We were and are still prepared to use the BBT is it seems that it will be useful for the couple. There were certain circumstances where the cervix was producing no mucus as, for example, following surgical procedures. For these women we used the BBT until the woman became familiar with her now diminished mucus sign, the value of the symptom of sensation being emphasized as an important element of the Ovulation Method teaching. Blind women can use the method satisfactorily. In teaching, however, we would always begin with helping the woman to understand as much as she can about the mucus sign. As the woman draws closer to the end of her natural fertility and she ovulates less and less frequently and eventually stops ovulating the time comes for total reliance on the mucus. It is now that the BBT will give less and less information and finally none at all and it is because of this insecurity that total abstinence results.

If the BBT is regarded as necessary or is requested then it will most certainly be taught. The first teaching is always the mucus pattern and this remains pre-eminent when other additions are used. The aim is to equip the woman to do without these aids and adjuncts, once the problem is solved. The procedure now when a couple wishes to change from the Sympto-Thermal Method to the Ovulation Method is simply to separate the various techinques and study each one to its full. In this way we can demonstrate the adequacy of the Ovulation Method and allow the couples to choose to give up temperature-taking which they usually do, but sometimes like to use it occasionally.

Where it is available, Professor Brown's Ovarian Monitor, which gives information about the whole cycle as well as the occurrence and the timing of ovulation, replaces the BBT. The Monitor is of exceptional value in infertility associated with a poor mucus symptom, as in couples striving to become pregnant after discontinuing contraceptive medication; in these cases the physiology of the vagina as well as of the cervix may be disturbed, making it too difficult to identify an occasional limited time when conception may be possible.

In the application of the Billings Ovulation Method for avoiding conception in cases where the mucus sign is poor as, for example, the approach to menopause when the cervix is aging, the procedure is to follow the Early Day Rules. By the application of these simple guidelines during months and years when ovulation is either suppressed or ended, couples are secure and free in their choice to avoid conception.

In the case of achieving pregnancy the Peak mucus with fertile characteristics is important. The slippery sensation without visible mucus is an important consideration. Professor Odeblad's recent discovery of P-mucus at the time of the Peak symptom (Odeblad 1994) substantiates the woman's observations. In close association with Professor Brown since 1962, over which time he has made thousands of ovarian hormone measurements which have validated the basic principles and guidelines of the Ovulation Method, the deficiencies of the Temperature Method have been illustrated, for example, the absence of the temperature shift in proven ovulation, the late luteal rise particularly in the pre-menopausal era and also pre-ovulatory rises.

All the other indicators were carefully studied and hormonally evaluated in the course of our continuing research programme. Intermenstrual bleeding and pain were found not to be reliable indicators. Everything was now to be related to the mucus symptom as the really reliable reference.

Self-examination of the cervix has never been taught in conjunction with the Ovulation Method. This is judged to be medically unacceptable, especially in consideration of the danger of causing microscopic abrasions of the lining of the cervix which is an epithelium of an internal organ similar to that which occurs above the anal canal. This damage makes the delicate lining susceptible to the entrance of micr-organisms, especially viral infections, for example, HIV. It is easy to see how anal intercourse leads to the spread of AIDS so readily.

Palpation of the cervix interferes with sperm selection (Odeblad 1989). He maintains that the cervix is an organ as delicate as the eye. As well as this, most women find the instruction to palpate the cervix repugnant. Sometimes reports have reached us of this practice leading to a stimulating and masturbatory effect. As far as gaining additional information is concerned it merely produces confusion since it studies mucus at the cervix. Mucus is changed as it passes through the vagina due to the physiology of the vaginal wall, especially the lower vagina at the pockets of Shaw where dehydration of the mucus occurs due to liberation of manganese under the influence of progesterone. Because of this, the observations at the upper vagina and at the vulva will be contradictory. Vulval observations made by women in the normal and natural way as they walk around have been evaluated by hormonal studies by Professor Brown (Billings et al, 1972; Brown et al. 1983) and verified by cervical studies by Professor Odeblad (Odeblad 1994).

By the early 1970's the Tongan trial was under way. This was the first overseas trial conducted on the Billings Ovulation Method. The method-related pregnancy was reported in the Lancet (Billings et al. 1972) as 1% but later on it was proved to have been 0%, the couple involved revealing the relevant information at a later date. The total pregnancy rate was 25% due to couples choosing to become pregnant.
The menopausal study which was being conducted in Australia at about this time showed a method-related pregnancy rate of 0% and a total pregnancy rate of 1% due to a deliberate departure by a couple from the Peak Rule, having been influenced by the temperature chart to do so. Many of these couples had had a recent pregnancy before learning the Ovulation Method and this was the reason for them seeking informaiton about the method. By now the Rhythm count and the BBT had been eliminated fromroutine teaching.

Over the years many other trials of the Ovulation Method have been conducted, including the WHO five-country trial in 1979-90 (WHO 1981 a, 1981b, 1983, 1984, 1987). Now recent world trials consistently show a method-related pregnancy rate of less than 1%. These trials have taken place in India, Indonesia and Burina Faso and the couples participating have come from Muslim and Hindu as well as Christian communities. The Billings Ovulation Method has proved to be universally acceptable and has been used successfully amongst couples who are illiterate and living in abject poverty. The continuation rate is substantially higher than any reversible method of contraception. The Ovulation Method has also established itself as the primary measure to be undertaken for the management of apparent infertility.

Following the trend to use condoms as advocated by the "safer sex" proponents of the AIDS programmes, many couples are trying to incorporate condoms into the Billings Ovulation Method. There is a biological incompatibility between condom use and the Billings Ovulation Method due to the production of secretions following intercourse with condoms which interfere with proper evaluation of the beginning of the fertile phase and of the Peak symptom. Confusion results, Couples are led to believe that they are protected against pregnancy as well as HIV infection. The result is an encroachment on the fertile phase for intercourse. Since the pregnancy rate of the condom is 5-15%, unintended pregnancies will be inevitable from time to time. This removes the choice couples make from cycle to cycle, as they come to rely on the contraceptive action of the condom. This introduces a weakening in their co-operation and in the acceptance of the child, and introduces a subtle discord into the harmony of the marriage with insidious tendency for it to grow. Protection against conception ultimately means rejection of the child. Complete acceptance of the child grows as couples rely on natural methods and accept responsibility for their combined decisions and actions.

The fact that biologically the Billings Ovulation Method and condoms cannot be used together is a strength of the Ovulation Method. Condoms can be combined biologically with BBT and Rhythm when they are essentials of the method being used and the mucus pattern is regarded as of secondary importance. All the other disadvantages of condoms become obvious in time.

Teaching all indicators, therefore, is not the same as teaching all methods. It cannot be claimed that the Billings Ovulation Method is taught as part of the Sympto-Thermal Method when the mucus is simply another indicator to be incorporated into a multiple-indicator method. The Billings Ovulation Method must be taught and recorded separately and thus keep its identity. The Basic Infertile Pattern and the Early Day Rules, the Peak and the Peak Rule are fundamental parts of the method. So too are the techniques of making and recording observations and of their interpretations. So, likewise, are the considerations associated not only with the physiological value of all phases of the cycle, infertile and fertile, but also of the psychological and spiritual value of all phases of the cycle. In the application of the guidelines of the method and the effect that this has on the relationships in the marriage, we perceive the injerent goodness of this life-style for couples. This results in an acceptance of nature, of the Creator, of the child, and of each other. The assurance that a woman gains from knowing her patterns of infertility and fertility results in a raising of her status in many cultures where respect for women is low. She now has the power of rectifying a disorder in the marriage, and the means of awakening love and respect in her husband who may have treated her far beneath her natural dignity and calling.

The Billings Ovulation Method is not a contraceptive because it does not suppress or destroy fertility nor does it impose any barrier to obstruct the meeting of the sperm cell and ovum; it is not taught with the object of having no children. Each phase of the cycle is taught as having its own positive value. Thus the fertile phase becomes the time for procreation and when a husband and wife make a prudent decision to postpone pregnancy the fertile phase becomes a time to be respected, a time when conjugal love demonstrates itself as fidelity, consideration and acceptance of each other in foregoing physical intercourse. Thus, the infertile time of the cycle becomes a time of happiness, a mutual turning to each other in gratitude, solidarity and love.

All this befits human nature of which human sexuality is a part, and like no other reproductive element to be found within the animal kingdom. In human sexual love, free will and intelligence are fully expressed.

The accuracy of the Ovulation Method has been known for many years and is appreciated for the help that it has been to many millions of couples. The better part, as we have found, but which we did not anticipate at the beginning, has been the strengthening of the marriage bond, the flourishing of love and respect between husbands and wives, with fidelity and the solidarity in the family. The responsibility and love for the child with security and happiness for them is an outstanding result.

Last but not least is the benefit to the woman's health who has lived her life naturally in conformity with the Creator's plan and therefore has escaped the ravages of all technological interference. A woman's good reproductive health is an undeniable entitlement. One of the great benefits of the Billings Ovulation Method is that the woman's chart displays disturbances caused by pathology. Early recognition of an abnormality enables the teacher to refer the woman to her doctor for appropriate early diagnosis and treatment. When a woman knows her own normal patterns she soon learns to ask for an explanation of anything which varies from the normal. This is particularly the case in changes in bleeding patterns which must be diagnosed promptly because the presence of cancer must always be considered. The Billings Ovulation Method teachers are trained and accredited to recognize these abnormalities and refer them.

Billings, E.L. Billings, J.J., and Catarinich, M (1989). "Billings Atlas of the Ovulation Method." 5th Edition. (Ovulation Method Research and Reference Centre of Australia: Melbourne.)
Billings, E.L. Billings, J.J., Brown, J.B., and Burger, H. (1972). Symptoms and hormonal changes accompanying ovulation. Lancet i, 282 - 4.
Billings, E. L., and Westmore, A. (1992). "The Billings Method." 3rd Edition. (Anne O'Donovan; Melbourne.)
Billings, J.J. (1983) "The Ovulation Method." 7th Edition. (Advocate Press: Melbourne.)
Brown, J.B. Harrisson, P., Smith, M.A., and Burger, H.G. (1983).Correlations between the mucus symptoms and the hormonal markers of fertility throughout reproductive life. Appendix 1 in "The Ovulation Method", by J.J. Billings, 7th Edition. (Advocate Press: Melbourne.)
Odeblad, E. (1989). The cervix, the vagina and fertility. Appendix 1 in "Billings Atlas of the Ovulation Method", 5th Edition, by E.L. Billings, J.J. Billings, and M. Catarinich. (Ovulation Method Research and Reference Centre of Australia: Melbourne.)
Odeblad, E. (1994) The discovery of different types of cervical mucus and the Billings Ovulation Method. Bulletin of the Natural Family Planning Council of Victoria 21, No.3.
WHO (1981-1987). A prospective multicentre trial of the Ovulation Method of natural family planning. 1. The teaching phase. Fertility and Sterility 36, 152 - 8 (1981a). II The effectiveness phase. Fertility and Sterility 36, 591 - 8 (1981b). III. Characteristics of the menstrual cycle and of the fertile phase. Fertility and Sterility 40. 773 - 8 (1983).
IV. The outcome of pregnancy, Fertility and Sterility 41, 593 - 8 (1984). V. Psychosexual aspects. Fertility and Sterility 47, 765 - 72 (1987).

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