It's all tampon adverts' fault. OK, we're being facetious. But it seems they have a lot to answer for. Lea von Bidder, co-founder of Ava, has studied the recent history of women ignoring their hormonal and menstrual cycles and it's something she wants to help to reverse with the conversation around her company's new fertility tracking wearable.
"We're trying to increase body awareness," she told us, "and let women track their hormonal cycle which we have ignored for the last 50 years. There's more women who wait a year or two and lose valuable time versus women using other tech in the space."
Which brings us to the tampon adverts.
"We've been ignoring women's health for so long. My best example is tampon commercials. It's this happy woman, wearing white pants, not realising she has her period, kissing that boy and going to the party. We have grown up with the idea that our menstrual cycle is something we ignore. We make fun of women who are influenced in any way by their menstrual cycles.
"Now we're helping the trend of talking about it more by having this conversation. It's going to get better and better, the more socially acceptable and the more lifestyle like we can make it." Starting the conversation is one thing but can Ava deliver on its headline-grabbing set of ambitions?
The headline, based on a clinical study at the University Hospital of Zurich, is that makers of the sensor packed $199 Ava bracelet claim it can detect 5.3 fertile days in a women's menstrual cycle with 89% accuracy. And that this can double the wearer's chances of conceiving each month, compared with no tracker at all and trying once a week. Bold claims indeed. There's a few particularly interesting aspects of how Ava is going about trying to upend the fertility space.
Firstly, there's a push away from purely focusing on basal body temperature (BBT), the current trend in fertility tracking tech. According to von Bidder, citing a British Journal of Pharmacology paper, only 11% of women experience a rise in temperature within one day of ovulation.
Ava claims it can detect 5.3 fertile days with 89% accuracy
Ava, which is worn only at night to get base readings, is designed to measure a whole host of other parameters to feed into its algorithm: resting heart rate, skin temperature, heart rate variability, sleep, breathing rate, movement, bioimpedance, heat loss and perfusion (supplying blood to tissue).
Second, the Ava app tried to present this mass of data as simply as possible. The companion app - iOS only for now with Android coming - has a violet background most of the month which turns pink when you are in your high fertile window and green in the peak fertile window.
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"We have an unbelievable amount of data and we put it back into three colours," said von Bidder with a laugh. "We gather so many health insights, we thought we might as well show it to people so for instance we show you your HRV ratio reflects stress. There's also a connection to getting pregnant. As soon as you have measurable stress i.e. not just I'm busy today, it does have an effect. Your body wants to prevent you from having a baby at that time."
It can reduce the female tax of being a woman trying to get pregnant
As for the benefits to the user, at least from Ava's beta testers, some women want to learn more about their body's changes, some are fed up of alternate methods and some just want to get pregnant. "We've made tracking easier and more effortless for women, it fits into their life," she said. "There has also been a lot of conversation about how it reduces the female tax of being a woman. Whatever we can do to reduce that is great.
"We detect ovulation and the fertile window so much earlier and this also gives women so much more time in their cycle. So we had one woman who said: 'This is the first time that but I can choose to watch Netflix all night on a fertile day because I know I have four more afterwards. Before you had to text your husband and say 'You can't watch the game tonight! You have to come home!"
The real question is - does Ava have real, independently validated science to back up its claims that its platform can predict fertility based on the values it is measuring? The answer. Almost.
Ava's one year Zurich clinical study has been presented at the Swiss Society of Obstetrics and Gynecology Annual Congress and it will be presented at similar conferences in Berlin and Salt Lake City later this year.
But what many in the know will be waiting for is the peer review: von Bidder tells us that Ava is confident to have its findings published in a leading, peer reviewed journal on reproductive health by the end of 2016. These things take about six months between submitting the research paper and publication which explains the wait.
"From all of the initial research, we knew what we had to be looking for," she said. "We knew what would probably be the parameters we could look for but again, the studies that goes back to are sometimes a little shaky. Then we decided to put those sensors in a device, went into a clinical study and then said: 'We think that works'. We were very lucky that it did."
The background of the co-founders holds Ava in good stead too with previous form in wearable tech, sensors, med tech and tech manufacturing.
The Ava bracelet is FDA approved in the US, not something that every health wearable can claim. That said, it's worth noting (and Ava makes no attempt to hide) that it's Class One approved which is low risk and therefore subject to the least regulations compared to say, a Class Three device such as, for instance, a heart valve.
Regulations, and resources, are the reason that women and couples in the US trying to get pregnant in the US have only a four to eight week wait but the rest of the world will have to hold on for another six months.
"We are looking at Europe and my current estimate for Europe is the end of 2016 or beginning of 2017," said von Bidder. "I'm not sure if that's confirmed but it will be soon with the CE market. The question is also one of our resources."
A tech contraceptive?
Ava has already sold "quite a lot of pre-sales which need to be fulfilled" and is planning a second clinical study looking into monitoring pregnant women. It makes sense as this is a group who may already own an Ava. It's also a time when, no matter your previous views on the quantified self, women tend to be very interested in their health data. So much so that some testers were loathe to give their units back at the end of the study.
"You're so body aware so you start to really analyse every little thing your body does. We know you heart rate goes up and up, for instance, it's super interesting.
The other area that von Bidder is very intrigued by is contraception. Ava is categorically not a contraceptive, the team have taken pains to be very explicit about this. But that doesn't mean it won't be in the future.
"The Holy Grail is contraception," said Ava's co-founder. "That's my personal wish of where I want it to go. We can't really say yet how accurate we're going to be. We're really not there yet.
"It's not going to be a contraceptive for the typical 16 year-old who goes to party all the time. But it's definitely going to be a contraceptive for women in between their first and second baby when they don't want to go back on hormonal birth control. Or for the two years before you start trying because you need to start regulating your cycle."
If and when Ava gets to the point it can recommend a device as a tech contraceptive as well as a fertility tracker and pregnancy health monitor, that could really shake up women's relationships with their bodies. Ignore less, understand more.