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

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THE QUEST - Part two

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leading to the discovery of the Billings Ovulation Method

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

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Professor Brown gradually came to the firm conclusion that the Peak is the most reliable of all biological markers of the time of ovulation, more accurate than the behaviour of the oestrogen curve and more accurate than the surge of the luteinising hormone (LH) which triggers ovulation.The change in the women’s observations, from a slippery feeling to an absence of any slipperiness or wetness, is resulting from a fall in the level of circulating oestrogen and a little later the progressive rise of progesterone which begins just a few hours before ovulation,The progesterone needs to continue to rise to a higher level before its measurement will confirm the occurrence of ovulation.

As a woman approaches ovulation the amount of mucus discharge may increase considerably and result in the mucus forming strings which can be drawn out by using a glass rod.This observation is sometimes referred to as “stretch” but there is no elasticity present, and the description made by the German gynaecologists who originally expressed it as “a tendency to form strings” is more accurate.The strings are most obvious about two or three days before the true Peak of fertility.It is unfortunate that a number of natural family planning teachers have adopted our terminology but define inaccurately the application of the term “Peak of the Mucus Symptom”.They place the Peak at the time when the stringiness is most obvious; the literature becomes confused by observations of this kind and their relationship to the time of ovulation.

Dr. Evelyn Billings was now directing her attention to the pre-ovulatory phase of the cycle, having observed that occasionally in a long cycle there will be a mucus discharge for two or three days, afterwards perhaps recurring intermittently before the full sequential pattern of the fertile phase begins and continues through to the Peak.The rule was developed that intercourse was avoided during these “mucus patches” and for 3 days afterwards, if pregnancy were to be avoided.This rule is important in making sure that the mucus patch is not the beginning of the fertile phase.

At other times there might be a discharge coming from the vagina which is not mucus.This may be present as a continuous discharge, for example, as a result of present or previous use of contraceptive medication.It was noticed that these continuing discharges were of a n unchanging character and this absence of change demonstrates that they are an indication of infertility.This means that during the time between the end of menstruation and the beginning of the fertile phase infertility may be diagnosed by dryness or by an unchanging discharge; both the dryness and the unchanging discharge represent what is designated a Basic Infertile Pattern.All of this information was incorporated into the formation of the guidelines so that the woman and consequently her husband could be sure that during the pre-ovulatory phase of the cycle, before the fertile phase began, the woman is able to identify infertility;it is only the mucus patches which call for the avoidance of intercourse until it is sure that the mucus discharge is not in fact the beginning of the fertile phase.As will be described later, Professor Erik Odeblad determined that this unchanging discharge originates in the vagina.

It was during the study of these very significant observations during the 1960s that it was determined that the couple was better served by the Ovulation Method alone than by a combination with any other method; this necessitated ensuring that the absence of temperature-taking did not result in any pregnancies. Good teaching of the ovulation method is required, careful charting on the part of the woman and the teacher making sure that she understands the guidelines for the application of the knowledge, according to the intention of the couple to achieve or to avoid pregnancy.

In the early part of the cycle a group of follicles (nests) each containing an ovum begins to develop, stimulated by the pituitary hormone FSH. At a later date it was discerned that, very occasionally, a continuous unchanging pattern of mucus with fertile characteristics is observed, particularly in breast-feeding women, even sometimes persisting for many weeks.This infertile pattern has been explained by Professor Brown as resulting from an arrest of the level of FSH at a point where one or more follicles were producing a moderate level of oestrogen but did not progress to the Peak and ovulation,. This is another example of a Basic Infertile Pattern, usually ending in a return to more familiar BIPs and atresia (atrophy) of the follicles that had been moderately active.This sequence was later incorporated in the Early Day Rules for its management.

Omitting the Temperature

Many women were by this time asking was it really necessary to continue taking the temperature.They observed how easily the mucus pattern could be understood; when they had waited without intercourse during the fertile phase, menstruation would confirm their confidence.

The publication of the Ovulation Method had aroused considerable interest in countries overseas and it was in 1968 that one was first invited to visit other countries in order to teach the Ovulation Method and provide help to establish teaching centres.The first country to make the request was New Zealand and in the following year there was a combined movement through Malaysia, Singapore and Hong Kong where it was now positively recommended that when the woman understood her cycle in the terms of the Ovulation Method, she required no other method to help her and her husband to regulate their family size.

In 1968-9 Mrs Mercedes Wilson from Guatemala was living in Melbourne.She visited the Catholic Family Welfare Centre and was taught the Temperature Method and the Ovulation Method.During 1969 she visited the home of the Drs. Billings and in a conversation with Dr Evelyn Billings she discussed the possibility of Natural Family Planning in Guatemala.She was concerned as to whether the poor, less educated women in her country would be able to be provided with adequate assistance.In this conversation she was told that there was now sufficient evidence to declare that the Ovulation Method used alone was adequate, provided the woman had a good understanding of it.There was no logic any longer to submit the reliable indicator (the mucus pattern) to the judgement of an unreliable method (the temperature record).Mercedes asked whether the Drs Billings would be willing to come to Guatemala to conduct a Teacher-Training and was assured that they would come, Dr. Evelyn Billings saying that all that would be taught was the Ovulation Method and that already good results were being reported in the application of the method in Tonga.It had been observed that the shift from the lower to the higher temperature could occur a few days before the day of ovulation or sometimes not until three or four days afterwards, and similar observations were to be found in the medical literature.There was also experience of another observation also appearing in the medical literature, that ovulation may occur without any indication of it al all from the temperature chart.One’s experience had included a cycle with a normal fertility mucus pattern, hormonal proof that the Peak of the Mucus Symptom was accurately located at the time of ovulation, menstruation had occurred two weeks later, but the temperature chart was flat throughout the cycle.

The count of 3 after the end of the mucus pattern had been determined by clinical observations.These involved the cooperation of a number of couples who had successfully postponed pregnancy for as long as they wished to do so and were now wishing to achieve another pregnancy.They were asked to “move backwards” the acts of intercourse in the post-ovulatory phase of the cycle, beginning with day three.One pregnancy occurred as a result.The remainder moved to day two and now a few pregnancies resulted.When the other couples moved to day one pregnancies occurred more frequently but most frequently of all when finally the last day of the mucus discharge was used for intercourse.It was some years later that Professor Brown’s laboratory studies demonstrated what had been named the “Peak of the Mucus Symptom” was in fact the day on which ovulation occurred most frequently, and that the day after the Peak also had a substantial level of fertility, but not as great as that on the Peak day.

So far the recommendation to proceed further without the temperature method had been confined to those women who had a clear understanding of the Ovulation Method and a classical mucus pattern.What was needed was a study of a random group of women who would be taught the Ovulation Method and use it alone from the beginning of their use of a natural method.Providentially this opportunity presented itself when there was a visit to Melbourne of a Missionary nun of the Marist Order, Sr. M. Cosmas Weissmann who had already been working for many years in Tonga.She had come to Melbourne with the express intention of learning a method which did not involve any temperature taking, being positive that the temperature method was incapable of being used successfully amongst the poor and largely illiterate women in Tonga.She was delighted to be told that such a method now existed and she stayed in Melbourne for a few weeks in order to be quite convinced that she fully understood the method and the manner in which it was being taught.

Sr. Cosmas went back to Tonga and commenced to instruct the women who were keen to learn a natural method of postponing pregnancy, even some who were not intending to use it immediately but at a later date when the family size had increased.Finally a total of 395 women were instructed and 331 couples opted for the Ovulation Method.The trial began in July 1970 and ended in February 1972.

A visit to Tonga early in the trial confirmed that Sr. Cosmas was keeping meticulous records of each individual retained in the trial, and that good progress was being made.Most women found the mucus immediately recognisable and were pleased with the simplicity of the method.Additional instruction was given where it was necessary to gain the woman’s confidence.Altogether a total of 282 couples used the Ovulation Method for a total of 2503 days.There was one case where the couple despite their statement that they had not engaged in intercourse during the fertile phase.So this “method-related pregnancy” was included in the final report of the project and published in the English Medical Journal Lancet (Oct. 14, 1972; 813-816).After the report had been published this couple admitted to Sr. Cosmas that they had knowingly conceived during the fertile phase and were now anxious to correct the previous untruth.The result of the trial was therefore 100% successful as long as couples continued to wait without intercourse during the presence of the fertile time determined by the Early Day Rules and the Peak Rule.

Towards the end of 1970 the Drs. Billings made a visit to Guatemala in response to an invitation by Mrs. Mercedes Wilson and in her company carried out a teaching program in all the countries of Central America.During this visit Mrs. Wilson inquired as to whether there was now complete confidence about teaching the Ovulation Method in isolation from other methods, and she was assured this was the case.She was given more information about the usccess being achieved in Tonga, and informed that the Ovulation method was now being regularly used on its own.

The journey to Guatemala was effected by a journey through Los Angeles, USA and there they met Mons. Robert Deegan, who was then Director of the Department of Health and Hospitals in the Archdiocese, which is the second largest in the United States of America.They had been introduced to him by a letter provided by a priest who had listened to the teaching carried out in Hong Kong.Mons. Deegan listened to the story of the Ovulation Method and arranged for the Drs. Billings to meet a group of doctors and nurses to present information to them on return.This meeting with the more than 40 individuals was very successful and a strong resolution was adopted to support the establishment of an Ovulation Method Teaching Centre in Los Angeles.Mons. Deegan followed up this recommendation by organising an Ovulation Method Institute each year for many years afterwards, which continued until his untimely death in 1983.They attracted visitors from all over the Americas and also from Asia and Europe.There was also a stop over in Mexico City on the way back to Los Angeles and the Ovulation Method was introduced to an interested group who went ahead with the setting up of a number of centres to teach the method.Subsequently teachers from Australia were able to supplement the teaching through Canada, the United States, and all through Latin America, with assistance to Mercedes Wilson and her group in Guatemala.

In 1978 our Humanae Vitae (Of Human Life) Conference attracted delegates from more than 40 countries around the world, enabling our Australian teachers to form strong friendships with individuals from many of these countries who subsequently spread the Ovulation Method on their return home.Since then many of our Australian Teachers have undertaken journeys to establish teaching programs overseas and these combined efforts have involved more than 100 countries altogether, in Eastern and Western Europe, the Middle East, all through Africa, the subcontinent of India, in Asia and in various Pacific Island communities.In China these efforts have produced remarkable success in recent years.

In 1977 at an International Conference on Natural Family Planning in Cali, Colombia, the research of Professor Erik Odeblad of the University of Umea, Sweden was mentioned.A publication by the World Health Organisation containing information supplied by Professor Odeblad was distributed; it contained detail regarding his earliest attempts to begin to classify the different types of mucus that he was recognising by modern physical techniques and also under the microscope.Not long afterward Dr. Kevin Hume learned that Professor Odeblad was to make a visit to Sydney, Australia, in response to an invitation coming from a group of veterinary scientists.Dr. Hume was able to attend Professor Odeblad’s presentation and afterwards informed him of the development of the Ovulation Method, providing him with copies of the Ovulation Method teaching materials which he took away for further study.About two years later he reported that he had gone back over the records of his own research into the activity of the cervix of the uterus during the menstrual cycle, in his capacity as Professor of Medic al Bio-Physics in the University of Umea.He said that he had been surprised and delighted to find that the work that had been carried out in Melbourne precisely coincided with his own studies in Umea and that the guidelines that had been devised in Melbourne for the use of the Ovulation Method were certainly correct.Professor James Brown has added that the ovulation Method has a rule to provide for every situation the woman may encounter during the reproductive era of her life.

Professor Odeblad had been able to explain that fertility has a changing pattern, because there are different types of mucus in varying proportions from day to day up to the time of the Peak of the symptom.He was able to explain why the stringiness does not persist up to the Peak of the symptom, because a zymogen (pre-enzyme) is released in granules from the isthmus of the uterus during the fertile phase, to form with the P2 mucus a mucolytic enzyme which breaks up the strings of mucus before the Peak is reached.He made it clear that the lower viscosity of the L-mucus and P2 mucus cause the release of the thick plug of G-mucus from the cervix to begin.A little of the fluid mucus passes through the vagina to the vulva revealing that sperm are now able to enter the cervical canal.He also pointed out that when the woman is walking the vagina moves a little from side to side and this helps the more fluid mucus to escape.If the woman is at first busy in household or other duties she may postpone micturition by contracting the pelvic musculature and this can obstruct the release of the fluid mucus for a time; he thus confirmed the rule of the Ovulation Method that when it is intended to avoid pregnancy, the couple should not engage in intercourse before the woman has been upright and moving about for some time after getting out of bed.

During the 1970s a committee of the World Health Organisation attached the Billings name to the method, explaining that every new scientific discovery should be given the name of those who made the discovery.

The teachers of the Billings Ovulation Method are enriched by their activities because they see how much the BOM exercises a therapy upon conjugal love.The marriage of the couple has made a covenant in which they give themselves completely to one another and within this gift is their precious fertility.The natural method preserves this unique gift and every act of intercourse remains open to the transmission of life.

The need to wait without intercourse at times is a part of every marriage, because of the birth of a new child, sickness of the husband or the wife, demands of employment and son on.When the couple accepts this gentle discipline they make a magnificent demonstration of their love, the husband for the wife, the wife for the husband, and both together for the children already born and to be born in the future.Each observes the goodness of their decision so that it has the effect of ennobling them both as they perceive what they have done for each other.They are happy to be cooperating with what the Creator has designed in Nature, are at peace with their conscience, and the family is growing in an atmosphere of love, happiness, security and peace which is so appropriate to the rearing of children, each of whom has experienced the beatitude of having from birth a father and mother who love them and love each other.

(Published: " The Bulletin of the Ovulation Method Research and Reference Centre of Australia" Vol. 29 no.1 March 2002)


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