Billings Ovulation Method® and Achieving Pregnancy
In many centres around the world where the Billings Ovulation Method® is taught, a majority of the couples presenting for instruction come for assistance in achieving a pregnancy. This was not so much the case in the past and is perhaps a measure of the rising infertility in the community, but also a recognition that natural methods of regulating fertility can be of great assistance in this regard.
It is estimated that approximately 20 per cent of couples trying to have a child are unable to do so. Yet most couples are unprepared for infertility and unaware that in many cases it can be overcome naturally by recourse to the time of optimum fertility in the cycle. Infertility is usually defined as the inability to conceive after twelve to eighteen months of sexual intercourse without contraception.
Apparent infertility may be caused by physical and/or psychological factors. Some of the contributing physical factors could be the age of the couple, particularly of the woman, whether either of them smokes tobacco or marijuana, if the woman is under or over weight, previous contraceptive use, illness, infection and damage to the reproductive organs. Some of the psychological factors may include stress perhaps from overwork, anxiety about money or other problems, or tension, fear or guilt – perhaps the couple blaming one another for the inability to conceive. Over-rigorous athletic training can inhibit ovulation temporarily. Menstruation may stop, but will return when ovulation returns due to resumption of normal exercise program.
The possibility of physical causes may be revealed by taking a good history at the initial instruction, or in the chart which the woman subsequently produces. When such problems are suspected, the Billings Ovulation Method® teacher should refer for medical investigation to assess and if possible treat the causes. A good teacher will also become aware of the possibility of psychological factors in the course of teaching the couple. These may be alleviated by offering the time, support and practical advice to deal with everyday problems, such as the suggestion that if possible the couple take a holiday to alleviate stress and give them time together away from their usual busy routine. However the couple should be referred for professional help where appropriate.
The importance of correct information
The first and most important step should be to teach the woman to chart the daily discharges felt and seen at the vulva. Understanding the signs of fertility – recognition of slippery mucus at the vulva, however minimal – will enable the couple to time intercourse to coincide with the most fertile part of the woman’s cycle. The chart will give the necessary information to help the couple identify Peak fertility. Fertility is characterised by the Peak followed by a normal length luteal phase. The hormonal pattern is reflected in the chart; if there has been damage to fertility, the chart monitors the woman’s return to fertility. Conception then follows on or near the Peak.
Some women may have mucus on only one or very few days in the cycle and in some cases even this limited discharge will be unsuitable for sustaining the sperm so that they can reach and fertilize the ovum, despite hormonal studies revealing that ovulation is occurring normally. This is particularly the case when the woman has previously taken chemical contraception which has a 3-fold damaging effect on her reproductive system: it damages the hormonal system, which produces a sterlizing effect; it alters the mucus – contraceptive effect; it prevents implanatation – abortifacient effect. However, given time and patience and provided age is not also a factor, the normal functioning of the cervix, endometrium and endocrine system are likely to recover and the woman will recognise even limited fertility and the couple be able to time intercourse appropriately to conceive.
The support of a good teacher will be invaluable during what may seem to the couple to be a very long time of waiting even up to two years or more. In a society which expects instant gratification of ones wishes the tendency may be to want to “take something to improve the mucus”. However the woman should be reassured that good nutrition, adequate rest, regular (not strenuous) exercise and a positive, relaxed attitude are the best means of allowing nature to rectify the damaged fertility. Medicating the woman with oestrogens may produce “wet mucus” with no fertility benefit and may add further sterilizing damage.
Medical investigations, which may be undertaken to determine the cause of apparent infertility, may include: For the woman – blood tests to determine circulating levels of oestrogen, progesterone, prolactin and testosterone, glucose tolerance and insulin resistance; ultrasonography, hysterosalpingogram (to test tubal patency) and laparoscopic investigation. For the man an analysis of seminal fluid may be ordered, though a masturbated specimen will be morally unacceptable to many couples and of less use than a Huhner’s Test which assesses the viability of sperm in the woman’s mucus from a sample of mucus taken from the cervix close to the Peak time.
For some couples the cause of their inability to conceive will not be found. They may be referred by their doctor to seek the help of assisted reproductive technology or invitro fertilization procedures. In a recent study of 358 couples who presented to Billings Ovulation Method® teaching centres in Australia for help with achieving pregnancy a pregnancy rate of 78% was achieved, including a success rate of 35% for couples who had previously failed with IVF or ART. More than half of the women who participated in the study had previously been declared as sub-fertile (unable to conceive for more than 12 months) and in women over 38 years of age the success rate was 66%. Ninety-five percent of those involved in the study said that the Billings Ovulation Method® gave them an understanding of fertility and infertility and 93% said they would recommend the Method to others.
Guidelines for Achieving Pregnancy using the Billings Ovulation Method®
The couple should be given an initial instruction and a good history taken. They should then be asked to commence charting whilst abstaining from intercourse, however if the woman recognises signs of fertility during the first cycle of charting – slipperiness and/or softness and swelling of the vulva – the couple should be advised to have intercourse as it may be that such symptoms are only occasionally observed. They should be asked to return for follow-up interviews at regular intervals.
At the first follow-up appointment, once the Basic Infertile Pattern can be identified, the couple should be encouraged to express their love for one another by having intercourse following the Early Day Rules (see Bulletin of Ovulation Method Research & Reference Centre of Australia No. 35, Vol 2, p 23). Prolonged abstinence, while waiting for fertility when hoping to achieve pregnancy, is counter-productive and detrimental to the relationship.
Once a change from the Basic Infertile Pattern is noticed the couple should wait until the slippery sensation develops. These few days of waiting will ensure sperm numbers are at optimum levels and will enable the women to be aware of the developing pattern of fertility without her being confused by the presence of seminal fluid. Intercourse over the days of the slippery sensation and for the first couple of days after the Peak will give the best opportunity for conception to occur.
For women who have difficulty recognising the slippery sensation the swollen vulva sign will be of assistance. For women who have previously been diagnosed with tubal damage on one side, the Lymph Node Sign, as described by Professor Odeblad, will be invaluable. Around the time of ovulation a lymph gland in the groin on the same side as the ovulating ovary enlarges to about the size of a pea and becomes tender when pressed. Daily examination of this gland will reveal the increase in size and tenderness. This is best done lying down with hands on lower abdomen and fingers straight and pointing down the leg, so that the middle finger can feel the pulsating artery to the leg. The index finger will then be over the gland which is indicating the side of ovulation. Intercourse can then be planned to avoid the damaged tube.
Above all a confident and relaxed teacher will engender a patient and relaxed couple who, with a sound understanding of fertility, will be able to maximize their chances of welcoming a baby into their family.
This article is an extract from Billings Atlas of the Ovulation Method: the mucus patterns of fertility and infertility by Evelyn L Billings, John J Billings and Maurice Catarinich, Fifth Edition 1989, pp 51-55. It has been revised by Dr E L Billings 2009.