Clinical question
How effective and safe are ovulation prediction methods for timing intercourse for conception in couples trying to conceive?
Bottom line
There was moderate-quality evidence that timed intercourse using urine ovulation prediction increased the chances of live birth and pregnancy (clinical pregnancy or positive urine pregnancy test), compared with intercourse without ovulation prediction. It is uncertain whether timed intercourse using urine ovulation prediction resulted in a difference in stress or quality of life (very-low-quality evidence).
Due to insufficient evidence, it is uncertain whether timed intercourse using fertility awareness-based methods (FABM) resulted in a difference in pregnancy outcomes, adverse effects or quality of life.
No studies assessed the use of timed intercourse with pelvic ultrasonography.
Caveat
The evidence obtained from the included studies consisted of a mainly fertile cohort. For example, when assessing pregnancy rate, 93% of couples in the urine ovulation prediction studies and 94% of couples in the FABM studies were classified as fertile. Moreover, 6 of the 7 studies only included women under age 40. Therefore, this review’s results cannot be extrapolated to an infertile population or those over age 40.
There is also potential for bias, given that many of the studies were funded by the manufacturer of the ovulation prediction device.
Context
Many factors influence fertility, one being the timing of intercourse. The “fertile window” describes a stage in the cycle when conception can occur – approximately 5 days before, to several hours after, ovulation. Timed intercourse is the practice of prospectively identifying ovulation and, thus, the fertile window to increase the likelihood of conception.
Methods of predicting ovulation include urinary hormone measurement (luteinising hormone and oestrogen), FABM (including tracking basal body temperatures, monitoring cervical mucus, and use of calendar charting or tracking apps) and ultrasonography. There has been a surge in the use of fertility apps in recent years, the majority of which use FABM alone.
Cochrane Systematic Review
Gibbons T, et al. Timed intercourse for couples trying to conceive. Cochrane Database Syst Rev 2023;9:CD011345. This review contains 7 trials with a total of 2464 participants.
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