22 physician-providers who serve natural family planning (NFP) programs, mostly in the private sector, gathered to formulate a standard terminology for the field. The Billings and sympto-thermal methods are the 2 methods taught by this group. The sypto-thermal method helps a woman predict ovulation by detecting changes in her cervical mucus and in the cervix itself. Ovulation is confirmed by monitoring the temperature shift as well as by observing the cessation of mucus buildup, closing of the cervix, and firmness of the os. Those women using the Billings ovulation method predict fertility by the appearance of the cervical mucus, its sensation, color, and elasticity. Sperm will only survive if the cervical mucus is of the fertile type. It is also helpful to recognize mucus patterns of anovulation during breastfeeding, weaning, and premenopause. Use-effective rates which only reflect pregnancy are inadequate in evaluating NFP. A series of definitions are presented which in the future will help to analyze NFP data to accurately reflect NFP effectiveness. The terms included are: total pregnancies, planned pregnancy rate, pregnancy avoidance, method effectiveness rate, method-related pregnancies, informed choice pregnancies, teaching-related pregnancies, and unresolved pregnancies. All NPF teaching programs include instruction in basic reproductive physiology and in the recognition of the fertile phase. The cervical mucus factor is emphasized in ovulation method groups while thermal and other parameters are given equal weight in the sympto-thermal groups. It is the intent of NPF to teach couples to distinguish the fertile phase by using the fertility markers and to have them integrate this information into their sexual decision making. Success is dependent on teacher skill and the ability to inspire confidence in the method. Recognition of the mucus patterns of ovulation and anovulation are crucial in assessing infertility. All family providers under Title 10 must by law offer either NFP instruction or referrals to sites which do. A directory of non-Title 10 providers of NFP Services is available for $4.00 from the Human Life and NFP Foundation, 205 South Patrick Street, Alexandria, Virginia, 22314.
natural family planning standard terminology definitions, NFP core curricula physician provider education, Billings sympto-thermal method terminology standardization, NFP effectiveness rate method-related pregnancy definitions, Klaus Brennan natural family planning terminology 1982, cervical mucus fertility marker NFP teaching programs, natural family planning use-effectiveness pregnancy rate definition, NFP anovulation breastfeeding premenopause mucus patterns, sympto-thermal method cervical mucus temperature shift, Title 10 natural family planning provider requirements, fertility awareness method standardized outcome measures
PMID 7095160 7095160 DOI 10.1016/s0015-0282(16)46409-5 10.1016/s0015-0282(16)46409-5 Brennan et al. 1982, Brennan 1982
Cite this article
Brennan, J. J., & Klaus, H. (1982). Terminology and core curricula in natural family planning. Fertility and sterility, 38(1), 117-118. https://doi.org/10.1016/s0015-0282(16)46409-5
Brennan JJ, Klaus H. Terminology and core curricula in natural family planning. Fertil Steril. 1982;38(1):117-118. doi:10.1016/s0015-0282(16)46409-5
Brennan, J. J., and H. Klaus. "Terminology and core curricula in natural family planning." Fertility and sterility, vol. 38, no. 1, 1982, pp. 117-118.
To compare the prevalence of chronic endometritis (CE) when different diagnostic methods are used. Prospective observational study. University-affiliated hospital. PATIENT(S): Four groups of women were studied, including women with proven fertility (Fertile; n = 40), unexplained recurrent miscarriage (RM; n = 93), recurrent implantation failure (RIF; n = 39), and infertile subjects undergoing endometrial scratch in a natural cycle preceding frozen-thawed embryo transfer (Infertility; n = 48). INTERVENTION(S): Endometrial biopsy was performed precisely 7 days after LH surge (LH+7). Plasma cells were identified by means of traditional hematoxylin and eosin (HE) staining and by means of immunohistochemistry (IHC) for Syndecan-1 (CD138). MAIN OUTCOME MEASURE(S): Prevalence of CE. RESULT(S): The use of CD138 epitope was more sensitive than HE staining in identifying plasma cells. The use of plasma cell count per unit area had the lowest observer variability compared with cell count per ten randomly chosen high-power fields and cell count per section. Using this method, the prevalence of CE in women with RM, RIF, and Infertility were 10.8%, 7.7%, and 10.4%, respectively, not significantly higher than that of Fertile subjects (5.0%). CONCLUSION(S): Using what may be a new method of plasma cell assessment, it appears that the prevalence rates of CE reported in many earlier studies may have been overestimated. CLINICAL ChiCTR-IOC-16007882.
Past practices of Natural Family Planning (NFP) have included such techniques as: 1) calendar rhythm in which a constant mathematical relationship was calculated between the day of ovulation and the beginning of the succeeding menstrual period, 2) temperature rhythm in which sexual intercourse is permitted by observing that the basal body temperature rises at the time of ovulation, 3) a combination of calendar and temperature rhythm methods, 4) paper test strips which measure glucose and electrolytes in vaginal secretions, 5) electronic devices of various sorts which record changes in the potentials of the pelvic organs at the time of ovulation, and 6) recent developments in computer technology which measure a number of variables. All of these techniques depend upon the identification of the fertile and infertile periods of the menstrual cycle. More recent studies by the World Health Organization have analyzed the teaching phase of NFP and the effectiveness phase of NFP using the detection of ovulation by following changes in the quality of cervical mucus. These studies tested 869 women with varied backgrounds in 5 countries. The data support the fact that many motivated women can detect ovulation reasonably accurately by following changes in their cervical mucus (the Billings method), although teaching time and motivation are considerable. Long-term and detailed data are necessary to determine the value of these methods. The advantage of NFP is the avoidance of drugs and devices. Disadvantages are that demands are placed on the sex life of couples, and there are associations between failures and increased rates of congenital abnormalities.
The percentage of 869 women in five countries capable of being taught to recognize the periovulatory cervical mucus symptom of the fertile period was determined in a prospective multicentre trial of the ovulation method of natural family planning. The women were ovulating, of proven fertility, represented a spectrum of cultures and socioeconomic levels, and ranged from illiteracy to having postgraduate education. In the first of three standard teaching cycles, 93% recorded on interpretable ovulatory mucus pattern. Eighty-eight per cent of subjects successfully completed the teaching phase; 7% discontinued for reasons other than pregnancy, including 1.3% who failed to learn the method. Forty-five subjects (5%) became pregnant during the average 3.1-cycle teaching phase. The average number of days of abstinence required by the rules of the method was 17 in the third teaching cycle (58.2% of the average cycle length). To what extent the findings of this study can be extended to other couples remains to be demonstrated.
Fertility awareness-based methods (FABMs), also known as natural family planning (NFP), enable couples to identify the days of the menstrual cycle when intercourse may result in pregnancy ("fertile days"), and to avoid intercourse on fertile days if they wish to avoid pregnancy. Thus, these methods are fully dependent on user behavior for effectiveness to avoid pregnancy. For couples and clinicians considering the use of an FABM, one important metric to consider is the highest expected effectiveness (lowest possible pregnancy rate) during the correct use of the method to avoid pregnancy. To assess this, most studies of FABMs have reported a method-related pregnancy rate (a cumulative proportion), which is calculated based on all cycles (or months) in the study. In contrast, the correct use to avoid pregnancy rate (also a cumulative proportion) has the denominator of cycles with the correct use of the FABM to avoid pregnancy. The relationship between these measures has not been evaluated quantitatively. We conducted a series of simulations demonstrating that the method-related pregnancy rate is artificially decreased in direct proportion to the proportion of cycles with intermediate use (any use other than correct use to avoid or targeted use to conceive), which also increases the total pregnancy rate. Thus, as the total pregnancy rate rises (related to intermediate use), the method-related pregnancy rate falls artificially while the correct use pregnancy rate remains constant. For practical application, we propose the core elements needed to assess correct use cycles in FABM studies.
Fertility awareness-based methods (FABMs) can be used by couples to avoid pregnancy, by avoiding intercourse on fertile days. Users want to know what the highest effectiveness (lowest pregnancy rate) would be if they use an FABM correctly and consistently to avoid pregnancy. In this simulation study, we compare two different measures: (1) the method-related pregnancy rate; and (2) the correct use pregnancy rate. We show that the method-related pregnancy rate is biased too low if some users in the study are not using the method consistently to avoid pregnancy, while the correct use pregnancy rate obtains an accurate estimate. SHORT In FABM studies, the method-related pregnancy rate is biased too low, but the correct use pregnancy rate is unbiased.