This Guy Got 200,000 Women Knocked Up*
I’m sitting on the 1 bus, cruising down Mass. Ave. toward MIT’s campus. The tech types around me are all staring at their phones, and so am I—but my interactions with my device are more personal than most. As I have every morning this week, I open the Ovia Fertility app and plug in some info about my weight, mood, and diet. But the app wants to know more. “What’s up, down there?” it chirps, inquiring about my monthly visit from Aunt Flo. I duck, trying to shield my phone’s screen from the gaze of my fellow passengers as I give the all clear.
This all started a few weeks earlier. My husband and I were discussing the possibility of trying for a kid, so I did what any type-A modern woman in America does: I downloaded an app. I’d already grown accustomed to tracking my diet and exercise on my phone, so it felt like a smart idea to have an app keep tabs on my ovulation window, too. Which is how I’ve come to this: typing intimate physical info into my phone on the bus.
I scroll down. Details about my cervical fluid can help me pinpoint when I’m most fertile, the app explains. And then it offers suggestions: Is it more like egg whites or school glue? Dear God, I have no idea. I pull my phone in close to my face as it prods me like a teenager at a sleepover. “Kiss and tell!” it urges: Did I have sex today? I swipe to refresh, and an animated sperm briefly appears, wriggling toward an egg. “9.0 fertility score!” the Ovia app announces on my screen. Each day, the app gives me a score based on how fertile I am. Ten is peak ovulation, but the app tells me nine is well within the go zone.
“Alert: Have sex today!” it tells me, and I grin at the absurdity of the scenario.
When I press save, Ovia transmits my info across town to the Techstars office in the Leather District, where the Boston-based company Ovuline claims to have helped more than 200,000 women conceive in less than two years. My data becomes a speck in Ovuline’s rapidly growing hoard, joining the millions of other stats Ovia has collected. This data, Ovuline claims, promises to not only help us better understand our monthly cycles but also provide greater insights into women’s health. And, of course, it also promises to make the company a lot of money.
Life tracking is big business, especially for women. In July, TechCrunch reported that women’s health apps raised more than $102 million in venture funding over the past year, more than all other health-focused apps combined. Period-, fertility-, and pregnancy-tracking apps are among the most popular, a telling trend that’s tied to rising interest in the quantified self. Based on government pregnancy statistics, Ovuline’s team estimates that at any given time, roughly two to three million women in America are trying to conceive. Today, about half of them are doing so with the help of a mobile app, and that number is growing. There’s also the blunt fact that anything pertaining to pregnancy is a gold mine for investors: Women who are tracking their fertility will soon make dozens of decisions about pregnancy- and baby-related purchases that add up to billions of dollars a year.
Companies like Target have used Big Data to lure newly pregnant moms into becoming loyal consumers. Pregnant women are fertile territory for brand marketers: By reaching a woman while she’s still in baby-making mode, they hope to capture a captive audience for a lifetime of parenting products. Some moms get squeamish at the thought of companies having that much insight into their lives: A Princeton sociologist recently spent nine months using the Cambridge-based anonymous browser Tor to hide her pregnancy from the Internet. But many others are using apps like Ovuline’s Ovia to harness their own data—in ways that may turn the women’s health market on its head.
Ovuline reports that user engagement is through the roof: More than a million women are entering their data into the company’s pregnancy and fertility apps at a rate its investors have compared to how often people play Candy Crush. The average woman will try for six months before she conceives; Ovuline claims that its users are conceiving within 60 days, on average. With their business growing exponentially, the company is reporting a user conception every two minutes.
With more than 250 million data points and counting, the company is engaged in what you can think of as the world’s biggest effort to track the health of pregnant women and those trying to conceive—ever. CEO Paris Wallace likes to say that the company may discover patterns and glean insights that would have been impossible for healthcare professionals to discern. In the press, he has speculated that collecting such a broad and rich data set could change the way we understand pregnancy and maternal health—that they might discover patterns that could allow parents to predict the sex of their child, or screen for the early onset of fetal distress syndrome. None of that has happened yet, of course. But the scale and scope of Ovuline’s sudden rise underscores how quickly we’re plunging into a thicket of moral and ethical quandaries related to Big Data.
After all, Ovuline was designed to help women conceive, but it was also created to make money. In July, the company announced a partnership with Amazon to begin selling products within the app. So an obvious question arises: Do I really want Jeff Bezos to know about my sex life?
“This is where the magic happens,” Gina Nebesar jokes as she welcomes me into Ovuline’s headquarters. She waves her hand toward the two long desks in Techstars’ offices where their dozen employees are stationed. (The company is planning to move into its own space downtown by the end of the year.) The staff is young, hip, and overwhelmingly female—they often wear T-shirts that read, “Let’s Make Babies.” Nebesar picks up one of the company’s unofficial mascots, a plush uterus complete with fuzzy ovaries, and then points to the entrepreneurship Barbie (with attaché case, business plan, and smartphone) that sits on a nearby desk.
Nebesar is in her early thirties—just like me—and heads Ovuline’s product development, meaning she’s the source of the app’s sassy voice and cheeky asides that I find so entertaining. She came onboard shortly after the company was selected to join Techstars’ highly competitive accelerator program in 2012. Since then, Ovuline has been funded directly by Techstars’ managing partner and CEO, David Cohen, along with the VCs Lightbank, LionBird, and LaunchCapital to the tune of $3 million.
“We’re in the baby-makation business,” Wallace says with a wink as we sit down to discuss the company’s rapid growth. (It’s one of his phrases.) Ovuline is actually Wallace’s second fertility startup; in 2007, he cofounded Good Start Genetics, which helps couples determine if they’re genetic carriers for disease, out of his dorm room at Harvard Business School. Over the course of five years, he raised more than $28 million in venture capital, then left to link up with two other Harvard grad students, Alex Baron and Vasile Tofan, who were toying around with the project that would eventually become Ovuline.
Baron and Tofan had a few things in common. They both hailed from Eastern Europe and were trying to start families with their wives at around the same time in 2011. But being hard-working, techy guys, they didn’t want to leave anything to chance. So they did what came naturally: They wrote an algorithm.
Simple apps to track menstrual cycles date back to the early days of the iPhone, but as any woman can tell you, no two periods are the same, and few women’s monthly visitors adhere to the textbook 28-day cycle. And because these apps didn’t understand the intricacies of irregular periods, they would often go haywire whenever the user’s cycle skipped a month.
The duo wanted to take a different approach to the problem, and build a responsive tool that would learn and adjust to cycle irregularities and incorporate health data on ovulation. “We looked at the clinical guidelines and anything in the literature that was related to fertility,” Baron says. Tofan and his wife managed to sort things out the old-fashioned way—those crazy kids got pregnant before they even finished writing the program—but Baron’s wife, Tatiana, used the algorithm and got results. Baron remembers feeling a rush of excitement about becoming a father, followed immediately by another rush: The algorithm had actually worked. Today in the Ovuline offices, they call Baron’s son the “Beta Baby.”
After Baron and Tofan partnered with Wallace, Wallace realized they needed some estrogen in the mix. So he brought in Nebesar, another HBS grad, who had worked as an engineer at Northrop Grumman before launching a company that sells clothing out of vending machines in places like Logan airport. (When Wallace wants to tease her, he’ll walk by and say, in mixed company, “Gina, I’m wearing your underwear today.” She’s gotten used to it. “I’ll be like: ‘It’s from my vending machine! It’s not mine!’” she says.) In addition to designing the interface, Nebesar has been instrumental in recruiting the female engineers and designers that now make up the bulk of their team.
Ovuline was accepted into Techstars in the spring of 2012, and launched the commercial version of Ovia Fertility at the end of that year. A sister app, Ovia Pregnancy, launched in November 2013. The apps are free, and many women segue directly from one to the next. They can also sync both apps with other life-tracking tools like Fitbit or MyFitnessPal, which transfer data about exercise or calories to Ovia. The company plans to launch yet another app to help new moms track their health and the health of their babies—joining a burgeoning market in life-tracking apps for infants. Already, startups such as Mimo and Sproutling are embedding sensors in onesies and creating teeny-tiny ankle monitors.
As we talk in the conference room, Nebesar explains that every time I plug in my mood (“frisky”) or describe my menstrual cycle (“heavy flow day”), the app’s algorithms get even smarter. Wallace says it is part of the app’s “virtuous cycle”: data is used to entice the user to enter even more data. “People also see the app learning about them and getting more personalized over time, so they want to give us all their information, because they know we might be able to give them better advice.”
This makes sense to me. As I’ve grown used to the app, I’ve found myself increasingly interested in tracking all the elements of my health—beyond mere calories or fitness—and noticing things about myself that I’d never put together before. Like how I always have a lousy night’s sleep before my period (turns out I’m not alone). Or how 23.6 percent of Ovia’s users get neck aches when they ovulate (as do I, apparently). I’ve realized that despite being an ardent feminist, there’s a lot that I didn’t know about the female body. Wallace tells me he gets emails all the time from women telling him that until they used the app, they had been trying to conceive during their periods (pro tip: not gonna work).
And in fact, Wallace says the app has become a kind of confidant. “I’ve probably talked to an infertile person or someone who had a miscarriage almost every other day,” Wallace says. “For many, many, many people it takes more than one try to have a baby…. It’s hidden away, you know? It’s not talked about.”
“It’s so sad, because you know a lot of people are going through this alone,” Nebesar says, and notes that they were the first app to enable women to enter information about their miscarriages if they happen. “I think a lot of the time people are so willing to share this stuff with the app because we’re the only ones that can talk to you.”
So what about the bigger ideas that Wallace has been telling the press, I ask, the idea that this data set that they’re collecting could enable us to better understand women’s health? So far, all they’ve published is a U.S. map showing the average number of days per month couples have sex when trying to conceive. Massachusetts couples, on average, get busy just over six times during their ovulation window (Idaho tops the list, with seven). But this isn’t really game-changing information.
Wallace tells me they’ve really only just begun to examine the data they’ve collected. “It’s really crowd-sourced research, right?” he says. “If you think about an OB, you know the most senior OB at a hospital, who has been practicing for 40 years, who has seen 5,000 patients, right? In a year, we’ve seen 500,000 patients who have shared 175 million data points with us, and we’ll never forget any of them.”
As Ovuline explores its mountains of data, he says, he hopes they can begin answering questions that, until now, have gone unanswered. “Is there a way to figure out that you’re pregnant before a pregnancy test will tell you based upon your physical symptoms or mood? Or is there a way to predict devastating pregnancy complications like preeclampsia earlier?… Our belief as a company, my belief personally, is that the answer exists. It’s just about getting enough data to get there.”
More important, Wallace tells me, Ovuline is creating an unprecedented longitudinal study of women’s health. “We can see a world in which we realize that what pill, what medication people were taking while they were trying to conceive has an effect on autism and their kid four years later on,” he says. “We’re going to be able to see with clarity what’s not been attainable up until now [in terms of] how these decisions may affect outcomes years and years later.”
That’s explosive talk, but it’s an idea shared by Adam Wolfberg, a local OB specializing in high-risk pregnancies who signed on to advise the Ovuline team after watching a presentation Wallace gave to local venture capitalists.
“I think that the number of data points Paris has collected from women across the United States and around the world is really unprecedented,” Wolfberg told me a few days after I visited the Ovuline office. “I suspect that there is no similar database on Earth that has that kind of granularity in terms of the sheer quantity of data points on what women are doing and how they are feeling. The opportunity to analyze that is exciting and very interesting.”
Wolfberg was quick to point out weaknesses in the data set—answers are subjective, and there are obvious “selection biases,” in part because the women using the apps are affluent enough to own smartphones and self-interested enough to want to plug their data into the app. “This is data provided by patients, when they want to and how they want to, and that limits what you can do with it,” he says. “But I think in terms of contributing to women’s health and contributing the public health practice of improving obstetric care, that there’s an enormous potential here.”
But the medical community isn’t the only population interested in these ever-expanding data sets. In my meeting with Wallace and Nebesar, they told me they’re inundated with pitches from companies who want to be there for the moment of conception.
Wallace said they try to maintain a “ customer-driven” approach to their corporate partnerships. Right now, that means they’re promoting products within the app, such as umbilical-cord-banking services or non- invasive prenatal testing, that they say align with their mission to deliver better information to women about their health (they’re also promoting Wallace’s earlier startup, Good Start Genetics). As for Ovuline’s recently announced partnership with Amazon, Wallace explained that their user surveys have indicated that their customers want product information—that as first-time parents they feel clueless about what to buy. So if a woman is running while pregnant, Wallace suggested their app might one day recommend a special jog bra to help limit her bounce. “We just want to help people make the best choices they can during this time,” he told me, “and fortunately those people want us to help them make it, and advertisers certainly are interested in working with them too.”
There’s a simple reason why Ovia has taken off in today’s generation of would-be parents, Wallace said: “There’s no better brand loyalty and trust that you can create in a customer than getting them pregnant.”
One morning while on vacation, I woke up and groped for my phone, as is my habit. After checking my emails and tweets, I pulled up Ovia to check my fertility score, and shook my head as I noticed it signaled that my menstrual cycle had already begun. Silly app, I thought to myself, correcting the data.
A few hours later I stood corrected. Silly me, I thought as I drove to CVS to pick up tampons.
I was obviously still adjusting to Ovuline’s insight into my personal life, and I wanted an outsider’s perspective. So I called Judy Norsigian, the executive director of the iconic Cambridge-based women’s health collective Our Bodies Ourselves. Within a few minutes of chatting, it became immediately clear that Norsigian wasn’t a fan of fertility tracking by smartphone—or of smartphones in general, which she sees as a risk to our health. She told me she’s concerned about the amount of wireless radiation women are exposed to each time they check their emails, snap an Instagram, or update their Ovia app. “We are in a sea of wireless radiation now that you almost can’t avoid,” she said. “I’m really struck by how many women are always right next to their apps, holding their phones within inches of their face.” I grimaced. Guilty as charged.
But more to the point, Norsigian told me that relying on an algorithm to get in tune with your body is counterintuitive. “There’s a lot you can do to gain fertility awareness without using apps, or without doing anything of the sort that’s now becoming a commercial entity,” she told me, and suggested that I read Toni Weschler’s ovulation opus, Taking Charge of Your Fertility. “That’s the kind of information women need. It’s perfectly adequate for understanding and for being more in tune with your body, following signs.”
I added it to my reading list—even though I have to admit that I’m not likely to be reading fertility tomes on the T any time soon, and the idea of wading into online baby-making forums gives me hives. In fact, I like the idea that my info might one day help us to better understand fertility in general.
But will it? Or are Wallace’s claims just hype? I posed the question to Nathan Eagle, who teaches epidemiology at Harvard, computer science at Northeastern, and is CEO of Jana, a company that works with global brands to deliver their apps to emerging markets. Eagle is also the coauthor of the new book Reality Mining: Using Big Data to Engineer a Better World, so I thought he’d be intrigued by Ovuline’s concept. But he sounded skeptical when I told him of the reported 200,000 pregnancies and how they’d been guessing at the potential secrets hiding in their data set, like how we might one day be able to better predict autism or the sex of a child.
“Oh my God, are they claiming this just to you, or publicly?” he exclaimed. I explained that these weren’t claims, but just some suggestions of what possible information might one day be gleaned from the data set. “Until they start publishing academic papers that are peer-reviewed about the predictive capabilities of the algorithms they’re using and applying to this data, it doesn’t merit a lot of attention,” he said. But then he started to change his tune.
Eagle began telling me about the moment, four years ago, when he and his wife, Caroline Buckee, an assistant professor at the Harvard School of Public Health, first learned that she was pregnant. “Immediately, the first thing I wanted to do was run probability distributions of miscarriage looking at how our probability changed each week,” he said. “It’s really difficult to find that data.”
The fact is, women are underrepresented in medical research, Eagle said. “Basically, white, old men and the diseases that get them are the diseases we know most about, and that’s a sad fact,” he said. I could hear the wheels turning in his head. “Okay, now I’m thinking you caught me a little off-guard. But thinking a bit more, I’m bullish on this; I think it’s a great idea,” he said.
Then he paused. “I would love to get my hands on that data.”
It was a statement echoed by other epidemiologists I spoke with across town, each of whom got excited in the way that only data scientists can when they hear about scads of numbers they could someday play with. But for the time being, Ovuline isn’t sharing its trove—at least, not with the medical community.
All of which leaves a lot of opportunity for Glow, Ovuline’s biggest competitor in the fertility- and pregnancy-tracking space. PayPal cofounder Max Levchin launched the company last year, and it now claims to have helped 25,000 women conceive. Glow has more money; in October, they closed a $17 million Series B funding round with support from Silicon Valley venture bigwigs Formation 8, Andreessen Horowitz, and Founders Fund. Glow also offers an innovative premium service that allows women to pay a membership fee, and if they end up having trouble conceiving, they can draw on that pool of funds to cover the cost of infertility treatments. And it has an edge in the research game: Their data scientists have been working with a San Francisco–based fertility physician, and in October, they presented a paper at the American Society for Reproductive Medicine’s annual conference drawn from the user-anonymized data.
Wallace and Nebesar said they don’t intend to publish any findings this year, as they’re focused on developing their next product. And Wallace told me he’s not worried about Glow. “Every day we’re adding a million data points,” he said. Ovuline is already so far ahead of everyone, data-wise, that he expects the company to stay on top.
And it’s my data that’s helping them get there. Over the past few months of using the app, I’ve come to terms with the fact that my partnership with Ovia is bound to have some tradeoffs. If it means giving up a bit of privacy for more insight into my health, I’ve determined I’m okay with that. It turns out I’m all for the idea that my data might help doctors better understand fertility in the future. And I know I’m not alone.
“What does the app say?” my husband asks coyly one morning as he sees me checking my phone. As I’ve gotten more accustomed to using the app, he has as well (though he hasn’t yet signed up for their email alerts, which would tell him exactly when I’m fertile). Through using the app, I’ve found that I like having a better sense of what’s happening in my body. Taking ownership of my fertility—even with the help of a digital component—is empowering.
I plug in the morning’s info and hit save.
“You are fertile!” Ovia concludes. “Now go get pregnant!”