Wearable Fertility Monitors By Betty McGehe, RN, MA, MSN
I have clients who have been using Billings for years. Recently, they have been doing research and discussing with other women the different gadgets out there, specifically the Ava Fertility Bracelet or Tempdrop. Has anybody else been getting similar questions?
As Billings teachers, we either already have – or soon will have – questions asked of us about one or more app purporting to be a quick, easy way to pinpoint fertility. Technology and the internet are producing glitzy aids for the woman wanting to achieve or avoid pregnancy. Entrepreneurs have recognized this gold mine. As a result, the field has exploded and it can seem impossible to get a handle on all the methods and gadgets on the market.
So how can we prepare ourselves to respond in the most helpful way to our clients, friends, and family members? Let’s begin with some specific thoughts about the question above. In a subsequent newsletter, we can develop a general approach to evaluating any device or method.
If a current client is asking about a specific website, app, or device, it might be easy to feel defensive. It has helped me to remind myself that her question does not necessarily mean she is unhappy using Billings. However, it is important to discover why she is interested in the particular device. Think about the following:
1) Initially, it is more helpful to ask questions than to begin giving her facts and advice. Just start by asking something like, “What caught your eye about ….?”, or, “What are your friends saying about ….?” Her response might help you identify something in her understanding or use of The Billings Method™ that calls for more education.
2) Unless you are already familiar with the app in question, it would be best to acknowledge her question, tell her you will look into it, and give her a day and means by which you will get back to her. Not only does this tell her you are interested in being sure she always gets accurate information from you, but it also gives you time to formulate your response 😊. Spend some time investigating the particular app. As you mentally compare the app to what you know about fertility and The Billings Method™, you will begin to identify the app’s deficiencies. This is also a great opportunity to review the research behind Billings. Don’t forget to consult other teachers using the BOMA-USA Teachers Network on Facebook.
Now, a few observations about the devices mentioned in the question:
1) Both are marketed to be easy to use and require no evaluation on the part of the user. Many women are lulled into a false sense of security, thinking that a device can give her 100% accuracy and relieve her of the need to observe her sensation throughout each day. No device is 100% accurate and capable of accounting for all the normal and abnormal variability in human physiology. This is an opportunity to reassure her that she knows her body.
2) Both devices are geared toward achieving pregnancy. How do we know this? First, both websites market to couples wanting to become pregnant. In addition, both devices rely heavily on a change in basal temperature. Since a sustained elevation in basal temperature is an indicator that ovulation has occurred, couples wanting to achieve pregnancy engage in intercourse at that time. Remember, though, that the mucus change after Peak, mediated through the activity of the Pockets of Shaw, gives us an indicator of the same hormonal activity as does the temperature change.
Emphasis on achieving pregnancy is an important point for another reason. Many couples falsely assume that they can take a method or device intended for achieving pregnancy and just adapt it to avoid pregnancy by refraining from intercourse during days the device indicates are fertile. Why doesn’t this always work? Devices intended to achieve pregnancy are calibrated to recognize the time of the greatest chance of conception and are not necessarily designed to be sensitive to the onset of the fertile window - what we would identify as the Point of Change. Couples needing to avoid pregnancy need to be able to recognize the ENTIRE time of potential fertility, from the point of change through the Peak or time closest to ovulation and three days following the Peak Day.
Manufacturers of any device worth considering should make available quality medical research noting the device’s sensitivity and specificity when identifying the entire fertile window and the time of ovulation. The device or method should be tested in clinical trials with actual users seeking to avoid or achieve pregnancy. Look for research that compares the method or device to hormonal levels. This is the type of research that has been done to verify the efficacy of the BOM.
3) That brings me to a third point. An app, method, or another device should always make available the research behind their claims. Neither the AVA bracelet or the Tempdrop provides satisfactory research on actual use of the device.
The Tempdrop site links to research testing the same category of thermometer, but not this particular device. Furthermore, there is no verification that this device accurately pinpoints ovulation.
The AVA bracelet site refers to research measuring pulse rate variability during the phases of the menstrual cycle; published and available at Nature.com. There are notable limitations to this study, but three aspects of the article are especially interesting:
1) The research does not evaluate the actual use of pulse rate information to achieve or avoid pregnancy.
2) The authors acknowledge the validity of the mucus sign and its superiority to basal body temperature when they write, “The self-detection of peak mucus day, defined as
clear, slippery and lubricative mucus, is a better predictor of ovulation…”. Although we would take issue with that definition of “peak mucus” (and would certainly not use that language), AVA researchers recognize the premier position of the mucus sign.
3) The authors conclude, “Given our findings, pulse rate is a strong candidate for inclusion in modern multi-parameter fertility awareness based methods (FABM).” In other words, they advocate that pulse rate information provided by the AVA bracelet be used in addition to verified signs such as cervical mucus changes. This article does not support the use of the AVA bracelet as a stand-alone cycle monitor.
The AVA bracelet declares it is “listed” by the FDA. A listed medical device is one that has been registered with the FDA and for which a registration fee has been paid. It does not mean the FDA has approved the device for its intended use. Being listed is NOT an FDA seal of approval. The AVA bracelet also indicates a Declaration of Conformity and a Testing Certificate. The Declaration and Certificate are requirements of the European Union. Looking at these certificates on the AVA website, neither document gives the user an indication of what standards are being maintained nor verifies the device’s medical accuracy.
Talking about testing and research may seem confusing at first. The main point is, if something is being marketed to help couples achieve or avoid pregnancy, lack of medical research giving the effectiveness in achieving or avoiding pregnancy is an automatic red flag. These devices are expensive. Although neither device is likely to harm, consumers should question if they are getting what they think they are getting.
It is a misconception that high tech automatically means high quality. With accurate use of the Billings Ovulation Method®, couples can be assured that they have high quality with high simplicity.
If you would like to share your thoughts, please do so in the comment section below.
Betty McGehe, RN, MA, MSN Billings Ovulation Method® teacher, trainer supervisor