Revisiting the fertile window

Author:
Joseph B. Stanford, M.D., M.P.H.

Volume 103, Issue 5, Pages 1152-1153

Abstract:
Reflections on “Self identification of the clinical fertile window and the ovulation period” by Ecochard et al.

  • jm

    We are grateful for Dr. Stanford’s studies on the role of cervical mucus for identification of the fertile window and the ovulation period (1,) and his others studies (2,3) to help us in our paper review in biomarkers and fertile window (4). We agree with Rene (5) about a combination of biomarkers, may provide a cooperative help to infertile couples to achieve pregnancy naturally without artificial reproductive techniques (ART).

    According to what has been said (1), at length, about the process of normal follicular development, FSH con-centration during the early follicular phase is of crucial importance to the peak of mucus. The surge of FSH levels in plasma above a special threshold will trigger the entry of follicles into the rapid growth phase. And, the period of time during which the concentration of FSH is above the threshold level will determine the number of follicles that reach their stage of maturation. It is essential that FSH levels quickly fall below the threshold, if follicular stimulation is to be limited to a single follicle in natural cycles (6). In subfertile patients, even if the amount of FSH is reduced, some follicles that have been recruited already may continue to grow, despite the decline in FSH concentration, but ultimately only one follicle with achieve dominance (7,8).

    Medicine currently counts on subjective and objective examinations so as to diagnose the highest and lowest fertility point. In addition, it is likely to keep track of the biological fertility factors which may eventually provide vital and reliable information regarding menstrual cycle. Follow-up examinations might come in useful for NaproTechnology, and also for some other focus groups interested in dealing with current theoretical resources stem from updated medical literature.

    Reference :

    1- Stanford JB. Revisiting the fertile window. Fertility and Sterility, Volume 103, Issue 5, May 2015, Pages 1152-1153.

    2- Stanford J. Fecundity and the mucus cycle score in couple using the CrMS. In: Hilgers T, ed. The Medical and Surgical Practice of NaProTechnology. Omaha: Pope Paul VI Institute Press; 2004:643-52.

    3- Stanford JB, Thurman PB, Lemaire JC. Physicians’ know- ledge and practices regarding natural family planning. Obstet Gynecol 1999; 94: 672–7.

    4- Murcia Jm, Esparza ML. The Fertile Window and Biomarkers. pers. Bioét, Vol 15 Número 2 Pags. 149-156. 2011.

    5- Rene Ecochard, M.D., Ph.D., Olivia Duterque, M.D., Rene Leiva, M.D., Thomas Bouchard, M.D.,and Pilar Vigil, M.D. Self-identification of the clinical fertile window and the ovulation period. Fertil Steril. 2015 May;103(5):1319-25.e3. doi: 10.1016/j.fertnstert.2015.01.031. Epub 2015 Feb 24.

    6-Brown JB. Pituitary control of ovarian function-concepts de- rived from gonadotropin therapy. Aust NZJ Obstet Gynaecol. 1978; (18): 47–54.

    7. Collins WP, Collins PO, Kilpatrick MJ, Manning PA, Pike JM, Tyler JP. The concentrations of urinary oestrone-3-glucuronide, LH and pregnanediol-3alpha-glucuronide as indices of ovarian function. Acta Endocrinol (Copenh) 1979; 90(2): 336-48.

    8. Billings JJ. The validation of the Billings ovulation method by laboratory research and eld trials. Acta Eur Fertil. 1991; 22(1): 9-15.

  • rene

    We are grateful for Dr. Stanford’s editorial accompanying
    our study on the role of cervical mucus for the Self-identification of the
    clinical fertile window and the ovulation period (1 ). Cervical mucus had previously
    been proposed as surrogate marker for ovulation identification (2,3 ). However,
    as pointed out by Stanford, our study is the largest dataset that calculated
    the specificity and sensitivity while using the concept of peak type mucus to
    identify the fertile and ovulation window.

    The use of other surrogates markers is becoming very popular
    as well. Of many of them, the use of LH surge seems to be most well validated. Its
    use for facilitating time to pregnancy may provide a slight advantage for those
    couples using a LH based monitor (4 ). Furthermore, combination of these
    markers may provide a cooperative help in more difficult clinical scenarios
    (5,6 ). At the end, we welcome the
    suggestion to promote RCT’s comparing the different methods to help infertile
    couples achieve pregnancy naturally.

    Rene Ecochard, M.D., Ph.D., Olivia Duterque, M.D., Rene
    Leiva, M.D., Thomas Bouchard, M.D.,and Pilar Vigil, M.D.

    1.Stanford JB . Revisiting the fertile window. Fertil Steril
    2015; in press.

    2. Guida M, Tommaselli GA, Palomba S, Pellicano M, Moccia G,
    Di Carlo C, Nappi C. Efficacy of methods for determining ovulation in a natural
    family planning program. Fertil Steril. 1999 Nov;72(5):900-4.

    3. Alliende ME, Cabezón C, Figueroa H, Kottmann C.
    Cervicovaginal fluid changes to detect ovulation accurately. Am J Obstet
    Gynecol. 2005 Jul;193(1):71-5.

    4. Iplady S, Jones G, Campbell M, Johnson S, Ledger W. Home
    ovulation tests and stress in women trying to conceive: a randomized controlled
    trial. Hum Reprod. 2013 Jan;28(1):138-51.

    5. Leiva R, Burhan U, Kyrillos E, Fehring R, McLaren R,
    Dalzell C, Tanguay E. Use of ovulation predictor kits as adjuncts when using
    fertility awareness methods (FAMs): a pilot study. J Am Board Fam Med. 2014
    May-Jun;27(3):427-9.

    6. Mu Q, Fehring RJ. Efficacy of achieving pregnancy with
    fertility-focused intercourse. MCN Am J Matern Child Nurs. 2014
    Jan-Feb;39(1):35-40.

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