Taking a History
Your Billings Ovulation Method™ tutor will firstly take a medical history – ask you questions about your age, previous family planning history, other pregnancies/miscarriages, health of you and your family, medications, etc.   She will then explain the Billings Ovulation Method™ to you and ask you to begin charting your natural bodily symptoms on a daily basis.  When you return with your chart a couple of weeks later she will help you to identify the patterns of fertility and natural infertility and when is the best time to have intercourse in order to become pregnant.  You may need a few follow-up visits to become familiar and confident with this information. 

Investigations
If any signs of abnormality are identified in the charting, or if you have still not conceived after correct timing of intercourse over a couple of cycles, your Billings Ovulation Method™ tutor may recommend that further investigations are undertaken.

Ovarian problems
Initially you may be asked to make an appointment with your doctor who will organise some simple blood tests to check on your hormonal levels, blood sugars and insulin resistance.  In countries where it is available, you may also be asked to collect daily urine specimens for urinary hormone monitoring to verify the occurrence and timing of ovulation.  Most problems that are identified can be corrected by treatment prescribed by your doctor.

According to Professor Pilar Vigil Portales, MD PhD:  Adrenal and ovarian abnormalities are the most frequent cause of ovarian dysfunctions. The most common is polycystic ovarian syndrome: an ovulatory dysfunction caused by hyperandrogenemia. In these women, irregular cycles are usually present, early after menarche.  They can also complain because of acne and/or hirsutism as well as increased body weight and mood changes.  Cycles are characterized by a hyper estrogenic state where a continuous fertile type of mucus pattern is identified or mucus patches are present. Cycles can be ovulatory, with a long follicular phase or anovulatory.

When a young woman complains because of menstrual abnormalities, the teaching of self-awareness of fertility in order to identify ovulatory dysfunctions is very important in order to be able to rule out metabolic conditions such as hyper insulinemia. Studies have shown that in 86% of women who present with menstrual irregularities, an endocrine abnormality is present of which hyperandrogenemia is the most common (80% of cases). It is important to note that an impaired insulin response to oral glucose tolerance test is a commonly (80% of time) associated condition in these women. This requires treatment to prevent the occurrence of type II diabetes mellitus. Proper care, including diet, exercise and medical treatment will restore normal cyclical ovarian activity. Women who know how to recognize their mucus symptoms will be able to follow the improvement of their endocrine abnormality.

Hypothyroidism is a less frequent (about 2%) cause of ovarian dysfunction but it and hyperthyroidism, have to be considered. Different types of ovarian dysfunction can be observed in patients with thyroid disorders. Menorrhagia is frequently associated to hypothyroidism. Although there is no specific pattern of ovarian activity associated to these endocrine abnormalities they should always be kept in mind and eliminated as a possible cause.

Women with ovulatory dysfunctions associated to irregular cycles and abnormal mucus patterns will not usually resume normal cycling spontaneously without appropriate treatment. Follow up studies have shown that in the absence of treatment these conditions only worsen with time.

Tubal abnormalities
Your doctor may decide that you should have some further physical investigations to check that your fallopian tubes are open and able to permit the passage of the sperm and the fertilized egg.  In many cases, doctors are able to correct any abnormality discovered.

You may also be referred for ultrasound to check that your internal reproductive organs look normal.