Talk:Fertility awareness/Archive 1

message: Why can't people simply do a bit of a medline search?  Here's some recent data.  I'm including everything that has effectiveness data subject to the following restrictions: omit everything before 1998, include only articles with "natural family planning" in the title, and omit studies with less than 100 participants, studies involving fertility monitoring devices (other than simple thermometers), studies which estimate pregnancy probabilities on semi-theoretical grounds (based on cycle day conception probabilities, say), and articles with no abstracts on medline.  All effectiveness figures are per woman per year unless noted otherwise.
# Arevalo M.; Jennings V.; Nikula M.; Sinai I.: "Efficacy of the new TwoDay Method of family planning", Fertility & Sterility. 82(4):885-92, 2004 Oct.  Sample size 450.  Locations: Guatemala, Peru, Philippines.  Correct use efficacy: 96.5%.  Overall efficacy (including incorrect use): 86.3%.
# Che Y.; Cleland JG.; Ali MM. "Periodic abstinence in developing countries: an assessment of failure rates and consequences", Contraception. 69(1):15-21, 2004 Jan.  This is a survey of 15 national surveys.  No distinction made between correct and incorrect use, and the abstract says that most of the users are using simple calendar rhythm (rather than the more sophisticated NFP methods).  Overall efficacy: 74%.  (Remark: Not very useful for assessing NFP as opposed to rhythm.)
# Howard MP.; Stanford JB. "Pregnancy probabilities during use of the Creighton Model Fertility Care System" Archives of Family Medicine. 8(5):391-402, 1999 Sep-Oct.  Sample size: 701.  Location of study: Houston TX.  Per 100 couples, the following were observed.  0.14 couples got pregnant despite perfect use.  2.72 couples got pregnant due to user/teacher error.  12.84 couples got pregnant because they had sex at a time at which they knew themselves to be fertile.  1.43 couples had "unresolved pregnancies".  (Remark: So perfect use pregnancy is not at all likely given NFP, but if you have sex while knowing that you're fertile, you might well get pregnant.)
# Anonymous(!). "European multicenter study of natural family planning (1989-1995): efficacy and drop-out". Advances in Contraception. 15(1):69-83, 1999.  Overall sample size: 1328 women.  All data is over 12 cycles, not over a year (though the two are pretty close).  Double check methods: Unintended pregnancy rate: 2.61% over 12 cycles.  Drop-out rate: 3.9%.  Lost-to-follow-up rate: 3.1%.  Single check methods: Unintended pregnancy: 8.5%.  Drop-out rate: 3.0%.  Lost-to-follow-up rate: 23.4%.  Additional information: "Most pregnancies occurred because of deliberate unprotected intercourse in the fertile phase".  (Remark: I have no idea why Medline lists this as anonymous, but it is published in what I assume is a refereed journal.)
# Hilgers TW.; Stanford JB. "Creighton Model NaProEducation Technology for avoiding pregnancy. Use effectiveness."  Journal of Reproductive Medicine. 43(6):495-502, 1998 Jun.  Overall sample size: 1876 couples.  Location: U.S.  Perfect use effectiveness: 99.5%.  Actual use effectiveness: 96.8%.  Discontinuation rate: 11.3%.
# Ecochard R.; Pinguet F.; Ecochard I.; De Gouvello R.; Guy M.; Huy F. "Analysis of natural family planning failures. In 7007 cycles of use". Fertilite Contraception Sexualite. 26(4):291-6, 1998 Apr.  Sample size: 626 couples, mostly French, some Swiss and Belgian.  Method effectiveness: 98.9%.  Method+user effectiveness: 93.5%.  (Remark: My guess based on the abstract only is that this number is what we get if we drop the people who quit using NFP during the study or something like that and then calculate the pregnancy rate in the remaining population, while the next number is the overall number.)  Overall non-pregnancy rate: 82.42%.  (Remark: I suspect this includes people who quit using the method.  It's hard to tell from the abstract.) -User:Pruss
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By the way, something worth mentioning somewhere in the article is the way that NFP users can adjust the amount of abstinence to obtain the effectiveness they want, by adding additional "safety days" on both sides of the identified fertile period.  Strong anecdotal evidence suggests that once one adds enough of these, the chance of pregnancy becomes close to that which one gets in the case of sterilization.  This is up to the individual couple.  The methods normally presented to users are a bit of compromise between effectiveness and not having too much abstinence.  But in cases where there is a strong enough need to avoid pregnancy, strong anecdotal data suggests that extremely high effectiveness (perhaps rivaling sterilization) can be achieved by adding enough safety days.  It's a rather nice thing about NFP that one can tailor the amount of abstinence to get the effectiveness one wants.  For instance, if one abstains except on one very carefully chosen day each cycle, I suspect one can probably ensure that the chance of conception is effectively nil.  I don't think there really are any studies in these extensions, because of difficulties in compliance I expect. -User:Pruss
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Can someone take a look at the edits by 214.13.4.151? I was going to revert them, but some of them are actually legit, and a few I really don't know enough about to want to touch. --InShaneee 15:47, 18 May 2005 (UTC)
thread_title: Medline search

message: I just reverted an edit that removed almost all of the information in this article.  This article started out as a NFP article, but the general topic changed to FA, so it was renamed.  This FA article is significantly different from the Fertility Awareness Method article, enough so that they should be merged instead of one being simply deleted.  If someone wants to create a new article to cover NFP, that would be a great idea.  But this article covers too much info that's not in the FAM article for all of that information to simply be deleted in an effort to return this article to it's NFP origin.  Recap: A new NFP article would be more than welcome, but I disagree with the editor who simply deleted all the info in this article that's not about religious attitudes toward FA/NFP.  --Icarus 23:11, 1 September 2005 (UTC)
thread_title:  FA vs NFP 

message: Why is it that this page is shown as a religious/Christian thing? No doubt the Pope and his religion have strong views on it, but it is not a strictly religious thing and ought to be changed to say that it exists, and certain religions and the Pope are very much in favor of this method due to their beliefs. The piece about the Pope can still be mentioned but shouldn't be so prominantly featured, if you feel the need, put it in it's own section(if there isn't one already) or put a link to a page with more information. 
I hope someone will fix this soon because I'm afraid I will mess up the article, but will do it myself if need be. Papa leaf 22:27, 3 October 2005 (UTC)
replies: text: The article mentions FA's role in certain Christian sects, but is pretty much focused on the practical aspects instead of the religious ones.  If you want to add a little info on other motivations for using FA, feel free.  But seeing how important it is to certain Christian sects, it would be wrong to not include the little that's already there. --Icarus 06:19, 4 October 2005 (UTC)

text: Ah, thanks for the clarification.  What happened was that for a while, the NFP article redirected to the FA article.  (It's actually a little more complicated, but that's the short of it.)  There's now a separate NFP article (again... like I said, it's a little complicated), but the talkpage still redirected to this talkpage even though the article no longer redirected to this article.  I've fixed that.  I'm also going to try to add something to the beginning of the NFP article to direct people looking for a more secular (or just non-religious or non-Catholic) approach to the FA article. --Icarus 06:19, 6 October 2005 (UTC)
thread_title: Religious/Christian

message: I just noticed this article is in the category "Accuracy Disputes".  Does anyone know what the dispute is about?  Maybe it's an old tag that's been corrected - if so, can it be removed?Lyrl 03:03, 21 December 2005 (UTC)
thread_title:  Accuracy dispute? 

message: The changes I made to the mucus observation were meant to clarify the science and physiology behind the sign, and to eliminate the 'interpretational' information that appeared to be method specific. Since there is a dramatic difference between the ways that different methods determine the end of fertility, I think it would be better either to cover each method separately, or none of them at all. Wanfactor 03:04, 5 January 2006 (UTC)
thread_title:  mucus observation 

message: Should the section on this stay in the FA article (as-is, or summarized)?  Or should all the information be moved to the LAM article? Lyrl 19:58, 8 January 2006 (UTC)
thread_title:  Breastfeeding infertility 

message: Anyone else notice that 'vatican roulette' redirects to fertility awareness? Or that if you type 'wikipedia billings ovulation' into Google, the first result is this fertility awareness page, and the second result is 'vatican roulette'? I have to say I find this rather insulting. Wanfactor 02:17, 12 January 2006 (UTC)
thread_title:  vatican roulette 

message: Following the rules for LAM greatly decreases the chances of ovulation occuring.  Preventing ovulation prevents conception.  I thought that was the definition of contraception? Lyrl 03:02, 28 January 2006 (UTC)
replies: text: It could be the definition for some people. But for others, it's not, so I just removed ambiguity. See also here. For Catholics (orthodox ones, at any rate!) such as Sheila Kippley, who did a lot to promote LAM, the word "contraception" carries connotations of thwarting and frustrating nature. The Couple to Couple League, co-founded by Sheila Kippley, is against contraception, but promotes Natural family planning, of which LAM is one method. Anyway, as far as I can see, my edit removed something that might be disputed, but didn't introduce anything that would be disputed. Hope that helps. AnnH (talk) 07:48, 28 January 2006 (UTC)
replies: text: To elaborate a little on the above — those who advocate charting fertility signs or ecological breastfeeding as a means of spacing birth, especially when it's for religious reasons, tend to avoid calling it contraception. The "contra" in contraception suggests it's against something. It's like the difference between eating salads if you want to lose weight and eating chocolate cake and then deliberately vomiting. In one case it's taking advantage of something which is in harmony with nature (the fact that lettuce doesn't have many calories); in the other case, it's acting against nature. So knowing you're infertile on day X of your cycle, and taking advantage of that is not considered to be thwarting what God built into nature. Similarly, taking advantage of the fact that you're infertile while practising a special kind of breastfeeding, which Sheila Kippley believes was the original kind, is again not considered to be thwarting what God built into nature. I realize a lot of people would shrug and say, "Oh, it's the same thing." But since it's very much disputed, and since supporters of NFP and Ecological Breastfeeding would be against "contraception", I thought it was better not to say that LAM is a form of contraception. AnnH (talk) 18:50, 28 January 2006 (UTC)

text: Yes, I know ecological breasfeeding isn't exactly the same as LAM, and that Sheila Kippley developed the former, but not the latter, although they're similar. (I have all the Kippleys' books — John and Sheila.)  I just worded my post a little sloppily because I was more concerned with explaining the objection to using the word "contraception" than I was with who developed what and what the two practices are. Thanks for the link. It looks interesting. I'll read it later. Cheers. AnnH (talk) 19:04, 28 January 2006 (UTC)
replies: text: LAM is somewhat different from the observational methods of fertility awareness as fertility is altered by the hormones produced during breastfeeding. However, since the purpose of breastfeeding is nurishment of the baby, and the resultant infertility is a secondary result (even if it is desired) it is not contraceptive in the way the Pill is contraceptive. It is more similar to pregnancy, where ovulation is suppressed as well. Obviously, pregnancy is not contraception either.Wanfactor 02:00, 30 January 2006 (UTC)
replies: text: Agreed. I can't imagine anyone breastfeeding (especially the kind of unrestricted breastfeeding involved here) with the primary intention of suppressing fertility and the secondary intention of nourishing the baby. AnnH (talk) 02:06, 30 January 2006 (UTC)
thread_title:  LAM not contraception? 

message: This article seems pretty focused on fertility awareness as a contraception method.  In my limited experience, it seems to be used more often as a conception aid.  Note that TTC (for "trying to conceive") directs readers to look at this topic for more.  Does anyone know more about using it for conception, and can they balance out the article a bit to reflect that usage?  moink 21:13, 8 February 2006 (UTC)
replies: text: Excellent idea. Maybe next month I'll look into it, if someone else doesn't beat me to it. AnnH (talk) 21:25, 8 February 2006 (UTC)
thread_title:  Confined to contraception? 

message: I've found a discrepancy in the Effectiveness section; 
:"(i.e. abstaining from intercourse from menstruation until after ovulation) have a method failure rate of 1% per year."
This doesn't make sense, as the said time period is the infertile phase; ergo abstinence during that phase would not have any significant effect as a contraceptive method. Does anyone else agree? To my knowledge, an egg cannot be fertlised BEFORE ovulation, can it? I mean, there's no egg there.
Let me know. TydeNet 09:09, 30 May 2006 (UTC)
replies: text: Ova typically live 6-12 hours, with a rare egg capable of surviving 24 hours without fertilization.  Sperm typically live 3 days, with up to 5 days considered normal and at least one documented case of pregnancy from intercourse eight days before ovulation.  An egg cannot be fertilized before ovulation.  However, intercourse before ovulation can certainly result in pregnancy, because of long sperm life.  Due to the short life span of human ovum, however, intercourse after ovulation is unlikely to result in pregnancy. Lyrl 22:51, 30 May 2006 (UTC)
thread_title: Factual accuracy

message: How is this different from Natural family planning and natural birth control? See discussion at Talk:natural family planning.--Andrew c 22:15, 13 June 2006 (UTC)
thread_title:  merge proposal 

message: Let's all work on reaching a consensus for a new infobox to be placed on each individual birth control method's article.  I've created one to start with on the Wikipedia Proposed Infoboxes page, so go check it out and get involved in the process. MamaGeek (Talk/Contrib) 12:12, 14 June 2006 (UTC)
thread_title:  Proposed Infobox for individual birth control method articles 

message: Typical use failure is currently listed at 25% per year.  That number is from the National Surveys of Family Growth, a survey that included 7,643 women.  Because only 1% of Americans (i.e. 76 women in the survey) use any form of FA or NFP, that survey did not obtain enough data to break down failure rates by method.  0.2% of American women aged 15-44 use one of the observational methods of NFP. 0.7% use the Rhythm Method - three times as many.  So the FDA failure rate is heavily skewed toward the failure rate of the Rhythm Method.
This is what is in The Art of Natural Family Planning on that subject:
:...references lump together all methods of 'period abstinence' as if they were the same.  This is because the data were derived from the National Surveys of Family Growth.  Therefore, the average of 20 surprise pregnancies per 100 couples per year is not based on published prospective studies, but only based on questionnaire-generated data.  The number of users of different NFP methods was too small to allow analysis of separate types of NFP.  This is where confusion can occur in any publication regarding effectiveness rates.
They then have a table with actual failure rates from a number of studies:
*Liberia 1990 - 4.3% (life table)
*Zambia 1990 - 8.9% (life table)
*Multinational 1981 (U.S., France, Canada, Columbia, Mauritius) - 7.2% (1% perfect use) (life table)
*U.S. 1981 - [From Kippley: 11.2% (0% perfect use) (life table)] [From PubMed abstract: 13.7-16.6% STM, 34.9-39.7% OM (Pearl Index)]
*U.S. 1981 - 14.4% (life table)
*Australia 1978 - 16% (life table)
*Columbia 1980 - 19.8% STM, 24.2% OM (life table) [26.0% STM, 33.8% OM (Pearl Index)]
*Germany 1991 - 2.3% with abstinence, 2.1% with barriers during fertile phase (Pearl Index)
*U.K. 1991 - 2.7% (Pearl Index)
*Europe 1992 - 2.4% STM; 10.6% muco-thermo (Pearl Index)
*Italy 1986 - 3.6% (Pearl Index)
*U.K. 1976 - 23.9% (Pearl Index)
Those studies were all of sympto-thermo or Billings. 
:I went ahead and typed up the references so I have them available here (I originally posted this on Talk:Natural family planning).  I also found the following while poking around on PubMed:
:*Germany 1997 - 2.2% (life table) (perfect use - 0.63% with abstinence, 0.45% with barrier during fertile phase)
:
:Lyrl 02:48, 25 June 2006 (UTC)
thread_title:  Typical use failure 

message: Saying "actually refers to" is POV, in that it seems like wikipedia is taking a stance on what is the more proper use of the term. I prefered the previous version that said "NFP can generally refer to..." and "however NFP can also more specifically refer to...". I think mentioning abstinence is very imporant in describing how NFP works as BC. However, as seen on other articles, Joie feels otherwise. I don't see how the changes helped, or what problems they were trying to address. Let's discuss.--Andrew c 21:12, 11 October 2006 (UTC)
replies: text: This paragraph has become wordy. any use of FA methods and One of these methods is a religiously-motivated practice of FA, and although.. seem like they can be cut completely. I don't see how this latest version is an improvement on what we had before. Could we specifically state what was wrong with the old version, so maybe we can address those issues. Because I really am not fond of some of the phrasing used in the current version. There is probably a better way to communicate what we need to say.--Andrew c 23:18, 27 November 2006 (UTC)
replies: text: I think the wordiness is an attempt to satisfy my complaint about implying FA was the only NFP method.  Joie de Vivre seems to have some enormous objection to saying that the Catholic version of NFP includes stastical and LAM methods. As far as I can tell, whatever this objection is has not been articulated.  I also do not see the current version as an improvement, but (sorry!) would be bothered by just cutting the phrases you mentioned because of FA/NFP conflation. Lyrl    Talk     Contribs   00:29, 28 November 2006 (UTC)
replies: text: I have addressed the wordiness (which also bothered me), while trying to maintain clarification about NFP as it relates to fertility awareness.  The original concern about referring to NFP as "a religiously based form of FA" has been addressed by clarifying that NFP refers to "a set of several" methods.  It is clear that NFP is more than just a religiously-based form of FA.  Anyone who wants to learn more about exactly which methods the Vatican has deemed morally appropriate is free to visit the article detailing those methods.  A link to the NFP main article is in the paragraph.   Joie de Vivre 21:08, 28 November 2006 (UTC)

text: In regards to this diff, I preferred the older version better (though I like the changes made in the birth control article). Lyrl    Talk     Contribs   19:45, 2 December 2006 (UTC)
thread_title:  NFP paragraph 

message: The current statement in the article: Cervical mucus observation - this method relies on identifying the slippery, stretchy type of mucus produced near and during ovulation.
* Not all women, or all cycles, experience the eggwhite type of cervical mucus.  Creamy, watery, and even sticky mucus are equally important observations.  The eggwhite type of mucus should not be so heavily emphasized in a description.
* Vaginal sensation is also an important aspect of cervical mucus methods, and should be mentioned equally with the visual observation of the mucus.
* "near and during ovulation" is misleading, for two reasons.  First, "near" implies both before and after, while mucus is primarily produced before ovulation - up to seven days before is considered normal.  Second, while ovulation happens most frequently on the last day of mucus observation, it frequently happens a couple of days before, or a couple of days after - or even three days before or after (). In the case of ovulation happening a few days after Peak, no mucus is being produced during ovulation.
* Different schools of CM-only methods have very different rules.  The Two-Day Method, for example, begins infertility on PK+2, while Billings and Creighton both begin infertility on PK+4.  The different emphasis on visual observation of mucus vs. the sensation it causes in the vagina and vulva are also important.  Point being, there is more than one kind of CF-only method.
I would prefer either shortening the statement to "Cervical mucus observation", and leaving the description entirely for the "observational methods" section, or having something more along the lines of these methods rely on identifying the cervical mucus and vaginal sensations particular to the several days leading up to ovulation. Lyrl    Talk     Contribs   01:10, 5 December 2006 (UTC)
thread_title:  Cervical mucus observation