Thijssen, A., Meier, A., Panis, K., & Ombelet, W. (2014). 'Fertility Awareness-Based Methods' and subfertility: a systematic review. Facts, Views & Vision in ObGyn, 6(3), 113-123.
Thijssen A, Meier A, Panis K, Ombelet W. 'Fertility Awareness-Based Methods' and subfertility: a systematic review. Facts Views Vis Obgyn. 2014;6(3):113-123.
Thijssen, Annelies, et al. "'Fertility Awareness-Based Methods' and subfertility: a systematic review." Facts, views & vision in ObGyn, vol. 6, no. 3, 2014, pp. 113-123.
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Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.
Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium. ; Faculty of Medicine and Life Sciences, Hasselt Univ...
RRM Academy Synopsis
Cervical mucus tracking finds the highest-pregnancy days in a cycle
A review of 10 cohort studies found that cervical mucus monitoring identifies the days with the highest chance of pregnancy. Most studies left out couples with fertility problems or did not consider them. The review reports a good match between mucus quality and pregnancy chances in fertile couples, and a weaker match in couples with reduced fertility.
Key Findings
The authors screened 3331 MEDLINE hits and selected 10 studies: nine prospective cohort studies and one retrospective cohort study.
In a 2003 retrospective study, the probability of pregnancy on the mucus peak day was 0.38 for fertile couples and 0.14 for couples with reduced fertility.
In a 2006 study, the probability of conception rose from 0.003 on days with mucus score 1 to 0.29 on days with mucus score 4.
Across the studies, vaginal discharge quality followed each cycle's pregnancy probability well for normally fertile couples and less well for couples with reduced fertility.
Interpretation
The review covers ten cohort studies, nine prospective and one retrospective. The studies observed how mucus relates to pregnancy within a cycle. None was a randomized trial. The findings mainly describe fertile couples, because most studies left out couples with fertility problems or did not consider them. The 2003 study of couples with reduced fertility was retrospective and had no independent marker of ovulation. The authors call for prospective cohort studies and randomized trials in that group.
RRM Context
Mucus monitoring underlies the Billings Ovulation Method and the Creighton Model, both covered in the review. The authors write that natural family planning methods can serve as a diagnostic tool for finding reduced fertility and its possible causes. RRM follows the same principle: cycle observation guides the search for the cause in both partners.
Our editorial summary of this paper, not the article's abstract.
Abstract
Fertility awareness based methods (FABMs) can be used to ameliorate the likelihood to conceive. A literature search was performed to evaluate the relationship of cervical mucus monitoring (CMM) and the day-specific -pregnancy rate, in case of subfertility. A MEDLINE search revealed a total of 3331 articles. After excluding articles based on their relevance, 10 studies and were selected. The observed studies demonstrated that the cervical mucus monitoring (CMM) can identify the days with the highest pregnancy rate. According to the literature, the quality of the vaginal discharge correlates well with the cycle-specific probability of pregnancy in normally fertile couples but less in subfertile couples. The results indicate an urgent need for more prospective randomised trials and -prospective cohort studies on CMM in a subfertile population to evaluate the effectiveness of CMM in the subfertile couple.
De Bayas Sanchez A et al., 2025·Open research Europe·Free full text on PubMed Central
The medically assisted reproduction (MAR) industry is a booming sector of the economy, and Spain is proving to be a notable example of this industry's rise. Marketing strategies in the healthcare sector are shaped by the constant tension between providing clear, complete and appropriate information about treatments and providing information to attract and retain customers.
We conducted a systematic analysis of success rate information published on the websites of Spain's five with the strongest online presence MAR clinics as of November 2023. The analysis examined terminology, certifications and audits by external bodies, references to data sources, age-specific success rates, and generalised claims about treatment effectiveness.
We identified significant deficiencies and ambiguities in how clinics present success rate data. Common issues included vague definitions, lack of certification details, absence of reliable data sources, and failure to differentiate outcomes by age or treatment type. Several clinics used overly optimistic or potentially misleading statistics, making it difficult for patients to assess their realistic chances of success. We provide recommendations aimed at improving consumer protection and regulating advertising practices. We also emphasise that presenting clear and truthful success rate information is not only a legal requirement but also an ethical duty in reproductive healthcare.
Stronger regulation of success rate reporting in Spain's fertility sector is urgently needed. We recommend that external authorities oversee and standardise data reporting to ensure transparency and prevent misleading practices. A centralised public body should be responsible for monitoring, collecting, and managing this data to protect patient rights and improve trust in fertility care.
Biomedical science is rapidly developing in terms of more transparency, openness and reproducibility of scientific publications. This is even more important for all studies that are based on results from basic semen examination. Recently two concordant documents have been published: the 6th edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen, and the International Standard ISO 23162:2021. With these tools, we propose that authors should be instructed to follow these laboratory methods in order to publish studies in peer-reviewed journals, preferable by using a checklist as suggested in an Appendix to this article.
To test consumables and other products used during oocyte collection, sperm preparation, IUI, embryo culture, and IVF-embryo transfer for their possible reprotoxic properties. A prospective 4-year survey of reprotoxicity testing of consumables and other products used in assisted reproductive technologies (ART). Private infertility center in a university-affiliated teaching hospital. INTERVENTION(S): Thirty-six products of 72 different brands, including plastics, syringes, tubing, and surgical gloves were analyzed for their reprotoxicity in 350 human sperm survival tests (SpST). MAIN OUTCOME MEASURE(S): The SpST index: percentage progressive motility of test sample/percentage progressive motility of control sample after 24 and 96 hours. RESULT(S): Thirteen of 36 products were found to be reprotoxic: an SpST index <0.85 was noted 24 and 96 hours after exposure. These products included eight brands of unpowdered surgical gloves, two types of hysterometers and one type of tubing attached to the oocyte collection needle, one type of ovum pickup procedure needle, and one type of embryo transfer catheter. One type of condom used for ultrasound, one type of sterile Pasteur pipette and petri dish, as well as the cover of a specimen container, were reprotoxic. CONCLUSION(S): The SpST is an inexpensive, easy, and reliable method to identify potential reprotoxic products and consumables used in ART procedures. These data underline the importance of the inclusion of the SpST in a continuous quality control (QC) program of ART outcome.
Evans-Hoeker E et al., 2013·Fertil Steril·Free full text on PubMed Central
To assess the use of cervical mucus monitoring (CMM) in women trying to conceive and determine whether monitoring is associated with increased cycle-specific probability of conception (fecundability). Time-to-pregnancy cohort study. Population-based cohort. PATIENT(S): Three hundred thirty-one women trying to conceive, ages 30 to 44 years, without known infertility. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): CMM prevalence and fecundability. RESULT(S): During the first cycle of the study, CMM was performed consistently (checked on >66% of pertinent cycle days) by 20 women (6%), inconsistently (34% to 66% of days) by 60 women (18%), infrequently (≤33% of days) by 73 women (22%), and not performed by 178 women (54%). Cycles in which CMM was consistently performed were statistically significantly more likely to result in conception after adjusting for age, race, previous pregnancy, body mass index, intercourse frequency, and urinary luteinizing hormone (LH) monitoring. Fecundability also increased with increasing consistency of CMM. CONCLUSION(S): Among women trying to conceive, CMM is uncommon, but our study suggests that CMM-a free, self-directed method to determine the fertile window-is associated with increased fecundability independent of intercourse frequency or use of urinary LH monitoring.
Manhart MD et al., 2013·Osteopathic Family Physician
Each year, over three-fourths of the women of reproductive age in the United States seek family planning services from primary care clinicians. Women and their doctors should be informed of all effective family planning options and their respective effects on a woman's reproductive health. Family physicians are well-trained to support the behavior choices necessary for the successful adoption of any reversible family planning method. However, many are unfamiliar with fertility awareness-based methods (FABM) of family planning or have misconceptions about their effectiveness, complexity, or suitability for their patients. FABM teach women to observe the physical signs and symptoms that follow hormonal fluctuations throughout the menstrual cycle to identify a couple's fertile window, which can be used to avoid or achieve pregnancy. One in 5 women in the United States expressed interest in using FABM when informed about such options. When correctly used to avoid pregnancy, modern FABM have unintended pregnancy rates<5 (per 100 women years). Studies of modern FABM show that their typical unintended pregnancy rates are comparable to those of commonly used contraceptives. This article presents a review of the FABM literature to (1) familiarize the reader with the physiological basis and features of modern FABM, (2) present and utilize a framework to evaluate clinical evidence using the Strength of Recommendation Taxonomy (SORT), which supports the effectiveness of modern FABM for avoiding pregnancy, and (3) serve as a resource for health care professionals offering FABM options to their patients.
Duane M et al., 2022·Front Med (Lausanne)·Free full text on PubMed Central
Fertility awareness-based methods (FABMs) educate about reproductive health and enable tracking and interpretation of physical signs, such as cervical fluid secretions and basal body temperature, which reflect the hormonal changes women experience on a cyclical basis during the years of ovarian activity. Some methods measure relevant hormone levels directly. Most FABMs allow women to identify ovulation and track this "vital sign" of the menstrual or female reproductive cycle, through daily observations recorded on cycle charts (paper or electronic). Physicians can use the information from FABM charts to guide the diagnosis and management of medical conditions and to support or restore healthy function of the reproductive and endocrine systems, using a restorative reproductive medical (RRM) approach. FABMs can also be used by couples to achieve or avoid pregnancy and may be most effective when taught by a trained instructor. Information about individual FABMs is rarely provided in medical education. Outdated information is widespread both in training programs and in the public sphere. Obtaining accurate information about FABMs is further complicated by the numerous period tracking or fertility apps available, because very few of these apps have evidence to support their effectiveness for identifying the fertile window, for achieving or preventing pregnancy. This article provides an overview of different types of FABMs with a published evidence base, apps and resources for learning and using FABMs, the role FABMs can play in medical evaluation and management, and the effectiveness of FABMs for family planning, both to achieve or to avoid pregnancy.
To determine if an electronic hormonal fertility monitor aided method (EHFM) of family planning is more effective than a cervical mucus only method (CMM) in helping couples to avoid pregnancy. Six hundred twenty-eight women were taught how to avoid pregnancy with either the EHFM (n=313) or the CMM (n = 315). Both methods involved standardized group teaching and individual follow-up. All pregnancies were reviewed and classified by health professionals. Correct use and total unintended pregnancy rates over 12 months of use were determined by survival analysis. Comparisons of unintended pregnancies between the 2 methods were made by use of the Fisher exact test. There were a total of 28 unintended pregnancies with the EFHM and 41 with the CMM. The 12-month correct use pregnancy rate of the monitor-aided method was 2.0%, and the total pregnancy rate was 12.0%. In comparison, the 12-month correct use pregnancy rate of the CMM was 3.0%, and the total pregnancy rate was 23.0%. There was a significant difference in total pregnancies between the 2 groups (p<0.05). EFHM is more effective than CMM. Further research is needed to verify the results.
PMID 25374654 25374654 Thijssen et al. 2014, Thijssen 2014
Cite this article
Thijssen, A., Meier, A., Panis, K., & Ombelet, W. (2014). 'Fertility Awareness-Based Methods' and subfertility: a systematic review. Facts, Views & Vision in ObGyn, 6(3), 113-123.
Thijssen A, Meier A, Panis K, Ombelet W. 'Fertility Awareness-Based Methods' and subfertility: a systematic review. Facts Views Vis Obgyn. 2014;6(3):113-123.
Thijssen, Annelies, et al. "'Fertility Awareness-Based Methods' and subfertility: a systematic review." Facts, views & vision in ObGyn, vol. 6, no. 3, 2014, pp. 113-123.