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What is the effectiveness of CrM to avoid pregnancy? ..

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What is the effectiveness of CrM to avoid pregnancy? ... Achieving-related pregnancy is almost always considered to be a positive outcome. ... – PowerPoint PPT presentation

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Title: What is the effectiveness of CrM to avoid pregnancy? ..


1
Effectiveness of the CREIGHTON MODEL System to
Avoid and to Achieve Pregnancy
  • Joseph B. Stanford, MD, MSPH, CNFPMC
  • Associate Professor
  • Family and Preventive Medicine
  • University of Utah School of Medicine

2
Why study use to avoid and achieve?
  • Couples who use CrM throughout their life will
    use it both ways.
  • In any CrM program, users will come for both
    reasons.
  • Interest in NFP to achieve is higher than
    interest to avoid (in USA).
  • About 33 interested to avoid 25 to achieve
  • Missouri and Utah

3
  • What is the effectiveness of CrM to avoid
    pregnancy?
  • What is the effectiveness of CrM to achieve
    pregnancy?
  • How do you distinguish between use to avoid and
    use to achieve?
  • What are the needs for future research?

4
  • What is the effectiveness of CrM to avoid
    pregnancy?
  • What is the effectiveness of CrM to achieve
    pregnancy?
  • How do you distinguish between use to avoid and
    use to achieve?
  • What are the needs for future research?

5
Distinguishing between use to avoid and use to
conceive
  • Unplanned and planned pregnancy
  • Achieving-related pregnancy

6
Pregnancy from genital contact during known
fertile time
  • (Un)planned pregnancy
  • Fertility control
  • Responsibility for pregnancy belongs to the
    method.
  • Subjective, superficially measured.
  • Achieving-related pregnancy
  • Fertility cooperation
  • Responsibility for pregnancy belongs to the
    couple.
  • Objective, based on knowledge and behavior.

7
Pregnancy from genital contact during known
fertile time
  • (Un)planned pregnancy
  • Sex and fertility are fantasized to be completely
    separate phenomena.
  • Unplanned is usually considered to be a
    negative outcome.
  • Achieving-related pregnancy
  • Sex and fertility are naturally and inseparably
    related.
  • Achieving-related pregnancy is almost always
    considered to be a positive outcome.

8
Consider 2 family planning methods
  • Inserted by doctor.
  • Suppresses fertility.
  • Has to be removed by doctor.
  • Encourages couple to forget about their
    fertility.
  • Low method pregnancy rate.
  • Low total pregnancy rate.
  • Planned Parenthood
  • Used by couple.
  • Cooperates with fertility.
  • Couple is continually encouraged to consider the
    gift and possibility of fertility.
  • Low method pregnancy rate.
  • Higher total pregnancy rate.
  • Responsible Parenthood

9
Distinguishing between use to avoid and use to
achieve (CrM)
  • Use to avoid is avoidance of genital contact
    during known times of fertility.
  • Avoiding-related pregnancy
  • Use to achieve is any genital contact during
    known times of fertility.
  • Achieving-related pregnancy
  • Couples rarely have any difficulty grasping and
    accepting this approach.

10
  • What is the effectiveness of CrM to avoid
    pregnancy?
  • What is the effectiveness of CrM to achieve
    pregnancy?
  • How do you distinguish between use to avoid and
    use to achieve?
  • What are the needs for future research?

11
Avoiding-related pregnancy rates
  • During use to avoid, method-consistent
  • method-related pregnancy rate
  • if method always used perfectly to avoid
    pregnancy
  • During use to avoid, method-inconsistent
  • use-related pregnancy rate
  • as method is used in real life
  • includes errors by user and/or teacher
  • Either of these can be calculated with
    full-denominator or specific denominator.
  • Illustrate with method-consistent use

12
Method (perfect use) pregnancy rates during use
to avoid
1
2
a
1
2
b
1 cycles of method-consistent use a perfect
use pregnancy
2 cycles of real life use with errors b
pregnancy due to error
Perfect use a / 12 full denominator
traditional measure
Perfect use a / 1 specific denominator new
measure
13
Statistical approaches
  • Pearl rates
  • Influenced by length of follow-up (morelower)
  • Net life table (multiple decrement)
  • Influenced by rate of discontinuation
  • Gross life table (single decrement)
  • Independent of rate of discontinuation
  • Higher rates than net life table
  • Kaplan-Meier (similar to life table)
  • Cox Proportional Hazards Regression
  • Multivariate modeling

14
Method (perfect) use pregnancy rates during use
to avoidSelected CrM studies, full denominator,
12-month
15
Avoiding use pregnancy rates Selected CrM
studies, full denominator, 12-month
16
CrM Effectiveness
  • Important Factors
  • Standardized method
  • Personalized instruction
  • Competent, trained teachers
  • Motivation
  • Couple communication
  • Not Important
  • Regular cycles
  • Educational status
  • Socioeconomic status
  • Religious denomination

17
  • What is the effectiveness of CrM to avoid
    pregnancy?
  • What is the effectiveness of CrM to achieve
    pregnancy?
  • How do you distinguish between use to avoid and
    use to achieve?
  • What are the needs for future research?

18
Effectiveness to achieve pregnancy
  • The achieving related pregnancy rate is a
    demographic measure of consciously chosen
    fertility in the population over all cycles of
    use (full denominator)
  • May include many cycles used to avoid
  • Normal fertility, pregnancy rate in cycles used
    to achieve (specific denominator)
  • Includes only cycles used to achieve
  • Infertility, pregnancy rate (specific
    denominator)
  • Essentially includes only cycles used to achieve
  • With or without Natural Procreative Technology

19
Selected studies of CrM to achieve
20
Effectiveness in infertility, method issues
  • Per cycle success rates are not appropriate for
    CrM (or any infertility treatment).
  • Biased measures used extensively for IVF and
    related techniques.
  • Cohort-based measures are appropriate for CrM,
    and to compare CrM to other infertility
    treatments.
  • Crude rates will underestimate effectiveness.
  • Traditional life tables will overestimate
    effectiveness (but probably less for CrM than for
    IVF).

21
CrM effectiveness summary
  • With exact use to avoid pregnancy, yearly
    pregnancy rates are less than 1 per 100.
  • Accounting for user or teacher error, the yearly
    avoiding pregnancy rates are 2 to 5 per 100.
  • Effective teaching required.
  • CrM can be used in all reproductive situations to
    avoid.
  • Irregular cycles, discontinuing oral
    contraceptives, breastfeeding
  • (Most clearly shown in Creighton Model Texas
    study, 1999)

22
CrM effectiveness summary
  • Nearly all pregnancies among CrM users result
    from intercourse during known fertile days.
  • The total pregnancy rate in CrM studies ranges
    from 17 to 33 at one year (per 100, Net).
  • The achieving-related pregnancy rate ranges from
    14 to 30 at one year (per 100, Net).
  • Achieving-related pregnancy varies by external
    circumstances (ie, unemployment rates)

23
CrM effectiveness summary
  • CrM is the method of choice for seeking pregnancy
    in infertility.
  • Depending on underlying age and diagnoseis,
    pregnancy rates without NPT may be around 33
  • With Natural Procreative Technology, pregnancy
    rates will be 40-80 or even higher, depending on
    underlying age and diagnosis.

24
  • What is the effectiveness of CrM to avoid
    pregnancy?
  • What is the effectiveness of CrM to achieve
    pregnancy?
  • How do you distinguish between use to avoid and
    use to achieve?
  • What are the needs for future research?

25
Evaluating CrM Effectiveness
  • We need new CrM studies with the specific
    denominator approach for both avoiding and
    achieving pregnancy.
  • We especially need studies in
  • Breastfeeding women (avoiding)
  • Premenopause (avoiding)
  • Normal fertility (prospective, achieving)
  • Women using yellow stamps (postpeak and prepeak)
  • Different subtypes of infertility with medical or
    medicalsurgical NPT
  • We need thorough, sound studies of the dynamics
    of achieving-related use.

26
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