Menstruation and Fertility Apps

What are the 3 primary uses of menstruation and fertility apps?

Although there are varied uses and they may change over time, the primary uses are:

1. Tracking fertility

2. Planning a pregnancy

3. Preventing a pregnancy

What are users of tracking of fertility either trying to do?

either trying to conceive or trying not to conceive

Why are women trying to conceive?

• Want to have kids

• Women of reproductive age want to have kids (range is getting wider)

How are women/why are women using fertility trackers to try to not conceive?

• using tracking fertility as a contraception

• for medical reasons

• to learn about cycle

• to understand body

What is tracked using tracking apps?

• cycle length

• cycle regularity

• rate of menstruation

• basal body temp

• cervical mucus

• mood

• ovulation tests

• pain related to ovulation

What does it mean to track fertility + info?

• self-tracking of menstruation and pregnancy is now new

• Promotes personal choice

• promotes self-knowledge

• promotes patient engagement

• affordable

• digital-based fertility awareness-based methods

  • a viable alternative for women who don’t use hormonal methods of contraception

• ‘Period-tracking’ apps have been increasing

• Over 200 million downloads (2016)

What are the 4 motivation for tracking fertility?

1. observing cycle

2. to conceive

3. to inform fertility treatment

4. as a method of contraception

**72% of apps users were were only observing their cycle

What are 5 reasons for tracking fertility?

1. to be aware of their body

2. to understand their body in different phases of the menstrual cycle

3. to be prepared

4. to become pregnant

5. to inform conversations with healthcare providers

Why is it possible for reasons to track fertility to change?

Reasons change overtime possible due to (younger) age, pregnancy, and menopause

What are the 3 categories for pregnancy planning apps?

1. to support pregnancy planning

2. to support pregnancy prevention

3. to support both 1 and 2

**interrelated, but different goals

**motivation and possibly other user differences due to the goal

What are the 3 pregnancy planning app types?

1. Calendar based

2. Calculothermal

3. Symptothermal

What are some important factors regarding pregnancy planning?

• precision in being able to determine the fertile window

• Significance of the use of app information for sexual behavior of couple trying to conceive (outside app control?)

What are some more information about the app NaturalCycles?

• FDA approval as a contraceptive

• CE Certification

• Requires women to enter

  • Basal body temperature

  • Date of menstruation

• Uses of proprietary algorithm, calculates ovulation and fertility

• women are also encouraged to purchase lutenising hormone tests that predict ovulation

More about Daysy App:

• Classified (in Europe) as a Class I Medical Device

• Used to ‘facilitate conception’

• Based on the principle that the use of apps can increase a person’s focus on their health

• Treated as a type of ‘female contraceptive’

What are some concerns with pregnancy/fertility apps?

• How apps have been marketed

  • used of social media influencers

• Tracking fatigue

  • too many things to track

• Questions surrounding their evidence based and efficacy

  • especially in relation to the risk of unintended pregnancies

What is the global impact for fertility/pregnancy apps?

• exponential growth in low and middle income countries

• wireless is sometimes for prevalent than wired

  • “leap-frogged” wired technology phase

• Tracking of current outbreaks and requests for assistance

What are some FDA challenges?

• Medical Mobile Application Guidelines

• FSRH/BASHH Standars for Online and Remote Providers of Sexual and Reproductive Health Services (2019)

What is the Mobile Medical Application?

• Approval via the FDA42 43

• FDA has approved many different types of MMAs for use across different health disciplines

• NaturalCycles is the only fertility approved app (2020) as a contraceptive

• DaysyView approved aa Class I medical device (europe)

How is tracking fatigue a challenge?

• concerns about tracking too many varibales

• Concerns about use of several apps

How is accuracy a challenge?

• quality

• validity of data

• validity of the algorithms used

Where do they lack evidence?

(same as for mHealth)

• positive impact on health (mixed results)

• No control in development

• No control in use

How is it an afforadbiloty challenge?

• not all apps are free

• free apps have issues