For years, cervical mucus monitoring has been recommended as a form of natural, and also extremely inexpensive, birth control. Now, researchers have turned the method on its head. They discovered that the very same method that once helped women prevent pregnancy could be the perfect tool to help them begin one.


As described by Aetna's Women's Health website, the cervical mucus method of birth control, often referred to as 'the Billings method,' simply requires a woman to observe her cervical mucus on a daily basis, beginning with the first day after her last period. Although almost no mucus will be found immediately after the end of the menstruation cycle, as ovulation approaches, the discharge will change, becoming more abundant, thin, transparent, and slippery, like egg whites. The rule of thumb is that when no mucus exists or when the thin discharge continues without change in the days just after the end of menstruation, this is an indication of infertility. If, though, the mucus begins to change and starts to develop the raw egg-whites feel, a woman has entered her period of fertility.

During periods of fertility, a woman following the Billings method would abstain from sexual intercourse. As a form of natural birth control, it is best for healthy women with regular cycles. The downside is that cervical mucus will be abnormal or unusual for any woman nearing menopause as well as for those who use feminine-hygiene products, contraceptive foams and jellies, and also lubricated condoms. Anyone with a vaginal infection would also develop inconsistencies in her mucus.

The method was named for its creator, Dr. John Billings, an Australian physician who originally trained as a neurologist and developed the method with his wife, Dr. Evelyn Billings, a pediatrician. At the request of the Catholic Marriage Guidance Bureau in 1953, Billings began to investigate the possibility of contraception that did not rely on either drugs or devices to block conception. Used in more than 100 countries, his natural birth control method was endorsed by the Roman Catholic Church.

Eventually, Billings would be awarded a papal knighthood for his efforts on behalf of contraception. Now, though, his technique has been turned on its head by researchers whose study found support from the National Institute of Child Health and Human Development and the National Institute of Environmental Health Sciences.


Dr. Anne Steiner, an ob-gyn at the University of North Carolina at Chapel Hill, and her colleagues set out to assess the use of cervical mucus monitoring in women trying to conceive. They wanted to know whether monitoring might increase the probability of conception and so put together a cohort of 331 women, aged 30 to 44, all of whom were trying to conceive, though without knowing their possibility of fertility.

The researchers found that for those women who consistently monitored their cervical mucus, the likelihood they would become pregnant increased by a factor of 2.3 times over a six-month period. Unfortunately, an overwhelming majority of the women did not consistently and therefore accurately monitor their mucus. During the first cycle, a period of six months, six percent of the women consistently performed cervical mucus monitoring, 18 percent of the women inconsistently did so, 22 percent infrequently and slightly more than half — 54 percent — of the women did not perform any monitoring whatsoever.

"Cycles in which cervical mucus monitoring was consistently performed were statistically significantly more likely to result in conception after adjusting for age, race, previous pregnancy, body mass index, intercourse frequency, and urinary luteinizing hormone (LH) monitoring," wrote the authors. Speaking to LiveScience, the researchers noted that this method of tracking fertility is superior to counting days between menses or tracking body temperature, and it is far less expensive than ovulation predictor kits, which track urinary levels of luteinizing hormone and cost up to $40 each month.

Female Infertility

Infertility is defined by most researchers as not being able to get pregnant (conceive) after one year of unprotected sex. The Centers for Disease Control and Prevention notes that about six percent of married women between the ages of 15 and 44 are infertile while nearly 11 percent of women in that same age range (though regardless of marital status) have impaired fecundity — difficulty getting pregnant or carrying a pregnancy to term. Roughly 7.4 million women within that age range have availed themselves of available infertility services in the U.S.

Unfortunately, among women who are infertile, depression is a frequent and well-documented consequence.

In a study conducted at the Infertility Clinic of Vali-Asr Hospital in Tehran, researchers found that among 638 infertile patients, at least one of the spouses in 140 couples was diagnosed with depression, anywhere from mild to severe. The researchers then randomly divided the depressed patients into two groups, and those in the experimental group received six to eight sessions of individual psychotherapy and were given an antidepressant in the period before beginning infertility treatment. The control group did not receive any intervention.

"There was a significant difference in pregnancy rate between the treatment and control groups," wrote the authors. Pregnancy occurred in 47.1 percent of the couples in the treatment group and in only 7.1 percent of the couples in the control group. In the treatment group, then, pregnancy occurred 14 times more frequently than the control group. "It is crucial to mandate psychiatric counselling in all fertility centers in order to diagnose and treat infertile patients with psychiatric disorders," wrote the authors.

Sources: Evans-Hoeker E, Pritchard DA, Long DL, Herring AH, Stanford JB, Steiner AZ. Cervical mucus monitoring prevalence and associated fecundability in women trying to conceive. Fertility and Sterility. 2013.

Ramezanzadeh F, Noorbala AA, Abedinia N, Rahimi Forooshani A, Naghizadeh MM. Psychiatric intervention improved pregnancy rates in infertile couples. The Malaysian Journal of Medical Sciences. 2011.