Ava Bracelet-All Your Questions Addressed with Lindsay Meisel – #23

0:26 Charlene Lincoln: Hi! Welcome back to another episode of The Fertility Hour. Before I forget, because if I don’t say this in the beginning, I’ll get caught up in the interview and not ask you to please supports us by subscribing. Also, I don’t know if you’ve ever been to our website. It’s called Fertilityhour.com and there you’re able to download a free report and I think it’s titled How To Restore Your Fertility Naturally – a wonderful report written by my podcast partner, Dr. Iva Keene of Natural Fertility Prescription. So head over there and download the free report.

Today, I’m really excited. I have Lindsay Meisel of Ava Women (is the name of the company). People know it more and it’s just getting a ton of buzz for the Ava bracelet. So let me introduce Lindsay and we’ll talk about the new technology that’s come out in 2017.

So Lindsay Meisel is a science editor and head of content for Ava, a cycle tracking sensor bracelet that uses new technology to precisely detect a woman’s fertile window in real time. She writes and edits The Ava World Blog covering the latest medical research about how the menstrual cycle impacts every aspect of health beyond just fertility, along with conducting Facebook Live user chats. Welcome, Lindsey.

Lindsay Meisel: Thank you so much for having me.

2:07 CL: Welcome. So I’ve been doing some really, really deep research on Ava, and that means going and watching random YouTube videos of people talking about it and going to fertility blogs. Because I did go on your website and I wanted to become familiarized with the Ava bracelet, but also kind of wanted to go in and see what the chatter was about. I think it’s funny on the internet. There’s people that have never tried something and they’re the ones that have the most to say and the biggest opinions about something, ironically. So you kind of have to dig through a lot chatter and misconceptions and questions. But, I mean, the takeaway was that women are really, really interested in this. They’ve heard a lot about it but there’s questions, so I’m hoping to debunk some of the myths and get to the real facts about it and see how this can benefit us.

LM: Yeah, definitely. And this is my favorite topic to talk about so I’m happy to debunk myths and share a lot more background.

3:17 CL: Okay, cool. You can find out more about Ava at Avawomen.com. So first question is, why was the Ava bracelet created?

LM: One of our founders, he and his wife were trying to get pregnant and she was using the temperature method to track her cycles. He had a background in sensor technology and data analysis and algorithm development. and he just looked at his poor wife waking up early every morning and sticking a thermometer in her mouth and the alarm going off, and he’s like, “there has to be a better way.”

So that was kind of the genesis story of Ava. What eventually happened is he gathered together a few other founders, people who had medical backgrounds and developing a hardware product background and more people in sensor technology. The first thing they did before a product was launched, was put together a clinical study and the goal was, well, if temperature changes so drastically during the menstrual cycle, and the big downside of temperature is that it only changes after ovulation when it’s too late to get pregnant, there must be other things that we can measure since sensor technology has advance so much in recent years. With the FitBit and the Apple Watch, there’s so many more things that we have the capability to measure.

So no one had ever really looked at the menstrual cycle continuously and how everything that we are capable of measuring changes during the different phases of the cycle and they honestly just said, “Let’s just look at everything we can and I bet we’ll find something else that changes.” They didn’t go into it knowing what they would find. So they put all of the sensors they possibly could on a device and they recruited a group of women, had them wear it every single night during their cycles while they slept. They found quite a few correlations enough to make the Ava bracelet. And while we’re working on publishing, the whole scientific publication process takes a while but we’ve already published the results of one of the most exciting findings which is resting pulse rate which changes just in the same way that temperature and progesterone follow a similar pattern, resting pulse rates and estradiol follow a similar pattern. That’s the nice thing about something that follows the estradiol pattern is that it changes before ovulation in most women about five days before. So that was just a really, really groundbreaking finding that’s offered obvious huge advantages for women who wanted to get pregnant because you have advanced warning of ovulation.

6:03 CL: That’s pretty cool. Because when I was trying to conceive, I also was waking up at the same time every day and tracking the temperature. I’m a big fan of that but also, a lot of the feedback is women go, “That’s really hard” or “I couldn’t sleep the night before and so I know that that’s going to throw it off” and things like that.

LM: When you know you’re going to test and you’re like, “Oh my God, is my temperature going to go down this morning?” It definitely gives you some anxiety.

6:34 CL: Exactly. And so the other things, like you were talking about the resting pulse rate, because this is just feedback that I’m getting from when I was on the forums and I was kind of joking about doing the deep research by watching a bunch of random YouTube videos. But women were saying, “But it doesn’t allow tracking of the cervical mucus.” And there was something else that they were saying. So, does it compensate for that by being able to test for other data points, I guess?

LM: Yeah. So I can definitely speak to that. So it tracks 9 different physiological parameters and the idea is that it’s by using a multiparameter method to detect ovulation, it makes a more robust detection of the fertile window and ovulation. Now, I’m a huge, huge fan of cervical mucus tracking. I love tracking cervical mucus and I think that the more women are tracking all kinds of things, the more data they have. The better, why not? Just why couldn’t Ava have a way of taking other data that women might have into account.

So, it’s a two-part answer. Number one, we do have a way in the app that if you track your cervical mucus, if you’re taking OPKs, if you just want to log any other symptoms, if you have ovulation pain, if you have cramping. You can log all of that in the app. There’s a way to store that and see it and see patterns in it. But we don’t take it into account in our algorithm. The reason why is that the whole idea of Ava is that it’s something that does this work for you and so that if we require the algorithm to work optimally, it wouldn’t do that unless you gave it cervical mucus data and OPK data, that would kind of defeat the purpose of Ava and I think even more importantly than that, there’s so much subjectivity in the way that people interpret their cervical mucus. In the way that even in OPKs which in theory seem like, okay they give you a positive or a negative result. But the LH surge can be really, really different lengths in different women. Also, when you ovulate, how long from when your LH surge begins ovulation happens. That varies. It could be as short as I think around 12 hours up to 36 hours. So it seems like, oh, we should just be able to enter all that data into Ava and it makes your predictions even better. But it’s really not that simple.

9:09 CL: Okay, I understand. One thing is with the ovulation predictor kits, and I think that I can be wrong but what I was told that as you are mature, that they can’t predict that you’re actually ovulating. It’s predicting that you’re having the LH surge, so that’s another thing. With Ava, you can actually confirm that you have ovulated by all the data points that it’s –

LM: Yeah. I mean, I like to think of it as there’s signs related to estradiol, estrogen and luteinizing hormone. Those are all signs that your body is preparing to ovulate. Most of the time it does but that’s not a guarantee. And then there’s signs that confirm ovulation and those are really due to progesterone. The estrogen and LH signs are never going to confirm ovulation; those are pretty ovulatory signs. So women have to do this triangulation of different methods – cervical mucus, OPKs, temperature – in order to have this complete picture of their fertility. I think if you’re doing all of that work and all those different things, then you can sometimes get, I mean, it’s a full-time job but you can get a pretty decent idea of what’s happening in your fertility. So Ava builds that, all of those different signs into one device that’s not work for you.

10:26 CL: I was reading that some women who are using the Ava bracelet, somehow they came up with that it takes a few months for it to calculate the data and actually be accurate.

LM: You can start wearing Ava at any point in your cycle. If you start wearing it the day before you’re going to ovulate, obviously it hasn’t had much time to collect your data. It might be accurate on your very first cycle but chances are, it needs a little bit more time to collect data if you start wearing it on like day 14 of your cycle. If you start wearing it while you have your period or close to the very beginning of your cycle, for a lot of women it’s accurate from the very first cycle. But we see the steepest learning curves between cycles 1 and 3. So if it’s not accurate by the first cycle, it should have reached its highest accuracy for you by the third cycle. So we do see that a lot of women, while in that 1 to 3 months beginning period where Ava is new to them and they’re just getting to know it, they’ll say, “Okay, I’m going to use the other methods that I’m comfortable with alongside Ava until I trust it.” It’s designed so that you don’t have to do that, but a lot of women do that in the beginning. If I was trying a brand new fertility tracker, I would want to do that too.

11:45 CL: Yeah absolutely. There was a big announcement that happened in January 2018. It was an improvement of the app. Can you talk about that?

LM: Yeah. So that was a biphasic parameter confirmation feature and, basically, for probably a lot of your listeners that have used Fertility Friend and they know that it has that crosshairs feature. This was something that in some ways I relate to that. It’s similar to the crosshairs feature. You get a checkmark when a biphasic parameter pattern has been detected on your chart. Basically, before this feature came out, we gave you an ovulation prediction and a fertile window prediction. But if let’s say you had an anovulatory cycle or let’s say your temperature didn’t really change or it went down, then the app didn’t have any way of telling you that there was no pattern detected here. It didn’t flag that it might have been an anovulatory cycle.

So this new development that we released at the end of January was a way to say, okay, we confirm that there was a biphasic pattern in your parameters in not just temperature but some of the other parameters where we’re seeing patterns in our clinical studies as well. One thing I do want to be careful with is as a medical company, we don’t like to say that, “okay, this confirms ovulatory cycles or anovulatory cycles,” because I think the only really, really certain way to do that is ultrasound. But a biphasic pattern in your temperature basically is most of the time goes with an ovulatory cycle. We say that it looks for the presence or absence of this biphasic pattern.

13:31 CL: Okay. Thank you. There is a woman on YouTube that was given the Ava bracelet as a gift and so she’s giving a really honest review (I felt) about it. And one thing she said, and I want to clarify this, that if you’re having your regular cycles, the Ava bracelet is not for you and then I’ll bring up another question about short cycles and long cycles. Then if you’re having regular cycles, why do you need to spend that much money when there’s less expensive options?

LM: So let’s start with the first part first. Ava gives you two types of information. It gives you an automatic fertility prediction. Basically, it says based on all the data we gathered about you while you were sleeping, we think that this is when you’re fertile and this is when you ovulated. Then it also just tells you this is all the data we gathered. This is how many hours you slept, this is what your temperature was last night, this is your heart rate, this is your breathing. It just gives you that kind of raw data from the recording of your night. And so, for the first part to work, for the automated, the algorithmic fertility prediction to work, in the current version of Ava, that is optimized for cycles that are between 24 and 35 days. So if you have a cycle outside of that range, then that automated part, we don’t guarantee that it will work. That’s something that we’re actually doing a clinical study on right now that I can talk more about later if it comes up. But I mean that’s an audience that’s hugely important for us and so that’s a very exciting development that we’re working on, meanwhile. But the current version of Ava, that prediction part works best for cycles 24 to 35 days.

Now, if you have irregular cycles, if you have PCOS, if you have something else going on with your cycles, that means 1 month there are 21 days, another month or another cycle you might not get your period for another 90 days, then you can still look at your pattern to see your chart and you can see how your temperature and your heart rate changes. You can use that as a way to collect data and analyze it for yourself. But in the current version of Ava, whatever Ava predicts as when your fertile window and ovulation is, won’t be correct for those really or highly irregular cycles.

So I’ll move on the second part. Did that fully answer?

15:55 CL: Sure, yeah. Absolutely.

LM: Okay. So, now, why would a woman with regular cycles need to use Ava? I think that’s a really good question and I think that the answer is kind of – what do you mean by regular cycles? I think there’s two ways I want to address this. One is that, there’s this adage in the TTC community that everyone’s regular until they’re not. And a lot of women think they’re regular and then they start tracking their cycles and they’re like, “Oh, I’m not as regular as I thought I was”, or, “Oh, I’m having this really weird cycle.” Like, even if you are regular and your period comes at pretty regular intervals, that doesn’t mean that when you’re fertile and like when you can get pregnant and when you ovulate is going to match when clinical guidelines say it will happen. When your period comes isn’t really the most important thing if we’re getting pregnant, that might be regular. But you might be an early ovulatory, you might be a late ovulator. There’s a really, really interesting study from 2000 in, gosh, I forget what journal it is but I can send it to you. But it said that for 70 percent of women, their fertile window does not fall within the time that clinical guidelines say it should fall. And so, just having regular cycles doesn’t mean that you always know when you’re fertile.

17:07 CL: Right. It’s not day 14.

LM: Right.

17:11 CL: Got it. Well, good. Great job in answering that question. A lot of women were talking about how the Ava bracelet tracks sleep patterns. Can you talk a little bit more about that?

LM: Yeah. So that’s another thing that I think is really cool about Ava compared to some of the other devices out there that are disposable or single purpose devices. So in addition to tracking your fertility, Ava tracks sleep and it tracks physiological stress. I can talk about both of those. So it tracks your sleep patterns, it tracks the total number of hours you sleep, and then the amount of time during the night you spent in a light, deep and REM sleep. It’s important for the algorithm to work properly because we want the data from the period of the night when you’re in your deepest sleep when all your other cycle really did parameters that are in their baseline states. It’s also just interesting to see for your own general curiosity about your health and your sleep patterns.

We also track physiological stress through something called heartrate variability. So heartrate variability is the interval of time between each of your heartbeats and you would think that you want that to be really even but it’s actually not true. The more resilient you are to stress and like the healthier you are, that means that your heartbeats are somewhat irregular. Like when you look at the length of time from one beat to the next, it varies back and forth. Actually, I think there’s even a way, like I think in some cases it can be an early warning sign of a heart attack. People who have this like extremely perfect metronomic heartbeat. But generally, for most people, it’s just a sign of like are you really stressed out physiologically or are you in a place that you’re well rested and feeling good. So Ava tracks that as one of its 9 physiological parameters and it shows you a reading for your HRV every morning when you sync. And while there’s not a range that unlike resting heart rate where we can say “oh, you know, if your resting heart rate is above X, that’s not great. That’s just not a healthy thing.” For heart rate variability, it doesn’t really work like that. There’s a huge, huge variation of what’s normal from one person to the next. But you can look at your number and see, “okay, this is what’s normal for me. I looked at it for my whole first cycle and now I can compare in the future after that first cycle.” “And am I stressed? How do I compare to my normal baseline?”

The really nice thing about that is that a lot of times people don’t realize that just because you don’t feel stressed doesn’t mean you have physiological stress happening in your body. I think especially for women who are trying to get pregnant often it’s common at that time to work on ways of reducing and managing stress. It’s good to have this like more of objective measure of how stressed you really are.

20:01 CL: I love that because, I mean, sleep is when you heal and I’m practicing for a number of years and women have a hard time getting restorative sleep. We process a lot at night whether we are having difficulty falling asleep or staying asleep, waking up at that 3:00 AM time.

LM: That’s my time when I wake up.

20:21 CL: Yeah. Because on this blog, a woman gave a screenshot of her readings and one thing I noticed was that she was getting like six hours of sleep at night. That’s not even sufficient and that alone can disrupt your chances of getting pregnant. Your body needs much more restoration than that. But anyways, that’s another topic. Okay, that is cool.

So, my podcast partner Dr. Iva Keene, she asked a question and I just want to make sure. So just to cover that again because that was kind of a big thing, what about if you’re on fertility drugs?

LM: Yeah. So when we did a clinical study and when we developed the algorithm and figured out exactly how it was going to work, we did not include women who are on fertility drugs. So we really can’t say. Ava is designed as this right now for women who are going through the hormone cycle that they would naturally have, just their normal menstrual cycle. That said, I will say that anecdotally, in our communities and just in speaking with hundreds and hundreds of our users over the past couple of years, what I see when someone is taking Clomid or Femara or even progesterone supplementation in the luteal phase, I see that it tends to make their cycle just look more perfect and easy to read because that’s kind of the purpose of those medications, like to make you ovulate more consistently, to make your luteal phase longer and your progesterone levels higher. So while it’s not something that as a company I would ever say, we haven’t done the testing so I wouldn’t want to make any false claims that we guarantee it will work if you’re taking artificial hormonal medications. But I’ve seen that it actually tends to make your chart very nice and easy to read.

22:09 CL: Okay, so Iva just sent me this. Why is it calculating ovulation after the temperature has risen for some days and not immediately as temperature is shifting?

LM: So I think that’s probably, if I’m understanding that question correctly, a data science issue. You won’t get that checkmark, that new biphasic parameter confirmation feature that we released in January until a few days after ovulation. That’s the same reason that in Fertility Friend, for example, they won’t give you the crosshairs until a few days after and it’s because often early in your cycle when you’re in the middle of your follicular phase, your temperature is going to go up and down and it takes a few days in order for the algorithm to verify, okay is this a false rise, is this just normal variation that happens before ovulation, or is this actually a consistent rise that’s enough to constitute a pattern? And so it’s not going to calculate it right away because then it would just say any rise in temperature could potentially be ovulation.

23:20 CL: I think that thought came up because of something that says in real time, so women feel like in real time they’re going to get that data.

LM: So in real time it’s able to detect your fertile window. Basically, it is able to say in real time your body is preparing for ovulation right now. Your body is doing the things that it does when it’s gearing up to ovulate, and that’s through changes in estradiol.

23:47 CL: Then here’s another one. We learn that temperature rises due to progesterone being secreted by the corpus luteum, the leftover of the burst follicle. So why then does Ava say you ovulated 3 to 4 days after the temperature has started rising?

LM: I think that might be a misunderstanding. So based on all of the parameters, it should put ovulation from when they start rising based on mostly when temperature starts rising. I mean, perhaps there was an individual instance on someone’s chart where they had a question about that that I could look at and see, but it’s not the case that it says that ovulation happened 3 or 4 days after the temperature started rising. Not at all. That’s not how long it takes to confirm that it was a true rise.

24:36 CL: Okay, thank you. So a little bird told me that you’re expecting.

LM: Yes, that’s true. I got pregnant with Ava. I’m due on May 31st.

24:45 CL: Wow. Okay, I can’t see your abdomen so it’s hard to tell. Congratulations. That’s very cool.

LM: Thank you very much. Yeah, it was interesting using Ava because I actually had experienced – I’m not sure if your listeners know what hypothalamic amenorrhea is, but that’s basically where your period goes away from a combination of like over exercise or undereating. I was a distance runner for a long time and so I didn’t get my period.

25:11 CL: For how long was it?

LM: I was on the pill for a long time in my 20s and I was a really, really intense runner and I eat super healthy, so it’s hard to say exactly how long but it might have been my entire 20s because I was getting artificial period on the pill. But yeah, I’ve learned a lot about how important it was for not just fertility but your overall health to get a normal menstrual cycle. And I made some major lifestyle changes and had to gain like 15 pounds in order to get my cycle back and then I used Ava to track everything. I did have one miscarriage and it was actually kind of interesting to see how my cycle when I had the miscarriage looked on my Ava data. But yeah, I was, eventually, using Ava able to conceive again and knock on wood, I hope this one is the real thing.

26:04 CL: Well, it seems like it.

LM: It’s been pretty far.

26:07 CL: Yes, I think you’re going to have a baby. Yes. I’m curious, how did it look after the miscarriage? What changed about it?

LM: It was a chemical pregnancy. It was a very, very early miscarriage. My parameters, what we usually see in pregnancy charts, not 100 percent of the time but the general pattern is that a lot of your parameters stay high like your temperature and your resting pulse rate, they’ll elevate after ovulation and they won’t really drop significantly until later in the pregnancy. So mine dropped and I didn’t know I was pregnant. I went to a doctor’s appointment. I thought I was spotting. I thought my period was just lasting for two weeks. I went to a doctor’s appointment and I said, “What’s going on? Am I dying? Do I have cervical cancer?” And she was like, “Take a pregnancy test for me,” and it was positive. So then I was like, “Oh, no wonder I’m having such a strange cycle and my parameters are dropping but I’m still bleeding,” because it was a miscarriage. It’s a very good way to have a miscarriage when you don’t realize that you’re pregnant until after.

27:17 CL: Yeah, exactly. So, I kind of went through the things. I wanted to obviously take some of the comments that were constantly kind of coming up for women. But you said you’ve talked to hundreds of women, of course, working for this company. What are some of the other myths or misconceptions about the Ava bracelet that you’ve come across?

LM: Yeah. So let me just my memory with the notes that I took. Let’s see. Well, I can start talking about some of them while I’m looking. One is that it works as a contraceptive method. That’s something that I hear so, so much. I feel like, well if it identifies your fertile days and I don’t want to get pregnant, I would just avoid those days. So while first of all, digital contraception is a huge, huge area of interest for Ava. We’re doing studies on it and it’s something that we want to release in the future. Don’t use it for contraception right now. Definitely not. And the reason why is that the algorithm is really optimized for detecting the days when you’re most likely to get pregnant. It’s trying to positively identify the most fertile days. If it was going to be a contraceptive method, which it will in the future, we would want to also be able to identify the days where it’s not likely but still possible to get pregnant because that’s the most important thing to have – an ever-reliable contraceptive method. So yeah, I definitely hear that a lot.

Another misconception I hear a lot is that you have to wear Ava all day. Oh my God, who would want to broadcast to the world on this bracelet that you’re trying to conceive? Like your mother-in-law is going to see this and give you a hard time. But no, you only wear it at night. You should not wear it during the day because the data from your body at night when you’re completely at rest is the most important.

Let’s see. I know I had one more. But I don’t know where it is in my notes, so it will come back to me later.

29:11 CL: Oh, that’s okay. What was I reading about on your blog? Oh yeah, that you are doing research so that people can use the Ava bracelet as a contraceptive device. That’s pretty cool. Let’s see. Hmm, I’m trying to think about some other things. We kind of covered most of them that were floating around on the internet, so I just want to be able to address those questions. Let me go through mine.

LM: One thing people ask about sometimes is, well, can Ava tell you if you’re pregnant before a pregnancy test? No, not right now but that’s something that our clinical research team is looking into. We do see significant differences between conceptive and non-conceptive cycles. And while it’s not like you could look at your chart right now and be able to conclusively say “oh yeah” that you’re definitely pregnant or you’re not. It’s a really interesting area of research for us that we presented some initial findings on. We hope to go a lot further with that and be able to strengthen the accuracy of those predictions.

30:27 CL: That would be very cool because that two-week waiting period is so long. Right? I mean if you could shorten that at all. All right, I mean, I feel like I’m well-informed. I hope that definitely cleared up any misconceptions about it. It seems like a very cool device. I was when I was watching those things going “Yeah, that person kind of has a good point” but no, I mean, charting, I’m a big fan of charting but it is a time commitment and you have to be really consistent about it. There’s a lot of things that can kind of make it, the variables or whatever, and you have to chart for a number of months to really get that pattern I’m going.

LM: Yeah. The last thing that I’ll just say about that whole charting. I’m a huge fan too and as someone who works at a fertility tracking company, I used Ava and I did every other fertility tracking method under the sun because I just thought it was cool. But I don’t know, a big part of our mission is this idea that women do enough work when it comes to anything related to fertility, to children, to domestic matters. And to the extent the technology can take away some of that work and make a more accurate and easier way to have this information that every single woman deserves to have, if she wants it about her body, then that’s a good thing I think.

31:54 CL: I think women will appreciate that. I agree. Okay, thank you so much. Congratulations again. Your whole life is going to change for the better.

LM: I’d have to find out. Yeah, hopefully. Thank you so much for having me. I loved talking to you.

32:08 CL: Thank you. Bye!