter, cream and animal fats, before conceiving in order to ensure perfect babies. These foods are high in cholesterol and vitamin A, both necessary for production of sex hormones, conception and pregnancy. The important work of creating healthy babies was not left to chance, or relegated to synthetic vitamins and minerals in a prenatal pill.
Couples today face the added complications of a plethora of foods that are rancid, processed, prefabricated and extruded, laden with additives, preservatives and synthetic vitamins, full of refined sweeteners (or artificial sweeteners) and caffeine, and carrying GMOs, antibiotics and chemical sprays.
But nutritional deficiency today can also be caused by a person’s inability to digest or assimilate even nutrient-dense foods. Nutrient-dense food intake does not necessarily equal nutrient-dense assimilation. Consequently, my consultation strategy encourages people who display digestive symptoms to adopt an eating program that addresses this first. For example, allergies or sensitivities to dairy or gluten affect which foods to consume; yet to obtain nutrients present in those types of foods, one must consume alternative foods that contain these nutrients. Foods such as bone broth can be a great alternative, although bone broth cannot compare with milk products as a source of calcium.
Tackling both nutritional deficiencies and toxicity may seem overwhelming and impossible. Realize though that the human body has an enormous capacity to heal if given the right tools. Our bodies have highly developed systems for detoxification and regeneration. Many couples have restored their cycles and fertility through natural means. With regard to toxicity, becoming aware of toxins, and taking actions to minimize or avoid exposure to them constitute important first steps.
To become aware of the types of toxins in our environment, Dr. Mark Schauss’ article “Toxicity and Chronic Illness” in the Spring 2015 issue of Wise Traditions is a must-read, or re-read. Around your house the most important culprits are likely to be phthalates, xylene and Bisphenol-A (BPA) with its sidekicks—BPS or BPF. Phthalates are found in plastics, personal care products and air fresheners (such as plug-in types and dryer sheets) that use heat to release the aroma. They are notorious for depressing testosterone production and have been implicated in miscarriages and birth defects.16
Xylene is a petroleum-derived chemical found in multiple places: air fresheners, adhesives in carpets, nail polishes and cigarette smoke.17 Well-known as a carcinogen and nerve toxin, it also has a reputation for increasing miscarriages and birth defects. BPA is found in hard plastic bottles, linings in canned foods and store receipts.18 It too is quite ubiquitous in our homes and is easily absorbed through the skin and inhaled. Note that many companies now claim their products are BPA-free. Don’t be fooled, however, because these companies are probably replacing BPA with BPS or BPF, with almost no testing. These substitute chemicals could be just as toxic, or possibly more so. The best advice is avoidance. Discover where to find toxins in household products and safe alternatives from the Environmental Working Group (ewg.org). Another good resource is Dying to Look Good—The Disturbing Truth About What’s Really in Your Cosmetics, Toiletries and Personal Care Products…and What You Can Do About It by Christine Hoza Farlow, DC (dyingtolookgood.com).
With toxicity as an additional piece to the mystery behind fertility issues, women (or couples) have an opportunity to accelerate their healing by integrating gentle detoxification strategies. Kim Schuette, CN, explained many of these in detail in Wise Traditions (Spring 2015). Personally, I have found detox foot (or tub) baths, alternately using plain Epsom salts, baking soda and organic apple cider vinegar, as well as consuming beet kvass, to fit my lifestyle best.
Next, seek out training in fertility awareness so you can assess your own fertility status. There are many NFP providers and NFP apps available. However, only a few such providers are knowledgeable of all possible patterns of fertility and infertility. The authentic Billings Ovulation Method (BOMA)—a Mucus-Only Method—(boma-usa.com) is one of those providers. My practice also incorporates this information (wisefertilitychoices.com).
NFP apps abound and many couples like to use them for tracking and interpreting their fertility signs. Most are easy to use if women have regular cycles; longer cycles or different patterns of discharge typically are not recognized and interpreted. Thus couples having these patterns who wish to avoid pregnancy will have longer periods of abstinence. Usually, women need first to have NFP instruction before successfully utilizing NFP apps.
A final step would be to implement a plan that’s right for you. Engaging the assistance of a well-trained and experienced consultant in fertility awareness and nutrition may be worthwhile.
Testimonials
When Kaylene Reinker, now Gleason, from California contacted me with a diagnosis of PCOS and her doctor’s recommendation to take a drug for insulin resistance, she was adamant not to travel down the drug path. She wanted to heal herself naturally. (See her testimonial below.)
Kaylene was able to reverse her PCOS by implementing a modification of a gut-healing program that fit her lifestyle—a program she liked and could follow. Conditions like PCOS take a long time to reverse; one to two years is not uncommon. So I would expect Kaylene to see further improvements if she continues with her present program.
As confirmed by NFP instructors and NFP users I have worked with, the practice of NFP can also be highly satisfactory with excellent fertility awareness instruction along with adequate nutrition advice.
Others have achieved pregnancy after years of infertility, or succeeded in avoiding pregnancy with minimal abstinence.
HEALTHY FERTILITY
A comprehensive approach to reversing the trend of cycle problems or fertility issues is often plausible and workable, thus allowing for a healthy fertility comeback. The goal of course during the fertile years is for healthy sperm to be capable of fertilizing healthy mature eggs in couples desirous of pregnancy, resulting in a healthy pregnancy and baby. Or if pregnancy is not desired, the goal is for the woman’s fertility cycles to be interpretable (with proper instruction) while not causing interference with her lifestyle. Hopefully this article will prompt those who desire healthy fertility to take steps to pursue it!
Disclaimer: This article does not provide sufficient instruction or rules in order to use fertility awareness to avoid pregnancy.
SIDEBARS
TESTIMONIALS ON FERTILITY AWARENESS
From a Couple-to-Couple League (CCL) NFP teacher, wife and mother: “For the first time in my life I know what it feels like to have more normal menstruations! I want to thank you for your advice, prayers and help! It has been a blessing! I wish more women knew about this so they could give it a try before accepting [any ablation or hysterectomy] surgery.”
From S. G., wife and mother: “I really appreciated our conversation—you spent a lot of time with me on the phone. I’ve made an effort to incorporate your dietary suggestions, and I know that helped a lot. I’ve been meaning to email you to tell you that I’m pregnant! I am twenty-three weeks along and besides normal tiredness, the baby and I are doing great! Thank you so much for all the amazing work you do!”
From V. J, NFP teacher: “It’s been so marvelous being able to go to you for this. When my client came to me at over fifty days past getting off the pill with no ovulation, I had no idea what to do except contact you. And I’ve learned a great deal through this process. What a gift you have been for me and my client and so many other people.”
From E. B., wife and mother: “That kind [of discharge pattern] is not discussed in The Art of Natural Family Planning—Transitions Student Guide, from the Couple-to-Couple League, and because of the phone conversation I had with Vicki, my husband and I were able to avoid three months of unnecessary abstinence. . . . We are extremely grateful for the phone counseling we received!”
From P. H., in premenopause transition: “In February of 2011 I called Vicki for assistance in interpreting my premenopausal charts. She helped decipher my mucus discharge pattern, which turned out to be an infertile pattern not discussed in the book I had. Because of her assistance my husband and I were able to resume marital relations during days of infertility (determined after first establishing this different type of infertile pattern). This saved us from abstaining for several months, and I was successful at avoiding pregnancy during this time.”
From an NFP teacher: “I once called Vicki about a client issue and got to talking about nutritional helps for conceiving in the later years of fertility (for myself). Her advice and encouragement after my miscarriage I think were a great part of my hope and nutritional interventions that were rewarded with our now three-year-old little boy, who came home from the hospital on my forty-third birthday!”
FASCINATING FERTILITY FACTS
• It’s normal for women in the transition to menopause and young teens to have variable cycle lengths. This is not
a disease and women, young teens included, should not be go on the birth control pill for this normal variability.
• On rare occasions women can ovulate but not show a temperature shift on the fertility chart.
• Occasionally women who do not ovulate will show a temperature shift on their charts. This seems to be due to
a phenomenon known as a luteinized unruptured follicle (LUF), whereby a developing follicle begins releasing
progesterone but does not release an egg.
• Many women can feel or sense the start of mucus before actually seeing it. This is caused by the ability of nerve
receptors on the inner labia (at the vulva) to detect the presence of much smaller quantities of mucus (up to 8
times less) than what it takes to see mucus.
• Blind women can practice NFP as successfully as sighted women; they focus on their sensations, which provides
sufficient information for interpreting their mucus sign.
• Infertile patterns of discharge may occur in healthy fertility cycles of less than thirty-five days, in long cycles, and
in transition times (that is, postpartum and premenopause) and are considered normal. There are multiple types
of infertile patterns. This knowledge is available, thanks to the late Professor James Brown (Australia).
• Couples using a sympto-thermal method of NFP are not taught about all the possible infertile patterns of discharge that could occur. If these couples have any of these infertile patterns and wish to avoid pregnancy, they will experience unnecessary extra abstinence.
• A woman’s mucus pattern directly correlates to her hormonal pattern. Observing mucus therefore enables a woman to understand what her hormones are doing, thanks to Professor Brown.
• Professor Brown also developed a highly sensitive and accurate home ovarian monitor that measures urinary metabolites of estrogen and progesterone to detect the onset and end of the fertile times. The only drawbacks are
the cost of the monitor and the testing protocol. Look for refinements with a more user-friendly protocol in the
future.
• Not all bleeding episodes are menstruations. Normal bleeding episodes can be divided into the following categories:
Menstruation
Implantation bleed
Withdrawal bleed
Breakthrough bleed
• A pregnant woman can accurately predict her baby’s due date. Only one catch: she needs to observe her fertility
signs!
• Dr. Erik Odeblad of Sweden has identified and named the major types and subtypes of cervical mucus produced
in the cervix and has discovered their functions. He predicts that more will come to light. Also to his credit are
the expanded explanations of the workings of the Pockets of Shaw in the vaginal walls, and the response of the
vaginal epithelial cells to sex hormones. Dr. Odeblad has discovered that not all mucus is a sign of fertility, which
supports part of Professor Brown’s discovery of different infertile patterns of discharge.
• In premenopause transition charts I have occasionally observed no temperature rise until six days after Peak Day, which is a sign that those cycles are infertile.
KAYLENE’S STORY
At age twenty-six, I was diagnosed with PCOS after my doctor did some blood tests. I was relieved to have an
explanation for all the symptoms I was experiencing. These symptoms included long and irregular cycles, weight gain (a total of forty pounds, which put me at an overweight BMI), hirsutism and acne. I was also concerned about low thyroid function because I had low basal temperatures, my fingernails peeled and my heels cracked. My doctor said that weight loss was the best thing I could do, so I could try to diet and exercise, but she also wanted to put me on medication (Metformin and an anti-bacterial face wash) right away. I had already made changes to my diet and exercise regimen, and it didn’t help, but I did not want to go on meds which I would potentially have to take for the rest of my life.
I contacted Vicki Braun, explained my situation, and asked for help. After asking me a few more background questions, Vicki recommended I do a program that would heal my gut and restore my hormone balance, thus reversing PCOS. I also started to change my cleaning and personal hygiene products to more natural or organic ones. At first I was very strict on the diet. I started losing weight and my symptoms began to disappear. After four months, my cycles became regular, and my acne was less severe. I became less strict on the diet, following the protocols, but also started adding some foods that were not recommended. My symptoms continued to reverse. While checking in with Vicki, she advised me to supplement iodine to help with a possible thyroid issue. My nails stopped peeling, my heels stopped cracking, and my basal temps rose slightly. I became even more lax with the diet. I still limited my refined carbs and sugars, but only followed the probiotic protocol of the gut-healing program. A year after I started this modified program, all my symptoms but hirsutism were gone, and I was back to a healthy BMI from losing thirty pounds. I followed up with my doctor. She was very impressed with my progress and said I was the first person in fifteen years of her practice to reverse PCOS without medication. The follow-up blood test results came back normal. The difference in my health today from a year ago is incredible. I feel like I am once again in control of my health and body.
ENDNOTES:
1. Baldani DP, Skrgatic L, Ougouag R. Polycystic Ovary Syndrome: Important Underrecognised Cardiometabolic Risk Factor in Reproductive-Age Women. Int J Endocrinol, 2015:786362. doi: 10.1155/2015/786362. Epub 2015 Jun 1.
2. Wang S, Alvero R. Racial and Ethnic Differences in Physiology and Clinical Symptoms of Polycystic Ovary Syndrome. Semin Reprod Med. 2013 Sep; 31(5): 365-9. doi: 10.1055/s-0033-1348895. Epub 2013 Aug 9.
3. Daraï E, Bazot M, Rouzier R, Coutant C, Ballester M. Colorectal Endometriosis and Fertility. Gynecol Obstet Fertil. 2008 Dec; 36(12): 1214-7.
4. Renner SP, Strick R, Oppelt P, Fasching PA, Engel S, Baumann R, Beckmann MW, Strissel PL. Evaluation of Clinical Parameters and Estrogen Receptor Alpha Gene Polymorphisms for Patients with Endometriosis. Reproduction, 2006 Jan; 131: 153-161.
5. Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, D’Hooghe T. High prevalence of Endometriosis in Infertile Women with Normal Ovulation and Normospermic Partners. Fertil Steril. 2009 Jul; 92(1): 68-74.
6. Eisenberg ML, Lathi RB, Baker VL, Westphal LM, Milki AA, Nangia AK. Frequency of the Male Infertility Evaluation: Data from the National Survey of Family Growth. J Urol. 2013 Mar; 189(3): 1030-4.
7. Odeblad, E. The Discovery of Different Types of Mucus and the Billings Ovulation Method. Bulletin of the Ovulation Method Research and Reference Centre of Australia, 27 Alexandra Parade, North Fitzroy, Victoria 3068, Australia; 1994 Sep: 21(3): 3-35.
8. Palan PR, Strube F, Letko J, Mikhail MS. Effects of Oral, Vaginal, and Transdermal Hormonal Contraception on Serum Levels of Coenzyme Q10, Vitamin E, and Total Antioxidant Activity, Obstet Gynecol Int. 2010; 2010: 925635.
9. Pelton R, LaValle JB, Hawkins EB, Krinsky DL. Drug-Induced Nutrient Depletion Handbook. 2001. Lexi-comp’s Clinical Library.
10. Campbell-McBride N. The Gut and Psychology Syndrome, Medinform Publishing, Cambridge, UK, 2010, p. 36.
11. Kahlenborn, C., Modugno, F., Potter, D., Severs, W. Oral Contraceptive (OC) Use as a Risk Factor for Premenpausal Breast Cancer: a Meta-analysis. Mayo Clin Proc. 2006; 81 (10): 1290-1302. “Consistent with the recent International Agency for Research on Cancer classification of OCs as group 1 carcinogens, this meta-analysis suggests that OCs are associated with an increase in premenopausal breast cancer risk, especially among women who use OCs before FFTP (first full-term pregnancy).”
12. Zilberlicht A, Wiener-Megnazi Z, Sheinfeld Y, Grach B, Lahav-Baratz S, Dirnfeld M. Habits of Cell Phone Usage and Sperm Quality – Does It Warrant Attention? Reprod Biomed Online. 2015 Sep; 31(3): 421-6. doi: 10.1016/j.rbmo.2015.06.006. Epub 2015 Jun 18.
13. Radwan M, Jurewicz J, Polańska K, Sobala W, Radwan P, Bochenek M, Hanke W. Exposure to Ambient Air Pollution-Does It Affect Semen Quality and the Level of Reproductive Hormones? Ann Hum Biol. 2015 Jul; 27: 1-7.
14. Sympto-thermal methods of NFP include: the Couple to Couple League (www.ccli.org ), Sympto-Pro (http://www.symptopro.org ), various local diocesan providers, as well as individual books written on the subject.
15. The most accurate way to determine length of luteal phase is probably by counting days after Peak Day as that corresponds most closely to the actual day of ovulation. Temperatures may begin to rise up to a few days before Peak Day and up to several days after Peak Day.
16. Schauss M. Toxicity and Chronic Illness. Spring 2015 Wise Traditions, Weston A. Price Foundation, p. 30.
17. Ibid., p. 30.
18. Ibid., p. 31.
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