Discussion of Review Article on Fertility Awareness-Based Methods

‘Fertility Awareness-Based Methods of Family Planning; a Review of Effectiveness for avoiding Pregnancy using SORT.’ (Review Article)1          

At the NFP2015 World Congress, Dr Michael Manhart, (Couple to Couple League, USA) one of the authors of the above review article outlined their findings.1 Each year, over 75% of the women of reproductive age in the United States seek family planning services from primary care clinicians. In the interest of informed consent, women and their physicians should know about all available family planning options and their effect on reproductive health.

Fertility awareness-based methods (FABM) of family planning rely on a woman’s understanding and recognition of her fertility. FABM provide couples with the information they need to identify the days in each cycle when the woman is likely to conceive. Couples can use this information to guide their family planning decisions. Natural family planning (NFP) is the subset of FABM where couples refrain from genital contact during the fertile days to avoid pregnancy or engage in sexual intercourse during fertile time to achieve pregnancy. One in 5 women in the USA express interest in using FABM when informed about these methods. However, many physicians are unfamiliar with FABM or have misconceptions about their effectiveness, complexity, or suitability for their patients.

Studies of modern FABM show that their typical unintended pregnancy rates are comparable to those of commonly used contraceptives. In this review1 by Dr Manhart et al, the article by P Frank-Herrmann et al3 (Heidlberg, Germany) met the criteria for Level 1 evidence giving an A rating for the strength of recommendation (SOR), defined as a recommendation based on consistent and good-quality, patient-oriented evidence. This study3 showed that the symptothermal double-check method of NFP in avoiding pregnancy, (i.e. the method taught by the NFPTAI) is a highly effective family planning method, provided the appropriate guidelines are consistently adhered to.

The authors of this review including Dr Manhart from the Couple to Couple League, Ohio, USA, and Dr Marguerite Duane of Georgetown University, Washington, DC, are members of FACTS (Fertility Awareness Collaborative to Teach the Systems)* which is coordinated through the Family Medicine Education Consortium in the USA.

*FACTS: The Fertility Appreciation Collaborative is comprised of physicians, other health care professionals and educators working together to Teach the Science of natural or fertility awareness based methods (FABMs) of family planning. www.factsaboutfertility.org

Our goal is to share the best evidence available with our health care colleagues so they can educate women and men about their fertility, empower them to make more informed choices about family planning, and enable women to collaborate with their physicians to better monitor and manage their reproductive health.

 What is SORT? : (Strength of Recommendation Taxonomy): ‘SORT’2 is a taxonomy, (i.e. method of classification or grading scale), developed by the major family medicine journals in the USA to evaluate evidence and to allow authors to assess the quality of individual studies and overall strength of a body of evidence. The SORT reviews assist physicians in evaluating outcomes that matter to patients and incorporating best evidence practices.

  1. ‘Fertility awareness-based methods of family planning: A review of effectiveness for avoiding pregnancy using SORT’;   Michael D. Manhart, PhD, Marguerite Duane, MD et al; Osteopathic Family Physician (2013) 5, 2–8; (available on the internet).
  2. Ebell MH, Siwek J, Weiss BD, et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician. 2004;69:548–556; (available on the internet).
  3. Frank-Herrmann P, Heil J, Gnoth C, et al. The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple’s sexual behaviour during the fertile time: a prospective longitudinal study. Hum Reprod. 2007;22(5):1310–1319
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