The aim was to compare the efficacy and acceptability of two Internet-supported fertility-awareness-based methods of family planning.
Study Design
Six hundred and sixty-seven women and their male partners were randomized into either an electronic hormonal fertility monitor (EHFM) group or a cervical mucus monitoring (CMM) group. Both groups utilized a Web site with instructions, charts and support. Acceptability was assessed online at 1, 3 and 6 months. Pregnancy rates were determined by survival analysis.
Results
The EHFM participants (N=197) had a total pregnancy rate of 7 per 100 users over 12 months of use compared with 18.5 for the CMM group (N=164). The log rank survival test showed a significant difference (p<.01) in survival functions. Mean acceptability for both groups increased significantly over time (p<.0001). Continuation rates at 12 months were 40.6% for the monitor group and 36.6% for the mucus group.
Conclusion
In comparison with the CMM, the EHFM method of family planning was more effective. All users had an increase in acceptability over time. Results are tempered by the high dropout rate.
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PMID 23153900 23153900 DOI 10.1016/j.contraception.2012.10.010 10.1016/j.contraception.2012.10.010
Cite this article
Fehring, R. J., Schneider, M., Raviele, K., Rodriguez, D., & Pruszynski, J. (2013). Randomized comparison of two Internet-supported fertility-awareness-based methods of family planning. Contraception, 88(1), 24-30. https://doi.org/10.1016/j.contraception.2012.10.010
Fehring RJ, Schneider M, Raviele K, Rodriguez D, Pruszynski J. Randomized comparison of two Internet-supported fertility-awareness-based methods of family planning. Contraception. 2013;88(1):24-30. doi:10.1016/j.contraception.2012.10.010
Fehring, R. J., et al. "Randomized comparison of two Internet-supported fertility-awareness-based methods of family planning." Contraception, vol. 88, no. 1, 2013, pp. 24-30.
To compare pregnancy rates when women have intercourse on self-estimated high and peak fertile days and when they only have intercourse on low fertile days during the fertile window (FW). We used a prospective observational cohort study design. Our convenience sample included 124 women who utilized our online charting Web sites to achieve pregnancy from January 2010 to November 2012. Participants used an electronic hormonal fertility monitor (EHFM) or self-observed cervical mucus or both to determine fertility during the estimated FW. Pregnancy rates were determined with Kaplan-Meier survival analysis. Chi square analysis was used to evaluate the efficacy of achieving pregnancy between two different intercourse patterns. The pregnancy rate was 87 per 100 women at 12 months when intercourse happened on high or peak days and 5 per 100 when intercourse occurred only on low days of the FW. Chi square analysis showed a greater proportion of pregnancies with intercourse on high and peak fertile days of the menstrual cycle (x2 = 40.2, p < .001, df = 1). Focusing intercourse on high or peak fertile days during the estimated FW enhances the probability of achieving a desired pregnancy. Fertility awareness-based online charting system is effective in helping women to determine their FW and target intercourse accordingly to achieve pregnancy.
Fertility AwarenessElectronic Hormonal MonitoringCorrect and Typical Use RatesCervical Mucus Monitoring
Fehring RJ et al., 2007·J Obstet Gynecol Neonatal Nurs
To determine the effectiveness of an electronic hormonal fertility monitor plus cervical mucus monitoring to avoid pregnancy.
A 12-month prospective clinical efficacy trial. One hundred ninety five (195) women (mean age 29.8 years) seeking to avoid pregnancy with a natural method at 5 clinical sites in 4 cities. Each participant was taught to track fertility by self-observation of cervical mucus and an electronic monitor that measures urinary levels of estrone-3-glucuronide and luteinizing hormone. Correctand typical-use unintended pregnancy rates. There were a total of 26 unintended pregnancies, 3 with correct use. With 1,795 months of use, the correct-use pregnancy rate was 2.1% per 12 months of use (i.e., 97.9% effective in avoiding pregnancy when rules of the method were always followed) and the imperfect-use pregnancy rate was 14.2% per 12 months of use (i.e., 85.8% effective in avoiding pregnancy when rules of the method were not always followed and all unintended pregnancies and months of use were included in the calculations). Correct use of an electronic hormonal fertility monitor with cervical mucus observations can be as effective as other fertility awareness-based methods of natural family planning. Comparative studies are needed to confirm this conclusion.
The purpose of this study was to compare the CUE Ovulation Predictor with the ovulation method in determining the fertile period. Eleven regularly ovulating women measured their salivary and vaginal electrical resistance (ER) with the CUE, observed their cervical-vaginal mucus, and measured their urine for a luteinizing hormone (LH) surge on a daily basis. Data from 21 menstrual cycles showed no statistical difference (T = 0.33, p = 0.63) between the CUE fertile period, which ranged from 5 to 10 days (mean = 6.7 days, SD = 1.6), and the fertile period of the ovulation method, which ranged from 4 to 9 days (mean = 6.5 days, SD = 2.0). The CUE has potential as an adjunctive device in the learning and use of natural family planning methods.
The Couple to Couple League (CCL) is pleased that an article and an editorial in the December 1995 issue of the well-respected New England Journal of Medicine confirm that natural family planning (NFP) has value and is scientifically based, a fact the CCL has known for many years. The research covered in the article entitled Timing of Sexual Intercourse in Relation to Ovulation found that the only fertile days were the five days before ovulation and the day of ovulation itself. Most conceptions (76.4%) occurred during the day of and the first and second days before ovulation. CCL's slide showing the extent of the fertile time reflects the data of the report, but also includes the possibility of a second ovulation occurring within 24 hours of the first ovulation. The study found that women conceived in only 37% of cycles in which intercourse took place during the six-day fertile period. This rate is not much different than that claimed by a NFP physician many years ago (about 30%). The study showed the highest conception probability to be when the couple had sexual intercourse every day during the fertile period (37% vs. 33% for every other day). CCL advises couples to abstain until the fertile period then follow one coital frequency period during one cycle (e.g., every day) and the other pattern the next cycle (e.g., every other day). The study refuted claims that the timing of coitus relative to ovulation was not associated to the sex of the baby and that aging sperm do not reduce the viability of the fetus and/or cause birth defects. In fact, aging sperm rarely fertilize the ovum. The only way to positively detect ovulation is seeing the ovum burst out of the ovary. Hormone analyses of blood or urine and observations of cervical mucus and basal body temperature allow an estimate of the day of ovulation. NFP is not based on detecting ovulation but on identifying the limits of the fertile period.