Natural Conception Rates After Fertility Awareness Training: A Review of Research
By: Mariam Ahmed, DO
Director’s Note: Today, we are highlighting research published in the Archives of Gynecology and Obstetrics by Frank-Herrmann et al[1] that analyzed the natural conception rates in subfertile couples following training in a fertility awareness-based method (FABM). Dr. Mariam Ahmed, a former FACTS elective student, summarized this 2017 study which accentuates the applications of FABMs among couples struggling to conceive. Beyond successful conceptions, Ahmed discusses additional benefits which may accompany the use of FABMs for subfertility and infertility, including improvement in patient self-awareness and self-image.
Introduction
The timing of sexual intercourse during a woman’s fertile time is vital for people attempting to conceive. Many women are unsure of or miscalculate their fertile period, which can delay conception. Sensiplan is a sympto-thermal method of natural family planning that enables a woman to recognize her fertile window. By observing and tracking her cervical secretions and body temperature, a woman is able to identify her peak fertile and infertile days.
Studies show that tracking cervical secretions and basal body temperature to identify peak fertility and ovulation is strongly correlated to true ovulation. This has been confirmed through the use of ultrasound and LH peak measurements. Research has also shown the fertile phase can start five days before a woman ovulates up until the day of ovulation. The purpose of the 2017 study[1] summarized below was to train subfertile couples with fertility awareness-based methods (FABMs) and determine the spontaneous conception rate after this training.
“Studies show that tracking cervical secretions and basal body temperature to identify peak fertility and ovulation is strongly correlated to true ovulation.”
Methodology
This study was conducted by the Department of Gynecological Endocrinology and Fertility Disorders of the Women’s Hospital at the University of Heidelberg, Germany from 2004 to 2008. Of the 194 patients recruited for the study, seven became pregnant spontaneously, so the study population consisted of 187 women. Fifty-one percent of these women were ≤ 35 years old with an age range of 21-41. Forty-eight percent of the women had been attempting to conceive for at least 3 years; 81% had never been pregnant. Of those who had previously conceived, 11% gave birth with the same partner, 4% with a different partner, and 9% had one or more abortions. Ninety-six percent of the women had no prior knowledge about the effects of cervical mucus on the fertile window.
The criteria for this prospective cohort study consisted of couples unable to conceive after one year of random and unprotected intercourse, no amenorrhea, and no prior history of subfertility treatments. They were also required to participate in at least two cycles and fill out three questionnaires related to past medical history and their understanding of the Sensiplan method.
A day 2-5 basic hormonal profile was performed to test for subfertility. At the end of their first menstrual cycle, the women had a telephone conversation to discuss their first chart. A transvaginal ultrasound and additional blood tests were performed when the women observed clear, stretchy, and slippery cervical mucus. They had a final blood test a week later to test hormone levels in the luteal phase. Eighty-three percent of the male participants had a basic semen analysis.
Using the Sensiplan method, women recorded the characteristics of cervical mucus they felt throughout the day by the end of the night. In the morning, they measured their basal body temperature upon waking up. The beginning of the fertile time is determined by the first day of wet cervical mucus until 3 days after the peak day of secretions. The fertile period concludes after that third day, and can also be correlated with a rise in basal body temperature. The temperature should be three readings higher than the previous six readings, and the last reading is 0.2 degrees Celsius higher than the previous six. This elevation means ovulation has happened, and this temperature is retained until the next menstrual period.
Couples were taught that these days of clear, slippery, and stretchy cervical mucus are the fertile days in which sexual intercourse may lead to conception. They should also engage in sexual intercourse 2 days after the ‘peak secretion day’ until the first higher temperature reading, regardless of secretions at that point. Couples were recommended to have intercourse at minimum 2-3 days during the fertile window.
Results
The basic pregnancy rate was determined with the data from the 7 women who became pregnant before Sensiplan training. Six of these women had been attempting to conceive for 1-2 years; the remaining one had attempted to conceive for 6 years, so the basic pregnancy rate was 21.6%. Using the basic pregnancy rate, the results showed a 38% spontaneous pregnancy rate within 8 months of using the Sensiplan method. Results were also broken down by age and duration of subfertility. The average time for couples to conceive was 6.4 cycles. Women ≤ 35 years old had a higher rate of spontaneous pregnancy (51%) compared to women ages 36 to 40 (25%) or ≥ 40 (20%, p=0.018). Using the Cox regression model, the probability of getting pregnant decreased by 8% every year.
“Couples that were trying to conceive for 1-2 years had a 56% spontaneous pregnancy rate increase compared to the basic pregnancy rate.”
Couples that were trying to conceive for 1-2 years had a 56% spontaneous pregnancy rate increase compared to the basic pregnancy rate. Couples trying to conceive for 3-4 years had a 20% spontaneous pregnancy rate compared to the basic pregnancy rate; those attempting to conceive for > 5 years had an 11% spontaneous pregnancy rate increase. Factors that reduce the likelihood of conception at significant levels include endometriosis, male subfertility, and > 2 years trying to get pregnant.
Discussion
The Sensiplan method is one of the fertility awareness-based methods couples can use whether trying to conceive or avoid conception. In this study, 38% of subfertile couples had a natural pregnancy after using the Sensiplan method for 8 months. While this study lacked a true control group, other observational studies showed a live birth rate of 25% after 12 months and 54.45% after 36 months in 726 couples. This is comparable to the basic pregnancy rate established by using the 7 women who became pregnant before this study began.
Many women struggle to identify their fertile window accurately. This leads to delayed time to conception, which may cause more stress for the couple. The use of cervical mucus characterization and charting is an easy, low-cost option for family planning. Some studies suggest that this method is better using LH kits. Also, FABMs can increase patient self-awareness and self-image. In fact, in this study, 78% of women indicated growth in self-awareness, and 53% indicated improvement in self-image.
“FABMs can increase patient self-awareness and self-image. In fact, in this study, 78% of women indicated growth in self-awareness, and 53% indicated improvement in self-image.”
Natural or fertility awareness-based methods are a reasonable first step for couples struggling to achieve pregnancy, since they help people identify when they may be fertile. As noted in the study, most couples are able to conceive within the first few cycles of accurate use of the Sensiplan method. While artificial technologies can also result in pregnancies, ease of use, low cost, effectiveness and lack of side effects are driving factors for individuals to choose FABMs over other options.
References
[1] Frank-Herrmann P, Jacobs C, Jenetzky E, et al. Natural conception rates in subfertile couples following fertility awareness training. Arch Gynecol Obstet. 2017;295(4):1015-1024. doi:10.1007/s00404-017-4294-z.
ABOUT THE AUTHOR
Mariam Ahmed, DO
Mariam Ahmed, DO is a first-year internal medicine resident in Atlanta, Georgia and a recent graduate of the Philadelphia College of Osteopathic Medicine (PCOM-GA). Dr. Ahmed is passionate about working with marginalized populations during residency training. She enrolled in the FACTS course because she finds it essential for patients to have easy, low-cost family planning options.
