Wednesday, March 23, 2016

‘Fitbit For Your Period’: The Rise of Fertility Tracking

Will Sacks did not plan to go into the menstruation business. When he travelled from Toronto to Reno to attend his first Burning Man festival in August 2009, he only knew that he needed a change. At the age of 29, he was having a personal crisis. “I had forgotten that I wanted to be an entrepreneur,” he told me earlier this year. “I had forgotten that I wanted to create a company that could put a dent in the universe.” He quit his job as an energy efficiency consultant, shut down the small online business he had been running on the side, and booked a plane ticket to the desert.

Before beginning the drive to Burning Man from Reno airport, Sacks posted a message on Craigslist offering a ride in his rental car to anyone who needed one. A young woman named Kati Bicknell answered. Petite and pale, with thick brown hair, Bicknell looks like she stepped out of a pre‑Raphaelite painting. She exudes an intense, slightly mischievous, energy. Sacks comes across as calmer. He locks eyes when he talks to you, pausing every few sentences to check in: are you still with him? Does his optimism sound naive?

Bicknell had flown to Reno from New York, where she had a job at TED Talks. The drive to Burning Man became the beginning of a shared mythology. After the gathering ended, Sacks and Bicknell dated long distance, taking overnight buses between Toronto and New York. One weekend in November, they found themselves having “the birth control conversation”.

“We had been dating for three months,” Bicknell told me not long ago. “He said, ‘I don’t love wearing condoms and I was wondering whether you would be willing to go on the pill.’ I said … ‘No!’”

“I was relatively unenlightened at that point,” Sacks conceded, “and Kati got pissed.” Bicknell thought it was “bullshit” that the burden of birth control always fell on women. She suggested that her boyfriend get a vasectomy. Sacks balked. Then she brought up an alternative he had never heard of: the fertility awareness method (FAM). Fertility awareness involves regularly tracking certain physiological signs in order to determine when a woman can conceive and when she cannot.

Bicknell had always taken a strong interest in fertility. Her mother was one of over two million American women fitted with the Dalkon Shield in the early 1970s, a defective intrauterine device that caused hundreds of thousands of patients to suffer infections, miscarriages, and other serious problems; Bicknell grew up hearing how hard she had been to conceive. Ever since she began menstruating at 11, Bicknell had experienced highly irregular periods. No doctor ever investigated why; they simply put her on the pill.

In her 20s, Bicknell became concerned that the “fake period” the pill gave her every 28 days was masking a health problem that she should know about. A roommate gave her a copy of a book titled Taking Charge of Your Fertility, by a nurse named Toni Weschler. It is the bible of the fertility awareness method. By the time she met Sacks, Bicknell had already been practising it for three years.

“Fertility charting is this thing I’m already doing that can be used to prevent pregnancy,” Bicknell told Sacks that night in November 2009. “It’s just the kind of cool, nerdy thing you would be super into.” As she explained how it worked, Sacks became more and more stunned by his own ignorance.

“I had an engineering degree and thought I knew everything,” he told me. “I was blown away. On the one hand I was shocked and dismayed that I had been under this totally false understanding of how women’s bodies work. On the other, I was like, ‘Wow, there’s a side-effect free, hormone-free, form of birth control.’”

“This is a technology that can change the world,” Sacks thought. Bicknell agreed. That winter, they decided to ditch their jobs and move to Panama together. They rented a house near the ocean, took freelance gigs to pay the bills and spent the rest of their time in a hammock, poring over scientific studies and beginning work on their business pitch. When they returned north, they filed preliminary patents for an app that would make it easier for couples to practise fertility awareness.

They did not know how hard it would be to translate their ideas into a company. “We had no idea what we were doing,” Bicknell recalled, “and we didn’t even know it.”

In 1990, Carl Djerassi, one of the biochemists who created the oral contraceptive pill, predicted that the invention that had made him rich and famous could soon become obsolete. In an article in Science magazine, Djerassi explained that recent advances in his field had made it possible to track changes in blood hormone levels simply by taking samples of saliva or urine. This meant that, using simple cheek swabs, women could accurately predict the days when they could become pregnant. If they did so, taking the synthetic hormones that he had developed would become unnecessary. But Djerassi thought it was unlikely that fertility tracking would replace the pill. Why? Powerful pharmaceutical companies had a huge interest in pushing the pill. As for tracking, nobody had figured out how to make money from it.

For around 20 years, nobody did. But today, the market in “smart wearables” is booming. Biosensors connected to phones and other mobile devices make it easy to record, store, and analyse data about your body and behaviours. Apart from “activity trackers” – which record information about how many steps you take each day, how many stairs you climb, calories you burn, and so on – fertility trackers are the most frequently downloaded kind of health app in the Apple Store.

Fertility awareness apps have an enormous potential market: women from puberty to menopause. The industries that they could disrupt are huge, too. A 2013 study by Transparency Market Research estimated that in 2018, women worldwide will spend $23.3bn on contraceptives. Americans also spend $5bn a year on assisted reproductive technology treatments – at least some of which fertility awareness advocates say they could avoid, if they and their doctors paid closer attention to their bodies.

by Moira Weigel, The Guardian | Read more:
Image: Bratislav Milenkovic