Get pregnant… or don’t!

Fertility apps help with both

Women have found a novel use for fertility apps: turning them into a new form of birth control.
Media for Medical, UIG via Getty Images

by Katie Collins, Feb 20, 2017

Recording basal body temperature at the same time every day is a key part of the fertility awareness method.

Bekkie Morgan wakes up at 7 am everyday, takes her temperature with a standard oral thermometer, enters it into fertility app Kindara and promptly rolls back into bed.

Morgan, however, isn’t trying to get pregnant. She’s actually using Kindara as a digital age form of birth control.

As apps increasingly do everything from ordering our food to hailing us a cab, they have also in the last few years gotten far more intimate with programs like Kindara, Natural Cycle or Glow, which track a woman’s cycle to help them conceive. But now women have figured out that the same algorithm that tells you when you can get pregnant can just as easily tell you when you can’t.

“We certainly understand there’s a huge market out there,” Kindara CEO Ira Hernowitz said in an interview. “We know what they’re doing, and there is really nothing more for us to add [in terms of features].”

Take Morgan, who got into a new relationship a year ago, but decided that she didn’t want to use hormonal contraception. She found out that Kindara could be used as contraception on a website when looking for pill alternatives online.

“I started to dig more into it and I found that there were these apps that you could get,” she said.

The app may be modern, but the method isn’t. The thinking is based on a natural form of birth control called the “fertility awareness method.” It’s been around since 1930 and is endorsed by Planned Parenthood.

But it’s not for the scatterbrained, requiring even more vigilance than remembering to take the pill every day. The app might do the heavy lifting, but it requires you to be on the ball with taking your temperature on time and entering the data.

It’s also something that you shouldn’t jump right into — the Family Planning Associations recommend consulting a specialist and Planned Parenthood points to a number of courses couples can take if they don’t fancy doing the reading. You’ll also need to be willing to use barrier methods or abstain from sex altogether on fertile days.

How does it work?

Apps like Clue, Ovia and Kindara help women by letting them track their menstrual cycles, body temperature and changes in the cervix. The goal is to identify the short, monthly fertile window. The more data you enter, the more accurately the apps can determine the ovulation date.

“At some point, if you’re going to get pregnant, you’re going to have to track your cycles to find out when you’re ovulating,” says Dr. Joyce Gottesfeld, an ob-gyn at Kaiser Permanente Colorado. The 17-year veteran is accustomed to patients bringing her phones armed with fertility cycle data. “It helps me get a complete picture of what’s going on.”

Companies are starting to see the opportunities on the contraceptive side.

Natural Cycles, conducted two clinical studies over the past two years to prove the app works as birth control. The more recent one, published in March, showed that the app was as good at preventing pregnancy as the pill, as long as couples abstained or used barrier protection when the woman was fertile. Natural Cycles conducted the tests, and is seeking external verification.

Natural Cycles will recommend you turn to other contraceptive methods if your body stats show you’re fertile.

“There are lots of women and men out there who are not satisfied with the current available options,” said physicist Raoul Scherwitz, who created Natural Cycles with wife Elina Berglund.

Last year, it became the first health app for women to be regulated as a medical device and to be given a CE mark — the European equivalent of approval by the US Food and Drug Administration. At the beginning of February, it became the first app specifically to be approved as a form of contraception by TÜV SÜD, an international independent body for testing and certification.

Kindara, meanwhile, doesn’t market itself as birth control. A vast majority still use it to get pregnant, and the company hasn’t added any features specifically to support its use as a contraceptive — everything a woman needs to practice the fertility awareness method is already built in. But it does give women the option to report whether they are trying to conceive or prevent against pregnancy, and this self-reporting feature has allowed the company to understand more about women’s reasons for using the app.

User beware

The results of the fertility awareness method and of Natural Cycles’ study sound compelling, but like all birth control, there are no guarantees that if you don’t follow the instructions vigilantly that you won’t get pregnant. This means being fastidious about collecting and inputting body temperature at exactly the right time every day.

“The error would be to think I’m putting this information into an app so I won’t get pregnant — there’s more behind it,” said Morgan, who spent the recommended three months using Kindara and reading up on the method before relying on it completely. “The app isn’t a condom.”

One problem is that many of these apps initially establish a woman’s fertile window using generic calculations. Clue, Ovia, and Kindara, for example, take the average luteal phase (usually somewhere between 12-16 days) and subtract that from a woman’s cycle length.

The apps continuously adjust the fertile window as women track their cycles over time, but those with irregular cycles could miss their window for months before realizing the math is off. This can be especially hindering for women whose timing isn’t the only part of the equation.

As a result, the method requires diligent monitoring, which is why teenagers and young adults should stay away.

And while Natural Cycles conducted two tests, more are needed. “We’d like to see large-scale, independent trials taking place so that women are able to make an informed choice about whether an app is right for them,” said Bekki Burbidge, head of communications and digital at the UK-based Family Planning Association.

It’s important not to confuse apps like Kindara and Natural Cycles with simpler programs like Clue that just track your period and suggest windows to conceive, but don’t provide a scientifically calculated picture of your fertility. “If an app only monitors your cycle length it’s unlikely to be able to tell you accurately when your fertile days are, putting you at risk of pregnancy,” she added.

The app should use a wide cross-section of data like basal body temperature and cervical fluid reports to accurately predict safe and unsafe times to have sex. “We have over 50 custom indicators that women can use, and what happens is the more women use it the better it gets,” Hernowitz said.

For Morgan, observing these indicators have done more than help her avoid getting pregnant — they’ve also taught her things she never knew about her own body. “It should be something that we learn in school,” she said.