catapult magazine

A pill for the diagnosis of fertility?

by Andrea Van Wyk

As a resident physician, I have observed numerous patients who seek a pill for everything, while other patients refuse to take pills for anything.  There are some diseases that will go away on their own without treatment. There are other diseases that don’t go away.  Fortunately, there are often medicines that help the diseases resolve.  But when did we as a society decide it was necessary or acceptable to take a pill to treat a healthy condition, such as fertility?  How is it that, according to the U.S. Department of Health and Human Services, 95% of sexually active American women of childbearing age are currently manipulating their natural fertility cycle by taking oral contraceptive pills (OCP) or some other variant of hormonal contraception?

I grew up in Christian circles where most friends and family members took OCP.  It was part of being responsible and trying to take control of when children should come into the family.  No one ever challenged the status quo by asking, “How does the pill really work?” or, “How did God design the natural monthly fertility cycle for his glory?” or,  “How does birth control help or hinder sexual intimacy?” or, “Is it God’s will that we try to have full control over timing of babies?”  I, too, would likely have taken OCP had I not been challenged during medical school to think about these questions.  It is not my goal to condemn those who haven’t asked these questions but to encourage everyone to make thoughtful decisions about fertility.

I attended a weeklong seminar in medical school dealing with various fertility topics including barrier devices (condoms), oral contraception, emergency contraception, chemical and surgical abortion and natural family planning (NFP).  When NFP was presented among all of the other ways our society seeks to control fertility, I found it compelling.  It was simple for me to see the unique beauty of how God designed the natural monthly fertility cycle for his glory, both at the physical molecular level and the spiritual level.  And even though NFP is often associated with Catholicism, it felt quite Reformed to me.

To be a Christian in the Reformational tradition is to recognize that all areas of our life exist under the lordship of Christ and all of these areas exist for His glory.  Fertility and sexuality are a significant part of our daily lives.  I believe that as Christians, we often unintentionally try to manipulate and control this aspect and keep it out of the realm of the lordship of Christ and, therefore, we often miss out on a more wholesome, God-glorifying approach to fertility and sexuality.

NFP recognizes and embraces the natural, creative reproductive cycle that God created in women.  There is incredible beauty in the feedback of hormones that is still not completely understood.  At a basic level, estrogen levels rise in the first half of the menstrual cycle and produces negative feedbacks on the pituitary gland in the brain, thus causing another hormone-luteinizing hormone (LH) to NOT be released.  But somehow, when estrogen reaches a certain threshold, the negative feedback switches to positive feedback and there is a surge in LH which leads to ovulation around day fourteen of the cycle.  Ovulation occurs when a tiny ovum (egg) bursts from the ovary and is swept into the fallopian tube by its tentacle-like fingers called fimbrae. After ovulation, progesterone slowly rises and stimulates the uterus to form a rich, fertile lining for the egg to implant if it happens to be fertilized. Another marvel of the human reproductive system is that natural estrogen stimulates libido.  Estrogen in OCP, on the other hand, is a different molecular make-up and does not stimulate libido.  There is new interest also in the environmental impact of estrogen in OCP being excreted into our water systems and causing feminization of fish.  Still other examples of the beauty of the reproductive cycle include how our body stimulates the shedding of the uterine lining and the intricacy of the molecular make-up of the cervical mucus, which changes throughout the month to allow or inhibit the entrance of sperm into the uterus.  These are just a few examples of how God designed our bodies to be remarkable.

In contrast, OCP and other forms of hormonal contraception seek to ablate this beautifully intricate cycle and control fertility by doing three things:

1. preventing ovulation
2. changing cervical mucus so sperm are less likely to enter the uterus
3. changing the lining of the uterus from a “fertile” environment to a “hostile” environment. 

Hormonal contraception has various levels of estrogen and progesterone that act on the pituitary to simulate a constant “negative feedback loop” to inhibit LH from being released, so it basically “tricks” your brain into thinking that you are pregnant.  Occasionally, one will still ovulate while on OCP.  Then that egg could be fertilized, but it likely will not implant because the lining of the uterus is more “hostile.”  I find this ethically problematic, because it is the human that has manipulated the uterine lining in such a way that a fertilized egg is miscarried.

Natural family planning (NFP) seeks to control fertility by working within the innate cycle that God created, rather than suppress it artificially.  The most researched and successful form of natural family planning is the Creighton model.  The Creighton method requires that the female tracks changes in her cervical mucus throughout the month.  Thus a couple should abstain from intercourse for approximately 6-8 days/month if trying to prevent pregnancy. To be effective in this method, one should have a counselor who can go much more in depth on the uniqueness of each woman’s cycle, but once the time is invested upfront, the method becomes quite easy-even easier than remembering to take a pill every day or refill a prescription every month.

Many peoples’ critiques of NFP are often based on misunderstandings.  NFP is often quoted to have success rates of 60% in the medical literature, but that method of NFP is simply “counting days” assuming every female has a precise 28 day cycle with ovulation on day 14 which is hardly ever the case!  The Creighton model has success rates of 98+% in couples who have had training.  My husband and I were both in graduate school/medical school when we were first married and believed that that environment may not have been the best to raise children.  We felt that NFP was a way to try to control fertility but within the natural cycle that God created.  Some say that NFP inhibits the freedom that God gives married couples to have intercourse whenever they want; but proponents of NFP argue that abstaining from sex is like fasting from food.  We often have a deeper appreciation for the flavors and textures of food after a fast, and we look forward to that first meal that breaks the fast with great anticipation. The same is true with sex.  Furthermore, couples who practice NFP have intercourse just as frequently as other couples, but their intercourse is just timed differently.

In summary, NFP promotes fertility as a healthy condition; one that does not require medical treatment with “pills.” It allows for control of fertility without the hormonal manipulation of our bodies.  It encourages sexual and spiritual intimacy within a marriage that may not always exist in other forms of contraception. It requires deep and frequent conversations, as both the man and woman are involved in tracking times of fertility each month and deciding whether to abstain from or engage in intercourse.  It requires us to “be renewed in the knowledge in the image of our Creator” (Col. 3:10) as we seek to understand the unique intricacies of our bodies.