The Quantified Woman: Fertility tracking and the future of our reproductive health

Taking control of fertility in the age of connected tech
The Quantified Woman

Over the past few years, tracking our health, fitness and wellbeing data has become second nature for many of us. There's now nothing weird about bragging to your colleagues about how many steps you've taken or worrying that your heart rate tends to skyrocket whenever you have to talk to your boss.

One of the more interesting and fast-emerging parts of the quantified self-movement is fertility tracking and reproductive health. Admittedly, these are two labels that cover a whole variety of different things, but the focus is mainly on either helping you to prevent pregnancy or helping you to conceive. Of course, there are a whole raft of emerging wearable tech devices and apps for women once they get pregnant, but that's for a different feature.

Over the past few years, fertility tracking apps, like Clue and Glow, have been slowly evolving from souped-up calendars to holistic data centres. Instead of collecting a list of dates and filling our screens with pink butterfly designs, they are now smart, usable and effective; more recently employing the help of separate wearable devices to make data tracking even more accurate.

Most of the creators behind the solutions won't make bold claims that their offerings are guaranteed to stop you getting pregnant or help you to get pregnant. And yet it's implied that they can and there are many success stories from both sides to prove it.

The most obvious value in this new influx is that they provide women with more knowledge about their bodies, enabling them to feel empowered when it comes to their reproductive health and make more informed decisions. Aside from that there's the fact that they're all informed by a significant amount of scientific research, they're easy to use, the data they provide is actually useful and many are slowly starting to filter into the wider quantified health ecosystem.

And this final point is why fertility tracking tech made the news earlier this year, when Apple controversially left out reproductive health from its Health app dashboard. When it was then added later to an iOS 9 update, it seemed to cement fertility tracking tech as a valid health tool, more and more reproductive health apps made headlines and since then there's been a huge number of different offerings from small tech startups through to bigger, more established healthcare organisations.

We've decided to take a look at the current fertility tracking landscape, explore how accurate the data is and speculate about what the future holds for tech, apps and wearables designed to either prevent you from getting pregnant and help you to conceive.

The fertility tracking landscape

When we tweeted asking for comments on this topic, many were quick to point out that monitoring your fertility isn't new. Like, at all. Women have been using a variety of methods for years, most notably the FAM (or the Fertility Awareness Method).

We spoke with Dr. Helen Webberley, the dedicated GP for Oxford Online Pharmacy who has years of experience in reproductive health and fertility tracking. She told us, "Women have been using this so-called 'natural family planning' method for years - either as a way to know when to increase sexual activity and conceive, or as a contraceptive to avoid getting pregnant during fertile times."

So, it seems inevitable that new tech applications, greater insights and smart new wearable devices could bring this age-old method well and truly into the digital.

Right now the fertility tracking landscape is an interesting one. Most systems have a solid app with a great user experience and smart calendar tracking features that rely on you entering in your own data. This is precisely the kind of thing that's been around for years under a number of guises.

The most popular by far in this category is Clue. It's a fertility tracking app that has redefined what it means to track your periods — replacing twee, condescending images and language with a matter-of-fact app that now has hundreds of thousands of dedicated users. You have the freedom to simply input when your period is with functions right through through to tracking your mood, activities, medicines, body temperature, cervical mucus and all kinds of other physical health indicators.

A number of companies are taking what the likes of Clue are doing one step further, building tech that makes the data collection step even more accurate and infallible. One of the most accurate ways to do this is to track temperature.

This is because a hugely important metric in the FAM is Basal Body Temperature, or BBT (you can't get away from the acronyms when discussing fertility).

It's important because when women have finished ovulating, their temperature increases by one half of a degree to a whole degree. By keeping tabs on slight fluctuations in temperature over the month, it's possible to figure out when you're ovulating. This then tells you the best times to conceive — or not to.

There are a number of different ways to track BBT with Ayda choosing to gage temperature from a wearable on your inner arm and Kindara's zeitgeisty new thermometer, the Wink, behaving like a super high-tech oral thermometer.

The accuracy of fertility tracking tech

Although wearables are emerging that track some of the important fertility tracking metrics for you, most notably temperature, there's still a lot of responsibility on the individual to perform a whole host of tasks — such as tracking other metrics correctly, ensuring no environmental factors are influencing readings too much and so on.

Although none of the wellbeing tech companies mentioned in this article guarantees they have a foolproof method of contraception (Kindara claims it's 99.6% effective) or a foolproof way to get pregnant, we wanted to find out more about just how accurate they're intended to be.

For Clue to work well, it's all about the manually-entered data.

"Clue makes predictions for your next period, fertile window and PMS," Ida Tin, Clue's CEO and co-founder told us. "As you keep using the app, the more data you enter throughout your cycle, the more accurate Clue's predictions become."

And although accuracy is highly important to Clue, it seems that empowering women and helping them get to know their bodies better is the key goal for the team.

"We do not promise miracles or have bold claims about magical solutions. We want to present things realistically," Tin explained. "We hear all the time from our users that having a better understanding of their reproductive health leads to an overall feeling of wellbeing and self-confidence, which is ultimately what we want to achieve.

"We hope that the data collected using Clue will make meetings with doctors more efficient and more fruitful, encouraging better conversations between patients and doctors."

Tin raises a crucial point here. Some women will talk about their periods over the dinner table; others still feel embarrassed about talking to their own doctor. Empowering women, helping them to get to know their bodies better and putting the control and knowledge into their hands is something really special and not only is Clue providing this, it's also making them more comfortable with this kind of tracking. In theory this could make using the app habitual further down the line.

On the other hand, James Foody, CEO and co-founder of Ayda, warned that if it's accuracy we're after we can't solely rely on individuals to collect the right kinds of data — due to human error and the fact everyone is different.

"Given the fact that a major contributor to infertility is poor or lack of ovulation, these apps are of little or no use to women with irregular cycles or ovulation issues," he said.

"This can be incredibly frustrating for many women and even misleading for those being told they are ovulating each month when they may not be - particularly if they are trying for a child."

Ayda, a company pioneering a wearable thermometer that sits on the back of the arm to take skin readings, is still in development. But Foody is confident that removing possible errors is the best way to get the most accurate readings.

"The Ayda wearable was developed by a team of biomedical engineers to detect minute core body temperature changes and takes thousands of readings throughout the night," he explained. "By removing the potential for human error and introducing this level of technical accuracy, Ayda produces data that is much more reliable and clinically relevant than the oral thermometer method. Combined with the other tracking features in the Ayda app - the combined solution makes for an unparalleled level of fertility tracking efficacy."

Dr. Helen Webberley said that, when done right, fertility tracking can be incredibly accurate. And she also agreed with Tin, that building up a detailed holistic picture is more important than obsessing over the accuracy of one or two metrics.

"This is particularly true when a combination of the various required parameters are inputted: basal body temperature, nature of cervical mucus, position of the cervix, day of the cycle. With this information you can get a really good prediction of when you are fertile," she told us.

We were still intrigued as to whether a GP would say using apps is still a bit too risky, but Webberley was really clued up about the latest tech.

"I can't see any problems at all," she said. "It is not meant to replace modern medical forms of contraception, but to assist women who can't or don't want to use them. And as for using it to help with conception, apart from removing a bit of spontaneity from love-making on the 'fertile days', what can be wrong with being in tune with your body?"

The future of reproductive health

It seems clear that in 2105, the technology, apps and services claiming to track and manage fertility have good track records and legions of followers and fans. But we were interested in hearing what people think the future holds.

Ida Tin from Clue gave an enthusiastic but secretive response: "We want to empower people to be in charge of their reproductive lives while moving science and health research forward."

More specifically, Ayda's James Foody claimed that wearables would just be a short-term stopgap on the road to more accurate readings about fertility.

"The future of fertility tracking tech is not wearables - they are simply a useful stepping stone," he said. "The future of fertility tracking tech is app integration with more seamless and frictionless tracking techniques such as microscopic implantables or 'skinables'. At this point in time, continuous tracking and algorithm sophistication will bring fertility tracking to a point of prediction and prevention."

Dr. Helen Webberley's focus as a GP is on a more joined-up approach. She wants us to be able to collect more and more data points.

"In the future, I can see a time when hormone measurements, from urine testing and finger prick blood testing will be brought into the equation. This additional data, combined with body measurements, will make the analysis even more accurate," said Dr. Webberley. She believes that patients are becoming "increasingly comfortable" with using wearables and apps to track their health, what she refers to as the 'self health' revolution.

The main ongoing challenges are to make collecting information about so many different data points, at home, by yourself possible and accurate without being time consuming of off-putting for the average woman.

Sure, some of the wearables seem a little gimmicky, like the Ayda stuck to your arm, but it's all about getting more data and more accurate data and wrapping it all up in a holistic way that makes you actually want to engage with it — not be put off by readings that aren't accessible. After all, from Foody's bold outlook it looks as if fertility tracking tech won't remain on our arms for much longer but inside them.

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