Randomized comparison of two Internet-supported fertility-awareness-based methods  of family planning

Richard J Fehring; Mary Schneider; Kathleen Raviele; Dana Rodriguez; Jessica Pruszynski

doi:10.1016/j.contraception.2012.10.010

Fertility Awareness Effectiveness

Randomized comparison of two Internet-supported fertility-awareness-based methods of family planning

Fehring RJ, Schneider M, Raviele K, Rodriguez D, Pruszynski J

Published July 2013 Contraception, 88(1), 24-30

DOI 10.1016/j.contraception.2012.10.010 PMID 23153900

RRM Academy Synopsis

Monitor users had fewer unintended pregnancies than mucus users

Couples using an electronic hormonal fertility monitor had 7 unintended pregnancies per 100 users in a year, against 18.5 with cervical mucus monitoring. This trial enrolled 667 couples trying to avoid pregnancy for 12 months. Both groups learned their method on the same website.

Key Findings

Total unintended pregnancy rate over 12 months: 7 per 100 users with the electronic hormonal fertility monitor and 18.5 with cervical mucus monitoring (log rank p < .01).
Mucus-group pregnancies occurred at 2.96 times the monitor group's rate; survival and hazard functions differed significantly between groups.
Perfect use pregnancies, per 100 women over 12 months of use: 0 in the monitor group, 2.7 in the mucus group, with no difference between groups.
At 12 months, 40.6% of the monitor group and 36.6% of the mucus group were still using their method, a difference without statistical significance.
Mean acceptability rose from 55.5 (SD = 9.9) at one month to 58.3 (SD = 10.7) at six months (p < .0001); the groups did not differ overall.

Interpretation

This trial put couples at random into two groups for 13 cycles: one used an electronic hormonal fertility monitor, the other used cervical mucus. Both groups also used a calendar-based back-up check and the same online teaching site. The monitor group's pregnancy rate came in well under a third of the mucus group's rate. Perfect use pregnancies were rare in both groups. Couples stayed with their method, and rated it, at close to the same level in both groups by 12 months. The authors note that participant loss over the trial was a limitation. The findings support larger trials of electronic fertility monitors alongside other fertility awareness methods.

RRM Context

Both partners took part in this trial. Couples joined as a pair, and each one rated how much they liked their method. The authors call fertility awareness based methods free of side effects and accepted across many cultures and faiths. Only about 0.1% of women of reproductive age use a modern fertility awareness based method, per the 2006 National Survey of Family Growth. The trial tested two ways to find fertile days, cervical mucus or an electronic monitor, each backed by a calendar check and the same teaching site.

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

Abstract

Background

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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Fertility Awareness Methods Compared

Topics

Fertility Awareness › Effectiveness › Comparative Effectiveness · Contraception › Comparative Studies › Contraception Versus Fertility Awareness

Richard J Fehring, Mary Schneider, Kathleen Raviele, Dana Rodriguez, Jessica Pruszynski

Rick Fehring, Dick Fehring, Rich Fehring, R Fehring, M Schneider, K Raviele, D Rodriguez, Jess Pruszynski, J Pruszynski

PMID 23153900 23153900 DOI 10.1016/j.contraception.2012.10.010 10.1016/j.contraception.2012.10.010 Fehring et al. 2013, Fehring 2013

Keywords

Estrone-3-glucuronide, Estrone