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Today’s fertility awareness-based methods (FABMs) are not our grandmother’s rhythm method. And we don’t track our fertility like our grandmothers either—meaning, yes, there’s an app for that. Or more like a hundred. The question isn’t so much whether a FABM app is worth using but rather where to begin.

For the uninitiated, FABMs work by identifying patterns in the biomarkers of a woman’s monthly cycle. Couples can determine which days she is fertile or infertile, and use this information to achieve or avoid pregnancy. Awareness of a woman’s cycle is valuable for reasons beyond fertility, like identifying the causes behind cycle irregularities, thyroid disease, or reproductive cancers. But since having a baby or preventing pregnancy are important responsibilities, it's good to know which apps are worth deleting a couple of photos for. 

These Apps Ranked Highest for Accuracy

Dr. Marguerite Duane, MD, MHA, FAAFP, family physician and the Executive Director of Fertility Appreciation Collaborative to Teach the Science (FACTS), tackled the abundance of apps in a study published this summer in the Journal of the American Board of Family Medicine. She and her coauthors developed a rating system for evidence-based FABMs with criteria “weighted based on their level of importance for avoiding pregnancy.”

The first thing you need to know about fertility tracking apps is that they're all tools to help, not replacements for learning a method. FACTS has information on its website about the different methods if you need an overview.

The next thing to know is that not all apps are created equal. Some are simply a way to record observations; others make fertility predictions for you. So how do you know what to choose? FACTS' rating system includes several criteria: the rules of the FABM that the app uses (e.g., sypmtothermal, Billings, Standard Days, etc.); its accuracy for determining fertile days; the effectiveness of the FABM itself; opportunities for users to have questions answered and to input additional information; cost; user-friendliness; and availability on multiple platforms. Each criterion was measured on a five-point scale.

Of the ninety-five apps reviewed, “Only six apps . . . had either a perfect score on accuracy . . . or no false negatives”:

Four of the six apps utilize the symptothermal method based on observing three key signs of fertility: cervical mucus, basal body temperature, and cervical changes. Ovulation Mentor and iCycleBeads are apps tailored for FABMs that have unique evidence-based rules and/or requirements, such as the Billings or Standard Days Method

It’s worth nothing that the Standard Days method is best for women with 26- to 32-day cycles. Based on large-scale clinical trials for Standard Days, the iCycleBeads app was developed by the Institute for Reproductive Health at Georgetown University and will notify users of fertile or non-fertile days and the next expected period. If you don't have a super regular period, a different method may be more appropriate for you.

A Good Fit May Still Be Useful

For women using a FABM not listed above, charting apps could still be useful for electronically recording their data. The study notes, "Success using FABMs depends on many factors, including the ability to accurately make and classify daily observations.” A woman using the Creighton or Marquette method, for example, could use an app to record her biomarkers without relying on it to accurately determine her fertile days.

It can be tough to remember to mark observations of basal body temperature, cervical mucus, hormone levels, or a combination of these at the end of a hectic day. Having a “ping” encouraging a woman to record the day’s biomarkers may help her use her FABM consistently and effectively, even if the app's data analysis isn’t perfect.

Most Importantly, Ask Questions and Seek Training

Although six apps were rated for perfect accuracy or no false negatives, the app study concludes that relying on apps without getting properly trained on how to use the FABM may not be enough to prevent pregnancy. Dr. Duane “encourage[s] women to learn the basics about each method to determine which may be best for her.” FACTS gives an overview of evidence-based FABMs to help understand the options. She advises, “Once a woman decides which method she would like to use, she should contact a trained teacher and schedule a time to learn more.” FACTs also has information about FABM teaching organizations.

The more we learn about the health risks of hormonal birth control, the more compelling the case for using FABMs to manage family planning. Understanding what FABM rules an app is using to determine fertile and infertile days is integral to determining whether it’s the right fit for your method and your fertility goals.

Technology can achieve incredible feats, but we’d argue that a woman’s ability to understand her fertility is much more impressive.

Photo Credit: Regina Leah