NO JOB FOR AN APP
Study finds most programs don’t use evidence-based fertility awareness methods
There are dozens of smartphone and web apps women use to avoid pregnancy — but do they actually work?
Most don’t, according to a new study from Georgetown University researchers. The peer-reviewed research, published in the latest issue of the Journal of the American Board of Family Medicine, looked at nearly 100 fertility awareness apps and found a majority aren’t designed for avoiding pregnancy and don’t use evidence-based fertility awareness methods women often use to track their cycles — some to avoid conception, others to aid in conceiving.
“I don’t think the apps are necessarily helping women as much as they purport they are,” says the study’s lead author, Dr. Marguerite Duane, an adjunct associate professor at the Georgetown University School of Medicine and executive director of Fertility Appreciation Collaborative to Teach the Science.
And that’s concerning, Duane says, given how popular these apps are becoming. The top apps have been downloaded more than one million times each, her study notes.
The research looked at 95 apps in total, but eliminated 55 off the top because they either had a disclaimer prohibiting use for avoiding pregnancy or didn’t claim to use evidence-based fertility awareness-based methods, which help predict fertile and infertile times in a woman’s cycle — systems such as the symptothermal method, which involves recording fertility clues such as a woman’s basal body temperature, mood and cervical secretions.
Duane wouldn’t recommend these apps for women trying to avoid pregnancy. “But if you want to track one of your periods coming, that’s completely different,” she adds. (A full list of apps involved in the research is available at FactsAboutFertility.org.)
When it came to the 40 apps Duane’s team did review, 30 predicted fertile days for users and 10 didn’t. The researchers entered seven different “cycles” to test each app, with data that varied in cycle length and fertility observations — reflecting the diversity of real women.
“Basically, the whole idea was if an app predicted that a day was infertile but the evidence-based guidelines said she was fertile, then the app would rate lower,” Duane says.
Out of the 30 apps predicting a woman’s fertile days, Duane only recommends the top-rated apps in the study: Ovulation Mentor, Sympto.org, iCycleBeads, LilyPro, Lady Cycle and mfNFP.net — which all had either a perfect score on accuracy or no days of fertility labelled as infertile by the app.
And of the 10 apps that didn’t predict fertility, Duane would recommend the top four: NFP Charting, Fertility Pinpoint, Kindara and Symptopro. “For those 10 apps that didn’t predict the fertile window, we still rated them highly on accuracy if they recommended the woman learn the (fertility awareness-based method) first, instead of just relying on the app,” she notes.
While many women swear by apps, citing success stories such as longtime pregnancy prevention or conception on the first go, others find them useless. Some women also end up using apps for both purposes — at first preventing pregnancy, then later in an attempt to conceive.
Vanessa Austin, a Guelph resident, used a period-tracking app before having kids and says it was helpful for tracking her cycles, particularly during a time when she switched birth control methods and wanted to be “extra careful.”
She switched to another app when she decided to get pregnant and found the notifications revealing her chance of pregnancy helpful. “I got pregnant, first try,” says Austin, who gave birth to son James in March.
Pickering resident Jenn Tesluk also used an app to track her cycles while using different forms of birth control — from condoms to the NuvaRing — and eventually just to check when she’d be getting her period after she stopped using various birth control methods. But she didn’t feel like the apps were totally reliable beyond period tracking. When it came to avoiding pregnancy, “we were just lucky,” she says.
Later, when Tesluk and her husband, Matt, decided to have kids, she tried two different apps that showed her ovulation days, but each one gave a different answer. On top of that, when either app told her she was ovulating, ovulation test strips didn’t back it up.
While Tesluk eventually did get pregnant — and gave birth to the couple’s son Emmett back in February — she says the apps weren’t helpful in the process.
“It was really frustrating,” she says. “The two apps weren’t matching up and the testing wasn’t matching up and I figured maybe it’s just not an exact science.”
Her cycles, she adds, are a bit longer than the average woman’s — around 35 days, instead of the typical 28.
If apps are using that “typical” menstrual cycle, that might explain why many women wouldn’t find them accurate, notes Dr. Yolanda Kirkham, an obstetrician-gynecologist at Women’s College Hospital and St. Joseph’s Heath Centre.
“Not everyone has a 28-day cycle ... and that can change the ovulation date, which changes when the egg is released,” she explains.
While Kirkham always encourages her patients to learn more about their cycles, she says the apps merely act as a tracking tool — and should be coupled with speaking to your doctor and learning how to gauge your own body, be it changes in cervical mucus or taking your basal body temperature, both indicators of fertility.
“We can’t rely just on computers. They don’t know you personally. It’s always much better to chart for yourself, rather than using a one-size-fits-all app,” Kirkham says.