# Fertility awareness methods and waiting conduct in idiopathic infertility: a prospective observational study

## TL;DR

This study compares natural conception using fertility awareness methods with assisted reproductive techniques in couples with unexplained infertility.

## Contribution

The study provides evidence that fertility awareness methods can be as effective as ARTs for some couples with idiopathic infertility.

## Key findings

- FAM users had a 51.22% pregnancy rate after 12 months, significantly higher than the 17.8% rate in the ART group.
- Younger women (<34 years) using FAMs had a 90.9% pregnancy rate, suggesting FAMs are more effective in this age group.
- The study recommends a waiting period with FAMs before pursuing ARTs for couples diagnosed with idiopathic infertility.

## Abstract

Couple infertility is a common clinical condition that is too often treated with assisted reproductive techniques (ARTs) without a proper evaluation of both male and female factors. To improve the likelihood of natural conception, fertility awareness methods (FAMs) are widely used.

We performed a multicenter prospective study enrolling couples with primary idiopathic infertility who were seeking natural conception. Participants were followed for 12 months using FAMs, and their outcomes were compared with those of couples who only used ARTs. The aim of our study was to evaluate the pregnancy rate after 12 months among couples with idiopathic infertility using FAMs compared with those who immediately pursued ARTs. We evaluated 41 couples in the FAM group and 56 couples in the ART group.

In the FAM group, we reported a pregnancy rate (PR) of 51.22%. Among women aged <34 years, we reported a PR of 90.9%, while it decreased to 36.7% among women aged 35–39 years. In the ART group, 10 couples achieved pregnancy (PR 17.8%). Within this group, we reported a PR of 30% among women aged <34 years and 17.4% among women aged 35–39 years.

After 12 months of unprotected intercourse without spontaneous conception in women younger than 35 years or after 6 months in women aged 35–39 years, couples should undergo a complete multidisciplinary diagnostic evaluation involving both the male and female partners. If a diagnosis of idiopathic infertility is established at the end of this process, couples (especially younger ones) may be advised to wait an additional 12 months while using FAMs, as no advantage has been observed with direct access to ARTs. They could then be referred to ART if a spontaneous pregnancy is not achieved during this period.