Billings ovulation method

Billings Ovulation Method
Background
Birth control type	Behavioral
First use	developed in 1950's
Failure rates (first year)
Perfect use	0-2.9%
Typical use	1-5%
Usage
Reversibility	immediate
User reminders	Accurate teaching and daily charting are essential.
Clinic review	None
Advantages and disadvantages
STD protection	No
Periods	Prediction
Weight gain	No
Benefits	Low cost, no prerequisites for use, no side effects, can aid pregnancy achievement

The Billings Ovulation Method (BOM) is a method which women use to monitor their fertility, by identifying when they are fertile and when they are infertile during each menstrual cycle. Users pay attention to the sensation at their vulva, and the appearance of any vaginal discharge. This information can be used to achieve or avoid pregnancy during regular or irregular cycles, breastfeeding, and peri-menopause. Described by the World Organisation of the Ovulation Method Billings (WOOMB) as "Natural Fertility Regulation", this method may be used as a form of fertility awareness or natural family planning, as well as a way to monitor gynecological health.

In trials method related pregnancy rates have ranged between 0% to 2.9%.^[1] In a recent trial in China 992 couples using the Billings Method were compared to 662 couples using the IUD. The method-related pregnancy rate amongst Billings users was zero and the total pregnancy rate was 0.5%.^[2] In studies up to the 1980s teaching related pregnancies ranged between 0% to 6%.^[1] Total pregnancy rates vary between 1 and 25%.^[3] Reasons for a higher total pregnancy rate include misunderstanding the method, risk taking, ambivalence toward pregnancy, and deciding to become pregnant.

John Billings developed the method as a form of natural family planning in accordance with his religious faith.^[4] He was recognized with a Papal knighthood in life, and condolences for his death were given by the Pope.^[5] Billings strove to raise awareness of the significance of cervical mucus to fertility to all people, regardless of their religion.

Thomas Hilgers later created the Creighton Model FertilityCare System as a variation of the Billings method. ^[6] While Hilgers describes his method as a "standardization" of the BOM, Billings and his wife disputed this claim in a position paper.^[7]

History

The first recorded observations of the relationship between cervical mucus and survival of spermatozoa come from the mid-19th century.^[8] The topic was not systematically studied, however, for almost another century. In 1948, Erik Odeblad was studying mycoplasms in the female genital tract. During the course of his studies, he noticed that cervical mucus changed in a predictable pattern through the course of a woman's cycle. He continued his study of the cervix.^[9]

Independently in 1953, Dr. John Billings (1918–2007) discovered the relationship between cervical mucus and fertility while assisting the marriage consultant for the Melbourne Catholic Family Welfare Bureau. Some of the couples he worked with had serious reasons to postpone pregnancy, and followed the Catholic Church's teachings of only using natural methods of pregnancy avoidance. While Dr. Billings was familiar with the Calendar and Basal Body Temperature methods, he felt there was a need for something more flexible and more reliable. He embarked on a study of medical literature, and found the mid-19th- and early-20th-century references to cervical mucus and sperm survival. He instructed women using the Rhythm method to avoid intercourse also on all days, and for a few days after, they noticed vaginal discharge. This resulted in a dramatic decrease in unintended pregnancies among these couples.^[8]

In the early 1960s, Dr. James Brown took a position at the Royal Women's Hospital in Melbourne, Australia. Dr. Brown had earlier developed the first tests to measure oestrogen and progesterone, and he used these tests to assist Dr. Billings in further study of the relationship between cervical mucus and fertility. Dr. Evelyn Billings joined the research team in 1965. By the late 1960s, the rules for identifying fertile days had been established and teaching centers began to be set up around the world. The method was called the Ovulation Method, to emphasize that the central feature of a woman's fertility cycle was ovulation, rather than menstruation. In the 1970s, a committee of the World Health Organization renamed it the Billings Ovulation Method.^[8]

Scientific verification of the Billings Method is ongoing. Dr. James Brown continued to study ovarian activity until his retirement in 1985.^[10] Dr. Erik Odeblad was acquainted with the Billings Ovulation Method in 1977, and reported that his research into the activity of the cervix confirmed all the conclusions made by Dr. Billings.^[8] Dr. Odeblad's research into the cervix and cervical mucus also continued for many decades.^[11]

Fertility

• A woman ovulates at only one time during her cycle, and an ovum can survive for only 12–24 hours.
• Cervical mucus enabling healthy sperm cells to navigate the genital tract is necessary for fertility
• Most commonly, spermatozoa live only one to three days in the presence of fertile mucus, with survival up to five days being rare. The possibility of pregnancy from sperm survival longer than five days has been compared to "the chances of winning a huge lottery."^[12]
• Menstruation will occur about 2 weeks after ovulation.
• A ten-year study of 45,280 subfertile couples in China found that 32.1% of women were able to achieve pregnancy and live birth through the use of Billings.^[13]

Function

In the days leading up to ovulation the cervix responds to oestrogen by producing mucus capable of sustaining sperm survival. This mucus leaves the vagina as the woman is in an upright position. The mucus is observed through the sensation at the vulva and by looking at any discharge. Daily charting of these observations will reveal either an unchanging pattern indicating infertility or a changing pattern of sensation and discharge indicating fertility. Both of these patterns follow the hormonal patterns which control sperm survival and conception.^[14]

Billings Method teachers help women recognize and understand their signs of fertility. This can help in the early diagnosis and treatment of gynaecological disorders, and can contribute to a woman's reproductive health.^[15]

References

1. ^ ^{a b} Trials of the Billings Ovulation Method The Billings Method, Dr. Evelyn Billings & Ann Westmore, 2000, p. 215.
2. ^ Evaluation of the Effectiveness of a Natural Fertility Regulation Programme in China: Shao-Zhen Qian, et al. Reproduction and Contraception (English edition), in press 2000.
3. ^ Hatcher, RA; Trussel J, Stewart F, et al. (2000). Contraceptive Technology (18th Edition ed.). New York: Ardent Media. ISBN 0-9664902-6-6. http://www.contraceptivetechnology.com/table.html. 
4. ^ ABC response
5. ^ Papal message
6. ^ Creighton Model
7. ^ Some Clarifications Concerning NaProTECHNOLOGY and the Billings Ovulation Method
8. ^ ^{a b c d} THE QUEST - leading to the discovery of the Billings Ovulation Method, Billings, J., Bulletin of Ovulation Method Research and Reference Centre of Australia, Vol 29 No.1 March 2002, pp18-28.
9. ^ The Discovery of Different Types of Cervical Mucus, Erik Odeblad, Bulletin of the Ovulation Method Research and Reference Centre of Australia, Volume 21 No.3 September 1994, pp3-35.
10. ^ Ovarian Activity and Fertility and the Billings Ovulation Method: Dr. James B. Brown, 2000.
11. ^ Cervical Mucus and their functions, Erik Odeblad, Journal of the Irish Colleges of Physicians and Surgeons, Vol. 26 No.1 January 1997.
12. ^ Kippley, John; Sheila Kippley (1996). The Art of Natural Family Planning (4th Edition ed.). Cincinnati, OH: The Couple to Couple League. pp. 88. ISBN 0-926412-13-2. 
13. ^ China Successfully Launching Billings Method: Dr. Shao-Zhen Qian
14. ^ Teaching the Billings Ovulation Method, Dr E. L. Billings AM, MB BS, DCH (London), 2001.
15. ^ Part. 2 Variations of the Cycle and Reproductive Health, Evelyn L. Billings and John J Billings.

External links

• (Official Billings Site) Billings LIFE: Leaders in Fertility Education
• Billings Ovulation Method Association - USA
• Billings Centre of Fertility Education Vancouver Island, BC, Canada
• billingsMentor (e-learning system for the Billings Method)