SCIENTIFIC VERIFICATION OF THE OVULATION METHOD BY DR. JAMES BROWN
James B. BrownDegrees and Fellowships
M.Sc. (1st Class Honours),
New Zealand University, 1940.
Ph. D., University of Edinburgh, 1952.
D.Sc., University of Edinburgh, 1970.
Fellow of the Royal Australian College of Obstetricians and Gynecologists.
Present Position
Professor Emeritus and Associate,
Department of Obstetrics and Gynecology,
Royal Women´s Hospital, University of Melbourne
Dr. Brown has worked since 1947 on the application of hormone assays in the identification of the phases of fertility and infertility during the menstrual cycle in Auckland, New Zealand, in Edinburgh, Scotland (1949-1962) and in Melbourne, refined the assays for estrogens and pregnandiol for rapid and mass application. During the 1960s, Dr. Brown used these assays in helping Drs. John and Lyn Billings develop and validate the Ovulation Method.
He is involved in the international application of hormone assays in cancer research and, with his colleagues at Harvard University, he has been awarded the 1986 Antoine Lecassagne prize by La Ligue Nationale Francaise contre le Cancer. He is also involved with Georgetown University, U.S.A.I.D. and Family Health International, in a large multinational study of returning fertility in breast-feeding women.
Much of the early key research into the Ovulation Method was carried out by Dr. James Brown. In 1962, Dr. Billings asked Dr. Brown to conduct hormonal studies to correlate the accuracy of women´s observations of the cervical mucus patterns associated with ovulation. Dr. Brown agreed and began a comprehensive program of clinical and laboratory research. Hundreds of women´s cycles in all reproductive categories were tested.
Dr. Brown´s research showed that the development of the mucus symptom coordinated with the estrogen levels in the folicular phase of the cycle much better than any other symptom accompanying ovulation; it also helped establish the relationship between estrogen and progesterone, the cervical mucus changes and ovulation.
Urinary estrogen and pregnanediol values, mucous symptoms, and basal temperature during three cycles in a normal subject.
While Dr. Brown worked on estrogen and progesterone, his colleague, Dr. Henry Burger, an endocrinologist at Monash University, Melbourne, worked on the other hormones which regulate the menstrual cycle: follicle stimulating hormone (FSH) which stimulates the development of the follicle containing the ovum; and luteinizing hormone (LH) which triggers ovulation.
Using blood samples provided by the Ovulation Method users, Professor Burger was able to chart the changes in LH and FSH during the cycles of normally fertile women. He was able to show the relationship of the peak mucus symptom and the LH peak. Professors Brown and Burger, working with Dr. Kevin Catt (1), showed tha the release of LH followed the mid-cycle estrogen peak by a mean 16 hours (range 0-2 days).
The work of Drs. Billings, Brown and Burger (2) relating hormone changes to the mucus symptom was first published in a British medical journal, the Lancet, in 1972. This study showed that the time of ovulation could be identified by women themselves when charting their mucus symptom without recourse to either basal body temperature measurement or more specialized tests. The study established the relationship between the surge of LH, ovulation, and the observation of the peak mucus symptom.
Further studies of these relationships have been conducted under the direction of the World Health Organization´s expanded program of research, development, and research training in human reproduction. The available evidence indicates that:
The estradiol spurt resulting in fertile-type mucus that warns of possible fertility, starts on average six days before ovulation.
The estradiol peak occurs about thirty-seven hours before ovulation.
The LH level begins to rise about thirty to forty hours before ovulation, reaching a peak about seventeen hours before the ovum is released.
The peak mucus symptom, as judged by women themselves, occurs on average 0.6 day (fourteen hours) before ovulation. In about 85 percent of women the Peak occurs within a day of ovulation and in about 95 percent within two days. (3)
93% of the subjects in one WHO study were able to identify and interpretable ovulatory mucus pattern in the first teaching cycle. (4)
Day of cycle relative to estrogen peak = day 0. The vertical broken line shows the approximate time of ovulation. From "Correlations between the mucus symptoms and the hormonal markers of fertility throughout reproductive life" J.B. Brown, P. Harrisson, M.A. Smith and H.G Burger. Monograph, Advocate Press, Melbourne, 1981.
The preceding graph was used by Dr. Billings in a study published in 1981 in the International Journal of Fertility. (5) The graph, illustrating the correlation between changes in mucus, basal body temperature, and pregnanediol in 43 cycles, further confirms that cervical mucus, as charted by women themselves, accurately reflects what is taking place in the ovary.
The combined clinical and hormonal studies of Drs. Billings, Brown and Burger over the past 20 years have involved several hundred women and over 5,000 estimations of the levels of the ovarian hormones.
Dr. Brown is currently working to perfect an at-home kit he has developed for measuring estrogen and progesterone levels during the cycle. The kit registers when there is a significant rise of estrogen early in the cycle, which shows the beginning of the fertile phase, and again when the progesterone level reaches a height that indicates that the woman has ovulated and the late infertile phase of the cycle has begun.
Every woman wishing to use Natural Family Planning will be able to use this low cost kit either as an aid in learning the Ovulation Method so that she can be sure she is identifying her mucus symptoms correctly, or to provide further reassurance that she has pinpointed the fertile and infertile phases of her cycle.
Women who have difficult mucus symptoms, such as those breast-feeding, discontinuing the Pill or approaching menopause, will find the kit most helpful in supplying absolute markers of fertility and infertility.
Obstetricians and gynecologists will find the kit valuable as an indicator of ovulation and the time of maximum fertility in infertility cases, and as a means of identifying abnormal but benign ovarian activity in premenopausal women and thus reduce the need for surgery at this time
NOTES
- "Relationship between plasma luteinizing hormone and urinary estrogen excretion during the menstrual cycle," H.G. Burger, K.J. Catt and J.B. Brown, Journal of clin. Endocrin. and Metab. 28:1508-1512, 1968.
- "Symptoms and hormonal changes accompanying ovulation," E.L. Billings, J.J. Billings, J.B. Brown and H.G. Burger, Lancet 1:282-284, 1972.
- "Cervical mucus, the biological marker of fertility and infertility," J.J. Billings, International Journal of Fertility 26:182-195, 1981.
- World Health Organization Colloquium, "The Cervical Mucus in Human Reproduction," Geneva, 1972.
- World Health Organization, "A prospective Multicenter Trial of the Ovulation Method of Natural Family Planning.
- II. The Effectiveness Phase," Fertility and Sterility, 36, 591, 1981.