Medicine and Health Sciences Commons^™

Case Reports From Women Using A Quantitative Hormone Monitor To Track The Perimenopause Transition, Maria Meyers, Richard J. Fehring, Mary Schneider

College of Nursing Faculty Research and Publications

The fertility tracking of menstrual cycles during perimenopause with a quantitative hormone monitor is a novel undertaking. Women in regular menstrual cycles have been tracking their fertility using different biomarkers since the 1960′s. Presently, there are newer electronic hormonal devices used to track fertility that provide more exact and objective data to help delineate the fertile time frame of a woman’s cycle. These devices measure quantitative levels of estrogen, the luteinizing hormone, progesterone, and follicle-stimulating hormone, all of which occur at varying levels during the menstrual cycle. As women advance toward menopause, their cycles vary in length, and their hormones …

Multisite Effectiveness Study Of The Marquette Method Of Natural Family Planning Program, Qiyan Mu, Richard J. Fehring, Thomas Bouchard

College of Nursing Faculty Research and Publications

Women of reproductive age need reliable and effective family planning methods to manage their fertility. Natural family planning (NFP) methods or fertility awareness-based methods (FABMs) have been increasingly used by women due to their health benefits. Nevertheless, effectiveness of these natural methods remains inconsistent, and these methods are difficult for healthcare providers to implement in their clinical practice. The purpose of this study is to evaluate the effectiveness of the Marquette Model NFP system to avoid pregnancy for women at multiple teaching sites using twelve months of retrospectively collected teaching data. Survival analysis (Kaplan–Meier) was used to determine typical unintended …

Natural Family Planning And Marital Chastity: The Effects Of Periodic Abstinence On Marital Relationships, Richard J. Fehring, Michael D. Manhart

College of Nursing Faculty Research and Publications

Marital chastity is the practice of periodic abstinence with use of natural family planning (NFP). The purpose of this study was to determine the influence of the most common methods of contraception (female sterilization, oral contraceptive pills, and condoms) and NFP on divorce/separation and cohabitation rates among reproductive age women. The study involved an extensive review of the literature on the effects of practice of NFP on marital dynamics and a statistical analysis of 2,550 ever-married women in the (2015–2017) National Survey of Family Growth data set. Importance of religion and frequency of church attendance were included in the analysis. …

Pilot Evaluation Of A New Urine Progesterone Test To Confirm Ovulation In Women Using A Fertility Monitor, Thomas Bouchard, Richard Fehring, Mary Schneider

College of Nursing Faculty Research and Publications

Background

Progesterone rises ~24–36 h after ovulation. Past studies using ultrasound-confirmed ovulation have shown that three consecutive tests with a threshold of 5μg/mL of urine progesterone (pregnanediol-3-glucuronide, PDG), taken after the luteinizing hormone (LH) surge, confirmed ovulation with 100% specificity.

Purpose

The purpose of this study was to a evaluate a new urine PDG self-test to retrospectively confirm ovulation in women who were monitoring ovulation using a hormonal fertility monitor.

Methods

Thirteen women of reproductive age were recruited to test urine PDG while using their home hormonal fertility monitor. The monitor measured the rise in estrogen (estrone-3-glucuronide, E3G) and LH …

Dissociation Between Cervical Mucus And Urinary Hormones During The Postpartum Return Of Fertility In Breastfeeding Women, Thomas Bouchard, Len Blackwell, Simon Brown, Richard Fehring, Suzanne Parenteau-Carreau

College of Nursing Faculty Research and Publications

Identifying the return of fertility with cervical mucus observations is challenging during the postpartum period. Use of urinary measurements of estrogen and progesterone can assist in understanding the return to fertility during this period. The purposes of this study were to describe the postpartum return of fertility by an analysis of total estrogen (TE) and pregnanediol glucuronide (PDG) profiles and to correlate these profiles with cervical mucus observations. Twenty-six participants collected urine samples during the postpartum period and recorded mucus scores. TE and PDG hormones were analyzed and compared with mucus scores. During amenorrhea, mucus reflected TE changes in only …

Current Medical Research: Summer/Fall 2017, Richard Fehring, Mary Lee Barron

College of Nursing Faculty Research and Publications

This issue of Current Medical Research (CMR) includes studies that provide evidence that use of natural family planning (NFP) can be helpful for subfertile couples wishing to achieve a pregnancy, the effectiveness of a method of NFP during breastfeeding, and the effects of using NFP on marital relationships. This review also includes evidence on predicting the sex of a baby by timing intercourse, evidence that brain injuries can be reflected in changes in the menstrual cycle, and that women prefer methods of family planning that have no side effects. The issue ends with an in-depth review of new technologies that …

Current Medical Research Winter/Spring 2017, Richard Fehring, Kathleen Raviele

College of Nursing Faculty Research and Publications

No abstract provided.

Achieving Pregnancy Using Primary Care Interventions To Identify The Fertile Window, Thomas Bouchard, Richard Fehring, Mary Schneider

College of Nursing Faculty Research and Publications

Objective: To determine the effectiveness of achieving pregnancy with focused intercourse in the fertile window identified using natural fertility indicators. Methods: 24-cycle prospective effectiveness study. Setting: A North American web-based fertility monitoring service. Participants: 256 North American women aged 20–43 (mean age 29.2 years) seeking to achieve pregnancy. Intervention: Participants identified their fertile window with either electronic hormonal fertility monitoring or cervical mucus monitoring, or both, and recorded their observations on an online fertility tracking system. Main outcome measures: Pregnancies were validated by nurses with an online self-assessed pregnancy evaluation form. Survival analysis was used to determine pregnancy rates. Results: …

Effectiveness Of An Online Natural Family Planning Program For Breastfeeding Women, Richard Fehring, Mary Schneider, Thomas Bouchard

College of Nursing Faculty Research and Publications

Objective To analyze the effectiveness of an online, nurse-managed natural family planning (NFP) program among breastfeeding women and subgroups of these women. Design Longitudinal comparative cohort study. Setting A university-based online NFP education program and menstrual cycle charting system. Participants Women (N = 816) with a mean age of 30.3 years (standard deviation = 4.5) who registered to use the online NFP system and indicated they were breastfeeding. Methods Participants tracked their fertile times with an electronic hormone fertility monitor (EHFM), cervical mucus monitoring, or both. All unintended pregnancies were evaluated by professional nurses. Results The correct use pregnancy rates …

Effectiveness Of A Natural Family Planning Service Program, Richard Fehring, Mary Schneider

College of Nursing Faculty Research and Publications

Purpose: The aims of this study were to determine and compare extended use-effectiveness of an online nurse-managed fertility education service program among women (and subgroups of women) seeking to avoid pregnancy.

Study Design and Methods: This was a 24-month prospective study of a university-based online Web site with 663 nonbreastfeeding women using an online charting system to avoid pregnancy. Participants tracked their fertility online with either cervical mucus monitoring, electronic hormonal fertility monitoring, or both fertility indicators. Unintended pregnancies were validated by professional nurses.

Results: Participants had a mean age of 30.4 years (SD = 6.3) and mean 1.7 children …

Couple Beads: An Integrated Method Of Natural Family Planning, George Mulcaire-Jones, Richard J. Fehring, Megan Bradshaw, Karen Brower, Gonzaga Lubega, Paskazia Lubega

College of Nursing Faculty Research and Publications

Various fertility indicators are used by natural family planning methods to identify the fertile and infertile phases of a woman's menstrual cycle: mucus observations, cycle-day probabilities, basal body temperature readings, and hormonal measures of LH and estrogen. Simplified NFP methods generally make use of a single fertility indicator such as cycle-day probabilities (Standard Days Method) or mucus observations (Billings Ovulation Method). The Couple Bead Method integrates the two simplest fertility indicators, cycle-day probabilities and mucus observations, expanding its applicability to all women, regardless of cycle regularity and length. In determining cycle-day probabilities, the Couple Bead Method relies on a new …

The Influence Of Contraception, Abortion, And Natural Family Planning On Divorce Rates As Found In The 2006–2010 National Survey Of Family Growth, Richard Jerome Fehring

College of Nursing Faculty Research and Publications

The purpose of this study was to determine the influence of contraception, abortion, and natural family planning (NFP) on divorce rates of US women of reproductive age. The variables of importance of religion and frequency of church attendance were also included in the analysis. The study involved 5,530 reproductive age women in the (2006–2010) National Survey of Family Growth who indicate that they were ever married. Among the women who ever used NFP only 9.6 percent were currently divorced compared with the 14.4 percent who were currently divorced among the women who never used NFP (x² = 5.34, …

Comparison Of Abstinence And Coital Frequency Between 2 Natural Methods Of Family Planning, Richard J. Fehring, Mary Schneider

College of Nursing Faculty Research and Publications

Introduction

The length of periodic abstinence, due to overestimation of the fertile phase of the menstrual cycle, is often a cause for dissatisfaction, discontinuation, and user error with natural family planning (NFP) methods. The objective of this research was to compare the length of required abstinence (ie, estimated fertility) and coital frequency between 2 NFP methods.

Methods

This was an analysis of data from a 12-month prospective comparison study in which participants were randomized into either an electronic hormonal fertility monitor (EHFM) group or a cervical mucus monitoring (CMM) group—both of which included a fertility algorithm as a double check …

Cohort Efficacy Study Of Natural Family Planning Among Perimenopause Age Women, Richard Fehring, Qiyan Mu

College of Nursing Faculty Research and Publications

Objective: To determine the efficacy of using natural family planning (NFP) methods to avoid unintended pregnancy among women of perimenopause age (i.e., age 40-55 years).

Design: A secondary analysis of subset data from two prospective observational cohort studies.

Setting: A university based in-person and online NFP service program.

Participants: One hundred and sixty couples who used either a website or an in-person NFP service to learn how to avoid pregnancy from January 2001 to November 2012.

Methods: A prospective 12-month effectiveness study among 160 women (between ages 40-55) who used NFP to avoid pregnancy. The …

Use Of Urinary Pregnanediol 3-Glucuronide To Confirm Ovulation, R. Ecochard, R. Leiva, Thomas Bouchard, H. Boehringer, A. Direito, A. Mariani, Richard Fehring

College of Nursing Faculty Research and Publications

Objective

Urinary hormonal markers may assist in increasing the efficacy of Fertility Awareness Based Methods (FABM). This study uses urinary pregnanediol-3a-glucuronide (PDG) testing to more accurately identify the infertile phase of the menstrual cycle in the setting of FABM.

Methods

Secondary analysis of an observational and simulation study, multicentre, European study. The study includes 107 women and tracks daily first morning urine (FMU), observed the changes in cervical mucus discharge, and ultrasonography to identify the day of ovulation over 326 menstrual cycles. The following three scenarios were tested: (A) use of the daily pregnandiol-3a-glucuronide (PDG) test alone; (B) use of …

Spiritual Care Of Couples Practicing Natural Family Planning, Richard Fehring, Dana Rodriguez

College of Nursing Faculty Research and Publications

There are few studies that have investigated the spiritual problems of couples practicing natural family planning (NFP). The purpose of this paper is to analyze the spiritual problems and interventions of couples who were taught NFP by means of a professional online Web-based support system. Responses from this online system and its forums were categorized according to spiritual responses, spiritual problems, and spiritual interventions to the practice of NFP. Themes addressed included spiritual care in regards to decisions about the transmission of new life, difficulties in dealing with chastity and abstinence, bioethical problems related to pregnancy and illness, end of …

Randomized Comparison Of Two Internet-Supported Fertility Awareness Based Methods Of Family Planning, Richard J. Fehring, Mary Schneider, Kathleen Raviele, Dana Rodriguez, Jessica E. Pruszynski

Randomized Comparison of Two Internet-Supported Methods of Natural Family Planning

Background: The aim was to compare the efficacy and acceptability of two Internet-supported fertility-awareness-based methods of family planning.

Study design: Six hundred and sixty-seven women and their male partners were randomized into either an electronic hormonal fertility monitor (EHFM) group or a cervical mucus monitoring (CMM) group. Both groups utilized a Web site with instructions, charts and support. Acceptability was assessed online at 1, 3 and 6 months. Pregnancy rates were determined by survival analysis.

Results: The EHFM participants (N=197) had a total pregnancy rate of 7 per 100 users over 12 months of use compared with 18.5 for the …

Randomized Comparison Of Two Internet-Supported Fertility Awareness Based Methods Of Family Planning, Richard J. Fehring, Mary Schneider, Kathleen Raviele, Dana Rodriguez, Jessica E. Pruszynski

College of Nursing Faculty Research and Publications

Background

The aim was to compare the efficacy and acceptability of two Internet-supported fertility-awareness-based methods of family planning.

Study design

Six hundred and sixty-seven women and their male partners were randomized into either an electronic hormonal fertility monitor (EHFM) group or a cervical mucus monitoring (CMM) group. Both groups utilized a Web site with instructions, charts and support. Acceptability was assessed online at 1, 3 and 6 months. Pregnancy rates were determined by survival analysis.

Results

The EHFM participants (N= 197) had a total pregnancy rate of 7 per 100 users over 12 months of use compared with …

Pilot Evaluation Of An Internet-Based Natural Family Planning Education And Service Program, Richard Jerome Fehring, Mary Schneider, Kathleen Raviele

College of Nursing Faculty Research and Publications

Objective: To evaluate the efficacy, knowledge of fertility, and acceptability of a web-based natural family planning (NFP) education and service program.

Design: A 6-month repeated measure longitudinal evaluation pilot study.

Setting: A university based online website.

Participants: The website was piloted with 468 volunteer women seeking NFP services. Of these participants, 222 used the automatic online fertility charting system to avoid pregnancy. The 222 charting participants had a mean age of 29.9 years (SD=5.6), 2.2 children (SD=1.9), 37% were postpartum, and 47% had regular menstrual cycle lengths.

Intervention: Nurse-managed web-based NFP education and service program.

Outcomes: …

Efficacy Of The Marquette Method Of Natural Family Planning, Richard Fehring, Mary Schneider, Mary Lee Barron

College of Nursing Faculty Research and Publications

Purpose: To determine the effectiveness of the Marquette Method (MM) of natural family planning (NFP) as a method of avoiding pregnancy.

Study Design and Methods: This was a 12-month retrospective evaluation of the MM system of NFP. Two hundred and four women (mean age, 28.6 years) and their male partners (mean age, 30.3 years) who sought to learn a method for avoiding pregnancy with the MM from four clinical sites were taught to track their fertility by self-observation of cervical mucus, by use of an electronic monitor that measures urinary levels of estrone-3-glucuronide and luteinizing hormone, and by use of …

Efficacy Of Cervical Mucus Observations Plus Electronic Hormonal Fertility Monitoring As A Method Of Natural Family Planning, Richard Fehring, Mary Schneider, Kathleen Raviele, Mary L. Barron

College of Nursing Faculty Research and Publications

Objective: To determine the effectiveness of an electronic hormonal fertility monitor plus cervical mucus monitoring to avoid pregnancy. Design: A 12-month prospective clinical efficacy trial. Setting and Participants: One hundred ninety five (195) women (mean age 29.8 years) seeking to avoid pregnancy with a natural method at 5 clinical sites in 4 cities. Intervention: Each participant was taught to track fertility by self-observation of cervical mucus and an electronic monitor that measures urinary levels of estrone-3-glucuronide and luteinizing hormone. Main Outcome Measures: Correct-and typical-use unintended pregnancy rates. Results: There were a total of 26 unintended pregnancies, 3 with correct use. …

New Low- And High-Tech Calendar Methods Of Family Planning, Richard Fehring

College of Nursing Faculty Research and Publications

Calendar-based methods are not usually considered effective or useful methods of family planning among health professionals. However, new “high-” and “low”-tech calendar methods have been developed, which are easy to teach, to use, and may be useful in helping couples avoid pregnancy. The low-tech models are based on a fixed-day calendar system. The high-tech models are based on monitoring urinary metabolites of female reproductive hormones. Both systems have high levels of satisfaction. This article describes these new models of family planning and the research on their effectiveness. The author proposes a new algorithm for determining the fertile phase of the …

The Future Of Professional Education In Natural Family Planning, Richard Fehring

College of Nursing Faculty Research and Publications

Nurses and other health care professionals often have little knowledge of methods of natural family planning (NFP) and do not readily prescribe natural methods for their patients. One reason for this is that little or no information on NFP is provided in nursing or medical schools. The holistic, informational, and integrative nature of NFP fits well with professional nursing practice. A university online distance education NFP teacher training program, which offers academic credit and includes theory, practice, and the latest developments in fertility monitoring, has been developed for health care professionals. Professional NFP services in the United States need to …

A Comparison Of The Fertile Phase As Determined By The Clearplan Easy Fertility Monitor™ And Self-Assessment Of Cervical Mucus, Richard Fehring, Kathleen Raviele, Mary Schneider

College of Nursing Faculty Research and Publications

The purpose of this study was to compare the fertile phase of the menstrual cycle as determined by the Clearplan Easy Fertility Monitor (CPEFM) with self-monitoring of cervical mucus. One-hundred women (mean age = 29.4 years) observed their cervical mucus and monitored their urine for estrogen and luteinizing hormone metabolites with the CPEFM on a daily basis for 2–6 cycles and generated 378 cycles of data; of these, 347 (92%) had a CPEFM peak. The beginning of the fertile window was, on average, day 11.8 (SD = 3.4) by the monitor and day 9.9 (SD = 3.0) by cervical mucus …

Accuracy Of The Peak Day Of Cervical Mucus As A Biological Marker Of Fertility, Richard Fehring

College of Nursing Faculty Research and Publications

The (PD) peak day of cervical mucus is an important biologic marker for the self-determination of the optimal time of fertility in a woman’s menstrual cycle. The purpose of this article is to provide evidence (literature and empiric) for the accuracy of the PD of cervical mucus as a biologic marker of peak fertility and the estimated day of ovulation. An analysis of data from four published studies that compared the self-determination of the PD of cervical mucus with the urinary luteinizing hormone (LH) surge was conducted. The four studies yielded 108 menstrual cycle charts from 53 women participants. The …