Comment by: Professor-Emeritus James B. Brown, M.Sc. Ph.D. D.Sc. F.R.A.C.O.G. Re: "A new model for ovarian follicular development during the human menstrual cycle", Fertility Sterility, July 6, 2003

Waves of anovulatory ovarian activity as described by the Saskatchewan study were documented by hormone assays and published in the scientific literature during the late 1950s and early 1960s. Their existence has been known to the Billings Ovulation Method for more than 40 years and rules have been developed to allow for it.

The woman observes patches of mucus associated with each wave of follicular activity and is taught to distinguish these patches from true ovulation, which is associated with a more definite increasing mucus pattern followed by the Peak symptom. This distinction is important because confusion between the two events could lead to mistakes in timing ovulation and this applies both to the avoidance and achievement of pregnancy.

Thus, the facts revealed in the Saskatchewan study are absolutely correct, we are grateful to the authors for reminding the world that the waves exist and we ask them to continue with their studies. There are more interesting phenomena to discover.

However, their interpretation that their findings indicate that fertile ovulations can occur more than once on different days during the menstrual cycle is grossly in error. From observing the millions of women using natural methods of family planning and from the daily study of approximately 10,000 ovarian cycles in a large spectrum of women we can state that once ovulation has occurred another ovulation cannot occur in the interval to the next menstrual bleed.

The Saskatchewan study confirmed this in that all the women released only one egg during the study cycle and the only two who appeared to ovulate more than once had abnormal (infertile) cycles. This is also our experience. The problem is to define the day of ovulation correctly and it should be stated that conception could not occur in such abnormal cycles and that they are an important cause of infertility.

The emphasis in the report on the assumed possibility that more than one fertile ovulation can occur on different days during a menstrual cycle reflects the unwarranted hostility of the authors, the Journal and the current official opinion to natural family planning. It also demonstrates that preconceived ideas obtained from assisted reproduction technology applied to infertile women are poor indicators of normal reproductive mechanisms compared with the study of normally fertile women using natural family planning.

Reference: The Continuum