December 23, 2024

Fertility Apps for Holistic Health Tracking: A Research Review

By: Rachel Kim, DO

Director’s Note: Increasing numbers of women have adopted mobile fertility apps to track their cycles. The research article reviewed this week was published in 2021 in JAMIA Open and is titled, “Goals, Life Events, and Transitions: Examining Fertility Apps for Holistic Health Tracking.” [1] Figueiredo et al provide an in-depth look at the role of modern methods of charting in medical management. The research was summarized by Dr. Rachel Kim, a student in the online FACTS fertility awareness elective offered via Georgetown University School of Medicine. Not all fertility apps are created equal! For answers about your data privacy questions, stay tuned for a lecture by Dr. Thomas Bouchard launching in 2025 as part of our online CME course. Or check out Part F of the CME course on FemTech today!

Introduction

The female ovarian cycle is a key aspect of health that plays a role from adolescence to the reproductive years, pre- to postnatal stages, and the peri-menopausal period. During these physiologic stages in reproductive-age women, fluctuations of multiple different hormones may impact an individual’s quality of health and life. Previous studies suggest connections between hormonal cycles and health issues, both physical and emotional, such as premenstrual syndrome (PMS), migraines, depression, asthma, rheumatoid arthritis, diabetes, and irritable bowel syndrome (IBS).* Yet, there has been less focus on issues related to the female reproductive cycle, and access to education and counseling has been limited, leading to suboptimal care for these patients. In recent years, the consumer health technologies market has gained interest in menses and female cycle tracking, with thousands of mobile health apps available for such uses. Most women who track to monitor their fertility now choose mobile apps. The study by Figueiredo et al [1] summarized below examines how mobile fertility apps support women’s fertility-related goals, including planned, expected, and unexpected life events.

“During these physiologic stages in reproductive-age women, fluctuations of multiple different hormones may impact an individual’s quality of health and life.”

Methodology

Using the keyword “fertility,” two app stores were used to search for relevant mobile apps. The following metrics were used to select specific apps: the app must (1) focus on female fertility, (2) have an average rating of > 3 stars, (3) have at least one update since 2017, (4) be free, and (5) include an English version. Apps for clinical use were excluded, as the study focused on “consumer-driven apps used in everyday life.” [1] Based on a ranking system involving star rating averages and number of ratings, the top 31 apps were selected for this study.

Once the apps were selected, 70,685 reviews were collected to analyze user experiences. In addition, app store content, app features, and review data were analyzed to understand the app’s claims and design. Further analysis identified four main themes of individuals’ goals when using these apps: (1) fertility goals, (2) available health indicators, (3) types of feedback, and (4) claims of control. User reviews were further examined for fertility-related terms (fertility, conception, miscarriage, menopause, endometriosis, etc.) to quantify user experience.

Results

This study suggests fertility apps can support women by empowering them with control over their bodies. Yet, in terms of support for different fertility goals, the primary focus of most apps is conception. Only 2 apps included all four goals of (1) attempting to conceive, (2) period tracking, (3) trying to avoid conception, and (4) pregnancy tracking. Only 8 apps included period tracking as a specific goal. Additionally, 19 of the 31 apps (61%) allowed users to change their goals later on.

Fertility apps do not seem to fully support reproductive-age women who do not seek conception at the time. This study also reveals that apps lack support for individuals with conception-related events such as miscarriages, breastfeeding, even pregnancy, or during adolescence or menopause. These mobile apps fall short in providing more general health data such as monitoring the regularity or inconsistencies in their cycles.

“Apps lack support for individuals with conception-related events such as miscarriages, breastfeeding, even pregnancy, or during adolescence or menopause.”

This study found that many of the apps analyzed offer multiple health indicators for tracking, including diet, exercise, and dates of menses. However, most indicators focus on fertility or pregnancy (basal body temperature, cervical mucus, ovulation, intercourse, pregnancy test), leaving many users desiring a broader list of indicators for tracking. Some users expressed interest in tracking headaches, mood, insulin levels, and milk production. Ratings for intensity of symptoms or menopause-related symptoms were rarely included.

Apps commonly used calendars and temperature graphs to provide feedback to users based on their information input. While many users appreciated these forms of feedback, there was criticism on how these visualizations do not fully support different fertility goals. Of the 31 apps, only 5 (16%) enabled visualizations of how health indicators, particularly non-conception-related indicators, relate to overall cycles. Additionally, all app visualizations are non-customizable, limiting user ability to correlate health indicators with the cycle.

Discussion

In a society quickly evolving with technology, individuals are turning to more convenient ways to track their health, such as mobile apps. This research elaborates on previous studies by looking at the specific ways apps support users and how amenable they are to changes in a user’s goals. This study revealed that fertility apps support goal-oriented uses for people who track their cycle. Nevertheless, the apps are skewed towards supporting the goal of conception, which may not align with many users’ interests of more holistic health tracking with these apps. While conception is an important part of fertility and women’s health, other health conditions are influenced by or influence an individual’s cycle and should thus be included as variables in fertility apps. Also, while mobile fertility apps provide a basic tool for women to better understand their cycles and health, limitations remain for those with irregularities and inconsistencies that affect their cycles and fertility.

This study differs from others, as it extrapolates data from reviews, essentially capturing users’ real-life experiences. By analyzing the reviews, this study has a better understanding of real feedback on how fertility apps may succeed or improve on the four main themes of users’ goals. However, the reviews provide qualitative, subjective data on how well these apps function. The subjective data create a bias towards individuals willing to share their experiences, and may not reflect the interests of the general population.

While the information this study uncovered has limitations, it provides insight into the extent of interest from the general public to learn about the relationship between fertility cycles and overall health. Women are no longer looking for ways to solely track their menses or ovulation; they want to understand the holistic nature of the human body in terms of fertility, menstruation, lifestyles, and systemic symptoms. This study also shows how dependent people have become on technology in terms of learning about fertility and health. This may be due to easier access to these resources compared to access to medical professionals, certified educators or online information to provide reliable education on reproductive health.

“Women are no longer looking for ways to solely track their menses or ovulation; they want to understand the holistic nature of the human body in terms of fertility, menstruation, lifestyles, and systemic symptoms.”

Unanswered questions remain about health equity and access to educational resources. How likely are individuals to turn to mobile fertility apps to learn about fertility and reproductive health? Are there differences in the four main themes on pay-for apps compared to the free apps analyzed in this study? The reviews compiled in this study were subjective; under-resourced, underrepresented populations may have different experiences and should be considered in future research.

App designers and fertility awareness-based method (FABM) practitioners should discuss ways to develop more holistic apps by expanding beyond family planning to incorporate general health in relation to reproductive health. If the mindset of fertility and reproductive health can broaden beyond conception, more women can regain control and power over their health and wellbeing.

* Editor’s Note: Follow the links below for more research reviews published in the FACTS blog addressing various medical conditions referenced above.

References

[1] Costa Figueiredo, M., Huynh, T., Takei, A., Epstein, D. A., & Chen, Y. (2021). Goals, life events, and transitions: examining fertility apps for holistic health tracking. JAMIA open, 4(1), ooab013. https://doi.org/10.1093/jamiaopen/ooab013

ABOUT THE AUTHOR

Rachel Kim, DO

Rachel Kim, DO is a second-year pediatric resident at Loma Linda University. She completed her medical training at Pacific Northwest University College of Osteopathic Medicine in Yakima, WA, and completed her undergraduate education at the University of Washington in Seattle, WA. She has a special interest in women’s health, particularly in the setting of health equity and education. Dr. Kim enrolled in the FACTS elective to gain a better understanding of natural family planning methods and ways to share them with patients as well as family and friends, so they can feel more empowered over their health and reproductive decisions.