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Fertility awareness methods involve determining the most fertile days of the menstrual cycle and avoiding unprotected intercourse during this period. Techniques for determining fertility include monitoring basal body temperature, cervical secretions, or the day of the cycle. They have typical first-year failure rates of 24%; perfect use first-year failure rates depend on which method is used and range from 0.4% to 5%. The evidence, on which these estimates are based, however, is poor as the majority of people in trials stop their use early. Globally, they are used by about 3.6% of couples.
If based on both basal body temperature and another primary sign, the method is referred to as symptothermal. Overall first-year failure rates of 2% to 20% have been reported in clinical studies of the symptothermal method.