How Much Do Practitioners Really Know About Fertility Awareness? (Episode 649)

Full Transcript: Episode 649

Lisa Hendrickson-Jack:

This is the Fertility Friday podcast, episode number 649.

In today’s episode, I’m tackling a very interesting and important topic. How much do practitioners really know about fertility awareness? We’re going to be going through some studies and some research to give us some insight into what’s really going on here.

If this is your first time tuning in, I’m Lisa Hendrickson-Jack. I’m a certified fertility awareness educator, and I’ve been teaching women to chart their menstrual cycles and use the menstrual cycle as a vital sign for over 20 years now. I literally wrote the book on it. I’m the author of The Fifth Vital Sign, co-author of Real Food for Fertility, and I’m also the founder of the Fertility Awareness Institute, where we teach women’s health professionals to use the menstrual cycle as a true vital sign in practice.

My message throughout my 20 plus year journey has been the same, that we should be using the menstrual cycle as a vital sign because there’s so much more that we can learn when we actually track it effectively. So let’s go ahead and jump into today’s topic.

So how do we test this? How do we really test how much health professionals know about fertility and fertility awareness? Well, one study published in Human Fertility looked at this in a really interesting way. The researchers studied 347 health professionals in the UK. And what they did was they created a test, a knowledge test on basic fertility information.

They gave this test to these health professionals, and they also gave it to women who were actively trying to conceive. And the results should really be eye-opening and should give us pause, I would say. The health professionals on average got about 47% on this test compared to about 50% for the women who are trying to conceive.

From a statistical standpoint, there’s really not much of a difference there. But again, it should give us pause. When they were looking at basic fertility knowledge, the health professionals actually didn’t do that much better than the women who are actively trying to conceive.

Now, obviously, when they survey in general lay people and they ask them who they trust the most for information about fertility, they’re going to rank health professionals. In fact, every group, health professionals included, ranked health professionals as the most trusted source of fertility information.

And interestingly, even though we had such a poor mark on this test, I mean, 50% is kind of no less than just guessing, 93% of the GPs said that they give fertility advice. So we have medical professionals who feel really, really confident in their knowledge, especially in this case, the basic fertility awareness knowledge. The vast majority are giving out fertility advice. But when they actually tested their knowledge, they got 47% on that test.

And I think the most compelling piece of this, just to wrap it up, is that many of the physicians themselves were not aware of the knowledge gaps that they had. So not only were they not the expert on the topic, they weren’t even aware that they didn’t know. And if I take a direct quote from the study, the researchers say, quote, “There were several knowledge gaps among healthcare providers interviewed. Some were aware of their own poor knowledge, but many were not,” end quote.

So when we look at fertility awareness knowledge specifically, again, none of this data surprises me, but one study wanted to take a deep dive into what practitioners were actually recommending to their patients who were trying to conceive. One study published in Obstetrics and Gynecology surveyed 375 U.S. physicians. These were physicians who were regularly working with women who have reproductive concerns. And they asked them what their recommendations were for timing sex when their patients were trying to conceive.

Interestingly, 64% of the physicians recommended timing sex solely based on calendar methods. So they were recommending for their patients to time sex between days 10 and 16, 64% of them. 71% recommended tracking basal body temperature, which is actually pretty exciting. That’s a pretty good number. I feel like that’s a win. But only 36% recommended tracking for cervical mucus.

If you know anything about fertility awareness-based methods, then you would know that when women are trying to conceive, the most significant fertility sign is actually cervical mucus. It doesn’t mean that we also shouldn’t be tracking basal body temperature or looking at other markers, but cervical mucus is truly what helps us to identify the fertile window. And the research stands behind that.

The research shows that tracking cervical mucus and understanding the different types of mucus and being able to identify the days of mucus of peak fertility in the highest quantities, that highly correlates to ovulation. So we already see the gap in knowledge of these physicians.

Now, in a separate study that looked at midwives, this was a study of 450 certified nurse midwives published in the Journal of Midwifery and Women’s Health, 81% recommended tracking cervical fluid. So you already see a difference between classically trained physicians and midwives, because at least in this case, according to the study, they had a much better concept of the link between cervical mucus and fertility and timing sex.

But if we pull the lens back on this again, what it shows is that even though we are in a time where we have so much fertility awareness knowledge available, and when we would assume that our healthcare providers have a good knowledge of these topics, especially if you are seeking support for fertility and conception, we’re seeing that the average physician is not aware of fertility awareness techniques, especially for timing sex, not to the degree that they should be, frankly, especially if they are specializing in fertility.

But I think we should put this in context. The one challenge I think that we have as a culture is that we elevate doctors and physicians to such a high level that we assume that they are experts in absolutely everything. And so if you have any type of issue, any type of health concern, you tend to assume that the doctor sitting in front of you has all of the knowledge about everything. And frankly, that’s an unfair expectation. It doesn’t make any sense. And there’s a reason why we have so many different specializations.

So I think the takeaway is that we really shouldn’t be assuming when we’re going to a general practitioner that they are specializing in the specific thing that we’re asking about. And especially if you’re trying to conceive and you’re looking at fertility awareness-based methods and you’re trying to understand more about timing, going to a regular practitioner who did not specialize in that field is no different than going to any other random person that didn’t specialize in that field. We can’t assume that just because they have a medical background, that they actually specialize in this specific modality.

If we take a direct quote from the physician study, the researchers say, quote, “Physicians in this study were much more likely to recommend calendar calculations and monitoring basal body temperature to help achieve pregnancy than monitoring vaginal discharge of cervical mucus,” end quote.

And before I move on, if I go back to what the research showed us, which was that they were typically recommending sex between days 10 and 16. Now, this, of course, is based on the 28-day myth, the myth that all cycles are 28 days, ovulation always happens on day 14. And regardless of the fact that the research shows that this is not the case all of the time in most women, this myth continues to persist and it’s just like we can’t shake it.

For many women, if we are strictly timing sex between those days, for women who ovulate earlier in the cycle or women who ovulate later in the cycle, even women who typically have regular cycles who just happen to have the occasional cycle that is out of that range, that is not a reliable way to time sex for pregnancy.

And again, this is why I think it’s really interesting that the researchers looked at the cervical mucus question. Obviously, the researchers are aware that timing sex based on mucus using fertility awareness techniques for conception is a lot more effective for pretty much every woman compared to just giving her calendar dates.

I feel like I’ve already alluded to this a bit, but just to hammer it a little bit more. The third point I want to make is that most practitioners receive little or no training in fertility awareness-based methods. Again, we really need to understand and know this. And this lack of training has a variety of different implications.

I think one of the implications that it has is that when you’re working with a practitioner, and you’re asking about advice, like when to time sex, from someone who isn’t trained in fertility awareness-based methods, then again, just the general advice that you’re getting is not going to be precise enough to really give you the best results.

But if we take it a step further, it’s not only that we may be getting incomplete information, it’s that we may be getting incorrect information. And to make it worse, the person who’s giving you that incorrect information has no idea that the information they’re giving you is incorrect.

So I want to share a couple studies with you. One study that was published in the Journal of Midwifery and Women’s Health, the other that was published in Frontiers in Medicine. One study that was published in Frontiers in Medicine took a really interesting approach, I would say, that gives us some insight into the level of confidence that medical professionals may or may not have about information they may or may not know.

In this study, the researchers tested third-year medical students on fertility awareness-based methods before and after having two lectures on the topic. They essentially took these third-year medical students and without giving them any information, they gave them a quiz. And then they proceeded to give them two lectures and educate them about the topic. And then they gave them another quiz. So that was the first part of the study.

Before the lectures, the students scored 39%. Obviously 39% on a quiz indicates that you don’t really know what’s going on. You’re certainly not a subject matter expert and you’re not really to be providing guidance on something if you’re only getting 39% on the topic.

Now, after these two lectures, the knowledge base did improve quite a bit. And the average rose to about 54%. But again, 54% is close to 50%. And 50% is like the same as guessing. It’s like if you’re flipping a coin. You’ll get it right 50% of the time. So really, the knowledge is not deep, right? And how could it be with just two lectures?

But what makes the study interesting is they also had these medical students rate their confidence level for using these methods to diagnose and treat. Before the lectures, again, when they got that 39% score, when they rated their confidence between one and five, the medical students put that confidence level right at one, which would make a lot of sense because they really were out of their depth there.

But after two lectures, again, raising that score from 39% to 54%, their confidence rose to three. So all of a sudden now they’re rating their confidence level at three out of five, when really their knowledge, deep knowledge in terms of using these methods to diagnose and treat is not that much different. So I think this study gives us a really interesting insight into the potential overconfidence.

And this spills into the last point that I want to make today, which ties everything together. Most physicians have not received adequate education about fertility awareness-based methods, because frankly, it’s just not part of the system. It’s just not part of the teaching system.

If we look at the classic medical system, if we look at the conventional medical system and the conventional approach to fertility-related issues, for reproductive health issues and for period-related issues, most physicians are trained to use the birth control pill, painkillers. We have a system that is heavily dependent on pharmaceuticals. And while we’re looking at fertility issues, many fertility issues, again, are looked at from a medical standpoint. And IVF and other types of options are the standard, right?

So fertility awareness-based methods that do not require pharmaceutical inputs are not the primary focus of modern medicine. I feel like that’s pretty obvious. But when we’re looking at what the implications are here, if we have physicians and practitioners, women’s health professionals that are not trained in fertility awareness-based methods, then obviously if they are not fully educated about it, they may be giving incomplete information or partially incorrect information.

But when it comes to even just understanding the effectiveness, most physicians severely, significantly underestimate how effective modern fertility awareness-based methods are. For any of you who are familiar with modern fertility awareness-based methods, or maybe not, one of the things that we hear, at least in my world, often over and over again, is that fertility awareness methods are the same as a rhythm method. It’s just like you have no method. You’re just basing things on a calendar. It’s like throwing up a coin in the sky. We don’t really know what’s going on.

But that would indicate that you lack knowledge of modern fertility awareness methods because we have a significant amount of research. We can actually take a deep dive. There isn’t just one method that counts as fertility awareness. There are multiple fertility awareness-based methods. There are mucus-only methods. There are temperature-only methods. There are symptothermal methods that combine mucus and temperature and other signs. There are symptohormonal methods that incorporate hormonal measures of urinary metabolites. And there are calendar methods. Yes, there are also calendar methods.

But most health professionals are not receiving either any knowledge about fertility awareness-based methods or at most a very limited knowledge. And so what happens is that most health professionals then are severely underestimating the effectiveness.

There was one really interesting study published in the Journal of Obstetrics and Gynaecology Canada. In this study, they looked at 242 family physicians. So they had them responding to the survey, gynecologists as well as residents. And what they found was that fewer than 6% knew the perfect use effectiveness of the methods that they were asked about.

And I really have to say that again for effect. Fewer than 6% of the respondents knew the perfect use effectiveness for the methods that they were asked about. If you’re going to your health practitioner, and only about 6% actually know the perfect use effectiveness of fertility awareness methods, how is it even possible that you’re going to get any type of accurate information about the topic?

And so I think, again, the takeaway here is that if you are looking into fertility awareness-based methods, whether you’re looking to learn more about how to time sex for pregnancy, you’re wanting to optimize your chances of conception, or whether you’ve had some negative side effects from birth control and you’re just looking for other alternatives, fertility awareness-based methods offer a surprisingly high effectiveness with perfect use. Symptothermal methods, double-check symptothermal methods, are at 99.4%. That’s a pretty significant effectiveness rate.

And for somebody who is committed to learning the method, who’s willing to take the time to chart their cycles, and just to get to the point that they can be really confident and learn how to achieve that high effectiveness level, it’s a really great option because there’s no side effects. You’re not putting any type of pharmaceutical input into your body. So therefore, there’s no physical side effects from using fertility awareness-based methods. So for the right person who is genuinely wanting to use this method, it can be a really great option.

But if your average practitioner really doesn’t know anything about it and assumes that they’re just not effective because they equate it with the rhythm method, they don’t really understand that there’s different types of fertility awareness-based methods, and there are actually methods that work, and with the proper instruction, we can get a really high effectiveness rate, then you’re not really even getting the right counsel. You’re not even having a chance to figure out if this is something that could work for you because of this lack of knowledge.

So there are implications, significant implications. From just getting incomplete information, being told, oh yeah, just have sex on day 14, blah, blah, blah, it’ll be fine. From getting incomplete information, incorrect information, to being completely dissuaded from even looking at it and being heavily discouraged from even considering it if your practitioner just assumes that it doesn’t work.

If we go back to the same study of these BC physicians, only 3% mentioned these methods as a viable option to most patients. And no gynecologist and no gynecology resident ever mentioned these methods at all.

So again, I’m just highlighting, I think, for those of you who are in the field and you’re working with clients and potentially you’re already working with fertility awareness clients or you yourself use fertility awareness, I’m just highlighting the things that you already know, potentially highlighting the experiences you’ve already had.

When I do surveys about, have you ever asked your doctor about fertility awareness? What’s the craziest thing that your doctor’s ever told you about fertility awareness? I hear the craziest stories. I’ve heard a lot of women saying they’ve been laughed at. They say, oh, I want to use fertility awareness for birth control. The doctor fully laughs at them and tells them it’s not effective and et cetera. And so I think this study shows us we need to know what we’re dealing with.

Again, I’m saying this as factual information because I want to validate the experiences that women really have with practitioners. And unfortunately, it may obviously feel like I’m putting down doctors, but I do think that it highlights what’s really going on. We have a lack of information that is not necessarily their fault.

At the end of the day, physicians have taken an incredible amount of time and energy to go through medical school and to become subject matter experts on the body, on health. But I think we would be remiss to pretend that that means that they’re experts in every single area.

And after over 20 years in the field, you really can’t talk to very many women without finding a very strong consensus that for matters related to the menstrual cycle, periods, for matters related to contraception, birth control, and for anybody who uses fertility awareness-based methods, they’re not getting a lot of support and love, generally speaking, from practitioners.

Now, I do think that’s changing. I do think that we are seeing more of an insurgence of this, I think partly because more and more women are asking for it. More and more women are seeking it out. More and more women are looking for alternatives that suit their lives. And more and more women just want to learn about their bodies. They want to understand what’s going on. So I do think it’s changing.

But if you’re irritated with me for bringing this up, I don’t know what to say. Even the study shows that the vast majority of physicians are completely underestimating the effectiveness and have very little knowledge in this area because it’s just not something that’s taught. So I think at least that’s something we could acknowledge, that fertility awareness-based methods are certainly not a standard subject that is taught in medical school or even in other women’s health professional settings.

If I take one quote from this study, the researchers are saying it, not me, quote, “It is clear that most physicians underestimate substantially the effectiveness of modern natural family planning,” end quote.

So if I pull it all together, what is the purpose of this? Why are we going through this? As a fertility awareness professional who’s been working in the field for a very long time, I think it’s really important for us to just recognize and acknowledge that for any type of very specific inquiry, whether it is asking about fertility awareness, wanting to learn more about it, or whether it’s that you have a thyroid issue, we should be looking at going to specialists.

We should stop expecting that general providers should have knowledge, specialized knowledge on every topic. I think it’s time to acknowledge that fertility awareness-based methods, fertility awareness instruction, is its own specialization. And so it’s time that we stop expecting our health professionals who have not been trained, who do not have specialized knowledge, to be able to guide us and advise us.

And I also think that it’s important for women who are interested in learning about fertility awareness-based methods, using them personally, for them not to be discouraged when their health professionals tell them things like it doesn’t work and it’s ineffective and there’s no research on that and blah, blah, blah. We really need to know that that’s coming from a place of ignorance, and ignorance with just the proper use of the term, like you just didn’t learn about it. And so you don’t know.

We also should know that even though we have a lot of research and evidence and lived experience to show us that health professionals are not trained in fertility awareness-based methods, they do not have a high base of knowledge in it, that doesn’t stop them from thinking that they have more knowledge than they do. So even though they may not have the actual knowledge, they don’t necessarily always know that they have those gaps in knowledge.

And so you could be in an office with a health professional and being told all kinds of things about fertility awareness by someone who’s very, very confident that they know what they’re talking about. And they literally don’t know what they’re talking about. And so again, if we look to the research, it shows us why that’s happening.

This is just something to keep in mind. I would say the biggest takeaway is if you are looking at learning about fertility awareness-based methods, you are wanting to learn how to time sex for conception, you’re wanting to even support your clients, encourage your clients if that’s something that they’re wanting to do, we just have to be aware that this is not a topic that everyone knows about. Most people are not trained in this. And so it’s time that we start looking to those who specialize in this field if we are wanting support in this area.

And of course, this is one of the reasons why we have created our Fertility Awareness Mastery Mentorship. To support women’s health professionals who are wanting to take their fertility awareness knowledge to the next level, to not only be able to confidently teach their clients how to chart and use the menstrual cycle for conception or for birth control, but also to be able to utilize the menstrual cycle as a tool in your practice, to be able to actually have your clients track in a specific way and to be able to identify what’s going on health-wise and track progress, using the menstrual cycle as a true vital sign in practice.

With that in mind, we’ve created an incredible resource for our women’s health professionals. We’ve created an ebook, How to Interpret Virtually Any Chart Your Client Throws at You. Head over to fertilityfriday.com/chart to grab your free copy of that.

And with that said, I hope you enjoy the rest of your day. And of course, as always, until next time, be well and happy charting.