Normal Fertile Cycle

Application of Rules to Postpone Conception

Continuous Discharge

Short, Early Ovulation

Long, Delayed Ovulation

Achieving Pregnancy

Variations of the Cycle and Reproductive Health

Teaching the Billings Ovulation Method Part 2
Evelyn L. Billings and John J. Billings

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1. Normal Fertile Cycle

Recording of Observations at the Vulva of the Sensation and Appearance due to Cervical Mucus

• For the first month, while observations are made, genital contact should not occur. Seminal fluid and secretions due to intercourse may delay learning mucus patterns.

• When teaching a woman to make observations, emphasize "how does the vulva feel?", during normal activities, for example, walking, etc. It is important that no internal investigations are made.

• When menstruation begins the vulva is not dry. The sensation is wet or sticky and the blood is seen.

• The sensation at the vulva is dry when nothing is leaving the vagina.

• When mucus begins, the sensation changes from dry to no longer dry. Some mucus may or may not be seen.

• Each woman is an individual and will describe her own mucus patterns in her own words. A good teacher listens carefully so that she can help the woman to record her observations faithfully and interpret them correctly.

• When teaching it is important not to tell the woman what she will find, but to encourage her to become aware of her own signs. These can be interpreted to indicate infertility or possible fertility. The rules for achieving or avoiding conception then can be applied reliably.

• In general, the fertile pattern of mucus changes from day to day, progressing from stickiness to slipperiness often with visible clear or cloudy strings of mucus until the Peak symptom, when the vulva is slippery, swollen and has a heightened sensitivity. At this time there may be very little or no mucus to be seen. Sperm survive in favourable mucus for 2-3 days, sometimes up to 5 days.

• Ovulation occurs very close to this Peak symptom, that is, the last day of the slippery sensation. The vulva then becomes dry or sticky, no longer wet or slippery and quickly loses the swelling. See day 15, Charts 1 and 2; day 14, Chart 3.

• At the end of the day, the most fertile sign is recorded.

• Ovulation to menstruation is 11-16 days (luteal phase).

The Basic Infertile Pattern

The Basic Infertile Pattern (BIP) is an unchanging pattern due to:

• low oestrogens before ovulation;

• absent cervical response to raised oestrogens through-out the cycle in special circumstances, e.g. age, pathology.

Note: Days of spotting only and with a dry sensation at the end of menstruation are infertile.

The BIP may be:

• dry;

• unchanging discharge;

• a combination of the above in long cycles.

Note: In cycles of average length (cycles under 35 days) there is only one BIP ... either dry or a continuous unchanging discharge. There is no sperm survival during the BIP.

Chart 1. A normal fertile cycle - the observations made at the vulva recorded using stamps and also using symbols.

Cycle Day	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
Stamp
Symbol
Sensation/ Appearance of discharge	wet	wet	wet	dry spotting	dry spotting	dry	dry	dry	dry	no longer dry, sticky cloudy	wet cloudy	wet cloudy stringy	slippery clear stringy	slippery clear	slippery clear Peak swollen vulva
Phases/Patterns				Infertile Unchanging pattern Basic Infertile Pattern (BIP)						Possibly fertile Changing pattern progressively becoming slippery
Cycle Day	16	17	18	19	20	21	22	23	24	25	26	27	28	29	30
Stamp
Symbol
Sensation/ Appearance of discharge	dry	sticky opaque	sticky opaque	dry	dry	sticky cloudy	sticky cloudy	moist cloudy	moist cloudy	dry	dry	dry	dry	wet	wet
Phases/Patterns	Still possibly fertile			Infertile egg is dead Wetness just before menstruation is normal
	Definite change, mucus is no longer wet or slippery. From ovulation to menstruation is 11 to 16 days (luteal phase).

Reference: Evelyn L. Billings and John J. Billings, Teaching the Billings Ovulation Method Part 2. Variations of the Cycle and Reproductive Health, Ovulation Method Research and Reference Centre of Australia, pp. 2-3,  Melbourne, 1997.

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2. Normal Fertile Cycle: Application Of Rules to Postpone Conception

Early Day Rules (before Peak)

• No intercourse during heavy menstruation.

• Alternate evenings are available during BIP (dry or unchanging continuous discharge).

• Any change from the BIP in sensation or appearance including bleeding, 'Wait and see'. If there is no Peak and BIP returns, wait 3 more days. Intercourse is again available on alternate evenings until a further change occurs.

Peak Rule

• From the 4th day past the Peak intercourse is available at any time. The egg is dead.

Judge fertility by making observations, not by counting days. It is normal for cycles to vary in length.

The rules are reliable. The method-related pregnancy rate is less than 1%. The teaching-related pregnancy rate should be zero. The total pregnancy rate varies from less than 1% to higher rates according to the choice of the couples using the method.

When teaching it is important to concentrate on accurate observations, not interpretations. For example, do not record fertile or infertile. Record the exact description paying particular attention to sensation at the vulva.

Interpretations are made reliably by study of the mucus pattern, not from isolated observations (e.g. sticky, cloudy mucus which begins the fertile phase, and sticky opaque mucus within 3 days past the Peak indicate possible fertility).

Sperm Survival

During the days of BIP, after intercourse in the evening, the discharge of seminal fluid may continue for several hours during the next day. There will be no live sperm cells in this seminal fluid. When they are prevented from entering the cervix they are rapidly destroyed in the vagina.

Contact Pregnancy

Note: During the fertile phase, any contact between sexual organs or intercourse with a condom or withdrawal may cause conception.

Chart 2. Application of the Early Day Rules and the Peak Rule to postpone conception in a normal fertile cycle. The white baby stamp (or the circular symbol) is used to indicate days of possible fertility and to record a change from the BIP, and is also used to record secretions following intercourse (I) which might obscure the mucus - the observations made at the vulva recorded using stamps and also using symbols.

Cycle Day	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
Stamp
Symbol
Sensation/ Appearance of discharge	wet	wet	wet	dry spotting	dry spotting	dry	wet seminal fluid	dry	wet seminal fluid	no longer dry, sticky cloudy	wet cloudy	wet cloudy stringy	slippery clear stringy	slippery clear	slippery clear Peak swollen vulva
Phases/Patterns				Infertile Unchanging pattern Basic Infertile Pattern (BIP)						Possibly fertile Changing pattern progressively becoming slippery
Cycle Day	16	17	18	19	20	21	22	23	24	25	26	27	28	29	30
Stamp
Symbol
Sensation/ Appearance of discharge	dry	sticky opaque	sticky opaque	dry	wet cloudy	wet cloudy	wet cloudy	moist cloudy	moist cloudy	dry	dry	dry	dry	wet	wet
Phases/Patterns	Still possibly fertile			Infertile egg is dead
	Definite change, mucus is no longer wet or slippery. From ovulation to menstruation is 11 to 16 days (luteal phase).

Reference: Evelyn L. Billings and John J. Billings, Teaching the Billings Ovulation Method Part 2. Variations of the Cycle and Reproductive Health, Ovulation Method Research and Reference Centre of Australia, pp. 4-5,  Melbourne, 1997

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