8. Special infertility considerations

a) Men avoid ejaculation until the woman has mucus present.
If a man has had a semen analysis that reveals a low count, or poor morphology or motility, it is best that he conserve his semen until the woman has cervical mucus present. Cervical mucus, especially of Peak quality, increases sperm survival and transport. Abstinence from ejaculation gives the man’s body an opportunity to accumulate sperm. Thus using mucus days only for intercourse are most likely to result in pregnancy. Additionally, intercourse on days within the count of 3 account for ovulation occurring on those.

b) Use mucus days of greatest quantity and quality and 2 days after intercourse.
This applies to women who have limited mucus patterns. Limited mucus patterns can be: mucus patterns in which the mucus never develops peak characteristics (clear, stretchy, or lubricative), or mucus patterns of less than 3 days in length even with peak mucus where the woman observes mucus less than 4x a day. For example, a woman with a limited mucus pattern may 3 days of mucus two days of 6Cx2 and one day of 8Kx1. A healthy mucus pattern would include more frequent observations of peak mucus on any given day and more days in which peak mucus appears. Limited mucus may be a reflection of low estrogen production by the follicle, damage to the cervical crypts due to infection or some other cause, or hormonal imbalance due to stress, illness, or dietary or lifestyle factors.

If a woman notices that she has a limited mucus pattern and wants to become pregnant then she needs to identify what for her is the greatest quantity and most Peak quality mucus. She observes for her threadiest mucus; her most abundant day of mucus; and for her most lubricative sensation. That day/s may not necessarily coincide with the Peak Day, which is the last day where a woman experience peak mucus. To increase her chance for becoming pregnant she has intercourse on mucus days of greatest quantity and quality, and the two days following. On the two days following, the alkalinity of the vagina at that point is still favorable to sperm, and ovulation can occur on these days.

c) Record abdominal or back pain.

Abdominal pain (mittelschmerz) accompanies ovulation in more than half of women. The pain may express itself as any of the following:

• a sharp short pain in the lower right or left abdominal region (RAP/LAP)
• a dull (pelvic) ache or crampy sensation in the lower abdominal region (pelvic)
• a lower back ache (LBA).

The pain may last for a few hours or all day. If you experience this pain note it on your chart using the shorthand RAP (right abdominal pain) or LAP (left abdominal pain) or LBA (lower back ache)