Studies of Fertility Smartphone Apps Reveal a Lack of Insight and Scientific Information

Background: Female reproductive health and fertility smartphone applications have grown rapidly into a 400 million dollar “femtech” industry. As such, there has been increased interest in their functions and benefits. Claims of app participation in research is a marketing tool for consumers, however there is little known about the current scope of reproductive health app research and specifically how it is performed and reported. Aim: This study aimed to determine the nature and extent of the peer-reviewed literature presented on fertility-based apps, to identify the reliability of the information within the apps, and to determine the ability of this information to educate users. Method: A systematic search of six databases was conducted in April 2020, returning a total of 21,158 records. After duplicate removal, title and abstract screening exclusionary steps, 27 records were reviewed and charted. Results: Fertility smartphone apps covered a variety of reproductive health themes including contraception, sexual health, and family planning, and used a range of research methodologies including prospective, retrospective and observational. A majority (63%) of the studies on apps specified ovulation windows as the sole information on fertility given to users. Around 52% of studies in the review based fertile window algorithms on stringent menstrual cycle length and variability requirements (typically 20-40 day length; <5 day variability). Furthermore, a third of studies in the scoping review contained authors that were affiliates or developers from an app company, and of these studies, 15% did not have co-authors independent to the app advisory board or employees. Conclusion: Female reproductive health apps have the potential to fulfil a range of reproductive health needs. However, they currently do so with severe limitations when it comes to the menstrual cycle variability, and they do not adequately succeed in multi-functional capabilities. Furthermore, the scope of information available in apps via the user interface is a major barrier to independent review for accuracy. Our findings support the recommendation for open source sharing of app contents. This would ensure developers are accountable to consumers, healthcare professionals and researchers. This study highlights lack of research evaluating the effectiveness of an app’s contents to translate to knowledge or behaviour change in participants.