Would you trust the (algo)rithm method?
As new apps make it easier to pinpoint your fertile days, more women are using them for contraception. Should you?
Get it on ( your phone)
Our appetite for alternative approaches to managing fertility has resulted in a slew of new apps. This year, Natural Cycles was the first to win approval as a contraceptive from the EU. Backed by three clinical studies, the technology was created by physicist Dr Elina Berglund, 32, and her husband Dr Raoul Scherwitzl. Launched in 2013, the app now has almost 400,000 users worldwide, with 180,000 UK downloads.
‘In 2012 I was looking for safe, reliable contraception for myself,’ says Berglund. ‘I knew there was concern about the side effects of hormonal contraceptives, as lots of friends were worried about taking a pill that puts you in an artificially infertile state. So I decided to write an algorithm.’
The app detects ovulation, calculating a woman’s fertile days by tracking her cycle, her temperature and sperm survival. Users take their temperature, enter it in the app and the algorithm provides a ‘red’ fertile or ‘green’ non-fertile day. If you want to have sex on red days, you need to use another form of contraception.
Jane Clark*, 30, has used Natural Cycles for six months, after the Pill exacerbated her anxiety. ‘ The more you use it, the better it gets,’ she says. ‘At first I had no green days but now my cycle is mostly green with about eight red days. I feel I finally have control over my own body and fertility.’
Writer Sarah Wiggs*, 28, says, ‘ The Pill gave me mood swings, endometriosis symptoms and I had terrible pain after sex, to the point where my relationship broke down. For four years I’ve used the rhythm method and the Clue app to track my cycle. The information it gives on my fertility is an added bonus. I can report zero pregnancies. I don’t want kids yet, but I imagine the app will be useful when I do.’
Apps rely on patterns, but our bodies Aren’t machines
The good, The bad and The evidence
Natural Cycles say their technology is around 93% effective. By contrast, when used perfectly, the Pill has an effectiveness rate of 99.7%. However, when you factor in typical use – women often forget to take it, take it at irregular times, or get sick – the Pill’s effectiveness rate drops to 91%. With their efficacy on a seemingly equal footing, is it any wonder that ‘natural health’leaning women are tempted by the app?
Nutrional therapist Maya Oakley understands its appeal. ‘Many of us are hormonally medicated throughout our life,’ she says. ‘ With the Pill as treatment for painful periods or acne, fertility drugs to aid conception, hormone replacement at menopause… These drugs mask issues in the body and prevent us knowing ourselves.’
That women are increasingly shunning hormonal contraception does not surprise pharmacist and co-founder of Victoria Health Shabir Daya, either. He believes ‘anything which disturbs the balance in the body may be detrimental’ and stresses that ‘most people think the Pill simply stops the release of eggs or prevents the egg from implanting, however this is simplistic… All hormones work with each other and any disruption in one may impact the rest.’
Moreover, recent studies have drawn correlations between use of the Pill and depression, decreased libido and an increased risk of breast cancer in some women. Despite this, fertility experts remain wary of women abandoning traditional options. ‘I’ve seen an anecdotal rise in women using technology to monitor their fertility,’ says Professor Tim Child, medical director of Oxford Fertility Unit. ‘But the evidence that using an app is as good as hormonal contraception just isn’t there.’
Gemma Wiles*, 31, became pregnant after coming off the Pill in favour of fertility planning apps and is about to have her first baby. She says, ‘I’m married and a pregnancy is something we can deal with. We’d have liked to have waited, but I wanted to come off the Pill. I don’t think my cycle was regular enough to give the app correct data.’
Indeed, The Faculty of Sexual and Reproductive Health (FSRH) at the Royal College of Obstetricians and Gynaecologists, the Family Planning Association and the national fertility awareness service Fertility UK have all said that ‘while fertility awareness apps have great potential to broaden contraception choices… being classed as a medical device does not guarantee that the app will effectively prevent pregnancy’.
They’ve called for large-scale, independent trials to ensure that these apps are subject to the same rigorous research as other contraceptives. Diana Mansour of the FSRH says, ‘ There are hundreds of apps that claim to help users plan or prevent pregnancy… some will be more effective than others.’ And apps, of course, don’t protect against STIS or HIV.
Moreover, Professor Child warns, ‘Apps rely on patterns, but the body doesn’t do the same thing every month. Bodies aren’t machines or algorithms. Couples should be aware that “natural” methods of contraception – as with any method that depends on the user doing something – have higher failure rates. It all comes down to how important it is to you to prevent a pregnancy. If it’s very important, apps probably aren’t reliable enough.’
However, Maya Oakley believes that medical professionals are out of step with why women want to come off hormonal contraception. ‘ The fertile part of a cycle corresponds with various emotional and physical states and understanding – not masking – why, at certain times of the month you may be more outgoing or have better concentration is important. It’s what makes us who we are. Women want to embrace the elements that make us female.’