Correlations between the mucus symptoms and the hormonal markers of fertility throughout reproductive life.

Abstract

The accuracy of the self-observed mucus symptoms in identifying the fertile and infertile phases of the ovarian cycle as used in the Ovulation Method (Billings) were tested a do-it-yourself kit for measuring urinary estrogen and pregnanediol excretion was assessed to determine value in natural family planning (NFP) and ovarian activity under all possible conditions encountered in a large population of women was documented. A final study objective was to feed back this information for the improvement of NFP methods. Of the 104 cycles studied the great majority (91) showed an unambiguous mid-cycle estrogen peak. Double estrogen peaks in white 2 higher values 2 days apart were separated by 1 lower value were encountered in 13 cycles. In these definition of day was made on the basis of the accompanying pregnanediol rise. This placed day as the 1st peak in 2 cycles the 2nd peak in 7 cycles and the intermediate value in 4 cycles. 2 of the conceptual cycles showed double peaks and thereford such a finding was not a bar to conception. Part of the information required from the study was whether identification of the 1st sustained estrogen rise early in the cycle would provide sufficient warning of ovulation to be of value in NFP. A 6-day prediction would be ideal to allow for the longest sperm survivals. In all cycles in which sufficient information was obtained there was a cleear transition from early baseline estrogen values which in the majority (91%) fluctuated between 4-14 mcg/24 hours to the sustained rise which culminated in the preovulatory estrogen peak. In the remaining cycles the base line values fluctuated between 11-22 mcg/24 hours. The pregnanediol values reached their lowest levels between days -7 and -1. Thereafter the values began to rise. Only 50% of the women would have received a 6 day or more warning of ovulation from either the 1st estrogen rise or the 1st value exceeding 15 mcg/24 hours. The 3 women who had only 3 days warning were all trying to conceive and were having intercourse over this time. Although it is generally agreed that intercourse has no effect on inducing ovulation in the human it is possible that ovulation when it was imminent could have been advanced by the acts of intercourse in these women. This phenomenon would operated to reduce the safety margins provided by the rules of the Ovulation method. On the basis of these findings it could be argued that a do-it-yourself kit based on estrogen estimation would not provide sufficient warning of ovulation in a high enough percentage of women to be of value in defining the beginning of the fertile phase for NFP. There is little problem in the application of a do-it-yourself kit for pregnanediol estimation. In another series of 43 ovulatory cycles the correlation coefficient relating the day of the preovulatory estrogen peak with the day of the maximum mucus production was 0.95 and the coefficient relating the estrogen peak with the last day of fertile mucus was also 0.95 In sum the self-observed mucus symptoms are an accurate reflection of the underlying ovarian activity.