Algorithms with Area under the Curve for Daily Urinary Estrone-3-Glucuronide and Pregnanediol-3-Glucuronide to Signal the Transition to the Luteal Phase

Background and Objectives: Home fertility assessment methods (FAMs) for natural family planning (NFP) have technically evolved with the objective metrics of urinary luteinizing hormone (LH), estrone-3-glucuronide (E3G) and pregnanediol-3-glucuronide (PDG). Practical and reliable algorithms for timing the phase of cycle based upon E3G and PDG levels are mostly unpublished and still lacking. Materials and Methods: A novel formulation to signal the transition to the luteal phase was discovered, tested, and developed with a data set of daily E3G and PDG levels from 25 women, 78 cycles, indexed to putative ovulation (day after the urinary LH surge), Day 0. The algorithm is based upon a daily relative progressive change in the ratio, E3G-AUC/PDG-AUC, where E3G-AUC and PDG-AUC are the area under the curve for E3G and PDG, respectively. To improve accuracy the algorithm incorporated a three-fold cycle-specific increase of PDG. Results: An extended negative change in E3G-AUC/PDG-AUC of at least nine consecutive days provided a strong signal for timing the luteal phase. The algorithm correctly identified the luteal transition interval in 78/78 cycles and predicted the start day of the safe period as: Day + 2 in 10/78 cycles, Day + 3 in 21/78 cycles, Day + 4 in 28/78 cycles, Day + 5 in 15/78 cycles, and Day + 6 in 4/78 cycles. The mean number of safe luteal days with this algorithm was 10.3 ± 1.3 (SD). Conclusions: An algorithm based upon the ratio of the area under the curve for daily E3G and PDG levels along with a relative PDG increase offers another approach to time the phase of cycle. This may have applications for NFP/FAMs and clinical evaluation of ovarian function.

To Evaluate Knowledge, Attitude, Practice of Natural Family Planning Method and Associated Factors among Reproductive Age Group of Women’s at Jimma Town, Jimma Zone, South West Ethiopia

Background: The high fertility rate leading to the rapid growth of country’s population is a major hindrance towards the development of a nation. Sub-Saharan Africa has the highest fertility rate in the world, which is further promoted by the low utilization of contraceptive methods. Yet, many communities claim to have natural methods of family planning that pre-date the introduction of modern contraceptives, implying that contraception is a culturally acceptable norm. Objective: To Evaluate the Knowledge, Attitude and Practice towards Natural family planning among reproductive age women of Jimma town, Oromia, Ethiopia. Methods: Across sectional community based quantitative study was done in Jimma town, among reproductive age group women from February to March; 2020. A total of3 99 sample size is calculated using single population proportion formula with a proportion (P) of 50 %.Systematic random sampling technique issued to draw the study participants among the target population. The data was collected using structured questionnaire adapted from similar and the tools modified to fit the local context. The collected data was tallied and analyzed by using scientific calculator. Results: From the total of 399 respondents who responded the questionnaire Majority, 90% of women in Jimma town had a good level of knowledge of natural family planning methods. A positive attitude towards natural family planning methods was seen in (68%) of the respondents. Conclusion: A fair level of knowledge of natural family planning methods is seen among reproductive women in Jimma town, yet differences in knowledge of specific natural family planning methods exist. Therefore, physicians and other health care providers‟ limited knowledge of and experience with Natural family planning methods inhibits broader use as reproductive age women reported getting information about NFFP methods from health providers and friends, therefore, their level of knowledge will depend largely on the information received.

The Fertility Indicator Equation Using Serum Progesterone and Urinary Pregnanediol-3-Glucuronide for Assessment of Ovulatory to Luteal Phase Transition

Background and Objectives: The Fertility Indicator Equation (FIE) has been shown to signal the fertile phase during the ovulatory menstrual cycle. It was hypothesized that this formulation, a product of two sequential normalized changes with a sign indicating direction of change, could be used to identify the transition from ovulatory to luteal phase with daily serum progesterone (P) and urinary pregnanediol-3-glucuronide (PDG) levels. Materials and Methods: Day-specific serum P levels from two different laboratories and day-specific urinary PDG levels from an additional two different laboratories were submitted for FIE analysis. These day-specific levels included mean or median, 5th, 10th, 90th and 95th percentile data. They were indexed to the day of ovulation, day 0, by ultrasonography, serum or urinary luteinizing hormone (LH). Results: All data sets showed a clear “cluster”—a periovulatory sequence of positive FIE values with a maximum. All clusters of +FIE signaled the transition from the ovulatory to luteal phase and were at least four days in length. The start day for the serum P and urinary PDG FIE clusters ranged from −3 to −1 and −3 to +2, respectively. The end day for serum P and PDG clusters went from +2 to +7 and +4 to +8, respectively. Outside these periovulatory FIE-P and FIE-PDG clusters, there were no consecutive positive FIE values. In addition, the maximum FIE-P and FIE-PDG values throughout the entire cycles were found in the clusters. Conclusions: FIE analysis with either daily serum P or urinary PDG levels provided a distinctive signature to recognize the periovulatory interval. The Fertility Indicator Equation served to robustly signal the transition from the ovulatory phase to the luteal phase. This may have applications in natural family planning especially with the recent emergence of home PDG tests.

The Role of Information Technologies in Natural Family Planning

Freedom is needed in family planning and in the decision on how many children the couple will have, not to be influenced by a third person, political situations, or religious conviction. There is a need for information, education, and communication about possibilities in natural family planning, in order to be able to choose the right way, because there are many options even without side effects. Nowadays, we can add to these traditional possibilities of natural family planning also information technologies and electronic devices, which are increasingly available to a large portion of the population. Their reliability, with correct usage, is comparable to the barrier methods and in some cases to hormonal contraceptive methods. Next development of these devices can more increase their reliability. Of course, the active approach of users is needed.

Premarital Education in the Catholic Church: Exploring Retrospective Perceptions of Effectiveness of a Theologically Oriented Program on Relational and Spiritual Outcomes

The effectiveness of a theology-focused marriage preparation program was tested for a group of Catholic couples (N=200). Each couple had been married for less than five years and participated in the same program. The program covered a variety of topics from communication enhancement to a Catholic theology of marriage, including marriage as a vocation and natural family planning. The study assessed the retrospective perceptions of change for relational and spiritual behaviors and attitudes, in light of these theological and relationship teachings. Couples reported increases in positive thinking about the relationship, deeper understanding of marriage as a vocation, and improved communication. However, the program produced less change in Mass attendance, and NFP practice. Results were moderated by cohabitation history, support of mentor couples and length of marriage. Views of marriage in terms of vocation and increased knowledge of NFP were indirectly linked to higher relationship satisfaction via improved communication.

Multisite Effectiveness Study of the Marquette Method of Natural Family Planning Program

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 pregnancy rates for a total of 1,221 women. There were forty-two unintended pregnancies which provided a typical use unintended pregnancy rate of 6.7 per 100 women over twelve months of use. Eleven of the forty-two unintended pregnancies were associated with correct use of the method. The total unintended pregnancy rate over twelve months of use was 2.8 per 100 for women with regular cycles, 8.0 per 100 women for the postpartum and breastfeeding women, and 4.3 per 100 for women with irregular menstrual cycles. The Marquette Model system of NFP was effective when provided by health professionals who completed the Marquette Model NFP teacher training program. Summary: This study involved determining whether healthcare professionals at ten sites across the United States and Canada trained to provide the Marquette Method NFP services can replicate the effectiveness demonstrated in previous studies of the method. We found a high level of effectiveness (i.e., very low pregnancy rates) in using the Marquette Method among women from various regions across North America with diverse reproductive backgrounds and in particular when using hormonal fertility marker. Healthcare providers who have been trained to teach NFP can successfully incorporate NFP services in their practice and assist their clients in choosing appropriate family planning methods.

Initiation of Postpartum Contraception by 90 Days at a Midwest Academic Center

Introduction. Contraception is a critical component of addressing the health needs of women in the postpartum period. We assessed contraception initiation by 90 days postpartum at a large, academic medical center in the Midwest. Methods. In this retrospective cohort study, 299 charts were randomly sampled and 231 were analyzed from deliveries between May 1 to July 5, 2018. Contraceptive method, maternal demographics, and obstetric characteristics at hospital discharge were collected, as well as contraceptive method at the postpartum follow-up appointment. Methods and strata of contraception were categorized as follows: 1) highly effective methods (HEM) defined as sterilization, intrauterine device, or implant, 2) moderately effective methods (MEM) defined as injectable contraception, progestin-only pills, and combined estrogen/progestin pills, patches, and rings, and 3) less effective methods (LEM) defined as condoms, natural family planning, and lactational amenorrhea. Women lost to follow-up who had initiated a HEM or injectable contraception were coded as still using the method at 90 days. We used logistic regression to identity factors associated with HEM use. Results. Of the 231 included patients, 118 (51%) received contraception before hospital discharge and 166 (83%) by 90 days postpartum. Postpartum visits were attended by 74% (171/231) of patients. Before hospital discharge, 28% (65/231) obtained a HEM and 41% (82/200) were using a HEM by 90 days postpartum. Patients obtaining HEM or injectable contraception before hospital discharge attended a follow-up visit less often than those who did not receive HEM before discharge (RR = 0.68, 95% CI: 0.54 - 0.86, p ≤ 0.01). Conclusion. When readily available, many women will initiate contraception in the postpartum period. Health systems should work to ensure comprehensive access to contraception for women in the postpartum period.

Awareness of the Multi-para Mothers on Family Planning Methods

Awareness of the Multi-para Mothers onFamily Planning MethodsJessica Athena S. VillaflorMauro Allan P. AmparadoAbstractObjectives: The study determined the awareness of the multi-para mothers on natural and artificial methods of family planning at Village Basak San Nicolas, Cebu City, Cebu, Philippines. The findings of the study served as basis for a proposed enhanced family planning education manual.Specifically, the study answered the following queries:1.What is the profile of the multi-para mothers as to:1.1.age; 1.2.educational attainment; 1.3.number of children; and1.4.monthly income?2.What is the level of awareness of the multi-para mothers on natural family planning methods in the aspects of:2.1.Lactational Amenorrhea method; 2.2.cervical mucus; 2.3.coitus interruptus;2.4.abstinence; and2.5.rhythm method?3.What is the level of awareness of the multi-para mothers on artificial family planning methods in the aspects of:3.1.intrauterine device;3.2.condom;3.3.bilateral tubal ligation;3.4.pills; and 3.5.Depo-medroxyprogesterone Acetate?4.Is there a significant relationship between the level of awareness on natural family planning methods and their:4.1.age;4.2.educational attainment;4.3.number of children; and4.4.monthly income?5.Is there a significant relationship between the level of awareness on artificial family planning methods and their:5.1.age;5.2.educational attainment;5.3.number of children; and5.4.monthly income?6.What enhanced family planning education manual can be proposed based on the findings of the study?7.What client service seminar can be proposed based on the findings of the study?Methods:The descriptive-correlational design was utilized as research design. The study was conducted in Village Basak San Nicolas, Cebu City, Cebu, Philippines. The respondents of the study were 371 multi-para mothers with two or more children. The study used a researcher-made instrument. Treatment of data used were simple percentage, weighted mean, and chi-square Test of Independence.Findings and Conclusion:Majority of the multi-para mothers belong to the 30-49 years old, high school graduates, with 2-4 children, and monthly income below 10,000 Philippine pesos. They were less aware on Lactational Amenorrhea method, Cervical Mucus, Coitus Interruptus, abstinence, and Rhythm method. They were moderately aware on IUD, condom, bilateral tubal ligation, pills, and Depo-medroxyprogesterone acetate. In general, they were less aware on natural family planning methods and moderately aware on artificial family planning methods.There were significant relationships between the level of awareness on the natural family planning methods and: age, educational attainment, number of children, and monthly income. In addition, there were significant relationships between the level of awareness on artificial planning methods and: educational attainment, number of children, and monthly income. Recommended citation:Villaflor, J. A. S. & Amparado, M. A. P. (2009, March). Awareness of the Multi-para Mothers on Family Planning Methods. 2009 Southwestern University Research Congress, 1(1), 26-28.