Most couples who seek reproductive assistance are sub-fertile, rather than sterile, and may conceive naturally. But for this to to be optimised, they need to accurately time intercourse on the fertile days of the menstrual cycle.

Even for women who have a regular menstrual cycle, the timing of fertile days can be variable. There are three generally accepted methods for women to recognise the fertile days of the menstrual cycle: the rhythm (when you estimate the timing of your fertile window), temperature (based on a temperature rise associated with ovulation and mucus (based on the presence of cervical mucus in relation to a maturing egg) methods.

Most women use the rhythm approach but this is accurate only for around a third of them. Only the temperature and mucus methods are accurate enough to work with for the purpose of getting pregnant. But they often require skilled education for correct use.

Assisted reproductive technology

Infertility affects around one in six couples in Australia, and they often turn to clinics for reproductive assistance. One in every 35 babies born in Australia is a result of reproductive assistance. In some countries the figure is higher – in Denmark, for example, it’s one in 16 babies.

But assisted reproduction technology (ART) is expensive and its success rate remains low. Most couples require multiple treatment cycles before having baby. And not all couples who are having trouble conceiving can access or wish to use reproductive technology for religious, personal and financial reasons.

Most couples having trouble conceiving are sub-fertile (rather than sterile) and may conceive naturally. Research shows that accurately timed intercourse within the fertile days of the menstrual cycle may reduce the time it takes a couple to get pregnant.

The research

We surveyed 204 infertile women seeking fertility assistance at ART clinics. Our intention was to get an idea of women’s knowledge about the fertile days in their menstrual cycle. The questionnaire was completed by women over six months and all the participants had failed to conceive after 12 or more months of trying be.

We found that most women (87%) having trouble conceiving actively try to improve their knowledge of the fertile days of the menstrual cycle, but only 13% accurately identify these days. So there’s clearly a significant gap between what women want to know about their fertile days and what they actually know.

While most women had either no knowledge (12%) or poor knowledge (53%), 68% believed they had accurately timed intercourse. The three most frequent sources of the information were the internet, books and general practitioners.

Given that pregnancy is only possible after intercourse within the fertile days of the menstrual cycle and that the menstrual cycle can be highly variable between women, there should clearly be a greater emphasis on educating women.

Knowledge and medicalisation

The problem is that information acquired from the internet, books and short appointments with general practitioners may be difficult or not well presented enough to understand. Such information is even less straightforward for women with common medical conditions, such as polycystic ovary syndrome.

The exact extent to which infertility could be reduced through improved health literacy in primary health care is not known but thought to be substantial, especially in the case of sub-fertile women. What we do know with certainty is that an increasing body of evidence suggests unnecessary medicalisation in health care not only wastes vast amounts of money, but can also do harm.

Indeed, the increasing use of specialist interventions rather than appropriate and well-timed primary health care is threatening the long-term sustainability of health systems worldwide.

We are now exploring the views of general practitioners and general practice nurses about the barriers and enablers to providing accurate and apt fertility-awareness education to couples having trouble conceiving, and the best ways to deliver this. Appropriate and appropriately-timed fertility-awareness education in general practice for couples who are having trouble conceiving has the potential to save them a lot of stress and money.