Manual for Lily Pro

Table of Contents
DISCLAIMER
1
HOW TO USE LILY
2
Main Menu
2
Menu Items in Main Menu
2
The Graph
7
The Calendar
7
FAQ
8
General
8
Evaluation
10
A WOMAN’S CYCLE
13
What is Regular?
13
Hormonal Interaction
13
The Cycle
14
The Three Primary Fertility Signs
16
The Secondary Fertility Signs
18
How to Check Your Fertility Signs
19
I
UP CLOSE & PERSONAL WITH FAB
21
What is FAB?
21
FAM and NFP - the Differences
21
Is it safe?
21
The Basic Rules for FAM
22
The Basic Rules for NFP (Workgroup NFP, Germany)
27
Temperature Patterns
31
Evaluation - Thermal Shift or Not?
36
TRYING TO CONCEIVE OR TRYING TO AVOID
38
Natural Birth Control
38
Pregnancy Achievement
39
GOOD TO KNOW
40
Irregularities and Anovulatory Cycles
40
Short Luteal Phase And other Irregularities
41
Drugs affecting the Fertility Signs
42
FAM/NFP and Menopause
42
THE PURPOSE OF LILY
44
II
DISCLAIMER
Lily is based on FAB (Fertility Awareness-Based Methods like FAM and NFP) and
should only be used by those women willing to learn the rules and apply them
correctly, especially if you want to use it as birth control. If you should ever have
doubts about whether or not you already are in your infertile phase, always use
extra protection like condoms if you want to avoid pregnancy.
Since this program works with averages, do not solely rely on its predictions.
The manual should help you get a a basic idea of how the method works and
how to read the information provided by Lily. This manual does not lay claim to
completeness. For further reference, please contact a qualified teacher and/or
obtain professional literature.
FAM and NFP are safe methods if applied correctly, but the failure of the method
is usually caused by misinterpretation of the fertility signs. Hence the method
is not foolproof and, as other contraceptive methods, can fail.
As natural contraceptives do not protect you from AIDS or STDs, women who
frequently change their partners can still use this method to keep track of their
cycle and gynecological health, but should always use condoms to prevent
infection with above mentioned illnesses, no matter if they are fertile or not.
Lily was not developed to diagnose, treat, prevent or cure any medical
conditions. For any medical related questions, please see your physician.
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HOW TO USE LILY
MAIN MENU
GENERAL NAVIGATION
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Scroll up or down to see all menu points.
Go back and forth a day or more by tapping the arrows at the bottom. The
day you are making changes to will always be displayed in between the
arrows. Please note: data cannot be added to days in the future.
The top bar gives you access to the settings, the graph and the calendar
(from left to right)
The buttons change according to the active menus’ needs. The buttons that
replace the standard buttons from the main menu when accessing any menu
item are i (info for each menu item), horizontal arrow (goes back up one level
at a time in the hierarchy that was selected), check mark (confirmation) and an
vertical arrow emerging from a box (export). Always depending on what menu
one is working in.
MENU ITEMS IN MAIN MENU
GENERAL NAVIGATION
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Scroll to see the complete info for each list.
Each menu point has selectable/de-selectable items or check marks, except
for temperature and wake-up time.
Anything you select will be saved automatically unless the top bar shows a
check mark button in the upper right corner.
Deselect any item to remove it from the records.
To go back to the main screen tap the horizontal arrow-button in the menu
bar at the top.
TEMPERATURE
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Enter your basal body temperature via the keypad. Changes will be saved
automatically.
To delete/correct the temperature use the backspace-button on the numbers
pad.
WAKE-UP TIME
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The wake-up time is the time you usually take your temperature in the
morning. The menu displays the standard time you specified upon setup of
Lily. To change the standard wake-up time, please go to the settings.
Use the numbers pad to occasionally record a time that is different from your
standard wake-up time.
There is a 30 minute buffer before and after the time you set which will not
affect your temperature (i.e. time is set to 7 am, you can enter the
•
temperature between 6:30 and 7:30 am without triggering the question if you
want to exclude the temperature).
If your temperature is easily affected by the time you take it you should
exclude values taken later/earlier than usual or adjust your standard wake-up
time.
CERVICAL FLUID
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You can scroll the lists and swipe from right to left to switch between the lists
of look and feel.
The quality of cervical fluid is determined by what it looks and feels like.
Always make sure to select from both categories to ensure a proper
evaluation.
Beginners should always use the two lists to create a log-book and become
more secure in assessing the quality of your cervical fluid.
Advanced users can use the manual override to either override the
automatic evaluation while still keeping a log-book, or to quickly enter the
mucus quality without further specification of the lists.
CERVICAL POSITION
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Tap the state your cervix is in once to select, and again to deselect.
Charting your cervical position is a fertility sign used to crosscheck when
encountering ambiguities in temperature and/or cervical fluid.
As there are no specific rules concerning the cervical position as to when
exactly to assume infertility, this info will not directly affect the blue bars in the
graph indicating the infertile time. It is very helpful, however, to better
determine the most fertile day of the cycle.
Your cycle will be evaluated according to the rules set for your temperature
and cervical fluid.
INTERCOURSE
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Select whether or not you had intercourse. The standard is ‘no’ = check mark
not set.
Tick the check mark to activate the list to select the kind of protection used.
Remove the check mark to go back to ‘no intercourse’.
PERIOD
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Enter all the necessary info concerning your period by scrolling to access all
the charting options.
Mark the first day of your period (no spotting!) by tapping on ‘start a new
cycle’.
To change the start of a cycle while being on a different date, tap on the date
below ‘first day of current cycle’ to enter the graph’s edit mode.
Also use this menu to chart intermenstrual bleeding or any kind of bleeding
that is not your period without setting a new cycle.
SECONDARY SYMPTOMS
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Scroll to access every item on the list.
Select as many as you wish to chart by tapping on any given item once, tap
again to deselect.
These secondary fertility signs do not affect the evaluation but help to better
determine for yourself which individual signs show up prior to your ovulation.
MENOPAUSE (OPTIONAL)
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Enable this menu by going to Lily’s settings. Scroll all the way down until you
find ‘Menopause Mode’. Here you can switch this menu on and off.
Only use this menu if you are approaching menopause. Enabling this menu
affects your evaluation (no infertile phase at the beginning of the cycle!).
CUSTOM NOTES
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Add symptoms to the list by tapping the + button.
To delete a symptom select the - button, select the items to delete and
confirm by tapping the check mark button in the upper right corner.
Scroll to access the complete list. Select as many as you need to chart the
necessary information.
PREGNANCY TEST
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Select the appropriate result from the list of positive and negative.
The result will also be displayed in the lower portion of the graph that can be
accessed by swiping upwards across the whole screen.
OPK/LH TEST
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As with the pregnancy test menu described above, select the appropriate
result from the list of positive and negative.
The result will also be displayed in the lower portion of the graph that can be
accessed by swiping upwards across the whole screen.
NOTEPAD
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You can use the Notepad for your daily observations or as a simple diary.
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Scroll to see the complete index of the manual.
Tap any heading to reveal this chapter’s content. Use the arrow in the upper
right corner to go up one level at a time.
HELP
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PDF EXPORT
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Select the cycle(s) you wish to export as PDF documents and tap the export
button in the upper right corner of the screen.
PDFs can be exported by eMail or to iTunes Documents. When connecting
your device to a computer, go to iTunes ➤ select your device ➤ Apps ➤
File Sharing ➤ Lily Pro. Click on the PDF in the right column and click ‘save
to...’.
You can also print the PDF documents using an AirPrint-enabled printer from
within Lily.
STATISTICS
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This represents the most important averages gathered from all the cycles you
charted with Lily.
CYCLE MANAGEMENT
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Tap on the heading to either delete days, whole cycles or to edit the
cycles in a visual editor.
Deleting days/cycles allows you to delete single or multiple days/cycles at
once.
Edit Mode will open the graph’s edit mode which allows you to visually
change the beginning and end of any given cycle. You can change, add or
remove the divider for each cycle
Drag the cycle divider around, tap the + button in Lily’s navigation bar or the x
below the slider to achieve the desired effect.
Tap the arrow in the top right corner to leave the edit mode and go back to
Cycle Management overview.
CYCLE OVERVIEW
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The cycle overview quickly summarizes the most important data of each cycle
you charted with Lily. Each cycle can be characterized as to what kind of
cycle it was.
Regular: cycles with ovulation (thermal shift, coverline, successful evaluation)
Anovulatory: cycles without ovulation (no thermal shift, no coverline,
unsuccessful evaluation)
Pregnancy: cycle with a luteal phase longer than 18 days and a positive test
(thermal shift, coverline, successful evaluation, cycle length around 270 days)
Possible pregnancy/miscarriage: cycle with a luteal phase longer than 18
days, with or without positive test (thermal shift, coverline, successful
evaluation but bleeding (strength of regular period or stronger) sometime after
those 18 days and the temperature drops well below the coverline again).
EMAIL SUPPORT
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Tapping on this menu item will let you contact us by eMail should you ever run
into problems this manual cannot answer.
Do not hesitate to contact us, we will take care of the problem or question as
quickly as possible.
RATE LILY
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If you like Lily and want to spread the word you can either tweet about it, write
a post on Facebook, or rate us on the AppStore.
SETTINGS
PASSWORD PROTECTION
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You can enable or disable password protection at any time.
To protect the data you track with Lily from others you should enable Lily's
Password Protection by setting it to ON.
Lily will ask you for a new password that has to be at least four characters
long. Please enter your new password once into each of both text fields.
After entering the password Lily will ask you for a password hint. This hint
should help you remember your password in case you should ever forget it
and will be displayed if you try to enter a wrong password a couple of times.
Choose a hint that only means something to you and avoid choosing a hint
that helps others to guess your password.
Should you ever lock yourself out and the hint you chose doesn't help to
remember your password you should contact us, we might be able to help
you log back in.
To change your password simply disable it in the settings and enable it again.
You can then choose a new password.
WAKE-UP TIME
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Change the standard wake-up time according to your schedule so you do not
have to manually enter it each morning if you take your temperature at the
exact same time every morning.
EVALUATION METHOD
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Choose between the US approach FAM (NFP) or the German approach
NFP by the Workgroup NFP from Düsseldorf, Germany.
Both approaches are symptothermal methods and serve the same goal but
differ in their rules of evaluation. See Rules of Evaluation for more info.
TEMPERATURE UNIT
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Chart in Celsius or Fahrenheit, according to your liking. Celsius requires a
thermometer with two decimals behind the comma for charting (0.05 °C
steps), Fahrenheit requires only one (0.1 °F steps).
TIME UNIT
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Select whether or not you want a 12-hour or 24-hour clock. This influences
the way the time is being displayed, i.e. 7:00 pm or 19:00.
MENOPAUSE MODE
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The Menopause Mode can be switched on and off at any time and vanishes
from the main menu when disabled.
The Menopause Mode is disabled by default because it influences evaluation
in a negative way if you are not approaching menopause.
THE GRAPH
NAVIGATION
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The Graph virtually displays your data and the evaluation of it.
Swipe left or right to scroll through all the cycles you charted with Lily.
Tap and hold on a certain day to activate an overview, keep holding and
swipe to switch to the overview of another day.
Tap the i to reveal a detailed key to all the symbols and colored bars you can
see in the graph.
Swipe vertically (up) to reveal any of the additional information you may have
charted for each day. See the icons to the left to see which category you
charted additional data for.
THE CALENDAR
NAVIGATION
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Swipe horizontally to switch between months
Swipe vertically to switch between years
Tap to select one particular day. You can then go back to the main menu and
make changes to this day.
Tap the i to reveal a detailed key to all the symbols and bars displayed in the
calendar.
FAQ
GENERAL
DO I HAVE TO TAKE MY TEMPERATURE AT THE SAME TIME EACH MORNING?
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If you know that your temperature will not be significantly different if you take it
at 9 am and not at 7 am then you don’t have to take it at 7 am sharp. Study
the way your temperature behaves according tot he time you take it. If it
produces erratic patterns try to be more consistent with the time.
WHERE CAN I CHANGE MY TEMPERATURE UNIT?
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In the Main Menu, select Settings ➤ Temperature Unit.
CAN I CHANGE MY STANDARD WAKE-UP TIME?
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In the Main Menu, select Settings ➤ Wake-up Time.
CAN I CHANGE THE EVALUATION METHOD?
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In the Main Menu, select Settings ➤ Evaluation Method.
HOW DO I START A NEW CYCLE?
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On the first day of your period tap on start a new cycle in the Period menu.
HOW DO I SEPARATE TWO CYCLES?
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In case you ever miss starting a new cycle and want to do this later, either go
to the day your period started and tap start new cycle in the Period menu.
You can also go to Cycle Management ➤ Edit Mode and tap on the +
button to create a new cycle divider. Tap anywhere in the graph to place it.
Tap, hold and drag it to adjust its position.
HOW DO I DELETE ALL DATA OF ONE DAY?
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In the Main Menu, scroll to the bottom, then go to Cycle Management ➤
Delete Data ➤ Select the day(s) you wish to delete.
CAN I DELETE A TEMPERATURE?
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Tap on the temperature menu and use the ⌫ until the dashes appear.
I WANT TO QUICKLY CHANGE THE BEGINNING OF A CYCLE, CAN I DO THAT?
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Go to Cycle Management ➤ Edit Mode and select the divider at the
beginning of the cycle you wish to make changes to. Drag the slider to the left
or right to change its position.
I ADDED A CYCLE BEFORE THE FORMER FIRST CYCLE, NOW I HAVE TWO CYCLES MERGED
AS ONE LONG CYCLE. WHAT DO I DO?
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Go to Cycle Management ➤ Edit Mode and tap the + button in Lily’s
navigation bar. Tap anywhere in the graph (preferably the beginning of the
second cycle-to-be) to add a new divider. Adjust the divider by tapping,
holding and sliding if you have to in order to set it to the correct day.
HOW DO I ADD/CHANGE INFORMATION TO DAYS IN THE PAST?
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To go back a few days use the arrows at the bottom in the Main Menu.
If you need to go back months or even years, go to the calendar by tapping
the icon in the upper right corner in the navigation bar.
In the calendar, swipe horizontally to switch between months, swipe vertically
to switch between years.
Tap on the calendar to select the desired day, tap the arrow in the upper right
corner to go back to the Main Menu and make the desired changes.
CAN I EXPORT MY DATA?
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In the Main Menu, scroll to the menu item PDF Export. Check mark the
cycle(s) you wish to export and tap the export button in the upper right
corner.
HOW DO I ACTIVATE PASSWORD PROTECTION?
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In the Main Menu, select Settings ➤ Password Protection ➤ ON.
Choose your password that is at least four characters long and enter it twice.
After entering your new password Lily will ask you for a password hint that
should help you to remember your password in case you should ever forget it.
CAN I USE BACKUP/SYNCHRONIZATION BETWEEN DEVICES?
The short answer is ‘Not at this point’.
Initially we planned to integrate iCloud backup and synchronization with Lily Pro to
enable you to have your data on all your devices simultaneously. And even
though Apple made iCloud perfect for seamless synchronization of smaller sets of
data, we quickly had to learn that larger sets of data are a whole different story.
Unfortunately, iCloud is not quite ready for prime time yet when it comes to
synchronization of larger amounts of data. With the current set of tools that Apple
provides it is nearly impossible to guarantee flawless data synchronization over
multiple devices.
We will continue to work on this, but when it comes to your data we do not want
to ship anything that is not working perfectly.
WHICH ELEMENTS CAN BE SCROLLED OR SWIPED?
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Lists can be scrolled, the Cervical Fluid list can be scrolled and swiped, the
graph and calendar can be swiped.
EVALUATION
I DON’T SEE A YELLOW COVERLINE, WHY?
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Your cycle could not be evaluated according to the rules set by the evaluation
method you chose. Reasons can be:
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An anovulatory cycle: no ovulation took place, no progesterone is
emitted, temperature won’t rise.
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Insufficient data due to a) too many excluded temperatures or b) too
many temperatures were not charted or skipped.
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You did ovulate, but your body reacts poorly or not at all to the
progesterone. According to the rules of evaluation a thermal shift could
not be detected.
I AM PRETTY SURE I DID OVULATE, I EVEN SEE A TEMPERATURE SHIFT. WHY IS THERE STILL
NO COVERLINE?
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In some cases it can happen that, even though the overall picture displays a
thermal shift, the rules are still not met. To see an example, please see
Evaluation - Thermal Shift or Not? in this manual.
LILY TELLS ME I AM PREGNANT, IS THIS ACCURATE?
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Lily assumes a pregnancy every time the temperature remains above the
yellow coverline for 18 days in a row. The luteal phase is between 12 and
16 days long, and at the 18th day a pregnancy is possible (that is how long a
fertilized egg would need to implant itself in the uterine lining).
Progesterone raises the temperature and keeps it elevated. Reasons for that
can be: a pregnancy or, in rare cases, a benign cyst that emits progesterone.
Only your doctor will be able to tell you whether or not you are really pregnant.
LILY TOLD ME I WAS PREGNANT, A FEW DAYS LATER I GOT MY PERIOD. WHAT DOES THIS
MEAN?
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You either were pregnant and suffered a miscarriage which, if you had not
been charting, could have been confused with a late period. Your
progesterone levels drop as well as your temperature, causing the bleeding.
You might have had a benign, progesterone emitting cyst which ruptured and
vanished, causing the progesterone levels to drop along with the temperature.
This causes the bleeding.
I WAS PREGNANT BUT HAD A MISCARRIAGE, WHAT DO I DO WITH LILY NOW?
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If you were pregnant (confirmed by a physician) and suffered a miscarriage,
you can start the new cycle on the day the bleeding started. You can go on
with regular charting.
I AM PREGNANT, WHAT DO I DO WITH LILY?
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If you confirm a pregnancy with a test from a physician (Main Menu ➤
Pregnancy Test ➤ positive), Lily will calculate an estimated date of birth
and display it in the graph. Lily will stay put until you give birth to your child.
Meanwhile you can keep on charting notes etc., anything you find worth
keeping track of during your pregnancy.
After birth you can take up charting again and start a new cycle, but your
body will most likely need some time to adjust and find a way back to
ovulating on a regular basis.
WHEN SHOULD I EXCLUDE A TEMPERATURE? (RULE OF THUMB)
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Whenever you experience interferences that affect your temperature (they are
notably higher than average and stand out among the rest) you should
exclude said temperature. To ensure proper evaluation you should consider
excluding this temperature. Lily will then ignore it but still show it in the graph
(grey) for your reference.
WHERE DO I EXCLUDE A TEMPERATURE?
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To exclude or include your temperature from evaluation, go to the
Temperature Menu and check or uncheck the box below the temperature.
I AM APPROACHING MENOPAUSE. CAN I STILL USE LILY?
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In the Main Menu, select Settings ➤ Optional Menus. Tap the toggle
button of Menopause to ON. The evaluation will be adjusted accordingly and
a new menu appears which lets you chart additional menopause symptoms.
I DON’T SEE THE INFERTILE TIME AT THE BEGINNING OF MY CYCLE. WHY?
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Make sure the menopause-menu is switched off (Main Menu ➤ Settings ➤
Menopause ➤ OFF).
If it is not enabled the Minus-8-Days Rule might apply to you and you might
be unable to assume infertility at the beginning of your cycle due to possible
early ovulation (see Minus-8-Days-Rule for more info).
If the previous cycle could not be evaluated (no yellow coverline), it counts as
anovulatory. Early ovulation has to be expected for the following cycle, hence
there is no infertile phase at the beginning.
Make sure you have not accidentally entered information on cervical fluid in
the first few days.
Make sure you started a new cycle on the day your period began. If you did
not, Lily will think these days to belong to the prior cycle.
CAN I OVERRIDE THE AUTOMATICALLY RESULTING QUALITY OF THE CERVICAL FLUID?
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In the Cervical Fluid Menu, tap on one of the three bars (1, 2 or 3) next to
Manual Override. You will still see what the regular evaluation would be. To
turn off the override, deselect the blue bars next to Manual Override.
A WOMAN’S CYCLE
WHAT IS REGULAR?
Any woman probably knows about the myth that a regular cycle consists of 28
days, with ovulation happening on day 14. Reality looks quite a bit different,
actually. Women with this kind of cycle are quite rare. The length of a cycle varies
from woman to woman, sometimes drastically. While some may have a short
cycle with only 25 days, others might have a longer cycle of 38 days. Of course,
in contrast to each other they are as different as black and white, but for each
woman her personal cycle length is as regular as it can be.
And since we are all individuals and no statistic, each woman might as well have
her own definition for what is regular.
Of course there are irregularities which some have to deal with. We cover that in
the chapter GOOD TO KNOW, so make sure to read this as well since this
knowledge might come in handy for you.
HORMONAL INTERACTION
The basics which every cycle (normally) consists of, are ovulation and
menstruation, without going too much into detail. Within a range of about 30 to
40 days depending on each woman, the body prepares to ovulate each cycle.
The cycle divides into two phases: preovulatory (prior to ovulation), and
postovulatory (after ovulation).
The preovulatory phase (follicular phase) is the phase in which the follicle evolves
under the influence of FSH (Follicle Stimulating Hormone). The largest follicle of
many will later release an egg during ovulation.
These are the hormones in the order as they work in a woman’s cycle
FSH (FOLLICLE STIMULATING HORMONE)
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FSH is being produced in the pituitary gland
It is the mainspring for the development of the ovarian follicles
ESTROGEN
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As you go from menstruation to ovulation, estradiol (a hormone of the group
of estrogens) is being produced by the ovarian follicles
Estradiol is responsible for what is happening in the preovulatory phase: as
you approach ovulation, the lining in your uterus and the eggs within the
follicles begin to grow, and you keep developing a wet, eggwhite-like fluid, the
cervical fluid
LH (LUTEINIZING HORMONE)
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LH is being produced in the pituitary gland
Together with FSH it stimulates and completes the follicular growth
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It is also responsible for the ruptured follicle turning into the corpus luteum,
once ovulation has occurred
The LH surge is a boost in LH production which triggers ovulation; ovulation
itself occurs about 1 or 2 days later
PROGESTERONE
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After ovulation you enter the postovulatory phase (luteal phase)
The ruptured follicle will turn into the corpus luteum and will immediately start
to emit progesterone
This hormone is the reason why the body temperature rises distinctly and
makes it possible to detect if a woman ovulated
It is also responsible for the fact that no other follicle will release an egg this
cycle and it keeps the uterine lining up so that, if fertilized, the egg can implant
in it
The corpus luteum will eventually break down, thus ending the luteal phase
Without the progesterone the uterine lining will not last and will be shed soon
afterwards (menstruation)
GNRH (GONADOTROPIN RELEASING HORMONE)
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It is the most important hormone, produced in the hypothalamus
It is responsible for the production of FSH and LH, without which the follicles
would not grow, no estrogen would be produced, there would be no LH to
trigger ovulation
One assumes that stress can influence the day ovulation occurs, as stress
influences the brain and hypothalamus
THE CYCLE
In a regular cycle (as in a cycle with ovulation, the length may vary) everything
starts with a surge of GnRH, which stimulates the FSH and LH production. FSH
and LH make the follicles grow, which then start emitting estradiol (estrogen).
After menstruation the level of each hormone is quite low. It needs to build up
before ovulation can happen.
follicles grow
the concentration of estrogen will at some point trigger a LH surge
ovulation happens about 1 or 2 days later
the concentration of estrogen drops and is replaced by progesterone
the temperature rises and remains high as long as the corpus luteum exists
(about 12 to 16 days, varying from woman to woman)
➡ the corpus luteum breaks down, the emission of progesterone stops
➡ the temperature drops again, and the uterine lining is being shed
➡
➡
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If a fertilized egg implants into the uterine lining, the corpus luteum will stay alive.
Embryos emit human chorionic gonadotropin (hCG), a hormone similar to LH
which keeps the corpus luteum alive, preventing other follicles from growing. After
a few weeks of pregnancy the placenta will take over the production of the hCG
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in order to prevent the loss of the corpus luteum. If the level of progesterone
drops the uterine lining would be shed and the embryo would most likely be lost.
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THE THREE PRIMARY FERTILITY SIGNS
The three primary signs which can be charted in order to see the development in
a cycle are the waking temperature (basal body temperature), cervical fluid and
cervical position.
THE WAKING TEMPERATURE
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Should be taken each morning at the same time, before getting up and
engaging in any kind of activity
Preovulatory waking temperatures range from 97.0°F (36.01°C) to 97.7°F
(36.5°C), the postovulatory temperature rises to about 97.8°F (36.55°C) and
higher
CERVICAL FLUID
There are three stages of cervical fluid (four, counting the ‘0’-stage): sticky,
creamy and eggwhite
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Those stages are characterized by the appearance of the cervical fluid and
the vaginal sensation
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To be more specific, we add a fourth, stage zero, which comprises no
mucus and no or a dry vaginal sensation
➡ It is very important to keep track of both, as the correlation of both will identify
your so-called Peak Day (more: THE BASIC RULES).
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Here is an overview of which vaginal sensations go hand in hand with what kind
of cervical fluid and how they are sorted into categories, increasing in fertility the
higher the number gets:
category 0 (no mucus):
FEEL - nothing, dry
LOOK - nothing
category 1 (sticky):
FEEL - itchy, uncomfortable
LOOK - rubbery/springy, semi-translucent, cloggy/sticky
The color can be white or yellowish.
category 2 (creamy):
FEEL - cold, moist, humid
LOOK - milky/watery, creamy, non/stretchy
The color can be white or yellowish.
category 3 (eggwhite):
FEEL - wet, slippery, lube-like
LOOK - spinnbarkeit, opaque streaks, eggwhite/clear, liquid/watery, spotting
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STAGE ZERO
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A few dry days (just moist/damp on the fingers, quickly dissipating in the air),
following menstruation
Real cervical fluid can only be washed off, it won’t dissipate in the air very
quickly
FIRST STAGE
•
•
Sometimes there are no real dry days, it starts out with sticky right away; this
is yellowish or white and looks like rubber-cement
It is springy but tears apart easily if stretched too wide and is often
accompanied by an itchy, uncomfortable vaginal sensation
SECOND STAGE
•
•
•
Creamy cervical fluid, looks like body lotion
Sometimes cloggy, cannot be stretched at all
It ranges from white to slightly yellow and is accompanied by a cold,
sometimes slightly moist feeling
THIRD STAGE (MOST FERTILE!)
The cervical fluid will look and feel like eggwhite
It is slippery and very stretchy (sometimes about 6 inches or more)
•
The vaginal sensation will be very wet, it feels like you were sitting in a small
puddle of lube, or as if water was running down the inside your vagina
•
Some woman experience their cervical fluid to be streaked with bright red or
brown, caused by the ruptured follicle. It is the most fertile quality your cervical
fluid can reach
➡ It can be distinguished from regular spotting, since it usually really is just a
very small amount. Sometimes you have to be very attentive to notice it at all.
•
•
Page 17 of 44
CERVICAL POSITION
Its shape and position change throughout the cycle, so it qualifies for charting just
as cervical fluid does. During the infertile days the cervix will be located far up in
the vagina and feels rather firm. At this time the cervix is closed. As you approach
ovulation the cervix begins to “sink” into the vagina, making it more difficult to
reach the cervix. It will also feel a lot softer and wet.
The opening and position of the cervix vary as follows:
Menstruation
•
•
Around Ovulation
Menstruation
closed, low, firm, non-wet (infertile days)
open, high, soft, wet (around ovulation)
In women who gave birth before the cervix might never fully close during their
infertile days.
If you are able to chart your cervical fluid you do not necessarily have to chart the
cervical position as well, but in order to cross-check with the cervical fluid and
temperature it is always good to know about the cervical position as well.
THE SECONDARY FERTILITY SIGNS
Aside from the primary signs there are many fertility signs which are more subtle:
the secondary fertility signs.
The list encompasses quite a few signs which many women notice on a regular
basis. No woman necessarily has to notice all of them, but chances are you will
notice at least one or two of them reoccurring throughout your cycle.
The secondary fertility signs may include:
•
•
Page 18 of 44
abdominal bloating
acne (break out)
•
•
•
•
•
•
•
•
•
•
•
•
breast tenderness
fatigue
heightened senses
increased energy level
increased sensitivity in skin
increased sexual feelings
midcycle spotting (blood from the ruptured follicle when the egg is released)
Mittelschmerz (midcycle pain)
pain near the ovaries
swollen vulva/vaginal lips
water retention
backache
Some women notice symptoms which are very individual and only obvious to
themselves. With time you will be able to see a pattern and determine if
something specific always happens around ovulation which you thought was just
a mere coincidence.
HOW TO CHECK YOUR FERTILITY SIGNS
The first day of charting should always be the first day of your next period. If
you start charting mid-cycle there will not be enough data to correctly evaluate
your cycle as Lily is bound to certain rules (THE BASIC RULES).
Taking your Temperature:
•
•
•
•
•
•
•
•
•
Page 19 of 44
Use a digital or an analog thermometer. It should be labeled for the use of
taking the Basal Body Temperature (BBT). Do not use forehead or ear
thermometers, they are too inaccurate!
For Celsius the digital thermometer needs two decimals behind the comma.
Chart Celsius in 0.05 °C steps and round accordingly (i.e. 36.62° to 36.60°,
36.63° to 36.65°, 36.67° to 36.65° and 36.68° to 36.70°).
For Fahrenheit one decimal behind the comma suffices. Chart Fahrenheit in
0.1 °F steps (i.e. 97.6°, 98.1° etc.), do not round!
Try to take your temperature at roughly the same time every morning.
Exclude temperatures which might have been influenced due to interferences
(fever, alcohol, staying up late etc.) to ensure proper evaluation.
Take your temperature always before you get up, activity will increase your
temperature rapidly. Make sure that, before taking your temperature, you
slept for four consecutive hours.
With a glass thermometer make sure to take your temperature for 5 full
minutes (always record the lower temperature, if the temperature should fall
between two numbers on a glass thermometer).
Record your temperature soon after taking it.
Decide where to take your temperature (orally (the less accurate method!),
vaginally or rectally) and stick to this method throughout one cycle. You may
change where you take your temperature in the next cycle, however, always
be consistent throughout one cycle.
Checking for Cervical Fluid:
•
•
•
•
•
•
•
•
Start checking for cervical fluid the day after your menstruation ended.
Check for cervical fluid either at the vaginal opening, or at the cervix. As with
the temperature, be consistent with one method throughout one complete
cycle.
Try to check for cervical fluid as often as possible.
Pay very close attention while using the bathroom. Sometimes the cervical
fluid flows out in one single drop. After that you might feel dry for the rest of
the day.
Check the appearance as well as the vaginal sensation
Look at your cervical fluid by taking some between your fingers and slowly
drawing them apart to see if it is stretchy. Who does not want to do that can
also try the same method with toilet paper. Though it is difficult since the
paper will soak up the fluid.
Do not check for cervical fluid while sexually aroused as you could mistake
the arousal fluid for eggwhite-quality cervical fluid.
Semen and eggwhite-like cervical fluid can be confused as they are
somewhat alike, however, semen is a lot thinner and also dries a lot quicker
than cervical fluid does.
NOTE: Using spermicide during the fertile phase can mask cervical fluid and
render you unable to identify your fertile phase.
Checking the Cervical Position:
•
•
•
•
Insert one or two fingers into your vagina, just like you would insert a tampon.
If you are very fertile, the cervix can be easily reached. If you are infertile the
cervix rises again and sits very low (in the back) of your vagina.
Check if it feels rather soft, or if it feels very firm.
Try to check whether or not your cervix is open. Sometimes it is hard to feel,
but when closed the opening feels like a small pimple.
To find out more about how Lily will display your results, go to INTUITIVE
CHARTING.
Page 20 of 44
UP CLOSE & PERSONAL WITH FAB
WHAT IS FAB?
FAB stands for Fertility Awareness-Based Method and encompasses all methods
which are aimed at identifying the fertile phase of a woman.
Lily is based on the most popular sympto-thermal methods (STM) FAM (Fertility
Awareness Method) and NFP (Natural Family Planning) as both combine the
evaluation of cervical fluid, cervical position and the basal body temperature.
These sympto-thermal methods help a woman identify which days of her cycle
are her fertile, and which ones her infertile days. Pregnancy achievers just as
pregnancy avoiders benefit from this knowledge, as they can time intercourse
around these phases to meet their needs.
FAM and NFP rely on the assumptions that an egg (ovum) can be fertilized
between 12 to 24 hours after ovulation (calculate with 48 hours in case more than
one egg is released), that sperm can survive in the vagina up to 5 days under
ideal circumstances, and that pregnancy is possible due to intercourse 2 to 3
days before and after ovulation. Since the exact time of ovulation can only be
identified in retrospective, you should add 2 to 3 days prior to and following your
thermal shift in order to either time intercourse to conceive, or to identify your
infertile phase for those using a sympto-thermal method as birth control method.
NOTE: FAM and NFP are not the Rhythm or Calendar Method!
FAM AND NFP - THE DIFFERENCES
Sometimes it is difficult to differentiate between FAM and NFP, however the
ethical approach is what differentiates these methods in the US. While practicing
FAM you use barrier methods like condoms in your fertile time, but with NFP you
completely abstain from intercourse during this phase. Other than that both
methods are identical.
In comparison to FAM, the Workgroup NFP in Germany has slightly different rules
for their approach of NFP in terms of evaluation and interpretation of the charted
data. We, however, will further discuss the method of FAM (NFP USA), as it is the
most popular of the two methods mentioned. However, the rules of the
Workgroup NFP will be explained.
Lily can be used for both approaches, regardless of whether you prefer to use
FAM/NFP or NFP (Workgroup NFP). You can set the method you wish to use for
evaluation.
IS IT SAFE?
The failure rate of the sympto-thermal methods are the result of human
misinterpretation of the fertility signs, inaccurate charting of the same and trying to
cheat. Studies have shown that, if applied correctly, these methods have about
the same Pearl Index as the Pill. Its efficacy lies at 99,4%, the Pill ranks at about
99,5%.
Page 21 of 44
THE BASIC RULES FOR FAM
Before you read the rules, there is one term which needs further explaining so you
can follow what is being said in the rules: the coverline.
The coverline is a horizontal line drawn 0,1°F (0,05°C) above the highest
temperature of the last six temperatures before your thermal shift with FAM. With
NFP the coverline will be drawn through the highest temperature of those prior
six.
That way you can easily see if a temperature drops below this coverline. The
coverline divides your preovulatory and postovulatory phase.
Preovulatory infertile phase
FIRST 5 DAYS RULE
You can assume infertility the first 5 days of your cycle if, 12 to 16 days prior to
the start of your period, you had a temperature shift (see fig. 1).
The blue bar represents the time at the beginning of a new cycle that you can
assume infertility. By determining that there was a thermal shift and ovulation 12
to 16 days prior to the bleeding, you can be sure this is your period and not
ovulatory spotting, in which case you would still be extremely fertile.
If you often happen to experience cervical fluid right after your period you should
never consider yourself infertile more than the first 5 days of your cycle, rather less
than 5. On day 6 in the chart below you can see that there is no bleeding but
spotting, and on day 7 there is already cervical fluid. The spotting on day 6
could mask cervical fluid, hence this day is not considered safe either.
FIG. 1
Page 22 of 44
MINUS 8 DAYS RULE
After 12 consecutive cycles (cycles with a temperature shift and thus with
ovulation) you can determine the earliest temperature shift you had within these
12 cycles. From this day you subtract 8 days. You now can assume infertility until
this day each cycle, however, only if you are not experiencing cervical fluid before
reaching that day.
Example: the earliest temperature shift within 12 consecutive cycles is day 15. 15
- 8 = 7, which means that infertility may be assumed until day 7 of your cycle, as
long as you don’t experience cervical fluid.
Exception: if, within those first 12 cycles (i.e. cycle 6), your temperature shift
(ovulation) should have occurred before day 13 of your cycle, you immediately
have to use the minus 8 days rule to heighten safety.
Example: temperature shift on day 12. 12 - 8 = 4. Infertility cannot be assumed
longer than until day 4 of the cycle. The 5 days rule does no longer apply to
you.
FIG. 2 This is cycle 14, the Minus 8 Days Rule can be applied. If this woman’s earliest thermal shift was on day
20, she could assume infertility until day 12 of her cycle, according to the Minus 8 Days Rule. However,
on day 10 she observes cervical fluid, which means that she has to consider herself fertile as of day 10.
This rule comes from the Workgroup NFP and is included in the regular evaluation
of Lily, as we consider this to be more exact than the more inexact approach of
FAM which says that in case of an early ovulation only 3 days at the beginning of
the cycle are to be considered infertile. The formula provided by the Workgroup
Page 23 of 44
NFP is more accurate for each individual, hence Lily will include this rule with the
evaluation of FAM as well.
NOTE: For women in pre-menopause those rules never apply, since the
hormonal imbalances can result in irregular cycles and early or late ovulation.
They should never assume infertility around the beginning of the cycle.
DRY DAY RULE (NOT SUPPORTED!)
This rule is very delicate and only used by very advanced FAM practitioners who
know their cervical fluid pattern like the back of their hand. Since it is quite difficult
to use, let alone impossible to make a mathematical rule out of it for Lily, we
choose to neither support it in Lily, nor do we elaborate on this rule.
If you are interested in more information you should read the appropriate literature
or speak with a FAM specialist.
Only one thing remains to be said about this rule - if applied incorrectly, this
rule increases the risk of becoming pregnant.
Postovulatory infertile phase
TEMPERATURE SHIFT RULE
If until the evening (6 PM) of the 3rd consecutive day your temperature remains
above the coverline, you can assume infertility
If one temperature is at least 0,2°F (0,1°C) higher than the 6 preceding
temperatures, this one indicates the temperature shift. A horizontal line, the
coverline, is being drawn 0,1°F (0,05°C) above the highest temperature of the
preceding 6. If one of the following two temperatures is at least 0,3°F (0,15°C)
above the coverline you can assume infertility starting at 6 pm of the third day
after the thermal shift.
NOTE: Lily will show infertility from day four, just as a margin to cover the
timespan between 6 PM of day three and 12 AM of day four.
Page 24 of 44
FIG. 3
You can see that the infertile phase starts on day 22. Lily will add one more day to be safe, which
would mean infertility is assumed as of day 23 instead. That is because those new to FAM/NFP might
forget about the after-6PM-rule. Hence Lily displays infertility for the following day instead.
Exception 1: if none of the three temperatures rises for at least 0,3°F (0,15°C)
above the coverline, then you have to wait on a fourth temperature which has to
be at least 0,3°F above the coverline.
Exception 2: the temperature shifts for only 0,1°F (0,05°C) instead of 0,3°F
(0,15°C) and ends up sitting directly on the coverline (slow-rise-pattern, see
TEMPERATURE PATTERNS)
!! CAUTION !!
➡ if within these 3 days one of the temperatures drops on or below the
coverline, the temperature shift rule has to be applied all over again, starting
from the day it rises back above the coverline
PEAK DAY RULE
You can assume infertility at the end of the 4th consecutive day (6 PM) following
your Peak Day
The Peak Day is the last day you see/feel cervical fluid of wet/slippery/eggwhite
quality (light turquoise in figure 4). If within those 4 days after your Peak Day no
cervical fluid or only less fertile quality fluid occurs, you can consider yourself safe
in the evening of day 4. Important is a definite change to less fertile quality cervical
fluid.
Page 25 of 44
NOTE: Lily will show infertility from day five, just as a margin to cover the
timespan between 6 PM of day four and 12 AM of day five.
FIG. 4
Please note that Lily will show infertility starting day 25 to cover the time between 6 pm of the 4th and
12 am of the 5th day instead of day 24 as in the picture above.
➡ Concerning the Temperature Shift Rule and the Peak Day Rule, whichever
comes last overrules the other one. If the Peak Day takes effect after the
thermal shift as seen above in figure 4, the Peak Day Rule overrules the
Thermal Shift Rule. You wait until the evening of day 24 before you can
assume infertility. See figure 4: with the thermal shift rule the infertile phase
would start on day 22, with the Peak Day rule it starts two days later.
NOTE: Whenever/as long as you experience cervical fluid of any kind you have to
consider yourself to be fertile.
Page 26 of 44
THE BASIC RULES FOR NFP (WORKGROUP NFP, GERMANY)
➡ The temperature will be evaluated according to the book, the way the cervical
fluid is sorted into categories will be the same as with FAM to ensure
compatibility should you ever want to switch between NFP and FAM.
FIRST 5 DAYS RULE
you can assume infertility the first 5 days of your cycle if, 12 to 16 days prior to
the start of your period, you had a temperature shift.
➡ This is indicated by the blue bars and will only be shown if the prior cycle
could successfully be evaluated (you see a yellow coverline).
*See example picture for 5 Days Rule for FAM, they are the same.
MINUS 8 DAYS RULE
After 12 consecutive cycles (cycles with a temperature shift and thus with
ovulation) you can determine the earliest temperature shift you had within these
12 cycles. From this day you subtract 8 days. You now can assume infertility until
this day each cycle, however, only if you are not experiencing cervical fluid before
reaching that day.
Example: the earliest temperature shift within 12 consecutive cycles is day 15. 15
- 8 = 7, which means that infertility may be assumed until day 7 of your cycle, as
long as you don’t experience cervical fluid.
Exception: if, within those first 12 cycles (i.e. cycle 6), your temperature shift
(ovulation) should have occurred before day 13 of your cycle, you immediately
have to use the minus 8 days rule to heighten safety.
Example: temperature shift on day 12. 12 - 8 = 4. Infertility cannot be assumed
longer than until day 4 of the cycle. The 5 days rule does no longer apply to
you.
*See example picture for Minus 8 Days Rule for FAM, they are the same.
TEMPERATURE SHIFT RULE
If until the evening (6 PM) of the 3rd consecutive day your temperature remains
above the coverline, you can assume infertility
If one temperature is higher than the 6 preceding temperatures, this one
indicates the temperature shift. A horizontal line, the coverline, is being drawn
through this higher temperature. If the following two temperatures remain above
said coverline, while the third has to be at least 0.4 °F (0.2 °C) above the
coverline, you may assume infertility in the evening (6 PM) of the 3rd day after
your temperature shift.
Page 27 of 44
NOTE: Lily will show infertility from day four, just as a margin to cover the
timespan between 6 PM of day three and 12 AM of day four.
FIG. 5
Note that in this approach only the coverline goes through the highest of the preceding six
temperatures, it is not drawn above it. The exceptions, when a temperature drops on or below the
coverline, are what distinguishes FAM most from the German approach of the Workgroup NFP.
Exception 1: if one of the following two temperatures falls on or below the
coverline you have to wait on a fourth temperature which has to be at least 0.4 °F
(0.2 °C) above the coverline.
Exception 2: if the third temperature lies below the required 0.4 °F (0.2 °C) you
have to wait on one more temperature. This one has to be above the coverline,
no matter how high, just above it.
!! CAUTION !!
➡ Those two exceptions can never be used together, always just one at a time.
PEAK DAY RULE
You can assume infertility at the end of the 3rd consecutive day (6 PM) following
your Peak Day
The Peak Day is the last day you see/feel cervical fluid of wet/slippery/eggwhite
quality (turquoise in graph). If within those 3 days after your Peak Day no cervical
fluid or only less fertile quality fluid occurs, you can consider yourself safe in the
evening of day 3. Important is a definite change to less fertile quality
cervical fluid.
Page 28 of 44
NOTE: Lily will show infertility from day four, just as a margin to cover the
timespan between 6 PM of day three and 12 AM of day four.
FIG. 6 As you can see in the image above, in this approach infertility is assumed one day earlier than with
FAM. Lily will again show infertility starting day 24 instead of day 23 to cover the time between 6 pm of
the 3rd and 12 am of the 4th day.
➡ Concerning the Temperature Shift Rule and the Peak Day Rule, whichever
comes last overrules the other one. If the Peak Day takes effect after the
thermal shift the Peak Day Rule overrules the Thermal Shift Rule and vice
versa.
NOTE: Whenever/as long as you experience cervical fluid of any kind you have to
consider yourself to be fertile.
RULE OF THUMB (BOTH, FAM AND NFP)
The Rule of Thumb allows you to exclude temperatures which, after thorough
observation, appear too high as a result of interferences. Interferences can range
from simple stress to sleeping in or eating late at night, partying of medication.
If you are a beginner you should be careful with what you exclude until you are
really sure the temperature was influenced by interferences.
Do not lightly use the rule of thumb, but figure out over time under what
circumstances your temperature spikes, if it reacts at all. Some women have no
problem with interferences while other’s temperatures go fluctuating up and down
like crazy at the slightest interference.
Once you know how you react, exclude these temperatures from evaluation. you
will still see them in grey on the chart, but they will be ignored when it comes to
evaluation.
Page 29 of 44
➡ Never exclude temperatures LOWER than average, this could falsify
the evaluation if there is a drop on or below the coverline! Do not use
the Rule of Thumb after ovulation. This rule can only be used in the
preovulatory phase.
FIG. 7
Page 30 of 44
Here you can see how the Thermal Shift Rule is overruled by the Peak Day Rule. Also, on day 8 of the
cycle the temperature has been excluded due to interferences, you can see how it clearly stands out
among the rest of the temperatures of the preovulatory phase. The red dot means unprotected, the
green dot means protected intercourse.
TEMPERATURE PATTERNS
Sometimes your temperature seems to be going awfully astray, bouncing up and
down and you don’t know why. Here is a short list of things to check before you
think something might be wrong:
•
•
•
•
•
Check the battery of your digital thermometer if you are using one.
Consider using a glass basal thermometer, as they appear to be more
accurate for some women (if you do, take your temperature for 5 full
minutes).
Consider taking your temperature vaginally rather than orally, as the oral
temperature may be inconsistent due to breathing through your mouth at
night.
Try to identify interferences (alcohol, illness, restless sleep, stress etc.) which
may have influenced your temperature. You may want to exclude these
temperatures from the evaluation.
Try to take your temperature at the same time every day. Some women
experience a significant increase in their temperature if they sleep way past
the time they usually take their temperature.
NOTE: high temperatures during your period are normal and due to residual
progesterone.
Your temperature will shift about a day or two after you ovulate. How distinct this
shift will be cannot be determined beforehand.
There are lower temperatures in the preovulatory phase, followed by ovulation.
The progesterone emission results in a distinct thermal shift. The temperature will
remain high for 12 to 16 days until the postovulatory phase ends and the
temperature drops. Menstruation follows.
If the temperature remains high for more than 18 days a pregnancy is highly likely.
If your thermal shift is not as distinct, you might want to take a look at the
following patterns. These are special cases which are harder to interpret, but
nonetheless manageable. You will have to adjust the rules of FAM to be safe of
you want to avoid pregnancy. The same applies for pregnancy achievers if they
want to time intercourse perfectly in order to increase their chances to conceive.
Page 31 of 44
Stair-Step Pattern
•
•
Your temperature shifts for at least 0,2°F (0,1°C) for 3 or 4 days until it rises
further, has a peak, then drops shortly before or on the day of menstruation (if
no egg has been fertilized).
Wait one more day to be safe. Figure 5 below shows that the thermal shift
rule is being modified a bit to achieve more safety. Usually the infertile phase
would start on the evening of day 22, but since the temperatures have been
hovering so close above the coverline it is safer to wait one more day to see if
it rises more or if it drops below the coverline. Hence the infertile time would
start on day 23, according to the modified thermal shift rule.
FIG. 8
Page 32 of 44
Here, Lily would display infertility starting on day 24 instead of 23, again keeping those in mind who
might forget that infertility may not be assumed before 6 PM on day 23 as seen above.
Slow-Rise Pattern
FIG. 9
•
•
Lily would display infertility on day 25 of this cycle instead of day 24.
Your temperature rises by 0,1°F (0,05°C) of a degree each day instead of
rising distinctly. The first higher temperature “sits” on the coverline (0,1°F
higher than the highest of the preceding 6), while the following temperatures
continue to slowly rise in steps of 0,1°F. Usually the temperature before the
first rise of 0,1°F above the highest of the preceding 6 temperatures is
distinctively lower than this first rise in temperature.
You do not apply the thermal shift rule until the first temperature rises at least
0,1°F above the coverline. The temperature sitting on the coverline does not
count. To be sure you extend the count of 3 days to 4, which means if your
temperature remains above the coverline you can assume infertility the
evening (6 PM) of day 4 after your thermal shift, which results in day 24 of the
cycle in the example above.
➡ Always cross-check with your cervical fluid (Peak Day Rule) or the
cervical position to be safe on this decision!
Page 33 of 44
Temperature Drop on Day 2 of the Thermal Shift
FIG. 10
Lily displays infertility on day 26 instead of 25.
If your temperature drops on or below the coverline on day 2 after the first rise of
your thermal shift, this temperature will be excluded from the evaluation. The
Thermal Shift Rule has to be applied all over again starting from the next
temperature above the coverline.
Page 34 of 44
Temperature Occasionally Dropping Below the Coverline after Ovulation
FIG. 11 Here you can see how the Peak Day Rule is overruled by the Thermal Shift Rule. On day 27 the
temperature drops and there is cervical fluid. However, the evaluation has already been successfully completed. Also note how during the time of period the temperature lies above the coverline. This
is due to residual progesterone from the former cycle and nothing to worry about.
Occasional temperature-drops below the coverline after ovulation can be a result
of a small surge of estrogen. If your Peak Day and temperature shift rules clearly
indicated that ovulation took place this is not a sign of fertility.
Page 35 of 44
EVALUATION - THERMAL SHIFT OR NOT?
Sometimes you see your chart and the thermal shift is easily visible to the eye, yet
Lily still does not show the coverline you are looking for.
The reason for that is that for Lily we turned the basic rules as well as some of
the exceptions into mathematic formulas to offer an automatic evaluation.
That means that, even though you do see your temperature rise, the basic rules
for the temperature evaluation are not met.
Only if the thermal shift can be detected by following the rules, Lily shows the
coverline. As an individual you can of course crosscheck with cervical fluid, your
cervical position and other secondary fertility signs to see whether or not ovulation
did take place despite the fact that your temperature pattern is not following the
rules.
Since Lily is as personalized as it can be, it still has to be (specifically but not
exclusively) based on the rules for temperature evaluation, and if they are not met
it is safer to assume ovulation did not take place. Evaluation of the infertile phase
based solely on cervical fluid and cervical position can be done but bares more
risks than the joint approach of what FAM is meant to be, and since Lily was also
designed to help beginners we opt for the safer approach of not showing infertility
at this point.
After a while, when the rules have become second nature to you, you will be able
to see why Lily does not show a coverline. Also, if charting other fertility signs, you
will be able to figure out if ovulation did take place nonetheless.
Sometimes, when you are not sure, you can switch from FAM to NFP (AG NFP)
as evaluation method and see what the other method says about your cycle.
Some cycles cannot be evaluated with FAM while they are perfectly evaluable
under NFP (AG NFP) and vice versa. That seemingly contradictory result is based
on the difference in temperature evaluation and the fact that the coverline is being
drawn in different places.
The example on the next page shows one cycle that cannot be evaluated under
FAM because the rules (and exceptions) fail after a few attempts, while the same
cycle is perfectly evaluable under NFP (AG NFP).
Page 36 of 44
FIG. 12 Here is a cycle evaluated with FAM, unsuccessfully.
FIG. 13 This is the same cycle as before, this time evaluated with the GErman approach by the Workgroup
NFP. The rules for the temperature evaluation and the placement of the coverline result in the cycle
being evaluable.
Page 37 of 44
TRYING TO CONCEIVE OR TRYING TO AVOID
NATURAL BIRTH CONTROL
Many people believe that FAM/NFP is either only a way to avoid pregnancy, or a
way to help conceive. However, both are correct. FAM/NFP can be used for both
as the method is all about defining your fertile and infertile days of your cycle.
Whether you use this knowledge to avoid pregnancy or to conceive is completely
up to you.
The huge advantage of FAM/NFP is that you do not tamper with hormonal
contraceptives which can mess up your natural hormonal balance and come with
heavy side effects. Some women coming off the Pill sometimes won’t ovulate for
months in a row. However, while you can have intercourse without barrier
methods while being on the Pill at (almost) every day of your cycle, FAM/NFP as
in charting your temperature and fertility signs alone is not a reliable method of
birth control.
You always need to be aware of the fact that when you are in your fertile time you
need to either abstain from intercourse or use a barrier method, just like
condoms for example (anything with spermicide is not recommended, as this can
mask cervical fluid. You may not be able to determine whether or not you have
fertile, wet-quality cervical fluid).
If understood and applied correctly, FAM/NFP is a natural and very reliable way to
prevent pregnancies.
Quick overview:
•
•
•
Whenever you show signs of fertility, either abstain from intercourse or use a
barrier method
FAM/NFP is most effective if intercourse is only practiced during your infertile
phase as barrier methods have a failure rate, just like any other contraceptive
Condoms are recommended as they will not mask cervical fluid and on top of
that protect you from STDs and HIV
An egg can be fertilized up to 24 hours after ovulation took place. The fact that
sperm can survive up to 5 days in your cervical fluid extends the fertile phase.
Hence the first part of your fertile phase is dictated by the time sperm can survive,
and the second part by the viability of your egg.
Combined, this leads up to 9 or 10 days each cycle in which you are fertile and
need to either abstain from intercourse or at least use a barrier method to prevent
a pregnancy. FAM/NFP includes a few days on both sides of the woman’s fertile
phase which act like a buffer, a safety margin, if you will (5 Day Rule, Peak Day
Rule etc.).
You should be aware of the fact that the exact day ovulation occurs can
hardly ever be determined. A woman can identify her fertile phase, but not
necessarily the day she ovulated. Even though there is a distinct temperature shift
following ovulation, the egg could have been released one or two days before the
temperature shift, depending on how long your body needs to react to the
change of hormones.
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Always keep in mind that the RULES OF FAM/NFP identify the beginning and end of
the fertile phase in which unprotected intercourse will most likely result in
pregnancy.
PREGNANCY ACHIEVEMENT
To increase your chances of becoming pregnant the knowledge about your cycle
is very important. Determining your fertile time is step one in trying to conceive.
Then time intercourse around the days you are most fertile to increase the
chances of pregnancy. Charting will help you detect any problems with your luteal
phase or else which could prevent you from a successful pregnancy.
➡ If you experience 18 consecutive days of high temperatures above the
coverline (mostly) in combination with a missed period, you are most likely
pregnant.
FIG. 14 The red bar is the estimated time of the expected period, the purple bar indicates a possible
pregnancy.
Spotting around the time you would normally expect your period can be
implantation spotting as the egg is burrowing into the uterine lining.
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GOOD TO KNOW
IRREGULARITIES AND ANOVULATORY CYCLES
Just like any process in our body, the hormonal balance can be easily disturbed
by outer influences. The result can be longer cycles than you are used to or
erratic temperature patterns.
To help you keep track of whether or not irregularities are linked to interferences,
you should chart anything out of the ordinary. After a while you will most likely
become an expert on what makes your cycle spin out of control here and there.
And remember, the following interferences are just a summary of the most
common interferences, and no woman has to react to all of those. You might
even discover there are things having an impact on you which are not even listed
here:
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drinking alcohol the evening before
changes in environment
changes in taking your temperature (when and where)
different thermometer
disrupted sleep
eating later in the evening
freezing at night
going to bed early
going to bed late
illness (fever)
medication
migraine/headache
night sweat
partying
getting not enough sleep
getting too much sleep
sleeping in
stress
The time prior to ovulation is especially prone to being disturbed by stress,
emotionally and physically alike. It can result in late ovulation or, in the most
drastic case, in an anovulatory cycle.
It is common belief that the postovulatory phase, the time after ovulation, is not as
easily influenced by stress. However, stress starts the following hormonal
reaction:
stress ➤ more prolactin ➤ inhibition of FSH and LH ➤ follicles will not
grow or just very slowly
A very high concentration of prolactin can lead to agenesis (underdevelopment) of
the follicles. Ovulation can still happen, but the corpus luteum will be weak and
the luteal phase shorter than usual.
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CHARACTERISTICS OF AN ANOVULATORY CYCLE
No thermal shift (no egg and no progesterone will be released)
The temperature goes up and down
•
The cervical fluid keeps building up to best quality, then decreases to less
fertile quality just to build up once again to best quality
➡ Your body is trying to ovulate but does not cross the estrogen threshold to
trigger the LH surge which then triggers ovulation.
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Your body might eventually give up trying to ovulate and ends the cycle with an
estrogen breakthrough bleeding. A regular period is called progesterone
withdrawal bleeding, due to the sudden drop of progesterone. Estrogen is
unable to support a growing endometrium, hence an anovulatory bleeding is
called estrogen breakthrough bleeding.
➡ Since you did not ovulate the regular rules (First 5 Days Rule) do not apply
until you had a cycle with a thermal shift and a regular period.
That means you cannot assume infertility the first 5 days of your next cycle.
You should consider yourself fertile during the whole period until you experience a
thermal shift and thus can be sure that you ovulated. You need to take this
precaution because ovulation can happen a lot sooner in the cycle following an
anovulatory cycle as you normally are used to. Hence you need to abstain from
intercourse or use a barrier method in order to avoid pregnancy.
SHORT LUTEAL PHASE AND OTHER IRREGULARITIES
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The luteal phase is the timespan between your thermal shift and your period
It can last between 12 to 16 days (mostly stable for an individual, sometimes
plus minus one day)
THE MOST COMMON PROBLEM
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The short luteal phase
Fewer than 10 days of postovulatory high temperatures above the coverline
may indicate a true shortened luteal phase, which means your corpus luteum is
breaking down too early.
This could be a problem for pregnancy achievers, as the lack of progesterone will
lead to shedding of the uterine lining too early and the fertilized egg will not have
enough time to implant in the lining. As it will happen around the same time as
your period the bleeding might be masking a miscarriage, since your body is not
able to keep up the progesterone long enough to outlast 18 days which the egg
needs to implant.
A fake short luteal phase is present, if your temperature needs some days to
adjust to the progesterone, therefore check for a significant gap between your
Peak Day and thermal shift. The days in between should be counted to the luteal
phase, even though the first three or four temperatures might not be above the
coverline.
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For questions about these conditions or if you think you might be dealing with a
short luteal phase, please see a physician.
DRUGS AFFECTING THE FERTILITY SIGNS
Lots of drugs or medications can influence your fertility signs and make it difficult
to properly evaluate them.
As going into detail about which drugs affect which fertility signs in what particular
way would be too time consuming, we ask you to always attentively read the
package insert or ask a pharmacist as to what kind of side effects a certain
medication will have on your body (especially ask about any mucolytic drugs
which can influence the appearance of your cervical fluid, and medications which
can result in a rise in temperature as in slight fever).
FAM/NFP AND MENOPAUSE
Charting can help you identify whether or not you are approaching menopause.
FACTS ABOUT MENOPAUSE AND FAM/NFP
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Irregularities (longer or shorter cycles, frequent anovulatory cycles)
Menopause is characterized as the last period a woman will experience (at the
average age of 51)
The process of approaching, reaching and overcoming menopause can take
up to several years
As with FAM/NFP each day is being observed for fertile conditions rather than
just the big picture, it still is a secure way of birth control
Using FAM/NFP during menopause means the rules for evaluation have to
be modified
THE MOST COMMON SYMPTOMS OF APPROACHING MENOPAUSE
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Irregular menstrual cycles
Hot flashes
Vaginal dryness
CHARTING DURING PRE-MENOPAUSE
Using FAM/NFP for birth control while approaching menopause can be tricky and
challenging, but nonetheless manageable. You will notice distinct changes in your
primary and secondary fertility signs.
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CHANGES OF THE PRIMARY FERTILITY SIGNS
WAKING TEMPERATURE
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Shorter and thus more frequent cycles (earlier ovulation)
Shorter luteal phases
More anovulatory cycles with your temperature mostly remaining in the lows
CERVICAL FLUID
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The quantity of your cervical fluid will decrease (less estrogen)
No ovulation means no progesterone to quickly dry up cervical fluid, hence it
will take a while to dry out and it will be difficult to determine your Peak Day
Your fertile pattern may change from dry-sticky-wet to dry-sticky without any
sensation or appearance of wet-quality cervical fluid
The vaginal sensation may become dry or sticky all throughout your cycle,
sometimes paired with patches of cervical fluid (attempt to ovulate)
CERVICAL POSITION
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Charting of the cervical position used to be helpful but optional, nut becomes
increasingly important as you approach menopause
You will be able to cross-check your cervical position with what you might (or
might not) experience with your cervical fluid
Your cervix will be firm, closed and low more frequently, confirming the longer
phases of infertility
CHANGES OF THE SECONDARY FERTILITY SIGNS
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The Mittelschmerz happens less often to those who know it
Midcycle spotting is common during long cycles
The breast tenderness decreases due to less progesterone
Once you are sure that you are approaching menopause and want to use FAM/
NFP as birth control, you should follow all the standard rules which apply to
FAM/NFP, except for the First 5 Days Rule.
That means you keep charting as usual, but you simply do not assume infertility
the first 5 days of your cycle since ovulation can happen sooner than before.
While going through pre-menopause you might experience months without any
dry days. That would mean that you are always fertile, which is not really true. The
BIP (basic infertile pattern) as described on page 6 comes into play. The
occurrence of the same (unchanging) cervical fluid day after day is called a BIP
and very common among women in pre-menopause.
This BIP allows women to determine more days as infertile than they would
normally be allowed according to the standard FAM/NFP rules. However, the BIP
pattern is more risky and requires more attention to the slightest change in
quality of your cervical fluid. If you are not sure, always use a barrier method
to avoid pregnancy.
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There is just one last thing to keep in mind: Every woman is considered
potentially fertile for the complete year following her last period.
THE PURPOSE OF LILY
Lily was designed to provide you with a handy tool to save you time and effort if
you are leading a very hectic life. As this should not keep you from successfully
charting your cycles and keeping an eye on your gynecological health, Lily will
substitute for pen and paper, help with the evaluation, save your data and make it
readily available for appointments with your physician.
We hope this PDF as well as out in-App Help are a useful guide to you. However,
if there are questions you cannot find the answer to, don’t hesitate to contact us
([email protected]). We will look into your problem to find a quick and
solid solution for you.
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