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Geneva, Switzerland, WHO, 1967. 20 p. (WHO Technical Report Series No. 360)In this report of a World Health Organization (WHO) Scientific Group on the Biology of Fertility Control by Periodic Abstinence, convened in Geneva during May and June 1966, existing knowledge of the menstrual cycle, ovulation, and fertility is outlined relevant to the objective of understanding the mechanisms of fertility control by periodic abstinence. Discussion is limited to physicological and arithmetical analyses of the subject to the relative effectiveness of different methods for determining the necessary period of abstinence. Attention is directed to genital and extragenital changes associated with the menstrual cycle as possible aids in detecting ovulaion and the demarcation of that part of the cycle that is potentially the fertile period. Studies of the use effectiveness of the calendar methods have given failure rates that vary from 14 to almost 40 pregnancies/100 woman-years of use. In 4 studies in Western Europe of the use effectiveness of the temperature method, the failure rate was 0.8 to 1.4 pregnancies/100 woman-years of use. The most common causes of failure, i.e., pregnancy, with the various forms of fertility control by periodic abstinence are probably lack of accurate knowledge regarding the method used and lack of motivation. Recommendations regarding research needs are included.
Washington, D.C., Georgetown University, School of Medicine, Institute for International Studies in Natural Family Planning, 1989 Jul. 15,  p. (USAID Cooperative Agreement DPE-3040-A-00-5064-00)Natural family planning (NFP) is a technique for determining a woman's fertile period to regulate childbearing. There are many methods in NFP including rhythm or calendar, basal body temperature, cervical mucus, modified mucus, and sympto-thermal. All of these methods use the natural signs and symptoms of a woman's fertile and infertile periods of the menstrual cycle. The rhythm or calendar is still the most widely used method, and women keep track of the lengths of previous menstrual cycles to determine the days of fertility. The cervical mucus method uses changes in the characteristics of the mucus during the fertile period. The basal body temperature method uses the change in resting temperature to determine the fertile period. The sympto-thermal method uses a combination of body temperature, cervical mucus, and breast tenderness to determine the fertile period. Breast feeding provides a period of about 6 months after birth when there is a delay in the return of ovulation. The advantages of natural family planning include the following: little contact with medical personnel and procedures, it is less expensive, it may provide a method in agreement with religious or ethical beliefs, and it can help couples understand how their reproductive system works. In a World Health Organization study, the effectiveness of NFP was shown to be 78% overall, and the continuation rate was 65%. Many other studies have shown rates between 70-90% effectiveness over a 12 month period. In a recent African study over a 5 year period, unplanned pregnancy rates were 4.3% and 9.6% in Liberia and Zambia respectively.
World Health. 1978 Aug-Sep; 20-1.The success of natural family planning (NFP) methods which use the pattern of the menstrual cycle to regulate fertility, depends on the quality of instruction provided to the user as well as on user understanding and motivation. In response to a request to help improve the educational aspect, WHO has developed educational materials for use by nonphysicians to form a standard NFP curriculum. These materials are currently being evaluated in several countries to determine the minimal information required to teach and practice NFP. A basic understanding of reproductive biology is essential for teaching and practicing NFP. Women users are taught to identify ovulation by observation of the cyclical changes in cervical mucus and by recording basal body temperature. Teachers are informed about the effects of pituitary hormones on reproduction. In addition, the materials include information on psychological and behavioral aspects of NFP.
In: Mishell DR Jr, ed. Advances in fertility research. Vol. 1. New York, Raven Press, 1982. 1-18.This discussion of natural family planning (NFP) focuses on the following: calculation of the calendar method; the basal body temperature method; the ovulation method; sympto-thermal methods; international studies on NFP; effectiveness of NFP; breastfeeding and birth spacing; psychological and psychosexual aspects of NFP; and research and development of new methods to determine the fertile period. The calendar method, the oldest technique for determining the fertile period, involves the identification of the fertile time from the records of the previous 6-12 menstrual cycles. The temperature or thermal method depends on the identification of the rise in the basal body temperature (BBT) from a relatively low level during the follicular phase to a relatively higher level during the luteal phase of the menstrual cycle. The basis of the ovulation method is that the cervical glands are highly sensitive indicators of the estrogen level in the blood and thus accurately reflect the follicular maturation in the ovary. In order to use the ovulation method, the woman must learn to recognize the sequence of changes in the quality and quantity of her mucus and the associated sensation at the vulva. The sympto-thermal methods incorporate several markers of ovarian function in order to define the infertile period with greater accuracy. From the perspective of fertility control, it should be recognized that traditional breastfeeding has a central regulating role in the spacing of births and is of considerable importance where methods of fertility control are either unacceptable or unavailable. Couples who follow the rules of NFP methods have a highly effective means of fertility regulation with method failure rates of 0.5-3.0 pregnancies in 1300 cycles. In general use, the methods are around 80% effective. The major advantage of NFP is that no hormones or chemicals are introduced into the woman's body. The couple oriented method promotes both self knowledge and self reliance. NFP calls for an education rather than a medical delivery system, and it aims to make the users both autonomous and potential educators of other users. The major problem with NFP is the modification of the sexual behavior involved and the extent of motivation necessary for successful use. Easy to use and inexpensive tests that identify the fertile period and ovulation would be useful for fertility control, and the World Health Organization task force is currently at work on the development of new technology in this field.
In: Jeffcoate SL, ed. Ovulation: methods for its prediction and detection. Chichester, England, John Wiley, 1983. 33-47. (Current Topics in Reproductive Endocrinology Volume 3)This chapter reviews certain recognizable biological effects that occur due to the major changes in the circulating blood levels of estrogen and progesterone and discusses the ongoing use of these biological signals for the self detection of ovulation and the fertile phase of the cycle. These biological changes include the basal body temperature, changes in the cervix and its mucus secretion, mittelschmerz, and the menstrual cycle molimina. The calculation or calendar method is the oldest technique for determining the fertile period and followed the work of Ogino (1930) and Knaus (1933). The fertile phase of the cycle was identified from the records of the previous 6-12 menstrual cycles. The potential fertile period was then calculated on the following basis: define the shortest and the longest menstrual cycle over the preceding 6 and preferable 12 cycles; the 1st day of the potentially fertile phase is the longest cycle minus 11 days. For a women whose menstrual cycles have varied between 26-31 days, the potential fertile period would be days 8-20 of the cycle. The greatest weakness of the calendar calculation is that it depends on a prediction, based on the menstrual history, of what is likely to occur and not on what is actually taking place. Very rapid electronic thermometers are now available which offer considerable advantages over the clinical thermometer. The daily taking and charting of the basal body temperature (BBT) is the simplest and most widely used method for detecting ovulation. To overcome the drawbacks of the calendar method and the BBT method for identifying the fertile period, John and Evelyn Billings of Melbourne in the early 1970s developed the ovulation method. Self recognition of cervical mucus symptoms provides the woman with a simple means of detecting the fertile phase of her cycle and the likely time of ovulation. Individual cycle variation in the preovulatory duration of the symptoms limits the position of the prediction, yet the "peak" day correlates better with the time of ovulation than the shift in BBT. In addition to effects on cervical mucus, estrogen also changes the morphology of the cervix. The preovulatory rise in estrogensoftens the tissues of the cervix and opens the cervical os. The softened cervix and gaping os with a cascade of clear mucus is a sign of optimal estrogen response and of imminent ovulation. A World Health Organization (WHO) multicenter study of the ovulation method provided a substantial amount of information of the normal menstrual cycle of a large number of women of proven fertility in the age group 18-39 years whose cycles were not influenced by the use of hormonal or other contraceptive methods.