The FemGuide: Issue 2

Unpacking ovulation, the race to fertility tracking, and why Freud is the f***ing worst (a short film)

Hello and welcome to the second edition of the FemGuide! If you are a newcomer, check out the first issue here, which covered PMDD, opportunities in the condom industry, and female athletes. 

For a quick recap, this newsletter will cover three areas: scientific understanding of the female body, startups that are innovating on issues related to female health, and social change as it relates to female bodies and experiences.

This month, I want to focus on ovulation, the key menstrual cycle mechanism around which the majority of fertility (and birth control) innovation is centered. It is my personal mission to make sure every female, female’s partner, and person who is remotely involved in FemTech understands this biological concept. 

Hope you enjoy and as always, feedback and shares are appreciated!

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Science: Ovulation

Ovulation is the single most important mechanism specific to the female body. Here’s a quick bio lesson to understand why:

The menstrual cycle begins on day 1 of your period, kicking off a complex combination of hormonal changes. The biggest one is ovulation, which happens roughly two weeks later (this varies by individual). Ovulation is when the egg is released and travels down the fallopian tube to select the sperm of its choosing. This is the only day of the month a female can get pregnant...kinda. Sperm are those lingerers who never get the cue to leave the party, and can survive for five days, extending that one fertile day into a six-day fertile window.

Baby-making aside, ovulation is massively important in its own right for all females, regardless of if you want to start or prevent a pregnancy. Most significantly, it is the only way to produce a healthy level of progesterone, which is crucial to overall female health ranging across everything from metabolism to mood. It also works as a vital sign - not ovulating is a red flag that your health is currently compromised rather than optimal. 

A significant portion of the FemTech sector is centered on ovulation in one of two ways: pregnancy prediction or prevention. The fertility industry seeks to confirm ovulation, and the birth control industry seeks to halt it. As the importance of ovulation becomes more mainstream knowledge, I believe a third ovulation-specific market will emerge: females who are interested in tracking ovulation as a way to optimize their health. I already see this tide changing in the demand in my own work helping females understand their cycles and regain their ability to ovulate. My prediction - and a career focus of mine - is that the most valuable ovulation innovation will be in solutions that can accurately track ovulation (and more broadly, sex hormones in general) as a consistent metric like heart rate, VO2max, or glucose, and pair this with wearable tech/health app use. 

Startups: inne and the race to fertile window tracking

One startup that I have been closely following (and, for transparency, working for) is inne. inne created the first at-home salivary hormone testing device, so you can use your spit to check your hormone levels from the comfort of your bedroom.

An inne mini-lab includes strips that you stick in your mouth and put in a “reader” that looks like a chic AirPod case. The inne device measures progesterone, that key hormone directly tied to ovulation, so you can understand your fertile window. Currently, inne’s main market are individuals trying to get pregnant. The longer-term aim is to also service those who are trying not to get pregnant and serve as a new version of contraception (that doesn’t require hormones or latex!). In my opinion, this innovation is both 50 years delayed and the most exciting thing since, well, hormonal birth control. 

While this is still early days, I am closely following this race to create a novel fertility and birth control solution. Some other players in this space include Canadian-based competitor, Eli, which has yet to launch but claims to track both estrogen and progesterone, and Kegg, an at-home test for cervical fluid. I am crossing my fingers that one day I can brag to my device-using granddaughters that I had the first inne lab in the U.S and, in return, they will laugh at the idea of peeing on a stick to track fertility or taking hormones to prevent a pregnancy.

Speaking of new birth control solutions, one major FemTech moment this month was period-tracking app Clue getting approved by the FDA as birth control - which you can read about here and here. I’ll discuss my thoughts on this, and period-tracking apps in general, soon! Please send any related questions on this my way and I’ll be sure to cover them.

Social Change: Hysterical Girl

If I took a shot every time a lecturer mentioned Freud during my women’s health graduate degree, I would’ve been drunk by lunch most days. Sigmund Freud is to scientists what Donald Trump is to presidents. For a quick review, please refer to this blog post in Scientific American. If you have a bit more time, this article in The Cut is a great depiction of how, despite the fact that pretty much everything he did was bad science and fake news, Freud still manages to commandeer great cultural influence today. Sound familiar? 

Freud legitimized victim-blaming and the notion that women both attract and enjoy sexual abuse. He was also a main contributor to the popularization of a centuries-old belief in the “hysterical woman'', arguing that women were crazy due to penis envy or masturbation when, in reality, they had legitimate medical issues and/or completely justified negative responses to their oppressive and misogynistic circumstances. Freud was more of an “ideas guy” and didn’t actually conduct any scientific experiments, rendering his work the mere speculation of a coked out white dude with twitter…I mean…a typewriter*** (whoops, Freudian slip). 

This idea of the “hysterical woman” eventually snowballed and permeated widespread cultural beliefs, such as the falsity that female hormones and female sexuality make women unstable. This influence displays itself today in how medical systems, judicial systems, and more continuously perceive women as incompetent and discredit their words.

A New York Times short film - to be showcased at SXSW - weaves between one of Freud’s major works, Dora, and current gender issues by retelling the story from “Dora’s” point of view. I was surprised, and to be honest a bit overcome, by the relatability of this perspective on the Dora story to the issues modern women face. It is a mere but powerful 13 minutes. Please be warned if topics of sexual assault are triggering for you.