Discerning the Efficacy of Fertility Awareness Apps
More and more women are turning to fertility awareness-based methods (FABMs) for both family planning and a read on their overall health. As research has become more available, there has been a demonstrated interest in natural methods of observing the body’s biomarkers to identify the root causes of various conditions and create plans to manage unwanted symptoms like acne without resorting to hormonal birth control.
An increasing number of the women interested in FABMs are millennials, who are accustomed to using electronic devices for information on everything from work to wellness. So it’s natural that many would look first to their phones for insight on their cycles and what to make of them.
It’s crucial, then, that greater amounts of research dollars and time are devoted to determining the efficacy of the various apps available today and those that are in development. A woman looking for a FABM app will be met with dozens of options in an instant, and she may not know where to begin in determining which is best suited to her body and her goals.
An exploratory pilot study on FABM app users found that, “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.” Results from improper use may deter other women from seeking out a method appropriate for them as well as detract funding from further FABM research. It is imperative that women understand the science of the apps they are using, so that they can have confidence in the efficacy of their chosen method.
Not All Charting Apps Are Created Equal
Some apps are based on preexisting and already tested FABMs (Sympto-Thermal method, Billings ovulation method, etc.) and collect data as part of a proven protocol. Others operate on their own algorithms, often incorporating machine learning (that is, adjustments determined by user input).
A study recently published in Contraception sought to evaluate the efficacy of one particular app, namely “Dynamic Optimal Timing (Dot), an algorithm-based fertility app that identifies the fertile window of the menstrual cycle using a woman’s period start date and provides guidance on when to avoid unprotected sex to prevent pregnancy.”
Led by Victoria Jennings, Ph. D., director of the Institute for Reproductive Health and professor in the department of Obstetrics and Gynecology at Georgetown University School of Medicine, the study looked at six cycles of 629 women who met certain criteria (a more involved study on 13 cycles is forthcoming). The study was partially funded by U.S. Agency for International Development (USAID). As such, all the data is available for public viewing.
With perfect use, researchers found there were no unintended pregnancies in the women who completed the study, revealing a 100% perfect-use effectiveness rate in preventing pregnancy. With typical use, the researchers reported a failure rate of 3.5%, revealing a 96.5% typical-use effectiveness rate in preventing pregnancy.
Jennings reviewed her findings in a webinar hosted by the International Institute for Restorative Reproductive Medicine. While the perfect and typical use rates are encouraging (they are on par with more invasive methods of contraception), some of her other observations are more surprising and will be significant as more research is done on FABM apps.
For one thing, more women in the study reported being in a long-term relationship than being married. In the past, FABMs have been studied primarily in the context of married couples. This shift in the demographic is consistent with the current population, and its implications ought to be considered in future studies.
Another interesting—and perhaps alarming—finding is how many people downloaded and used this app, despite the prior lack of research on this method. Jennings noted in her presentation that women reported an interest in research-based methods, and yet only a theoretical study had been completed on the algorithm at work in Dot before it was implemented in this app.
Whether or not they rely on an app, women interested in charting for either health management or pregnancy prevention will be consoled to know that there are a number of charting methods that boast higher than 90% typical-use effectiveness rates—on the condition that users are trained by a certified FABM teacher in the method.
A tremendous amount of research has been done over the past fifty years to understand the feminine cycle and empower women to make choices about their lives. The Sympto-Thermal Method, Creighton Model, and Billings ovulation method are just three options that have been developed by looking at thousands of cycles over decades of study. Our hope is that the increasing interest in FABM apps will also lead more women to seek out information regarding these and other evidence-based methods that have been proven effective in a clinical setting.
Going forward, we, with Dr. Jennings, recommend further study on the integration of FABM apps with care from healthcare providers and continuing evaluations of the efficacy of new and existing apps. An app is convenient, but it is no substitute for a woman’s understanding her body and having the knowledge to interpret the signs she observes.