Duane, M., Stanford, J. B., Porucznik, C. A., & Vigil, P. (2022). Fertility Awareness-Based Methods for Women's Health and Family Planning. Frontiers in Medicine, 9, 858977. https://doi.org/10.3389/fmed.2022.858977
Duane M, Stanford JB, Porucznik CA, Vigil P. Fertility Awareness-Based Methods for Women's Health and Family Planning. Front Med (Lausanne). 2022;9:858977. doi:10.3389/fmed.2022.858977
Duane, Marguerite, et al. "Fertility Awareness-Based Methods for Women's Health and Family Planning." Frontiers in Medicine, vol. 9, 2022, pp. 858977.
For EndNote, Zotero or Mendeley:
Open access
No open license is recorded for this paper. Reuse terms are set by the publisher.
Fertility awareness charts can guide family planning and diagnosis
A 2022 review of fertility awareness methods finds that charting cervical fluid and other body signs shows when ovulation happens. In studies of 100 or more women, correct use to avoid pregnancy meant fewer than 5 pregnancies per 100 women years.
Study at a glance, review of fertility awareness methods of studies of 100 or more women: Fertility awareness charting shows when ovulation happens. Source: Duane M et al., 2022, PMID 35685421.
Key Findings
Across the studies cited, 87–98% of the time ovulation falls within 2–3 days of the mucus peak day, a marker seen in cervical fluid.
Correct use to avoid pregnancy gave <5 per 100 women years across all methods included. Typical use ran from about 2 to 23 per 100 woman-years.
Studies of fertility focused intercourse suggest 85–90% of couples without fertility problems conceive within 6 months. Couples paying no attention to timing reach approximately 85% by the end of 1 year.
A 2016 systematic review found the large majority of apps marketed for avoiding pregnancy do not follow evidence-based methods of fertility awareness.
Interpretation
The paper is a review that collects separate studies into tables: mostly cohort studies, plus two randomized trials of couples trying to conceive. The pregnancy-prevention table lists studies with at least 100 women, published since 1990 and judged of reasonable quality in a systematic review. Three newer studies the authors believe may meet the same standard are added. Most pregnancy-prevention studies enrolled couples who learned the method from a trained instructor. The authors state that rates in daily life depend on instruction, motivation and partner support, so they may differ from study rates. The authors describe chart patterns as possible signs of underlying conditions that need further evaluation.
RRM Context
The authors treat the chart as input for restorative reproductive medicine. Physicians can use it to help diagnose cycle-related conditions. Two protocol sets rest on charting. One is NaProTechnology, developed from Creighton Model FertilityCare System charting. The other comes from the Reproductive Health Research Institute. The authors cite a 2015 ACOG Committee Opinion that calls the menstrual cycle a vital sign.
Our editorial summary of this paper, not the article's abstract.
Abstract
Background
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).
Applications
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.
Challenges
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.
Conclusions
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.
