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PubMedDate not supplied

Fertility awareness in the 1990s--the Billings Ovulation Method of natural family planning, its scientific basis, practical application and effectiveness.

Early methods of natural family planning (calendar rhythm, basal body temperature, and symptothermal) are briefly mentioned and dismissed as unsatisfactory for fertility regulation at our present state of knowledge of female reproductive physiology. Cervical mucus patterns, which reflect ovarian hormone levels, are shown to be accurate markers of the fertile and infertile phases of a woman's menstrual cycle. Interpretation of these patterns forms the basis of the Billings Ovulation Method of natural family planning. Extensive laboratory and clinical studies have shown this method to be on a sound scientific footing, that it is applicable to all phases of a woman's reproductive life, and that women readily understand and are able to teach other women the meaning of these patterns as experienced by changing sensations at the vulva and changing characteristics of any visible mucus. The simple rules which have been formulated for postponing and achieving pregnancy are given. Field trials of this non-invasive method for fertility regulation in both developing and developed countries show that the rules are readily understood by participants. In the most recent trials, it has been shown that the method-related pregnancy rate is less than 1 per 100 woman years, which compares more than favorably with other contraceptive techniques.

Australia↗
PubMed1989

Simple office methods to predict ovulation: the clinical usefulness of a new urine luteinizing hormone kit compared to basal body temperature, cervical mucus and ultrasound.

A new urine luteinizing hormone (LH) kit, First Response (Tambrands Inc., Palmer, MA) was compared with basal body temperature (BBT), cervical mucus scoring and abdominal ultrasound follicular scanning in their ability to predict ovulation to within 2 days of the serum LH peak. BBT was kept daily. From day 10 daily ultrasound scanning and cervical mucus examination were performed and serum oestradiol, luteinizing hormone, follicular stimulating hormone and progesterone were assayed. First Response was significantly more accurate than BBT and cervical mucus when compared in their ability to predict ovulation to within 2 days of the LH peak (p less than 0.05). First Response pinpointed 93% (27/29) of the ovulatory cycles compared to 72% (18/25) and 61% (19/31) for BBT and cervical mucus respectively. It was better but not significantly so against abdominal ultrasound which predicted 77% (24/31). The implications of this finding and the value of the other simple office tests in clinical practice are discussed.

Ambulatory Care↗
PubMed1998

Progesterone resistance in women who have had breast cancer.

OBJECTIVE: To investigate whether certain physiological responses to luteal progesterone are normal in women previously treated for breast cancer. DESIGN: Salivary progesterone concentrations, basal body temperatures, and breast blood flow changes (surface temperature method) were all recorded daily for one natural menstrual cycle. SETTING: Participants in the study made saliva collections and temperature measurements at home under semi-standardised conditions with supervisory visits by a project nurse. PARTICIPANTS: Twenty-five controls were compared with 30 women with previous breast cancer; all but three participants were parous and the average ages were 39 years (range 28-48) and 40 years (range 29-46), respectively. On average the women with previous breast cancer had had surgery 2.4 years previously; the operation was usually mastectomy, leaving the contralateral breast for study. RESULTS: Follicular phase (day 1-14) oral temperature averages were statistically indistinguishable between women in the control group and those with previous breast cancer. Luteal progesterone profiles were considered in the normal range for the controls and patients. However, the women with previous breast cancer, on average, exhibited a significantly smaller rise in the luteal phase basal body temperature. Follicular phase breast surface temperature was significantly higher in the breast cancer group (+0.30 degree C). This group showed a highly significant reduction of the luteal heat cycle in their breasts. CONCLUSIONS: Two progesterone-mediated physiological mechanisms have been found to be significantly less responsive in women with previous breast cancer than controls. The literature has been reviewed. Progesterone resistance could be a clinical entity and could be important in carcinogenesis.

Adult↗
PubMed1991

Evaluation of the luteal phase.

The values of various methods used to evaluate the luteal phase, including basal body temperature, measurement of progesterone (P), endometrial biopsy, ultrasonographic measurement of endometrial thickness, and measurement of endometrial proteins, are reviewed. Luteal phase defect (LPD) is a controversial entity. The diagnosis of this condition is best based on a histological study of the endometrium. Methods to improve the accuracy of the diagnosis are discussed. LPD is more likely to be a result of an abnormal response of the endometrium to P, than to a subnormal production of P by the corpus luteum. Many methods of treatment for LPD have been proposed but none is based on a properly controlled clinical trial. Treatment designed to improve the response of the endometrium to P may be more rewarding than P supplementation.

Biopsy↗
PubMed1994

Natural family planning.

Natural family planning (NFP) methods can be effective if taught well and practised by well-motivated couples. Midwives should be able to give couples an understanding of the basic principles of the methods. The observable signs of the fertile cycle are changes in basal body temperature, in the consistency of cervical mucus and in the texture and position of the cervix. Practised properly the ovulation method can have a failure rate of as little as 2.2 pregnancies per 100 woman-years. The ovulation method is a suitable method for mothers who have breastfed to detect the onset of ovulation.

Family Planning Services↗
PubMed2005

Fertility awareness-based methods for contraception: systematic review of randomized controlled trials.

CONTEXT: Fertility awareness-based (FAB) methods of family planning estimate the fertile days of the menstrual cycle whether by observing fertility signs such as cervical secretions and basal body temperature or by monitoring cycle days. The efficacy and acceptability of these methods are unclear. METHODS: We retrieved and analyzed all randomized controlled trials that examined any FAB method used for contraception. RESULTS: Because of poor methods and reporting, pregnancy rates could not be determined. A trial in Colombia found similar numbers of pregnancies among women randomized to the ovulation and symptothermal methods, but a trial in Los Angeles observed more pregnancies in the group assigned to the ovulation method. In the two American trials, recruitment of participants was unexpectedly difficult. Continuation rates were poor. CONCLUSION: Despite intensive training and ongoing support, most participants in these trials discontinued prematurely. The comparative efficacy of these methods remains unknown. However, with the ovulation and symptothermal methods, pregnancies appear to be common; method continuation rates are low.

Awareness↗
PubMed2001

Reliability of ovulation tests in infertile women.

OBJECTIVE: To assess the reliability of the most widely used clinical methods for predicting or confirming ovulation. METHODS: We monitored spontaneous cycles in 101 infertile women using basal body temperature (BBT), transvaginal ultrasound, a urinary stick system for LH surge, and three serum progesterone measurements in the midluteal phase. Transvaginal ultrasound monitoring was standard for ovulation detection and sensitivity. We calculated specificity and accuracy of each method compared with that standard. RESULTS: Follicular development and ultrasound evidence of ovulation were confirmed in 97 of 101 cycles (96%). Urinary LH surge preceded follicular rupture assessed by ultrasonography in all cycles and showed concordance with ultrasound-evidenced ovulation in 98 of 101 cases. The timing of BBT nadir had wide variability, and BBT and ultrasonography agreed in a similar percentage of cases (74%). Midluteal serum progesterone assessments showed ovulatory values in 93 subjects, and ovulation was concordant with ultrasonography in 90 subjects. CONCLUSION: Urinary LH was accurate in predicting ovulation with ultrasonography as the standard for detection, but time varied widely. The nadir of BBT predicted ovulation poorly. The BBT chart was less accurate for confirming ovulation, whereas a single serum progesterone assessment in midluteal phase seemed as effective as repeated serum progesterone measures.

Adolescent↗
PubMed2000

Mechanism for the development of ovarian cysts in patients with congenital lipoid adrenal hyperplasia.

OBJECTIVE: Although ovarian cysts commonly occur in patients with congenital lipoid adrenal hyperplasia (CLAH), the mechanism of development remains to be determined. To clarify the pathogenesis of the ovarian cysts, endocrinological examinations were performed in patients with CLAH. METHODS: The subjects were three Japanese CLAH patients. Basal body temperature, serum and urinary gonadotropin levels, serum and/or urinary ovarian hormones and mutations of the steroidogenic acute regulatory protein (StAR) gene were examined. RESULTS: The basal body temperature was not biphasic in any patient. Basal LH levels were high in all CLAH patients and markedly responded to LH-releasing hormone in two patients. Urinary gonadotropin analysis revealed repetitive LH surges in the menstrual cycles of the CLAH patients. No increase in the urinary pregnanediol suggested anovulation in all patients, and bilateral ovarian cysts were found in two of the subjects. Examination of the StAR gene revealed a frameshift mutation 840delA at codon 238, a nonsense mutation Q258X at codon 258, a homozygotic mutation at Q258X, and a compound heterozygotic mutation with 251insG and Q258X. CONCLUSIONS: We concluded that the development of ovarian cysts may be derived from continued anovulation in CLAH patients. Elevated LH levels may be explained by increased sensitivity of the anterior pituitary to circulating estrogen.

Adolescent↗
PubMed1990

Evaluation of the accuracy of the home ovulation detection kit, Clearplan, at predicting ovulation.

A home ovulation testing kit, Clearplan, that detects the urinary luteinizing hormone (LH) surge was compared with basal body temperature (BBT) charts and cervical scoring as a method of ovulation prediction in 54 consecutive patients. The accuracy of all these methods was evaluated using daily serum LH measurements. Clearplan was shown to be significantly more accurate at timing ovulation than were BBT charts (P less than 0.0001) and cervical scoring (P less than 0.025). In 82%-88% of cases the kit predicted ovulation within one day and in 89%-96% of cases within two days of the serum LH surge. The kits were found to be easy to use and their potential place in clinical practice is discussed; home ovulation testing may ultimately replace serum LH assays as the method of choice in timing ovulation.

Body Temperature↗
PubMed1996

The association between basal body temperature, plasma progesterone and the oestrous cycle in a marsupial, the Tasmanian bettong (Bettongia gaimardi).

Basal body temperature, quantitative changes in vaginal smears and plasma concentrations of progesterone were measured during a number of oestrous cycles in Tasmanian bettongs (Bettongia gaimardi). These methods of monitoring the reproductive cycle were compared in an attempt to find a technique that allowed non-stressful assessment of the reproductive condition of the bettongs. Telemetric measurement of basal body temperature showed that there was a diurnal variation of 1.3 degrees C, typical of a nocturnal animal. During the oestrous cycle, there was a small, but not significant, peak in basal body temperature at oestrus (day 0) followed by a significant trough on day 2. There was a significant increase on day 3 and the temperature remained raised until day 10, during which time plasma progesterone concentrations are also high; the temperature then fell 2 days before oestrus. This fall corresponds to a decrease in concentration of plasma progesterone and in the numbers of leucocytes in vaginal smears. Telemetric measurement of body temperature may be useful as a non-stressful method of monitoring the oestrous cycle in bettongs.

Animals↗
PubMed1998

[The effect of various methods of luteal phase supplementation on serum progesterone level].

OBJECTIVES: Examined was the effect of luteal phase supplementation on serum progesterone level with the use of two methods: oral administration of 10 mg dydrogesterone twice daily since the detection of corpus luteum till the menstruation and intramuscular HCG administration in the dose 1500 IU every 4 days and 10 mg dydrogesterone twice daily in the same period. DESIGN: A randomized study, controlled by placebo. PATIENTS AND METHODS: 56 infertile women, with luteal phase deficiency assessed on the basis of basal body temperature (decrease shortly after the peak the luteal phase shorter than 11 days) and ovulation determined sonographically. Progesterone was evaluated by an EIA method, on the 3rd, 7th and 11th day since the corpus luteum occurred. RESULTS: The peak of progesterone concentration was assessed in the midluteal phase (7th day) in both supplemented groups, significantly higher than in the placebo group, also in group with dydrogesterone and HCG it was higher than in group with dydrogesterone alone. Progesterone concentration decrease on the 11th day after the ovulation to the values comparable with the placebo group. CONCLUSION: It has been found that both methods increase serum progesterone level in the time of an assumed implantation but they do not affect the premenstrual period if conception is not achieved.

Adult↗
PubMed1992

A prospective study of the menstrual cycle and spinal cord injury.

Sixty seven menstrual cycles were studied prospectively in a nonclinical sample of 20 women who had suffered a traumatic spinal cord injury (quadriplegia n = 13; paraplegia n = 7) at least 1 yr before assessment. Level of injury did not influence cycle length (mean +/- SE = 28.7 +/- 3 days), duration of menses (4.6 +/- 1 days) or serum concentrations of gonadotropins and ovarian hormones. Midluteal phase serum progesterone values were consistent with ovulation (progesterone = greater than 5 ng/ml) in 93% of the cycles in which endocrine measures were obtained; but the ability of basal body temperature pattern to predict serum progesterone was low (43%). Cyclic dysmenorrhea was reported by 13 women with injuries ranging from C5 to T12. These findings suggest that ovulatory menstrual cycles are common in women after traumatic spinal cord injury and support the need for contraception by those wishing to avoid pregnancy. Basal body temperature charts revealed potential problems in applying the symptothermal method of natural family planning to a population of women at risk for oral contraceptives.

Adult↗
PubMed1997

Evaluation of luteal phase in normal and infertile women.

Evaluation of luteal phase function is an important part of fertility evaluation in the female. Among fifty clinically identified patients with primary infertility certain well-established laboratory methods were used to identify the luteal phase defect. These methods included serum progesterone assays, endometrial biopsy, vaginal cytology, basal body temperatures and cervical mucus scoring, with appropriate controls. Based on both endometrial biopsy which was two or more days out of phase and the serum progesterone level of less than 2.5 ng/ml, luteal phase defect was found in five patients among the 50 patients (10 percent). It was found that an endometrial biopsy which was well dated showed a definite correlation with the progesterone assays and could be considered as the most easily performed and reliable indicator, useful in detecting a luteal phase defect.

Adult↗
PubMed1987

Ultrasonic visualization of the endometrial cycle.

The dynamic morphological aspects of the uterine mucosa during the various phases of the endometrial cycle were examined, by using ultrasonographic methods, in 148 patients having regular menstrual cycles and a biphasic basal body temperature. During the proliferative phase, ultrasonographic examinations permitted a visualization of the mucosa in 33%-45% of the cases, respectively in the initial and in the later part of the phase. During the secretory phase, the endometrium was identifiable in 81.4% (initial part) to 90% of the cases (later part of phase). During the menstrual phase, on the other hand, the median echo of the endometrial cavity could never be clearly identified.

Endometrium↗
PubMed2006

Fructose administration increases intraoperative core temperature by augmenting both metabolic rate and the vasoconstriction threshold.

BACKGROUND: The authors tested the hypothesis that intravenous fructose ameliorates intraoperative hypothermia both by increasing metabolic rate and the vasoconstriction threshold (triggering core temperature). METHODS: Forty patients scheduled to undergo open abdominal surgery were divided into two equal groups and randomly assigned to intravenous fructose infusion (0.5 g . kg(-1) . h(-1) for 4 h, starting 3 h before induction of anesthesia and continuing for 4 h) or an equal volume of saline. Each treatment group was subdivided: Esophageal core temperature, thermoregulatory vasoconstriction, and plasma concentrations were determined in half, and oxygen consumption was determined in the remainder. Patients were monitored for 3 h after induction of anesthesia. RESULTS: Patient characteristics, anesthetic management, and circulatory data were similar in the four groups. Mean final core temperature (3 h after induction of anesthesia) was 35.7 degrees +/- 0.4 degrees C (mean +/- SD) in the fructose group and 35.1 degrees +/- 0.4 degrees C in the saline group (P = 0.001). The vasoconstriction threshold was greater in the fructose group (36.2 degrees +/- 0.3 degrees C) than in the saline group (35.6 degrees +/- 0.3 degrees C; P < 0.001). Oxygen consumption immediately before anesthesia induction in the fructose group (214 +/- 18 ml/min) was significantly greater than in the saline group (181 +/- 8 ml/min; P < 0.001). Oxygen consumption was 4.0 l greater in the fructose patients during 3 h of anesthesia; the predicted difference in mean body temperature based only on the difference in metabolic rates was thus only 0.4 degrees C. Epinephrine, norepinephrine, and angiotensin II concentrations and plasma renin activity were similar in each treatment group. CONCLUSIONS: Preoperative fructose infusion helped to maintain normothermia by augmenting both metabolic heat production and increasing the vasoconstriction threshold.

Adult↗