Table 1.

Revised Postpartum Protocol With Additional Rules

Original Protocol^* for Artificial Cycles During Amenorrhea	Additional Rules for First 6 Cycles After the Return of Menses
Trigger a cycle by pushing the “M” button on the monitor. Fast-forward the monitor to day 5. The monitor will ask for a test for the next 20 days. Test your first morning urine every other day. When a high is recorded, test the urine every day. Retrigger the monitor and fast-forward every 20 days. Continue steps 1–6 until you detect a peak reading and resume menses. To avoid pregnancy, avoid intercourse on high and peak days and 3 full days after the last peak day.	9. When menses returns, reset the monitor and erase the memory (erase the memory for all 6 cycles postpartum). Day 1 is the first day of menses. Begin testing when the monitor asks for a test on day 6. 10. Fertility begins on day 10 of the first cycle after the return of menses, day 9 in the second cycle, day 8 in the third cycle, day 7 in the fourth cycle, and day 6 in the fifth cycle onward. However, if the monitor records a high reading before these days, then fertility starts on the day of the first high reading. 11. (Optional) Beginning on day 6 of the first menstrual cycle postpartum, women may do a second test for the LH surge in the evening with a separate LH test kit.

Original Protocol^* for Artificial Cycles During Amenorrhea

Additional Rules for First 6 Cycles After the Return of Menses

Trigger a cycle by pushing the “M” button on the monitor.
Fast-forward the monitor to day 5.
The monitor will ask for a test for the next 20 days.
Test your first morning urine every other day.
When a high is recorded, test the urine every day.
Retrigger the monitor and fast-forward every 20 days.
Continue steps 1–6 until you detect a peak reading and resume menses.
To avoid pregnancy, avoid intercourse on high and peak days and 3 full days after the last peak day.

9. When menses returns, reset the monitor and erase the memory (erase the memory for all 6 cycles postpartum). Day 1 is the first day of menses. Begin testing when the monitor asks for a test on day 6.
10. Fertility begins on day 10 of the first cycle after the return of menses, day 9 in the second cycle, day 8 in the third cycle, day 7 in the fourth cycle, and day 6 in the fifth cycle onward. However, if the monitor records a high reading before these days, then fertility starts on the day of the first high reading.
11. (Optional) Beginning on day 6 of the first menstrual cycle postpartum, women may do a second test for the LH surge in the evening with a separate LH test kit.

This study used the rules of the original protocol, which are listed in the left column. The revised rules are in the right column.
↵* The original protocol is taken from Ref. 21.
LH, luteinizing hormone.