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Obstet Gynecol. 2018 Sep;132(3):591-604. doi: 10.1097/AOG.0000000000002784.

Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review.

Author information

1
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina; Reply OB/Gyn & Fertility, Cary, North Carolina; the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; the Guttmacher Institute, New York, New York; the Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina; GreeneWorks, Washington, DC; and the Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah.

Abstract

OBJECTIVE:

To summarize best available prospective data on typical and perfect use effectiveness of fertility awareness-based methods for avoiding pregnancy.

DATA SOURCES:

We conducted a systematic review of studies published in English, Spanish, French, or German by June 2017 in MEDLINE, EMBASE, CINAHL, Web of Science, and ClinicalTrials.gov.

METHODS OF STUDY SELECTION:

We reviewed 8,755 unique citations and included 53 studies that contained 50 or greater women using a specific fertility awareness-based method to avoid pregnancy, calculated life table pregnancy probabilities or Pearl rates, and prospectively measured pregnancy intentions and outcomes. We systematically evaluated study quality.

TABULATION, INTEGRATION, AND RESULTS:

Of 53 included studies, we ranked 0 high quality, 21 moderate quality, and 32 low quality for our question of interest. Among moderate-quality studies, first-year typical use pregnancy rates or probabilities per 100 woman-years varied widely: 11.2-14.1 for the Standard Days Method, 13.7 for the TwoDay Method, 10.5-33.6 for the Billings Ovulation Method, 4-18.5 for the Marquette Mucus-only Method, 9.0-9.8 for basal body temperature methods, 13.2 for single-check symptothermal methods, 11.2-33.0 for Thyma double-check symptothermal methods, 1.8 for Sensiplan, 25.6 for Persona, 2-6.8 for the Marquette Monitor-only Method, and 6-7 for the Marquette Monitor and Mucus Method. First-year perfect use pregnancy rates or probabilities among moderate-quality studies were 4.8 for the Standard Days Method, 3.5 for the TwoDay Method, 1.1-3.4 for the Billings Ovulation Method, 2.7 for the Marquette Mucus Method, 0.4 for Sensiplan, 12.1 for Persona, and 0 for the Marquette Monitor.

CONCLUSION:

Studies on the effectiveness of each fertility awareness-based method are few and of low to moderate quality. Pregnancy rates or probabilities varied widely across different fertility awareness-based methods (and in some cases, within method types), even after excluding low-quality studies. Variability across populations studied precludes comparisons across methods.

PMID:
30095777
DOI:
10.1097/AOG.0000000000002784
[Indexed for MEDLINE]

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