Findings from a mobile application-based cohort are consistent with established knowledge of the menstrual cycle, fertile window, and conception.

OBJECTIVE: To investigate the validity of self-reported fertility data generated by a mobile application-based cohort in comparison with data collected by traditional clinical methodologies. DESIGN: Data were collected from July 2013 to July 2018 through a mobile application designed to track fertility. Bayesian hierarchical models were used to assess day-specific pregnancy probabilities. Descriptive statistics were used to estimate differences in day of ovulation and lengths of menstrual phases and to assess changes in the cervix and ovulation-related symptoms drawing closer to the day of ovulation. SETTING: Not applicable. PATIENT(S): Data consisted of 225,596 menstrual cycles from 98,903 women. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Day-specific probabilities of pregnancy, variability in lengths of the follicular and luteal phases, trends in prevalence of symptoms and cervix changes across the fertile window. RESULT(S): Analyses were consistent with established clinical knowledge. Probability of conception was highest during the 5 days before and day of ovulation, with the highest probability occurring the day before ovulation. The average cycle length was 29.6 days, and average lengths of the follicular and luteal phases were 15.8 and 13.7 days, respectively. Closer to day of ovulation, women were more likely to report changes in the cervix corresponding to fluid consistency, feel, position, and openness and symptoms associated with ovulation, including pelvic pain, tender breasts, increased sex drive, and cramps. CONCLUSION(S): Components of the menstrual cycle and fertile window, when re-evaluated with a mobile application-based cohort, were found to be consistent with established clinical knowledge, suggesting an agreement between traditional and modern data collection methodologies.

Optimizing natural fertility: a committee opinion.

This Committee Opinion provides practitioners with suggestions for optimizing the likelihood of achieving pregnancy in couples/individuals attempting conception who have no evidence of infertility. This document replaces the document of the same name previously published in 2013, Fertil Steril 2013;100(3):631-7.

Effectiveness of a Natural Family Planning Service Program.

PURPOSE: The aims of this study were to determine and compare extended use-effectiveness of an online nurse-managed fertility education service program among women (and subgroups of women) seeking to avoid pregnancy. STUDY DESIGN AND METHODS: This was a 24-month prospective study of a university-based online Web site with 663 nonbreastfeeding women using an online charting system to avoid pregnancy. Participants tracked their fertility online with either cervical mucus monitoring, electronic hormonal fertility monitoring, or both fertility indicators. Unintended pregnancies were validated by professional nurses. RESULTS: Participants had a mean age of 30.4 years (SD = 6.3) and mean 1.7 children (SD = 2.0). Among the 663 nonbreastfeeding participants there were 2 unintended pregnancies per 100 at 24 cycles of correct use and 15 pregnancies at 24 cycles of typical use. However, the 212 women using the electronic fertility monitor had a typical use unintended pregnancy rate of 6 at 24 cycles of use in comparison with the 118 women using cervical mucus monitoring that had a typical use pregnancy rate of 19 at 24 cycles and with the 333 women using both fertility indicators that had a pregnancy rate of 18 at 24 cycles of use. CLINICAL IMPLICATIONS: Use of the fertility monitor to estimate fertility among nonbreastfeeding women provides the most secure method of avoiding pregnancy.

Standardized protocols for characterizing women's fertility: A data-driven approach.

Experts are divided on whether women's cognition and behavior differs between fertile and non-fertile phases of the menstrual cycle. One of the biggest criticisms of this literature concerns the use of indirect, imprecise, and flexible methodologies between studies to characterize women's fertility. To resolve this problem, we provide a data-driven method of best practices for characterizing women's fertile phase. We compared the accuracy of self-reported methods and counting procedures (i.e., the forward- and backward-counting methods) in estimating ovulation using data from 140 women whose fertility was verified with luteinizing hormone tests. Results revealed that no counting method was associated with ovulation with >30% accuracy. A minimum of 39.5% of the days in the six-day fertile window predicted by the counting methods were non-fertile, and correlations between counting method conception probabilities and actual conception probability were weak to moderate, rs=0.11-0.30. Poor results persisted when using a lenient window for predicting ovulation, across alternative estimators of the onset of the next cycle, and when removing outliers to increase the homogeneity of the sample. By contrast, combining counting methods with a relatively inexpensive test of luteinizing hormone predicted fertility with accuracy >95%, but only when specific guidelines were followed. To this end, herein we provide a cost-effective, pragmatic, and standardized protocol that will allow researchers to test whether fertility effects exist or not.

Fertility awareness-based mobile application for contraception.

OBJECTIVES: The aim of the study was to retrospectively evaluate the effectiveness of a fertility awareness-based method supported by a mobile-based application to prevent unwanted pregnancies as a method of natural birth control. METHODS: In a retrospective analysis, the application's efficiency as a contraceptive method was examined on data from 4054 women who used the application as contraception for a total of 2085 woman-years. RESULTS: The number of identified unplanned pregnancies was 143 during 2053 woman-years, giving a Pearl Index of 7.0 for typical use. Ten of the pregnancies were due to the application falsely attributing a safe day within the fertile window, producing a perfect-use Pearl Index of 0.5. Calculating the cumulative pregnancy probability by life-table analysis resulted in a pregnancy rate of 7.5% per year (95% confidence interval 5.9%, 9.1% per year). CONCLUSIONS: The application appears to improve the effectiveness of fertility awareness-based methods and can be used to prevent pregnancies if couples consistently protect themselves on fertile days.

Evaluation and treatment of infertility.

Infertility is defined as the inability to achieve pregnancy after one year of regular, unprotected intercourse. Evaluation may be initiated sooner in patients who have risk factors for infertility or if the female partner is older than 35 years. Causes of infertility include male factors, ovulatory dysfunction, uterine abnormalities, tubal obstruction, peritoneal factors, or cervical factors. A history and physical examination can help direct the evaluation. Men should undergo evaluation with a semen analysis. Abnormalities of sperm may be treated with gonadotropin therapy, intrauterine insemination, or in vitro fertilization. Ovulation should be documented by serum progesterone level measurement at cycle day 21. Evaluation of the uterus and fallopian tubes can be performed by hysterosalpingography in women with no risk of obstruction. For patients with a history of endometriosis, pelvic infections, or ectopic pregnancy, evaluation with hysteroscopy or laparoscopy is recommended. Women with anovulation may be treated in the primary care setting with clomiphene to induce ovulation. Treatment of tubal obstruction generally requires referral for subspecialty care. Unexplained infertility in women or men may be managed with another year of unprotected intercourse, or may proceed to assisted reproductive technologies, such as intrauterine insemination or in vitro fertilization.

Cervicovaginal fluid changes to detect ovulation accurately.

OBJECTIVE: The purpose of this study was to evaluate changes in cervicovaginal fluid characteristics to identify ovulation. STUDY DESIGN: Several ovulation indicators were studied in a university-based natural family planning center. Fifteen parous women during 29 ovulatory cycles detected cervicovaginal fluid at the vulva. They self-aspirated their upper vaginal fluid, described it, and kept it for later checking. They also took basal body temperature, collected timed first morning urine samples for estrone and pregnanediol glucuronide enzyme immunoassays, and submitted to serial ovarian transvaginal ultrasound scans. RESULTS: Considering a +/-1-day period since ultrasound ovulation detection or allowing an extra day (-1 to +2), women perceived ovulation from cervicovaginal fluid at the vulva in 76% or 97% of cycles, on the basis of their visual description of vaginally extracted fluid in 76% or 90%, which rose to 90% or 97% for the instructor's description, and in 76% or 86% with a rapid drop in glucuronide ratio. Basal body temperature was less precise (71% or 79%). CONCLUSION: Evaluation of cervicovaginal fluid changes is an accurate ovulation indicator.

New low- and high-tech calendar methods of family planning.

Calendar-based methods are not usually considered effective or useful methods of family planning among health professionals. However, new "high-" and "low"-tech calendar methods have been developed, which are easy to teach, to use, and may be useful in helping couples avoid pregnancy. The low-tech models are based on a fixed-day calendar system. The high-tech models are based on monitoring urinary metabolites of female reproductive hormones. Both systems have high levels of satisfaction. This article describes these new models of family planning and the research on their effectiveness. The author proposes a new algorithm for determining the fertile phase of the menstrual cycle for either achieving or avoiding pregnancy.

Comparison of different methods used for oestrus examination in the bitch.

The aim of this study was to determine the reliability of oestrus symptoms of the bitch (vulvar swelling, vaginal fluid, attraction of the male, teasing) and that of the most frequently used examination methods (vaginal smear, vaginoscopy, serum progesterone determination) which indicate the stage of the cycle and allow to predict the optimal day of mating (ODM). The determination of the cycle stage was based upon the number of days left from the day of examination to the day of parturition (DTP). Our results indicate that none of the above-mentioned symptoms and examination methods is reliable alone for the determination of DTP, and even the complex picture obtained from the integrated results of different methods will not enable an exact estimation. ODM can be predicted with a higher reliability, and 1-2 days before it, it can be detected very safely. Since most bitches are presented for timing to practitioners, a scheme was created based upon a scoring system, which gives a point value to each individual symptom and examination result, and judges the bitch according to the total amount of points.

Evaluation of the postcoital test in cycles involving exogenous gonadotropins.

OBJECTIVE: To evaluate the hypothesis that a postcoital test, optimally performed in the periovulatory period of cycles in which gonadotropin-induced superovulation was used, correlates with cycle fecundity. METHODS: Of 1135 total consecutive cycles, 367 first cycles were analyzed from the reproductive endocrinology and infertility service of a university medical center. This referral population had a mean age of 34.6 years for the female partner, a nulliparity rate of 81%, and a mean length of infertility of 4.8 years. Postcoital tests were performed 36-40 hours after hCG administration in gonadotropin-stimulated cycles. Clinical pregnancy was defined as fetal cardiac activity as seen on transvaginal ultrasound examination. RESULTS: Couples with no sperm observed per high-power field in the cervical mucus achieved a 16% fecundity rate (21 pregnancies in 129 cycles), one to ten sperm a 18% fecundity rate (28 pregnancies in 154 cycles), and more than ten sperm a 15% fecundity rate (13 pregnancies in 84 cycles). There was no significant difference between groups (n = 367, P = .85); the power to detect a statistically significant difference was .82. As validation of optimal cervical mucus, fecundity rates were compared with these postcoital test values across the entire range of peak periovulatory serum estrogen levels, and no correlation was seen (P = .61, .86, and .96 for estrogen levels of 201-500, 501-1500, and 1501-3433 pg/mL, respectively). CONCLUSION: With precise periovulatory timing and supraphysiologic estrogen levels optimizing qualitative cervical mucus characteristics in gonadotropin-induced cycles, the number of sperm observed per high-power field does not correlate with cycle fecundity.

A comparison of the ovulation method with the CUE ovulation predictor in determining the fertile period.

The purpose of this study was to compare the CUE Ovulation Predictor with the ovulation method in determining the fertile period. Eleven regularly ovulating women measured their salivary and vaginal electrical resistance (ER) with the CUE, observed their cervical-vaginal mucus, and measured their urine for a luteinizing hormone (LH) surge on a daily basis. Data from 21 menstrual cycles showed no statistical difference (T = 0.33, p = 0.63) between the CUE fertile period, which ranged from 5 to 10 days (mean = 6.7 days, SD = 1.6), and the fertile period of the ovulation method, which ranged from 4 to 9 days (mean = 6.5 days, SD = 2.0). The CUE has potential as an adjunctive device in the learning and use of natural family planning methods.

Ultrasound monitoring of ovarian follicular growth during spontaneous cycles in Nigerian women.

Thirty-nine spontaneous cycles in 34 women (22 patients from the infertility clinic and 12 normal volunteers) were serially studied by ultrasound to monitor follicular growth for ovulation prediction and detection. Ovulation was also confirmed by a mid-luteal phase progesterone assay using WHO match RIA kits. Ovulation occurred from the left ovary in 21 cycles (54%) and from the right ovary in 18 cycles (46%). The maximum follicular diameter prior to ovulation was 21.0 +/- 3.48mm with a range of 15-28 mm. The maximum pre-ovulatory size in the group of infertile patients 21.4mm (range 15-28 mm) was not statistically different from the size in normal volunteers 20.8mm (range 15.5-27mm) (P > 0.05). Bilateral ovulation occurred in two patients. Changes in shape and/or size of the follicle mostly associated with increased internal echoes were the indices of ovulation in 84.7% of cases. Follicular diameter of 15mm may indicate imminent ovulation in Nigerian women. Infertility management procedures such as artificial insemination, timed sexual intercourse may commence just before or once this follicular size has been attained until ovulation is detected.

Evaluation of a simple and fast self-test for urine luteinizing hormone.

Ovulation can be predicted by measuring the midcycle urine luteinizing hormone surge with a simple 5-minute enzyme-immunoassay. This assay has proved to be suitable for self-tests with a sensitivity of about 90% and a specificity of 100% in unstimulated and clomiphene citrate stimulated cycles. Whereas a reference method (hemagglutination test) yielded better sensitivity, its specificity was markedly worse. Self-tests carried out by patients and control laboratory tests showed an excellent correlation. Patient compliance with self-tests should not be taken for granted.

Validity of the Bioself 110 fertility indicator.

The Bioself 110 (Bioself Canada, Inc., Montréal, Québec, Canada) is an electronic computerized thermometer designed to identify the fertile and infertile phases of the menstrual cycle. The purpose of this study was to evaluate the validity of the device by comparing it with a reference method, the Ovustick (Monoclonal Antibodies, Inc., Mountain View, CA) luteinizing hormone (LH) surge detection kit. The Bioself 110 identified the 6-day fertile period in 86.4% of 220 cycles studied and 5 fertile days in 93.2%. The Bioself 110 correctly identified the postovulatory infertile phase in 93.3% of 178 cycles. On average, the device identified 10.9 fertile days and 10.6 postovulatory "safe" days per cycle. It was concluded the device would be a useful aid to couples trying to conceive or prevent pregnancy.