Billings Ovulation Method

Billings Ovulation Billings Ovulation MethodMethod

Natural Fertility RegulationNatural Fertility Regulation


A natural way to:

Achieve Pregnancy

Postpone Pregnancy

Monitor Reproductive Health


easy to learn

simple to use

no drugs or devices

no side effects

reliable

morally acceptable to all cultures

Male FertilityMale Fertility

Sperm production begins at puberty

Production of sperm continues throughout life

Female FertilityFemale Fertility

Begins from puberty

Cyclic – potentially fertile for approx 5-7 days

Finishes at menopause

++

== Couple FertilityCouple Fertility

THE FEMALE REPRODUCTIVE ORGANSTHE FEMALE REPRODUCTIVE ORGANS

THE OVARIES – whose function is the cyclic maturation of ova (eggs), produce hormones oestrogen and progesterone

FALLOPIAN TUBES – tubes through which sperm cells are assisted in their passage from the uterus to the ovum (egg)

FALLOPIAN TUBES – the fertilized ovum (embryo) is actively transported to the body of the uterus

THE UTERUS - the organ of the female in which the embryo implants and develops

ENDOMETRIUM – the inner lining of the uterus which is shed at menstruation

THE CERVIX – the neck of the uterus which bears the mucus-producing crypts

THE VULVA – the external parts of the female genital organs. It is the sensing organ for cervical mucus

THE VAGINA – the birth canal, the passage through which the baby is deliveredThe lining of the vagina has no glands

POCKETS OF SHAW – after ovulation, under hormonal control, mucus is dried as it passes through the vagina

Keeping a RecordKeeping a Record

Observations made at the vulva as the woman goes about her normal daily activities No internal examination

Most fertile characteristic of day recorded each evening

One or two words recorded to describe sensation and appearance Coloured stamps or symbols used on chart

The woman will both feel and see the bleed as it arrives at the vulva

• ••

• •

wet wet wet sticky dry

• • • • • •• •

Sensation/Appearance of discharge

Menstruation, indicated by a red stamp or the symbol

Following menstruation cervix occluded with thick, dense plug of mucus

Plug prevents passage of sperm into cervix and protects body from infection

Sperm cells kept out in vagina quickly become incapable of fertilizing ovum and destroyed by surrounding cells

The ovaries are quiescent

Nothing leaving the cervix, vulva feels dry

• ••

• •

wet wet wet sticky dry dry dry dry dry dry

• • • • • •• •

| | | | |

DRY - nothing is felt, nothing is seen

Recorded with a plain green stamp or the symbol |

BASIC INFERTILE PATTERN (BIP)BASIC INFERTILE PATTERN (BIP)

UNCHANGING PATTERN - DRYUNCHANGING PATTERN - DRY

Discharge remains same day after day, cycle after cycle

Small fragments breaking off lower part of plug results in discharge

BASIC INFERTILE PATTERN (BIP) BASIC INFERTILE PATTERN (BIP)

UNCHANGING PATTERN - DISCHARGEUNCHANGING PATTERN - DISCHARGE

• ••

• •

wet wet stickydry

slight mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

• • •• •• • O O O

• ••

• •

wet wet wet stickydry

slight mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

• • • •• •• • = = = = =

• ••

• •

wet wet wetdry

slight mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

• • •• •• • = = = =

Basic Infertile Pattern of mucus remains the same day after day, cycle after cycle.

Initially recorded with white baby stamp or the symbol O

Then recorded with yellow stamp or the symbol = when pattern is seen to be unchanging

• ••

• •

wet wet stickydry

slight mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

• • •• •• • O O O

• ••

• •


slight mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

• • • •• •• • = = = = =

• ••

• •

wet wet wetdry

slight mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

• • •• •• • = = = =

Basic Infertile Pattern of mucus remains the same day after day, cycle after cycle.

Three cycles are studied in order to identify correctly the point of change of sensation or appearance of the mucus or both

• ••

• •

wet wet stickydry

slight mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

• • •• •• • O O O

• ••

• •


slight mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

• • • •• •• • = = = = =

• ••

• •

wet wet wetdry

slight mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

• • •• •• • = = = =

Basic infertile pattern of mucus remains the same day after day, cycle after cycle.

There is no entry of sperm into the cervix because of the plug of mucus

This unchanging pattern of infertility is common for many women

Ovaries are active and are producing oestrogen

Cervix is stimulated – fluid mucus is produced,this frees the plug, sperm can now enter cervix

oestrogen

• ••

• •

wet wet wet sticky dry dry dry dry dry drysticky

cloudy

• • • • • •• • | | | | | O

Change in sensation – no longer dry

Recorded with white baby stamp or symbol O

Ovaries are active and are producing oestrogen

Cervix is stimulated – fluid mucus is produced,this frees the plug, sperm can now enter cervix

• ••

• •

wet wet wetdry

slight mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

dryslight

mucus

moistcloudy

• • •• •• • = = = = O

Change in vulval sensation or appearance of mucus

• ••

• •


cloudywet

clearslippery

clear

slippery

clearstrings

slippery slippery

• • • • • •• • | | | | | O O O O O O

Changing pattern of fertility

Ovaries producing greater amounts of oestrogen

Mucus progressively changing to a wet, slippery sensation

Clear strings of mucus may be noticed

CHANGING PATTERN OF FERTILITYCHANGING PATTERN OF FERTILITY

• ••

• •


cloudywet

clearslippery

clear

slippery

clearstrings

slippery slippery

• • • • • •• • | | | | | O O O O O O

Maximum amount of mucus may diminish

Slippery sensation may continue for a day or two

Last day of slippery sensation the most fertile day of the cycle - PEAK OF FERTILITY

Very close to the time of ovulation

CHANGING PATTERN OF FERTILITYCHANGING PATTERN OF FERTILITY

THE PEAKTHE PEAK

• the last day of the slippery sensation

• associated with increased sensitivity and with swelling of the vulva

THE PEAKTHE PEAK

The ovary is now producing progesterone,preparing follicle to shed ovum (ovulation)

progesterone

oestrogen

• ••

• •


cloudywet

clearslippery

clear

slippery

clearstrings

slippery slippery dry

• • • •• •• •

| | | | | O O O O O O I

• ••

• • X 1


cloudywet

clearslippery

clear

slippery

clearstrings


• • • •• •• •

| | | | | O O O O O O Ix 1

RECOGNISING THE PEAKRECOGNISING THE PEAK

Peak is recognised on the day of change

No longer any lubricative sensation at the vulva

Peak is marked with a cross on the record

Ovulation occurs on Peak day or days 1 or 2 after Peak

The ovum can live for up to 24 hours

DAY 1 to 3 PAST PEAKDAY 1 to 3 PAST PEAK

Cervix gradually closes with thick plug of mucus

Small channels remain through which sperm can travel

• ••

• • X 1


cloudywet

clearslippery

clear

slippery

clearstrings


• • • •• •• •

| | | | | O O O O O O Ix 1

The three days following the Peak are markedwith a numbered green or yellow baby stamp ora numbered symbol | or =

DAY 1 to 3 PAST PEAKDAY 1 to 3 PAST PEAK

• ••

• • X 1 2 3


cloudywet

clearslippery

clear

slippery

clearstrings

slippery slippery dry sticky sticky

• • • •• •• •

| | | | | O O O O O O I = =x 1 2 3

THE LUTEAL PHASETHE LUTEAL PHASE

From the fourth day past Peak, cervix is closed

Sperm cannot enter

If not fertilized, the egg will have disintegrated

• ••

• • X 1 2 3


cloudywet

clearslippery

clear

slippery

clearstrings

slippery slippery dry sticky sticky sticky drydry

cloudydry

cloudydry

cloudydry

moistcloudy

dry dry dry dry

• • • •• •• •

| | | | | O O O O O O I = = = | = = = | = | | | |x 1 2 3

THE LUTEAL PHASETHE LUTEAL PHASE

Plain yellow or green stamps are now used or the symbols = for discharge or | for dry

Occurs 11-16 days after ovulation

Plug has left the cervix allowing flow of blood

Start of next cycle

MENSTRUATIONMENSTRUATION

Billings Ovulation Method

3 Early Day Rules

Peak Rule

4 Rules

Early Day Rule 1

Avoid intercourse on days of heavy bleeding during menstruation.

Early Day Rule 1

Reason:

Ovulation might occur quite early in the cycle and menstrual bleeding could obscure mucus

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

X 1 2 3

Date ____/____/___

• • • •••

0••

0••

0x

|1

|2

|3

| | | | | | | |

Description of Mucus: Sensation/ Appearance

Wet Wet Wet Wet

spotting

slippery

spotting

slippery

stretchy

spotting

slippery

clear

Peak

sw ollen

v ulv a

dry dry dry dry dry dry dry dry dry dry dry

Early Day Rule 1

Ovulation can occur as early as day 5 Menstrual bleeding would obscure beginning of fertile phase

Early Day Rule 2

Alternate evenings are available for intercourse when these days have been recognised as infertile. (Basic Infertile Pattern)

Early Day Rule 2

Reason:

If the woman is lying down the fluid mucus that leaves the cervix in the beginning of the fertile phase, collects in the upper part of the vagina. The woman needs to be in an upright position for a few hours for this cervical mucus to make its presence felt at the vulva.

Seminal fluid on the day following intercourse could obscure the mucus.

It is important to allow time for the seminal fluid to disappear and to confirm the BIP is still present by avoiding intercourse on consecutive evenings.

•••

•• I I

X 1 2

Date ____/____/___

• • • •••

••

|

I0 |

I0 0 0 0 0 0 0

x|1

=2

Description of Mucus: Sensation/ Appearance

Wet Wet Wet Dry

spotting

Dry

spotting

dry w et

s.f.

dry w et

s.f.

no

longer

dry ,

sticky

cloudy

w et

cloudy

w et

cloudy

stringy

slippery

clear

stringy

slippery

clear

slippery

clear

Peak

sw ollen

v ulv a

dry sticky

opaque

Early Day Rule 2


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

••

•• I I I X 1 2 3 I

• • ••

••

=

I0 =

I0 =

I0 0 0 0 0

x=1

=2

=3

=

I= =

Wet Wet Wet Wet StickyCloudy

WetSF

StickyCloudy

WetSF

StickyCloudy

WetSF

DampCloudy

WetCloudyStrings

SlipperyClear

Strings

SlipperyClearSV

StickyThick

StickyLittle

DrySmear

StickyCloudy

WetCloudy

StickyCloudy

Early Day Rule 2


Early Day Rule 3

Avoid intercourse on days of discharge or bleeding which interrupts the Basic Infertile Pattern.

Allow 3 days of BIP afterwards before intercourse is resumed on the fourth evening. Rule 2 continues

Early Day Rule 3

Reason:Waiting will enable the woman to either recognise the Peak in which case the Peak Rule is used……………….

•••

•••

X 1 2 3

• •••

••

| | | | 0 0 0 0 0 0

x

|

1

=

2

=

3

| |

Wet Dry

spotting

Dry

spotting

dry dry dry dry no

longer

dry ,

sticky

cloudy

w et

cloudy

w et

cloudy

stringy

slippery

clear

stringy

slippery

clear

slippery

clear

Peak

sw ollen

v ulv a

dry sticky

opaque

sticky

opaque

dry dry

Early Day Rule 3

Waiting will enable the woman to either recognise the Peak in which case the Peak Rule is used, or ……………………

Or when the change is an interruption of the BIP caused by raised oestrogens, the hormonal level will return to a basic low level and the woman will recognise a return of the BIP.

She counts 3 days to enable the oestrogens to settle at the basic low level, before resuming intercourse applying Early Day Rule 2

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

•••

•• 1 1 2 3 1 2 3

•••

••• 1 2 3

• • • •••

••

| | 0 0 0 |1

0 |1

|2

|3

| 0 |1

|2

|3

| | | | | | | • • •••

•••

|1

|2

|3

|

Wet Wet Wet w et Dry

spots

dry dry damp

y ellow

damp

y ellow

w et

thick

dry w et

clear

dry dry dry dry change

w et

clear

dry dry dry dry dry dry dry dry dry dry Wet Wet sticky

spots

sticky dry dry dry dry

Early Day Rule 3

or when the change is an interruption of the BIP, caused by raised oestrogens……

Allow 3 days of BIP before intercourse is resumed on 4th evening

Peak Rule

From the beginning of the 4th day past the Peak until the end of the cycle, intercourse is available every day at any time.

X 1 2 3I I I I I

| 0 0 0 0 0 0x

|1

=2

=3

|

I=

I=

I= = = | | | |

I=

I=

dry no

longer

dry ,

sticky

cloud

y

w et

cloudy

w et

cloudy

stringy

slipperyclear

stringy

slipperyclear

slippery

clear

Peak

sw ollen

v ulv a

dry sticky

opaque

sticky

opaque

dry w et w et

cloudy

w et

cloudy

moist

cloudy

moist

cloudy

dry dry dry dry w et w et

Peak Rule

From the beginning of the 4th day past the Peak until the end of the cycle, intercourse is available every day at any time.


Observation of PatternsObservation of Patterns

FertilityFertility

Changing, developing pattern of variable length

InfertilityInfertility

Unchanging pattern

Rules for achievement of Pregnancy

Apply the Early Day Rules

Postpone intercourse until the slippery sensation occurs

Intercourse should occur over the time of the slippery sensation and for one or two days after

Rules for postponement of Pregnancy

Apply

The Early Day Rules

The Peak Rule

Billings Ovulation Method

3 Early Day Rules

Peak Rule

4 Rules

Can be used throughout all stages of reproductive life


Effectiveness

Recent trials have reported effectiveness greater than 99% when the Method guidelines were followed for avoidance of pregnancy *

*Indian Council of Medical Research Task Force on NFP (1995)

*Jiangsu Family Health Institute, China (1997)


RequirementsRequirements

• Accurate Observations

• Accurate Charting

• Motivation

• Loving co-operation


BenefitsBenefits

• Accurate, scientific, simple method of regulating fertility

• Increases knowledge, understanding and of respect for fertility

• Joint responsibility

• Does no harm

• Develops couple communication and relationships


Research began in 1953. Ongoing research has confirmed validity of this safe, effective and reliable method

Drs John and Evelyn Billings

Billings Ovulation Method

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