Natural Cycles
{{Short description|Fertility tracking software}}
Natural Cycles is the company behind the Natural Cycles birth control app. The app was the first to be certified as a contraceptive in the European Union and in August 2018 the Food and Drug Administration approved U.S. marketing for the contraceptive app as a Class II medical device.{{cite web |url=https://abcnews.go.com/GMA/Wellness/fda-approves-marketing-contraception-app-1st-time/story?id=57146537 |title=FDA approves marketing for a contraception app for the 1st time |publisher=ABC News |first1=Catherine |last1=Thorbecke |date=August 12, 2018 |access-date=August 13, 2018}} It remains the only digital form of birth control on the market in the United States and has also received regulatory clearances from Canada (Health Canada), Australia (TGA), Singapore (HSA), and South Korea (MFDS).{{Cite web |title=https://www.eu-startups.com/2024/05/stockholm-based-natural-cycles-snaps-e50-8-million-series-c-to-make-hormone-free-birth-control-more-accessible/ |url=Stockholm-based Natural Cycles snaps €50.8 million Series C to make hormone-free birth control more accessible}}
The Stockholm-based company, which was co-founded by particle physicists Dr. Elina Berglund Scherwitzl and Dr. Raoul Scherwitzl, has received $100 million in funding.
History
Berglund was a physicist partly based at CERN, collaborating with the team who discovered the Higgs boson, before co-founding the company with her husband Scherwitzl. Because the couple was in search of an alternative natural contraceptive themselves, Berglund used data analysis to develop an algorithm designed to pinpoint her ovulation.
The couple then decided to create an app with the underlying algorithm, Natural Cycles. Following several medical trials, the app became the first tech-based device to be certified for use as contraception in the European Union in February 2017 by the European inspection and certification organisation TÜV SÜD.{{cite news |author=Maddy Savage |date=7 August 2017 |title=The Swedish physicist revolutionising birth control |url=https://www.bbc.com/news/business-40629994 |publisher=BBC News}} In November 2017 Natural Cycles received a $30M investment in series B round led by EQT Ventures fund, with participation from existing investors Sunstone, E-ventures and Bonnier Growth Media (the VC arm of privately held Swedish media group, the Bonnier Group).{{cite news | url = https://techcrunch.com/2017/11/09/natural-cycles-gets-30m-for-its-eu-certified-digital-contraception/ | title = Natural Cycles gets $30M for its EU-certified "digital contraception"|last=Lomas|first=Natasha|work=TechCrunch|access-date=2017-12-15|language=en}}
While the app is currently only certified in the European Union, where its users are concentrated in the United Kingdom and the Scandinavian countries, it is available worldwide. Natural Cycles offers a subscription product, which had over 800,000 users across 160 countries as of June 2018. 75 percent use the app as a contraceptive, and the rest use it to try to become pregnant.{{Cite news|url=http://www.businessinsider.com/a-birth-control-app-raised-30-million-to-come-to-the-us-2017-11?r=US&IR=T&IR=T|title=A Swedish app that wants to replace your birth control pill has raised $30 million to expand to the US|work=Business Insider|access-date=2017-12-15|language=en}}
The app works by having users take their temperature each morning immediately after waking and logging it into the app. This is done with a basal thermometer. The apps algorithm calculation is based on the observation that post-ovulation, progesterone warms the female body by up to 0.45 °C.{{Cite news|url=https://www.telegraph.co.uk/women/sex/ive-tried-the-app-thats-as-reliable-as-the-contraceptive-pill/|title=Could an app really replace the contraceptive pill?|last=Cohen|first=Claire|date=2016-04-13|work=The Telegraph|access-date=2017-12-15|language=en-GB|issn=0307-1235}} Natural Cycles algorithm then determines, based on the temperature, whether the user is fertile or not. A red day means fertile (which is when one should abstain or use a condom); a green day means not fertile.{{Cite news|url=https://www.breakit.se/artikel/9672/p-piller-i-appform-darfor-satsas-en-kvarts-miljard-pa-natural-cycles|title=P-piller i appform – varför satsar någon pengar på det?|work=Breakit|access-date=2017-12-15|language=sv}} For the app to remain effective, women need to follow the app's instructions correctly, and it does not protect its users from sexually transmitted diseases.
In 2019, the company completed a pilot program in Sweden that tested a feature to help women trying to get pregnant determine if they should seek fertility help.{{Cite news|url=https://www.bloomberg.com/news/features/2019-04-01/birth-control-app-natural-cycles-is-more-effective-than-the-pill|title=It's Tough Being the First Birth Control App|date=2019-04-01|access-date=2019-06-12|language=en}} A new mode also became available in 2019 that helps users monitor pregnancy.
Research
Studies carried out by the app's creators have found it to be as effective in preventing pregnancies as the contraceptive pill for typical use (for perfect use, Natural Cycles effectiveness was lower than the contraceptive pill's).{{citation |author=Emma Lundin |title=Could an algorithm replace the pill? |date=7 November 2016 |newspaper=The Guardian |url=https://www.theguardian.com/lifeandstyle/2016/nov/07/natural-cycles-fertility-app-algorithm-replace-pill-contraception}}{{cite journal | vauthors = Berglund Scherwitzl E, Lundberg O, Kopp Kallner H, Gemzell Danielsson K, Trussell J, Scherwitzl R | title = Perfect-use and typical-use Pearl Index of a contraceptive mobile app | journal = Contraception | volume = 96 | issue = 6 | pages = 420–425 | date = December 2017 | pmid = 28882680 | doi = 10.1016/j.contraception.2017.08.014 | pmc = 5669828 }} These studies, however, only consider women who were paying members and were within the age range 20-35.{{Cite web|url=https://www.nhs.uk/news/pregnancy-and-child/would-you-trust-a-smartphone-app-as-a-contraceptive/|title=Would you trust a smartphone app as a contraceptive?|date=15 April 2016|website=NHS|access-date=10 February 2019}}
Criticism
In 2018, Södersjukhuset, a hospital in Stockholm, Sweden, filed a complaint with the Medical Products Agency of Sweden after 37 women who had been using Natural Cycles as their primary method of contraception sought an abortion at the hospital after becoming pregnant unintentionally.{{Cite web|url=https://nordic.businessinsider.com/a-swedish-hospital-is-reporting-birth-control-app-natural-cycles-to-the-authorities--after-37-of-its-patients-got-pregnant--/|title=Hyped birth control app Natural Cycles has been reported to the authorities - after 37 unwanted pregnancies|website=nordic.businessinsider.com|access-date=2018-08-14|archive-url=https://web.archive.org/web/20180814232751/https://nordic.businessinsider.com/a-swedish-hospital-is-reporting-birth-control-app-natural-cycles-to-the-authorities--after-37-of-its-patients-got-pregnant--/|archive-date=2018-08-14|url-status=dead}} Natural Cycles responded by saying the number of pregnancies was within the reported effectiveness rates.{{Cite web|url=http://www.businessinsider.com/natural-cycles-under-investigation-unwanted-pregnancies-2018-1|title=Contraceptive app Natural Cycles is under investigation over unwanted pregnancies|website=Business Insider}}{{Cite web|url=https://naturalcycles.com/en/science|title=Discover the Science | Digital Birth Control|date=5 August 2020}} In the UK, the app came under investigation by the Advertising Standards Authority over supposedly misleading claims in its marketing; the complaint was upheld by the ASA in August 2018, concluding that the app misled consumers regarding being "highly accurate" and a "clinically tested alternative to birth control".{{Cite news|url=https://www.independent.co.uk/news/uk/pregnancy-app-contraception-period-natural-cycles-uk-investigation-a8468741.html |archive-url=https://ghostarchive.org/archive/20220618/https://www.independent.co.uk/news/uk/pregnancy-app-contraception-period-natural-cycles-uk-investigation-a8468741.html |archive-date=2022-06-18 |url-access=subscription |url-status=live|title=Contraceptive app investigated over 'misleading' claims about its accuracy|work=The Independent|access-date=2018-08-14|language=en-GB}} A number of users and healthcare professionals have expressed concerns over the efficacy of the app.{{Cite web|url=https://www.theguardian.com/society/2018/jul/21/colossally-naive-backlash-birth-control-app|title='I felt colossally naive': the backlash against the birth control app|last=Sudjic|first=Olivia|date=2018-07-21|website=The Guardian|language=en|access-date=2018-08-14}}
In August 2018, Lauren Streicher, professor of clinical obstetrics at Northwestern University's Feinberg School of Medicine expressed concerns over the Food and Drug Administration's approval of the app. Streicher has claimed that the app is "problematic" as it relies on users' self-reported temperatures which must be taken as soon as they wake up each morning in order to be accurate. In an interview with Vox, Streicher claimed "The minute you rely on action, the efficacy goes down."{{Cite news|url=https://www.vox.com/2018/8/14/17684392/natural-cycles-birth-control-app-fda|title=The first "birth control app" was just approved by the FDA. Its transparency and effectiveness are in question.|work=Vox|access-date=2018-08-14}}
Natural Cycles has also been criticised for its marketing strategy of paying social media influencers to promote the app. In July 2018 researchers at the London School of Hygiene and Tropical Medicine published a study which claimed "Natural Cycles' marketing materials ought to be entirely transparent, more clear than they currently are about the limitations of their app and pregnancy risks".{{Cite journal|last1=Hough|first1=Amy|last2=Bryce|first2=Maggie|last3=Forrest|first3=Simon|date=2018-07-21|title=Social media and advertising natural contraception to young women: the case for clarity and transparency with reference to the example of 'Natural Cycles'|url=https://srh.bmj.com/content/early/2018/07/21/bmjsrh-2018-200110|journal=BMJ Sex Reprod Health|volume=44|issue=4|language=en|pages=bmjsrh–2018–200110|doi=10.1136/bmjsrh-2018-200110|pmid=30032124|s2cid=51707769|issn=2515-1991|url-access=subscription}}