Charting, Fertility and Infertility

By Dr. Les Ruppersberger, DO, FACOOG

In general, infertility is defined as not being able to get pregnant after one year of unprotected coital activity (TTC). Because fertility in women is known to decline steadily with age (women are born with all the eggs they will ever have and that number decreases with age), some providers evaluate and treat women aged 35 years or older after 6 months of unprotected coital activity. Men are fertile all the time. Women with infertility should consider making an appointment with a specialist. These specialists may also be able to help women with recurrent pregnancy loss, defined as having two or more spontaneous miscarriages. Preferably, the specialist will be conversant in fertility awareness based methods and interpretation of charts.

What is necessary to conceive:

• A woman’s body must release an egg from the ovaries.

• A man’s sperm must join with the egg along the way (fertilize), and the man needs to have a normal sperm count with good motility.

• The fertilized egg must go through a fallopian tube toward the uterus (womb).

• The fertilized egg must attach to the inside of the uterus (implantation).

Infertility may result from a problem with any or several of these steps or other hormonal problems like thyroid disease or genetic/inborn errors of metabolism. Impaired fecundity is a condition related to infertility and refers to women who have difficulty getting pregnant or carrying a pregnancy to term.

Frequency of Infertility
About 6% of married women aged 15 to 44 years in the United States are unable to get pregnant after one year of trying (infertility). Also, about 12% of women aged 15 to 44 years in the United States have difficulty getting pregnant or carrying a pregnancy to term (impaired fecundity).

Couple Problem
Infertility is not always a woman’s problem. Both men and women can contribute to infertility. any couples struggle with infertility and seek help to become pregnant, but it is often thought of as only a woman’s condition. However, in about 35% of couples with infertility, a male factor is identified along with a female factor.

In about 8% of couples with infertility, a male factor is the only identifiable cause. Almost 9% of men aged 25 to 44 years in the United States reported that they or their partner saw a doctor for advice, testing, or treatment for infertility during their lifetime.

Doctors will begin by collecting a medical and sexual history from both partners. The initial evaluation usually includes a semen analysis, a tubal evaluation, and ovarian reserve testing, blood work, and, in the NFP world, evaluation of charts which document certain fertility markers. Of course, the charting does not evaluate the male.

Medical Conditions That May be Diagnosed from Charting
A good chart tells you about your hormones, and your hormones are linked to so many things! It’s a great place to start. There are several fairly common reproductive health conditions that can show up on women’s charts: ovarian cysts, PCOS, endometriosis, thyroid dysfunction, among others. When charting, it is strongly advised that you do not self-diagnose. Refer to a physician or practitioner trained in understanding the woman’s cycle to get an exact diagnosis. Checkout our directory or or to find these trained educators and medical professionals.

Keeping menstrual charts as taught in fertility awareness methods along with getting evaluations by a health-care practitioner trained in fertility awareness based methods can help get an early diagnosis and potential treatment.

Dr Lester Ruppersberger, D.O., FACOOG is a retired Ob/Gyn, who along with his wife, was an NFP instructor for the Archdiocese of Philadelphia for nearly 20 years through the Harrisburg NFP program. The Ruppersbergers and other Philadelphia STM teachers formally transitioned to CCL’s program in 2017. Dr. Ruppersberger, an NFP-only physician, has been the past president of the Catholic Medical Association, works with Philadelphia-area crisis pregnancy centers, and has extensive experience on boards and in collaborating with national groups. He serves as the Vice Chair of the Couple to Couple League Board of Directors.

To find a STM NFP class and learn how to chart, visit or