1. Billings Ovulation Method
Natural Fertility Regulation

2. Billings Ovulation Method
A natural way to:
Achieve Pregnancy
Postpone Pregnancy
Monitor Reproductive Health

3. Billings Ovulation Method
easy to learn
simple to use
no drugs or devices
no side effects
reliable
morally acceptable to all cultures

4. + = Couple Fertility Male Fertility Female Fertility
Sperm production begins at puberty
Production of sperm continues throughout life
Female Fertility
Begins from puberty
Cyclic – potentially fertile for approx 5-7 days
Finishes at menopause + =
Couple Fertility

5. THE FEMALE REPRODUCTIVE ORGANS

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

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

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

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

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

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

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

13. THE VAGINA – the birth canal, the passage through which the baby is delivered The lining of the vagina has no glands

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

15. Keeping 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

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

17. Menstruation, indicated by a red stamp or the symbol 
Sensation/ Appearance of discharge
Menstruation, indicated by a red stamp or the symbol 

18. Following menstruation cervix occluded
with thick, dense plug of mucus

19. 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

20. The ovaries are quiescent
Nothing leaving the cervix, vulva feels dry

21. BASIC INFERTILE PATTERN (BIP) UNCHANGING PATTERN - DRY
DRY - nothing is felt, nothing is seen
Recorded with a plain green stamp or the symbol |

22. BASIC INFERTILE PATTERN (BIP) UNCHANGING PATTERN - DISCHARGE
Discharge remains same day after day, cycle after cycle
Small fragments breaking off lower part of plug results in discharge

23. Initially recorded with white baby stamp or the symbol O
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

24. 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

25. This unchanging pattern of infertility is common for many women
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

26. Ovaries are active and are producing oestrogen
Cervix is stimulated – fluid mucus is produced, this frees the plug, sperm can now enter cervix

27. Change in sensation – no longer dry
Recorded with white baby stamp or symbol O

28. Change in vulval sensation or appearance of mucus
Ovaries are active and are producing oestrogen
Cervix is stimulated – fluid mucus is produced, this frees the plug, sperm can now enter cervix

29. 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

30. CHANGING PATTERN OF FERTILITY
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

31. THE PEAK the last day of the slippery sensation
associated with increased sensitivity and with swelling of the vulva

32. THE PEAK
oestrogen
progesterone
The ovary is now producing progesterone, preparing follicle to shed ovum (ovulation)

33. RECOGNISING 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

34. Ovulation occurs on Peak day or days 1 or 2 after Peak
The ovum can live for up to 24 hours

35. DAY 1 to 3 PAST PEAK
Cervix gradually closes with thick plug of mucus
Small channels remain through which sperm can travel

36. DAY 1 to 3 PAST PEAK
The three days following the Peak are marked with a numbered green or yellow baby stamp or a numbered symbol | or =

37. THE LUTEAL PHASE From the fourth day past Peak, cervix is closed
Sperm cannot enter
If not fertilized, the egg will have disintegrated

38. THE LUTEAL PHASE
Plain yellow or green stamps are now used or the symbols = for discharge or | for dry

39. MENSTRUATION Occurs 11-16 days after ovulation
Plug has left the cervix allowing flow of blood
Start of next cycle

40. Billings Ovulation Method
4 Rules
3 Early Day Rules
Peak Rule

41. Early Day Rule 1
Avoid intercourse on days of heavy bleeding during menstruation.

42. Early Day Rule 1
Reason:
Ovulation might occur quite early in the cycle and menstrual bleeding could obscure mucus

43. Early Day Rule 1
Ovulation can occur as early as day 5 Menstrual bleeding would obscure beginning of fertile phase

44. Early Day Rule 2
Alternate evenings are available for intercourse when these days have been recognised as infertile. (Basic Infertile Pattern)

45. Early Day Rule 2
Reason:
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.
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.

46. Early Day Rule 2
Alternate evenings are available for intercourse when these days have been recognised as infertile. (Basic Infertile Pattern)

47. Early Day Rule 2
Alternate evenings are available for intercourse when these days have been recognised as infertile. (Basic Infertile Pattern)

48. 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

49. Early Day Rule 3
Reason:
Waiting will enable the woman to either recognise the Peak in which case the Peak Rule is used……………….

50. Early Day Rule 3
Waiting will enable the woman to either recognise the Peak in which case the Peak Rule is used, or ……………………

51. 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

52. 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

53. 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.

54. 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.

55. Billings Ovulation Method
Observation of Patterns
Fertility
Changing, developing pattern of variable length
Infertility
Unchanging pattern

56. 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

57. Rules for postponement of Pregnancy
Apply
The Early Day Rules
The Peak Rule

58. Billings Ovulation Method
4 Rules
3 Early Day Rules
Peak Rule
Can be used throughout all stages of reproductive life

59. Billings Ovulation Method
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)

60. Billings Ovulation Method
Requirements
Accurate Observations
Accurate Charting
Motivation
Loving co-operation

61. Billings Ovulation Method
Benefits
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

62. Billings Ovulation Method
Research began in Ongoing research has confirmed validity of this safe, effective and reliable method
Drs John and Evelyn Billings