How to Use Apps for Fertility Awareness-Based Methods to Avoid Pregnancy - Verily
Here’s what a doctor says we should understand about choosing and using the right one.

When it comes to taking care of your health, asking questions never hurts. But is it always worth a visit to your doctor? We’re asking experts to weigh in on your burning questions—from feminine to general health and everything in between—so you can get advice from a pro before you go. The doctor will see you now.

Early this year and for the first time ever, the European Union officially certified the Natural Cycles app as an approved medical device for fertility monitoring that "can be used to avoid pregnancies," reported The Guardian. Last month a new study published in Contraception, an international reproductive health journal, concluded that the typical use rate for the Natural Cycles app was 95 percent over 12 months using data from 22,785 users.

As you can imagine, the Internet exploded with headlines like "This App Might Get You Off the Pill Once and For All" and "Could an App Actually Replace Condoms For Good?" Which left lots of women wondering, Well, could it?

While the EU certification of Natural Cycles as a form of contraception seems totally legit, Dr. Victoria Jennings, director and principal investigator of the Institute for Reproductive Health at Georgetown University, notes, “The entity in the European Union that has certified Natural Cycles is not to be confused with something like our FDA.” Neither the FDA nor any other U.S. government entity are regulating feminine health apps at this time. With little regulation, just about anybody can put a fertility app in the app store.

Dr. Jennings has more than thirty years of experience in the international family planning and reproductive health field. She shares how the EU certification compares to FDA approval and what women need to know if they are considering using an app to avoid pregnancy.

Q. What are the major differences between EU certification and FDA approval of fertility apps?

Dr. Jennings: There are a number of types of EU certification and of FDA qualification. The app field is relatively new, and oversight by all government bodies that focus on health-related devices is in development. EU certification tends to be more along the lines of functionality—the software functions as intended—and safety, while FDA focuses on functionality and safety plus whether it is actually effective. The FDA has strict standards for establishing effectiveness.

Q.  Why are experts skeptical of using fertility apps for family planning?

Dr. J: One real concern with fertility apps in general is that it is a confusing space, and there is little guidance for women regarding which ones are appropriate for pregnancy prevention. With more than 1,000 fertility apps available (it’s very easy to put a fertility app in the app store), there is simply no road map.

Several studies looking at some of the more frequently downloaded fertility apps suggest that few of them provide women with accurate information about their fertility sufficient to allow them to prevent pregnancy. From our own work, we’ve seen that several apps make claims that, at best, are not well supported. Another reason some experts are concerned is that family planning (or birth control) unfortunately has become so medicalized that “control” has been placed in the hands of medical experts, and methods that rely on only the user herself are often dismissed. For instance, there is a knee-jerk response that fertility awareness methods don’t work despite the large body of evidence that has shown otherwise. 

Q. How do fertility apps help with using fertility awareness-based methods (FABMs) for family planning?

Dr. J: Some fertility apps are essentially digital platforms that women can use instead of a paper and pencil chart to use with an evidence-based fertility awareness method, such as the Ovulation Method or the Sympto-thermal Method. [Women] use the app to keep track of their fertility signs—their periods, cervical secretions, basal body temperature. While there haven’t been studies on this topic, these digital platforms seem to work well. They can be very convenient, and it may be easier for some women than other means of tracking.

Q. How can fertility apps hinder using FABMs accurately for family planning?

Dr. J: Some fertility apps are based on algorithms that are incorporated into the software. The problem here is that many of these apps have not been tested in any kind of scientific study, or at least not a study that has been reviewed by the scientific community. We have no idea how reliable—or not—these [algorithm-based] apps are, but it is very likely that most of them provide a woman with incorrect information about whether or not she is likely to get pregnant on any given day.

Q. Are there any algorithm-based fertility apps that are effective?

Dr. J: One app with which I’m familiar because we are doing an efficacy study on it, is the Dot app. The developers of the app were able to establish a theoretical efficacy based on computer analysis. We are currently doing an efficacy study so that the perfect use and typical use effectiveness of this app can be compared to other contraceptive methods. Evidence to date suggests that the information it provides is quite accurate.

Q. What do we need to know about using a fertility app for family planning?

Dr. J: Women need to select the right app, based on their fertility goal. If they want to avoid pregnancy, it is essential that they use one that is either a digital platform for an evidence-based method (like the Ovulation Method or Sympto-thermal Method that has been studied extensively), or that the algorithm-based one they choose has a scientific basis and has been studied in a well-designed efficacy trial. This again comes back to the issue of a road map. If women pick fertility apps the same way they pick any other app—based on price, user ratings, and appearance instead of basing their choice on scientific evidence—they are likely to be disappointed, and this could result in an unintended pregnancy.

If you’re curious about which apps to try . . .

Dr. Marguerite Duane, 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. Out of ninety-five apps reviewed, they found only six apps had a perfect score on accuracy or no false negatives. Read more about the study and why you should get trained on how to use a FABM properly before relying on an app for any of your feminine health and family planning needs.