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Women who use the Fertility Awareness Method (FAM) monitor body temperature and cervical signs of pregnancy similarly to those who practice NFP. However, women using FAM may either avoid intercourse or use a backup nonhormonal method of birth control, such as a condom, during the fertile period.

Women using FAM monitor 3 primary fertility signs: basal body (waking) temperature, cervical fluid, and cervical position.

Basal body temperature before ovulation is considered to range from 97-97.5°F. After ovulation, temperatures rise to about 97.6-98.6°F and stay elevated until a woman’s next period, about 12-16 days later. Temperatures usually rise within a day or so after ovulation, so the rise in temperature generally means that ovulation has already occurred. A basal body temperature chart can be obtained from 4women.gov.

Cervical fluid qualities are also charted throughout a woman’s cycle. Cervical fluid qualities aside from during the menstrual period are designated as nothing/dry, sticky, creamy, or eggwhite. A woman is most fertile when her cervical fluid is like a raw eggwhite. During this time, cervical fluid is clear and stretchy.

The cervix becomes softer and opens around ovulation so that the sperm can pass through the uterus and to the fallopian tubes. The cervix also rises during this time during because of the effects of estrogen on the ligaments that hold your uterus in place.

For maximum effectiveness, FAM users follow 4 rules:

1. Intercourse is allowed in the first 5 days of the menstrual cycle (beginning with the first day of your period) if you had an obvious temperature shift 12-16 days before.
   
   
2. Before ovulation, intercourse is allowed the evening of every dry cervical fluid day.
   
   
3. Intercourse can resume the evening of the third consecutive day your temperature rises to postovulatory levels.
   
   
4. Intercourse can resume the evening of the fourth consecutive day after your peak cervical fluid day.

Intercourse is not considered "safe" for avoiding pregnancy unless all of these rules are met. It is recommended that 2 full cycles be charted before relying on this method.

FAM has advantages and disadvantages.

• How effective: If a couple takes chances and has intercourse without backup protection during the fertile period, their odds of pregnancy increase dramatically. In August, 2002, the FDA reported a failure rate of 20 pregnancies per 100 women per year for periodic abstinence. This figure did not differentiate for particular types of periodic abstinence. ACOG lists a higher failure rate for periodic abstinence of 25%. Again, this figure did not differentiate for method of periodic abstinence. 
  
  
• Advantages: No harmful effects from hormone use occur. FAM methods can also be used to achieve pregnancy. 
  
  
• Disadvantages: Complete abstinence is necessary during the fertile period. This method requires discipline and systematic charting. The method is not effective with improper use. For maximal effectiveness, a woman or couple should be trained by a medical professional or qualified counselor. A relatively high failure rate has been reported. This method does not protect against STDs.

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