Fertility awareness-based methods (FABM) of family planning have increased in popularity in recent years. The effectiveness of various methods can vary substantially and can be user dependent. For various reasons, there is a bias in OBGYN physicians against the use of FABMs for family planning. However, once educated about the methods of FABMs, this bias improves. There is limited regarding the education dedicated to FABM use in residency. We hypothesized that the residency education obtained regarding FABMs would be insufficient in preparing resident OBGYNs in effectively counseling patients regarding FABMs.
Methods
a 16-question survey was created via SurveyMonkey and was sent to all ACGME accredited OBGYN residency programs for distribution to current residents. The survey was administered from October 2023 to December 2023.
Results
125 responses were collected. Less than 40% of residents received formal training in regards to FABMs. Respondents indicated they felt most comfortable describing the calendar method to patients (68% respondents agree or strongly agree when queried if they could describe the method). 79.5% of respondents could not describe mucus-only, hormone monitoring, or sympto-thermal methods of family planning. When questioned if they were prepared to counsel postpartum patients who refused contraception regarding FABM, 58% of respondents indicated they could not assist their patients.
Conclusions
Despite increased use in recent years and multiple options for FABM use, resident education in the application and use of FABMs is lacking. Additionally, residents indicated they are most familiar with the least effective methods (calendar method) which would likely be a significant detriment to their patients.
OBGYN resident knowledge fertility awareness based methods, FABM education residency training family planning, fertility awareness methods physician bias counseling, calendar method sympto-thermal mucus method resident knowledge, OBGYN residency FABM training survey study, postpartum fertility awareness counseling resident preparedness, natural family planning education medical residency, fertility awareness based methods ACGME residency program, physician education FABMs patient counseling effectiveness, Damba-Cunningham FABM resident knowledge survey
DOI 10.63264/vn859v14 10.63264/vn859v14
Cite this article
Damba-Cunningham E, Borland A, & William Nolan (2025). Knowledge of OBGYN Residents of Fertility Awareness Based Methods of Family Planning. Journal of Restorative Reproductive Medicine, 1, 1-6. https://doi.org/10.63264/vn859v14
Damba-Cunningham E, Borland A, William Nolan. Knowledge of OBGYN Residents of Fertility Awareness Based Methods of Family Planning. J Restorative Reprod Med. 2025;1:1-6. doi:10.63264/vn859v14
Damba-Cunningham E, et al. "Knowledge of OBGYN Residents of Fertility Awareness Based Methods of Family Planning." Journal of Restorative Reproductive Medicine, vol. 1, 2025, pp. 1-6.
Parnell TA et al., 2026·Journal of Restorative Reproductive Medicine
This secondary analysis examined two independent U.S. surveys (J.L. Partners, N=1002; McLaughlin & Associates, N=1000) investigating public perspectives on fertility treatments. Initial support for IVF reached approximately 80%, though respondents demonstrated limited procedural knowledge. Conversely, only 33% initially supported restorative reproductive medicine (RRM), with 43% unfamiliar with it. After receiving detailed information, preferences 69% favored natural fertilization approaches versus 17% preferring laboratory fertilization. Respondents prioritized "baby health (74%) over cost (13%) and time to conceive (6%)." Support for IVF declined by 10% following presentation of medical risks and ethical considerations. Findings suggest the public values comprehensive assessment, diagnostic approaches addressing underlying causes, treatment transparency, and ethical sensitivity in fertility care.
Velmahos AH et al., 2026·Journal of Restorative Reproductive Medicine
To evaluate the extent to which a history of infertility is associated with adherence to specific diets among reproductive-aged females. Cross-sectional analysis. Between 2017-2023, 7,227 North American female pregnancy planners aged 21-45 years enrolled in PRESTO (Pregnancy Study Online), a preconception cohort study. Participants completed self-administered baseline questionnaires during preconception. Infertility history, 1) self-reported 12-month clinical infertility, 2) history of visiting a clinician for an infertility work-up, and/or 3) clinician-identified cause of infertility (e.g., ovulatory or tubal). Adherence to specific diets, including vegetarian, vegan, Mediterranean, Paleo, Weight Watchers, ketogenic, dairy free, gluten free, Atkins, South Beach, Zone, raw foods, or other at baseline. Multivariable log-binomial regression models estimated the prevalence ratios (PRs) and 95% confidence intervals (CIs), adjusted for age, income, and body mass index (BMI). The percentage of participants with a history of infertility was 26% based on the 12-month clinical infertility definition, 30% based on visiting a physician for infertility evaluation, and 26% based on an infertility diagnosis following a physician visit. Overall adherence to any particular diet was low (4.6% vegetarian, 2.8% ketogenic, 1.7% Weight Watchers, 1.4% Mediterranean, 1.3% vegan, 0.8% Paleo, <0.8%); 86.6% reported not adhering to any particular diet. A history of 12-month clinical infertility was associated with lower adherence to vegetarian (PR=0.78; 95% CI: 0.60-1.03), Paleo (PR=0.43; 95% CI: 0.19-0.91) diets. An infertility history involving a medical work-up was associated with a higher prevalence of adherence to a ketogenic diet (PR=1.56; 95% CI: 1.17-2.09). Participants whose infertility was attributed to ovulatory or tubal causes were nearly two times more likely to adhere to a ketogenic diet (PR=2.01; 95% CI: 1.38-2.94; PR=2.22; 95% CI: 1.09-4.49, respectively). The cross-sectional design cannot establish temporality or causality. The ketogenic diet was more prevalent among females with an infertility history, while vegetarian, Paleo, and Weight Watchers diets were less prevalent.
Body LiteracyHealthcare Professional TrainingMedical School CurriculumEducational Intervention
Open Access
To assess the effectiveness of an elective to improve students’ knowledge of fertility awareness-based methods for family planning and to determine whether there was a difference in knowledge gained by student type and/or course structure.
A quasi-experimental study of preand postassessment scores among three different groups of healthcare students. In one group, 24 undergraduate nursing students in a semester-long hybrid course. In a second group, 16 second year medical students in a six-week hybrid selective course. In the third group, 80 fourth year medical students in a two-week online elective for a total of 120 students completing the elective from January 2018 to June 2020. All students completed a knowledge assessment before the course, and the identical assessment after the course, with a maximum possible score of 20. ANOVA and non-parametric tests were used for data analysis.
The main outcome measure was comparison of post-course scores to pre-course scores. The mean pre-course score of about 50% in the undergraduate nursing group (x) was lower than the medical students in the six-week course (y) and two-week course (z) both about 70%. However, there was no difference in the mean post-course scores between the groups, which was about 90%. Assessments were mandated, but lectures were not, which could skew assessment scores. Additionally, the study focused on students signing up for the elective so it may not be generalizable to all medical and nursing student populations. Finally, educational interests and demographics impacting a student’s ability to learn and retain FABM knowledge is beyond the scope of this study. This elective was effective in improving fertility awareness-based method knowledge of medical and nursing students. All student groups had strong post-course knowledge scores – 90% accuracy, regardless of course structure. A fully online elective has the potential to make this knowledge easily available worldwide.
RRM MethodsDefinition and PrinciplesPatient AutonomyRRM vs IVF
Open Access
Recently, editorials have been published in reproductive medical journals that have misunderstood and misrepresented the origin and meaning of “restorative reproductive medicine” (RRM).1,2 This term was first used in 2000 when a group of physicians established the International Institute for Restorative Reproductive Medicine (IIRRM, iirrm.org ). I am a founding member and am currently president of the IIRRM.
The IIRRM was founded as a secular, not a faith-based organization. We adhere to time-honoured medical principles to understand and treat underlying factors responsible for infertility. We are always seeking to improve our diagnosis and treatment of those factors, the training of clinicians who offer RRM, and the quality of clinical practice of RRM. We believe that in the clinical realm, in vitro fertilization (IVF) is often offered quickly without sufficient efforts first made to help couples conceive naturally.
IVF was originally developed to treat patients with bilateral tubal occlusion who could not conceive through sexual intercourse. Most patients who undergo IVF today do not have blocked fallopian tubes. Intracytoplasmic Sperm Injection (ICSI) was developed for patients with severe male factor infertility. Most patients who undergo ICSI today do not have severe male factor infertility. Remarkably, the most recent Cochrane review of IVF indicates ongoing uncertainty about whether IVF improves the live birth rate compared to expectant management for previously untreated couples with “unexplained” subfertility.3
I am an active RRM clinician since 1998 and I have treated thousands of couples. When patients present for fertility treatment, I do not ask them what religion, political view, or philosophy they support, because that is irrelevant to people who want a solution for their infertility. If they have a condition that is better treated by IVF, I tell them that at the first appointment. If natural conception is possible with RRM, I explain what is involved and outline the treatment process which can take up to 12 cycles (most often less) to reach a healthy ongoing pregnancy, or a full course of treatment.
RRM honours patient autonomy. We do not seek to prohibit patient access to IVF. Patients seek us out. RRM expands their choices and options. Many of my patients were previously seen in fertility clinics that offer IVF. Patients repeatedly tell me they did not receive the same depth of investigation or non-IVF treatment in the IVF clinics. I recently received these comments from patients, “RRM empowered us in our fertility journey. It provided a personalised approach. We are so grateful.” And “even if we didn’t conceive, we’d never regret trying RRM as my health improved immeasurably…”
The World Health Organization states that “Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse”.4 As RRM physicians, we respectfully suggest a slight “Infertility is a medical condition defined by failure to achieve a pregnancy after 12 months or more of regular sexual intercourse without contraception, which is caused by one or more underlying diseases and conditions involving the male or female reproductive system.” This definition indicates that infertility is not a singular condition to be treated solely by treatments to generate a pregnancy and birth. Rather, it is “a canary in the coal mine” for human health, indicating the need to identify and address underlying health concerns. 5,6
As RRM physicians and clinicians we have training and backgrounds that allow us to treat infertility patients with a focus on treatments and approaches that restore and optimize natural function. The specialty of reproductive endocrinology and infertility has extensive training with a particular focus on IVF and treatments to improve the success of IVF. But we can and should be in agreement to offer patients evidence-based information and treatments that meet the needs and preferences of patients.
Further research is needed and is currently ongoing on patient-relevant questions, How does an RRM evaluation differ in process and results from a fertility evaluation before initiating IVF? How do the outcomes of RRM and IVF compare on multiple levels including live birth rates, premature delivery, patient satisfaction, health improvement, and repeat successful births?7
For the sake of our patients with infertility, let us strive to be objective about the scientific facts, and meet all patients with respect. Surely as we challenge and learn from one another and strive for excellence, the patients will be the ultimate beneficiaries.