Ovulation prediction is messy and difficult. It should not be


Every morning, I pee in a cup. Before I do anything else—pick up my toddler daughter, pet my dog, even fully open my eyes—I collect a sample of urine, soak a cotton swab in it for fifteen seconds, put the swab in a machine, and wait five minutes for a beep.

Nothing can make you more obsessed with science and technology than the biological imperative to reproduce. And nothing makes the execution of that imperative more difficult than your own body. For the first two weeks of the menstrual cycle of a woman’s ovaries grow an egg. If the egg is ripe, it leaves the ovary and goes through the fallopian tube to the uterus. This process is known as ovulation.

You are the most fertile in the two to three days before ovulation. However, points out that window is a difficult and, OK, sometimes gross affair. Methods such as my fertility monitor or the ovulation predictor kits rely on the detection of estrogen and the luteinizing hormone in the urine. A sudden rise of LH triggers ovulation.

Many women find themselves in a stick-to-pee frenzy, the timing of bathroom breaks at work to try to catch that elusive LH surge, which can occur anywhere from 10 hours to 8 hours after day 10 of your menstrual cycle.

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Other methods, such as taking your basal body temperature, means that you need to buy a special thermometer and take your temperature at exactly the same time every morning, before you’ve even gotten out of bed. An increase of BAT-signals that you have ovulated. But you can only see rise after you have ovulated, and not earlier, which defeats the purpose. And of course, there is my urine-swab of the machine, the fertility of the monitor, which uses your first morning urine in the course of a week or two to detect the LH surge—and good luck if you forget and go to the bathroom to collect a sample.

The Centers for Disease Control and Prevention reports that one in eight couples have problems with setting up or support of a pregnancy due to age, health or other factors. That means that the market is wide open for something that will make the technology of this annoying, anxious process a bit further into the 21st century. Apps such as Glow and Apple’s own Reproductive Health kit in iOS easier to register, visualize, and collect large amounts of data.

But also for each individual user, these applications in the form of an advance in ovulation prediction is if the purchase of a FitBit that requires you to count your steps manually. I was more interested in the search for devices that the process of collecting data easier.


One of the most exciting developments in that direction this year with the release of the Ava bracelet, also known as the “fertility FitBit.” A team of researchers, which includes data scientists, wearable tech experts, and a medical advisory council, studied the existing literature on the changes that the estradiol (a form of estrogen) and luteinizing hormone fluctuations of precipitation in the body when you ovulate.

The Ava team developed a sensor that can record data from nine different parameters, such as temperature, pulse rate and heart rate variability when worn in the course of a night. An algorithm uses this data to predict the five most fertile days.

A year-long clinical study at the University Hospital of Zurich, confirmed that the team’s findings that the Gms is 89% accurate in predicting five fertile days per cycle, but with a sample of 41 women in the course of the year, it is hardly convincing.

The research team is currently conducting another, larger study, 200 women over the course of six months to further fine-tune the algorithm, and the adding of more data use-cases. But despite the fact that they still do not publish their research (they have presented the Swiss and German OB-GYN conferences, and the American Society of Reproductive Medicine), Ava’s current two – three months on the waiting list speaks to the need for a device like this.

“For us, the convenience is important,” said Ava VP of data science Lisa Falco. “[Ava] also responds to earlier. You may be a little more relaxed.” The measurement of nine parameters also makes the Ava’s predictions more robust, instead of relying on a urine or temperature of the test, which makes use of a single measurement.

After the testing of the Ava for two weeks, I can testify that it is much, much easier to use than a fertility monitor or OPKs. You don’t have to put off the use of the toilet within a certain time, or manually recording data into an app. Instead, take the bracelet in the morning, plug it in next to your iPhone on your ease, and the wireless sync within a few seconds.

The Ava’s a big disadvantage is that at the moment, it only works for women with regular menstrual cycles between 24 and 35 days. Women with irregular cycles or with polycystic ovary syndrome would see little benefit. “This is where we want to get stronger,” says Falco.

Signs of life

Another device that was released this year, the Knowhen, is effective for women with irregular cycles, or medical conditions. The Knowhen is a pocket-sized microscope that detects ovulation through a process called ferning.

Each morning place a drop of saliva on the lens. After it dries, you look at the pattern through the microscope. The rise in estrogen that precedes ovulation also leads to an increase of sodium chloride in your saliva. When you start with the ovulation process, the salt crystallizes in a notable sail pattern visible through the lens.

“I am convinced that infertility is not an epidemic. It is a lack of knowledge,” said Helen Denise, Knowhen founder and CEO. “Sometimes I meet women who say that there is something wrong with the microscope, that they never see the ferning. It is not for the microscope. It’s you. If you are [polycystic ovary syndrome], or a thyroid problem, we can help you find the cause of the still earlier, a doctor in the time ‘ before spending months in fruitless attempts at conception.

People have ferning microscopes for a long time, but Knowhen is a product that hopes to make the technique more accessible. Placing a drop of saliva on the pocket-size lens and wait until the dry is an easier and slightly more sanitary method of testing than pee in a cup while still half asleep. Timing is also less of a problem. But the Knowhen is also susceptible to user error. You should not forget to make use of a spit drop first thing in the morning, before eating or drinking. Not to clean the lens in advance, or using a spit drop that call, can also confound the results.

We are By

What is clear is that, although a large part of the market is focused on the improvement of the access to reproductive technologies such as in-vitro fertilization and egg freezing, is there enough of the room in a different fertility of the technical area.

In an era where a nice waterproof watch can be seen on our light and deep sleep cycles and receiving texts, it is absurd that so many women rely on the technology of the 1970’s for such an important, intimate process. Even if you discount the financial gains, there are other enormous rewards.

“We had this really big success story from one of our users,” Falco said. “According to the calendar method, they would not have taken place in the fertile window. They used the Gms, a day earlier than she thought, because her husband was going away, somewhere. We realized [she was pregnant] before her husband did.”

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