{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:42:14Z","timestamp":1784641334743,"version":"3.55.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009882","name":"Regione Lombardia","doi-asserted-by":"publisher","award":["H1.2010.0008061"],"award-info":[{"award-number":["H1.2010.0008061"]}],"id":[{"id":"10.13039\/501100009882","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Reprod. Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the FAM group, we reported a pregnancy rate (PR) of 51.22%. Among women aged &amp;lt;34 years, we reported a PR of 90.9%, while it decreased to 36.7% among women aged 35\u201339 years. In the ART group, 10 couples achieved pregnancy (PR 17.8%). Within this group, we reported a PR of 30% among women aged &amp;lt;34 years and 17.4% among women aged 35\u201339 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>After 12 months of unprotected intercourse without spontaneous conception in women younger than 35 years or after 6 months in women aged 35\u201339 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frph.2026.1753325","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T06:43:55Z","timestamp":1773125035000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Fertility awareness methods and waiting conduct in idiopathic infertility: a prospective observational study"],"prefix":"10.3389","volume":"8","author":[{"given":"Michele","family":"Barbato","sequence":"first","affiliation":[{"name":"Sintotermico C.A.Me.N. (Italian National School of the Camen Symptothermal Natural Method for Fertility Knowledge)","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Del Zoppo","sequence":"additional","affiliation":[{"name":"Sintotermico C.A.Me.N. (Italian National School of the Camen Symptothermal Natural Method for Fertility Knowledge)","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Parazzini","sequence":"additional","affiliation":[{"name":"Department of Clinical and Community Sciences, University of Milan","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Graziani","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Padova","place":["Padova, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Guida","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u201cFederico II\u201d University Hospital, University of Napoli","place":["Napoli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Ferlin","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Padova","place":["Padova, Italy"]},{"name":"Department of Systems Medicine, Unit of Andrology and Reproductive Medicine, University Hospital of Padova","place":["Padova, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Frigerio","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII","place":["Bergamo, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Grande","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, Unit of Andrology and Reproductive Medicine, University Hospital of Padova","place":["Padova, Italy"]},{"name":"International Chair in Bioethics \u201cJerome Lejeune\u201d","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"B1","volume-title":"WHO Laboratory Manual for the Examination and Processing of Human Semen","year":"2021"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1093\/humrep\/dem046","article-title":"International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care","volume":"22","author":"Boivin","year":"2007","journal-title":"Hum Reprod"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e442","DOI":"10.1210\/clinem\/dgaa781","article-title":"Male infertility due to testicular disorders","volume":"106","author":"Sharma","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1007\/s40618-022-01741-6","article-title":"Management of male factor infertility: position statement from the Italian Society of Andrology and Sexual Medicine (SIAMS)","volume":"45","author":"Ferlin","year":"2022","journal-title":"J Endocrinol Invest"},{"key":"B5","doi-asserted-by":"publisher","first-page":"591837","DOI":"10.3389\/fendo.2020.591837","article-title":"Practical clinical and diagnostic pathway for the investigation of the infertile couple","volume":"11","author":"Garolla","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1093\/humrep\/deae032","article-title":"Guideline for unexplained couple infertility: misunderstandings on the approach to the male factor","volume":"39","author":"Grande","year":"2024","journal-title":"Hum Reprod"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2122","DOI":"10.1111\/andr.70006","article-title":"Comprehensive diagnostic and therapeutic approach to male factor infertility aimed at natural fertility: a multicentric retrospective cohort study","volume":"13","author":"Grande","year":"2025","journal-title":"Andrology"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.3390\/jcm9061644","article-title":"Infertility: practical clinical issues for routine investigation of the male partner","volume":"9","author":"Ferlin","year":"2020","journal-title":"J Clin Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1007\/s40618-024-02524-x","article-title":"Current drawbacks and future perspectives in the diagnosis and treatment of male factor infertility, with a focus on FSH treatment: an expert opinion","volume":"48","author":"Santi","year":"2025","journal-title":"J Endocrinol Invest"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1093\/humrep\/dead150","article-title":"Evidence-based guideline: unexplained infertility","volume":"38","author":"Romualdi","year":"2023","journal-title":"Hum Reprod"},{"key":"B11","doi-asserted-by":"publisher","first-page":"101303","DOI":"10.1016\/j.mam.2024.101303","article-title":"Diabetes and male fertility disorders","volume":"99","author":"Graziani","year":"2024","journal-title":"Mol Aspects Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1080\/14737159.2019.1633917","article-title":"Contemporary genetics-based diagnostics of male infertility","volume":"19","author":"Ferlin","year":"2019","journal-title":"Expert Rev Mol Diagn"},{"key":"B13","doi-asserted-by":"publisher","first-page":"600","DOI":"10.3390\/genes15050600","article-title":"Genetic causes of qualitative sperm defects: a narrative review of clinical evidence","volume":"15","author":"Graziani","year":"2024","journal-title":"Genes (Basel)"},{"key":"B14","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1038\/s41585-018-0003-3","article-title":"Genetics of male infertility","volume":"15","author":"Krausz","year":"2018","journal-title":"Nat Rev Urol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"689","DOI":"10.3390\/cancers17040689","article-title":"Fertility preservation in more than 7000 male patients: a single-center, tertiary care registry study over 30 years","volume":"17","author":"Graziani","year":"2025","journal-title":"Cancers (Basel)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"969","DOI":"10.3390\/life14080969","article-title":"FSH Therapy in male factor infertility: evidence and factors which might predict the response","volume":"14","author":"Grande","year":"2024","journal-title":"Life"},{"key":"B17","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1093\/humrep\/dead277","article-title":"A cryptozoospermic infertile male with Y chromosome AZFc microdeletion and low FSH levels due to a simultaneous polymorphism in the FSHB gene: a case report","volume":"39","author":"Graziani","year":"2024","journal-title":"Hum Reprod"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2187","DOI":"10.1007\/s40618-025-02614-4","article-title":"Testicular index: clinical, applicable tool to predict pregnancy in men with idiopathic infertility under FSH treatment","volume":"48","author":"Santi","year":"2025","journal-title":"J Endocrinol Invest"},{"key":"B19","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/andr.12300","article-title":"Prednisone treatment in infertile patients with oligozoospermia and accessory gland inflammatory alterations","volume":"5","author":"Milardi","year":"2017","journal-title":"Andrology"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.1056\/NEJM199512073332301","article-title":"Timing of sexual intercourse in relation to ovulation\u2014effects on the probability of conception, survival of the pregnancy, and sex of the baby","volume":"333","author":"Wilcox","year":"1995","journal-title":"N Engl J Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1093\/humupd\/dmv042","article-title":"Sperm selection in natural conception: what can we learn from mother nature to improve assisted reproduction outcomes?","volume":"21","author":"Sakkas","year":"2015","journal-title":"Hum Reprod Update"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1815","DOI":"10.3390\/life12111815","article-title":"Light microscopy and proteomic patterns of ovulation in cervical mucus","volume":"12","author":"Fernandez-Hermida","year":"2022","journal-title":"Life"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1016\/s0029-7844(03)00358-2","article-title":"Vulvar mucus observations and the probability of pregnancy","volume":"101","author":"Stanford","year":"2003","journal-title":"Obstet Gynecol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1093\/humrep\/12.7.1582","article-title":"The spontaneous pregnancy prognosis in untreated subfertile couples: the Walcheren primary care study","volume":"12","author":"Snick","year":"1997","journal-title":"Hum Reprod"},{"key":"B25","doi-asserted-by":"publisher","first-page":"186","DOI":"10.3389\/fpubh.2017.00186","article-title":"A latent Markov model with covariates to study unobserved heterogeneity among fertility patterns of couples employing natural family planning methods","volume":"5","author":"Pennoni","year":"2017","journal-title":"Front Public Health"},{"key":"B26","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1186\/s12884-021-03946-8","article-title":"Restorative reproductive medicine for infertility in two family medicine clinics in New England, an observational study","volume":"21","author":"Stanford","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"B27","first-page":"e267","article-title":"Natural procreative technology for infertility and recurrent miscarriage: outcomes in a Canadian family practice","volume":"58","author":"Tham","year":"2012","journal-title":"Can Fam Physician"},{"key":"B28","doi-asserted-by":"publisher","first-page":"375","DOI":"10.3122\/jabfm.2008.05.070239","article-title":"Outcomes from treatment of infertility with natural procreative technology in an Irish general practice","volume":"21","author":"Stanford","year":"2008","journal-title":"J Am Board Fam Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1159\/000512790","article-title":"2021 European Thyroid Association guideline on thyroid disorders prior to and during assisted reproduction","volume":"9","author":"Poppe","year":"2020","journal-title":"Eur Thyroid J"},{"key":"B30","first-page":"48","article-title":"Natural methods for fertility control: a prospective study\u2014first part","author":"Barbato","year":"1988","journal-title":"Int J Fertil"},{"key":"B31","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1016\/S0015-0282(16)47059-7","article-title":"A comparison of methods to interpret the basal body temperature graph","volume":"39","author":"McCarthy","year":"1983","journal-title":"Fertil Steril"},{"key":"B32","first-page":"170","article-title":"The sympto-thermal methods","volume":"26","author":"Parenteau-Carreau","year":"1981","journal-title":"Int J Fertil"},{"key":"B33","article-title":"Teaching methodology and contents for NFP at CAMEN: a supervision work to point out the educative role of NFP teacher","author":"Barbato","year":"1997"},{"key":"B34","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1016\/j.fertnstert.2012.01.091","article-title":"Can the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) be used to accurately report clinic total reproductive potential (TRP)?","volume":"97","author":"Stern","year":"2012","journal-title":"Fertil Steril"},{"key":"B35","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.fertnstert.2023.01.011","article-title":"Alternatives to in vitro fertilization","volume":"120","author":"Wessel","year":"2023","journal-title":"Fertil Steril"},{"key":"B36","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1111\/1471-0528.15409","article-title":"Reproductive medicine: still more ART than science?","volume":"126","author":"Wilkinson","year":"2019","journal-title":"BJOG"},{"key":"B37","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1080\/03009734.2020.1729904","article-title":"Long-term health of children conceived after assisted reproductive technology","volume":"125","author":"Bergh","year":"2020","journal-title":"Ups J Med Sci"},{"key":"B38","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1093\/humupd\/dmz001","article-title":"The health of children conceived by ART: \u201cthe chicken or the egg?\u201d","volume":"25","author":"Berntsen","year":"2019","journal-title":"Hum Reprod Update"},{"key":"B39","doi-asserted-by":"publisher","first-page":"2243","DOI":"10.1093\/humrep\/dev163","article-title":"Economic aspects of infertility care: a challenge for researchers and clinicians: figure 1","volume":"30","author":"Baird","year":"2015","journal-title":"Hum Reprod"},{"key":"B40","author":"Carosso","year":"2020"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1249","DOI":"10.1093\/humrep\/dez072","article-title":"IVF For unexplained subfertility; whom should we treat?","volume":"34","author":"van Eekelen","year":"2019","journal-title":"Hum Reprod"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1007\/s00404-017-4294-z","article-title":"Natural conception rates in subfertile couples following fertility awareness training","volume":"295","author":"Frank-Herrmann","year":"2017","journal-title":"Arch Gynecol Obstet"},{"key":"B43","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1177\/00243639221081980","article-title":"A multidisciplinary quality of care path for couple infertility: development of an integrated approach founded on A multidisciplinary, personalistic, and ecological model for couple fertility","volume":"89","author":"Grande","year":"2022","journal-title":"Linacre Q"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1696679","DOI":"10.3389\/frph.2025.1696679","article-title":"Natural procreative technology (NaProTechnology) for infertility: take-home baby rate and clinical outcomes in a 5-year single-center cohort of 1,310 couples","volume":"7","author":"S\u00e1nchez-M\u00e9ndez","year":"2025","journal-title":"Front Reprod Health"},{"key":"B45","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1080\/1464770312331369363","article-title":"Waiting for in vitro fertilization treatment: spontaneous and ART live births","volume":"6","author":"Horne","year":"2003","journal-title":"Hum Fertil"}],"container-title":["Frontiers in Reproductive Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2026.1753325\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T06:43:57Z","timestamp":1773125037000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2026.1753325\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,10]]},"references-count":45,"alternative-id":["10.3389\/frph.2026.1753325"],"URL":"https:\/\/doi.org\/10.3389\/frph.2026.1753325","relation":{},"ISSN":["2673-3153"],"issn-type":[{"value":"2673-3153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,10]]},"article-number":"1753325"}}