Before ovulation can occur the dominant follicle causes feedback
to the hypothalamus which responds by triggering a release of
Luteinizing Hormone (LH) from the pituitary.
This release of LH causes changes to the dominant follicle
with the beginning of the rise in progesterone and usually
results in the release of the ovum – ovulation.
The LH peak is approximately 17 hours before
ovulation.
Occasionally the LH surge occurs but the follicle is
not released, resulting in a Luteinised Unruptured
Follicle (LUF). Progesterone levels are not
sustained and as ovulation has NOT occurred as a result
of this LH surge, there is no corpus luteum.
Following a Luteinised Unruptured Follicle bleeding may occur
when the oestrogen levels fall and the endometrium is no longer
supported.
Alternatively FSH levels can rise quickly with a new dominant
follicle followed by another LH surge. Ovulation may occur
or another Luteinised Unruptured Follicle may result.
Luteinised Unruptured Follicles are normal variants of the
Continuum from Menarche to Menopause or may be the result
of ovarian dysfunction due to pathology causing suppression
of fertility. Women most likely to experience LUFs are women
returning to fertility following childbirth/lactation or weaning;
ceasing chemical contraceptive medication; perimenopause and
during times of stress. |
For couples using the Billings Ovulation Method™ identification
of a Peak symptom indicates ovulation is imminent. Ovulation
occurs on the day of Peak or within the next 48 hours.
Criteria for identifying the Billings Ovulation Method™
Peak symptom are:
“A changing, developing pattern of variable length,
resulting in a slippery sensation at the vulva. The Peak symptom
is identified in retrospect on the day of change to no longer
slippery”.
LH Ovulation Kits available for commercial sale measure the
LH surge. They can be useful for women wishing to conceive
who do not follow the Billings Ovulation
Method™ or for those women who have a limited mucus
symptom, making the identification of ovulation difficult.
If the LH surge is to result in ovulation
the information from these kits alerts the couple to the possibility
of impending ovulation and optimum fertility.
These kits are more problematic for women wishing to avoid
pregnancy. The LH surge does not prove that ovulation
has occurred. The LH surge may result in a LUF. Following
a LUF, ovulation can occur quickly as a result of another
dominant follicle responding to the second LH surge. Couples
relying on the information from an LH kit to identify ovulation
and post-ovulatory infertility could very likely be deceived
into believing that ovulation has occurred when in fact the
LH rise resulted in a LUF. Pregnancy may occur as a result
of intercourse if the couple believed it was a time of infertility,
when in fact it was a time of high fertility.
When a LUF occurs, couples who use the Billings Ovulation
Method™ would identify that ovulation had not occurred
because a Peak, according to Billings Ovulation Method™
criteria, would not be identified. Following the Billings
Ovulation Method ™ the couple is aware of their day
to day fertility and infertility.
Our experience over many years indicates that such kits are
very rarely justified for the identification of ovulation.
When these kits are used, the woman often places more emphasis
on the results of the tests and will be less faithful with
her observations and recording. When there is a discrepancy
between the woman’s observations and the tests results,
the test results are often erroneously believed to be more
accurate.
With good updated teaching of the Billings Ovulation Method™
couples can be taught to accurately identify their ovulatory
variants including LUFs.
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