Fertility Awareness Biomarkers

Natural family planning

Brown JB, Blackwell LF, Billings JJ, Conway B, Cox RI, Garrett G, Holmes J, Smith MA

Published October 1987 American Journal of Obstetrics and Gynecology, 157(4 Pt 2), 1082-1089
DOI 10.1016/s0002-9378(87)80137-0 PMID 3314524

RRM Academy Synopsis

Cervical mucus and urinary hormones can help mark the fertile days

A 1987 review of natural family planning reports that a woman can conceive on only about 7 days of each menstrual cycle. Mucus symptoms and urinary hormone measurements can help locate those days. The review summarizes a World Health Organization trial and describes home enzyme immunoassays.

Key Findings

  • In 78% of cycles (n = 179), the mucus peak day fell within ± 1 day of ovulation, as tested by laboratory hormone analyses.
  • In the World Health Organization trial of the ovulation method, 93% of women could be taught to recognize and record their symptoms within three cycles (884 couples in the teaching phase).
  • The application phase included 725 couples for 7514 cycles. Per 100 woman-years, pregnancy rates were 15% from conscious departure from the rules, 3.5% from inaccurate application, and 3.0% from method failure.
  • Using the pregnanediol eye test at home, 32 women obtained one additional safe day compared with mucus symptoms, and none conceived under the resumption rule.
  • The wet chemistry pregnanediol immunoassay correlated with the gas-liquid chromatography reference method (r = 0.96, n = 65) and had been used routinely for 3 years.

Interpretation

The paper pairs a review of symptom-based natural family planning methods with a report on developing home enzyme immunoassays for urinary hormones. The World Health Organization trial drew couples from five countries. The home eye test involved 32 women who found symptoms hard to recognize or required absolute contraception for medical reasons. The authors state that contraceptive efficacy depends on how couples apply the information the method gives. The authors note that the home pregnanediol meter test had been tested only in the laboratory. They state that applying the assays to large populations of women practicing natural family planning will greatly increase knowledge of human reproduction.

RRM Context

The ovulation method (Billings) relies on daily observation of cervical mucus. Creighton Model FertilityCare and NaProTechnology chart the same signs. Restorative reproductive medicine reads a charted cycle as information about ovulation. Evaluation can then come before treatment, and both partners share one record.

Abstract

It is now well accepted that a woman can conceive from an act of intercourse for a maximum of only about 7 days of her menstrual cycle. The reliability of natural family planning depends on identifying this window of fertility without ambiguity. Several symptomatic markers, cervical mucus and basal body temperature, have been used extensively and with considerable success in most women but failures occur. Ovarian and pituitary hormone production show characteristic patterns during the cycle. Urinary estrogen and pregnanediol measurements yield reliable information concerning the beginning, peak, and end of the fertile period, provided that the assays are accurate and performed on timed specimens of urine. We have developed such enzyme immunoassays for urinary estrogen and pregnanediol glucuronides that can be performed at home. In the early versions of the assays, enzyme reaction rates were measured by eye, but more recently, a simple photoelectronic rate meter has been used. The final problem to be solved is not technologic but whether women are sufficiently motivated to expend the same time and effort each day for 10 days a month, with less cost, on fertility awareness as they spend on making a cup of tea.

Topics

By this author

Related research

Fertility Awareness › Biomarkers › Urinary Hormone Monitoring · Menstrual Cycle › Cycle Biomarkers › Hormonal Markers · Reproductive Endocrinology › Ovarian Hormones › Estrogen
Leonard F Blackwell
L Blackwell
PMID 3314524 3314524 DOI 10.1016/s0002-9378(87)80137-0 10.1016/s0002-9378(87)80137-0 Brown et al. 1987, Brown 1987