Abstract
Fertility awareness methods (FAM): cervical mucus monitoring (CMM), ovulation predictor kits (OPK), and basal body temperature charting (BBT) are effective methods to predict ovulation. We sought to compare the efficacy of these methods as tools to improve natural fertility. Prospective, time-to-conceive study. Women, 30-44 years old, with no history of infertility, who were trying to conceive for less than 3 months, were enrolled and then followed until pregnancy. Women were not required to use a FAM. Each day women recorded bleeding, use and result of any FAM, intercourse, and pregnancy test results for up to 4 months while attempting to conceive. Each cycle was classified by presence or absence of type 4 cervical mucus (CMM), a positive ovulation predictor kit result (OPK), or basal body temperature charting for at least 10 consecutive days (BBT). Discrete Time Event History Analysis models were used calculate fecundability ratios (FR) to compare FAMs adjusting for maternal age. 1533 cycles from 571 women were included in this analysis. CMM, OPK, BBT were used in 32%, 17%, 16% of cycles, respectively. Choice of FAM differed by age, race, education level, and parity. After adjusting for age, fecundability was similar when CMM was compared to OPK (FR: 0.87, 95% CI: 0.52-1.44) and BBT (FR: 0.82, 95% CI: 0.48-1.42). Cycles in which a woman achieved a positive OPK were as likely to result in a pregnancy as cycles in which BBT was used (FR: 0.95, 95% CI: 0.53-1.70). Results did not change when the analysis was restricted to cycles 25-35 days in duration. While FAMs improve natural fertility by increasing fecundability and reducing time to pregnancy, these results suggest that no single method is superior. A randomized trial is needed to support or refute these findings.
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