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Creighton-Model NaProEducation Technology for avoiding pregnancy

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To evaluate the use effectiveness of Creighton Model (CrM) NaProEducation Technology for avoiding pregnancy. CrM is a medical model of natural procreation education that is a fully standardized modification of the Billings ovulation method. This system has been used as a means to avoid pregnancy and has been prospectively evaluated in five use effectiveness studies. A prospective life-table analysis of the five studies (meta-analysis) was undertaken, yielding both net and gross rates. Discontinuation rates were also calculated. These studies were conducted at CrM centers in Omaha, St. Louis, Wichita, Houston, and Milwaukee. A total of 1,876 couples used CrM NET for a total of 17,130.0 couple months of use. The method and use effectiveness rates for avoiding pregnancy were 99.5 and 96.8 at the 12th ordinal month and 99.5 and 96.4 at the 18th ordinal month, respectively. The discontinuation rate was 11.3% at the 12th ordinal month and 12.1% at the 18th ordinal month. CrM is highly effective as a means of avoiding pregnancy in both its method and use effectiveness. The method effectiveness has remained stable over the years of the studies, but the use effectiveness for avoiding pregnancy appears to have improved over the study period.
... Various mucus-only FAMs have demonstrated high perfect-use contraception rates:  Billings Ovulation Method ® : 96.6%-98.9% (Bhargava et al. 1996, Trussell andGrummer-Strawn 1991),  Creighton Model System (CrMS) of FertilityCare 99.5% effective (Hilgers and Stanford 1998). ...
... Although RCTs would improve the evidence base (Grimes et al. 2004), they may be problematic in this arena given pragmatic and ethical issues including recruitment methods, FAM instruction, and pregnancy intention of the couple. Effectiveness of the various FAMs for avoiding pregnancy has been reviewed for individual methods (Fehring, Schneider, and Barron 2008, Hilgers and Stanford 1998, The European Natural Family Planning Study Groups 1999 as well as in comparison with one another (Manhart et al. 2013, Peragallo Urrutia et al. 2018, Grimes et al. 2004). ...
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Alzheimer`s disease (AD) is the most common and incurable form of dementia. The present AD treatments produce only an uncertain amelioration of symptoms. Research on AD has particularly focused on the central nervous system. Though, some systemic and peripheral abnormalities are now clearly understood that are associated to AD. Current research on these alterations that leads to AD are becoming further defined more evidently. Two microscopic features contribute for the depiction of the disease, the amyloid plaques and neurofibrillary tangles. All these aspects are accountable for the deliberate and gradual weakening of memory that disturb the cognitive control, language, thinking and personality. For the diagnosis of AD, some neuropsychological tests are being performed in various spheres of cognitive functions. To date, cholinesterase inhibitors are used as a drug for the treatment of AD, because these are the individual drugs that have depicted substantial enhancements in the cognitive functions of AD patients. Despite the efficacy of cholinesterase inhibitors, the degeneration of neurons is continuing even while being treated an AD patient. For this cause, further biochemical pathways related to pathophysiology of AD have been revealed as an alternative for the treatment of these conditions such as hindrance of glycogen synthase kinase-3β and β-secretase. The present chapter aims to conduct a review of the pathophysiology, symptoms, epidemiology, analysis and treatment of AD.
... Accurate recording of ovulation provides insights into other health-related matters. This may include undertaking selective intercourse for achieving or avoiding pregnancy, identifying vaginal and cervical inflammatory conditions and characterising ovulatory disorders such as polycystic ovary syndrome (PCOS) [18][19][20]. ...
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To determine the relationships between luteal-phase steroidal hormonal profile and PMS for a large number of women attending a dedicated fertility clinic. This was a retrospective cross-sectional study on women attending a hospital-based clinic for fertility concerns and/or recurrent miscarriage. All participants were assessed with a women’s health questionnaire which also included evaluation of premenstrual symptoms. Day of ovulation was identified based on the peak mucus symptom assessed by the woman after instruction in a fertility awareness-based method (FABM). This enabled reliable timing of luteal-phase serum hormone levels to be taken and analysed. Between 2011 and 2021, 894 of the 2666 women undertaking the women’s health assessment had at least one evaluable serum luteal hormone test. Serum progesterone levels were up to 10 nmol/L lower for symptomatic women compared with asymptomatic women. This difference was statistically significant ( p < 0.05) for the majority of PMS symptoms at ≥ 9 days after the peak mucus symptom. A similar trend was observed for oestradiol but differences were generally not statistically significant. ROC curves demonstrated that steroid levels during the luteal phase were not discriminating in identifying the presence of PMS symptoms. Blood levels for progesterone were lower throughout the luteal phase in women with PMS, with the greatest effect seen late in the luteal phase.
... This means that medical students have heard about NFP methods but probably know little about them and are unlikely to use them in practice. Meanwhile, it is known that modern NFP methods may have a high success rate in avoiding conception; for example: The Billings Method in correct use has a PI of 1.1 and in typical use a PI of 10.5 (Duane et al. 2022), the Creighton Model System has a PI of 0.5 (Hilgers, Stanford, 1998), and multi-iIndex -symptothermal methods have a PI of 0.4 with correct use and a PI of 1.8 with typical use (Frank-Herrmann, et al. 2007). The female respondents tend to be slightly more familiar with NFP methods than the men, for example the Billings Method was known by 44% of the women and by 35% of the men. ...
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Fertility Awareness-based Methods (FAMs) observe physiological signs to determine fertile and infertile phases in a women's cycle. WHO recommends to use both natural family planning (NFP) or FAM as a synonym. They may serve as methods for family planning as well as a procreation health monitor in restorative medicine and as a useful biomarker in management of reproductive-health disorders. Unfortunately, this knowledge is marginalized during medical education. A cross-sectional study was performed among 542 Polish medical students to assess their skills in NFP. The most common NFP method indicated by 84.9% students was the Calendar Method, the one with historical value. The Billings Method and Creighton Model System were known by 42% and 14% participants respectively, while Multi Index Methods were known by 26.4%. A total of 6% of the respondents use NFP themselves. The largest group of students (42%) assessed the effectiveness of NFP in avoiding pregnancy at about 50%. The results show little interest and incomplete knowledge in up to date NFP among future medical professionals. It seems there is an urgent need to introduce this subject into medical education as a valuable tool to understand and monitor procreation health as well as family planning method.
... com. In this case she began recording her cycle with the Creighton model FertilityCare System [9,10]. See the data summary and Fig. 2 ...
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Background Restorative reproductive medicine represents a comprehensive approach to subfertility (infertility and miscarriage) with investigations, diagnoses, and treatments combined with fertility charting to restore optimal reproductive function. Restorative reproductive medicine assumes that multiple factors need to be identified and treated (cycle optimization) for up to 12 cycles to achieve a successful pregnancy. Conception can occur during normal intercourse without intrauterine insemination or in vitro fertilization. Case presentation A 35-year-old Croatian female presented for fertility treatment in May 2019 with a previous diagnosis of polycystic ovaries, infertility of 16 years duration, and 8 unsuccessful embryo transfers with in vitro fertilization and intracytoplasmic sperm injection. She was gravida 3 para 0, with 2 miscarriages after spontaneous conception at 5–6 weeks gestation in 2002 and 2004, followed by a miscarriage after in vitro fertilization at 12 weeks gestation in 2011. We initially found poor follicle function and suboptimal progesterone levels. Restorative reproductive medicine treatment resulted in conception after two cycles of treatment. This pregnancy ended in miscarriage at 7 weeks 4 days. Additional investigations found a balanced Robertsonian translocation (13, 14) and a uterine septum. We achieved repeat fertilization with restorative reproductive medicine after three cycles of treatment following resection of the uterine septum and ovulation induction with letrozole and human chorionic gonadotrophin. She had a full-term healthy pregnancy and live birth in 2021. Conclusion We propose that a full evaluation of underlying factors, and up to 12 cycles of cycle optimization, should be offered to subfertile patients before considering in vitro fertilization treatment.
... Serum levels of the reproductive hormones, LH, estradiol, and P have been used for decades to study fertility and treat infertility [21,22]. With the development of urinary LH, and later, urinary estrone-3-glucuronide home kits, hormonal diagnostic adjuncts became available to incorporate more traditional NFP methods [23][24][25][26][27][28][29][30]. Such advances in what is now called Fertility Assessment-Based Methods(FAMs) more recently include test strips for urinary PDG, which are based upon a threshold signal of 5-7 µg/mL (15.6-21.8 ...
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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 majority of fertility awareness/natural family planning (NFP) methods encompass subjective observations of cervical mucus/cervical-vaginal fluid (CVF) [1][2][3]. The physical properties of cervical mucus/CVF that lend themselves to female self-observation can be even more accurate in assessing the fertile time than timing relative to the point of ovulation [4]. ...
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: To evaluate the cervical-vaginal mucin, CA125, as a measure of fertility and possible method for natural family planning (NFP). Cervical-vaginal fluid (CVF) swab samples have been previously used to measure CA125, ‘Qvaginal CA125 levels’, as a function of time of cycle relative to Day 0, the first day of positive urine LH (luteinizing hormone). Data from 15 women, 20 cycles were used with an algorithm to establish the Fertile Start Day (FSD) for the cycles. The FSD was determined as either the second consecutive day of ≥20% Qvaginal CA125 rise or the first day of ≥400% rise. The interval, (FSD to Day +3), was used as the theoretical window of fertility, and conception rates assuming abstinence during this predicted period of fertility were computed using published day-specific probabilities of conception (PoC). The mean FSD was Day −4.8 ± 0.5 (SE), 95% CI (−5.9, −3.7). The estimated pregnancy failure rate (PFR) with abstinence during [FSD, +3] was 10.7% ± 2.0% (SE), 95% CI (6.9%, 14.8%); with exclusion of one cycle with very low levels of Qvaginal CA125, the estimated PFR was 9.8% ± 1.9%, 95% CI (6.3%, 13.8%). Furthermore, the day-specific Qvaginal CA125 values were normalized to the respective peak Qvaginal CA125 for each cycle, and a mean normalized day-specific Qvaginal CA125 plot was generated. The first derivative of the mean normalized day-specific Qvaginal CA125 plot showed a significant increase between Day -4.5 and Day -3.5, which correlated with the mean FSD. A Qvaginal CA125-based method holds promise as a means to identify the start of the fertile window and may prove useful in NFP, especially when combined with available home hormonal fertility awareness kits.
Article
Objectives To summarize the evidence on typical and perfect-use effectiveness of fertility awareness-based methods for avoiding pregnancy during the postpartum period, whether breastfeeding or not. Study design We conducted a systematic review of studies published in English, Spanish, French, or German by November 2021 in MEDLINE, EMBASE, CINAHL, Web of Science, and ClinicalTrials.gov. Abstract and full text reviews were completed by 2 independent reviewers. Study inclusion: at least 50 subjects who enrolled prior to experiencing 3 cycles after childbirth and were using a specific fertility awareness-based method to avoid pregnancy; unintended pregnancy rate or probability calculated; postpartum amenorrheic and postpartum cycling individuals analyzed separately; and prospectively measured pregnancy intentions and outcomes. Outcomes were abstracted and study quality was systematically assessed by 2 independent investigators. Results Four studies provided effectiveness data for 1 specific fertility awareness-based method among postpartum individuals. Of these, there were zero high quality, 1 moderate quality, and 3 low quality for our question of interest. Typical-use pregnancy probability for the first 6 cycles postpartum for Marquette Method users was 12.0 per 100 women years (standard error [SE] not reported) and for Billings Ovulation Method users ranged from 9.1 (SE 3.9) for non-lactating women <30 years old to 26.8 (SE 4.6) for lactating women <30 years old. Typical-use pregnancy probabilities for the first 6 months post-first menses for the Postpartum Bridge to Standard Days Method users was 11.8 (95% confidence interval 6.01-17.16) and for Billings Ovulation Method users was 8.5 per 100 women (SE 1.7). Conclusion The current evidence on the effectiveness of each fertility awareness-based method for postpartum persons is very limited and of mostly low quality. More high quality studies on the effectiveness of fertility awareness-based method in postpartum persons are needed to inform clinical counseling and patient-centered decision-making. Implications Although postpartum individuals may desire to use fertility awareness-based methods to avoid pregnancy, the evidence of the effectiveness of fertility awareness-based methods in this population is limited. More high-quality studies are needed to inform shared decision-making.
Article
Aim: Simplified contraceptive method-efficacy and/or typical-use effectiveness rates are commonly used for direct comparison of the various contraceptive methods. Use of such effectiveness rates in this manner is, however, problematic in relation to the fertility awareness methods (FAMs). The aim of this review is to critically examine current international representation of contraceptive effectiveness for the various FAMs in clinical use. This review also details important issues when appraising and interpreting studies on FAMs used for avoiding pregnancy. Methods: Current international literature regarding contraceptive effectiveness of FAMs was surveyed and appraised. This included World Health Organization and Centers for Disease Control (USA) resources, key clinical studies and recent systematic reviews. Chinese literature was also searched, since these data have not been reported in the English literature. Results: Reliance on certain historical studies has led to the misrepresentation of contraceptive effectiveness of FAMs by perpetuation of inaccurate figures in clinical guidelines, the international literature and the public domain. Interpretation of published study results for FAMs is difficult due to variability in study methodology and other clinical trial quality issues. Recent systematic analyses have noted the considerable issues with study designs and limitations. Several non-English published studies using the Billings Ovulation Method have demonstrated that a broader review of the literature is required to better capture the data potentially available. Conclusion: A deeper understanding by clinicians and the public of the applicability of contraceptive effectiveness rates of the various FAMs is needed, instead of reliance on the inaccurate conglomerate figures that are widely presented.
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The Billings/ovulation method is a periodic abstinence method of regulating births based on the client's interpretation of changing patterns in secretions of cervical mucus monitored by external self-examination. It was developed in Australia and is now widely promoted overseas. This paper outlines the method's recent history and goes on to discuss its physiological basis, its use-effectiveness as measured in a number of major trials, and some evidence concerning its general acceptability and applicability in family planning programs.
Article
Objective: To determine the use effectiveness of the Creighton model ovulation method in avoiding and achieving pregnancy. Design: Prospective, descriptive. Setting: A natural family planning clinic at a university nursing center. Participants: Records and charts from 242 couples who were taught the Creighton model. The sample represented 1,793 months of use of the model. Main outcome measure: Creighton model demographic forms and logbook. Results: At 12 months of use, the Creighton model was 98.8% method effective and 98.0% use effective in avoiding pregnancy. It was 24.4% use effective in achieving pregnancy. The continuation rate for the sample at 12 months of use was 78.0%. Conclusion: The Creighton model is an effective method of family planning when used to avoid or achieve pregnancy. However, its effectiveness depends on its being taught by qualified teachers. The effectiveness rate of the Creighton model is based on the assumption that if couples knowingly use the female partner's days of fertility for genital intercourse, they are using the method to achieve pregnancy.
Article
Channel formation in dried cervical mucus and the presence or absence of fern formation are correlated. The mean number of channels was 9.2 when the fern was negative, 42.8 when the fern was poor positive, and 73.9 when the fern was good positive. The difference between the means in the 3 groups was statistically significant. The channel number in dried cervical mucus and the presence or absence of fern formation are correlated with the day of the menstrual cycle in which the specimens were obtained and with the woman's observation of the PEAK mucus symptom while using the ovulation method of natural family planning. The data organized itself more clearly when it was related to the woman's observation of the PEAK symptom. This has been explained by the fact that the PEAK mucus symptom is essentially an ovulatory event. The reliability of the woman's vulvar observations while using the ovulation method was tested against observations of cervical mucus obtained from the level of the endocervix. In those vulvar observations that are considered fertile by the method, the channel number and the frequency of good positive ferning were higher than in those observations that are considered infertile. When the vulvar observations that indicate fertility were compared with those vulvar observations that indicate infertility, the difference was statistically significant. Finally, a practical model of human fertility is described using practical experience with the ovulation method, the woman's vulvar observations while using the method, and the channel and fern formation of endocervical mucus. A progressively declining index of fertility is described that is statistically significant.
Article
Analysis of data from the 1988 National Survey of Family Growth--corrected for the underreporting of abortion--reveals that contraceptive failure during the first year of use remains a serious problem in the United States, contributing substantially to unintended pregnancy. The pill continues to be the most effective reversible method for which data were available (8% of users accidentally became pregnant during the first year of use), followed by the condom (15%). Periodic abstinence is the method most likely to fail (26%), but accidental pregnancy is also relatively common among women using spermicides (25%). Failure rates vary more by user characteristics such as age, marital status and poverty status than by method, suggesting the extent to which failure results from improper and irregular use rather than from the inherent limitations of the method.
Article
Throughout Germany, 851 women who were instructed in natural family planning participated in a prospective study. Of these, 255 women with 3174 cycles used only natural family planning for family planning and 274 women with 3995 cycles occasionally used barrier methods in the fertile phase. For natural family planning--only users, the Pearl rate for unplanned pregnancy was 2.3 and for mixed-method users 2.1. Most pregnancies resulted from unprotected intercourse during the fertile phase, and the use of barrier methods does not reduce risk-taking.
Article
This report provides an update of the authors' previous estimates of first-year probabilities of contraceptive failure for all methods of contraception. Estimates are provided of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct use at every act of intercourse). The difference between these two probabilities provides a measure of how forgiving of imperfect use each method is. These revisions are prompted by recent studies that provide the first estimates of failure during perfect use for periodic abstinence and the cervical cap, by more complete evaluations of implants, and by the appearance of the Copper T 380A and disappearance of other IUDs from the US market. Also provided is a more complete explanation of how the previous estimate of the probability of becoming pregnant while relying solely on chance should be interpreted, and this estimate is revised slightly downward.
Article
A methodology for the statistical evaluation of the effectiveness and acceptability of 2 groups of contraceptive methods utilizing life-table procedures adapted for this purpose is described. 2 sets of illustrative tables one for clinical data on IUDs and the other for clinical data on oral medication which is also applicable to other methods of contraception that can be discontinued by the user at any time are presented. The procedures for the statistical analysis of use-effectiveness of which the 2 most important components are the antifertility effect expressed as the rate of accidental pregnancy and acceptability as reflected in the rate of continued use are described. To measure use-effectiveness by life-table procedures certain infomrati on is required: 1) the period covered by the study; 2) the number of women who accept the method (for IUDs the number of first insertions) by date of acceptance; and 3) for each termination the date of acceptance and the reason for discontinuing the contraceptive method by duration of use (ordinal months of use). Numerous self-checking features are included in the analysis.
Article
The final results of a prospective comparative study of two methods of natural family planning indicate a significant difference in the 12 month net cumulative pregnancy rates between the ovulation and symptothermal methods. These differences are on the order of two to one in favor of the symptothermal method. Pearl pregnancy rates confirm similar differentials between the two methods. Dropout rates for both methods were high. Lack of interest or dissatisfaction with the method was the major reason for dropout training while pregnancy or desire for pregnancy were the major reasons for dropout during the formal phase of the study.
Article
Results of a comparative study of the ovulation method (OM) and symptothermal method (STM) of natural family planning in Colombia are presented. Recruitment of volunteer couples began in August, 1976, and continued through December, 1978, during which time 566 couples were randomly assigned to one or the other of the two methods. The study included 3 to 5 months of training in the method assigned, after which the couples entered the follow-up phase of the study. They remained in follow-up until (1) they dropped out or (2) the study closed in June, 1979. Total dropout rates were high for both methods of natural family planning. One year after entry into the follow-up phase of the study, net pregnancy rates were 24.2% for OM users and 19.8% for STM users. Gross pregnancy rates were 29.2% for OM and 26.1% for STM. Differences in pregnancy rates between the two methods were not statistically significant.