Stratification of fertility potential according to cervical mucus symptoms: achieving pregnancy in fertile and infertile couples

Marshell, M.; Corkill, M.; Whitty, M.M.; Thomas, Abraham; Turner, Joseph V.

doi:10.1080/14647273.2019.1671613

Cited by 8 publications

(8 citation statements)

References 20 publications

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“…The duration of subfertility has been used as a major factor to start infertility treatment. Several studies showed that the pregnancy rate was particularly compromised by the duration of subfertility in TI (31,42,(48)(49)(50), a finding that agrees with our findings. Our study was similar to a prospective cohort study of couples with at least 1 year of unsuccessful attempts to conceive who undergo TI after FABM training.…”

Section: Discussionsupporting

confidence: 93%

Predictive Factors of Conception and the Cumulative Pregnancy Rate in Subfertile Couples Undergoing Timed Intercourse With Ultrasound

et al. 2021

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The aim of this study was to determine predictive factors for pregnancy and assess the cumulative pregnancy rate (CPR) and live birth rate (CLBR) in subfertile couples undergoing timed intercourse (TI) using ultrasound. This retrospective cohort study included 285 women (854 cycles) who started TI with ultrasound between January 2017 and October 2019. The overall clinical pregnancy rate was 28.1% (80/285) per couple and 9.4% (80/854) per cycle. Pregnant women had a higher body mass index (BMI), higher percentage of irregular menstrual cycles, a shorter duration of subfertility, lower serum follicle-stimulating hormone levels, and higher anti-Müllerian hormone levels than non-pregnant women. A longer duration of subfertility (≥24 months vs. <12 months; odds ratio: 0.193; 95% confidence interval: 0.043-0.859) and endometriosis (vs. ovulatory factors; odds ratio: 0.282; 95% confidence interval: 0.106-0.746) as causes of subfertility were unfavorable factors that independently affected clinical pregnancy. In subgroup analysis, old age ≥ 35 years [vs. < 35 years; odds ratio: 0.279; 95% confidence interval: 0.083-0.938), a longer duration of infertility ≥24 months (vs. <24 months; odds ratio: 0.182; 95% confidence interval: 0.036-0.913) and a higher BMI ≥ 25 kg/m2(vs. >25 kg/m2; odds ratio: 3.202; 95% confidence interval: 1.020-10.046) in couples with ovulatory factor and a longer duration of infertility ≥24 months (vs. <24 months; odds ratio: 0.185; 95% confidence interval: 0.042-0.819) in couples with non-ovulatory factors were significant independent predictive factors for pregnancy. No significant differences were found in the cycle characteristics between pregnant and non-pregnant women. The CPR substantially increased during the first three cycles and significantly increased until the sixth cycle. No significant increase was observed in the CPR after the sixth cycle. The CLBRs substantially increased during the first three cycles and significantly increased until the fourth cycle. No significant increase was observed in the CLBRs after the fifth cycle. When comparing CPRs and CLBRs according to subfertile causes, CRPs was significantly different and CLBRs was different with borderline significance. Our findings may indicate that women with a longer duration of subfertility or subfertility due to endometriosis have poor outcomes during TI with ultrasound. Women who failed to achieve conception by the fourth or fifth cycle of TI with ultrasound may be encouraged to consider advancing to the next treatment strategy.

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Section: Discussionsupporting

confidence: 93%

Predictive Factors of Conception and the Cumulative Pregnancy Rate in Subfertile Couples Undergoing Timed Intercourse With Ultrasound

et al. 2021

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“…In the present study, participants expressed that they found the Billings Method easy to understand, simple to use, and affordable, and that they were attracted by the supporting scientific evidence [ 8 , 10 , 26 – 28 ]. When using the Billings Method for family planning, a few participants in our FGs expressed that achieving pregnancy was "easy," and it has been described that the Billings Method observations can predict successful conception [ 29 ]. Some users appear to be interested in using the method because it allows them to use the same method for both planning and avoiding pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Understanding the perspective of women who use the Billings Ovulation Method®: a focus group study

et al. 2023

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Background The Billings Ovulation Method®(the Billings Method) is a fertility awareness-based method (FABM) of family planning that relies on the observation of patterns of fertility and infertility based on vulvar sensations and appearance of discharges. This allows people to choose when to have intercourse, depending on whether they want to avoid or achieve pregnancy. Few studies have documented user experiences with FABMs. Methods We conducted four virtual focus groups (FGs) in May and June 2021 with current adult women users of the Billings Method. We asked questions about users' reasons for selecting a FABM and the Billings Method, positive experiences and challenges learning and using the Billings Method, and suggestions for improving the user experience. We performed a content analysis of the transcribed FGs to explore key themes from the discussions. COREQ guidelines were followed. Results Twenty women between the ages of 23 and 43 participated in the FGs. Reasons women described choosing a FABM included to follow religious beliefs, to avoid side effects of hormonal contraception, and/or to learn more about their bodies. Reasons for selecting the Billings Method included perceiving it as more precise and easier to understand than other FABMs, having a scientific basis, and being recommended by family and friends. Experiences related to learning and using the Billings Method were mainly positive. They included finding the method easy to use and learn, successfully using it to either postpone or achieve a pregnancy and increasing their awareness of their bodies. Challenges for participants included the inherent learning curve for identifying sensations at the vulva and the required periods of abstinence. Participants provided suggestions and recommendations for improving users' experience, including raising awareness of the Billings Method among healthcare providers. Conclusions Users of the Billings Method expressed an overall positive experience when learning and using it for family planning and body awareness. Some challenges were identified that offer opportunities to improve how the Billings Method is taught and delivered. These findings can also enhance healthcare providers' interactions with FABM users, including those of the Billings Method.

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“…Second, the cervical mucus peak day is an efficient way to track the timing of ovulation, relevant to certain diagnostic tests, such as midluteal assessments ( Fehring, 2002 ; Stanford et al , 2020b ), and also for timing some treatments, such as ovulation stimulation drugs or ovulation trigger shots. Third, cervical mucus patterns provide direct insight into fecundability ( Marshell et al , 2021 ). Fourth, when the clinician employs medications or surgical interventions to stimulate ovulation and/or support the hormonal function of the menstrual/ovulation cycle, the CrM chart can be used as a tool to assess the response to treatment ( Tham et al , 2012 ).…”

Section: Introductionmentioning

confidence: 99%

International Natural Procreative Technology Evaluation and Surveillance of Treatment for Subfertility (iNEST): enrollment and methods

Stanford

Parnell

Kantor³

et al. 2022

Human Reproduction Open

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STUDY QUESTION What is the feasibility of a prospective protocol to follow subfertile couples being treated with natural procreative technology for up to 3 years at multiple clinical sites? SUMMARY ANSWER Overall, clinical sites had missing data for about one-third of participants, the proportion of participants responding to follow-up questionnaires during time periods when participant compensation was available (about 2/3) was double that of time periods when participant compensation was not available (about 1/3), and follow-up information was most complete for pregnancies and births (obtained from both clinics and participants). WHAT IS KNOWN ALREADY Several retrospective single-clinic studies from Canada, Ireland, and the USA, with subfertile couples receiving restorative reproductive medicine, mostly natural procreative technology, have reported adjusted cumulative live birth rates ranging from 29% to 66%, for treatment for up to 2 years, with a mean women’s age of about 35 years. STUDY DESIGN, SIZE, DURATION The international Natural Procreative Technology Evaluation and Surveillance of Treatment for Subfertility (iNEST) was designed as a multi-center, prospective cohort study, to enroll subfertile couples seeking treatment for live birth, assess baseline characteristics, and follow them up for up to 3 years to report diagnoses, treatments, and outcomes of pregnancy and live birth. In addition to obtaining data from medical record abstraction, we sent follow-up questionnaires to participants (both women and men) to obtain information about treatments and pregnancy outcomes, including whether they obtained treatment elsewhere. The study was conducted from 2006 to 2016, with a total of 10 clinics participating for at least some of the study period across four countries (Canada, Poland, UK, and USA). PARTICIPANTS/MATERIALS, SETTING, METHODS The 834 participants were subfertile couples with the woman’s age 18 years or more, not pregnant, and seeking a live birth, with at least one clinic visit. Couples with known absolute infertility were excluded (i.e., bilateral tubal blockage, azoospermia). Most women were trained to use a standardized protocol for daily vulvar observation, description, and recording of cervical mucus and vaginal bleeding (the Creighton Model FertilityCare System). Couples received medical and sometimes surgical evaluation and treatments aimed to restore and optimize female and male reproductive function, to facilitate in vivo conception. MAIN RESULTS AND THE ROLE OF CHANCE The mean age of women starting treatment was 34.0 years; among those with additional demographic data, 382/478 (80%) had 16 or more years of education, and 199/593 (34%) had secondary infertility. Across 10 clinical sites in four countries (mostly private clinical practices) with family physicians or obstetrician-gynecologists, data about clinic visits were submitted for 60% of participants, and diagnostic data for 48%. For data obtained directly from the couple, 59% of couples had at least one follow-up questionnaire, and the proportion of women and men responding to fill out the follow-up questionnaires was 69% and 67%, respectively, when participant financial compensation was available, compared to 38% and 33% when compensation was not available. Among all couples, 55% had at least one pregnancy and 42% at least one live birth during the follow-up time period, based on data obtained from clinic and/or participant questionnaires. All sites reported on female pelvic surgical procedures, and among all participants 20% of females underwent a pelvic diagnostic and/or therapeutic procedure, predominantly laparoscopy and hysterosalpingography. Among the 398 (48%) of participants with diagnostic information, ovulation-related disorders were diagnosed in 81%, endometriosis in 30%, nutritional disorders in 52%, and abnormalities of semen analysis in 25%. The mean number of diagnoses per couple was 4.7. LIMITATIONS, REASONS FOR CAUTION The level of missing data was higher than anticipated, which limits both generalizability and the ability to study different components of treatment and prognosis. Loss to follow-up may also be differential and introduce bias for outcomes. Most of the participating clinicians were not surgeons, which limits the opportunity to study the impact of surgical interventions. Participants were geographically dispersed but relatively homogeneous with regard to socioeconomic status, which may limit the generalizability of current and future findings. WIDER IMPLICATIONS OF THE FINDINGS Multi-center studies are key to understanding the outcomes of subfertility treatments beyond IVF or IUI in broader populations, and the association of different prognostic factors with outcomes. We anticipate that the iNEST study will provide insight for clinical and treatment factors associated with outcomes of pregnancy and live birth, with appropriate attention to potential biases (including adjustment for potential confounders, multiple imputation for missing data, sensitivity analysis and inverse probability weighting for potential differential loss to follow-up, and assessments for clinical site heterogeneity). Future studies will need to either have: adequate funding to compensate clinics and participants for robust data collection, including targeted randomized trials; or a scaled-down, registry-based approach with targeted data points, similar to the multiple national and regional ART registries. STUDY FUNDING/COMPETING INTEREST(S) Funding for the study came from the International Institute for Restorative Reproductive Medicine, the University of Utah, Department of Family and Preventive Medicine, Health Studies Fund, the Primary Children’s Medical Foundation, the Mary Cross Tippmann Foundation, the Atlas Foundation, the St. Augustine Foundation, and the Women’s Reproductive Health Foundation. The authors declare no competing interests. TRIAL REGISTRATION NUMBER The iNEST study is registered at clinicaltrials.gov, NCT01363596

show abstract

Stratification of fertility potential according to cervical mucus symptoms: achieving pregnancy in fertile and infertile couples

Cited by 8 publications

References 20 publications

Predictive Factors of Conception and the Cumulative Pregnancy Rate in Subfertile Couples Undergoing Timed Intercourse With Ultrasound

Predictive Factors of Conception and the Cumulative Pregnancy Rate in Subfertile Couples Undergoing Timed Intercourse With Ultrasound

Understanding the perspective of women who use the Billings Ovulation Method®: a focus group study

International Natural Procreative Technology Evaluation and Surveillance of Treatment for Subfertility (iNEST): enrollment and methods

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