Director’s Note: Dr. Danielle Dowell, an internal medicine resident and former FACTS elective student, interviewed Laura,* a woman who uses a fertility awareness-based method (FABM) to both avoid and successfully achieve pregnancy. In discussing how Laura learned about and incorporated FABMs into her and her husband’s family planning, Dowell learned about the new app technology that exists to help families take control of their family planning and the importance of convenience when users are choosing a natural family-planning (NFP) method.
Meet Laura
Laura* — a woman in her mid-20s — has been on some form of hormonal birth control since she was 16. She initially used oral contraceptive pills (OCPs) before switching to a hormonal IUD at 21. About two years ago, she and her husband decided to have the IUD removed and learn more about NFP as they discussed having children. The couple wanted to “take more control of the family-planning process,” as well as learn more about their own fertility to achieve pregnancy when desired.
“The couple wanted to “take more control of the family-planning process,” as well as learn more about their own fertility to achieve pregnancy when desired.”
The couple began researching different FABMs online and settled on a method they deemed the most convenient and easy, as well as the most likely to help determine the likely day of ovulation: a sympto-hormonal method (SHM). After using the SHM for a little over a year to avoid pregnancy, they began using the method to achieve pregnancy. After three cycles, they were able to conceive! Laura is now 20 weeks pregnant and expecting a healthy baby boy.
Sympto-Hormonal Method (SHM)
Sympto-hormonal methods are a type of FABM that not only track cervical mucus (CM) patterns but also specific urine metabolites to determine the beginning and end of the fertile window and an estimation of ovulation. By using multiple biomarkers (CM and urine metabolites) to identify the fertile window, the SHM also affords users a “double-check” system that contributes to the method’s effectiveness.
“Sympto-hormonal methods are a type of FABM that not only track cervical mucus (CM) patterns but also specific urine metabolites to determine the beginning and end of the fertile window and an estimation of ovulation.”
The most established SHM is called the Marquette Model, developed at Marquette University by Dr. Richard Fehring and his team and now taught by the Boland Institute for Natural Family Planning. The Marquette Model combines cervical mucus observations with the use of the ClearBlue Fertility Monitor (CBFM) to measure urine estrogen metabolites and luteinizing hormone (LH). Tracking both of these urinary hormones allows the woman to determine the beginning of the fertile window with the beginning of a rise in estrogen; peak days of fertility by the rise and peak in LH; and the end of the fertile window by confirming an LH peak and adding 3 days. The method also supports the optional use of Basal Body Temperature (BBT) tracking in addition to the other biomarkers described above to help confirm ovulation retrospectively; however, it is not required for correct use of the method. Effectiveness of the Marquette Model has shown to be >99% with correct use and 89% effective with typical use [1]. Marquette University offers information about fertility health, protocols for special circumstances — like postpartum or perimenopausal charting [2].
“The most established SHM is called the Marquette Model…(which) has (been) shown to be >99% with correct use and 89% effective with typical use … (and offers) protocols for special circumstances — like postpartum or perimenopausal charting.”
The Marquette Model requires less thorough evaluation of cervical mucus findings, as compared to other mucus-based methods, like the Creighton Fertility Model and the Billings Ovulation Method. Because of this, the Marquette Model and other SHM can be taught effectively often in just a single 15-minute visit with a trained educator. This method can also be used by women with irregular cycles and women in various stages of life, from postpartum to perimenopause.
Primary drawbacks of sympto-hormonal methods include the cost associated with the required testing for the urinary metabolites. With the Marquette Model, the cost of a new CBFM runs around $160 online, with additional fees for LH strips. Couples looking to cut down on cost can use less expensive LH strips that tend to run around $15 for 50 testing strips (about 5 months worth of test strips); however, they will not be able to take advantage of the estrogen measurements the CFBM offers. It should also be noted that the SHM is even recommended for use in women with PCOS; however, Fehring recommends only using LH strips because the multiple estrogen and LH peaks characteristic of PCOS cycles can be incompatible with the programming of the CBFM (3).
NFP Technology Apps
After settling on using an SHM, Laura found a free app, the Premom Ovulation Tracker, to track everything directly on her phone and purchased the associated LH testing strips online. The app not only allows users to input daily cervical mucus findings but also provides a quantifiable LH reading for urine tests, taking the guesswork out of the LH peak timing. Once LH readings from the monitor have been uploaded to the app, the readings are displayed on a graph showing a rise and peak in LH alongside any other symptoms and biomarkers the woman may be tracking. The app then uses an algorithm to identify the likely day of ovulation. Laura tells me this feature was a key reason for choosing the app and method — she was truly looking for an FABM that was comprehensive yet convenient for her busy lifestyle. Apps like the Premom Ovulation Tracker allow users to take some of the guesswork out of reading LH strips and identifying peak fertility days. However, these algorithms vary between different apps, and more research is still needed to determine if these app algorithms are as efficacious as the original method, the Marquette Model.
*Names have been changed to respect the privacy of the interviewee. All information is shared with permission.