It's 1957 and a new drug, Enovid, has been authorized in the USA for the treatment of severe menstrual disorders. The medicine, a mixture of synthetic estrogen and progesterone, lists suppression of ovulation as a side effect. In the couple of years that follow, previously unsuspected numbers of American women seek treatment from their doctors for severe menstrual problems; the 'menstrual disorders' market quickly comes to be worth over $37 million annually. In 1960, the FDA caves in to what is essentially a fait-accompli and Enovid becomes the first authorized oral contraceptive pill. Following protracted argument, its use is legalized for all Americans in 1972.
Fast-forward to 2016, and a clinical study on a promising new injectable hormonal contraceptive for men is halted early due to concerns over side effects. The list of side effects given in media reports of the study, and cited as responsible for its abandonment—including changes in mood and libido, acne, and weight gain—share more than a passing resemblance with those that female users of hormonal contraceptives are often, sadly, all too familiar with.
For the Baby Boom generation, the advent of hormonal contraception was a miracle. Its consequences were momentous—freed from effective slavery to their fertility, a generation of women were able to take up educational opportunities, forge careers and contribute fully to society and professions for the first time. Perhaps it's the fate of any truly revolutionary progress that within a generation, it comes to feel like no less than our fundamental right. So it is with fertility control—what was miraculous barely more than 50 years ago, is essentially taken for granted now (though likely less so after a Trump-Pence administration makes them expensive and hard to get). Many current birth control users start to take the pill in their teens, and continue to use it, or one of the other hormonal variants, throughout most of their adult lives. And yet many—including those who tolerate the pill without experiencing particularly debilitating side effects—are just a little unsatisfied with their current options.
But what, apart from springing for an IUD or settling for the sub-par experience of condom sex, can be done to avoid them? In this age of wearable technology, can we perhaps come up with something… better?
The Ava bracelet, launched this past summer, aims to provide a complete approach to menstrual cycle tracking. Ava is currently marketed to women trying to get pregnant, but Lea von Bidder, President and Co-Founder of Ava Science Inc, believes much broader applications are possible in the future.
"We're planning to add a ton of new services based on the existing technology," she says. "There are certain things we believe we can do with pregnancy monitoring: In the fertility area, we haven't done any research so far on PCOS [poly-cystic ovary syndrome], but it's something that's really interesting for us. And then finally, the Holy Grail for us, that we want to reach, is contraception. That's really where we want to go."
Contraceptive approaches based on detecting or predicting, and then avoiding, the fertile part of a woman's menstrual cycle have both a long history and a poor record. Because sperm can survive for up to five days in the female reproductive tract under ideal conditions, the most likely time for unprotected sex to result in pregnancy is in the couple of days before ovulation occurs. Ovulation detection itself is quite straightforward—it causes a rise of about half a degree Celsius in a woman's basal body temperature, so in theory all you need is a thermometer and a notebook—but unless your cycle is perfectly regular and predictable from one month to the next, it's pretty useless, since it occurs several days into the 'danger' period, and after peak fertility has passed.
Ava isn't the only start-up working in this area. Prima-Temp, developers of the Priya Ring (previously called the Bloom ring)—an intravaginal near-continuous temperature sensor and app marketed as a fertility aid and due to launch in the spring of 2017—are also interested in alternative applications. Other gadgets such as the Lady-Comp range of temperature-logging computers are also jostling for a place in the market, and are already making contraceptive claims, though outside the US.
"Non-hormonal birth control is already an option, but for women doing it it's still very risky with the temperature method [in terms of unplanned pregnancy] but that's their choice," says von Bidder. Data suggest that a within a group of 100 women using traditional fertility-awareness techniques of birth control for 10 years, 94 women would experience at least one unplanned pregnancy. That's two more than using the withdrawal method. "To some extent that's always going to be the case – it's never going to be completely risk-free, but it's going to get so much better that at some point it's going to be an actual alternative."
Using a combination of temperature monitoring, heart rate monitoring, accelerometery and bioimpedance (body composition) measures based on clinical trials carried out by the company, Ava currently claims to detect the start of the fertile window earlier than alternative techniques that use urine testing strips, identifying an average of 5.3 fertile days with 89% accuracy.
"We could do non-hormonal birth control now, but we'd be saying to women Yes, use Ava, but we have to block you 15 days in your cycle, to have fifteen days as 'possibly fertile.' You can only be a real alternative to hormonal birth control when you have a high accuracy and only a very limited time period that you have to block out with condoms or alternatives.
But von Bidder feels that the time is right for alternative approaches. "I don't think it's going to happen in the next one or two years, I think it's going to take a little longer, because it's a huge thing. But I personally really believe we will," she says. With continuing research and developments in wearable technology, it seems very likely that the fertility-risk window can be narrowed so that the inconvenience of abstaining or using barrier methods is minimized.
"I think hormonal birth control will still be around, for a long time," she says. "But I think there are more and more women looking for alternatives. What I've seen is that women have started to become a lot more conscious that they have a menstrual cycle, and that it might affect them. As more women become more conscious that it's important, that it might change things if they understand it better—I think that's a really interesting movement."