Clearblue Easy Fertility Monitor: A Review Based On Our Experiences

I used the Creighton Model of NFP post-partum/breastfeeding from 2 months post-partum (fertility returned at a little over 2.5 months post-partum, with first menses at 3 months post-partum), and had an unintended pregnancy 9 months after my c-section when we were trying to avoid. A pregnancy evaluation confirmed that this was a “method related pregnancy” (aka a method failure pregnancy.) We’d had problems with continuous but variable mucus, meaning 100 straight days of abstinence, and a lot of abstinence after yellow stamps were introduced, because the Essential Sameness Question could not be applied most times due to the variability of mucus. We conceived on a run of 6 dry days (like 0AD, 2×1 sort of days), when it’s supposed to be “impossible.” It was then that I discovered that the efficacy statistics for Creighton do not necessarily apply specifically to women who are post-partum/breastfeeding. The formal studies on efficacy in the Creighton model are, like most NFP and contraceptive studies, based on women aged around 18-44-ish (ie. not perimenopausal or new to cycles), and in regular cycles of between around 22-42 days, with no known fertility issues. This is standard, of course, but I hadn’t realized that efficacy for my specific sub-group (breastfeeding women in the initial post-partum cycles) may be different. There is one Creighton study that I’m aware of that did look at this subgroup, and it found 100% efficacy with perfect use, but only 80% efficacy with typical use. That’s a wide gap. It might reflect greater difficulty in achieving correct and consistent use over the method, and that would jive with my experience. We did manage to use it correctly and consistently, but not everybody might handle such long extended abstinence with fertile signs that cannot *ALL* be actually fertile. People in those circumstances, with confusing mucus presentation and excessive abstinence, may begin to take chances because they no longer believe or trust what the method is telling them about their fertility.

Anyway, after this experience, I switched to Marquette, where I knew that the 98% efficacy statistic for avoiding pregnancy was specific to my current situation (post-partum/breastfeeding.) Prior to cycle return, I was using a test stick a day, which cost me about $35 a month. After cycles returned, for the first 6 cycles, I used about 15 test sticks a month, when ovulation was delayed and the luteal phase short. After cycles had returned to a more regular pattern, I used about 8-12 sticks per month, for an average cost of about $10-12 a cycle.
I consider that cost to be reasonable, although we had to make sacrifices to afford it. I believe the cost for regular follow-ups with an FCP varies, so I can’t make a reliable comparison.
Oh, and I should mention I purchased the monitor used on eBay for about $80, so that was my initial start-up cost. It’s ok to purchase a used monitor, but you will need to do a hard reset or reprogram the monitor to clear the memory, as you don’t want it operating on the prior user’s hormonal data.

Marquette offer a variety of protocols. The “monitor alone” protocol is actually the monitor along with a default rule for abstinence (for those without 6 regular cycles worth of data), or the algorithmic rule (for those with at least 6 regular cycles worth of data.) The only time the monitor is genuinely used alone is for post-partum women in “cycle 0”, prior to the return of cycles. In that use, it was 98% effective in avoiding pregnancy. The researchers found that for the post-partum/breastfeeding group of people, using monitor+mucus (plus any applicable rules) did not increase efficacy, although it seemed to increase abstinence, and in fact seemed to decrease efficacy. Reasons for this may be that people were using mucus to “trump” the monitor or default/algorithmic rule for abstinence, in order to reduce abstinence. Typically, a cross-check is used to increase conservatism. That is, if the monitor reads low, but you see fertile mucus, you begin abstaining. But it may be that people were using mucus to decrease conservatism… so the rule saying to begin abstaining, or the monitor reading high, but not seeing fertile mucus so not abstaining.
I personally know one person who did this. She was also a prior Creighton user, but had switched because she had a yellow-stamp pregnancy. I don’t know if it was a user related pregnancy or a method related pregnancy. Marquette’s default rule said that in her second full post-partum/breastfeeding cycle she should begin abstinence on cycle day 9. She got a high reading on the monitor on day 10. But on days 9-11 she did not observe any fertile mucus, so thought it was impossible to conceive. She had sex on day 11, and conceived from that act. I’m wondering if the higher pregnancy rate for people using monitor+mucus is due to that sort of thing? I’m not sure. I wonder if the researchers did an analysis of it.

The other protocols Marquette offers, in addition to monitor “only” and monitor+mucus are ones that incorporate temps. You can do monitor+temps, mucus+temps, and monitor+mucus+temps. These are not all reflected on the public website, but the Marquette forums or an instructor can take you through them, and the waiting-to-be-released new charting website and app provide for all of these possibilities.

I did want to say that there shouldn’t be any “false reads” with the monitor, barring situations where tetracyclines are being taken, or the woman is pregnant (the monitor will read hCG as LH), or fertility meds are taken, etc. The monitor otherwise will accurately reflect the estradiol and LH levels in the urine, and those accurately reflect serum hormonal levels. That’s proven. It can be that some women experience what is called “false peaks” but are actually what is better termed “practice peaks”. That is, their bodies do have elevated estrogen and LH levels, both of which are needed together to trigger a peak reading, but the ovulation attempt is unsuccessful. It’s a true peak, but not one that leads to successful ovulation. This is a bit of a terminology problem. Women with PCOS are advised to work with an instructor if using Marquette, as they can be prone to frequent LH rises before a successful ovulation.
In Sarah’s friend’s case, it seems her mucus peak preceded actual ovulation by a day or two? That’s not uncommon. Creighton allows for a mucus peak that comes =/- 2 days of actual ovulation. As with all fertility tracking tools commonly in use, they provide a window for ovulation, not an exact pin-pointed day. It’s the same with Marquette. It too has a window for ovulation, where almost all ovulation occurs on the two days of peak or the high day following peak. For those trying to conceive, that’s why it helps to have intercourse on the days of monitor high preceding peak – or for mucus based systems, on the days of fertile-but-not-peak-type mucus preceding peak, as well as on peak days.

Obviously, Sarah’s and my differing experiences are just that. Individual anecdotal accounts. I will say that after I stopped breastfeeding, my mucus presentation became far more readable and useful, so that it basically tracked what the monitor was telling me. I ecologically breastfeed, and for longer than the norm (15 months, and 3.5 years with my two older children. My current is only 5 months old and I don’t know how long he’ll continue nursing), and since mucus is not a reliable indicator of fertility for me for long periods of time, I’m thankful for the monitor and the Marquette Method that allows an effective use of the monitor to avoid pregnancy! And honestly, once my mucus returns to “normal” again after this baby weans, I have no plans to use it for NFP decision-making purposes. One of the great benefits of using the monitor-only protocol (monitor+default/algorithmic rules) or the monitor+temps protocol is that intercourse is available any time of the day in all phase 1 days (as soon as you’ve tested that morning if it’s a testing day.) Since my husband starts work in the afternoons, that gives us the potential for intimacy in the morning or early afternoon, instead of having to wait when he’s come home at night, and we’re both exhausted from work and child-wrangling. It also means days of menses bleeding are all available too, although we don’t use those so frequently.