Predictors of Fertility-Awareness-Based Method Use Among Women Trying to Conceive and Women Contemplating Pregnancy.

BACKGROUND: Fertility-awareness-based methods have been linked to shorter time to conception; however, little is known about the predictors of fertility-awareness-based method use among women who are currently or will soon be trying to conceive. OBJECTIVES: The aim of this study was to identify predictors of fertility-awareness-based methods use among women trying to conceive or contemplating pregnancy within the next year. METHODS: Women participating in the Nurses' Health Study 3 were asked if they were trying to become pregnant or contemplating pregnancy and whether they are using fertility-awareness-based methods. Multivariable negative binomial regression was used to identify predictors for a number of fertility-awareness-based methods used. RESULTS: Among the 23,418 women asked about pregnancy intention since 2015, 955 were trying to conceive, and 2,282 were contemplating pregnancy within the next year. The three most used fertility-awareness-based methods among women trying to conceive were menstrual cycle tracking, ovulation prediction kits, and cervical mucus monitoring. Among women contemplating pregnancy, the three most commonly used methods were menstrual cycle tracking, cervical mucus monitoring, and basal body temperature monitoring. The ongoing duration of pregnancy attempts and gravidity were associated with the number of methods used among women actively trying to conceive. When compared with women who were trying for 2 months or less, the number of methods was 29% higher when trying for 3-5 months, 45% higher when trying for 6-12 months, and 38% higher when trying for more than 1 year. Compared with nulligravid women, the number of methods was lower for women with a history of two or more pregnancies. Among women contemplating pregnancy, those who were married or in a domestic partnership used more fertility-awareness-based methods than unpartnered women. No other significant predictors of fertility-awareness-based method use were identified. DISCUSSION: Duration of ongoing pregnancy attempt and gravidity were the only significant predictors for the number of fertility-awareness-based methods used among women actively trying to conceive, whereas partnership was the only significant predictor of the number of fertility-awareness-based methods among women contemplating pregnancy.

An Integrative Review of Fertility Knowledge and Fertility-Awareness Practices Among Women Trying to Conceive.

OBJECTIVE: To synthesize the literature on fertility knowledge and fertility-awareness among women seeking pregnancy. DATA SOURCES: The search terms "fertility-awareness OR fertility knowledge AND women AND subfertile OR infertile OR seeking pregnancy OR trying to conceive OR pre-conception OR conception NOT contraception NOT birth control" were used via CINAHL, PubMed, and Web of Science. Primary research studies were considered in the search parameters. STUDY SELECTION: Searches yielded 116 studies published between 1978 and 2020. After screening, 43 full-text studies were assessed for eligibility, 35 of which were omitted as not relevant. Nine quantitative studies using cross-sectional designs met this review's inclusion criteria. DATA EXTRACTION: Studies were reviewed for information on the relationship between fertility knowledge/fertility-awareness and pregnancy intention. Studies examining the results of fertility-awareness based method (FABM) efficacy, FABMs for contraception, and provider knowledge regarding FABMs were omitted. DATA SYNTHESIS: Analysis showed low knowledge regarding the identification of the fertile window in the menstrual cycle to optimize pregnancy. There was moderate general knowledge on fertility (e.g., infertility definition, age of fertility decline, etc.). Use of an FABM and education regarding FABMs were infrequent, yet participants recognized that it would be beneficial to use and learn when trying to conceive. CONCLUSION: Women seeking pregnancy have low to moderate fertility knowledge. More research is necessary on the relationship between fertility knowledge/fertility-awareness and unexplained infertility. Nurses, nurse practitioners, and nurse-midwives should provide education on FABMs to women when they first report difficulty achieving pregnancy. Clinicians' approaches toward FABM education for women and how to implement FABM education into the preconception visit are important areas for future research.

Exploring Fertility Awareness Practices Among Women Seeking Pregnancy.

OBJECTIVE: To explore use of fertility awareness-based methods (FABMs) and factors that influence their use. DESIGN: Secondary data analysis of the National Survey of Family Growth, 2015 to 2017. SETTING: Surveys were conducted in the homes of a national sample of women in the civilian, noninstitutionalized population of the United States. PARTICIPANTS: A subset of women (N = 423) ages 19 to 49 years who sought advice about becoming pregnant. INTERVENTION/MEASUREMENTS: Descriptive statistics and multivariate logistic regression were used to describe sample characteristics and to examine predictors for FABM use. RESULTS: The sample was primarily married (70%), non-Hispanic women age 35 years or older (M = 37.4 years, SD = 7.3). Most were college educated (n = 253, 74.4%), were employed (n = 317, 74.9%), and had health insurance (n = 392, 92.7%). Only 113 women (27%) used one of three FABMs. The most frequent FABM was calendar rhythm (n = 103, 24.6%). Few used temperature/cervical mucus (n = 33, 7.9%) or Standard Days/Cycle Beads (n = 25, 6%). Catholic religion and age were not significant factors in FABM use. There was no significant difference among women with and without college degrees in FABM use: χ2(1, N = 423) = .27, p = .60. The model containing all predictors was not statistically significant: χ2(6, N = 423) = 5.686, p < .459; this indicates that the model was unable to distinguish differences in predictors between respondents who had or had not used an FABM. The model explained 1.7% (Cox and Snell R2) and 2.5% (Nagelkerke R2) of the variance in FABM use. CONCLUSION: The most effective FABM (temperature/cervical mucus) was used infrequently among women who sought advice to achieve pregnancy. Although the effects were insignificant in predicting which women used an FABM, descriptive findings on FABM use were clinically informative. Considering the cost, emotional strain, and potential complications of infertility treatment, clinicians should consider initially recommending a fertility awareness-based method to women seeking advice about achieving pregnancy.