EDITORIAL COMMENT: In this paper the authors have made an important point. Counselling concerning simple treatment options should be the first step in the management of infertility as for most other medical problems. Conversely it could be said, as stated by an Anglican priest to the editor about 10 years ago, that counselling the infertile couple, who were candidates for only the most complicated regimens of reproductive technology, should include acceptance of their infertility. Many years ago the editor, when doing a locum,met a couple whose longstanding infertility was the result of misunderstanding of the physiology of conception,with avoidance of coitus at the fertile time of the cycle- conception occurred 2 months after a simple explanation of the physiology of the menstrual cycle as advocated in this paper.
World Health Organisation: Task Force on Methods for the Determination of the Fertile Period, Special Programme of Research, Development and Research Training in Human Reproduction. World Health Organisation. Geneva, Switzerland. The intra and inter woman variation in nine physiological or biochemical indices of the fertile period has been studied over 58 menstrual cycles from 13 experienced users of the symptothermal method of family planning by periodic abstinence. The time and duration of a possible fertile period have been determined by five methods (symptothermal, cervical mucus, basal body temperature plus calendar calculation, defined changes in the concentration of estrone-3-glucuronide and the ratio of estrone-3-glucuronide to pregnanediol-3a-glucuronide as determined by immunochemical tests on daily samples of early morning urine). The values were compared with a period of probable fertility (day of urinary luteotropin (LH) peak -3 to day of LH peak -2). The duration of the possible fertile period for each method (mean= standard deviation) was 13.4 (2.9), 11.9 (2.9), 11.8 (3.3), 9.3 (2.2), and 10.9 (2.3) days, respectively,while the percentage of the probable fertile periods covered entirely by each approach was 98%, 91%, 90%, 83%, and 84%, respectively. The results warrant the initiation of clinical traits to ascertain the practical value of the individual or combined tests for family planning and the management of infertility.Fertil Steril 39:647, 1983.
FERTILITY AND STERILITY Vol.29. No.5 May 1983 Copyright 1983 The American Fertility Society Printed in U.S.A
ABSTRACT: Information about fertility awareness helps to fulfil the broader definition of the services many family planning clinics offer. Although information about natural family planning is requested by a small number of clients seeking family planning advice, many more clients benefit from information about fertility awareness. Fertility awareness is far more than just basic reproductive anatomy and physiology; fertility awareness involves understanding basic information about fertility and reproduction, being able to apply it to oneself, and being able to discuss it with a partner or with a health professional. Fertility awareness is fundamental to understanding and making informed decisions about reproductive health and sexual health. If clients have a better understanding of fertility awareness, they are in a stronger position to make informed decisions about how they wish to manage their reproductive and sexual health, for example: (1) Fertility awareness information is used to help couples to plan pregnancies as well as to
avoid them. This can be helpful to couples who are having difficulty conceiving, for the timing of intercourse or for the timing of some of the subfertility investigations. The information is also useful when helping couples to understand how each method of family planning works – how the family planning method interrupts normal fertility, how the method will fail if not used correctly, and how fertility returns when the method is discontinued. (3) Women who are fully breastfeeding value the knowledge about reduced fertility, as do women during the perimenopausal years who value being given clear information about their declining fertility. (4) When counselling couples about the importance of avoiding sexually transmitted diseases it is important they understand sexually transmitted diseases may damage their fertility. (5) Couples who choose only to use a barrier method during the time they think the woman is fertile are a group who do not readily identify themselves to family planning providers. These couples often do not have adequate information about fertility awareness. Advances in technology and the understanding of ovulation, ovum and sperm survival have confirmed that the guidelines used to teach fertility awareness and natural family planning effectively identify the fertile phase of the menstrual cycle. Serial ultrasound studies on the ovaries during the menstrual cycle have confirmed the accuracy of the hormonal assays in pinpointing the likely time of ovulation. Ultrasound studies have also shown that subjective
Correspondence: D: C.M.M. Pyper, Health Services Research Unit, University of Oxford, Department of Public Health & Primary Care, Institute of Health Sciences, Oid Road, Oxford OX2 SHE, UK
The European Journal of Contraception and Reproductive Health Care 2 (1997) 131–146 Fertility awareness and natural family planning M. M. Pyper Health Services Research Unit, Department of Public Health & Primary Care, Institute of Health Sciences, Oxford, UK