Frank-Herrmann, P., Freundl, G., Stanford, J. B., & Mikolajczyk, R. T. (2004). More than one fertile ovulation per cycle? Fertility and Sterility, 81(3), 728-729. https://doi.org/10.1016/j.fertnstert.2003.11.016
Frank-Herrmann P, Freundl G, Stanford JB, Mikolajczyk RT. More than one fertile ovulation per cycle? Fertil Steril. 2004;81(3):728-729. doi:10.1016/j.fertnstert.2003.11.016
Frank-Herrmann, P., et al. "More than one fertile ovulation per cycle?" Fertility and Sterility, vol. 81, no. 3, 2004, pp. 728-729.
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Department of Gynaecological Endocrinology and Fertility Disorders, University of Heidelberg, Vossstrasse 9, 69115 Heidelberg, Germany. petra.frank-herrmann@med.uni-heidelberg.de038t36y30
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RRM Academy Synopsis
Second ovulation in natural cycles has no clinical role, data suggest
Four physicians write in a letter to the editor that the bulk of evidence suggests a second ovulation plays no clinical role in natural cycles. No pregnancy occurred with luteal-phase intercourse in more than 30,000 natural family planning cycles at a Duesseldorf research center. The letter answers a 2003 study of follicle growth.
Key Findings
Among more than 30,000 cycles of modern natural family planning users at the Duesseldorf research center, no pregnancy occurred when intercourse took place during the luteal phase.
In those cycles, the luteal phase was diagnosed by elevated basal body temperature together with evaluation of cervical mucus.
Effectiveness studies of the symptothermal method place the probability of pregnancy at far less than 0.1% per cycle when intercourse occurs outside the fertile window.
Across 1,681 cycles of the standardized mucus-only Creighton Model System, no evidence of conception appeared outside the fertile window of 6 days before to 4 days after the mucus peak day.
The authors consider delayed ovulation, which is relatively frequent, a much more plausible explanation than an additional ovulation for anecdotal reports of unplanned late pregnancies during calendar method use.
Interpretation
The letter comments on a 2003 report of extra waves of follicle growth. It draws on pregnancy outcomes from people who practice natural family planning. The Duesseldorf group and the symptothermal method studies classified each cycle by basal body temperature and cervical mucus, while the Creighton Model System analysis used mucus alone. The authors note that each cited paper refers to many older studies with similar findings.
RRM Context
Restorative reproductive medicine is cycle-charting informed. Clinicians read basal body temperature and cervical mucus as signs of the ovulatory event. The symptothermal method and the Creighton Model System, both named in the letter, are charting methods that find the fertile window from the body's own signs.
Our editorial summary of this paper, not the article's abstract.
Abstract
Baerwald et al. (1) proposed a new model for ovarian follicular development in the human menstrual cycle. They showed additional waves of follicular development in the follicular and luteal phase of normal ovulatory cycles. Although no additional ovulation was observed, the authors speculated that the anovulatory follicles from the additional waves of follicular development may be able to ovulate in the presence of an additional LH surge.
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