The sympto-thermal method is one of several methods of natural family planning.

It is
based on the combined use of the basal body-temperature and the secretion of cervical mucus as
a mean of regulating births. In western countries, the method has gained moderate attention since
its introduction in 1965 by Josef Rtzer (Doblhammer & Lutz, 1996), and is, e.g., used in Austria
by less than 5% of the population. In contrast to other natural methods, the method after Rtzer
attaches importance to living periodical abstinence in the few days of fertility if responsibility for
a child could not be taken. Authentic natural family planning should never interfere with the
transmission of life. On the other hand, the first pre-ovulatory phase starts on the first day of
menstruation until the last preovulatory dry day (unsafe). The second phase from the beginning
of wet day with mucus until the fourth day past the peak mucus is the fertile period where the
likelihood of conception is very high and possible. The third phase is the infertile time (safe) just
after ovulation. During the first half of a woman's period, the temperature is low indicating low
fertility. As fertility increases, so does the basal body temperature. Highest temperatures begin
one or two days after ovulation and according to this method, it's safe to resume intercourse 3
days after the temperature rise (World Health Organization Task Force in Methods for the
Determination of the Fertile Period, 1983)
The sympto-thermal method also involves cervical mucus monitoring, which requires a
woman to examine her mucus with her fingers. The more mucus there is and the stretcher
indicates higher fertility. It becomes dry and scant during the infertile period which makes
intercourse allowable 4 days after maximal cervical mucus is detected and until next
menstruation.
Effectiveness
This method works well with women who are dedicated to following the rules and
keeping track of their body signs, with some studies indicating at least 95% level of effectiveness
(Flyn, 2004). But in order to achieve this effectiveness, abstinence must be complete during the
fertile phase. If a woman does not follow the method strictly, the couple risks intercourse during
the fertile period, and so the failure rate of this type of birth control can be as high as 25%. The
symptom-thermal method requires high levels of discipline and the ability and patience to
continue systematic charting for all the years a couple wishes not to have children. It has all
advantages of cervical mucus plus BBT method combined.
Procedure
According to Wilson (2002), the Sympto-thermal Method can be practiced by following
rules mentioned below:
(1) First Five Days Rule: you are considered infertile during the first five days of a new cycle, but only
if you experienced a spike in basal body temperature 12 to 16 days prior to menstruation. However, if you
have experienced any cycles that are less than 25 days in length (or if you are perimenopausal or just
starting out with STM) this rule will change to assume infertility only the first three days of a new cycle;
(2) Dry Day Rule: you are considered infertile the evening of every day you experience a dry day or a
day with no visible cervical fluid. However, if you happen to have a non-dry basic infertile pattern (BIP),
you are considered infertile the evening of every day you experience no change in your cervical fluid.
Additionally, if semen, lubricant, or spermicide is not expelled from the vagina after intercourse, then
unprotected intercourse is not safe on the following day since each one has the potential to mask fertile
cervical fluid; (2a) Doering Rule (a conservative addition to the dry day rule): your fertile window begins
seven days before the earliest cycle day on which a temperature shift has occurred over the past 12 cycles.
At least 12 cycles of BBT data are necessary to use this rule. Presence of cervical fluid will always
override this rule; (3) Peak Day Rule: this rule is satisfied in the evening of the third day after your peak
day, unless you experience a slow-rise temperature shift, in which case the rule is satisfied in the evening
of the fourth day after your peak day. The double-check rule (rule #5) must be followed to determine
when your post-ovulatory infertile period begins; (4) Temperature Shift Rule: this rule is satisfied after
three consecutive days of a BBT that is above the coverline, as long as the third temperature after your
temperature shift is at least 0.3 F (0.15 C) above the coverline. For a slow-rise temperature shift, or in
the case that your third temperature was not at least 0.3 F (0.15 C) above the coverline, this rule is
satisfied after four consecutive days of a BBT above the coverline. The d ouble-check ule (rule #5) must
be followed to determine when your post-ovulatory infertile period begins; (5) Double-Check Rule: you
must wait until both the peak day rule and the temperature shift rule are satisfied before you consider
yourself infertile for the remainder of your current cycle. (Wilson, 2002).

Bibliography
Doblhammer G. & Lutz F. Family and Fertility Survey (FFS). Austrian Institute for Family
Studies. Vol. 28: pp 54; 162. 1996.
Flyn, A. Natural Methods of Family Planning. Clin Obstet Gynaec, 11:661-678, 2004.
Wilson M.A. The practice of natural family planning versus the use of artificial birth control:
family, sexual and moral issues. Catholic Social Science Rev. Vol VII, Nov., 2002.
World Health Organization Task Force in Methods for the Determination of the Fertile Period. A
Prospective Multicentric Trial of the Ovulation Method of Natural Family
Planning. II. The Effective Phase. Fertil Steril 40:773-778, 1983.