I have been teaching the Boston Cross Check method of Natural Family Planning (NFP) for well over a decade at this point— it's a fascinating and really fun method because it offers a lot of flexibility and various combinations of biomarkers to work with. All standard clients learn how to observe cervical fluid, basal body temps (either traditional oral temping or with Tempdrop), and check urinary metabolites through use of the Clearblue Fertility Monitor. Even though you learn all three, the method only "requires" the use of two indicators to identify the Cross Check, so clients get to choose which combination works best for them.

Apart from those three primary indicators, we also offer secondary indicators like LH testing and PdG (progesterone) testing with the Proov system. Those don't substitute for one of the primary indicators, but offer additional options to personalize the charting system even more.

So it makes sense that—as a BCC instructor who works with a lot of gadgets and tools for fertility tracking— people might reach out to me to ask my thoughts on various other "femtech" gadgets that are on the market. This was actually a question I received last year from a group of seminarians, when I presented my annual talk to them about pastoral considerations with NFP (can we pause for a moment to be impressed that a seminarian knew about the cycle tracking capabilities of the Oura ring????). It was also a question I received following my talk at the Portsmouth Institute conference this summer.

So I'd like to share my thoughts with you here, which I would summarize as generally favorable towards the development of new cycle tracking technologies.... while being very cautious and concerned about the way in which tech companies may either mislead or take advantage of couples.

First of all—couples are perfectly capable of discerning whether a particular tech company or gadget is something they want to invest in, and how any of my concerns as an NFP instructor may stack up against their personal preferences and goals when charting for fertility.

There is ZERO moral imperative for Catholic couples to use "an officially-approved method" of NFP (whatever that means to them), as long as they are meeting the Church's criteria that we do not interfere with the natural ends of any sexual act.

When we consider a natural tracking device (like Oura, Natural Cycles, Inito, or Mira) of course these options are FAR superior—morally speaking—to artificial reproductive technologies which do not respect the natural processes of intercourse, fertilization, implantation, and/or pregnancy. That needs to be said and respected, and it makes me really upset when anyone tries to suggest that there is some sort of moral superiority to using a "Catholic" method of NFP over a secularly-developed, tech-based method like Natural Cycles.

What is the device designed to do?

But we do need to remember that especially in the US, ​the femtech industry​ is a multi-billion dollar industry which is primarily geared towards capitalizing on couples' desire for children. This isn't exclusively true and there are a few notable exceptions, but in general it's important to know that the hormone monitors, fancy wearables, and cycle tracking apps are *mostly* designed for couples who are trying to conceive. So if they offer any sort of interpretation of fertility (e.g., low, high, peak), they will tend to favor a SMALLER fertile window to help couples maximize their chances of conception by identifying the MORE fertile or MOST fertile days. But for couples who are trying to postpone pregnancy, that's not the information that is most useful. Instead, couples want to identify a larger window of possible fertility, including those days that have a low chance of conception. So if there is a serious need to postpone pregnancy, it's very likely that these devices or hi-tech options may not be "calibrated" for the sort of fertility assessments that are actually needed.

How does the company treat my data?

Beyond that restriction, it's also important to consider the way that different companies treat our biodata information. Some companies will use your information for their own internal research, but others won't. Maybe you care about that, maybe you don't!

An aspect we often don't think about, however, is how a particular device (or app) approaches your personal "ownership" of your data. Does the information that you want/need from that device come as a standard part of the package, or do you have to pay extra money to access it?

An example of two different approaches here is seen through the way Tempdrop and Oura offer temperature data:

• With ​Tempdrop,​ you purchase the device and get a free app. You're welcome to pay for an app with advanced interpretation and charting features, but the core information you want to get from the Tempdrop (that is: your temperature) is FREE for you to access each morning.
• ​Oura​ has taken a different approach, which is a subscription-based model. So the ring tracks your BBT... but it's not part of their standard monitoring package. You have to pay extra to get that information through an ​additional subscription​, even after having purchased the device outright.

As an instructor and part-owner of the BCC method, I can say that our professional stance towards ANY femtech device is that we have a strong preference that users should own their data and not be required to pay to get information that the company is getting from them for free. So that's a BIG concern that I have, and prompt women and couples to understand the full investment they are making (including ongoing costs!) before purchasing any device.

Does the device empower me to make my own decisions, or make me beholden to their proprietary tech?

Another thing I want people to think about is whether a device is making me dependent upon their technology, offering predictive or interpretive features WITHOUT giving me the information to understand and interpret my own data. To go back to Oura, a couple can pay the membership fee and get a temperature reading... sort of. The temperature readout in Oura looks like this:

 

You can see that there is a line, which is assumed to be a sort of baseline temperature value, and the little bars represent deviation from that baseline. The final one is 0.4 degrees above baseline... but what's the NUMBER??? If a client is working with a standard NFP method and using this device, they'd have to randomly pick a value for "baseline" (e.g., 97.0 or 98.0 is easiest to work with) and then chart their temps relative to that value. It may be functional enough, but the data is sort of intentionally presented in a way that obscures immediate interpretation by the user.

So in many cases, a device will require you to rely on its own interpretation or assessment of values, without educating the user with knowledge to override or question the device's interpretation of the data... something which couples learn how to do in NFP classes!

Whether utilized by an app or a device, predictive and interpretive features which don't allow manual overrides or adjustments are designed to tell the user what to do, not to equip the user to make informed decisions about data points that they are collecting. Which may seem simple enough and for some people, may be a welcome relief! But there's an element of autonomy which is lost when couples become dependent upon the femtech company instead of their own knowledge. What happens if that company goes out of business? Or the device breaks and you don't have the funds to replace it? In that case, couples are left with few options on how to work with fertility charts on their own.

I see this more and more, and I am wary of devices and companies that circumvent the part of the learning process where the couple actually learns anything. This has bothered me for quite some time, as you can see reflected in ​my review of the Teena BBT thermometer​ (made for girls).

So... could a couple take an NFP class, learn how to interpret temperature patterns, and simply collect data with the Oura? Yes. Sure. But remember: they have to pay for that information still, and would have to sometimes use their NFP training to override the interpretive features offered with that device.

Is the device honest and transparent about its efficacy?

But that leads me to one more concern is that we DO NOT have researched efficacy rates for a lot of these newer devices. They may seem really convenient, but have they been tried and tested? Is that something we care about as a couple? It's a fair question. So I want to explain one thing that comes up a LOT, especially with new wearable temperature tracking options, because tech companies are not exactly forthcoming with this information:

Traditional temping research utilized either vaginal or oral temperatures. And most people know there's a difference between oral temps, underarm temps (aka axillary temps), rectal temps, ear temps, and forehead/skin temps. You simply get different ranges of "normal" when measuring temperature these different ways. We know from research that vaginal temps and oral temps follow certain patterns relative to ovulation, and that having a certain number of temps above certain values means ovulation has passed. Cool. What we don't know is whether axillary or skin temperatures follow those same researched patterns.

So, unless a company has done its own research with its specific device (which, most haven't) it is grossly misrepresentative to present potential users with efficacy stats about using an NFP method with ANY device that does not use researched temping methods. ​Natural Cycles,​ for example, presents efficacy stats this way:

 

If you look into their ​research paper,​ they say that users logged various information like cycle lengths, BBT, and LH surges for the efficacy study. But they do not say whether couples received proper training in using and interpreting these tools, or WHICH method they were using to collect temperature data. Because they reference similar outcomes in the Frank-Hermann study, I'm inclined to think that users in the study logged oral temps... it's not clear.

But you can see how this gets very complicated if you start saying that we can just substitute the Oura ring temperature assessments with oral temperature techniques and still get the same efficacy. That hasn't been shown. And it renders the "researched efficacy" of the app kind of moot if there could be meaningful differences between data collected one way or another.

Could we get to a point where we have data with all these new devices and techniques? Yes. I think we can. But we're not there YET.

But I think it's intentionally misleading and maybe even predatory to give people false efficacy rates for a "symptothermal method" without informing them that all those rates are based on different temperature techniques than the one they will be using. Therefore, until companies support seminal research on those techniques OR are at least fully transparent in their reported stats, I cannot in good conscience recommend them.

Technology can make NFP more accessible!

So—do I take umbrage with a lot of these femtech companies? Yes. Are they inherently problematic for Catholics to use? Not necessarily.

Objectively speaking, I'm not opposed to a company that is able to provide an ethical, robust charting platform which effectively allows the woman and/or couple to self-teach through an app.

I'm not opposed to the technology in and of itself and am not so jealous as to believe that instructors are absolutely vital in every case. I can certainly imagine a world in which couples could learn various methods on their own, and only need an instructor in cases where charting proves particularly difficult. That would be neat and might be a very attractive option! But I don't see that option available anywhere yet.

A final point I should make is that ​official methods,​ if they are worth their salt, will only teach couples about calculations for the fertile window which are backed by research. And they should be upfront with clients about any time when a protocol is recommended that does NOT have a good body of research behind it. By example, BCC is very upfront when presenting the Tempdrop option to clarify that axillary temps are NOT equivalent with oral BBT, and doesn't have the robust body of research to back it up. We always try to be very clear about the lack of efficacy information when modifications need to be made for conditions like PCOS, and I know that Marquette is very good about letting people know that their protocols with Mira are still under research. That's the level of transparency that you should expect from a trained instructor, which is not always present with apps or new gadgets.

In summary:

I think women and couples should know that MOST femtech gadgets on the market today are NOT supported for use in established NFP methods (not sure what I mean by "established method"? Here's a post to help!)—not because instructors are trying to be gatekeepers, but because we know that the research is not usually there to back it up.

So if someone wants to use a particular device, the first question to ask is: "Does your chosen method support it?"  You don't want to buy something and then find out that your instructor will not be able to support you in its use.

If you don't want to use an official method, then the questions become: "Are you comfortable interpreting data from this device without professional support?" "Are you comfortable with the possibility of decreased efficacy for TTA (sometimes unknown!) in exchange for the convenience of this device?" If the answers are yes, then that's fine! Again: Catholics aren't required to learn "Catholic methods ONLY"— as long as you still uphold the Church's moral teaching in this area.

If you want to learn more, the NFP office at the USCCB has standards for assessing not only the scientific quality of methods, but also the moral philosophy which is taught alongside the method. So you can always use their website as a reference.