Increased Likelihood of Pregnancy Using an App-Connected Ovulation Test System: A  Randomized Controlled Trial

Sarah Johnson; Joseph B Stanford; Graham Warren; Sharon Bond; Sharon Bench-Capon; Michael J Zinaman

doi:10.1089/jwh.2019.7850

Fertility Awareness · Effectiveness

Increased Likelihood of Pregnancy Using an App-Connected Ovulation Test System: A Randomized Controlled Trial

Johnson S, Stanford JB, Warren G, Bond S, Bench-Capon S, Zinaman MJ

Published January 2020 Journal of Women's Health (2002), 29(1), 84-90

DOI 10.1089/jwh.2019.7850 PMID 31483187 PMC PMC6983750

RRM Academy Synopsis

App-connected ovulation tests raised pregnancy rates over two cycles

A randomized trial of 844 women trying to conceive in Britain found that women using an app-connected ovulation test got pregnant more often within two cycles. After one cycle, about 25 out of 100 test users were pregnant, against about 15 out of 100 without testing.

Key Findings

After one cycle, 25.4% of the test arm were pregnant against 14.7% of the control arm (odds ratio 2.0, 95% CI 1.4 to 2.8; p < 0.001).
After two cycles, 36.2% of the test arm and 28.6% of the control arm were pregnant (odds ratio 1.4, 95% CI 1.01 to 1.9; p = 0.026).
Test-arm women reported intercourse 9 times per cycle (range 1 to 60) against 10 times (range 1 to 50) in the control arm (p = 0.027).
88.5% of the test arm said they aimed intercourse at a particular part of the cycle, against 57.8% of the control arm (p < 0.001).
In the control arm, 40.0% used a cycle tracking app of their own. The paper reports that nonstudy cycle tracking apps were not associated with the likelihood of pregnancy.

Interpretation

The trial followed women trying to conceive in Britain across two menstrual cycles. The authors note that the test system was tracked for only two cycles, so the study does not speak to pregnancy rates with longer-term use. The findings support larger studies of this approach over longer-term use.

RRM Context

The fertile window opens days before ovulation and shifts between cycles. The authors cite a study in which cycle-tracking apps found the day of ovulation correctly no better than 21% of the time. Timing intercourse to observed fertility signs fits the cycle-charting principle of restorative reproductive medicine. Couples who do not conceive after well-timed intercourse call for a search for the cause in both partners.

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

Abstract

Background

Women trying to conceive are increasingly using fertility-tracking software applications to time intercourse. This study evaluated the difference in conception rates between women trying to conceive using an application-connected ovulation test system, which measures urinary luteinizing hormone and an estrogen metabolite, versus those trying without using ovulation testing.

Materials and Methods

This home-based study involved 844 volunteers aged 18-40 years seeking to conceive. Volunteers randomized to the test arm were required to use the test system for the duration of the study while those randomized to the control arm were instructed not to use ovulation testing. Pregnancy rate differences across one and two cycles between the two groups were examined.

Results

Volunteers in the test (n = 382) and control arms (n = 403) had similar baseline demographics. The proportion of women pregnant after one cycle was significantly greater in the test arm (25.4%) compared with the control arm (14.7%; p < 0.001). After two cycles, there continued to be a greater proportion of women pregnant in the test arm compared with the control arm (36.2% vs. 28.6%; p = 0.026). In the test arm, volunteers had intercourse less frequently per cycle compared with those not using ovulation testing (9 [range: 1-60] vs. 10 [range: 1-50]; p = 0.027), but were more likely to target intercourse to a particular part of their cycle compared with those not using ovulation testing (88.5% vs. 57.8%; p < 0.001).

Conclusion

Using the test system to time intercourse within the fertile window increases the likelihood of conceiving within two menstrual cycles.

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Fertility Awareness Methods Compared

Topics

Fertility Awareness › Effectiveness › Comparative Effectiveness · Menstrual Cycle › Cycle Biomarkers › Hormonal Markers

Sarah Johnson, Joseph B Stanford, Graham Warren, Sharon Bond, Sharon Bench-Capon, Michael J Zinaman

S Johnson, Joe Stanford, Joey Stanford, J Stanford, G Warren, S Bond, S Bench-Capon, Mike Zinaman, M Zinaman

PMID 31483187 31483187 DOI 10.1089/jwh.2019.7850 10.1089/jwh.2019.7850 Johnson et al. 2020, Johnson 2020