Click Here for Studies on Human Reproduction by Professor-Emeritus James B. Brown M.Sc., Ph.D., D.Sc., FRACOG

---

THE QUEST - Part one

Leading to the discovery of the Billings Ovulation Method

by Dr. John J. Billings AM KCSG MD FRACP FRCP (Lond.)

"The Bulletin of the Ovulation Method Research and Reference Centre of Australia" Vol.29 no.1 March 2002. Reprinted here with kind permission of J. J. Billings MD.)

-----------

The medical research which led eventually to the recognition, development and refinement of the Billings Ovulation Method began in Melbourne in 1953. At that time, now nearly 50 years ago, the only natural methods of regulating fertility were the Rhythm Method and the Temperature Method, but there was not yet very much interest in the Temperature Method. The gynaecologists showed little interest at all in natural methods except a few Catholic gynaecologists who taught the Rhythm Method.

In the commencement of a program of clinical research the first effort was to study available texts defining the Rhythm Method, based on the brilliant research of two distinguished gynaecologists, the Austrian Dr Herman Knaus and the Japanese Dr Kaysaku Ogino. Their quite separate lines of research led to a similar conclusion that ovulation occurs on only one day in the cycle and, in the absence of pregnancy, ovulation is followed about two weeks later by menstruation. Knaus believed that the interval is exactly 14 days, but Ogino had demonstrated an interval of 12- 16 days.

The discoveries made by Knaus and Ogino provided a scientific basis for the elaboration of this natural family planning method, which involved studying the length of menstrual cycles over a period of at least 6 months, there was a counting of days to mark the time when the woman could not conceive. As long as the woman’s cycle remained within the observed lengths many couples followed this Rhythm Method with considerable success.

There remained however, the obvious problems of unexpected irregularity of the cycles and situations such as breast-feeding when the woman usually has no cycles at all for several months, even sometimes for a year or more. There are also problems for the small group of women who may ovulate only 2 or 3 times in the course of each year, and also for the women experiencing considerable irregularities near to menopause.

One had been drawn into this work by a splendid priest, Fr Maurice Catarinich, who had recently been appointed by our Archbishop Daniel Mannix to fulfill the role of a marriage consultant in the Melbourne Catholic Family Welfare Bureau. On one evening each week couples referred by Fr Catarinich were interviewed in his consulting rooms.  As well as that he organised some weekend “Cana” Conferences for Catholic couples. Those who had experienced an unintended pregnancy while endeavouring to use the Rhythm Method successfully were invited to come for interview. This drew attention to another cause for unexpected pregnancies which is always to be remembered, that the apparent failure of the method to prevent conception was due to the woman receiving incorrect information from her teacher and not to any weakness of the method itself.

Many of the couples had very serious reasons, especially of a medical nature, to have a rest from pregnancy at least for a few years, or sometimes permanently. One therefore turned to the Basal Body Temperature method for assistance. It was in 1905 that a doctor van de Velde observed a drop in the body temperature of one of his patients towards the middle of her menstrual cycle, followed by a higher temperature until near menstruation.  Already in 1868 it had been noticed that a fall in temperature occurs at the time of menstruation. The woman observed by Dr. van de Velde was obviously having cycles varying very little from about 28 days in length as the drop in body temperature preceding the rise occurred in the middle of the cycle.

With the help of some nurses we were able to compare oral, vaginal, and rectal daily temperatures and found that if the temperature is taken correctly any of these locations could be chosen as the method to be used.

There are obvious weaknesses of the Temperature Method in that the behaviour of the temperature is non-specific, as it may be elevated by influences that have nothing to do with the menstrual cycle. Furthermore, it is only after the shift from a lower to a higher temperature has occurred that days of infertility can be located. In long cycles or again during breast-feeding there are necessarily very long times of avoidance of intercourse if pregnancy is to be postponed. A number of people combined the3 two methods to produce a Temperature-Rhythm method, applying variable interpretations of counting days for the pre-ovulatory phase of the cycle; this could not give a formula that was completely reliable. It was already known that a single act of intercourse in the cycle during menstruation could produce pregnancy because ovulation had occurred on about day 5 or 6 in the cycle.

The determination of so many of these couples to reject any but a natural method of regulating fertility was the inspiration to stimulate a careful study of the medical literature, seeking a clue which might lead to the development of a really reliable natural method. One felt a need to concentrate on a study of ovulation which is clearly the most fertile time in the cycle, much more important than menstruation and cycle length which had been the focus of the Rhythm Method.  The Temperature Method was capable of demonstrating when ovulation has occurred but this was not likely to help couples to achieve pregnancy, as usually the ovum will have disintegrated by the time the significant temperature rise is recognised.

There was in the literature a document produced by a Dr W. T. Smith in 1855 under th heading of “The Pathology and Treatment of Leucorrhoea”.  Smith pointed out that conception is most likely to occur at that time of the menstrual cycle when the mucus content of the cervix is “in its most fluid condition”. In 1868 Dr J.M. Sims wrote that the post-coital test for spermatozoa which he had helped to develop showed the best movement of the spermatozoa within the mucus “when the cervical mucus becomes clear and translucent, and about the consistency of the white of egg”. These very important observations had been largely neglected until the 1930’s when some French gynaecologists Seguy and Vimeux noted that about the time of ovulation, confirmed by laparotomy, the mucus in the cervix becomes temporarily permeable to spermatozoa.

The word leucorrhoea means simply “white discharge” and there were occasional references to leucorrhoea in textbooks of gynaecology, that some women reported the presence of such a discharge in the menstrual cycle, with the added comment that it did not have any serious significance.  It was even suggested by one gynaecologist that it was a psychosomatic disorder. There was no suggestion seen that it could be of physiological significance and therefore worth of further study.

One now began to ask every woman coming for instruction about regulating fertility whether she noted such a discharge at some at some place within the cycle, and this produced a positive response from everyone who was asked the question. The women were then asked to describe it in detail, the number of days it was present, what it looked like, what it felt like and any other feature that they may have observed. There was, of course, slight variation in these descriptions with regard to the number of days on which the discharge was present in each cycle and details indicating that some women had a more copious discharge than others when they would often describe the tendency of the mucus to form strings. What was clear was that there were sequential changes in the observation of what they saw and what the vulva felt while the discharge was present. Similar changes were a regular feature of what the women were saying so that it became clear that this phenomenon associated with the fertile time in the cycle could be the essential indicator of the only time in the cycle when the woman could conceive.

The first step therefore was to add to the instruction given to those women using Rhythm Method calculations, daily observations which would include the time when this physiological discharge was present, and always to avoid intercourse over those days and for a few days after it ceased. The result was that there were no pregnancies over a long period of time when the women followed that advice.

Instruction in the Temperature Method continued as well, for two reasons. The main reason was that many women were astonished at the information they had been given regarding this white discharge, which had been a familiar observation to them for so many years, and they tended to be doubtful as to whether pregnancy could be reliably avoided by waiting without intercourse as they had been instructed.  The idea seemed to them to be too simple. As still sometimes happens when couples are instructed together, the husbands were mystified by what the woman was being told and has so easily understood; some husbands had the idea that a temperature record that they could see was likely to be more reliable.

There was also the fact that it was by now the time when the contraceptive pill was being introduced and vigorously promoted by the pharmaceutical industries, with claims that the pill is a wonderful new discovery.  There were other false statements in this propaganda for the pill, that it is harmless, just imitating nature, able to regulate ovulation and so on. Many women were dazzled by this relentless publicity, and so were many doctors, members of the clergy and other men as well. The deception caused many women to believe that the pill would be a simple answer to all their problems and were hesitant to accept a natural method, even claiming that it would be difficult to keep an accurate record of the mucus discharge; it was therefore considered advisable to provide instruction in the Temperature Method, which would then enable them to resist persuasion to accept the pill.

It was now in 1962 that Professor James Brown took up an appointment at the Royal Women’s Hospital in Melbourne after completing an appointment he had held in a notable laboratory unit in Edinburgh, Scotland. While in Edinburgh he had developed what was later known internationally as Brown’s Method of measuring oestrogens and progesterone in blood and urine. The last task he understood in that laboratory was to respond to a request from the Director to use his new techniques to measure each day, in a group of women taking the contraceptive pill, the level of the pituitary and ovarian hormones involved in the hypothalamic-pituitary-ovarian axis controlling the cycle. Professor Brown did so and found that all of these hormonal levels were flattened so that they remained at a low level throughout the cycle. He was appalled by these observations and concluded, as many doctors had already suspected, that the pill was producing a very serious abnormality within the whole of the woman’s reproductive system and that under no circumstances should such medical treatment be encouraged. More widespread complications were predicted.

One had already been hoping that the information already acquired and given practical application in Melbourne could protect the women from medication which was contrary to sound medical principles, as well as being morally wrong according to the Magisterial teaching of the Catholic Church.

Professor Brown was approached and acquainted with the Melbourne work and asked whether he would help to validate the present developments by measuring the hormonal patterns of the women being instructed in natural fertility regulation. Professor Brown was immediately interested and revealed that he had already hoped that his laboratory techniques could be used to assist the developments of the natural method!

By the end of the 1950s there was clear evidence that the beginning and the end of the fertile phase of the menstrual cycle are reliably defined by the cervical mucus pattern. This prompted a decision to write a book to publicise the results of this clinical research. Thoughts were already turning towards the illiterate poor living in the developing countries of the world and their need for a reliable and harmless method of indicating those days in the cycle when it is possible for the woman to conceive and those days when conception is impossible.

The Rhythm Method had been demonstrated to be inadequate. The distribution of thermometers and the necessary instruction in their use could not be accepted as an acceptable target for the millions of poor, illiterate couples in India for example, nor in many countries in Africa, Latin America and Asia where similar problems exist.  It was decided that the book would contain accurate information about the Rhythm Method and the Temperature Method for any couples who wished to use either of those methods, knowing that many of them may have needed correction in the instruction that they had received. The inability of the Rhythm Method and the Temperature Method to indicate infertility before the beginning of the fertile phase was an insoluble problem.

Chemical contraception was now being introduced into Australia and we were soon able to observe the physical complications which resulted, many of these complications being of a very serious nature, including blood clotting resulting in strokes, heart attacks and pulmonary embolism. There was also an impact upon the conjugal relationship as the woman was often irritable or depressed while taking the pill, and the intended separation of sexual intercourse from parenthood clearly damaged the conjugal relationship in many cases, promoting infidelity and marriage breakdown. One came to be impressed by the fact that the physiology of a woman’s fertility had been part of Creation since the creation of the first woman and that it was just at this time that the Creator was allowing the details of this physiology to be recognised, with its obvious application of regulating fertility by a method superior in every way to chemical contraception, whether by the pill, implants or injections.

Professor Brown’s appointment in Melbourne was in time to add to the book his daily measurements of the ovarian hormones in two women and displayed with the concurrent charts they had produced. The book was released in 1964 with detailed description of the cervical mucus pattern, and the name given to the method it provides was the Ovulation Method, to emphasise that a new idea was being described with reference to the time of ovulation and the resulting ability to recognise the fertile phase.

In 1965 Dr Evelyn Billings joined the male medical team at the Catholic Family Welfare Bureau in Melbourne and to her were assigned those couples where the woman was reporting some difficulty in developing a proper understanding of the Ovulation Method. It was clear from the beginning that she quickly established a good rapport with the women and after several months she said to the male group of teachers, “Where are these difficult cases that you have been talking about?”. This confirmed the insight that had been gradually developing amongst the male teachers that women have special advantages as teachers, arising out of their personal experience of the mucus pattern and because many women found it much easier to discuss their own observations with another woman.  That does not mean that all women make good teachers nor that all men can be predicted to be poor teachers.

By this time Professor Brown’s collaboration was yielding important information. It had become evident at an early stage that the sequence of changes in the mucus pattern begins as a rule with a sticky opaque secretion which gradually becomes more transparent and finally takes on a distinctly lubricative quality which is easily recognised by the sensation experienced by the vulva, as the woman came close to ovulation. The slippery feeling then abruptly changes to dryness with or without a small opaque discharge. The last day of the slippery sensation, irrespective of quantity, was called the Peak of the Mucus Symptom, because it is the day of maximum fertility and usually the day of ovulation. Sometimes ovulation occurs on the next day or rarely the second day after the Peak. It is unnecessary for the woman to touch the mucus or to collect mucus with tissues; it is rather a matter of her understanding that the most important observation is the sensation experienced by the vulva as it changes from day to day. Professor Brown’s hormonal studies confirmed the rule that had been made to count 3 days following the last day of mucus before resuming intercourse. From the beginning of the fourth day there is no possibility of pregnancy on any day in the rest of the cycle.......continued in part two of The Quest

WOOMB International Inc. WEBSITE