Duane, M., Contreras, A., Jensen, E. T., & White, A. (2016). The Performance of Fertility Awareness-based Method Apps Marketed to Avoid Pregnancy. Journal of the American Board of Family Medicine : JABFM, 29(4), 508-511. https://doi.org/10.3122/jabfm.2016.04.160022
Duane M, Contreras A, Jensen ET, White A. The Performance of Fertility Awareness-based Method Apps Marketed to Avoid Pregnancy. J Am Board Fam Med. 2016;29(4):508-511. doi:10.3122/jabfm.2016.04.160022
Duane, Marguerite, et al. "The Performance of Fertility Awareness-based Method Apps Marketed to Avoid Pregnancy." Journal of the American Board of Family Medicine : JABFM, vol. 29, no. 4, 2016, pp. 508-511.
Most Fertility Apps Carry Disclaimers or Lack Evidence-Based Methods
Of 95 fertility apps, 55 forbade use to prevent pregnancy or did not claim an evidence-based FABM. A 2016 brief report scored the rest on real cycle data. Only 6 of 40 reviewed apps had perfect accuracy or no false negatives.
Key Findings
Searches of iTunes, Google, and Google Play identified 95 apps. The authors excluded 55 that carried a disclaimer prohibiting use for avoiding pregnancy or did not claim an evidence-based FABM.
Of the apps reviewed, 30 predicted days of fertility for the user and 10 did not.
Only 6 apps earned a perfect accuracy score, meaning app-defined fertile days matched evidence-based fertile days, or had no false negatives, meaning no fertile days labeled infertile.
At least 1 app reached a perfect accuracy score in every FABM category except symptohormonal methods.
Several popular apps use proprietary algorithms that peer-reviewed literature has not evaluated, which makes them hard to assess.
Interpretation
This brief report scored 40 fertility apps against 7 cycles of daily fertility observations drawn from real cycle data, using a rating tool the authors built for the task. The authors conclude that an app alone, used without training in the method, may fall short of preventing pregnancy. The findings support a larger, ongoing review of app-based fertility tracking as these tools evolve.
RRM Context
The authors cite level 1 studies of FABMs used correctly, with effectiveness similar to common hormonal birth control. Restorative reproductive medicine builds on cycle charting. The method-level evidence belongs to named methods such as Creighton, symptothermal, and two-day. The rating tool used those methods as its standards.
Our editorial summary of this paper, not the article's abstract.
Abstract
Introduction
In recent years there has been an explosion in the development of medical apps, with more than 40,000 apps now available. Nearly 100 apps allow women to track their fertility and menstrual cycles and can be used to avoid or achieve pregnancy. Apps offer a convenient way to track fertility biomarkers. However, only some use evidence-based fertility awareness-based methods (FABMs), which with ideal use have rates of effectiveness similar to those of commonly used forms of hormonal birth control. Since having a baby or preventing a pregnancy are important responsibilities, it is critical that women and couples have access to reliable, evidence-based apps that allow them to accurately track their fertility.
Methods
We developed a tool to evaluate and rate fertility apps. This tool is specifically designed to help couples avoid pregnancy.
Results
Results showed that the majority of fertility apps are not based on evidence-based FABMs or include a disclaimer discouraging use for avoiding pregnancy. However, at least 1 app in each FABM category (except symptohormonal methods) had a perfect score on accuracy.
Conclusion
Relying solely on an app to use an FABM, without appropriate training in the method, may not be sufficient to prevent pregnancy.
