Eggs-tra ova

July 9, 2003 2:03 PM

One egg, one month. Seemed like such a simple, comprehensible system - until now. "We are literally going to have to re-write medical textbooks," said Dr. Roger Pierson. Turns out many women may ovulate more than once a month, which may be why the rhythm method fails so often.
posted by soyjoy (56 comments total)

Oh my lord. This explains so much. Wish the article contained links to more information.
posted by widdershins at 2:13 PM on July 9, 2003

I don't doubt that they're right, being medical people and me not being one, but I can't help wondering:

How much of a difference does it make to have ovulations taking place when Ye Olde Wombe isn't set up for visitors?
posted by ROU_Xenophobe at 2:20 PM on July 9, 2003

Shit shit shit. Thanks for posting that. Summer months usually fly by, but now the next three weeks will seem very long indeed.
posted by Mayor Curley at 2:21 PM on July 9, 2003

This version has a teensy bit more information about the study. Plus: A dissent from the creators of (surprise, surprise) a natural birth-control method: "What he's describing simply doesn't happen." And there you have it.
posted by soyjoy at 2:22 PM on July 9, 2003

I heard one of these researchers interviewed on CBC radio. The host asked him about implications for people using the rhythm method. He said, "We call those people 'parents'."
posted by timeistight at 2:23 PM on July 9, 2003

from the yahoo article: "We see women come in with twins and when we do an ultrasound we see one is at one 10 weeks development and another at seven."

wouldn't that imply that the semen were swimming around for 3 weeks waiting for another egg? I didn't think they lived that long...
posted by GeekAnimator at 2:24 PM on July 9, 2003

Twins conceived that far apart would presumably be conceived during two different sexual encounters.
posted by occhiblu at 2:26 PM on July 9, 2003

Geek, not if they had sex more than once a month. Str8 People do have sex more than one a month, don't they?
posted by jopreacher at 2:26 PM on July 9, 2003

Nope, just once a month, and only for procreative purposes. Used to be anything else was illegal in several states.
posted by occhiblu at 2:28 PM on July 9, 2003

*sigh* yup, that occured to me right after hitting the post button. it's been a long day.
posted by GeekAnimator at 2:28 PM on July 9, 2003

Here's a link to the journal article. I don't know how accessible it'll be to people outside of a subscribing (read: academic) domain, though...
posted by Johnny Assay at 2:30 PM on July 9, 2003

No, and as far as science knows today, GeekAnimator, they don't live that long. The female reproductive system is not the most hospitable enviornment, to say the least. Its acidity does a pretty good job of killing off a lot of sperm real quick-like. (One of many reasons so many millions are released at once.)

It does, however, imply that the implantation of an embryo in the uterine wall doesn't always halt the release of more ova from the ovaries, as hormone and physiology theories suggest. (Which is a step of implication further forward, not really covered in this study.)
posted by gramcracker at 2:33 PM on July 9, 2003

Jeez! What an eggregious error!
posted by Civil_Disobedient at 2:47 PM on July 9, 2003

Johnny Assay: The Abstract is viewable. The full text is (unsurprisingly for a big-time medical journal) not.
This article has a little more information. Here's the abstract of a companion article published in Biology of Reproduction. This journal is (it seems) fully accessible online and you can download the full text...
This seems weird to me... I would have imagined that multiple ovulations wouldn't have been that hard to spot from the moment ultrasound was available onwards. I mean, if the study is correct it's the rule rather than the exception among women, so how could this not have been noticed earlier?
posted by talos at 2:50 PM on July 9, 2003

People still use the rhythm method? Man oh man.
posted by trillion at 2:50 PM on July 9, 2003

the article with contrary info (from theage) had quotes from the creators of the Billings method, which I hadn't heard of before. Doing google searches gives "method-related" failure rates of usually less than 2% depending on what study, which is amazing - better than many technical methods. Unfortunately as far as I could tell, all the studies were done by teachers/practitioners or people otherwise biased towards it.

Does anyone know how real these failure-rates are (e.g. are the really representative of actual failure rates if one practices this method, etc), and if there are any obviously unbiased studies about this? Since this method apparently teaches women to (accurately) know when they are ovulating (and this is only once a month), it does seem to be completely in contradiction with the fpp article.
posted by advil at 2:50 PM on July 9, 2003

ROU_Xenophobe: Ye olde womb is usually ready more often that not. The lining that is shed during the . is built up during the prior 3 weeks.

And I thought we already knew about more than one egg at a time. A lot of women can feel them coming out of the ovary. It's a slight but sharp pain in the ovary location. Women who are trying to get pregnant tend to notice that the signs (elevated temperature, etc.) are there more than once a month sometimes.
posted by hippo at 2:54 PM on July 9, 2003

Brief thread derailment: As someone who's successfully used Fertility Awareness Method (which is different from the rhythm method) of birth control for seven years, I have to take a tiny little moment to say that natural birth control methods fail most often because people suck at using them. Not because the methods themselves are flawed.

Unlike the pill, FAM requires more work than just remembering to swallow something once a day. For folks used to push-button convenience, it's a no-go. Then again, you don't feel like a hormonally altered petri dish. In my totally personal opinion, the biggest issue is lack of education. Women don't know what their bodies are doing, and if they did, they'd find that natural birth control methods are more effective than the western medical industry suggests. If anyone's interested in FAM, I recommend this book.
posted by arielmeadow at 2:58 PM on July 9, 2003

Now, they just need to look at the link between extreme arousal and the unexpected release of an egg... which has happened to at least two women I know.

None of this comes as a suprise to me; medical science hadn't even properly described the anatomy of the clitoris until just a few years ago. It makes sense that closer investigation is needed of much of the generally accepted wisdom to do with the female body.
posted by jokeefe at 3:12 PM on July 9, 2003

I understand that some women have strong negative reactions to birth control medications and some couples find condoms just plain uncomfortable. What I don't understand is why people still utilize the rhythm method at all. It just seems overly complex compared with more technical methods and risky as well. Anyone care to shed any light on my ignorance?
posted by ttrendel at 3:28 PM on July 9, 2003

From the Fertility Awareness Method:

FAM relies upon the following assumptions:

A single egg is released from the ovary (ovulation) 14 days before the next menstrual period. The egg lives inside the woman's body for 12-24 hours.

It looks like we've got some evidence that the methods themselves are flawed. Or maybe some women just "suck at" dutifully ovulating according to FAM assumptions.
posted by stefanie at 3:29 PM on July 9, 2003

natural birth control methods fail most often because people suck at using them. Not because the methods themselves are flawed.

That is a flaw in the method. It doesn't matter if a system works when used properly if it's difficult to use properly. People are imprecise and forgetful, and will screw up anything you give them. There is nothing you can do about this but design a system that rolls with the punches. This is true for any field of engineering that involves human beings.

Here are the stats:

Of 100 couples who use any of these methods for one year, 20 women will become pregnant with typical use. The failure rate is higher for single women. Combining the various methods with careful and consistent use and having no unprotected vaginal intercourse during the fertile phase can give better results.

Of 100 couples who use the temperature method for one year with perfect use, two women will become pregnant.

Of 100 couples who use the cervical mucus method for one year with perfect use, three women will become pregnant.

Of 100 couples who use the calendar method for one year with perfect use, nine women will become pregnant.

Few couples, however, are able to use these methods perfectly.

Maybe some people really don't mind if they get pregnant, and would just sort of prefer not to have a baby right now; for them, such a method might be appropriate. For myself, there is no way in hell I am willing to take a risk like that. (The 5 in 100 failure rate associated with the pill is plenty frightening already.)
posted by Mars Saxman at 3:37 PM on July 9, 2003

ttrendel, some of us believe that once an egg implants, that's that-therefore we don't use the pill or iuds. Condoms break and are rather unesthetic, and other methods don't really work all that well anyway. When we were done hubby had a vasectomy.

I know a family who have been able to space their children almost exactly three years apart, and have planned almost all their children. That ain't bad for having 8 stretched out between college and toddlerhood. (the last one was a little bit unexpected.) They did and as far as i know still use the natural method-the only reason they have so many is the mom just plain likes having kids.

Practicing strict Catholics don't believe in artificial birth control at all, and I believe the Billings method was developed with them in mind.
posted by konolia at 3:43 PM on July 9, 2003

konolia, so only 1 out of 8 children was unplanned? If you don't want children that's one too many. Like Mars said, there's a difference between those would prefer not to have a child and those who are totally against it. The latter better stick to something more reliable.
posted by trillion at 3:55 PM on July 9, 2003

People still use the rhythm method? Man oh man.

Some people use a method approaching it. Let's assume a hypothetical couple. The woman can't physically tolerate any known method of chemical contraception, and, because they're young, incidents of intimacy are too frequent to faciliate barriers like a diaphragm. So they use condoms, except for a few days immediately after the end of menstruation when conventional wisdom says that conception is nearly impossible.

Now imagine the agony if the man in said hypothetical couple happened upon the above link and he knew that he was being stupid and impulsive anyway and then he had to stop typing now so that he could run to CVS and buy a pregnancy test.
posted by Mayor Curley at 3:56 PM on July 9, 2003

I wonder what the implications are for women like me who use fertility monitors like the Persona as a form of birth control. They are supposed to measure hormone levels, spit out the likelihood of getting pregnant, and store the info in order to more accurately predict safe and unsafe days in the future.

Oh, and the Persona? Developed in the US, tested in the US and only available outside the US. Thanks FDA.

The pain when you ovulate that someone mentioned earlier is called mittleschmertz. I get that every month - best form of birth control I've ever had (in conjunction with barrier methods). It 's more than "a slight but sharp pain" for me though - sharp, constant, throbbing pain. It hurts for about a day and a half before launching the S.S. Ovum. Joy.
posted by echolalia67 at 4:09 PM on July 9, 2003

I know a family who have been able to space their children almost exactly three years apart, and have planned almost all their children. That ain't bad for having 8 stretched out between college and toddlerhood. (the last one was a little bit unexpected.) They did and as far as i know still use the natural method-the only reason they have so many is the mom just plain likes having kids.

konolia, you never said you knew my cousin...
posted by jokeefe at 4:21 PM on July 9, 2003

I'm ovulating just thinking about it.
posted by rusty at 4:28 PM on July 9, 2003

(The 5 in 100 failure rate associated with the pill is plenty frightening already.)

Especially when one's spouse wants kids and might decide to "accidentally" skip a pill or ten. It's not unheard of for women to "trap" a husband into having a kid. I'd watch out if I were you.

Better to just get a vasectomy or have your partner get a hysterectomy (or both) if you're that terrified of children.
posted by beth at 4:54 PM on July 9, 2003

From what I understood of the article, they followed 63 women, and 50 of them had "normal" cycles, 13 didn't. So for some women, methods like FAM might work, if you have the "conventional" cycle. the trick is knowing whether you are a normal ovulator or a super-ovulator. And it has been known for some time that ovulation can occur at any point in the cycle. However, they used to think this was a rare occurence, but now it seems as if this can occur regularly in about 25% of women. And, it was known that multiple eggs could be released, but it was assumed they were released on the same day. I think there are a lot of fraternal twins where one is a few weeks older. However, since it was thought to be impossible to ovulate more than once per cycle, differences were attributed to differences in blood flow and such. It's known to happen in animals, so I never understood why it was considered impossible in humans. I always suspected that it was possible, but extremely rare. As far as "natural" birth control methods-- I think the FAM is too risky to be used to prevent pregnancy, but it might be useful if you are trying to acheive pregnancy. My husband and I are trying to get pregnant, and I suggested to him based on this article that we should just have sex all the time then. He seemed to be pretty happy with that. And well, we were pretty much doing that anyway. Not bad for a couple of earlythirtysomethings who've been together two years... :)
posted by Shoeburyness at 5:06 PM on July 9, 2003

Beth, I don't think that hysterectomy is done for the purposes of birth control. I actually don't know of any doctor that would do it, or an insurance company that would cover it in those circumstances.

A vasectomy is a few snips. Hysterectomy can have implications for the physical and psychological future of the patient, plus the risks of anesthesia. Tubal ligation at least mimizes the first two possible problems.
posted by answergrape at 5:10 PM on July 9, 2003

I know, I was being drastic for effect, answergrape.
posted by beth at 5:55 PM on July 9, 2003

Mother Theresa said that one of the biggest problems in our culture is "fear of children." We do spend an amazing amount of brainpower on keeping the ankle-biters away, and then the culture wars against "natural" birth control added to that.
posted by loafingcactus at 6:16 PM on July 9, 2003

I highly recommend lesbianism as a form of birth control. My partners agrees wholeheartedly.
posted by answergrape at 6:18 PM on July 9, 2003

The female reproductive system is not the most hospitable enviornment, to say the least. Its acidity does a pretty good job of killing off a lot of sperm real quick-like.

Although sperm don't live in the vagina very long (a few hours?), the little rascals that make it beyond there and into the uterus can live for several days and fertilize an egg if ovulation was to take place.
posted by G_Ask at 6:25 PM on July 9, 2003

loafingcactus, and what is wrong with that? i'd rather that people who "fear" kids don't have them. We're all better off that way-especially the children (think of the children!-it had to be said.)
posted by aacheson at 6:33 PM on July 9, 2003

Civil_Disobedient, you should be shelled for that comment! You scrambled my sensitive brain, though I've kept trying to look on the sunny side. Do let me know when your new comedy albumen will be coming out. I'll play it ova and ova.


(you can all come back out now, I'm done.) You know, this is not news to me at all -- I knew for a long time that I ovulated twice a month sometimes -- not just from the Mittleschmerz but also from other physical signs that only happened at that time. Guess I wasn't reading my med information close enough to realize I wasn't supposed to be doing that . . .
posted by jfwlucy at 6:45 PM on July 9, 2003

Well, this explains a few things (well, one thing anyway).

If couples are wishing to halt the baby-making process, a vasectomy seems to be the fairest and most effective way, as the overall effect on the man's body is negligible compared to that on a woman's body after a tubal ligation. Trying to work up the courage, myself (us men are such babies when it comes to people in masks fiddling with our private bits). Of course, there is always that tried and proven method of contraception - have a few kids and you will either not have time or will be too tired to have sex in the first place. You know your life is over when sleep is more attractive than sex :-(
posted by dg at 6:47 PM on July 9, 2003

I dunno if the stats from this study are correct, I was just slackjawed that the pure and simple one-egg-one-month equation could even be considered. It always seemed like a logical elemental part of nature, I had no idea it happen this way other than in some rare situation. But now that I've considered it, it doesn't seem illogical or anything.

One of the books that helped me see it so "elegantly" by playing on that ever-unifying image, and which remains one of my favorite books of poetry, is Sharon Olds' The Gold Cell. I'll wonder if she'll have to issue an updated version.
posted by soyjoy at 7:16 PM on July 9, 2003

Hey, here's another thing. I was telling my lovely wife about this and the twins a few weeks apart thing, and she said "so you could have twin sons of different fathers."

For the second time today I was slackjawed. Is this possibility already known and/or documented? Or are we misunderstanding this whole thing?
posted by soyjoy at 7:52 PM on July 9, 2003

trying to work up the courage, myself (us men are such babies when it comes to people in masks fiddling with our private bits).

Easy, just do what I did. Told my doctor to give me a big ol valium shot to "ease the nervousness." Then pain killers far above and beyond the actual level of pain so you don't notice your black and blue balls. :-)
posted by Plunge at 8:06 PM on July 9, 2003

Here is another story which explains that multi-ovulation questions the safety of the placebo week used in oral contraceptives. From the end of the article:

Most birth control pills are based on a 21-day treatment cycle, where women take active hormones, followed by seven days of placebo or dummy pills, which trigger menstruation.

Another study by the same team in the same issue of Fertility and Sterility suggests women can still get pregnant during their hormone-free interval, because there's enough space in the pill-free period that allows the development of a new wave of follicles.

"It questions the need for women to have a pill-free week," says Dr. Arthur Leader, chief of reproductive medicine of the University of Ottawa.
posted by jsonic at 8:15 PM on July 9, 2003

I highly recommend lesbianism as a form of birth control. My partners agrees wholeheartedly.

I agree. When I think about real-life (as opposed to porno) lesbians, my stomach churns and an erection is impossible. Unless I had money riding on the outcome of that rugby match...
posted by Mayor Curley at 8:20 PM on July 9, 2003

Soyjoy-
They don't really know how often twins have different fathers, because most twins aren't tested for something like that. They've only noticed it when the fathers are of two different races so there's an obvious color difference. But this has happened in the past.
posted by stoneegg21 at 8:39 PM on July 9, 2003

Sorry to hear about your erection issues, Mayor Curley. I'm sure I could find a sympathetic gal to comfort any significant other you might have. Now that women like the lovely Portia de Rossi are fessing up to playing for our team, perhaps you should broaden your lesbian horizons.
posted by answergrape at 8:43 PM on July 9, 2003

Here's the Straight Dope on twins with different fathers.

I'd also like to point out there is a difference between unwanted kids and unplanned kids. I was unplanned, but wanted. Any kid of mine would have been unwanted from day one. And I can't think of anything worse than that, which is why I braved the hormone roller coaster for so many years. My personal discomfort was nothing compared to the thought that I would accidentally get pregnant and have to go through an abortion...or even worse, create a human being who would have to go through life wondering why his or her mother didn't want them.

Of course now I have the best of both worlds...a husband who's been snipped. I highly recommend it! (Or you know, the lesbian thing.)

Oh, and I'd also like to point out that I'm annoyed that they are just figuring this out now. I mean, are women new or something? Are we that exotic a creature?
posted by JoanArkham at 4:13 AM on July 10, 2003

Joan, thanks. That's fascinating.

Mayor Curley, have you seen a doctor about this problem?
posted by soyjoy at 7:52 AM on July 10, 2003

Since women, like queer folks, are newly-minted as actual people, there hasn't been the kind of research dollars put into women's physiology as there have been into things like, oh I don't know...viagra.

But they could have at LEAST figured out how big the clitoris is....or maybe not. Sounds like most men might end up with clit envy...
posted by answergrape at 8:14 AM on July 10, 2003

Mayor Curley - that was dumb. I'm going to give you the benefit of the doubt and not believe that you think all lesbians look like or are rugby players. But it really was a stupid comment.
posted by widdershins at 8:51 AM on July 10, 2003

Is it possible that daily ultrasound scans might trigger "abnormal" ovulation? (or at least the follicle development?)
posted by joaquim at 9:40 AM on July 10, 2003

Uh, at my college, the purely het girls on the rugby team were a minority. I laughed at MC's post, even though most of them actually were really damn hot. Then again, I'm spending next weekend with a rugby vet. She's getting married in October,. To a man. Who knew?
posted by NortonDC at 12:03 PM on July 10, 2003

It was indeed a stupid comment. I got irritated and my response was inappropriate, so I would like to retract it.

I should have written "So you're a lesbian and you felt like interjecting that fact where it was completely irrelevant. That's permissable if you're a freshman in college and you just got far away enough from your parents to say it, but you should have gotten that out of your system by now. Please stick to the discussion."

I really do apologize. I cringe a little bit at how caustic I can be.
posted by Mayor Curley at 1:19 PM on July 10, 2003

Yeah, I cringe a little bit too. How interesting to apologize and then follow it up with an even more inappropriate comment.
posted by answergrape at 2:25 PM on July 10, 2003

That's ugly, Curley. Too bad, too; this is a great thread otherwise.
posted by norm at 3:08 PM on July 10, 2003

Are we that exotic a creature?
Why, yes, you are. Why else would we chase you to the ends of the earth, while not understanding in the slightest what makes you tick. Women are the most exotic creatures on this planet, in my opinion.
posted by dg at 4:17 PM on July 10, 2003

Here's another rule-breaking story that seems related...

Contradicting nearly all the medical textbooks, doctors have proven for the first time that fraternal, or nonidentical, twins can share a placenta.
posted by soyjoy at 8:25 PM on July 10, 2003