Table 1.

Revised Postpartum Protocol With Additional Rules

Original Protocol* for Artificial Cycles During AmenorrheaAdditional Rules for First 6 Cycles After the Return of Menses
  1. Trigger a cycle by pushing the “M” button on the monitor.

  2. Fast-forward the monitor to day 5.

  3. The monitor will ask for a test for the next 20 days.

  4. Test your first morning urine every other day.

  5. When a high is recorded, test the urine every day.

  6. Retrigger the monitor and fast-forward every 20 days.

  7. Continue steps 1–6 until you detect a peak reading and resume menses.

  8. 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.