The technology that helps women get pregnant

The take-away

  • With its ovulation tracker, Ava has helped more than 10,000 women become pregnant. It now hopes to expand its algorithms for use in contraception.
  • Experts are cautious. They recommend further clinical trials.

Soon after Lisa Falco began her job, she began sharing intimate details of her alcohol intake and sexual activity with her bosses. In many career tracks, it’s fair to say, this would be considered highly inappropriate. But Falco wasn’t starting on a normal career path – she had joined the Zurich-based fertility tracking start-up Ava, and the company was in urgent need of data from test users.

That was in 2015. The following July the company launched its first device: a wristband and accompanying app that can be used to assist conception by predicting a user’s monthly window of fertility. Since its launch, Ava has grown rapidly. The company has announced $30 million in Series B funding, reached a major milestone with 10,000 user pregnancies, and employs 80 people in Zurich, San Francisco and Belgrade.

A data scientist with a PhD in signal processing from the École Polytechnique Fédérale de Lausanne (EPFL), Falco is understandably proud of Ava’s progress. “When I joined the company, we didn’t have much data,” she says. “My work focused on signals, statistics and literature. Now we have enough users to work on ‘big data’ properly, using machine learning.”

Ava is not alone. Between 2013 and 2017, femtech (or female technology) start-ups raised over €850 million worldwide.

Fertile ground for innovation

Ava’s ovulation tracker is based on the fact that the best time to conceive is just before ovulation. Because internal body temperature fluctuates during the menstrual cycle, a daily temperature record is useful. Worn at night, the bracelet measures not only skin temperature but also resting pulse, breathing, heart-rate variability, perfusion, movement, bio-impedance, heat loss and sleep. All the data are synced with the app. The company is committed to ‘privacy by design’, meaning privacy concerns are considered at every stage of the engineering process. Consequently, data can’t be linked to user identities.

Recording relevant variables isn’t a new concept, but the ability to do so conveniently while sleeping is a major innovation. Over time, this data can be translated into highly personalised insights on menstrual cycles and fertility windows. “We were really the first company that tried collecting data across the whole cycle,” says Falco.

Shoring up the science

When it comes to accuracy, conversations around women’s health trackers quickly become complicated. Fertility apps can be helpful for planning a pregnancy, but not necessarily for contraception.

While Ava is conducting clinical studies to adapt its algorithms for use as a non-hormonal contraceptive device, more solid research is required. “One only has to look at the low number of people recruited for trials and the numbers lost to follow-up to realise that more work is needed,” says Cecilia Pyper, director at the UK’s Public Health Action Support Team. “Pregnancy outcomes of people who drop out of trials represents a significant reporting gap.”

Pyper is careful to commend Ava – as well as Dot, an app-only fertility tracker made by Washington DC-based competitor Cycle Technologies – for its efforts to invest in proper research. But she believes there are clear pathways to improving the science. “Companies need to focus on independent research, publication of their research design protocols and better strategies for avoiding loss to follow-up,” she says. Another key point is that, according to the UK’s National Health Service, over 80% of couples trying to conceive will do so in the first year, regardless of how they calculate fertility windows.

Myriad applications

Menstrual-cycle data has broader day-to-day use. Changes in hormone levels impact women in various ways, causing headaches and hunger, affecting sleep patterns and energy levels. Understanding how various symptoms are linked to the menstrual cycle can make some easier to manage.

Ava continues to invest heavily in clinical trials. “We’re involved in an exploratory trial at the University Hospital Zurich around diagnoses of infections in pregnancy,” Falco explains. “Beyond that, the amount of data we’re currently collecting opens the door to so many avenues of research for diagnosis or personalised treatment. We’re considering all of them.”