A Latent Markov Model with Covariates to Study Unobserved Heterogeneity among Fertility Patterns of Couples Employing Natural Family Planning Methods

Assessing heterogeneity in menstrual cycles by means of a multilevel latent class approach

In this paper, we study the problem of heterogeneity in cervical mucus hydration at different times relative to the mucus peak both between cycles and women, specifying and estimating appropriate multilevel latent class models for longitudinal data. We estimate multilevel and growth latent class models which classify women on the basis of the evolution of cervical mucus characteristics observed over the fertile period of each menstrual cycle taking into account that we observe a different number of cycles per woman and correlation over time between consecutive observations. The effect of potential covariates on mucus evolution patterns is as well evaluated. Results confirm the existence of heterogeneity in mucus evolution between cycles and women. Moreover, an important significant effect of a woman's age is found.