A randomized trial of web-based fertility-tracking software and fecundability

Abstract

Objective: To assess the effect of randomization to FertilityFriend.com, a mobile computing fertility-tracking app, on fecundability.

Design: Parallel non-blinded randomized controlled trial nested within the Pregnancy Study Online (PRESTO), a North American preconception cohort.

Patient(s): Female participants aged 21 to 45 years attempting conception for ≤6 menstrual cycles at enrolment (2013-2019).

Intervention: Randomization (1:1) of 5532 participants to receive a premium Fertility Friend (FF) subscription.

Main outcome measure(s): Fecundability (per-cycle probability of conception). Participants completed bimonthly follow-up questionnaires until pregnancy or a censoring event, whichever came first. We first performed an intent-to-treat analysis of the effect of FF randomization on fecundability. In secondary analyses, we used a per-protocol approach that accounted for adherence in each trial arm. In both analyses, we used proportional probabilities regression models to estimate fecundability ratios (FR) and 95% confidence intervals (CI) comparing those randomized vs. not randomized and applied inverse probability weights to account for loss-to-follow-up (intent-to-treat and per-protocol analyses) and adherence (per-protocol analyses only).

Results: Using life-table methods, 64% of the 2775 participants randomized to FF and 63% of the 2767 participants not randomized to FF conceived during 12 cycles; these respective percentages were each 70% among those with 0-1 cycles of attempt time at enrolment. Of those randomized to FF, 72% were defined as adherent (68% of observed menstrual cycles). In intent-to-treat analyses, there was no appreciable association overall (FR = 0.97; 95% CI, 0.90-1.04) or within strata of pregnancy attempt time at enrolment, age, education, or other characteristics. In per-protocol analyses, we observed little association overall (FR = 1.06; 95% CI, 0.99-1.14), but weak-to-moderate positive associations among participants who had longer attempt times at enrolment (FR = 1.15; 95% CI, 0.98-1.35 for 3-4 cycles; FR = 1.14; 95% CI, 0.87-1.48 for 5-6 cycles), were aged <25 years (FR = 1.29; 95% CI, 1.01-1.66), had ≤12 years of education (FR = 1.32; 95% CI, 0.92-1.89), or were non-users of hormonal contraception within 3 months before enrolment (FR = 1.10; 95% CI, 1.02-1.19).

Conclusion: No appreciable associations were observed in intent-to-treat analyses. In secondary per-protocol analyses that accounted for adherence, randomization to FF was associated with slightly greater fecundability among selected subgroups of participants; however, these results are susceptible to unmeasured confounding.

Keywords: fecundability; fertility; preconception; randomized trial; time-to-pregnancy.

Figure 1.

Use of app features among those randomized to FF who entered data into app, 2013–2020, PRESTO Abbreviations: FF=FertilityFriend.com, OPK=ovulation predictor kit (urine LH), BBT=basal body temperature, Cervix Other=position/openness/texture. Notes: Dark shaded bar displays percentage of participants randomized to FF who entered data into FF app at any point during follow-up (unit of analysis: participant). Light shaded bar displays the percentage of menstrual cycles during which participants randomized to FF entered data into FF app (unit of analysis: menstrual cycle).