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The early development of the Billings Ovulation Method was the
product of clinical research which began in Melbourne in 1953 with
the use and
assessment of the calendar rhythm method for the avoidance of pregnancy.
This essentially is a " menstruation method" requiring
that the woman is
having menstrual cycles and that these cycles vary very little in
length. Some years later the basal body temperature (BBT) method
was added in
order to establish greater effectiveness in the avoidance of pregnancy,
at least in the post-ovulatory phase. The BBT method had the added
advantage of helping women with irregular cycles to avoid contraceptive
medication which was being promoted from about 1960 onwards. The
BBT
method may be described as a "hormonal method" related
to the rise of progesterone which usually begins a few hours before
ovulation. The rise of
temperature is not precisely related to the rise of progesterone
and sometimes cycles occur in which there is confirmation of the
occurrence of
ovulation by measurement of ovarian hormones without a temperature
rise occurring at all. There is also no constant relationship of
the temperature
record to the time of ovulation, however the temperature pattern
is interpreted. Furthermore, the temperature record is subjected
to influences which
do not have any relationship to ovulation and the BBT method can
provide no information regarding the pre-ovulatory phase of the
cycle.
The deficiencies of these methods led to a study of the activity
of the cervix of the uterus during the cycle and to the discovery
that virtually every
fertile women observes, or can be trained to observe, the secretion
of a particular pattern of mucus coming from the cervix around the
time of fertility;
this appears at the vulva as a vaginal discharge. The temperature-rhythm
combination continued to be used while careful observations were
made to
determine those days in the cycle when it is possible for the woman
to become pregnant, when she is unable to do so, and the day on
which she was
most likely to become pregnant. It was only after the self-observation
of the mucus pattern and the application of guidelines appropriate
to the desire
of the couple to achieve or to avoid pregnancy in the cycle that
the temperature-rhythm calculations were abandoned. By 1962 a decision
was made
to publish a book regarding these studies and the conclusions that
had been reached.
It was in this same year, 1962, that Dr James Brown took up an
appointment at the Royal Women's Hospital, Melbourne. The international
reputation
that he had acquired in Edinburgh, Scotland, particularly in the
development of a method for measuring oestrogen and progesterone
metabolites in
urine, had preceded him. Soon afterwards he was approached and given
information about our Melbourne work and was asked if he would submit
all
of our conclusions to the evaluation of his laboratory techniques.
He immediately agreed to this request and over the 38 years which
have elapsed
since this first meeting, we have had the good fortune to have had
his active collaboration and guidance. He had immediately undertaken
the daily
measurements of oestrogen and progesterone metabolites in the urine
of two women which confirmed our judgments, and this information
was added
to the content of the book, which was published in 1964. We decided
to call this new method The Ovulation Method in order to emphasize
that
attention was now taken away from menstruation and directed to ovulation,
which is the more important event in the women's cycle.
It had been observed that the characteristics of the mucus secretion,
determined by the sensation produced by its presence on the vulva
and by any
visual observations that might be made, is a changing pattern. This
could now be related to the hormonal patterns, beginning with the
progressive rise
of oestrogens up to a peak about a day before what was now described
as the Peak day, the day on which there was the best possible chance
of a
woman becoming pregnant. This was quickly followed by a change in
the physical characteristics of the mucus which was now reflecting
the rise of
progesterone just before ovulation. In the pre-ovulatory phase the
days before the development of the mucus symptom were recognized
as infertile
and after the fertile phase it was established that the rest of
the cycle was also infertile after allowing a count of 3 days past
the mucus symptom.
These conclusions were reached after a careful study over some years,
undertaken by couples who were now anxious to achieve pregnancy,
in which
a single act of intercourse was placed within the days of possible
fertility in successive cycles, working backwards from the fourth
day after the Peak
symptom.
The precise time of ovulation was now able to be determined by
daily measurements of oestrogen and progesterone metabolites. It
was clear that
ovulation occurs on the day of the Peak symptom or the following
day, rarely on the second day after the Peak so that allowing for
the possibility of
ovum survival for 24 hours, a count of 3 days after the Peak symptom
had to be applied to be sure that by the beginning of the fourth
day after the
Peak every woman had ovulated and the egg had disintegrated. So
the earlier allowance made for the avoidance of intercourse on 3
days following
the end of the mucus pattern was now more precisely translated to
a count of 3 days to allow for the disintegration of the ovum following
the Peak of
the mucus symptom.
Soon after Dr Brown's collaboration began, Dr Evelyn Billings also
joined in the research. At the beginning the work had been in the
hands of Dr
John Billings, working with the help of an experienced marriage
consultant, Rev. Maurice Catarinich. Dr Evelyn Billings undertook
a survey of
pre-menopausal women, leading to the recognition of infertility
even in the presence of a discharge other than mucus. A variety
of discharges exist,
and she was able, with invaluable help from Dr Brown, to demonstrate
that if the discharges, whenever they were observed over a period
of two
weeks remained unchanged and no bleeding had occurred, they were
an indication of infertility. The discharges indicating infertility
now
supplemented the infertile days of dryness, the "dry days"
when there is no discharge at all.
It was soon after this time that Dr Brown was awarded a personal
professorial appointment within the University of Melbourne, as
a special honour
for his brilliant laboratory work as Director of the Research Laboratory
at the Royal Women's Hospital. He was now involved in the development
of
what he called an Ovarian Monitor, a device which can quickly and
accurately measure the metabolites of oestrone and pregnanediol
in a timed
specimen of urine, giving values which reflect accurately the levels
of circulating oestrogen and progesterone. The Monitor is able to
be used in the
laboratory or even by a woman in her own home. It has been of immense
value in assisting apparently infertile couples to achieve pregnancy,
and is
also very useful in confirming all the basic principles and guidelines
of the Billings Ovulation Method and for investigating the causes
of unexplained
bleeding from the uterus and other gynaecological disorders.
It was in the 1970s that we learned about the excellent research
of Professor Erik Odeblad of the Department of Medical Biophysics,
University of
Umeå, Sweden. He had been studying the physical properties
of the various cervical secretions and was beginning to define different
types of mucus,
with appropriate functions. He too has collaborated with Professor
Brown and ourselves for more than 20 years up to the present time.
It had
gradually become clear that sperm survival and sperm transport within
the woman's reproductive system are critically dependent upon the
presence of
a healthy mucus pattern.
An important feature of these disciplines within medical research--the
clinical studies of the cervical mucus symptom, of the ovarian hormonal
pattern
and of the physical characteristics of the various types of cervical
mucus--have displayed a remarkable congruence. There is no contradiction
between any of the results of these individual and collaborative
projects. It is common practice now for the phases of the cycle
and the occurrence of
ovulation to be determined by ultrasound studies, but it is easier
and more accurate to do this by the Billings Ovulation Method, as
it is now being
named, following the recommendation of a Committee of the World
Health Organization.
The woman who knows the Billings Ovulation Method will always know
the day on which she has conceived and this will provide for a reliable
estimation of the expected date of delivery. It therefore protects
the woman from imprudent interference with the pregnancy when the
calculation
has been made from the date of the last menstrual period.
It must also be pointed out that the study of natural family planning
offers special research possibilities because the gynaecological
health of the
woman has not been disturbed nor has her fertility been suppressed
by any medication, however administered, nor by any instrument or
surgical
operation. There is therefore the opportunity to study any change
from normal: infertility, irregular bleeding, disorders produced
by ovarian cysts or
tumours, vaginal infections and so on.
Professor Brown's work has encompassed many areas of interest to
medical science beyond his great service to natural family planning.
He
developed impressively sound explanations of the interaction between
the pituitary and the ovarian hormones in both the normal fertile
cycle and those
incidences of physiological and pathological alterations from it.
He made very interesting observations of FSH and oestrogen levels
at menopause and
afterwards. He explained the action of prolactin in delaying the
return of fertility for a variable time following child birth and
the establishment of
breast-feeding. He made interesting observations of the progressive
suppression of fertility in women undertaking strenuous physical
exertion over a
long period of time, for example those involved in running marathons
and the long training required for such athletic pursuits. His studies
of infertility
influenced his opinions regarding the polycystic ovary syndrome.
He had an interest in the oestrogen levels in women developing breast
cancer and
suspected the accumulation of carcinogenic material within the mammary
ducts as a cause of the cancer, pointing out that this risk is removed
by
pregnancy and lactation. He was one of the first to recognize that
certain adreno-genital disorders can cause a raised level of progesterone
in the
circulation, and through his assistance to those undertaking studies
of prolactin levels and infertility knew that a raised prolactin
level can result from
pituitary tumours and the ingestion of certain drugs.
This monograph has been written to help women understand why the
rules of the Billings Ovulation Method are as they are and to give
women
confidence that they are in control of their fertility at all times.
However, this monograph is more than that. It should come to be
regarded as a classic
in medical literature. It is an example of Professor Brown's unique
contribution to the protection and restoration of women's health,
with particular
reference to her ability to conceive and nurture children. His superb
scientific work has been of inestimable value not only to the disciplines
of
obstetrics and gynaecology, but especially to the dignity and self
esteem of women all over the world.
John J. Billings & Evelyn L. Billings
Kew, Victoria 3101
April 2000
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