Teaching Fertility Appreciation

by Ross Novack and Lisa Novack

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Teaching Fertility Appreciation Teacher’s Guide

by Ross and Lisa Novack

 

The Fertility Appreciation class series was developed by Ross and Lisa Novack in January 1998 and was taught by them at Elizabeth’s New Life Center in Dayton, Ohio, from March 1998 to September 2001. The class plan was revised for publication in October 2002.

 

Ross Novack is an officer and an Electrical Engineer in the United States Air Force. Lisa is a stay-at-home wife and mother of three young children. They are trained users of the Sympto-Thermal Method of Natural Family Planning. They were involved with Elizabeth’s New Life Center in Dayton, Ohio, for four years. Ross was a member of the board of directors, and Lisa worked as a peer counselor and also offered computer graphics help. Together they developed these classes to make clients aware of the beauty of their God-given fertility, as well as informing them about the effects of contraception and the benefits of Natural Family Planning.

 

Contents

Why Teach Fertility Appreciation?

Fertility Appreciation Class Plan Part I: Understanding Your Fertility

Fertility Appreciation Class Plan Part II: Family Planning Methods

Fertility Appreciation Basics: A Review

Class Diagram

Teaching Fertility Appreciation and the Principle of Double Effect

What a Woman Should Know about Contraceptives, by Chris Kahlenborn, MD with Ann Moell, MD

Teaching Fertility Appreciation in a Pregnancy Support Center

Resources for Teaching Fertility Appreciation

 

Why Teach Fertility Appreciation?

What follows is the text of a pamphlet published by One More Soul describing the benefits achieved at Elizabeth’s New Life Center in Dayton, Ohio, through teaching Fertility Appreciation.

“Therefore, whoever breaks one of the least of these commandments and teaches others to do so will be called least in the kingdom of heaven. But whoever obeys and teaches these commandments will be called greatest in the kingdom of heaven.” Matt 5:19

 

“If you remain in my word, you will truly be my disciples, and you will know the Truth, and the Truth will set you free.” John 8:32

 

At Elizabeth’s New Life Center, our philosophy is to be present to the needs of the women who come to us by providing peer counseling, material assistance, prenatal medical care, emotional support and friendship, spiritual guidance, education, whatever these needs may be. It is by being present to them that we reach these women with love, influencing them to choose life for their babies, supporting them in that decision, and helping them to change their lives for the better. Lisa and I have come to see this as the living application of the slogan, “Love them both.” An integral part of truly loving these women as God does is telling them the TRUTH — In Love — about marriage, sexuality, and chastity — the Truth that the world does not give.

 

The women who come to the Center are often not prepared to hear and accept the Truth we present to them. They have been conditioned by the world’s message: instant gratification, pleasure above all, and casual sex without strings. They have been taught that contraception is the world’s greatest invention, that children are a burden, and that babies can be disposed of. Some have never been taught what is right and good — not from their parents or families, not in school, and often not even in their churches. If they are told these things, it is by way of “Don’t do this” or “Don’t do that” without the reasons behind it. As a result, some clients have little or no basis on which our counselors can talk to them about chastity or morality.

 

A Fertility Appreciation class is another opportunity to teach these clients, to lay the foundation, and to encourage them to change their behavior. In this context we can do the groundwork necessary for the client to consider chastity or secondary virginity. The class gives us time to present our case in a way that is different from one-on-one counseling. The clients share their experiences and observations with each other, often validating in their eyes what we are trying to teach them.

 

In teaching Fertility Appreciation, we are trying to give the skills and information they need to form their consciences and make good choices. The primary goals of our class are to: 1) Teach God’s plan for sex and marriage, 2) Promote chastity or secondary virginity among unmarried women, and 3) Promote Natural Family Planning and generous self-giving within marriage in preference to contraception.

 

Really, though, the purpose and reach goes much further. We want them to realize the beauty and complexity of their fertility and the immeasurable value of their life and sexuality. We want to inform them of the physical, emotional, spiritual, and relational risks and harms of using contraception. In addition, we want them to be aware of the abortifacient effects of many types of contraception including the Pill, IUD, Norplant, Depo-Provera, and the Patch.

 

It is our responsibility to share the knowledge and Truth we’ve found. People have a need and a right to know how their bodies work, the purpose of sex, God’s plan for sex and marriage, the harms of artificial contraception, and that Natural Family Planning exists and is highly effective and worthwhile. Armed with this Truth, they can begin to turn their lives toward constructive relationships, freedom, and joy.

 

Is It Right to Teach Fertility Appreciation to Single Persons?

 

In this class, participants learn the basics of their fertility and are introduced to the ovulation method of Natural Family Planning. Some people are concerned that by teaching an unmarried person to read natural fertility signs, we are encouraging sexual activity without the potential consequence of making a baby. It is, however, impossible to give women the full understanding of how their bodies work without also discussing the observable signs of when they are fertile and when they are not. While providing this information, we also teach participants about the natural law (and therefore God’s law) concerning their sexuality — both the moral imperatives of God’s law and the consequences of not living by God’s law concerning sex. The information presented in the class is strongly oriented toward use within a marriage relationship and would be very difficult to use in a situation of adultery or fornication.

 

Women have the right to know how their bodies work as well as the right to know the effect contraceptive drugs and mechanical devices have on their bodies. Spreading this Truth is so critical because it is a basis for positive behavior change, which is our best hope for overcoming the problems of women and of society that are brought into pregnancy support centers every day. People are unlikely to get this message anywhere else.

 

In the “Artificial versus Natural Family Planning” video used in the class, Dr. Jerome Lejeune sheds light on this situation. He says, “I think the reason why NFP is not widely used by everyone is in fact because of two things: first, a man must have love for his woman and second, he must have respect for her physiology. And it cannot be used if you have random partners or if you do not have a real conjugal law.” By conjugal law, he means an understanding and respect for God’s law for sex. Consequently, our students are unlikely to use NFP without respecting God’s order for sexuality, which is chastity. In talking to a priest about the class, he said, “We can never be wrong about giving people information with which to make good moral choices. We are not responsible for the choices others make, but in fact we may be culpable for withholding the truth.”

 

Through this class, we try to instill in the clients a sense of the wonder and gift of their fertility and of pro-creating with God in bringing new life into the world. These are ambitious goals. We’re planting seeds. Only God knows if and when these seeds will germinate and bear fruit. However, God does sometimes let us see the fruits of our efforts to encourage us.

 

We have had several participants tell us later that our class helped them choose chastity. We’ve also had several married participants learn and practice NFP. They were pleased with the understanding it gave them of their own bodies. One participant, after sitting through our class, confided in us that she had an appointment to get an IUD the next day, and that, after listening to our presentation, she decided not to go. We’ve been amazed how God has used this class to change lives.

Structure of a Fertility Appreciation Class

The class has two parts:

 

Part one

covers philosophy and biology. We talk about how a woman’s natural fertility works and how wonderfully God has made our bodies. We discuss God’s plan for sex, how the female reproductive system works, and the naturally occurring signs of fertility (mucus) in a woman’s cycle.

 

We talk to them about God’s plan for sex and marriage and discuss the two-fold Natural Law purpose of sex — “Bonding and Babies.”

 

Bonding

— We talk about chastity, the emotional and psychological effects of premarital sex, and WHY sex is for marriage. We tell them that sex speaks the language of the body and what it says is, “I give myself to you completely and accept you completely not just now but for always.” We tell them how this bonding produces effects that are great for marriage, but it is disastrous outside of marriage — often causing couples to overlook serious problems with their partner.

Babies

— The “two become one” so completely that nine months later you’re picking out a name for that “one.” Openness to life when you have sex with your spouse is like saying, “I love you so much that I want to make another person just like you!” By withholding our fertility in sex, we put up a barrier to our love and union.

We explain the consequences of breaking God’s Natural Law for sex by using sex outside of the purposes for which it was created. We stress to them that it’s never too late — even though they’re not virgins, it’s never too late to choose chastity.

 

We show the video, “Appreciating Your Fertility” and explain the female reproductive system using a poster, talking about all the parts, what each does, and what happens in a woman’s normal cycle.

 

Part two

of the class reviews all the concepts covered in part one — especially God’s plan for sex and marriage, and the naturally occurring signs of fertility. We show the video “Artificial vs. Natural Family Planning” and then discuss the effects of artificial contraception, covering each method of contraception in detail.

We then discuss Natural Family Planning, which is the way God gives us to be able to postpone a pregnancy for a justifiable reason. This is done by learning the naturally occurring signs of a woman’s fertility so that the couple knows when to have and when to abstain from sex. We include several important points in our discussion of NFP including the scientific proof of the method, its low cost (money and time), moral acceptability, high success rate in a wide variety of cycle situations, reversibility, and ease of use. We stress that this is not the calendar rhythm method (the old rhythm method was only 65% effective — modern NFP is 98-99% effective if used properly). We tell them basically how it works day to day for a couple — charting, decision-making, and showing mutual respect. Lastly, we relate the many advantages of NFP including improved communication between husband and wife, increased respect and understanding, relationship building, reversibility (can be used to achieve pregnancy), and the decreased divorce rate of couples practicing NFP.

 

“When we first started working on this class we expected the clients to sit there and stare blankly at us as so often happens in a classroom setting — but we’ve been pleasantly surprised. Clients often share their own experiences, adding credibility to what we have said. They ask questions that are relevant and usually very astute; they answer questions when asked; and we often receive comments of amazement that they’ve never been told these things. We attribute this to the very intimate nature of the subject matter as well as the casual, comfortable, matter-of-fact way in which we try to approach it.”

 

Ross & Lisa Novack (developers of the Fertility Appreciation class)

 

 
Fertility Appreciation Class Plan

Part I: Understanding Your Fertility

I. Introduction and Purpose

A. Hi, thank you for coming. We’re really glad you’re here. [Tell them your name(s) and, if applicable, how long you’ve been married and how many kids you have. Have each of them introduce themselves and if they’re pregnant, have them tell when they’re due.]

 

B. The class is called “Understanding Your Fertility,” and it is the first class of a two-part series. Please try to make it again next week for the second class, which is called “Family Planning Methods.” In this part of the class we will:

 

1. Learn about God’s beautiful plan for sex and marriage,

 

2. Learn about how a woman’s natural fertility works — her reproductive system and the naturally occurring signs of fertility in a woman’s cycle, and

 

3. Learn to appreciate how wonderfully God has made our bodies — they are so intricate and so carefully balanced.

 

C. [Ask them a few questions and get their answers. You may give the basics now or wait.]

 

1. What do you already know about how the woman’s cycle works?

 

2. How many days a month do you think you can get pregnant?

 

[One day per cycle. A woman’s egg lives for 12-24 hours — though a man’s sperm may live in her for up to five days before that to fertilize the egg.]

 

3. How do you know when you’re fertile and when you aren’t?

 

[Presence of mucus or wetness. Low waking basal body temperature.]

 

These are some of the things we’ll learn more about in today’s class.

II. God’s Plan for Sex

A. What do you think God’s plan is for sex and marriage? [Listen to some of their answers.] Well, God has given a purpose and meaning to everything in life including sex. Sex can be a truly beautiful and amazing experience between a man and a woman, but God’s plan for sex is within the context of Marriage. It is only within this context that sex can really be true and beautiful. Experienced outside this context, sex’s meaning is distorted, and it can have serious consequences, as we’ll talk about. In this class, we’ll be focusing on God’s plan and how God made you in light of this plan.

 

B. Let’s begin with a quick lesson in Natural Law, which comes from elementary philosophy, because it’s helpful in understanding this section. The Natural Law is a self-evident truth. It is something you use everyday without knowing it. What the Natural Law says is this, “You have to treat things in accord with the nature and reality that they have if you want them to prosper.” [REPEAT] So, if you want something to thrive, you have to treat it according to the way it is made. Take the tomato plant, for example. If you want to get good tomatoes, you’ve got to treat that tomato plant in accord with its nature and reality, with the way it was made — that means providing it with the right amount of water, the right sunlight, temperature, etc. You can’t put the plant in the closet for a week and expect it to produce good tomatoes. Similarly, we have to treat ourselves and our sexuality in accord with our nature and reality so we prosper and reach our full

God-given potential.

 

C. So, why did God make sex — what’s its purpose? God made sex for two inseparable purposes: for the unification of the married couple and for the procreation of children, or for “Bonding and Babies.” So, that’s its nature and reality. First, let’s talk about bonding.

 

1. Bonding— We use our bodies to communicate. Our actions tell others about us and who we are as a person. We can’t separate a person from their actions. Sex speaks the language of the body, and what it says is “I give myself totally to you and accept you totally — not just for this moment but for always.” When a couple has sex, the two become one — physically, mentally, and spiritually. Sex is the super glue of the heart, bonding the two together. God meant for sex to bind the married couple together — to help them to outlast the difficult times and those times when they aggravate each other and get on each other’s nerves. It also helps them to overlook their spouse’s faults. For example, it helps me overlook Lisa throwing her clothes on the floor, and it helps Lisa overlook me not listening real well when she talking. [Add your own example.] This “blindness” is a good thing within marriage but can be very harmful outside of marriage. Consequently, it’s so important that we don’t have sex while dating. It could cause you to overlook faults that you need to see — such as selfishness, lack of self-control, or dangerous or harmful behavior. If you’re having sex before marriage, you could be bonding with someone that isn’t the right person for you to spend the rest of your life with. This bond is why breaking up, when you’re in a sexual relationship, is so hard to do. If the time comes that you realize the person you’re with isn’t the right person for you and you break up, part of your heart is torn away with that super glue. And it hurts. Each time we have a sexual relationship and break up, our hearts get a little harder. And so it’s harder to bond and really open ourselves up to truly loving the other. That’s not God’s plan for you. He doesn’t want you to go around with all these little parts of your heart torn out, and He surely doesn’t want us to lose our capability to love. By remaining chaste during dating — by not having sex — we are best able to clearly and wisely judge whether the other person is right for us, whether you’re compatible to live together for the rest of your lives. Now, let’s talk about babies.

 

2. Babies— In the sexual union, the “two become one” so completely that nine months later, they might be picking out a name for that “one.” The most special thing a husband and wife can do is to participate with God in the creation of a totally new person. God is the only one who can really make a baby — He gives us a part in that creation, but without Him we can’t make it happen. God wants to use the husband and wife’s act of lovemaking to bring forth new life. Being open to life when you have sex with your spouse by not using contraception is like saying to them, “I love you SO MUCH that I want to make another person just like you!” Saying, “I want to have children with you,” has so much more real, true love in it than saying, “I want to have sex with you.” When a couple contracepts, they refuse the self-giving nature of sex and put up a barrier to their love and union. They use each other for pleasure. They hold something back — “I love you except—your fertility.” This doesn’t mean we have to have as many babies as we can, but it does mean that we have to be responsible parents, use self-control, and follow God’s Natural Law. We’ll talk about this more later.

 

D. So God made sex for bonding and for babies — that’s His natural law or His purpose and design for sex. He meant for us to bond and have babies with someone who will be there for us through all the good times, through all the tough times. For better or for worse. God gives us His law. He made us, after all, and He knows how we work best! God’s law is written in all of our hearts — we know it deep down, and our experience tells us it’s true. Behaving contrary to the natural law is like putting honey in your gas tank even though the owner’s manual says that you should use gas. Of course, it is your car. So, you can do what you want with it because you have your God-given free will, but it’s not going to work right if you use it in a way that’s contrary to its nature and design. It’s also your body — you can do what you want with it because you have your God-given free will, but it’s not going to work right if you use your body contrary to its nature and design. Living by God’s law brings peace, joy, and freedom. God’s laws about sex are not rules to oppress us but guidelines to help us be really happy and healthy and free and to reach our full human potential. If we violate this law, we harm ourselves.

 

E. Let’s talk about some of the consequences or the ways we harm ourselves when we use sex outside of God’s plan by having sex outside of marriage or by using contraception:

 

1. Emotional — the pain of breaking that “super glue” bond of the heart and of closing us to truly loving others. This is a pain God never intended for us — it’s really the pain of divorce.

 

2. Sexually Transmitted Diseases (STDs) — there are over 50 strains of STDs today. The main STDs are Syphilis, Gonorrhea, Chlamydia, HPV (AKA Genital Warts), Herpes, and HIV/AIDS. The last three [Repeat them.] are incurable — if you get them, you have them for the rest of your life, and you may not even know you have them. Today alone 55,000 people (12,000 of them teens) will contract a STD. STDs cause pain and suffering and even death. Some cause serious infections or harm to your reproductive organs, sometimes causing permanent sterility — so later, when you want to get pregnant, you can’t.

 

3. Other consequences of violating God’s plan include unexpected pregnancy, divorce, abuse of women, sexual addiction, and adultery and infidelity. Adultery and premarital sex are made possible by contraception because it appears to separate babies from sex, making sex outside marriage possible without the consequences. Unfaithfulness always damages marriages and is often the cause of divorce. Most of these consequences hurt women more than men.

 

F. God loves us so much and doesn’t want us to suffer and get hurt from these things. He wants what’s best for us. To Love is wanting and doing what’s best for the other person. It’s very important to remember that it’s never too late. If you’re having sex outside of marriage and want to stop and wait until you’re married, remember that God forgives us. You can choose chastity or what some people call “secondary virginity.” You can always admit to Him that you’ve done wrong, ask for forgiveness, and pray for the strength to do what’s right.

III. The Female Reproductive System

A. I’d like to start out this next section on the female reproductive system by telling you, “A woman’s fertility is not a disease, it’s a natural function of her body.” God created us in a very intricate way. It’s amazing how everything works together. What’s going on in a woman’s body affects not only whether she can get pregnant but also how she feels and even how she thinks. Remember we talked a little while ago about what we already know about how our bodies work — now I’m going to show you a video about how it all fits together.

 

B. Show “Appreciating Your Fertility” video from Family of the Americas. (If you do not have the video or it is not available, you may proceed with the class anyway. The following reiterates and expounds on everything from the video.)

 

C. Now, we’re going to talk about what you saw in the video. (Use poster or diagram. Point to the different parts and have them tell you what it is. Then, explain what each part does.)

 

1. Vagina or birth canal

 

2. Uterus or womb

 

3. Cervix — neck of the womb. The mucus is produced here in the cervical crypts.

 

4. Endometrial Lining — the membrane that lines the walls of the uterus. It forms at the beginning of each new cycle to provide a kind of bed in which a newly conceived baby can implant and grow. At the end of the cycle, if the egg has been not fertilized, this bed will be expelled as menstruation.

 

5. Ovaries — the organs where the eggs are stored, develop, and grow and where some hormones are produced. At birth, a female’s ovaries contain all the eggs she will have for the rest of her life.

 

6. Fallopian Tubes — the channels that lead from the ovaries to the uterus. This is where conception occurs. Growing up, I always thought the sperm and egg met in the womb.

 

D. The Woman’s Cycle — Now we’re going to talk about the woman’s cycle and the hormones that control it.

 

1. The entire cycle begins in the brain. The pituitary gland begins by sending out a signal, a hormone called FSH (follicle stimulating hormone). It is sent through the bloodstream and stimulates the follicle on the ovary from which the egg will eventually develop and be released.

 

2. As the follicle develops, the ovaries begin producing the hormone estrogen, triggering several things to happen in the woman’s body. Estrogen signals the cervical glands to begin producing a type of secretion or mucus necessary for conception. This mucus starts out thick and tacky, and eventually becomes clear, slippery, and very stretchy. At that point, it can look like raw egg white. A woman can check the mucus throughout the day any time she goes to the bathroom — just by observing any mucus on the tissue after she wipes. This mucus filters out abnormal sperm and helps the healthy ones to survive and swim up to try to fertilize the egg. Without mucus, the sperm quickly die. Ladies, you may have noticed this mucus and thought something was wrong. We’ve even known nurses to think this. But this mucus is quite natural and necessary for new life to be conceived. The estrogen also helps make the endometrial lining thick and plush, so it’s ready to nourish a newly conceived baby, if the egg is fertilized.

 

3. Next, the estrogen sends a signal back to the pituitary gland, which then releases LH or luteinizing hormone. This hormone triggers the release of the egg or ovulation. After ovulation, the follicle that just released the egg now produces progesterone, which means “for gestation”). This hormone also affects several functions, including continuing to stabilize the endometrial lining of the uterus, making the mucus become thick and tacky and dry up, and elevating and stabilizing the woman’s temperature for incubation. When the sperm and egg meet at conception, a whole new human being is formed with a whole new genetic makeup — part mom and part dad. The single cell egg begins to divide and divide again. All the while, it travels down the fallopian tube and then implants in the uterus and begins to grow. By 10 weeks, the baby is completely formed. The baby’s heart, brain, spine, fingers, and toes are all there, and the baby just needs time to mature.

 

4. If conception has not occurred usually within 24 hours after ovulation, the egg that was released will disintegrate, the endometrial lining will be expelled with menstruation, the progesterone level drops, and the whole cycle will start all over again.

 

E. Breastfeeding and Fertility:

 

1. When a woman is breast-feeding, her body produces a hormone called prolactin (meaning “for milk”). If her body is producing a high enough level of prolactin, this hormone suppresses the other hormones and causes her not to ovulate — giving her a period of infertility. To do this, the mother must be exclusively breast-feeding — no bottles and no nursing on-demand. This does not work for all women. Mothers who are using “ecological” or exclusive breast-feeding, generally experience an absence of cycles from 6 months to a year and a half. Fertility usually returns when the baby stops nursing frequently and starts on solids. This is the body’s way of spacing babies — it’s one of God’s many design features and one of the many benefits of breast-feeding.

 

2. Another important benefit of breast-feeding is the protection it provides against cancer. A major study published [by Oxford University] in 2002 found that the risk of breast cancer dropped by 4.3 percent for every year woman breast-feeds and by 7 percent for each additional child a woman has — even if she doesn’t breast-feed. On the flip side, research has shown an increased risk of breast cancer from abortion and the use of hormonal contraceptives. These and many other benefits of breast-feeding for mom and baby really show us that doing things God’s way — the way He designed them — is best.

 

F. Now, we’re going to review the Fertility Appreciation Basics sheet. [Hand out sheet and have them follow along. What follows below expands on the points made on the sheet.]

 

1. Ovulation occurs on only 1 day in each cycle. The woman’s egg lives only 12 — 24 hours if it’s not fertilized.

 

2. The man’s sperm need mucus for food and protection to survive. Sperm without mucus die within hours. Sperm in the best fertile mucus may live 3 — 5 days. Men are always fertile.

 

3. A woman’s fertility depends on ovulation and satisfactory mucus.

 

4. Pregnancy can result from contact of sexual organs on fertile mucus days without penetration or ejaculation. The man can release a tiny drop of highly fertile seminal fluid when he’s aroused before climax.

 

5. Intimate sexual contact on days of possible fertility may cause conception even though contraceptive devices are employed. Many women get pregnant every year while using contraception like the Pill, Depo Provera, or Norplant and even after sterilization (tubal ligation or vasectomy). We see a lot of them in our center. None are 100% effective except for abstinence or hysterectomy (or castration).

 

6. The changing levels of a woman’s hormones each day may affect her feelings, moods, and perceptions. Ladies, this is why you may feel like a different person from one day to the next.

 

7. Charting the signs of your fertility will help you to understand what is going on with your body and your emotions — get you in tune with your body. Understanding your fertility depends on accurate information and accurate charting.

 

8. A married couple may use these charts to know when the wife is fertile and help them achieve or avoid getting pregnant by knowing when to have or abstain from intercourse. This method is called Natural Family Planning, and it has been shown to be highly effective (as good or better than most methods of artificial contraception) and has many great benefits for the married couple.

 

9. Remember that even though you’ve learned a little about NFP today, if you want to practice it, it’s very important to take a class to learn all the guidelines and have your charts reviewed by an instructor.

IV. Conclusion

A. God made you in a very special, intricate way, and He loves you and wants what’s best for you.

 

B. Your body is a beautiful creation and the way that it works is really something special and amazing. Your natural fertility is something to be cherished and taken care of.

 

C. You can learn to read the natural signs your body gives you to know when you are fertile and when you are not.

 

D. Remember that God’s plan for sex is a part of marriage, sex is for babies and bonding. God set up this plan for sex and marriage because He loves new life — but He wants us to be able to have a part in the decision of when to have children. The husband and wife must be generously open to new life, but if there’s a serious reason that they need to postpone getting pregnant, God has given us the tools to do this naturally while still being open to new life and obedient to His plan for sex. We call this Natural Family Planning.

 

E. In the second part of this class, called “Family Planning Methods,” we’ll build on what we learned today. We’ll look at different types of birth control and family planning, how effective they are, and what effects they can have on your body. Hope to see you then. Thanks for your attention.

 

 

Fertility Appreciation Class Plan

Part II: Family Planning Methods

I. Introduction and Purpose

A. Hi, thanks for coming. We’re really glad you’re here. [Reintroduce yourself and spouse or teaching partner and have those present introduce/reintroduce themselves.]

 

B. This class, called “Family Planning Methods,” is the second class of a two-part series. We’ll be reviewing some of what we learned in the first class. If you weren’t here for the first class, called “Understanding Your Fertility,” please try to come the next time it’s offered. It’s an important class and complements what you’ll learn today. In this class, we’re going to be talking about artificial contraception and natural family planning.

II. Review from Part 1

A. What do you remember from last week?

 

1. What are the two purposes of sex?

 

[Babies & Bonding]

 

2. What is the primary sign of fertility?

 

[Mucus]

 

B. Let’s review what we learned in the first class about the female reproductive system. [Point to each part on chart and have them name the part and its function. Review the class plan for part one, if necessary.]

 

1. Vagina, cervix, uterus, endometrial lining, ovaries, and fallopian tubes.

 

2. Review the basics of what happens in a normal cycle including the timing of the different hormones.

III. Disadvantages of Artificial Birth Control

A. Show the “Artificial vs. Natural” video from Family of the Americas. [It is possible to teach this class without the video, but you may need to be more detailed in explanations of each type of artificial contraception listed below. The video provides good witness testimony and moving images.]

 

B. Now, let’s review and take a closer look the different types of artificial contraception and their effects. [Encourage the women to share their stories — it gives credibility to the information presented here. Some of the best and most compelling reasons for not using this or that type of artificial contraception came from the women in our classes. The following information can be reduced or tailored to the audience, especially if the class is talkative about their experiences. To shorten the lesson content, go over how each type works, skip the cost, and highlight only a few of the side effects.]

 

Often women are not told the risks and side effects by their doctors. We must take control and responsibility for our own bodies. It is up to us to ask the questions and make the sometimes-tough decisions about what we put into our bodies and how we use them.

 

C.

The Pill

 

 

1. It costs $250 to $300 per year.

 

2. The Pill contains synthetic forms of the hormones estrogen and progesterone.

 

3. It works in three ways: first, it suppresses ovulation; second, it thickens the cervical mucus; and third, it thins the lining of the uterus or endometrium.

 

a. The third method, thinning of the endometrium, causes an early abortion by preventing implantation of the fertilized egg or ovum if an egg has been released and fertilized.

 

b. It’s estimated that the Pill may cause one or more early abortions a year.

 

4. The Pill suppresses pituitary functioning all month long (other functions than ovulation).

 

5. It has over 30 known side effects including: nausea, vomiting, weight gain, acne, decreased sex drive, yeast infections, moodiness, headaches, blood clots, increased risk of stroke and cancer of reproductive organs, high blood pressure, irregular bleeding, difficulty in conceiving after stopping the Pill, and it may actually increase the risk of STDs.

 

a. More than a third of all women who start taking the Pill stop within three months because of the side effects — so know you’re not alone if you’ve had problems while on the Pill.

 

b. The Pill can have harmful effects on the circulatory system, just as smoking does. A woman who takes the Pill and smokes increases her risk of heart disease by 500%.

 

D.

Norplant

 

 

1. It costs $600 to $800 per 5 years for insertion and removal.

 

2. Norplant consists of five or six rods placed just under the skin in the upper arm which release hormones into the bloodstream over a period of five years.

 

3. It works similar to the Pill. It thickens the cervical mucus, but because of the different hormone mix, it suppresses ovulation only half of the time inducing early abortions the other half of the time by making the endometrium hostile to the newly fertilized egg.

 

Norplant may cause as many as three early abortions yearly.

 

4. Side effects are similar to the Pill but others include: severe abdominal pain, migraine headaches and blurred vision, arm pain and infection, migration or fragmentation of the rods (where the rods actually break and move to other parts of the arm), hair loss, liver tumors, gall bladder disease, ovarian cysts, absence of periods (two-thirds of all users).

 

a. Not having periods may sound good, but nature intended the woman’s period to cleanse her body from unwanted bacteria.

 

E.

Depo-Provera

(also known as “The Shot”)

 

1. It costs up to $200 per year.

 

2. Depo is a hormonal contraceptive injection given every 3 months [with the hassle of having to go to her OB/GYN every 3 months to get it].

 

3. It works similar to the Pill and Norplant.

 

4. Its side effects are like those of the Pill.

 

a. If you have an allergic reaction or bad side effects, you can’t take it out of your system. They have to give you more drugs.

 

b. In a brochure for the patient, the manufacturer warns women not to use Depo if they have any heart or lung problems or have a family history of these problems.

 

c. The manufacturer also tells users that Depo-Provera strips the body of calcium and recommends increasing their intake of calcium-rich foods. Long-time users may be at an increased risk for osteoporosis.

 

F.

Intrauterine Device (IUD)

.

 

1. It costs $200 to $300 per year.

 

2. An IUD consists of a metal or plastic device inserted

into the uterus.

 

Many IUDs also have a spermicide or hormone added.

 

3. It causes a chronic irritation of the uterine lining, making the endometrium hostile to the fertilized egg. The woman still has her cycle and ovulates normally.

 

4. It usually acts by preventing sperm transport, but also can prevent implantation, resulting in an early abortion. IUDs are 84% effective. The rest of the time doctors either have to remove the device from the pregnant woman or perform an abortion. If a woman doesn’t realize until later in her pregnancy that she is pregnant, there is great risk to her and the baby.

 

5. Side effects are: pain and menstrual fluctuations; occasional perforation of the uterus or cervix; embedding, migration, or fragmentation of the IUD; continual spotting or prolongation of menstrual flow.

 

6. The IUD can cause serious pelvic infections like Pelvic Inflammatory Disease, which progresses from the uterus through the fallopian tubes into the pelvis, sometimes going undetected for long periods and causing infertility.

 

7. The IUD does not prevent STDs, rather it increases the risk of STDs like HIV. This happens for two reasons: first, it can cause chronic infection in the woman’s uterus, and second, there’s a string attached to the IUD (to remove it if necessary) that can act as a wick for bacteria or viruses.

 

G.

Condoms

 

 

1. Ineffectiveness: They normally fail between 15 and 35% of the time in preventing pregnancy, and there’s a 35-44% failure rate for unmarried women. A recent Center for Disease Control study, where the CDC pooled the results from all available studies, found the condom to fail one-third (or 33%) of the time.

 

The higher failure rate of condoms for unmarried women may be due to unmarried partners taking less care in using the condom. Also, unmarried people are more likely to store condoms in their wallet or car, where heat can damage the condom and cause it to break.

 

2. Condoms have a much higher failure rate for preventing STDs. No matter what “safe sex” advocates want to tell you, condoms don’t protect against HIV. The HIV virus and the sperm are smaller than the smallest detectable hole in a condom. To visualize this, think of the smallest hole in the condom being the same diameter as a softball, the sperm is the size of a shrimp, and the HIV virus is the size of a pea. Condoms don’t protect against Syphilis or HPV (also known as genital warts) either, which are contracted by skin to skin contact and may be on parts of the body not covered by the condom.

 

H.

Gels, foams, and spermicides

 

 

These can contribute to Toxic Shock Syndrome, have low effectiveness rates, and increase risk of STDs.

 

I.

Sterilization

 

 

1. Tubal ligation or “Getting your tubes tied”

 

a. This involves surgically cutting the fallopian tubes and sealing the tubes by tying them or burning the ends.

 

b. This is supposed to prevent the egg from passing from the tube to the uterus and the sperm from getting to the egg.

 

c. Side effects: severe bleeding, pelvic infection, increased cramping, decreased sex drive, psychological problems, ectopic or tubal pregnancy

 

A sterilized woman has a three times greater risk of a tubal pregnancy. This occurs when the egg is fertilized but can’t travel down to the uterus. The growing baby then ruptures the fallopian tube, causing serious hemorrhaging that can be life-threatening. We once had a woman in our class whose aunt had a tubal ligation and later had five ectopic pregnancies.

 

2. Vasectomy

 

a. This involves surgically cutting and sealing the Vas Deferens, which is the tube that transports the developed sperm from the testes out toward the penis.

 

b. It prevents the sperm from leaving the testes. The man’s body must then break the sperm down and absorb them. It’s this fact that causes many of the physical side effects of the vasectomy. The man’s body reacts as if his sperm were harmful bacteria. In essence, his body becomes allergic to itself. This is called the Auto-Immune Syndrome, and it happens in 55-75% of patients.

 

c. Other side effects, some of which may be caused by the Auto-Immune Syndrome, include: thyroid and joint disorders, heart and circulatory disease, diabetes, 85-90% higher risk of prostate cancer, increased risk of kidney problems, decreased sex drive, and psychological problems.

 

d. Furthermore, both tubal ligation and vasectomy are meant to be permanent. However, we don’t know what the future holds — unforeseen and tragic things may happen — and we may desire to have another child later on. A sterilization reversal can be costly, painful, and not 100% successful.

IV. Natural Family Planning

A. A doctor in the video made a really good point when he said, “A woman is only fertile about one hundred hours of every cycle, yet most methods of artificial contraception act on her body throughout her entire cycle, 24 hours a day, every day.” Now, we’re going to talk about a method called Natural Family Planning (NFP). This is where, as we learned last week, the couple learns to read and understand the naturally occurring signs of her fertility to know when she’s fertile and when she’s not. Couples then use this information to decide together whether to try to conceive or to postpone getting pregnant.

 

B. Natural Family Planning is scientifically proven, highly effective (98-99%), and successful in a wide variety of cycle situations, whether you’re nursing, pre-menopausal, or have long cycles. It is readily available, very inexpensive, simple to learn, and easy to use. It doesn’t take much time — only 5 minutes or less every day. It’s morally acceptable to everyone — to Catholics and other Christians, Mormons, and Muslims. It’s completely natural, doesn’t interfere with the normal functioning of your body, and has absolutely no harmful side effects — though there are many benefits that we’ll discuss in few minutes.

 

A study published in 1991 in the British Medical Journal found that the couples who were taught the Ovulation Method of Natural Family Planning by Mother Teresa and her Missionaries of Charity in Calcutta, India were using it with a 99.5% effectiveness rate — as good or better than any other method of family planning available. For the most part, these people in this study, who learned the Ovulation Method, were poor and illiterate.

 

C. This is not the old Calendar Rhythm Method you’ve probably heard about. Modern methods of NFP are often confused with the Rhythm Method of the 1950s and 1960s.

 

The Rhythm Method was only about 65% effective. When it was developed in the 1930s, it was thought that every woman’s fertility was the same as every other woman’s and that all women had the same 30-day cycle from month to month, which of course we know now is not true.

 

D. There are two main methods of NFP — the Ovulation Method, which involves observing the mucus sign, and the Sympto-Thermal Method, which combines the mucus sign with other crosschecks. The primary crosscheck is the woman’s basal body temperature — this is her temperature right when she wakes up. Both methods are highly effective (98-99% effective), if taught correctly and used properly. The Ovulation Method is simpler to learn and use and best for women with normal cycles. The videos we watched focus on this method. The Sympto-Thermal Method is best for women who have harder to read or more variable cycles, those who are nursing, or those who are having difficulties getting pregnant.

 

E. Really NFP is very simple to use. This is how it works for most: During the day, the woman observes her mucus sign, which she does by checking for mucus on the tissue when she wipes. Then, at bedtime, the husband notes the observations on a chart. If they are using the Sympto-Thermal Method, he’ll also mark down her morning temperature and any other crosschecks, which could include cervical position, breast tenderness, cramps, headache, moods, etc. Usually, a couple is using the method to postpone a pregnancy, and they want to know when the woman is in her infertile time. By applying some simple rules to the data, they will know whether or not she’s starting her fertile time, if she’s still in her fertile time, when she’s transitioning into the infertile time, and usually when her period is about to start. If she is fertile, they might discuss whether they want to try to conceive or avoid a pregnancy and why. This could lead them to talk about bigger issues in their marriage like their budget, what they’re spending their money on, his/her job situation, how much support the husband is giving with parenting or housekeeping, how overwhelmed or overburdened they might be feeling with the children they have, or other future plans. After the discussion, they might decide, “Let’s go for it” or “Let’s wait.” Whatever the decision, they just had some pretty important communication. When a couple is contracepting, it could be a long time between discussions like this one.

 

F. If the couple decides to abstain until the infertile time, which may be between 8 and 15 days long for a normal cycle, they can show their love in many other creative ways. This becomes a time for growing in their relationship — building the “best friends” side of their marriage. They should not tempt each other if they’ve agreed to abstain. She may not be able to wear her slinky nightgown because of her effect on him. It may also be difficult for her because a woman usually has a higher libido during her fertile time. They may have to guard what they watch and read. Remember, we’re not animals, we can control our passions and develop self-control. Sure it takes work to guard your heart and mind from all the sensuality of the world, but you’re doing it out of love for one another and growing in faithfulness. The couple using NFP to postpone will usually experience what’s been called the “courtship/honeymoon cycle.” When they reach the “safe-time” to have sex, these couples often experience a more exciting and fulfilling union — like on their honeymoon, because of their growth in friendship and the sacrifice that they made for each other.

 

G. Then when the couple is ready for children, they can use NFP to help you conceive a child. By using NFP, they’ll know exactly when it’s the best time to have intercourse to achieve a pregnancy. We know many couples who used NFP to get pregnant when they were having trouble doing so — ourselves included.

 

H. Having the husband involved in charting and making decisions together is very important to the success of the method. It may be hard to believe, but the man will come to understand his wife’s body more and be more sensitive to her needs. Over time of using the method, he may know before her that the symptoms she’s having are due to PMS and then be able to be more understanding and helpful to her. If she’s feeling crabby, moody, or irritable, then he knows why she’s feeling that way, knows not to take it personally, and knows when to “cut her some slack.” Through the understanding he gains of her by using NFP, the man learns to truly love and care for his wife and her body. He gains respect for the “mystery and mystique” of her body, as I like to call it, and will realize, as I did, how amazingly intricate my wife is made and how wonderful is it that she can conceive and nurture new life within her.

 

I. The woman will understand her body more, too, and can more quickly and easily detect changes and problems if they occur. By knowing her body well, she’s able to identify when things aren’t right with her body and discuss it more accurately with her doctor.

 

J. By using NFP, the couple learns respect for the natural way their bodies work. They work with the natural cycles and are not polluting her body with chemicals or foreign objects or putting up a barrier to their union. They learn to be more generous and giving with each other, because they’re holding nothing back. They’re respecting sex for what God created it to be in saying to each other, “I give myself totally to you and accept you totally — not just for this moment but for always.”

 

K. By not using artificial means to prevent a pregnancy, they keep themselves open to God’s working in their lives and through their lovemaking. In doing this, they’re following God’s Natural Law. Natural Law is the way that God designed things to work the best. It’s also the purpose for which He made things. As we discussed last week, God designed sex for both babies and bonding. When we try to thwart God’s plan by having sex outside of marriage or by using artificial contraception, there are harmful consequences — emotional pain of breaking up, sexually transmitted diseases, abuse of women, unexpected pregnancy, divorce, and many others.

 

Behaving contrary to Natural Law is like putting honey in your gas tank even though the owner’s manual says that you should use gas. Of course, it’s your car, so you can do what you want with it because you have your God-given free will. But it’s not going to work right if you use it in a way that’s contrary to its nature and design. Living by God’s law brings peace, joy, and freedom. God’s laws about sex are not rules to oppress us but guidelines to help us be really happy and healthy and free. It’s meant to help us to learn to love and be loved as He loves us — for our own sake.

 

L. Does anyone know the current national divorce rate? They say it’s around 50%. Does any one know when the divorce rate started ramping up? Would it surprise you if I told you, that it was around the time the contraceptive pill became widely available? Does anyone want to guess what the divorce rate is among couples practicing NFP? The estimate is less than 5%. It sounds to me like God knew what He was doing. This doesn’t mean that NFP is going fix a bad marriage, but it does strengthen marriages.

V. Conclusion

A. Remember that God’s plan for sex is a part of marriage. Saying “I want to have children with you” is much more meaningful than just saying “I want to have sex with you.” Sex before marriage can be just using the other person — not truly loving them. Remember, truly loving someone means you want what’s best for the other person, and you act accordingly. God made you in a very special, intricate way, and He loves you and wants what’s best for you. Your body is a beautiful creation, and your natural fertility is something to be cherished and taken care of. Also remember that it’s never too late to choose chastity — to wait until marriage for sex; it’s how God planned for us to work.

 

B. You have learned a little about NFP and how to read your natural signs of fertility, but there’s a bit more to it. There are special rules of charting and guidelines you need to know for how to avoid or achieve pregnancy with the ovulation method of Natural Family Planning.

 

C. If you want to learn more about how to practice NFP, we will have a follow up meeting with an instructor. [time & date] You’ll receive a book and charting supplies, and she will make sure you understand all the rules and how to chart your cycle.

 

Thanks for your time and attention. We’re available now or can be contacted anytime if you have questions.

 

The Fertility Appreciation class series was developed and taught by Ross and Lisa Novack for Elizabeth’s New Life Center in Dayton, Ohio.

Fertility Basics: A Review

  • OVULATION occurs on only 1 DAY in each cycle
  • The EGG lives only 12 — 24 hours if not fertilized
  • SPERM need MUCUS to survive
  • SPERM without MUCUS DIE within HOURS
  • SPERM with best MUCUS may live 3 — 5 DAYS
  • FERTILITY depends on OVULATION and SATISFACTORY MUCUS
  • PREGNANCY can result from CONTACT of sexual organs on FERTILE MUCUS days WITHOUT PENETRATION or EJACULATION
  • Intimate sexual contact on days of possible fertility MAY CAUSE CONCEPTION even though CONTRACEPTIVES are used
  • The changing levels of hormones may affect: FEELINGS, MOODS, AND PERCEPTIONS
  • Understanding your fertility depends on: ACCURATE INFORMATION and ACCURATE CHARTING

Remember: If you want to practice Natural Family Planning — it is important to have your charting reviewed by an instructor.

Class Diagram

 

Reprinted with permission of Family of the Americas.

This diagram is available in color on the One More Soul website onemoresoul.com in the Online Publications section under Other Items look for the title “Teaching Fertility Appreciation class diagram (pdf version) ” To copy this file to your computer, go to the page for the diagram and, with the link labeled “Download a printable version of this publication” follow the directions below.

 

If you’re on a PC, right-click the link and choose “Save Target to disk…” or “Save to disk…” or “Save Target as…”

 

If you’re on a Mac, option-click the link and it will download to the default download location on your Mac.

Teaching Fertility Appreciation and the Principle of Double Effect

The following is adapted from the Catholic Dictionary (published by Our Sunday Visitor Books).

 

Principle of Double Effect: Actions sometimes have two effects closely related to each other, one good and the other bad. The question is: Is it permissible to perform an action from which two such results follow?

 

Action: Teaching Fertility Appreciation (FA) at a Pregnancy Support Center to unmarried women.

 

Possible Results: 1) The women apply the knowledge of FA and NFP to fornicate by using NFP as a contraceptive, or 2) The women choose “secondary virginity” or chastity until marriage and embrace God’s plan for marriage and sexuality, or 3) The married and unmarried women choose to go off artificial birth control and choose to be generous with their fertility.

Using the Principle of Double Effect

It is permissible to perform the action if all of the following five conditions are met:

 

1. There is no other action which will produce the good effect without the possibility of also causing the bad effect. Teaching FA and NFP is the only action we have available to open the clients up to chastity. They’re likely to never hear about these things (i.e., morality of sex and marriage, how their body works, harmful effects of and abortifacient action of artificial birth control) ever again anywhere else.

 

2. The action is good (or at least neutral) and directly productive of the good effect. Teaching God’s plan for sex and marriage and the beauty and design of our fertility is a good action. There is nothing intrinsically evil about Fertility appreciation or Natural Family Planning. It is good for people to know the Truth “for it will set you free.” Also, teaching and informing consciences has the direct effect of influencing people and bringing about a change in their beliefs and behavior.

 

3. The intention of the person is good. Our intention in teaching the class is good and correct. We intend and hope and pray that the result will be good. We do not want or intend to have the woman use NFP to contracept and fornicate.

 

4. The circumstances are good for producing the good effect. We have a positive class setting. Our class is spread out over two meetings, which gives a double reinforcement of the message. We back all our information up with videos and materials we hand out. The clients and their guests are taught both the method and the reasons behind the method. We’re not telling them this on the bus or on the street corner where they don’t get the whole pitch.

 

5. The reason for the action is proportional to the seriousness of the indirect bad effect. Reason we are doing this is to give them the knowledge and Truth by which to make proper moral judgements with, or put simply, to get them to stop fornicating and/or contracepting. The possible ramifications of withholding the Truth from people are readily apparent in the world (i.e., fornication, adultery, contraception, pornography, abortion, etc.).

 

All the conditions are met.

 

Father Bill Kramer of the Archdiocese of Cincinnati said, “We can never be wrong about giving people information with which to make good moral choices. We are not responsible for the choices that others make [granted their choices are not directly caused by our coercion or lies], but in fact we may be culpable for withholding the truth.”

 

What if we don’t teach them? If we don’t teach them, will this bring their promiscuity to an end? Probably not. If we don’t teach them, are they likely to choose chastity or secondary virginity? Probably not. We may be the last people to plant in them the seed about the Truth of their sexuality and God’s design.

Scripture Verses

“Much will be required from the person entrusted with much..”

 

Lk 12:48

 

“Whoever obeys and teaches these commandments will be called greatest in the kingdom of heaven.”

 

Mt 5:20

 

“If you remain in my word, you are truly my disciples and you will know the truth and the truth will set you free.”

 

Jn 8:31,32

 

“I am the Way, the Truth, and the Life.”

 

Jn 11:25

 

For these and other reasons, we feel that it is right and good that we do this.

 

 

What a Woman Should Know about Contraceptives

“The Pill”

The birth control pill is used by over 10 million women in the US today and about 4 million of those are under age 25.1The Pill consists of a combination of two types of artificial hormones called estrogens and progestins. It works by inhibiting ovulation and sperm transport and by changing the lining of the inside of a woman’s uterus (called the endometrium) so that if the woman does conceive she will often have an early abortion.

 

Ethical side effects: It is estimated that women experience at least one very early abortion for every year that they are on the Pill.2Both pro-abortion and pro-life groups acknowledge that the Pill causes early abortions.3

 

Medical side effects: The birth control pill increases the risk of breast cancer by over 40% if it is taken before a woman delivers her first baby.4This risk increases by 70% if the Pill is used for four or more years before the woman’s first child is born.5Other side effects that women have experienced include the development of high blood pressure, blood clots, stroke, heart attack, depression, weight gain, migraine, dark spots on the skin and difficulty with breast-feeding. Diabetics who take oral contraceptives may note increased sugar levels. Some women who stop taking the Pill do not have a return of their fertility (menstrual cycles) for a year or longer. Although the Pill decreases ovarian and some uterine cancers, it increases breast, liver, and cervical cancer.4At least three studies have noted that the AIDS virus is transmitted more easily to women who are taking the Pill and whose partner(s) has the HIV virus. 6, 7, 8The cost of using the Pill for five years is over $1,000.

“The Shot” and Norplant

Commonly known as “the shot,” Depo-Provera, a long acting progestin hormone, is injected into a woman’s muscle every three months. It works by decreasing ovulation, by inhibiting sperm transport and by changing the lining of a woman’s uterus. Norplant is another progestin that is placed into silastic (rubber-like) tubes and placed under the skin of a woman and left there for up to five years.

 

Ethical side effects: By changing the lining of the uterus, Norplant and Depo-Provera both can cause an early abortion when conception does occur. Women who use Norplant will probably experience more than one abortion each year since the average woman ovulates in more than 40% of her cycles while using Norplant.9Depo-Provera may theoretically cause just as many abortions as Norplant since it is also a type of progestin.

 

Medical side effects: The results of two major world studies have shown that women who take Depo-Provera for two years or more before age 25 have at least a 190% increased risk of developing breast cancer.10In addition, Depo-Provera may reduce a woman’s bone density, and worsen a woman’s cholesterol level. One study found that women who had received injectable progestins (i.e., usually Depo-Provera or norethisterone enanthate) for at least five years and who had used them at least five years prior, suffered a 430% increased risk of developing cervical cancer.11Several studies have shown that women who receive injectable progestins have a much higher rate of contracting the AIDS virus if their partner is infected, with one study showing a 240% increased risk.12Norplant, which was developed later than Depo-Provera, has received less scrutiny, but may carry just as high a risk as Depo-Provera. In addition, over 50,000 women have participated in law suits against the manufacturer of Norplant, citing complaints of irregular bleeding, scarring, painful muscles, and headaches.13

 

Other Hormonal Contraceptives

The same artificial hormones used in the Pill, Depo-Provera, and Norplant are packaged in a variety of other delivery systems: the Patch, the “Morning after Pill,” the monthly injection Lunelle, hormone impregnated IUDs and vaginal inserts, and others. More are in development. Most are so new that their side effects have not been well researched. They use the same chemicals as the Pill and can be expected to have generally the same effects. All the hormonal contraceptives can also cause extended periods of infertility after they are discontinued.

Barrier Methods: The Condom and the Diaphragm

The condom has a failure rate that is estimated to be between 10-30%.14, 15There are several reasons for this such as breakage or slippage during use, defective condoms that have been damaged or poorly manufactured in the factory, and cracked condoms caused by storage in a hot or very cold place.

 

Medical side effects: The condom does not adequately stop the transmission of the AIDS virus: CM Rowland, Ph.D., editor of the journal Rubber Chemistry and Technology, tells us that electron micrographs (pictures taken with a very powerful microscope) reveal voids (holes) in the condom that are up to 50 times bigger than the HIV particle.16 The analogy would be that of throwing a marble at a tennis court fence and expecting it to stop the marble from going through.

 

The diaphragm is a barrier method of birth control so it theoretically does not cause early abortion. At least one study has noted that women who use barrier methods such as the diaphragm or condom, or the withdrawal method, had a 137% increased risk of developing preeclampsia in future pregnancies.17Preeclampsia, a complication occurring in some pregnant women, consists of a syndrome of high blood pressure, fluid retention, and kidney damage, which may eventually lead to prolonged seizures and/or coma. It is theorized that exposure to the male’s sperm has a protective role against preeclampsia.

Spermicides

Frequently, couples will use a spermicide in conjunction with their barrier method. A spermicide is an agent that is designed to kill the male’s

sperm and is often sold as a gel or as an ingredient in the vaginal sponge. Toxic Shock Syndrome has been associated with the spermicide sponge.18One researcher has noted that couples who have used certain spermicides within a month of conception have experienced a doubling in the rate of birth defects as well as a doubling of the rate of miscarriage.19

 

The IUD (Intrauterine Device)

[Most of the information regarding the IUD is taken from the 1997 PDR20 (Physician’s Desk Reference)]. This is a coil-like device made of hard plastic which may also contain copper. A doctor inserts it into a woman’s uterus. It works by irritating the lining of the uterus and obstructing sperm transport. When conception occurs in spite of this, it has

a secondary function of preventing implantation, thus causing an early abortion.21Other side effects include uterine perforation which may lead to a hysterectomy, and infection, such as a pelvic or tubo-ovarian abscess. Use of all IUDs has been associated with an increased incidence of PID (Pelvic Inflammatory Disease).20According to Rossing and Daling, two prominent researchers, women who had previously used an IUD for three or more years were more than twice as likely as women who had never used an IUD to have a tubal pregnancy (adjusted relative risk = 2.5, 95% confidence interval = 1.5-4.3). Among these long-term users of an IUD, risk of ectopic pregnancy remained elevated for many years after the device was removed. [An ectopic pregnancy is one in which the unborn child implants himself/ herself in a location other than in the mother’s uterus, usually in the fallopian tube.] Ectopic pregnancy remains the leading cause of maternal death in the United States. In addition the IUD may cause back aches, cramping, dyspareunia (painful intercourse), dysmenorrhea (painful menstrual cycles), and infertility. Since women who have an IUD in place experience a number of early abortions, they theoretically are at increased risk for developing breast cancer, since abortion has been associated with an increased risk of breast cancer.4

 

“Permanent” Sterilization: Tubal Ligation and Vasectomy

Tubal ligation, the “tying off” or cutting of a woman’s fallopian tubes, does not always prevent pregnancy. When pregnancy does occur, it is associated with a much higher incidence of ectopic pregnancy,22which, as was noted, is the leading cause of death in pregnant women. In addition, women who undergo the procedure may experience complications from the anesthesia or from the laparoscopic technique. Complications of laparoscopy include: bladder puncture, bleeding, and even cardiac arrest after inflation of the abdomen with carbon dioxide.23In addition, some women who have undergone a tubal ligation experience a syndrome of intermittent vaginal bleeding associated with severe cramping pain in the lower abdomen.24

About 50% of men who undergo a vasectomy will develop anti-sperm antibodies.25In essence, their bodies will come to recognize their own sperm as “the enemy.” This may have far-reaching complications and could theoretically lead to a higher incidence of autoimmune disease. In addition, several studies have noted that men who undergo a vasectomy have a higher incidence of developing prostate cancer especially 15-20 years after their vasectomy26, 27, 28, 29although a recent large study did not find a link.30In addition, Giovannucci31noted that men who died from their prostate cancer had a trend of having undergone vasectomy.

Wise Options

The best option before marriage is abstinence. The obvious benefits include greater self-respect, freedom from the risk of venereal disease especially AIDS, as well as monetary savings and no chance of a surprise pregnancy.

 

Within marriage it should be noted that an openness towards having children yields specific medical benefits. Having more children reduces the risk of breast cancer, some uterine cancers, and ovarian cancer dramatically.

NFP: Natural Family Planning

Natural Family Planning is a totally natural method by which couples can manage their fertility. In NFP a woman determines when she is either fertile or infertile by observing the consistency of her cervical mucus. The WHO (World Health Organization) has performed several large-scale trials that have had a “failure rate” of between 0.3 and 3%, which is as good as any artificial form of birth control. One very large trial performed on about 20,000 Indian women showed a failure rate of less than 0.3%.32

Some obvious benefits of NFP are that it is free of cost and there is no increased risk of cancer. Couples who use NFP have a divorce rate that is less than 5%33__far lower than the national rate of about 50%.

 

For more information on NFP or the side effects of a particular contraceptive contact:

  • The Couple to Couple League
    (513) 471-2000
    www.ccli.org
  • Family of the Americas Foundation
    (800) 443-3395
    www.familyplanning.net
  • Billings Ovulation Method Assn.
    (651) 699-8139
    www.Boma-usa.org
  • Pope Paul VI Institute
    (402) 390-6600
    www.popepaulvi.com
  • Northwest Family Services
    (503) 215-6377
    www.nwfs.org
  • One More Soul NFP Center
    1846 North Main Street
    Dayton, OH 45405-3832
    (937) 279-5433
    OneMoreSoul.com

REFERENCES:

1 Faust JM. Image change for condoms. ABC News Report. [Internet E-mail]. 6/8/97.

 

2 Kahlenborn C. “How do the Pill and other contraceptives work?” Breast Cancer, Its Link to Abortion and the Birth Control Pill. Dayton, OH: One More Soul; 2000; 315-335.

 

3 Alderson Reporting Company. Transcripts of oral arguments before court on abortion case. New York Times. April 27, 1989; B12.

 

4 Kahlenborn C. “Breast Cancer and the Pill.” Breast Cancer, Its Link to Abortion and the Birth Control Pill. Dayton, OH: One More Soul; 2000; 29-42, 149-180.

 

5 Romieu I, Berlin J, et al. Oral contraceptives and breast cancer. Review and meta-Analysis. Cancer. 1990; 66: 2253-2263.

 

6 Allen S. et al. Human immunodeficiency virus infection in urban Rwanda. JAMA. 1991; 266: 1657-1663.

 

7 Simonsen et al. HIV infection among lower socioeconomic strata prostitutes in Nairobi. AIDS. 1990; 139-144.

 

8 Mati et al. Contraceptive use and the risk of HIV in Nairobi, Kenya. Inter. J. of Gyn. and Ob. 1995; 48: 61-67.

 

9 Croxatto HB, Diaz S, et al. Plasma progesterone levels during long-term treatment with levonorgestrel silastic implants. Acta Endocrinologica 1982; 101: 307-311.

 

10 Skegg DCG, Noonan EA, et al. Depot medroxyprogesterone acetate and breast cancer [A pooled analysis of the World Health Organization and New Zealand studies]. 1995; JAMA: 799-804.

 

11 Herrero et al. Injectable contraceptives and risk of invasive cervical cancer: evidence of an association. Int. J. of Cancer. 1990; 46: 5-7.

 

12 Ungchusak et al. Determinants of HIV infection among female commercial sex workers in northeastern Thailand: Results from a longitudinal study. J. of Ac. I. Def. Syn. and H. Retro. 1996. 12: 500-507.

 

13 Taylor D. Spare the Rod. The Guardian (U.K.) March 12, 1996; 11.

 

14 Collart D. Biochemistry & Molecular Biology. Condom failure for protection from sexual transmission of the HIV-a review of the medical literature. 5393 Whitney Ct., Stone Mountain, GA 30088.

 

15 Rahwan R. Chemical Contraceptives, Interceptives and Abortifacients, 1995. College of Pharmacy, Ohio State University.

 

16 Rowland CW., The Washington Post (letter) June 25, 1992.

 

17 Klonoff-Cohen HS et al. An epidemiologic study of contraception and preeclampsia. JAMA. 1989; 262: 3143-3147.

 

18 Faich G et al. Toxic shock syndrome and the contraceptive sponge. JAMA. 1986; 255: 216-218.

 

19 Jick et al. Vaginal spermicides and congenital disorders. JAMA. 1981; 245:1329-1332.

 

20 Ortho Pharmaceutical. Description of Paraguard. Physician Desk Reference. 1997: 1936-1939.

 

21 Ortho Pharmaceutical. Description of Paraguard. Physician Desk Reference. 1997: 1936-1939.

 

22 Gaeta TJ et al. Atypical ectopic pregnancy. Am J Emer Med. 1993; 11: 233-234.

 

23 Dunn HP, Unexpected Sequellae of Sterilization. International Review of Natural Family Planning, 1:4 (Winter, 1977) 318.

 

24 Townsend DE et al. Post-ablation-tubal sterilization syndrome. Obstet Gynecol. 1993; 82: 422-424.

 

25 Rosenberg et al. Vasectomy and the risk of prostate cancer. American J. of Epidemiology. 1990; 132: 1051-1055.

 

26 Giovannucci E et al. A prospective cohort study of vasectomy and prostate cancer in US men. JAMA. 1993; 269: 873-877.

 

27 Giovannucci E et al. A retrospective cohort study of vasectomy and prostate cancer in US men. JAMA. 1993; 269: 878-882.

 

28 Hayes RB et al. Vasectomy and prostate cancer in US Blacks and Whites. American J. of Epidemiology. 1993; 137: 263-269.

 

29 Rosenberg L et al. Vasectomy and the risk of prostate cancer. American J. of Epidemiology. 1990; 132: 1051-1055.

 

30 John EM et al. Vasectomy and prostate cancer: results from a multiethnic case-control study. JNCI. 1995; 87: 662-669.

 

31 Giovannucci et al. A long-term study of mortality in men who have undergone vasectomy. NEJM. 1992; 326: 1392-1398.

 

32 Ryder RE. “Natural Family Planning”: Effective birth control supported by the Catholic Church. BMJ. 1993; 307: 723-6.

 

33 Kippley JF, Kippley SK. The Art of Natural Family Planning (Fourth Edition). Couple to Couple League, Cincinnati, USA, p. 245.

Teaching Fertility Appreciation in a Pregnancy Support Center

(Part1) What follows is a presentation made by Ross & Lisa Novack at a Heartbeat International conference in the year 2000 at Columbus, Ohio. They explain why this class is a crucial part of Pregnancy Support ministry.

 

Good morning! Are you enjoying the conference so far? Well, my name is Ross Novack and this is Lisa, my lovely and pregnant wife, helpmate, and mother of our 20 month daughter, Emily. It’s such a great honor for us to come to speak to you today — You who are so committed to the cause of life. Lisa and I have been working with Elizabeth’s New Life Pregnancy Support Center in Dayton, Ohio, for about three years. I’m a member of its Board of Trustees, and I’m always amazed, though I shouldn’t be, at the work that God is doing there and in all pregnancy support centers. I also helped to put together our “Chastity by Choice” high school abstinence program, and I’ve been one of the program’s presenters. I’m happy to tell you that the program is having great success in getting Dayton area teens to choose and live chastity. As for Lisa, she did peer counseling before Emily was born. She is also my co-board member and my helpmate in everything. Together, we developed and now teach a class series called Fertility Appreciation at Elizabeth’s New Life Center. This is why we’re here to speak to you today.

 

Since becoming active in the pro-life movement, I’ve come to feel that, next to prayer, working with and supporting pregnancy support centers is the most important work we can do to save babies, help mothers, and spread the Gospel of Life. God’s response to the tragedy of legalized abortion and the hardening of people’s hearts against life and their fertility has been to raise up crisis pregnancy centers so that our hearts might be softened and we might go out to spread His good news. What a great grace it is to do this work — to be His hands, His feet, and His voice in this work of Mercy. What a great need there is out there for your services, your support, and your hope — God’s hope. The battle will only be won with God’s grace and our everyday efforts to open hearts and minds to the Truth — the Truth of the God-given dignity of the human person and the right to life for born and unborn. However, even if the laws were to change today and abortion be made illegal, there would still be a great need for pregnancy support centers. We all know, as long as there is human nature, flawed as it is by the fall, there will be crisis pregnancies. We can easily see the damage all around us of the culture of death — of contraception and abortion on demand. This is why we all entered the fight and this is why you’re here: to learn more about how to improve your centers and help women to change their lives for the better.

 

So, Lisa and I are here today to give you another approach or tool, so to speak, to use to preach the Gospel of Life and to influence women and men to change their minds and behavior and respect their sexuality. First, I’ll be telling you why this is the most important new class for you to start in your pregnancy support center. And then, Lisa will briefly introduce our class and tell you about the resources you might need for developing a class at your own pregnancy support center.

 

The Fertility Appreciation class grew out of the vision of Vivian and Steve Koob, the founders of Elizabeth’s New Life Center. We at Elizabeth’s try to be present to the needs of the women who come to us by providing peer counseling, material assistance, emotional support and friendship, spiritual guidance, education, whatever these needs may be. It is by being present to them that we reach these women with love, influencing them to choose life for their babies, supporting them in that decision, and helping them to change their lives for the better. Lisa and I have come to see this as the living application of the slogan “Love them both.” An integral part of truly loving these women as God does is telling them the TRUTH — In Love — about marriage, sexuality, and chastity — the Truth that the world does not give.

 

However, as those of you who have counseled these women know, the women that come to us are often not immediately inclined or prepared to hear and accept the Truth we present to them. They have been conditioned by the world’s message — the world’s call to instant gratification, pleasure above all, and casual sex without strings, and the belief that contraception is the world’s greatest invention, that children are a burden, that marriage is an archaic invention that oppresses women, and that babies can be disposed of. Sadly, their consciences have been formed in this mistaken philosophy. Some have never been taught what is right and good — not from their parents or families, not in school, and often not even in their churches. Or if they are told these things, it is by way of “Don’t do this” or “Don’t do that” without the “Why” or the reasons behind it. As a result, our counselors find that some clients have little or no basis or foundation on which they can talk to them about chastity or morality. The short counseling session a counselor may have with a client is often not enough time to lay the ground work necessary to get the client to consider chastity or secondary virginity. The fertility awareness class provides centers with another opportunity to teach these clients, lay the foundation, and encourage them to change their behavior. The class gives us more time to present our case to the clients in a way that is different from one-on-one counseling. The clients share their experiences and observations with each other, often validating in their eyes what we are trying to teach them.

 

In offering Fertility Appreciation classes to our clients, we are trying to give them knowledge and information to help them form their consciences and make good choices. The primary goals of our class are 1) to teach God’s plan for sex and marriage, 2) to promote chastity or secondary virginity among unmarried women, and 3) to promote Natural Family Planning and generous self-giving within marriage over artificial contraception. Really, though, its purpose and reach goes much further. We want them to realize the beauty and complexity of their fertility and the immeasurable value of their life and sexuality. We want to inform them of the physical, emotional, spiritual, and relational risks and harms of using artificial contraception. In addition, we want them to be aware of the abortifacient effects of many types of artificial contraception including the Pill, IUD, Norplant, and Depo-Provera and that if they are using them, they can have numerous chemical abortions each year without ever knowing it.

 

It is our responsibility to share the knowledge and Truth we’ve found. These women, and in fact all people, have the right to hear these things. They have a right to know how their bodies work, the purpose of sex, and God’s plan for sex and marriage, the harms of artificial contraception, and that Natural Family Planning exists and is highly effective and worthwhile. Armed with this Truth, they can begin to turn their lives into something good, free, and joyful.

 

In our class, the women learn the basics of their fertility and are introduced to the ovulation method of NFP. You may be concerned that by teaching an unmarried woman to read her fertility signs, we are giving her the tools to sin without the potential consequence of making a baby. It is literally impossible to give them the full understanding of how their bodies work without also informing them of the observable signs of when they are fertile and when they are not. However, we don’t give them this information without also teaching them about the natural law concerning their sexuality — both the moral imperatives of God’s law and the consequences of not living by God’s law concerning sex. The information presented in the class is highly unlikely to encourage them to commit adultery or fornication. Additionally, as I said before, women have the right to know how their bodies work as well as the right to know the effect contraceptive drugs and mechanical devices have on their bodies. We don’t intend the clients to use NFP as contraception. On the contrary, we hope and pray that the women who attend our classes will change their behavior for the good. In fact, spreading this Truth is so critical, because the potential for harm is so great for both women and society. In fact, the effects of withholding the Truth from people are apparent in the problems our society is facing today and our centers address on a daily basis. Our clients are unlikely to get this message anywhere else. In the “Artificial versus Natural Family Planning” video, we use in the class, Dr. Lejeune sheds light on this situation. He said, “I think the reason why NFP is not widely used by everyone is in fact because of two things: first, a man must have love for his woman, and second, he must have respect for her physiology. And it cannot be used if you have random partners or if you do not have a real conjugal law.” By conjugal law, he means an understanding and respect for God’s law for sex. Consequently, our clients are unlikely to use NFP without respecting God’s order for sexuality, which is chastity. In talking to a priest about the class, he said, “We can never be wrong about giving people information with which to make good moral choices. We are not responsible for the choices other make, but in fact we may be culpable for withholding the Truth.”

 

Through this class, we try to instill in the clients a sense of the wonder and gift of their fertility and of pro-creating with God in bringing forth new life into the world. Surely, these are ambitious goals, but we’re about planting seeds. Only God knows if and when these seeds will germinate and bear fruit. However, God does sometimes encourage us by letting us see the fruits of our efforts. We have had several clients tell us later that our class helped them choose chastity. We’ve also had several married clients learn and practice NFP and have been pleased with the understanding it gives them of their own bodies. Another client, after sitting through our class, confided in us that she had an appointment to get an IUD the next day, and that after listening to our presentation, she had decided not to go. We’ve been amazed how God has used this class to change lives.

 

Listen to Jesus— words from the Sermon on the Mount found in the Gospel of Matthew Chapter 5:

 

“Think not that I have come to abolish the law and the prophets; I have come not to abolish them but to fulfil them. For truly, I say to you, till heaven and earth pass away, not an iota, not a dot, will pass from the law until all is accomplished. Whoever then relaxes one of the least of these commandments and teaches men so, shall be called least in the kingdom of heaven; but he who does them and teaches them shall be called great in the kingdom of heaven.”

 

May you (and you and you) be called “great” in the kingdom of heaven and may a thousand thousand people embrace you and thank you in heaven for leading them to the Truth and helping them to get to heaven. May Jesus say as you enter heaven, “Well done, good and faithful servant, enter the kingdom my Father has prepared for you.”

 

Now, I will turn it over to Lisa who will give you a sample of what we teach in the class and introduce you to the materials that we use.

Teaching Fertility Appreciation in a Pregnancy Support Center (Part 2):

Review of the Class Outline (given by Lisa Novack)

I want to begin by making it clear that we do not actually teach NFP to our clients in this class. We do teach them the signs of fertility in their own bodies, and as Ross said, we teach them God’s plan for sex and marriage. We introduce the concepts of Natural Family Planning and talk about the benefits gained through its use. If clients are interested in learning and practicing NFP, we refer them to certified teachers. We personally have been users of the sympto-thermal method of NFP for over four years, but we teach about the ovulation method to our clients because of its simplicity. Mother Teresa and her Missionaries of Charity taught the ovulation method to the illiterate poor of Calcutta with a documented effectiveness rate of 99.6%. In the United States, both methods of NFP have 98 — 99% effectiveness rates when taught properly and used properly by highly motivated couples.

 

It’s not absolutely necessary to teach this class as a married couple, but we feel it benefits our clients to see a couple working together as a team and to see the loving example of a Godly man. It would be much more difficult for a man than a woman to teach the class on his own (unless he were a doctor), simply because the clients are more open to hearing this information from a woman.

 

When we first started working on this class we expected the clients to sort of sit there and stare blankly at us as so often happens in a classroom setting — but we’ve been pleasantly surprised again and again at how actively the clients participate in this class. They will often share their own experiences, ask questions that are relevant and usually very astute, answer questions when I ask them, and we often receive comments of amazement that they’ve never been told these things. We attribute this to the very intimate nature of the subject matter as well as the casual, comfortable, matter-of-fact way in which we try to approach it. By the way, another class that Elizabeth’s New Life Center has begun to offer to our single clients is a three part class called “Chastity by Choice,” and it goes hand in hand with this class. It has had similarly active participation, I believe, due to the intimate nature and casual approach to the material.

 

At this point, I’d like to go through our class with you in a slightly abbreviated form. You may find some of the material blunt or graphic but this is necessary for clarity and truth.

 

The class is set up in two parts, each an hour and 15 minutes, a week apart. We begin by introducing ourselves and asking the clients to introduce themselves. In the first class, we talk about how a woman’s natural fertility works and how wonderfully God has made our bodies — they are so intricate and so carefully balanced.

 

Ross and Lisa proceeded to give a detailed outline of their Fertility Appreciation presentations. This material is presented in greater detail earlier in this book, beginning on page 7.

 

 

Resources for Teaching Fertility Appreciation

Books:

Mercedes Arzu Wilson, Love and Family: Raising a Traditional Family in a Secular World, San Francisco: Ignatius Press, 1996.

 

Mercedes Arzu Wilson, Love & Fertility (booklet), Dunkirk, MD: Family of the Americas Foundation, Inc., 1986, (800) 443-3395.

 

Mary Beth Bonacci, Real Love: Answers to Your Questions on Dating, Marriage, and the Real Meaning of Sex, Ignatius Press, 1996.

 

John and Sheila Kippley, The Art of Natural Family Planning, 4th edition, Cincinnati: Couple to Couple League, 1996, (800) 745-8252.

 

Sheila Kippley, Breastfeeding and Natural Child Spacing: How Natural Mothering Spaces Babies, Cincinnati: Couple to Couple League, (800) 745-8252.

 

Marilyn M. Shannon, Fertility, Cycles and Nutrition, 2nd edition, Cincinnati: Couple to Couple League, 1996, (800) 745-8252.

 

Pope Paul VI’s Encyclical Letter Humanae Vitae (Of Human Life), Boston: Pauline Books & Media, 1968 (Cleveland Center (216) 621-9427).

 

Pope John Paul II’s Apostolic Exhortation Familiaris Consortio (The Role of the Christian Family in the Modern World), Boston: Pauline Books & Media, 1981.

 

Pope John Paul II’s Encyclical Letter Evangelium Vitae (The Gospel of Life), Boston: Pauline Books & Media, 1995.

Video Tapes:

Appreciating Your Fertility (video), Dunkirk, MD: Family of the Americas Foundation, Inc., 1993.

 

Love & Fertility (video), Dunkirk, MD: Family of the Americas Foundation, Inc., 1989.

 

Natural vs. Artificial Family Planning (video), Dunkirk, MD: Family of the Americas Foundation, Inc.

 

Sex Has a Price Tag (video), Pam Stenzel, Creative Youth Resources / Youth for Christ, (800) 735- 3252 (available through One More Soul).

Organizations:

The following organizations have a wide variety of resources available. Most will send a free catalog upon request:

  • One More Soul, 1846 N. Main St., Dayton, OH 45405, (937) 279-5433, (800) 307-7685, Fax (937) 275-3902, www.OMSoul.com e-mail: OMSoul@OMSoul.com.
  • Family of the Americas, PO Box 1170, Dunkirk, MD 20754-1170, (301) 627-3346, (800) 443-3395 (orders only), Fax (301) 627-0847, www.familyplanning.net/
  • Couple to Couple League International, PO Box 11184, Cincinnati, OH 45211-1184, (513) 471-2000, (800) 745-8252 (orders only), Fax (513) 557-2449, www.ccli.org.
  • Heartbeat International, 7870 Olentangy River Road Suite #304, Columbus, OH 43235-1319, (614) 885-7577, (888) 550-7577, Fax (614) 885-8746, www.heartbeatinternational.org, email: support@heartbeatinternational.org.
  • Real Love, Inc., 1520 West Warner Rd. Suite #106-138, Gilbert, AZ 85233, (602) 812-1194, www.reallove.com (chastity education).
  • Human Life International, 4 Family Life, Front Royal, VA 22630, (540) 635-7884, (800) 549-LIFE (catalog orders only), Fax (540) 636-7363, www.hli.org, email: hli@hli.org.
  • The Pope Paul VI Institute, 6901 Mercy Rd, Omaha, NE 68106, (402) 390-6600, (fertility/ infertility research & information). www.popepaulvi.com
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Teaching Fertility Appreciation

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