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Volumetric vaginal aspirator may aid in natural family planning.

All natural family planning (NFP) methods are based on the determitnation of a woman's fertile period so that a couple may abstain from sexual relations or use a mechanical means of birth control during that time. Researchers are seeking more accurate methods of predicting the onset of ovulation in order to increase the effectiveness of NFP. A new device developed by Dr. Gebhard F.B. Schumacher, a fertility specialist at the University of Chicago who serves on FHI's Technical Advisory Committee, and Dr. Stepen J. Usala, a former medical student at the University's Pritzker School of Medicine, holds the promise of providing a new, cheap, and relatively simple way of predicting ovulation. Called a volumetric vaginal aspirator, the instrument allows women to measure their own vaginal fluid on a daily basis. In early studies of 7 women carefully studied over 18 menstrual cycles, a striking 3 fold to 30-fold increase in the volume of vaginal fluid occurred a few days before ovulation. Results from 12 more women for a total of 26 cycles confirmed the earlier studies. Blood samples were taken in order to measure the levels of estrogen, known to increase prior to ovulation, and luteinizing hormone, which peaks sharply on the day of ovulation, in the women studied. These confirmed that ovulation typically had occurred after the fluid volume increase. In addition, participants recorded their basal body temperature (BBT) upon awakening. Although the BBT does not predict ovulation, it frequently increases by 1/2-1 degree Fahrenheit after ovulation thus serving as an indicator of the end of the fertile period. The prototype of the vaginal aspirator is a disposable plastic syring marked at .05 milliliter intervals so that fluid levels can be easily measured. After the manufacturing process for the aspirator is perfected so that the instrument can be mass produced, Dr. Schumacher hopes that largescale clinical trials will be initiated in the US and abroad. The larger studies and an endocrine study are needed in order for effective rules to be developed for applying the method in either birth control or fertility enhancement. The vaginal aspirator could be useful not only for preventing unplanned pregnancy but also for aiding couples experiencing infertility to pinpoint the time that conception is most likely to occur. As an aid in birth control, the aspirator should have a success rate similar to or better than that of a diaphragm, Dr. Schumacher believes. Although the women testing the vaginal aspirator were ablet to use it without assistance, Dr. Schumacer emphasizes that some patient education will be necessary if it becomes commercially available. Fertility awareness teachers could incorporate it into their courses. Research on the volumetric vaginal aspirator has been supported by FHI and by Mothers' Aid Research Fund of Chicago Lying-In Hospital.

Clinical Laboratory Techniques↗

The behavior of Italian family physicians regarding the health problems of women and, in particular, family planning (both contraception and NFP).

The hospital-centered trend that has dominated medical culture and the management of health care during this entire century has, in the last few years, undergone a reversal in Italy. Conditions in other countries suggest that similar changes have or will become increasingly common. The family physician today manages many of the functions previously handled by hospitals and specialists. In the field of reproductive health, family physicians are responsible not only for diagnosis and treatment, but also for prevention and education. The present study considers this new context with the objective of investigating the knowledge and behavior of Italian family physicians in the field of women's health, with particular regard to family planning (including natural family planning), through (1) a qualitative study (focus groups) of a small group of family physicians and (2) a questionnaire sent to 500 family physicians throughout Italy. The results of the focus group are summarized in the form of obstacles that the family physician finds in providing family planning services and proposals for change. The results indicate that because of their holistic approach, the family physician is an appropriate provider of family planning services although continued use of specialists' services, changes in logistics of the family physicians' practice, increased gender sensitivity, and additional training and information are necessary. The results of the questionnaire (121 responses, 24.2%) indicate that the Italian family physician currently lacks certain important information about family planning and would require logistical support to provide these services but is interested in acquiring information and is an appropriate family planning provider. An additional challenge for encouraging family practitioners to provide natural methods is that they favor a "medical" approach rather than a "behavioral" one in their treatment preferences for several other conditions.

Contraception↗

Mucus observations in the fertile window: a better predictor of conception than timing of intercourse.

BACKGROUND: Intercourse results in a pregnancy essentially only if it occurs during the 6-day fertile interval ending on the day of ovulation. The strong association between timing of intercourse within this interval and the probability of conception typically is attributed to limited sperm and egg life times. METHODS: A total of 782 women recruited from natural family planning centres in Europe contributed prospective data on 7288 menstrual cycles. Daily records of intercourse, basal body temperature and vaginal discharge of cervical mucus were collected. Probabilities of conception were estimated according to the timing of intercourse relative to ovulation and a 1-4 score of mucus quality. RESULTS: There was a strong increasing trend in the day-specific probabilities of pregnancy with increases in the mucus score. Adjusting for the mucus score, the day-specific probabilities had limited variability across the fertile interval. CONCLUSIONS: Changes in mucus quality across the fertile interval predict the observed pattern in the day-specific probabilities of conception. To maximize the likelihood of conception, intercourse should occur on days with optimal mucus quality, as observed in vaginal discharge, regardless of the exact timing relative to ovulation.

Adult↗

Salivary ferning and the menstrual cycle in women.

The Authors report the data relative to the monitoring of menstrual cycle carried out by the observation of salivary ferning. They compared the usual physical and hormonal parameters of four groups of women with the aspect of the crystallisation of the saliva observed both by normal optical microscope and by a special type of pocket microscope which can be used by women themselves. In conclusion the Authors report a careful examination of the biochemical correlation relating the women's hormonal climate and its salivary constituents.

Adolescent↗

Service provider attitudes toward natural family planning.

"Our study...addresses the issue of availability of NFP [natural family planning] within the established family planning provider setting--clinics and private practice.... The data for this study were gathered by means of questionnaires administered by mail to clinic administrators and service providers, OB/GYN physicians in private practice, and NFP-only providers...in Los Angeles and San Diego Counties in California.... The principal analytical goal in this research is to determine the effect that service provider attitudes may have on the availability of NFP....Our research has indicated that the single most identifiable barrier to the availability of NFP is the negative attitude of physicians toward the method, prompted by their skepticism about its use-effectiveness."

Americas↗

RHYTHM METHOD.

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Family Planning Services↗