HAPPY INDEPENDENCE DAY!

FemTech Series
FABMs Validation Studies, Patient Data Privacy, & Menstrual Health Literacy
FACTS Speaker Highlight: Thomas Bouchard, MD
By: Sarah Makarewicz
Director’s Note: As we continue our FemTech series this month, we are delighted to introduce one of the leading researchers in cycle-tracking technology, Dr. Thomas Bouchard, a board-certified Family Physician from Canada. Dr. Bouchard is also trained in the Marquette Method and brings his years of research experience to the world of fertility awareness…and to our upcoming FACTS virtual conference. Join us on October 18th and 19th and hear Dr. Bouchard discuss the importance of data stewardship, collection, and privacy with FemTech and cycle-tracking apps. Millions of women worldwide use these apps daily to track their cycles and symptoms, which often includes logging very personal and intimate data. Can’t make the virtual conference? Learn more about FemTech in Part F of our online, self-paced CME course, which includes a lecture by Dr. Bouchard comparing quantitative fertility monitors.
A Budding Neurologist’s Journey to Family Medicine
After finishing his undergraduate degree in 2004, Dr. Thomas Bouchard admitted that, like many hopeful pre-med students, it took a few tries to be accepted. To strengthen his application and expand his clinical-thinking skills, he worked for three years as a research assistant under a neurologist at the Glenrose Rehabilitation Hospital in Edmonton. Dr. Bouchard studied dementia in Parkinson’s disease and wrote two papers on MRI techniques in Parkinson’s. [1][2]
“I got the research bug before getting into medicine,” Dr. Bouchard said.
When he began medical school in 2007, he initially thought his Parkinson’s research would be a springboard towards a successful career as a neurologist or neurosurgeon. However, during his clinical rotations, he experienced a life-changing moment that completely changed his career path.
“Delivering my first baby as a medical student was a game changer. After participating in that delivery, I knew I had to do something in low-risk obstetrics. That was the reason I decided to go into family medicine.”
Caring for mothers and babies in the peripartum and postpartum periods was an incredibly rewarding experience for Dr. Bouchard. His newfound interest not only gave him direction in his medical training, but also opened new research doors in the field of fertility awareness.
“Caring for mothers and babies in the peripartum and postpartum periods was an incredibly rewarding experience for Dr. Bouchard.”
Discovering New Research Horizons During Residency
When asked about his interest in natural or fertility awareness-based methods (FABMs) of family planning, Dr. Bouchard explained that he had been interested for years, even prior to medical school. He was familiar with the Sympto-Thermal Method from a young age, but his first exposure to FABMs in medicine was the Marquette Method during his Family Medicine residency.
Just prior to discovering Marquette, Dr. Bouchard crossed paths with Dr. Stephen Genuis, an OBGYN from Edmonton and leader in the field of FABM research. In 2010, they wrote an article using the ClearBlue Fertility Monitor to correlate urine E3G levels with serum estradiol. [3] Shortly after publishing his paper, Dr. Bouchard attended a conference at Marquette University where he met Dr. Richard Fehring and Dr. Mary Schneider, notable researchers who helped develop the Marquette Method of natural family planning (NFP).
“At that conference, I realized there was a group of researchers and nurses at Marquette doing the same thing with the ClearBlue monitor that Dr. Genuis and I described in our 2010 paper.”
Reflecting on that time, Dr. Bouchard described himself as a “young upstart” who approached Dr. Fehring, eager to delve into further research with the Marquette Method. During his residency, Dr. Bouchard completed a research elective with Dr. Fehring and Dr. Schneider where he evaluated a breastfeeding protocol with the ClearBlue monitor [4] before going on to complete the Marquette Method Professional training in 2013.
“I chose to focus on Marquette because it was something new,” Dr. Bouchard said. “Having a device with technology makes it an easier knowledge translation tool to patients, and the breadth of evidence-based research behind the method gives it legitimacy in the eyes of medical colleagues.”
“I chose to focus on Marquette because it was something new … and the breadth of evidence-based research behind the method gives it legitimacy in the eyes of medical colleagues.”
The Mira Monitor and a Revolutionary PhD Project
In 2018, Mira Fertility launched their quantitative fertility monitor on the market. A few years later, Mira Fertility reached out to Dr. Bouchard, Dr. Fehring, and Dr. Schneider, offering to collaborate as research partners to determine interest in the Mira monitor among Marquette users. Shortly afterwards, Dr. Bouchard began his PhD at the University of British Columbia in 2022 and has since published several papers with research on the Mira monitor. In October 2021, he published a clinical trial comparing the quantitative Mira monitor to the qualitative ClearBlue monitor in detecting the fertile window and ovulation [5]; in January 2023, he completed a case study comparing Mira to a different quantitative monitor, Inito, in identifying LH and PDG patterns [6]; and in November 2023, he published an observational study using the Mira monitor to identify the postpartum return of fertility. [7]
Dr. Bouchard has found that the Mira monitor is the most user-friendly for patients, as well as the most accurate quantitative monitor in detecting hormone changes. Furthermore, Mira’s technology is revolutionary as it provides valuable information on hormonal patterns over time.
“Compared to obtaining serum hormone values on cycle day 3 or day 21, which provides only a snapshot of a single day, using daily urine samples with a quantitative monitor captures the pattern of hormonal variability that exists both within a cycle and between cycles,” explained Dr. Bouchard. “Furthermore, kidneys are a concentrating organ; they give us a better idea of what hormones are doing over a course of 4 to 6 hours, versus at a single point in time with serum values.”
“Compared to obtaining serum hormone values on cycle day 3 or day 21, which provides only a snapshot of a single day, using daily urine samples with a quantitative monitor captures the pattern of hormonal variability that exists both within a cycle and between cycles.”
Dr. Bouchard is currently in the final stages of writing a case series about patients who are Marquette users using Mira to track their cycles for conditions like PCOS, Perimenopause, and during chemotherapy treatments. Soon, Dr. Bouchard will begin a study to validate the hormonal changes on the Mira monitor with ultrasound-confirmed dates of ovulation. This study is highly promising, as it could indicate that quantitative monitors like Mira may set the new standard for at-home clinical fertility monitoring rather than labour-intensive follicle-tracking ultrasounds or repeated serum hormone tests. [8]
Stewardship of Patient Data Privacy with FemTech
When starting his PhD, Dr. Bouchard discovered the myriad cycle-tracking apps available to help women gain menstrual literacy through tracking their cycles. However, very few are validated or evidence-based, and some have even been involved with data breaches and class-action lawsuits. [9] While most apps require the user to agree to Terms and Conditions that outline data usage and storage, these user agreements are lengthy. Many users don’t fully read or understand them, and companies with data interest stand to profit from users’ data for research or financial purposes.
Dr. Bouchard explained, “For app creators and researchers, there is always a temptation to mine data from cycle-tracking apps. If companies are using the data to further their research with patients’ implicit permission from only the initial user agreement, the risk is a breach of privacy. There should be stronger rules around this, such as cycle-to-cycle consent from users on how their data is being stored and used.”
For his upcoming Mira validation study, Dr. Bouchard and his research group are developing an in-house tool to collect research data from participants who will have full knowledge of the storage and usage of their cycle-tracking information. They are also partnering with Read Your Body, a UK-based nonprofit that created a comprehensive cycle-tracking app. Compared to similar apps, Read Your Body sets the standard for data privacy and confidentiality. The company does not have access to any user’s personal charting data; the user can choose to encrypt their data; and user’s data is not shared with third parties. [10]
Dr. Bouchard emphasized, “As healthcare professionals, the privacy and confidentiality of our patients should be a top priority. As researchers and teachers of these fertility-awareness methods, we must be stewards of our patients and their right to privacy when recommending charting apps.”
Hope for the Future
In terms of his vision for the future of FABMs in medical practice, Dr. Bouchard hopes to see more medical professionals interested in cycle-tracking tools. He believes improving menstrual health literacy should be a goal not only for patients, but equally for health professionals.
“Dr. Bouchard … believes improving menstrual health literacy should be a goal not only for patients, but equally for health professionals.”
“Currently, the main emphasis of many physicians is on menstrual and ovulatory suppression with exogenous hormones, which have their own risks. Many professionals are unaware that many FABMs, like the Marquette Method, are evidence-based and effective. There is a large interest and demand among patients to do things more naturally.”
Dr. Bouchard describes how the growing amount of evidence-based research supporting FABMs is attracting interest from physicians and universities in Canada and the USA. He hopes that the work of many physicians and researchers in the field of FABMs, along with stewardship of patient data privacy, may lead to open-minded conversations with colleagues about the benefits of FABMs in achieving their patients’ fertility goals.
Dr. Thomas Bouchard is a board-certified Family Physician who has been practicing in Calgary, Alberta, Canada since 2012. He completed both Medical School and his Family Medicine residency at the University of Calgary. In 2013, he completed his Marquette Method Certified Practitioner training. Presently, Dr. Bouchard manages an independent family clinic within Westglen Medical Centre in Calgary practicing full-scope Family Medicine and Long-Term Care. He regularly incorporates Natural Family Planning (NFP) and fertility awareness-based methods (FABMs) into his practice, helping patients achieve their fertility goals. He is a prolific researcher with 50 publications on topics ranging from Parkinson’s Disease to NFP. In 2022, he began a PhD program with the University of British Columbia (UBC) researching Quantitative Fertility Assessment with a special focus on the Mira Fertility monitor.
References
[1] Camicioli RM, Hanstock CC, Bouchard TP, Gee M, Fisher NJ, Martin WRW. Magnetic resonance spectroscopic evidence for presupplementary motor area neuronal dysfunction in Parkinson’s disease. Movement Disorders. 2007;22(3):382-386. doi:https://doi.org/10.1002/mds.21288
[2] Acharya HJ, Bouchard TP, Emery DJ, Camicioli RM. Axial Signs and Magnetic Resonance Imaging Correlates in Parkinson’s Disease. Canadian Journal of Neurological Sciences. 2007;34(1):56-61. doi:https://doi.org/10.1017/s0317167100005795
[3] Bouchard TP, Genuis SJ. Personal fertility monitors for contraception. Canadian Medical Association Journal. 2010;183(1):73-76. doi:https://doi.org/10.1503/cmaj.090195 doi:10.1007/BF01978103.
[4] Bouchard T, Fehring RJ, Schneider M. Efficacy of a New Postpartum Transition Protocol for Avoiding Pregnancy. The Journal of the American Board of Family Medicine. 2013;26(1):35-44. doi:https://doi.org/10.3122/jabfm.2013.01.120126
[5] Bouchard TP, Fehring RJ, Mu Q. Quantitative versus qualitative estrogen and luteinizing hormone testing for personal fertility monitoring. Expert Review of Molecular Diagnostics. 2021;21(12):1349-1360. doi:https://doi.org/10.1080/14737159.2021.2000393
[6] Bouchard TP. Using Quantitative Hormonal Fertility Monitors to Evaluate the Luteal Phase: Proof of Concept Case Study. Medicina. 2023;59(1):140. doi:https://doi.org/10.3390/medicina59010140
[7] Bouchard TP, Schweinsberg K, Smith A, Schneider M. Using Quantitative Hormone Monitoring to Identify the Postpartum Return of Fertility. Medicina. 2023;59(11):2008-2008. doi:https://doi.org/10.3390/medicina59112008
[8] Bouchard T, Yong P, Doyle-Baker P. Establishing a Gold Standard for Quantitative Menstrual Cycle Monitoring. Medicina (Kaunas, Lithuania). 2023;59(9):1513. doi:https://doi.org/10.3390/medicina59091513
[9] Lawsuit claiming Flo Health app shared intimate data with Facebook greenlit as Canadian class action. CBC. Published March 8, 2024. https://www.cbc.ca/news/canada/british-columbia/flo-health-privacy-class-action-1.7137600
[10] Privacy & terms. Read Your Body. Accessed June 6, 2024. https://readyourbody.com/privacy-terms/
ABOUT THE AUTHOR
Sarah Makarewicz
Sarah Makarewicz is a 3rd Year MD student at the University of Alberta in Edmonton, Alberta, Canada. After attending FACTS’s September 2023 conference in Minneapolis, she was inspired to join FACTS as a Medical Student Ambassador. In November 2024, she plans to complete FACTS’s 4-week medical school elective and hopes to begin the Marquette Method Medical Consultant training in Fall 2024. Her career dreams include pursuing Family Medicine in residency with specialized training in Low-Risk Obstetrics, Lactation, and Restorative Reproductive Medicine.