Petra Frank-Herrmann

Determination of the fertile window: reproductive competence of women--European cycle databases.

Objectives.u2003The objective of the present paper is to review the main results of recent European cycle databases on ovulation detection and determination of the fertile window performed by the women themselves. Methods.u2003The ongoing German Long-term Cycle Database currently comprises 32u200a788 prospectively collected cycle charts of 1551 women, the I European Cycle Database (10 countries) 1328 women/19u200a048 cycles, the II European Cycle Database (six countries) 782 women/6724 cycles, and the World Health Organization Database (one European country) 234 women/2808 cycles. The women record cycle parameters (cervical mucus changes, temperature rise, etc.), family planning intention and sexual behavior. Results.u2003With the symptothermal method of natural family planning it has become possible to determine the fertile window in order to avoid pregnancy with a method effectiveness of 0.3%. According to a small sub-study, the ovulation time observed by the women themselves correlates closely with ovulation detected by ultrasound and measurement of luteinizing hormone (correlation within 1 day in 89% of the 62 cycles). Fertility awareness methods can be integrated into the management of sub-fertility. They seem to shorten the time to pregnancy. Conclusions.u2003Self-observation of the fertile window puts women into a position to develop a high level of reproductive competence that could be used much more in different areas than is currently the case.

Effectiveness and acceptability of the sYmptothermal method of natural family planning in Germany

Throughout Germany, 851 women who were instructed in natural family planning participated in a prospective study. Of these, 255 women with 3174 cycles used only natural family planning for family planning and 274 women with 3995 cycles occasionally used barrier methods in the fertile phase. For natural family planning--only users, the Pearl rate for unplanned pregnancy was 2.3 and for mixed-method users 2.1. Most pregnancies resulted from unprotected intercourse during the fertile phase, and the use of barrier methods does not reduce risk-taking.

Natural family planning with and without barrier method use in the fertile phase: efficacy in relation to sexual behavior: a German prospective long-term study

A large prospective long-term study with users of natural family planning (NFP) methods has been conducted to analyze the relation between unintended pregnancy rates and sexual behavior with special reference to barrier method use in the fertile phase. Seven hundred and fifty eight NFP beginners, 19-45 years of age, 14 870 cycles, 28 unintended pregnancies were studied.Of the couples, 54.2% use NFP only or predominantly and 45.9% use mixed methods (additional barrier method use in the fertile phase in 55.7% of the cycles). The overall pregnancy rate after 12 cycles of exposure is 2.2% according to the actuarial method. There is no significant difference between NFP users and mixed methods users and also no significant effect of duration of use in the first 5 years of exposure. During perfect use the pregnancy rate at 12 months is 0.63%. When only protected intercourse takes place in the fertile phase the pregnancy rate is 0.45%. The symptothermal method of NFP is most unforgiving for imperfect use (unprotected intercourse in the fertile phase). However, it is extremely effective when either abstinence or protected intercourse is used in the fertile phase.

Natürliche Familienplanung@@@Natural family planning: Sensiplan® – eine moderne, verlässliche Methode@@@Sensiplan® – a modern and reliable method

ZusammenfassungDurch Weiter- und Neuentwicklungen ist das Feld der natürlichen Methoden der Familienplanung unübersichtlich geworden. Unter den klassischen Methodenbezeichnungen – Temperaturmethode, Billings-Methode, symptothermale Methode – verbergen sich zahlreiche Varianten, die sich hinsichtlich Sicherheit, Praktikabilität und Akzeptanz erheblich unterscheiden. Sensiplan® (www.sensiplan.eu) ist der neue Name für die evidenzbasierte symptothermale Methode der deutschen Arbeitsgruppe NFP. Die hohe Zuverlässigkeit ist nachgewiesen. Mit relativ wenig Aufwand können Frauen das fertile Fenster im Zyklus selbstständig bestimmen und dies zur Familienplanung sowie zum differenzierten Zyklusmonitoring nutzen.AbstractDue to new and further developments, the field of natural family planning methods has become confusing. The conventional nomenclature—the temperature method, the Billings method, the symptothermal method—includes numerous variations of natural methods that vary substantially in efficacy, practicability, and acceptability. The new name of the evidence-based symptothermal method of the German working group NFP (Natural Family Planning) is sensiplan® (www.sensiplan.eu), which has a proven high efficacy rate. Women can reliably and independently determine the fertile window of their individual cycle without much effort. Thus, this method can be used for family planning and differentiated monitoring of a woman’s cycle.

Natürliche Familienplanung - aktueller Stand

ZusammenfassungHintergrundNatürliche Familienplanung (NFP) ist ein Sammelbegriff für zahlreiche Methoden, die sich hinsichtlich Sicherheit, Praktikabilität und Akzeptanz erheblich unterscheiden. NFP-Methoden beruhen auf der Erkennung des fertilen Fensters und der Beschränkung des ungeschützten Sexualverkehrs auf die nichtfruchtbaren Tage.Ziel der ArbeitUm Orientierung zu ermöglichen, hat die Deutsche Gesellschaft für Gynäkologische Endokrinologie und Fortpflanzungsmedizin (DGGEF) eine Leitlinie zum aktuellen Stand der natürlichen Familienplanungsmethoden verfasst.MethodikHerangezogen wurden wissenschaftliche Publikationen („peer reviewed“) zur Empfängniswahrscheinlichkeit innerhalb der fertilen Phase und zur kontrazeptiven Sicherheit natürlicher Methoden der letzten 30xa0Jahre, deren Daten überwiegend aus prospektiven Kohortenstudien mehrerer europäischer und amerikanischer Datenbanken sowie einer WHO-Datenbank stammen.ErgebnisseBei heutigen NFP-Methoden beobachten die Anwenderinnen Veränderungen von Körpersymptomen im aktuellen Zyklus, sie sind daher nicht mehr auf einen regelmäßigen Zyklus angewiesen. Die alten Kalendermethoden sind zumindest im europäischen Kontext obsolet. Unter den verschiedenen NFP-Methoden wird aktuell die Sensiplan®-Methode empfohlen, da sie wissenschaftlich überprüft ist und in die Kategorie der sehr sicheren Familienplanungsmethoden eingeordnet werden kann (Methodensicherheit 0,4xa0Schwangerschaften/100xa0Frauenjahre). Einige andere NFP-Methoden, auch Zykluscomputer, weisen eine mittlere Sicherheit auf, häufig fehlen jedoch entsprechende Studien.DiskussionDie guten Ergebnisse mit der Sensiplan®-Methode wurden nach Beratung durch ausgebildete NFP-Berater/innen erreicht. Ob die hohe kontrazeptive Sicherheit auch nach Information durch qualifizierte Internet-Ressourcen gegeben ist, sollte überprüft werden.AbstractBackgroundNatural family planning (NFP) is a collective term for a variety of methods that differ considerably in efficacy, practicability and acceptability. The NFP methods are based on knowledge of the fertile window and the restriction of unprotected sexual intercourse to only non-fertile days. They are also known by the term fertility awareness based methods (FAM).AimTo facilitate orientation the German Society for Gynecological Endocrinology and Reproductive Medicine has compiled guidelines regarding the current status of the methods of NFP.MethodsScientific publications (peer reviewed) concerning the probability of conception within the fertile window and the contraceptive efficacy of natural methods from the last 30 years were included. The data are predominantly derived from prospective cohort studies of several European and American databases and from a World Health Organization (WHO) database.ResultsIn modern NFP methods users observe changes in body symptoms during the current cycle. They are therefore no longer dependent on a regular cycle. The old calendar methods are obsolete, at least in the European context. Of the different NFP methods, the Sensiplan method is the one that is currently recommended because it has been scientifically validated and can be assigned to the category of very effective family planning methods (method-related efficacy of Sensiplan 0.4 pregnancies/100 women years). Several other NFP methods, including cycle monitors, offer an average efficacy; however, efficacy studies for many natural methods are often lacking.DiscussionThe good results with the Sensiplan method were achieved after counseling by trained NFP teachers. Whether this high contraceptive efficacy is also achieved after information through qualified internet sources should be investigated.

A new method to detect significant basal body temperature changes during a woman's menstrual cycle

Abstract Objective To compare the results of a computer programme based on the Triggs tracking system (TTS) identification of the basal body temperature (BBT) shift day from daily records of BBT values (TTS transition day), with the BBT shift day identified from the same records using the Sensiplan® symptothermal method of natural family planning. Methods A computer programme was written to display the daily BBT readings for 364 menstrual cycles from 51 women aged 24 to 35 years, obtained from the German Natural Family Planning (NFP) database. The TTS transition day so identified from each record was then compared with the BBT shift day estimated from the same record by the Sensiplan® method. Results Total agreement between the methods was obtained for 81% (294/364) of the cycles and 18% (67) cycles differed by ± 1 day. For the 364 pairs of values distributed among 51 women the medians of the differences between the TTS transition day and Sensiplan® initial day of the BBT rise (shift day) were not significantly different (χ2 = 65.28, df = 50, p = 0.07205). Conclusion The advantages of the tracking signal algorithm are that in many cases it was possible to identify the BBT shift day on that very day – rather than only some days later – and to estimate the probability that a transition had occurred from the different values of the tracking signal. Chinese Abstract 摘 要 目的 比较基于triggs追踪系统（ttS）的计算机程序与自然避孕法中的Sensiplan®症状体温法在根据相同的每日基础体温(BBt)测定记录数据的前提下识别基础体温转换日(ttS转换日)所得结果的异同。 方法 一种计算机程序被编写用于显示51位年龄位于24至35岁之间妇女的364次月经周期中的每日基础体温测定值（BBt）。资料来源于的德国安全期计划生育数据库（nFP）。程序在每个月经周期中识别出的ttS转换日将与使用相同数据的Sensiplan®法所得出的BBt转换日作比较。 结果 81%的周期(294/364)中两种方法所得结果完全相同。18%的周期（67）结果相差±1天。分布于51名妇女的364对数据所得出的ttS转换日与Sensiplan®的BBt升高首日（转换日）的中位数并无显著差异(χ2=65.28, df = 50, p =0.07205)。 结论 追踪信号算法的优势在于许多情况下其在月经周期中的BBt转换日当天即可识别而不是在几天之后才识别出转换的发生，并可根据不同的追踪信号数值估计转换已发生的概率。

Fertility awareness-based mobile application

Currently, a variety of start-up companies are developing mobile phone apps to track the menstrual cycle and the fertile window, for the use of women who are trying to conceive or trying to avoid pregnancy. Very few have published any data in a peer-review venue. In this context, Bergund Scherwitzl et al. [1] are to be applauded for publishing outcome data on the NaturalCycles app or program, which interprets daily basal body temperature measurements based on a proprietary algorithm, in order to determine the fertile window in the menstrual cycle. However, their study design and data have severe limitations, and therefore the estimates of rates of unplanned pregnancy cannot be considered reliable for comparison with other studies of fertility awareness-based methods (FABM) or contraceptives.

Natural conception rates in subfertile couples following fertility awareness training

PurposeTo analyze cumulative pregnancy rates of subfertile couples after fertility awareness training.MethodsA prospective observational cohort study followed 187 subfertile women, who had received training in self-observation of the fertile phase of the menstrual cycle with the Sensiplan method, for 8xa0months. The women, aged 21–47 years, had attempted to become pregnant for 3.5 years on average (range 1–8 years) before study entry. Amenorrhea, known tubal occlusion and severe male factor had been excluded. An additional seven women, who had initially been recruited, became pregnant during the cycle immediately prior to Sensiplan training: this is taken to be the spontaneous pregnancy rate per cycle in the cohort in the absence of fertility awareness training.ResultsThe cumulative pregnancy rate of subfertile couples after fertility awareness training was 38% (95% CI 27–49%; 58 pregnancies) after eight observation months, which is significantly higher than the estimated basic pregnancy rate of 21.6% in untrained couples in the same cohort. For couples who had been seeking to become pregnant for 1–2xa0years, the pregnancy rate increased to 56% after 8xa0months. A female age above 35 (cumulative pregnancy rate 25%, pu2009=u20090.06), couples who had attempted to become pregnant for more than 2xa0years (cumulative pregnancy rate 17%, pu2009<u20090.01), all significantly reduce the chances of conceiving naturally at some point.ConclusionsTraining women to identify their fertile window in the menstrual cycle seems to be a reasonable first-line therapy in the management of subfertility.

Natürliche Familienplanung@@@Natural Family Planning

ZusammenfassungBei der modernen natürlichen Familienplanung beobachten Frauen die zyklischen Veränderungen des Zervixschleims und der basalen Körpertemperatur. Zur Bestimmung des Anfangs und Endes der fertilen Phase werden jeweils zwei Parameter herangezogen, die sich gegenseitig absichern (double-check). Wenn kein ungeschützter Geschlechtsverkehr in der fertilen Phase stattfindet, liegt die Methodensicherheit dieser in Deutschland gebräuchlichen symptothermalen Methode bei 0,3–0,5 Schwangerschaften pro 100 Frauenjahre, die Gebrauchssicherheit bei 2. Diese Ergebnisse stammen aus großen europäischen Datenbanken. Diese Methode ist die einzige hocheffektive natürliche Methode. Sie ersetzt deshalb in Industrieländern die alten Methoden wie Kalendermethode und Temperaturmethode und auch die Billings-Methode.AbstractThe symptothermal method (STM) is the most effective method of natural family planning, if two parameters to determine the beginning as well as the end of the fertile phase are used (double-check). The main parameters observed by women are BBT and cervical mucus changes. The method-effectiveness is 0.3–0.5 pregnancies per 100 women years, if there is no unprotected intercourse in the self-detected fertile phase. The use-effectiveness is about 2 in Germany. These results are derived from large European databases. In developed countries, the STM replaces the old calendar and temperature methods and the Billings method.

Plausibility of Menstrual Cycle Apps Claiming to Support Conception

The interval of peak fertility during the menstrual cycle is of limited duration, and the day of ovulation varies, even in women with fairly regular cycles. Therefore, menstrual cycle apps identifying the “fertile window” for women trying to conceive must be quite precise. A deviation of a few days may lead the couple to focus on less- or non-fertile days for sexual intercourse and thus may be worse than random intercourse. The aim of the present investigation was to develop a scoring system for rating available apps for determining the fertile window and secondarily pilot test 12 apps currently available in both German and English (consisting of 6 calendar-based apps: Clue Menstruations- und Zykluskalender, Flo Menstruationskalender, Maya-Mein Periodentracker, Menstruationskalender Pro, Period Tracker Deluxe, and WomanLog-Pro-Kalender; 2 calculothermal apps: Ovy and Natural Cycles; and 4 symptothermal apps: myNFP, Lady Cycle, Lily, and OvuView). The calendar-based apps were investigated by entering several series of cycles with varying lengths, whereas the symptom-based apps were examined by entering data of cycles with known temperature rise, cervical mucus pattern, and clinical ovulation. The main criteria for evaluating the cycle apps were as follows: (1) What methods/parameters were used to determine the fertile window? (2) What study results exist concerning that underlying method/parameters? (3) What study results exist concerning the app itself? (4) Was there a qualified counseling service? The calendar-based apps predicted the fertile days based on data of previous cycles. They obtained zero points in our scoring system, as they did not comply with any of the evaluated criteria. Calculothermal apps had similar deficits for predicting the most fertile days and produced suboptimal results (Ovy 3/30 points and Natural Cycles 2/30 points). The symptothermal apps determined the fertile days based on parameters of the current cycle: Lady Cycle scored 20/30 points, myNFP 20/30 points, Lily 19/30 points, and OvuView 11/30 points. We concluded that the available cycle apps vary according to their underlying scientific quality and clear rating criteria have been suggested. Three of the tested apps were judged to be eligible for further study. The scientific evaluation of cycle apps depends on good prospective studies undertaken by independent investigators who are free of commercial bias.