2003 Science & Research Forum

Biosketch:

Richard J. Fehring, RN, DNSc, is a Professor and Director of the Marquette University College of Nursing Institute for Natural Family Planning. He received his masters and doctorate in nursing science from Catholic University of America and his baccalaureates in nursing and biology from Marquette University. He is a current member of the National Advisory Board to the United States Conference of Catholic Bishops (USCCB) for Natural Family Planning (NFP) and editor of “Current Medical Research” a publication of the USCCB. Dr. Fehring is a past president of the American Academy of (Natural Family Planning) FertilityCare Professionals. His research interests include clinical application of new technology for fertility monitoring and marital dynamics of family planning.
Co-authors: Mary Schneider, BSN, RN, Marquette University; Kathleen Raviele, MD, Atlanta, Georgia

Presentation Abstract:

A Comparison of the Fertile Phase as Determined by the Clearplan Easy Fertility Monitor and the Self-Assessment of Cervical Mucus

Background: The accuracy of biological markers to predict and detect ovulation is critical for women and couples who wish to use natural means of achieving or avoiding pregnancy. The Clearplan Easy Fertility Monitor (Unipath Diagnostics Co., Princeton, New Jersey) is a significant new development in the prediction and detection of ovulation. The Clearplan monitor consists of a hand-held digital monitor and disposable test sticks. The monitor identifies a woman’s fertile period by tracking the changing levels of estrone-3-glucuronide (E3G), the urinary metabolite of estradiol and by identifying the urinary surge of luteinizing hormone (LH). The Clearplan Fertility Monitor reads the Test Sticks to identify changes in the hormone levels and provide the user with a reading of low, high and peak fertility.

Research Objective: The Clearplan Fertility Monitor is currently sold and marketed only for women and couples who wish to achieve pregnancy. However, the information provided by the monitor could be used inversely for avoiding pregnancy. If the Clearplan monitor is used in conjunction with the information provided by other natural markers of fertility, (i.e., cervical mucus) the information and feedback provided by each marker might facilitate a more accurate determination of the fertile window. The specific research objective of this study was to compare the beginning, peak, and length of fertility in a woman’s menstrual cycle as determined by the Clearplan monitor with the beginning, peak, and length of the fertile period as determined by self-monitoring of cervical mucus.

Methods: Eighty healthy women (mean age 28.9 year, SD = 5.7) who were seeking to learn NFP for the purpose of avoiding pregnancy were asked to observe their cervical mucus and monitor their urine for estrogen and LH metabolites with the Clearplan Easy Fertility Monitor on a daily basis for 2-6 cycles. The 80 women participants generated 226 cycles of data. The mean length of the cycles was 28.8 days (SD = 4.0). All 80 participants signed a research consent form approved by the Office of Research Compliance before beginning the study. The same office approved the research protocol as meeting Federal regulations for human subject protection.

Outcomes: The beginning of the fertile window was on average day 10.6 (SD = 4.3) as determined by the Clearplan monitor and on day 10.2 (SD = 3.3) by cervical mucus (r = 0.46, p < 0.001). The average day of peak fertility determined by the monitor was 15.2 and 16.2 (SD = 3.6) and by cervical mucus day 15.3 (SD = 4.8) (r = 0.63, p < 0.001). The mean length of the fertile phase as determined by cervical mucus (with a count of 3 days past peak day) was on average 10.06 days (SD = 3.18) and the fertile phase by the Clearplan monitor (with a count of 3 after the last peak day) was on average 7.94 days (SD = 3.14). There was a statistical difference between the mean length of fertility as determined by the two methods (t = 8.00, p < 0.001). The average total days of high and peak fertility by the monitor was 3.4 (SD = 2.8) and the average total days of peak type mucus was 3.8 (SD = 2.8).

Conclusion: The estimated fertile phase of the menstrual cycle as determined by the Clearplan Easy Fertility Monitor and the self-assessment of cervical mucus are similar, however, there are some significant differences that might or might not enhance the interpretation of the fertile phase. The Clearplan monitor tends to underestimate and the self-assessment of cervical mucus tends to over estimate the fertile window. Implications of these findings for teaching and using NFP will be discussed.

Commentary:

Some couples will experience difficulties in learning a "mucus based" method of natural family planning. This can be related to educational, psychosocial, or medical issues. This also involves the timing of "achieving" or "avoiding" related behavior. Appropriate technology may provide some assistance to these couples while continuing in standardized teaching, observations, and charting. The menstrual cycle and the associated hormonal changes that occur has been extensively studied in the natural family planning and general scientific literature. This study looks at the use of a simple device that determines a woman's fertile phase through the measurement of the urinary metabolite of estradiol and luteinizing hormone (LH). This is compared to the fertile phase as determined by the self-assessment of cervical mucus in natural family planning. Beyond confirming hormonally what we know to be true, such devices may provide the practitioner an additional tool to help those couples experiencing particular challenges in learning natural family planning, and give them some extra confidence via technology.