Hilgers, T. W. (1980). Two methods of natural family planning. American Journal of Obstetrics and Gynecology, 136(5), 696-697. https://doi.org/10.1016/0002-9378(80)91032-7
Hilgers TW. Two methods of natural family planning. Am J Obstet Gynecol. 1980;136(5):696-697. doi:10.1016/0002-9378(80)91032-7
Hilgers, Thomas W. "Two methods of natural family planning." American Journal of Obstetrics and Gynecology, vol. 136, no. 5, 1980, pp. 696-697.
Ovulation method effectiveness depends on peak symptom teaching
A 1980 letter to the editor argues that the ovulation method's effectiveness depends on couples learning the peak symptom correctly. Thomas W. Hilgers wrote it after an NIH site visit to a trial of two natural family planning methods. He questions how the trial trained teachers and defined user failure.
Study at a glance, letter to the editor: Ovulation method effectiveness depends on peak symptom teaching. Source: Hilgers TW, 1980, PMID 7355953.
Key Findings
The trial paper placed the peak symptom at maximal mucus secretion, a definition the letter rejects; the ovulation method defines it as the last day of clear, stretchy, or lubricative mucus.
The author visited the trial at the request of the NIH and analyzed several pregnancies among ovulation method users, some of which he attributes to poor teaching of the peak symptom.
Teachers in the trial were women who had used the method or had formalized training, and the letter says the interim report offered no account of how teaching quality was assured.
The letter characterizes the trial as closer to extended use-effectiveness, with no objective definition of user failure and no assessment of either method for achieving pregnancy.
Interpretation
The item is a letter to the editor responding to an interim report of a randomized prospective trial of two natural family planning methods. The author visited the trial for the NIH and analyzed several pregnancies among ovulation method users. He argues that effectiveness depends on how a method is defined, how teachers are trained, and how failure is counted. In his view, simple use of a method does not qualify an individual to teach it.
RRM Context
Fertility awareness-based methods, including the Creighton Model FertilityCare System, rest on couples learning to chart their cycles from a trained teacher. Restorative reproductive medicine builds on cycle charting. A clear definition of a sign such as the peak symptom lets couples and clinicians read a cycle the same way.
Our editorial summary of this paper, not the article's abstract.
Abstract
I read with interest the recent article by Wade and associates, "A randomized prospective study of the use-effectiveness of 2 methods of natural family planning: an interim report" (134: 628, 1979). In reference to the study of the ovulation method, the authors noted that abstinence begins on the 1st day of mucus secretion and continues until the evening of the 4th day beyond the peak or maximal mucus secretion. In the ovulation method, the peak symptom is not the same as maximal mucus secretion as was indicated in the paper. The peak symptom is defined as the last day of the mucus discharge that is clear and/or stretchy and/or lubricative. In the definition of peak symptom, the amount of mucus discharge is not specifically important and may often be misleading. I had the opportunity to do a site visit at this study at the request of the National Institutes of Health while the study was in progress. I analyzed several pregnancies which occurred in users of this ovulation method. Some of the pregnancies occurred as the result of poor teaching of the concept of peak symptom. In the ovulation method, proper understanding and teaching of that concept are essential to the measurement of its effectiveness. Noticeably missing from this interim report was any discussion of the quality control procedures which were utilized to guarantee a high-quality educational service to the people entered into the study. While the authors claim that the methods were taught by professional teachers, these teachers were actually women who had previously used the method and/or had formalized training in teaching the method. Simple use of either of the methods certainly does not qualify an individual to teach natural family planning. For those with formalized teaching, such training should have been outlined since judgment on the effectiveness of the teaching cannot be made; such a judgment is essential to the proper analysis of results. Finally, while the study claims to be a use-effectiveness study, it is rather a modified version of extended use-effectiveness. No objective definition of "user failure" is provided. One cannot ascertain how many pregnancies were related to poor teaching, nor can one tell how many occurred as the result of the couples' last minute exercise of their freedom to use their fertility. The use-effectiveness of the 2 methods under study as a means to achieve a pregnancy have been ignored. In doing so, the investigators have ignored use-effectiveness reality.
The Billings Ovulation Method uses only cervical mucus to identify the fertile window. Learn how it works, what the evidence shows, and its value in restorative reproductive medicine.
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