Natural family planning (NFP) typically refers to methods that seek to either prevent or achieve a pregnancy. It is often called fertility awareness. Modern fertility awareness methods use a variety of physiologic changes that occur during a woman’s menstrual cycle to assist the couple in daily fertility awareness. These physiologic changes include the length of the woman’s menstrual cycle, changes in basal body temperature (BBT), and cervical mucous changes. Some women also may use additional body changes, such as discomfort at time of ovulation (mittelschmerz) or breast tenderness before menstruation to predict fertility.

NFP has been found to be acceptable to many couples for a variety of reasons. Some couples elect to use fertility awareness because of religious beliefs; other couples use fertility awareness to avoid the use of medications or contraceptive devices; still others feel that fertility awareness involves both partners in sexual decision making and use of a method. Others use natural fertility awareness practices to assist with conception. Regardless, with proper instruction, fertility awareness has proven to be acceptable and successful, primarily for women with uncomplicated menstrual cycles and a cooperative partner.

Most providers strongly recommend that the patient and her partner enroll in a fertility awareness class or complete a fertility awareness home study course before using this method. There are a number of organizations that assist couples with this method. One such group is the Couple to Couple League, which maintains a website with information on fertility awareness. Instructions are in English and Spanish, and a home study course is also available. It is an international organization. Their website can be found at http://www.ccli.org. Please note that many websites promoting fertility awareness have a religious basis, may be opposed to abortion, and may be offensive or unacceptable to some patients. The Office of Population Awareness, sponsored by the U.S. Department of Health and Human Services, provides information that some couples may deem more acceptable. Their information may be found at the following website: https://www.hhs.gov/opa/sites/default/files/natural-family-planning-fact-sheet.pdf. Other fertility awareness resources are listed in Appendix A.

Although it is impractical and unwise for a triage nurse to do extensive fertility awareness counseling over the telephone, it is important that the triage nurse know a bit about how patients are using fertility awareness and the valuable community resources that are available. For this reason, this book contains a fertility awareness protocol.

There are products that are available to help women pinpoint ovulation by identifying hormonal markers associated with ovulation. These may be more expensive than many women are willing to use regularly. If a practice recommends any products, triage personnel should be familiar in the proper use of the products, the limitations of the methods, and the cost of obtaining them in their area. There is a website, GoodRx, that allows patients to “price shop” for various prescription medications and other health care products that patients and providers may find useful (https://www.goodrx.com/)

Any Internet sources suggested should be researched for the reliability and trustworthiness of any products sold. These products to pinpoint ovulation are most widely used in conjunction with home infertility evaluations and are best discussed with a knowledgeable provider before spending time and money on them.