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Dr Tatjana Gibbons leads study that suggests a woman's chance of conceiving is improved by using urine tests to detect the optimum time for intercourse, but further research is still needed to assess whether timed intercourse via any ovulation detection method creates a difference in live births and pregnancy rates.

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MSc by research student Tatjana Gibbons from the Nuffield Department of Women's & Reproductive Health presented findings on ovulation detection methods at the 38th Annual Meeting of The European Society of Human Reproduction and Embryology (ESHRE) in Milan last week. 

An updated Cochrane review suggests urine tests can improve pregnancy chances, but definitive conclusions could not be reached on other home-based or clinic-based ovulation detection methods because of insufficient evidence. These include fertility awareness-based methods (FABM) which are used in the majority of menstrual cycle apps for women trying to conceive. FABM include using calendar predictions, identifying changes in cervical mucus or even changes in body temperature with body-worn devices fitted with biosensors to detect when ovulation is most likely. 

Tatjana Gibbons - MRes Student‘This update suggests a benefit of timed intercourse using urinary ovulation detection. However, more evidence is needed on the adverse effects of timed intercourse and its effectiveness in different groups - such as those with unexplained infertility – before clinicians are able to promote this practice. Future studies should also assess the use of FABM for couples trying to conceive.’

Timed intercourse may be more widely practised because of a surge in the availability of health apps, including ovulation detection methods. These predict the days in a woman’s menstrual cycle when the ovary is most likely to release an egg.

For this Cochrane analysis the researchers assessed the effectiveness of timed intercourse assisted by ovulation detection methods such as digital apps linked to urine monitors, urine ovulation tests which measure fertility hormones, and FABM.

The attempted aim was also to look at the impact of timed intercourse on live birth rates, pregnancy rates, time to pregnancy and quality of life. The purpose was also to investigate any links between timed intercourse and adverse events, including stress which may be caused by the lack of spontaneity and pressure of sexual performance.

Data were used from six studies involving 2,374 women in total who were attempting to conceive naturally.

Overall, results showed that timed intercourse using urinary ovulation detection was associated with higher rates of pregnancy than in couples who were not timing intercourse specifically around the fertile window.

The authors assessed the chance of pregnancy via timed intercourse as between 20% to 28% compared with 18% for spontaneous intercourse.

However, the findings were inconclusive as to whether timed intercourse using FABM resulted in a difference in live birth or pregnancy rates. Data were only available from two studies involving a total of 160 women and the evidence was low grade.

For couples using ovulation detection, a clear benefit was demonstrated in couples who had been trying to conceive for less than 12 months but there was insufficient evidence to detect a difference in subfertile couples (over 12 months). Moving forward, it was concluded that more evidence is needed across all types of fertility awareness-based methods to help inform women who are trying to maximise their chances to get pregnant.