Newly designed NaturalCycles app for iOS in App Store!

The newly designed NaturalCycles app for iPhone and iPad is now approved and in the App Store. Update your apps or download it for free here!

https://itunes.apple.com/us/app/naturalcycles/id765535549?ls=1&mt=8

You get a three month free Plan/Prevent trial.

Newly designed NaturalCycles app for iOS

New beautified NaturalCycles website out!

Today is the most amazing Friday ever! It’s a beautiful spring day in Stockholm and we could have lunch outside in the sun for the first time here at SUP46. They have a nice really big courtyard just outside the office.

What of course makes the day even better is that the new, beautified NaturalCycles website is out and the new iOS app has been submitted for approval. The new website is not only much prettier, but it also allows you to try NaturalCycles Prevent of Plan for free for 3 months, or you can pay for a year and get a basal thermometer shipped home to you. Cool! Another amazing feature of the new website is that it’s available in 6 languages!

NaturalCycles website

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The very first cycle with NaturalCycles

We get a lot of questions about how many green days to expect in the beginning when using NaturalCycles, since NaturalCycles needs some data to get to know you and your body. Every woman is different, with different cycle characteristics and different body temperatures, so we cannot make any reliable assumptions about your body until you start entering your own data in your NaturalCycles account.

The number of green days a woman gets in the first ovulatory cycle depends a lot on those first data points. What cycle day did she start measuring at? Does she measure every day or does she skip a lot of days? How much is her temperature fluctuating? Which cycle day does she ovulate? Has she recently been on hormonal contraception and will this postpone ovulation? I’ve already written a separate blog entry concerning how much the pill affects your cycle, here:

http://blog.naturalcycles.com/will-quitting-the-pill-disrupt-your-cycle

NaturalCycles requires 6 low temperature values before looking for a rise due to ovulation. This means that if she ovulates around day 15, she needs to start measuring around day 10 at the latest. If she starts measuring after the temperature rise, then it is of course not possible for NaturalCycles to detect ovulation. Below is such an example, where she started measuring on day 21:

One could argue that most probably ovulation had happened there and NaturalCycles could give green days, but before the following menstruation, there is really no way of knowing whether ovulation has happened and if the temperature is high, or if ovulation is for some reason delayed and the rise is still to come. As safety comes first, these days should not be green!

Below you see another example of a user that started measuring her temperature on cycle day 11, ovulated on day 20 and then got green days on day 23. She also entered a first positive LH test (ovulation test) on day 20, which helps to get easier green days.

In some extreme scenarios, where the woman does not measure very often in combination with highly fluctuating temperatures, it can take up to two cycles to get the first post-ovulatory green days.

To summarize: on average, if a user starts measuring before ovulation, she gets 40.2% green days during her first cycle. So even though the number of green days in the first cycle varies greatly, depending on several factors, the users do on average get a significant amount of green days.

Accuracy of perception of ovulation day in… [Curr Med Res Opin. 2012] – PubMed – NCBI

Accuracy of perception of ovulation day in… [Curr Med Res Opin. 2012] – PubMed – NCBI

Will quitting the pill disrupt your cycle?

I get a lot of concerned questions from women who are coming off the pill, or other hormonal contraception, and starting to use NaturalCycles as a birth control. How much will the hormones affect my cycle? Will NaturalCycles be safe and take the pill into account? How many green days (no need for condom) will I get? For those who are not familiar with NaturalCycles, it is a natural contraception, which analyses your body temperature, and optionally ovulation test data, to determine when you are fertile (red days) and when you most definitely are not fertile (green days).

Contraceptive pill

How much will the hormones affect my cycle?

The cycles of many women, although they had been many years on hormones, just directly go back to normal. Some women are only mildly affected, like for instance myself. I had the Implanon (the hormonal implant in the arm) for 10 years and after taking it out, my first 2 cycles were 5 weeks long, then a few cycles were 4 weeks and then back to 3.5 weeks, which is normal for me. Some women are unfortunately highly affected. The worst case I saw was a woman who quit the pill last summer and started measuring for NaturalCycles. Her first cycle was 108 days and since the time between ovulation and the next menstruation usually stays the same for one woman, she ovulated on day 97. Her next cycle was a bit shorter; about two months, and the one after that about 6 weeks. Basically it took almost a year until her cycle was back to normal.

The research that has been carried out on the subject has different conclusions, much depending on who was financing and/or performing the studies (one should not forget that the pharmaceutical industry has a very strong lobbying business). One interesting fact that I read is that the hormonal treatment that affects the cycle the most is the combined oral pill, which contains both progesterone and estrogen. For women using the combined pill, 50% got severely affected for the following year after stopping the pill. This was clear from a study performed on women quitting the pill in order to get pregnant and the majority of women who had been taken the combined pill had more difficulties to get pregnant. The good news is that after a year of being free of hormones more than 90% of the women had gone back to having regular cycles.

One conclusion to draw from this is that it is important to quit the pill quite some time before one plans to get pregnant. Not only due to the decreased chances of falling pregnant, but also to give the body a break for a while. It’s clear that being on a constant dose of hormones, is very disruptive and unhealthy for the body. If this is followed directly by pregnancy, which is an even stronger dose with lots of hormones, it might be even more difficult to find a balance again after the pregnancy and breastfeeding is over.

Will NaturalCycles be safe and take the pill into account?

Yes, definitely. When you set up your personal account with NaturalCycles, we ask you if you’ve recently been on the pill, for how long and when you stopped. NaturalCycles will then be extra cautious with your cycle and it knows that it’s very likely that you’ll start off with longer cycles, due to delayed ovulation, which will get shorter and shorter with time. So there is no need to worry, just be patient and confident that your cycle will eventually go back to normal.

How many green days (no need for condom) will I get?

How many green days you will get of course greatly depends on how much your cycle is disruptive by the use of hormones. If your cycle directly goes back to being somewhat regular, then no problem, you will get a nice amount of green days. If your cycle is very disrupted and you almost never ovulate, then the green days will be few. In that case, on the other hand, it is still very useful to monitor your cycle and confirm that it is slowly improving with time. The woman I mentioned above, who had a very disturbed cycle after quitting the pill, only had 25% green days her first year using NaturalCycles. 25% is still better than nothing and it’s nice for a couple to not have to use condoms 100% of the time, which is the other option when quitting the pill.

Overall, it is a big decision to quit the pill and to change birth control, and there is no guarantee that your cycle and body will just continue as nothing happened if you have been taking hormones for years. It’s nevertheless important to give your body a chance and to try to take the healthier path for the future.

Elina on the beach at sunset

Entering the swiss coaching program for technology start-ups

Today we went to Bern to present NaturalCycles in front of a jury from CTI, to be accepted into their coaching program for start-ups.

CTI is the federal commission of technology and innovation and if you enter their program there is an 88% chance that your start-up is in business 5 years later. We had already met with our coach a few times, but today was the official day of coaching acceptance. Raoul gave a great presentation and we got to discuss a lot with the jury, who were giving us several difficult, but interesting, questions.

Coaching program for start-ups - NaturalCycles

After the presentation and the discussion, we had to leave the room for a while for the jury to convene. It took quite long so we got a bit nervous about whether we would make it or not, but luckily we did! As a milestone they said that we should aim to have IP check completed, and have decided on which market and business strategy to focus on, by February 2014.

Lots of fun work ahead! Afterwards we went for a nice lunch outside in sunny Bern.

Coaching program for start-ups - NaturalCycles

The fertile window

 

The woman’s body is really a remarkable thing. Cycle after cycle, the uterus does its job and releases another egg, expecting it to be fertilized. Today, since we have such great knowledge through medical research on what’s going on in the uterus, we can use it to our advantage to either prevent or plan a pregnancy. The time frame when a woman is fertile only occurs once per cycle and is called the fertile window.

The fertile window includes the 5 days prior to ovulation and the day of ovulation.

Fertile Window - NaturalCyclesThe 5 days period prior to ovulation is determined from the longest time sperm can survive in the uteral environment. Note, however, that most sperm have a lifetime significantly less than 5 days – more like 2 or 3 days, but to completely exclude a possibility of pregnancy one must take the longest living sperm into account. For sperm to survive any significant time at all, the uterus must contain the fertile type of cervical mucus, which helps the sperm to live longer as well as to be able to travel up the uterus and fallopian tubes. Without the presence of fertile cervical mucus sperm typically only survive about 4 hours.

The fertile cervical mucus is triggered by a rise in estrogen prior to ovulation. The amount of fertile cervical mucus does not only vary from woman to woman, but also on the age of the woman. The older you get, the fewer days you produce cervical mucus and hence the narrower your fertile window becomes.

Once released through ovulation, the egg can maximally survive up to 36h, but typically only 12-24h. Studies have shown that the quality of the egg deteriorates very quickly; causing the probability of conception to decrease rapidly every hour once the egg has been released. For optimal chances of conception, sperm should thus already be present in the fallopian tube once the egg is released. Therefore, the most fertile day of the woman’s cycle is rather the day prior to ovulation than the day of ovulation itself.

To prevent pregnancy through detecting ovulation and predicting the fertile window, one must assume the longest living sperm and egg. This sums up to 6 days in the cycle. What’s more tricky is to accurately calculate the uncertainty of the ovulation day for a woman. That is, when do we think she will ovulate and what’s the earliest possibility of ovulation to occur. Luckily this is what NaturalCycles‘ algorithm does for you. When you start measuring your temperature, NaturalCycles will be very cautious as it does not know around what time you usually ovulate. With more and more data, NaturalCycles is able to better estimate your ovulation day, the variation of your ovulation day and the uncertainty on the estimated variation of your ovulation day. All this is required for a full-proof birth control method using natural family planning. So don’t chart by hand to prevent getting pregnant ladies – it is doomed to end up in an accident. Use the mathematical tools provided for you and you’ll save both time and hassle.

When to measure and when not to measure

One question about tracking the basal body temperature for natural family planning is when to refrain from measuring. If you are clearly sick and have a fever, NaturalCycles will detect your temperatures as abnormal and automatically exclude them. However, if you are just feeling slightly under the weather, or have been partying the day before, or simply sleeping significantly more or less than usual, your temperature measurement for that morning could be slightly shifted. This is not at all “dangerous” and it will not make you get green days during your fertile window. It could however cause you to get less green days as NaturalCycles provides the same level of safety for all types of temperature fluctuations.

It is therefore better to refrain from measuring for days where you don’t follow your normal rhythm. Especially if you haven’t just started measuring your temperature. NaturalCycles uses all of your data data from the first cycle you enter, when it analyses your new incoming temperatures and therefore, after three cycles or so, statistics become less crucial. Myself, I have now used NaturalCycles for 500 days and I have meanwhile acquired quite some statistics. I therefore only measure on days where everything is according to my normal every day schedule. For example, before this morning (Monday), I did not measure since Wednesday (see chart). Thursday was the Swiss national holiday so there was some drinking involved for both Wednesday and Thursday evening. Then, during the weekend, I slept considerably longer than usually. Since my data are not limited by statistics anymore, and I am not yet close to ovulation, it is fine for me to skip those 4 days in a row. I you have a look at my chart below you see that there is a nice line until today, probably since I skipped the days before where I’d otherwise get elevated temperatures due to sleeping in/alcohol.

Measures - NaturalCycles

I will summarize some useful rules of thumb that you could adopt for optimal temperature tracking:

  • For the first 3 cycles, try to measure as often as possible
  • For the 5 days before and after expected ovulation, try to measure almost every day
  • Outside these two scopes try to at least measure 4 mornings/week, but strictly don’t measure if:
    1. You get more than 2 hours of more/less sleep than usual
    2. You wake up more than 3 hours earlier/later than usual
    3. You drank more than usual the evening before and you feel the alcohol the following morning
    4. Skip the first morning after having traveled long distance to a different time zone
    5. You feel ill or have a fever

If you apply these guidelines, you should get nice temperature curves. There will of course always be some fluctuations, which cannot be avoided, but that’s normal and nothing to be concerned about. You should also try to avoid first measuring and then deciding whether to use the temperature value or not. That might bias your chart to look like you want it to, rather than what is actually correct.

When you have to measure the LH hormones with ovulation tests (OPKs), you don’t have to worry about more/less sleep or alcohol.

You should however try to not drink any liquids and not go to the bathroom at least 2 hours before measuring, preferentially more than 4 hours. Best is also to avoid taking the test in the morning. This might sound confusing, as pregnancy tests are best taken when you wake up, but the LH surge often starts in the morning, so if you take your ovulation test then you are more likely to miss your LH peak. Of course, if you don’t find a good time during the day to avoid liquids for a longer time, then the morning is to be preferred.

Happy measuring!