The rapid proliferation of fertility apps has created a market that has the potential to address the needs of women and couples worldwide. Some women who seek to prevent pregnancy are making behavioral decisions based on information they receive from fertility apps, yet fertility apps may not always be accurate and reliance on them could lead to unintended pregnancies. Little research has been done to understand who uses fertility apps for pregnancy prevention, how those who use them perceive their efficacy, and their preferences for how apps should be designed and presented to accurately assist them in preventing pregnancy.
Methods
A web-based pilot survey was launched through Facebook recruiting women who either currently use a fertility app for pregnancy prevention or intend to use one in the future. Data collected from 1,000 women surveyed user preferences around fertility app characteristics, including aesthetics, features, functionality, and reputation. User knowledge about fertility and reproduction was assessed, and knowledge categories were created. Chi-square tests assessed differences in app characteristic preferences according to knowledge category. Additional qualitative analyses on free-text answers explored which features of apps are important to users when they search for one to use.
Results
Approximately one quarter (23.1%) of survey respondents reported currently using a fertility app or had used one in the recent past, and 76.9% reported intention to use one in the future. A majority of both current and intended users (65.4%) had some knowledge of fertility and reproduction, while 16.5% had very little knowledge. 18.1% reported receiving prior provider counseling on using a fertility-awareness based method. Users across all knowledge groups said it was very important for apps to be science-based and that they identify fertile days during the menstrual cycle.
Conclusions
Women who use or wish to use apps to prevent pregnancy are seeking apps that are scientifically sound and provide them personalized information around their potential fertility. However, most fertility apps women reported using lack the capability for true fertility-awareness based method application for accurate, reliable pregnancy prevention. More research is needed to evaluate apps for efficacy and accuracy preventing pregnancy. Collaborations between app developers and women's health experts are encouraged, as well as informed consumerism campaigns.
To characterize how commercially available fertility-tracking devices and wearables define ovulation and anovulation, evaluate available comparator evidence, and assess user burden across 19 selected technologies.
We conducted a structured landscape analysis of 19 fertility-tracking devices and wearables available in the United States. Technologies were evaluated for biomarker type, operational definitions of ovulation and anovulation, comparator evidence, intended use, regulatory status, and user burden, among other variables.
Technologies clustered into four major categories: luteinizing hormone (LH)-only devices, multi-hormone devices, basal body temperature (BBT)-based wearables, and BBT-based thermometers. LH-only devices generally defined ovulation by detecting an LH surge or peak; multi-hormone devices incorporated LH and/or pregnanediol-3-glucuronide (PdG) measurements; and BBT-based technologies relied on thermal shifts. Explicit definitions of anovulation were uncommon and were frequently inferred from the absence of ovulation-associated biomarkers. The existence and design of comparator evidence varied substantially across technologies. Most comparator studies relied on surrogate measures such as urinary or serum hormones, whereas few technologies had comparator evidence against physiological reference standards such as transvaginal ultrasound (TVUS). Comparator studies in irregular-cycle populations were uncommon despite frequent marketing of these devices as appropriate for users with irregular cycles. User burden varied substantially across technologies.
Fertility-tracking technologies demonstrate substantial heterogeneity in operational definitions, comparator evidence, and user burden. Greater transparency regarding ovulation and anovulation definitions, clearer reporting of comparator evidence, and more representative evaluation in irregular-cycle populations are needed to support accurate interpretation and integration into reproductive healthcare.
To identify factors associated with unacceptable Patient Acceptable Symptom State (PASS) responses, Visual Analog Scale (VAS) scores, and satisfaction at time of intrauterine device (IUD) placement.
Recruitment occurred at six Utah clinics between 6/24-2/25. Participants completed procedure surveys on demographics, reproductive history, anticipated pain, anxiety, and coping skills. Post-placement surveys assessed PASS responses, experienced pain by VAS (1-100mm) and satisfaction with IUD placement (5-point Likert scale). We determined factors associated with unacceptable PASS responses and a cut point delineating "low" vs "high" pain to assess measure associations.
Of 194 participants, 21% (n = 41) reported an unacceptable PASS, which was associated with higher mean anticipated (65 mm vs 51 mm; padj=0.01) and experienced (76 mm vs 46 mm; padj<0.001) pain, prior sexual assault (55% vs 28%; padj=0.016), or violent death of someone close (25% vs 7%; padj=0.024). In controlled analysis, higher experienced pain predicted unacceptable PASS (OR:1.10;95%CI:1.06, 1.14). "High" pain (≥61mm) occurred in 44% of all participants. Of those with high pain, 55% reported an acceptable PASS response. History of prior pelvic exam (p = 0.02, padj 0.20), prior IUD placement (p = 0.003; padj 0.12), or violent death of someone close (p = 0.011; padj 0.13) influenced unacceptable PASS responses in this group. Of all participants, 21% reported dissatisfaction (n = 16) or neutral response (n = 24) regarding their IUD placement, among which only 13 reported an unacceptable PASS (32%). Satisfaction was influenced by mean VAS score (61 mm dissatisfied/neutral vs 50 mm satisfied; p = 0.01; padj 0.90).
IUD placement pain level may influence satisfaction, but less than half of those with high pain (≥61mm) reported an unacceptable experience.
IUD placement pain experiences are multi-dimensional and cannot be described by pain level alone. High levels of placement pain influence satisfaction and overlap but are not collinear with acceptability responses. Acceptability of IUD may be subject to temporal bias and influenced by whether their goals/needs are met and whether the pain was ultimately worth it.
Nantume A et al., 2025·Drug and alcohol dependence·Free full text on PubMed Central
Substance use disorder (SUD) during pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes, yet many patients face significant barriers to accessing treatment, including experiencing bias and stigma from healthcare providers. To inform improvements in care delivery, this study explored the experiences of healthcare providers who care for pregnant individuals with SUD.
Researchers conducted seven focus group discussions (FGD) and fifteen in-depth interviews (IDI) using semi-structured guides, with participants drawn from both rural and urban hospital settings across Utah. All discussions were audio recorded, transcribed verbatim, and examined using the Template Analysis approach.
Among FGD participants (n = 37), the sample was predominantly white (94.6 %), female (86.5 %), rural (89.2 %), and comprised of nurses (78.4 %). The IDI sample (n = 15) was more gender diverse (60 % female), had greater representation of physicians (53.3 %), and a higher proportion of urban participants (60.0 %). Template analysis revealed four major themes. First, providers held a range of perceptions toward pregnant individuals with SUD, reflecting both stigma and empathy. Second, many emphasized the importance of building trust through nonjudgmental communication and emotional support. Third, providers reported high levels of burnout, particularly due to limited resources and systemic barriers. Finally, participants highlighted knowledge gaps related to SUD clinical care and confusion around regulatory requirements like mandatory reporting.
Despite the challenges described, many providers expressed strong dedication to delivering compassionate, person-centered care. The findings underscore the need for targeted provider education, institutional policies that reduce care barriers, and increased community and institutional resources to better support patients with SUD during pregnancy.
Stanford JB et al., 2024·Linacre Q·Free full text on PubMed Central
Fertility awareness-based methods (FABMs), also known as natural family planning (NFP), enable couples to identify the days of the menstrual cycle when intercourse may result in pregnancy ("fertile days"), and to avoid intercourse on fertile days if they wish to avoid pregnancy. Thus, these methods are fully dependent on user behavior for effectiveness to avoid pregnancy. For couples and clinicians considering the use of an FABM, one important metric to consider is the highest expected effectiveness (lowest possible pregnancy rate) during the correct use of the method to avoid pregnancy. To assess this, most studies of FABMs have reported a method-related pregnancy rate (a cumulative proportion), which is calculated based on all cycles (or months) in the study. In contrast, the correct use to avoid pregnancy rate (also a cumulative proportion) has the denominator of cycles with the correct use of the FABM to avoid pregnancy. The relationship between these measures has not been evaluated quantitatively. We conducted a series of simulations demonstrating that the method-related pregnancy rate is artificially decreased in direct proportion to the proportion of cycles with intermediate use (any use other than correct use to avoid or targeted use to conceive), which also increases the total pregnancy rate. Thus, as the total pregnancy rate rises (related to intermediate use), the method-related pregnancy rate falls artificially while the correct use pregnancy rate remains constant. For practical application, we propose the core elements needed to assess correct use cycles in FABM studies.
Fertility awareness-based methods (FABMs) can be used by couples to avoid pregnancy, by avoiding intercourse on fertile days. Users want to know what the highest effectiveness (lowest pregnancy rate) would be if they use an FABM correctly and consistently to avoid pregnancy. In this simulation study, we compare two different measures: (1) the method-related pregnancy rate; and (2) the correct use pregnancy rate. We show that the method-related pregnancy rate is biased too low if some users in the study are not using the method consistently to avoid pregnancy, while the correct use pregnancy rate obtains an accurate estimate. SHORT In FABM studies, the method-related pregnancy rate is biased too low, but the correct use pregnancy rate is unbiased.
The advent of new technological approaches to family planning has the potential to address unmet need in low- and middle-income countries. Provision of fertility awareness-based apps have the ability to provide accessible, direct-to-user fertility information to help women achieve their reproductive goals. The CycleBeads app, a digital platform for the Standard Days Method (SDM), a modern method of family planning, helps women achieve or prevent pregnancy, or track their cycles using the only their period start dates.
Brief social marketing campaigns were launched by the app developer to monitor cost and distribution of the CycleBeads app, understand the user profile, and assess user experience. Monitoring and evaluation through in-app micro surveys occurred over a 6-cycle period in seven countries: Egypt, Ghana, India, Jordan, Kenya, Nigeria, and Rwanda. In-app micro-surveys were utilized to collect data around demographics, mode of use of the app, prior experiences with family planning, and satisfaction to better understand women's interactions with the apps, and the possibility for meeting unmet need. Analyzes focused on women who were using the app to prevent pregnancy or track their cycles.
Social media campaigns proved to be an easy, low-cost approach to advertising the CycleBeads app. As a result, 356,520 women downloaded the app, and the cost to the advertiser per download ranged from $0.17-0.69. A majority of app users were between 20-29 years old, married or in exclusive relationships. Overall, 39.9% of users were using the app to prevent pregnancy, 38.5% to plan a pregnancy, and 21.6% were tracking their cycles. Among the users preventing pregnancy, 64.1% of women had not used a family planning method 3 months before downloading the CycleBeads app. One-third of users who were using the app to track their cycles, reported that they had not been using any form of family planning. In all seven countries, nearly 60% of women reported that they would definitely recommend the CycleBeads app to a friend, indicating their satisfaction with the app.
Our main findings indicate that a social media campaign is a low-cost approach to making the CycleBeads app accessible to women. The app addresses multiple reproductive intentions and attracts a diverse demographic of users across different life stages. For many women the app was the first modern method they used in the last 3 months, showing that fertility awareness-based apps have the potential to address an unmet need. Future studies should focus on changes in behavior during the fertile window, partner communication, and future family planning intentions.
Ali R et al., 2020·Reprod Biomed Online·Free to read
To characterize mobile fertility tracking applications (apps) to determine the use of such apps for women trying to conceive by identifying the fertile window.
An exploratory cross-sectional audit study was conducted of fertility tracking applications. Ninety out of a possible total 200 apps were included for full review. The main outcome measures were the underlying app method for predicting ovulation, the fertile window, or both, price to download and use the app, disclaimers and cautions, information and features provided and tracked, and app marketing strategies.
All the apps except one monitored the women's menstrual cycle dates. Most apps only tracked menstrual cycle dates (n = 49 [54.4%]). The remainder tracked at least one fertility-based awareness method (basal body temperature, cervical mucus, LH) (n = 41 [45.6%]). Twenty-five apps measured dates, basal body temperature, LH and cervical mucus (27.8%). Seventy-six per cent of apps were free to download with free apps having more desirable features, tracking more measures and having more and better quality educational insights than paid apps. Seventy per cent of apps were classified as feminine apps, 41% of which were pink in colour. Mobile fertility tracking apps are heterogenous in their underlying methods of predicting fertile days, the price to obtain full app functionality, and in content and design. Unreliable calendar apps remain the most commonly available fertility apps on the market. The unregulated nature of fertility apps is a concern that could be addressed by app regulating bodies. The possible benefit of using fertility apps to reduce time to pregnancy needs to be evaluated.
Costa Figueiredo M et al., 2021·JAMIA Open·Free full text on PubMed Central
Fertility is becoming increasingly supported by consumer health technologies, especially mobile apps that support self-tracking activities. However, it is not clear whether the apps support the variety of goals and life events of those who menstruate, especially during transitions between them. Thirty-one of the most popular fertility apps were evaluated, analyzing data from three sources: the content of app store pages, app features, and user reviews. Findings: Results suggest that fertility apps are designed to support specific life goals of people who menstruate, offering several data collection features and limited feedback options. However, users often desire holistic tracking that encompasses a variety of goals, life events, and the transitions among them. These findings suggest fertility patients can benefit more from holistic self-tracking and provide insights for future design of consumer health technologies that better support holistic fertility tracking. Fertility apps have the potential to support varied experiences of people who menstruate. But to achieve that, apps need to expand their support by offering ways for more users to perform holistic, personalized, and personally meaningful tracking, so they can derive long-term benefit from the data they collect.
There has been a phenomenal worldwide increase in the development and use of mobile health applications (mHealth apps) that monitor menstruation and fertility. Critics argue that many of the apps are inaccurate and lack evidence from either clinical trials or user experience. The aim of this scoping review is to provide an overview of the research literature on mHealth apps that track menstruation and fertility. This project followed the PRISMA Extension for Scoping Reviews. The ACM, CINAHL, Google Scholar, PubMed and Scopus databases were searched for material published between 1 January 2010 and 30 April 2019. Data summary and synthesis were used to chart and analyse the data. In total 654 records were reviewed. Subsequently, 135 duplicate records and 501 records that did not meet the inclusion criteria were removed. Eighteen records from 13 countries form the basis of this review. The papers reviewed cover a variety of disciplinary and methodological frameworks. Three main themes were identified: fertility and reproductive health tracking, pregnancy planning, and pregnancy prevention. Motivations for fertility app use are varied, overlap and change over time, although women want apps that are accurate and evidence-based regardless of whether they are tracking their fertility, planning a pregnancy or using the app as a form of contraception. There is a lack of critical debate and engagement in the development, evaluation, usage and regulation of fertility and menstruation apps. The paucity of evidence-based research and absence of fertility, health professionals and users in studies is raised.
Fertility Awareness › Technology › Cycle Tracking Apps · Contraception › Family Planning Use and Attitudes › Attitudes and Acceptability
Mary Summer Starling, Zosha Kandel, Liya Haile, Rebecca G Simmons
M Starling, Z Kandel, L Haile, Becky Simmons, R Simmons
PMID 30050917 30050917 DOI 10.2196/resprot.6886 10.2196/resprot.6886 Starling et al. 2018, Starling 2018
03r0ha626