The different methods of natural family planning evolved in the 20th century, (mainly in the latter half of the 20th century), in tandem with the scientific developments in the physiology of fertility. At first a single fertility indicator was used to define the fertile phase and then combinations of different fertility indicators were used to define the beginning and end of the fertile phase. The scientific basis of natural family planning is well established. The effectiveness of natural family planning has been documented by research groups in Europe and also by the World Health Organisation12-19among others.
The Temperature Method : (a single index method of natural family planning) :
The Temperature Method was one of the first natural family planning methods used. The hormone progesterone, secreted by the corpus luteum in the ovary after ovulation causes the temperature to rise in the luteal phase of the cycle (thermal shift). This gives the classic biphasic temperature pattern in the ovulatory cycle, i.e. low in the pre-ovulatory phase and high in the post-ovulatory phase (luteal phase). The post-ovulatory phase is called the ‘definitely infertile phase’ as after ovulation the ovum lives for just one day, and no further ovulation can occur in that cycle. The beginning and end of the ‘definitely infertile phase’ is defined by the RULES of the Natural Family Planning Method used. (The Temperature Method is a reliable method of avoiding pregnancy but as it can only detect the end of the fertile phase, long periods of abstinence may be required.1
- In 1868 Dr W. Squire, London first noted that the basal body temperature follows a biphasic pattern in the reproductive period of life and in 1876 Dr Mary Putnam Jacobi, Philadelphia described the BBT rise in the cycle. In 1904 Van de Velde in Holland noted that the temperature shift from a lower to a higher level was related to ovulation. In 1928 Van de Velde pointed out that the rise intemperature was due to progesterone secretion from the corpus luteum. In 1947 Basal Body Temperature was used to assess the fertile time by Ferin. In 1968 Dr John Marshall a Neurologist in England did the first prospective field trial of BBT.1
Ogino -Knaus Method (1930s); (Calendar Method):
The Calendar Method, developed by Dr Ogino (Japan) and Dr Knaus (Austria), was based on their independent discovery of the length of the post-ovulation phase, (luteal phase) of the cycle. The ‘calendar rule’ or ‘calendar method’ devised by them to define the probable beginning and end of the fertile phase of the cycle is a statistical measurement based on knowing the following three facts; (a) the longest and shortest cycle lengths over 6 to 12 months, (b) the lifespan of the sperm and ovum and (c) the luteal phase length (on average 14 days). This necessitates having an accurate history of the menstrual cycle lengths for at least 6-12 months.
The Calculo-Thermal Method was the first combination method of natural family planning as it used more than one indicator, i.e. the combination of the ‘Temperature Method’ with the ‘Calendar Rule’, and was taught by Fr Wilhelm Hillebrand in Germany in 1935.
The Symptothermal Method:
The Symptothermal Method is another combination method of natural family planning which uses both ‘cervical mucus’ and ‘basal body temperature’, and this method was taught by Dr Josef Roetzer, an Austrian public-health physician in 1951 and by Dr Edward Keefe an obstetrician in New York in 1953. Dr Keefe also reported in 1962 on the changes that occur in the cervix at the time of ovulation.7 The combination of Cervical Mucus and Basal Body Temperature was studied by Dr John Marshall in London.4
Billings Ovulation Method: (a single index method of natural family planning) :
Dr John and Evelyn Billings in Melbourne in 1964 used observations of the changing quality and quantity of the cervical mucus secretion as a single fertility indicator to identify the beginning and end of the fertile phase of the cycle, and called it the ‘Ovulation Method’.2,3 Their co-workers included Dr James Brown, a pioneer in oestrogen biochemistry, Prof. Erik Odeblad, School of Medicine, Umea, Swedan who has done pioneering research in the biophysical properties of cervical mucus since 1959.
Symptothermal Double-Check Method, (Multiple-Index Method):
In the ‘symptothermal double-check method’ of natural family planning two fertility indicators are used to define both the beginning and end of the fertile phase of the cycle. This method was originally suggested by Paul Thyma in the USA in 1973.5,6 One of the pioneers of the ‘symptothermal double-check method’ in the mid 1970s was Dr Anna Flynn in Birmingham, England8 and the Natural Family Planning Teachers’ Association of Ireland (NFPTAI) teach her method. Others who also developed the ‘symptothermal double-check method’ were Dr J Roetzer, Austria9 and Dr K. Prem, and John & Sheila Kippley10 of the Couple to Couple League, USA.
Creighton Model Fertility Care System:
This method devised by Dr Thomas W Hilgers, Creighton University, Omaha, Nebraska, USA is a modification of the cervical mucus method.11 It utilizes a standard nomenclature to describe the mucus observations.
- Marshall, J; A field trial of the basal body temperature method of regulating births; Lancet,1968, July, 8-10;
- Billings, JJ; “The ovulation Method”; (1964) ; Advocate Press, Melbourne, Australia;
- Billings, E & J; Symptoms &Hormonal Changes accompanying ovulation; Lancet; Feb 5; 1972; 282-284.
- Marshall, J; ‘Cervical mucus and Basal Body Temperature method of Regulating births'; Lancet; Aug 1976; 282-283.
- Thyma, P; Fertile and Infertile days in married life; authors edition, Fall River, Massachusetts: Raritan Printing Company; 1973
- Thyma, P;’The Double-Check Method of Natural Family Planning';Married Life Information,Fall River,Massachusetts; 1976.
- Keefe, E; ‘Self-observation of the cervix to distinguish days of possible fertility'; Bull of the Sloane Hosp for Women;1962; 129-136
- Flynn, Anna & Brooks Melissa;’The Manual of Natural Family Planning’ p32;1996; ISBN 0 7225 3115 X
- Roetzer, Josef; ‘The sympto-thermal Method': Ten years of change; Linacre Quarterly, Nov 1978; 358-374
- Kippley; ‘The Art of Natural Family Planning; 4th ed 1996; ISBN 0-926412-13-2
- Hilgers TW; ‘The medical and surgical practice of NaProTECHNOLOGY; 2004; ISBN 0-9744147-0-0.
- World Health Organization; ‘Temporal relationships between ovulation and defined changes in the concentration of plasma estradiol-17N2, luteinizing hormone, follicle-stimulating hormone, and progesterone'; 1. Probit analysis; Am. J. Obstet. Gynecol. 138:383-390, 1980.
- World Health Organization; ‘Temporal relationships between ovulation and defined changes in the concentration of plasma estradiol-17N2, luteinizing hormone, follicle-stimulating hormone, and progesterone'; 11. Histologic dating; Am. J. Obstet. Gynecol. 139:886-895, 1981.
- World Health Organization; ‘Temporal relationships between indices of the fertile period'; Fertility & Sterility; Vol 39, May 1983; p647-655. (Dr Anna Flynn MRCOG, Birningham was one of the task force investigators).
- World Health Organization; ‘A prospective multicentre trial of the Ovulation Method of Natural Family Planning 1;B The Teaching Phase'; Fertility & Sterility; Vol 36, no 2, Aug 1981; p152-158.
- World Health Organization; ‘A prospective multicentre trial of the Ovulation Method of Natural Family Planning 11;B The Effectiveness Phase'; Fertility & Sterility; Vol 36, no 5,B Nov 1981; p591-598.
- World Health Organization; ‘A prospective multicentre trial of the Ovulation Method of Natural Family Planning 111; Characteristics of the menstrual cycle and of the fertile phase'; Fertility & Sterility; Vol 40, No 6, Dec 1983; 773-778.
- World Health Organization; ‘A prospective multicentre trial of the Ovulation Method of Natural Family Planning 1V; The Outcome of Pregnancy'; Fertility & Sterility; Vol 41, no 4, April 1984; p593-598.
- World Health Organization; ‘A prospective multicentre trial of the Ovulation Method of Natural Family Planning V;B Psycosexual aspects'; Fertility & Sterility; Vol 47, no 5, May 1987; p765-772.