Time to Pregnancy for Women Using a Fertility Awareness Based Mobile Application to Plan a Pregnancy

Abstract

Background: Time to pregnancy (TTP) is a biomarker of fecundability and has been associated with behavioral and environmental characteristics; however, these associations have not been examined in a large population-based sample of application (app) users. Materials and Methods: This observational study followed 5,376 women with an age range of 18 to 45 years who used an app to identify their fertile window. We included women who started trying to conceive between September 30, 2017 and August 31, 2018. TTP was calculated as the number of menstrual cycles from when the user switched to "Plan" mode up to and including the cycle in which they logged a positive pregnancy test. We examined associations with several characteristics, including age, gravidity, body mass index, cycle length and cycle length variation, frequency of sexual intercourse, and temperature measuring frequency. Discrete time fecundability models were used to estimate fecundability odds ratios. Results: For the complete cohort the 6-cycle and 12-cycle cumulative pregnancy probabilities were found to be 61% (95% confidence interval [CI]: 59-62) and 74% (95% CI: 73-76), respectively. The median TTP was four cycles. The highest fecundability was associated with an age of less than 35 years, with cycle length variation <5 days and logging sexual intercourse on at least 20% of days added (the proportion of days in which intercourse was logged) (11.5% [n = 613] of entire sample). This group achieved a 6- and 12-cycle cumulative pregnancy probability of 88% (95% CI: 85-91) and 95% (95% CI: 94-97), respectively, and a TTP of 2 cycles. Conclusions: Natural Cycles was an effective method of identifying the fertile window and a noninvasive educational option for women planning a pregnancy. Women under age 35 with regular cycles showed a high pregnancy rate.

Keywords: FABM; conception; fertility; mobile application; time to pregnancy.

FIG. 1.

Study timeline (time axis not to scale).

FIG. 2.

Kaplan–Meier nonpregnancy probability of the entire study population with 95% CI. CI, confidence interval.

FIG. 3.

Kaplan–Meier probability of pregnancy per cycle of optimal cohort (age <35, cycle length variation <5 days, logged intercourse on at least 20% of cycle days) with 95% CI.

FIG. 4.

FOR with 95% CI corresponding to the selected set of exposures, from a single discrete-time fecundability model. For the relative percentages in each cohort please refer to Table 1. Older age, BMI in the underweight range, irregular cycles, and sporadic sexual activity are related with FOR <1, indicating worse fecundability. BMI, body mass index; FOR, fecundability odds ratio.