Contraceptive apps; are they a reliable form of tracking fertility?

REPRODUCTIVE HEALTH

Many women will have experienced the feeling of panic that a missed monthly period can bring. For young women today, there is the emergency contraceptive, but this is a very recent development - barely a decade old, and there are issues of efficacy and side effects with repeated use.

One would imagine that the attention to means of contraception would match the frequency of occurrence of sex, but these things are not always straightforward. The needs, power and circumstances of women vary so greatly, that choice and means of contraception are not a given.

From the 1960s, all emancipated and empowered women would subsist for decades on a Pill a day, to keep the babies at bay. It's one of the most efficient forms of contraception and, at the time, revolutionised reproductive control for women. The Pill has been developed and re-imagined until it is now being taken for reasons other than contraception - to regulate periods, menstrual cramps, acne and endometriosis. 

However, there are dangers and side effects associated with contraceptive pills, like increased risk of cancer and deep-vein thrombosis, bleeding between menstrual cycles, breast tenderness, headaches and migraines, weight gain, mood changes, missed periods and even reduced libido (which kind of defeats the purpose of contraception in the first place).

For many women these risks pale in comparison to the issues surrounding an unwanted pregnancy.

Gradually, the periodic implant became the improved alternative to the daily Pill - to have a contraceptive placed under your skin and forget about it for a year or more was a true technological advancement for sure peace of mind.

I used to have candid health discussions with my father (a doctor and professor of paediatrics) and when the time came for me to make a choice of contraception, he advised against the implant - in fact, against any hormone-based contraception.

His argument was two-fold: women come in all ages, sizes and physical temperaments - some have a 3 daylight period where others go for a fortnight, some sprout beard and chest hair where others begin menstrual periods at age eight. He said he often wondered about the science behind one contraceptive Pill being able to regulate all our differences. 

On the other hand, although he was a pediatrician and not a gynecologist, he very often had to discuss contraception with young parents and the possible effects of contraception on women who were having difficulty conceiving again.

I thought about the intra-uterine device (IUD), but not for long - having had a history of allergic reactions to all manner of things including some metals, I was not sure it would be a prudent choice.

Also, just the idea of carrying a hunk of metal up there all the time made me uncomfortable. I wondered if it would get dislodged and hurt me, rust and make me ill, or ping every time I went through a metal detector.

Today, my choices have widened; not only can I gossip, shop, and do my banking on my phone, I can now download a contraceptive app. This is an era where an algorithm on a dating site can be trusted to produce the man of your dreams. Algorithms will also help you and that man plan your childbearing.

Today there are nearly 100 fertility apps available, ranging from apps to help you conceive to apps that aid contraception. Clue, Fertility Friend, Glow, Kindara, Natural Cycles, Ovia and Period Tracker... some free, some for a subscription. At the heart of how they all work is the idea that the level of a woman's fertility during each cycle can be tracked using different physical indicators.

Major indicators such as your last period, your body temperature when you wake up, cervix location and cervical fluid can help determine when you're fertile.

You input the data regarding these indicators in the app and it provides information regarding your ‘safe' days - like technological Moon Beads. Your responsibility is then to avoid sex or use condoms on unsafe days. 

It is not common knowledge the women are only fertile for a few days each month, or that a woman could know which days those were. Even when you are not concerned about contraception, using a fertility app can open you up to amazing knowledge of, and love for your body that will spark unforeseen health benefits.

Fertility apps also appeal to women who, like myself, would like to cut unnecessary chemicals out of their lives, as well as a huge Catholic demographic, whose views on artificial contraception are governed by Vatican decrees. Fertility apps can greatly increase the efficacy of natural family planning and the withdrawal method.

Fertility awareness, which was originally viewed as contraception for the poor, overly religious or plain dumb, has gained more legitimacy since a fertility tracking app was certified in the European Union and cleared for marketing by the U.S  Food and Drug Administration as a contraceptive. 

However, even though research is improving the science behind how these apps work, there is still a failure rate - with about 7% of women who use the app expected to fall pregnant anyway. This is in part due to inconsistent use, but also due to the fact that menstrual cycles and the factors that affect them cannot ever be 100% predictable.

Another major issue is lifestyle. Irregular sleep patterns, illness, travel, and substance use (or abuse) can affect the body's natural functions, thereby skewing the data and providing inaccurate safe day readings.

But this should not be a reason for backlash against fertility apps. Every other contraceptive means has a failure rate, with the one for the IUD being negligible but still present.

Apparently, even female sterilisation has a tiny chance of failure. Women need to learn more about their fertility and not take the little school-book learning they have for granted. Knowing your cycle and how your body behaves could have consequences and benefits for menopause and beyond. 

The developers of these apps continue to look for ways to make this data make sense for women. Ava - a firm that makes a fertility-tracking bracelet and app - last year announced it had raised $30 million to expand into various aspects of female health. Natural Cycles, which was developed by a Swedish couple, has put $38 million into research and are evolving the app to do more.

For instance, the developers say a new mode available on the app which helps users monitor a pregnancy, could be enhanced to detect signs of a miscarriage, and they hope to offer a Bluetooth-connected thermometer that communicates automatically with the app.

What to consider if you chose a contraceptive app

It's a serious app, not a sexy tool. Natural family planning methods were never made for younger women (18-25) with multiple partners and a party lifestyle. Women for whom the possibility of a pregnancy is frightening should stick to a more foolproof method of contraception.

Furthermore, the app is telling you when you can have unprotected sex; if you're not having it in a committed relationship, you open yourself up to STDs. Apps may be a millennial idea, but the business of making babies shouldn't be equated to making microwave dinners.

You get what you pay for. There are free apps and subscription apps. While the principle may be the same, free apps may have privacy and data security concerns, and you do not want your personal information misused. Also, users have reported that when they pay for the app they take inputting the data more seriously, leading to better efficiency of the app.

Be diligent. Although you may pay to use the app, you must do the work of monitoring your body and providing the data. Be as diligent as possible to follow instructions and learn about the glorious workings of your own body. 

Watch out for data influencers. There are things that will automatically affect the state of your body, and therefore give you skewed readings.

For instance, your basal body temperature must be measured at the same time every morning, as soon as you wake up, with no exceptions. Eating or drinking anything first can affect your basal body temperature. Sickness and/or any medication will also mess with the data.

Don't track fertility while on the Pill. If you are taking any birth control, it throws off your basal body temperature so the data won't serve much purpose.

Give your body time to adjust. Wait for at least three menstrual cycles before having unprotected sex, in order to allow the app to track you and come to more accurate predictions.