Understanding a Woman’s CycleJuly 16, 2008
When does conception begin? Today on the broadcast, Dr. Bill Cutrer, an OB-GYN, and Dr. Mark Povich, a family physician, explain how a woman’s monthly cycle promotes or inhibits her chances of fertility.
When does conception begin? Today on the broadcast, Dr. Bill Cutrer, an OB-GYN, and Dr. Mark Povich, a family physician, explain how a woman’s monthly cycle promotes or inhibits her chances of fertility.
Understanding a Woman’s Cycle
Mark: When I am entering into discussion with people in regard to when does life begin, especially if they're coming at it from a Christian perspective, I can go back to when Jesus Christ was first within His mother's womb. God's spirit did not indwell in an already-fertilized egg, and that was the point of His life – the Holy Spirit fertilized the egg of a virgin.
Bob: This is FamilyLife Today for Wednesday, July 16th. Our host is the president of FamilyLife, Dennis Rainey, and I'm Bob Lepine. When you're dealing with the subject of family planning, one of the issues you have to wrestle with is the issue of what you believe about when life begins. Stay tuned.
And welcome to FamilyLife Today, thanks for joining us on the Wednesday edition. Over the years, we have touched on a number of subjects that can be somewhat controversial, where there is not always clear agreement among people who believe the Gospel and who believe that the Scriptures are true. And what we've tried to do when we get to those issues is to open up the Scriptures together, to look at what they say, to recognize that there may be different viewpoints, to approach those disagreements charitably, and yet to try to wrestle together with how we ought to understand and interpret the Scriptures as we look at whatever the issue is.
And the reason I bring that up is because this week we're dealing with one of those subjects in this current series.
Dennis: That's right. We're dealing with the subject of contraception and really helping our listeners hammer out what they believe about the whole process of having children, the value of children, and how God wants them to enter into this process of decision-making about the number of children they should have.
Bob: It's certainly one of the first questions that every engaged couple or married couple has to make a decision about – are we going to do anything in the area of contraception? If we are, what's it going to be and are we comfortable with those decisions?
We've gotten enough mail and enough e-mails over the years with folks asking us for biblical guidance on the subject. We decided it would be good for us to create a resource in these broadcasts to help couples answer those questions for themselves.
Dennis: And to put together this series, we invited two physicians to join us – Dr. Bill Cutrer is a – well, he's a doctor who is also a seminary professor who is also a husband and a daddy. And, Bill, you've got a lot of titles and a lot of education, and we're counting on you to help steer us in the right direction. Welcome back to FamilyLife Today.
Bill: Thank you so much.
Dennis: Dr. Mark Povich joins us. He is a family doctor from the Upper Peninsula of Michigan, and anybody who has been up in that area knows they call it the "U.P." The U.P. where it's balmy – balmy this time of year. He and his wife have nine children and, as I mentioned, he is a family doctor.
And I'm going to start with you, Mark, because yesterday we touched on this subject just a bit. I asked you where you would start us if we were an engaged couple or a newly married couple coming to you for advice as a family physician, wanting your help in hammering out what they believe about the subject of contraception.
And yesterday, I think you kind of shocked all of our listeners by not beginning with the Bible. You started with biology, and you explained to that young couple the biology of cycles that the body goes through.
Mark: That's a good place to start, because unless you can understand what's happening with the body, you can't understand how decisions you make will impact and what moral implications they could have.
Bob: And you think most women – you said this yesterday, and I was a little surprised – most women, they know that they are going to menstruate semi-regularly, you know, every 28 days or thereabouts there is going to be some kind of a menstrual cycle. Is that as much as they understand about what's really going on in their body do you think?
Mark: Well, there's probably some people that are more educated on it, but for a lot of women there is not a good understanding of what's happening.
Dennis: Dr. Cutrer, you are nodding your head at this point. You practiced in the OB area for a number of years.
Bill: As an OB-GYN and the infertility specialty – that's exactly right. Some women are very educated and know how their cycles work and others, I'd say the majority, as Dr. Povich mentioned, probably are fairly vague.
Bob: All right, then, Dr. Povich, explain it to us what goes on in a woman's body? How does the cycle function? What happens from the start of the first period to the start of the second period?
Mark: A woman's cycle is dependent upon several parts. The brain has an important role in instructing the ovary what to do. The brain will send the ovary a signal, a little hormone through the blood, to tell it to start preparing an egg to be released. The hormone will come down to that ovary, the egg starts to mature, it enlarges in size. At the same time, you are seeing the uterus start to prepare for the possibility of a pregnancy, and it will go through a phase where also, under the regulation of hormones, become a fertile soil, so to speak, for this egg to implant, should it be fertilized.
Dennis: Mark, let me ask you a question about that – a woman has two ovaries. Does she release two eggs each month or is just one of those ovaries producing an egg for each of those months?
Mark: Generally, it's just one. Once in a while, you'll get two eggs released which, if both fertilized, could cause twins, but that's the exception rather than the rule.
Bob: And let me again see if I've got this straight in kind of non-medical terms – the ovaries are like the storage tank for all the eggs, right?
Mark: That's correct.
Bob: That's where they …
Dennis: Storage tank, Bob?
Bob: Okay, I'm trying – like I said, non-medical terms, help me here.
Dennis: How about it's a nest – they're a nest where the eggs are.
Bob: They're in the nest, and once a month one of those eggs is going to drop out of the nest and come down the Fallopian tube, come down the slide, into the uterus, is that where it comes?
Mark: Well, it depends. Now, if we're talking about a cycle where the woman has had intercourse, the couple has had intercourse at the right time, as that egg is coming down the Fallopian tube, sperm are swimming up to the egg, and fertilization occurs in the Fallopian tube.
Mark: So a fertilized egg will then come down the rest of the way in the tube.
Dennis: By comparison, there is one egg being released. During normal intercourse, how many sperm then would make their way upstream?
Mark: Well, there are millions of sperm released, and there's a competitive struggle to see which one is going to win the race and get there and how many actually make it up to the egg, I'm not sure.
Bob: Now, I've heard this is because men won't ask for directions, that's why there are a million.
Dennis: That redeems you from the storage tank, Bob.
Bob: If an egg is not fertilized in the Fallopian tube as it's coming down, then it comes into the uterus. The uterus has been prepared for a fertilized egg, but there is no fertilized egg there, and so that preparation, that lining of the uterus and the egg are what are flushed out during the menstrual cycle, is that right?
Mark: Yes, by that point the egg has dissolved, and the lining of the uterus, as you say, not being used for pregnancy, sloughs off, and the woman has her menses.
Bob: And if the egg has been fertilized, and it comes down, then it may or may not naturally implant in the uterine wall in what's been prepared there. If it does, then there is no menstrual cycle to slough off the discharge, but if it doesn't implant, the same thing will happen at that point? Will the menstrual cycle occur with a fertilized egg being flushed out?
Mark: If there is no implantation, the egg will not continue to develop, and the – normally, if there is implantation as that egg develops, it will give off hormones, which continue the nourishment from the uterus.
Bob: And in a normal cycle – let me see if I've got all of this straight – in a normal cycle, from the time a woman starts her period until the point that she releases an egg, that's about the first half of the cycle, is that right?
Bob: The first eight or nine days after you end your period is when the egg might start to drop down and, again, now we're talking in general terms. We don't women to start looking at the calendar and go, "I ended here. I'll be fertile in eight days," because we can't know that with any scientific" …
Mark: That's correct.
Bob: But halfway through the cycle, she releases the egg, and then this process of whether it implants or whether it's discharged is another 10- to 14-day day period, is that right?
Mark: If the egg were fertilized in the Fallopian tube, it's going to take five to seven days coming down that tube before it implants into the side of the uterus.
Bob: Dr. Cutrer, we touched on the fact that fertilization takes place five to seven days before implantation. An egg can be fertilized as it's coming down the Fallopian tubes. Five to seven days later is when it will attach itself to the uterine wall and begin to develop, and there is some theological, moral, and ethical debate that goes on even among conservative Christians, as to whether the fertilized egg in the Fallopian tube is a human life or whether it has to get to implantation to be a human life. Is that right?
Bill: You're correct, particularly in the Christian medical community, there is a difference of opinion. Some hold, as Dr. Povich and I do, that fertilization event is the origin of life. That's when you have all the genetic material you're ever going to have. From then on, it's a matter of growth and development.
Others hold that it's not until that embryo implants in the wall of the uterus, a term that in many medical textbooks is conception. We prefer to connect it with the fertilization event, but that is very important from the moral and ethical standpoint because if it's not a human life prior to implantation, then methods that interrupt that life are not abortifacient but are, in fact, a contraceptive device.
So sometimes we talk using the same language but meaning things that are very different. So it's important to get our terminology straight.
Dennis: Bill, at the point the sperm fertilizes the egg in the Fallopian tubes, it's a single cell. Not long after, however, it begins to divide. By the time it attaches itself to the uterine wall, potentially how many cells have multiplied from that single cell that was fertilized?
Bill: Oh, remarkably, by that time, most estimate that it's in the 150- to 200-cell stage, and in our current time debate about stem cell research and the destruction of embryos to harvest those stem cells, this is critical. Because if you don't believe that one cell is a human worthy of dignity and protection, then the embryo stem cell research makes perfect sense.
Mark: When I'm entering into discussion with people in regard to when does life begin, especially if they're coming at it from a Christian perspective, I can go back to when Jesus Christ was first within His mother's womb. God's spirit did not indwell in already-fertilized egg, and that was the point of His life – the Holy Spirit fertilized the egg of a virgin, and Christ began at that moment in time, not at a later time.
For us to accept the virgin birth, we can't have a father in the picture that could have fertilized an egg and subsequently would be indwelled by the Holy Spirit.
Bob: Yeah, the incarnation took place at that moment. Jesus began as a man at that moment that the Holy Spirit fertilized the virgin's egg.
Dennis: And there may be some who are listening who are going, "Now, why are you splitting hairs over this issue?" Well, you have to decide when life begins. If it's not at the point of the egg being fertilized, then when are you going to have life starting? Some, as you said, Dr. Cutrer, believe that it begins after the egg, the multiplied cells, that is, of the egg have attached themselves to the uterine wall. Other Christians have held, throughout the years, that the life begins when it takes its first breath.
Now, you've got to back up and decide because of what we know today. Now, 150 years ago, we wouldn't be having this discussion, because we didn't know, what, 5 percent of what we know now?
Bill: I would guess. I don't know. We know considerably more now than they had any inkling then.
Bob: And years ago we read talk or hear talk about "quickening" – the first movement of the baby. That was kind of considered the point – it wasn't that a woman had missed her menstrual cycle, and we said, "Oh, she's pregnant." There was no sense of her being pregnant necessarily until she felt the baby stir, right?
Bill: Correct. She was not declared to be pregnant, even though she had perhaps missed a period or two, until she could feel the baby move, which, for a first baby, would be about 20 weeks, about halfway through. For a woman having her second or third pregnancy, a few weeks earlier than that.
Bob: And I think I remember you talking about Thomas Aquinas, in the Middle Ages, holding that view that quickening was the origin of life. That's the point where God put the soul in the tissue, right?
Bill: Exactly. That's the information that he had.
Bob: And, again, I know it feels a little bit like we're splitting hairs, but the reason we're going through all of this is because couples have got do decide whether their conviction is that a human life begins at the moment that the egg and the seed join and a conception has taken place, or does it begin at implantation, five to seven days later when that embryo attaches itself to the uterine wall?
And if a couple asks a doctor today, where does life begin? What's an average OB going to tell them?
Mark: I think you're going to find an average OB is going to follow the definition of pregnancy that's been developed by the American College of Obstetrics and Gynecology, which I understand is that pregnancy starts at the time of implantation, and if a person would go to any of a number of medical websites available, they're going to find that definition pretty freely used as well.
So a definition that we, as Christians, would accept as life starting at the time of fertilization is …
Bob: That's a minority opinion today.
Mark: It is a minority opinion.
Bob: And even beyond that, some doctors who would say, "Pregnancy happens at the time of implantation," but they wouldn't go so far as to say a human exists at that point. They're still talking about embryos and about tissue and about fetuses rather than ever talking about babies, right?
Bill: Right. They call it "pre-embryo" so that they don't give the idea that it's actually human life.
Dennis: Okay, we've had a highly technical discussion here, and …
Bob: Now, wait, I called the ovary a storage tank. Do you think that's technical?
Dennis: We upgraded to a "nest."
Bob: That's right.
Dennis: But we really have talked about, very analytically, the whole cycle of how the egg is released, when it's fertilized, when it implants. But I'm thinking there is an engaged couple listening who are saying, "So what? How does this impact the selection of contraception methods that we choose?"
Bob: Yeah, they're saying, "I just want to decide if we want to have a baby this month or not, and I want something, that if I decide no, is going to keep it from happening, and I want something that if we decide yes, that it's going to be make it a possibility. And you guys are telling me I've got to think about a lot of stuff that I wasn't sure I wanted to think about." Dr. Cutrer, how do you answer them?
Bill: Well, you've complicated it a bit more by saying a "month-by-month event." But there are some types of birth control methods that would be problematic if you believe that life begins with fertilization. That would definitely take the IUD out as far as, in my opinion, and it might well take out the progesterone-only birth control pill.
Now, we haven't talked about those in detail but, basically, fertilization requires the sperm meeting the egg. So there are certain techniques that keep that from happening either by abstaining during that time or using some sort of barrier in between or some sort of chemical method. Those things, if the sperm does make it to the egg, the result is a pregnancy, not an abortion. So with the case that you presented, the very important issues that we discuss will determine which of those are reasonable for that couple that will fit with their ethical construct?
Bob: And, Dennis, we're going to spend some time over the next day or two walking through what's being used today and talk about what it does, what the side effects are and help folks wrestle through the ethical and moral and spiritual implications of those choices.
Dennis: And also help those who perhaps are beyond the childbearing years who have made choices and who are sitting there reflecting back on their choices thinking, "Wow, did I make some choices that – well, maybe they weren't the best or maybe they were, God forbid, wrong?"
We'll talk about that as well, and how we should process this. But, you know, I think the issue that we're talking about here is, especially for the Christian community, we've got to decide what we believe, and that doesn't mean the collective community is going to get together and vote. It means that as a man and a woman in marriage, or a single man and a single woman outside of marriage, you need to be grappling over these issues and coming to grips with where you stand on the word of God.
Bob: Well, and, hopefully, the discussion we're having this week is helping folks grapple and getting a copy of Dr. Cutrer's book, "The Contraception Guidebook," will help them grapple with this subject as well. We've got the book in our FamilyLife Resource Center, and it helps couples engage on this subject – to be able to have conversation and to be able to pray intelligently about what's right for them as they think about their family.
You can find information about Dr. Cutrer's book by going to our website, FamilyLife.com. On the right side of the home page, you'll see a box that says, "Today's Broadcast," and if you click on the "Learn More" button, it will take you to an area of the site where you'll find transcripts of our programs. You can listen to past editions of FamilyLife Today online, if you'd like. There's also information on how to order a copy of Bill Cutrer's book. There is a link there to the list that you shared with us earlier this week, Dennis, of things we need to keep in mind as we consider the choice we're going to make as a family in this area.
And there is a link to an article by our friend, Randy Alcorn, who has written on the subject of the birth control pill, and not all of our listeners are going to necessarily agree with the conclusions that Randy comes to in this article, but we think it's something you ought to read through and think about and consider as you wrestle with this issue.
So, again, go to our website, FamilyLife.com. On the right side of the screen where you see "Today's Broadcast," click the "Learn More" button, and you'll be where you need to be on the site. Or call 1-800-FLTODAY, that's 1-800-358-6329. 1-800-F-as-in-family, L-as-in-life, and then the word TODAY, and someone on our team can let you know how you can order a copy of "The Contraception Guidebook" from Bill Cutrer and Sandra Glahn, and we'll get that book sent to you as quickly as we can.
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All right, tomorrow we're going to start to look specific at methods of contraception, the pros and the cons. We'll talk about that with Dr. Bill Cutrer and Dr. Mark Povich. I hope you can join us as well.
I want to thank our engineer today, Keith Lynch, and our entire broadcast production team. On behalf of our host, Dennis Rainey, I'm Bob Lepine. We'll see you back tomorrow for another edition of FamilyLife Today.
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