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How Dry -- and Fertile -- I Am

Simpler contraceptive system may work in Third World, say experts

THURSDAY, Oct. 25, 2001 (HealthDayNews) -- American and Italian researchers say a new method of identifying the fertile days in a woman's menstrual cycle could prove useful in developing countries, where customs, illiteracy and poor health care can make family planning a serious challenge.

The system, called the "TwoDay" method, requires that women note vaginal dampness or secretions that are unrelated to menstruation, intercourse or disease. According to the system, a woman is potentially fertile if she notices dampness on the current or previous day and should avoid unprotected intercourse if she doesn't want to get pregnant.

A study of the method appears in the Oct. 26 issue of the journal Human Reproduction.

Lead author David Dunson, an investigator at the National Institute of Environmental Health Sciences, in Research Triangle Park, N.C., says that while the "TwoDay" method originally was intended to prevent pregnancy, "You could also potentially use it when you were trying to conceive. If you can predict when the fertile days are in the menstrual cycle, you can do either thing."

The menstrual cycle is split into the follicular phase (when the ovary is stimulated), the ovulatory phase (when the egg is released) and the luteal phase (lasting about two weeks, when hormone levels remain high).

"The fertile interval of the cycle occurs during approximately the five days prior to [ovulation], ending on the day of ovulation," says Dunson. "During this cycle, there's a variety of physiological changes, and one of these is that the cervical mucus becomes more hydrated during the fertile interval of the cycle prior to ovulation."

"What's actually been shown is that this fertile mucus permits sperm to travel through the reproductive tract, whereas, if you don't have this fertile-type mucus, then the sperm won't be able to make it through the reproductive tract."

Dunson says monitoring secretions is the key to the "TwoDay" method. "If you have dampness on a given day or the day before, then you're potentially fertile on that day," he says. "If you're wanting to avoid conception, then you would avoid having intercourse on that day, or you would use protection. If you wanted to increase your probability of conception, then you'd have intercourse on that day."

Dunson calculated that a healthy couple that has unprotected intercourse an average of three times per week -- and not having sex on the days the "TwoDay" method classifies as fertile -- would have roughly an 8 percent chance of conceiving in the course of one year, compared with a 97 percent chance for couples not using this system.

He says the method could become more widely used than current fertility awareness methods in the developing world, where women either don't have access to hormonal contraception or aren't willing to use it for religious or other reasons.

"In the developing world, there's a bunch of problems," he says. "One is that a lot of people aren't literate or numerate, so they won't be able to apply those types of methods. Also, it's not possible to have wide-scale distribution of hormonal contraception. Some approach like this that was simple … would potentially be very important in the developing world."

Study co-author Irit Sinai, a research analyst at Georgetown University's Institute for Reproductive Health, in Washington, D.C., says other methods often require a woman to record her daily body temperature or to learn to judge the characteristics of her cervical mucus compared to an established norm.

"They are complex to teach," says Sinai. "[The cervical mucus method] requires several counseling sessions over a period of several months and follow-up from the provider."

"That is simply not practical in many places. If a woman needs to walk 10 hours to get to her health provider, she's not going to do it more than once."

David Katz, professor of biomedical engineering and obstetrics and gynecology at Duke University, in Durham, N.C., says the various current fertility awareness methods range from simple to extremely complex and often expensive.

Katz says predictions about fertility are more accurate if information is gathered for more than two days of the menstrual cycle, but women are less likely to use more lengthy and complicated methods. Striking the proper balance between accuracy and practicality is critical, he says.

"This 'TwoDay' method is intended to be a really practical, simple method," he says. It doesn't involve record keeping, and "it's really intended for women around the world who may have varying levels of knowledge of their reproductive cycles."

"It's simple enough to be used in the developing world, where the level of literacy and knowledge of reproductive processes may be less," says Katz. "I think the method is very promising."

What To Do

Find out more about fertility awareness and natural family planning methods from the Institute for Reproductive Health or FertilityUK.

PlannedParenthood also provides information about family planning, contraception and other reproductive choices. There's more on the menstrual cycle at the Family Practice Notebook.

SOURCES: Interviews with David B. Dunson, Ph.D., investigator, biostatistics branch, National Institute of Environmental Health Sciences, Research Triangle Park, N.C.; Irit Sinai, Ph.D., research analyst, Institute for Reproductive Health, Georgetown University, Washington, D.C., and David F. Katz, Ph.D., professor, departments of biomedical engineering and obstetrics and gynecology, Duke University, Durham, N.C.; Oct. 26, 2001, Human Reproduction
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