Study finds most pro­grams don’t use ev­i­dence-based fer­til­ity aware­ness meth­ods

The Hamilton Spectator - - GO - LAU­REN PELLEY

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 Fact­sAboutFer­til­

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,, iCy­cleBeads, Li­lyPro, Lady Cy­cle and — 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.


When Jenn 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.

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