Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review

Rachel Peragallo Urrutia; Chelsea B Polis; Elizabeth T Jensen; Margaret E Greene; Emily Kennedy; Joseph B Stanford

doi:10.1097/AOG.0000000000002784

Fertility Awareness Effectiveness

Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review

Peragallo Urrutia R, Polis CB, Jensen ET, Greene ME, Kennedy E, Stanford JB

Published September 2018 Obstetrics and Gynecology, 132(3), 591-604

DOI 10.1097/AOG.0000000000002784 PMID 30095777

RRM Academy Synopsis

First-year pregnancy rates vary widely by fertility awareness method

A 2018 review of 53 studies found first-year pregnancy rates with typical use ran from 1.8 to 33.6 per 100 woman-years. These rates come from 21 moderate-quality trials of fertility awareness methods.

Key Findings

Of 8,755 unique citations, 53 prospective studies of at least 50 women qualified. For avoiding pregnancy, none rated high quality, 21 rated moderate, and 32 rated low.
In moderate-quality studies, first-year typical use rates or probabilities per 100 woman-years were 11.2–14.1 for the Standard Days Method and 10.5–33.6 for the Billings Ovulation Method.
In moderate-quality studies, first-year typical use rates or probabilities were 1.8 for Sensiplan, 2–6.8 for the Marquette Monitor-only Method, 6–7 for Marquette Monitor and Mucus, and 25.6 for Persona.
First-year perfect use rates or probabilities in moderate-quality studies were 0 for the Marquette Monitor, 0.4 for Sensiplan, 4.8 for Standard Days, and 12.1 for Persona.
One randomized trial found first-year pregnancy rates of 6.8 with the Marquette Monitor-only Method and 18.5 with the Marquette Mucus-only Method.

Interpretation

This review pooled first-year pregnancy rates across fertility awareness methods. Each method tracks body signs such as cervical mucus, body temperature, and hormones to find the fertile window. Sensiplan and the Marquette Monitor-only Method had the lowest typical-use rates. Persona and the Billings Ovulation Method had higher rates. The gap between typical use and perfect use was widest for Persona and the Standard Days Method. How closely a couple follows the rules seems to matter a lot. The authors note that the studies they pooled came from different groups of women, which limits direct comparisons. The findings support larger studies that compare these methods side by side.

RRM Context

Fertility awareness methods give couples a daily read on their cycle. Restorative reproductive medicine shares this idea. Look at the cycle first. Treat after that. NaProTechnology and the Creighton Model use the same charts. They help find causes of irregular or missed ovulation.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To summarize best available prospective data on typical and perfect use effectiveness of fertility awareness-based methods for avoiding pregnancy.

Data Sources

We conducted a systematic review of studies published in English, Spanish, French, or German by June 2017 in MEDLINE, EMBASE, CINAHL, Web of Science, and ClinicalTrials.gov.

Methods of Study Selection

We reviewed 8,755 unique citations and included 53 studies that contained 50 or greater women using a specific fertility awareness-based method to avoid pregnancy, calculated life table pregnancy probabilities or Pearl rates, and prospectively measured pregnancy intentions and outcomes. We systematically evaluated study quality.

Tabulation, Integration, and Results

Of 53 included studies, we ranked 0 high quality, 21 moderate quality, and 32 low quality for our question of interest. Among moderate-quality studies, first-year typical use pregnancy rates or probabilities per 100 woman-years varied widely: 11.2-14.1 for the Standard Days Method, 13.7 for the TwoDay Method, 10.5-33.6 for the Billings Ovulation Method, 4-18.5 for the Marquette Mucus-only Method, 9.0-9.8 for basal body temperature methods, 13.2 for single-check symptothermal methods, 11.2-33.0 for Thyma double-check symptothermal methods, 1.8 for Sensiplan, 25.6 for Persona, 2-6.8 for the Marquette Monitor-only Method, and 6-7 for the Marquette Monitor and Mucus Method. First-year perfect use pregnancy rates or probabilities among moderate-quality studies were 4.8 for the Standard Days Method, 3.5 for the TwoDay Method, 1.1-3.4 for the Billings Ovulation Method, 2.7 for the Marquette Mucus Method, 0.4 for Sensiplan, 12.1 for Persona, and 0 for the Marquette Monitor.

Conclusion

Studies on the effectiveness of each fertility awareness-based method are few and of low to moderate quality. Pregnancy rates or probabilities varied widely across different fertility awareness-based methods (and in some cases, within method types), even after excluding low-quality studies. Variability across populations studied precludes comparisons across methods.

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Fertility Awareness Methods Compared

Topics

Fertility Awareness › Effectiveness › Typical and Perfect Use · Research Methods › Evidence Synthesis › Systematic Reviews · Contraception › Comparative Studies › Contraception Versus Fertility Awareness

Rachel Peragallo Urrutia, Chelsea B Polis, Elizabeth T Jensen, Margaret E Greene, Emily Kennedy, Joseph B Stanford

R Urrutia, C Polis, Liz Jensen, Beth Jensen, Betsy Jensen, E Jensen, Maggie Greene, Peggy Greene, M Greene, E Kennedy, Joe Stanford, Joey Stanford, J Stanford

PMID 30095777 30095777 DOI 10.1097/AOG.0000000000002784 10.1097/AOG.0000000000002784 Peragallo Urrutia et al. 2018, Peragallo Urrutia 2018

Keywords

Awareness, Family Planning Services, Female, Fertility, Humans, Pregnancy, Reproductive Techniques

Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review

First-year pregnancy rates vary widely by fertility awareness method

Key Findings

Interpretation

RRM Context

Abstract

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Topics

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