Last year, I sat in the bathroom of an Irish pub, trying desperately to solve a maths equation. I had abandoned my friends at the bar, where I'd been pretending to drink an IPA, to tend to this pressing arithmetic in private. If I solved correctly for 'x', the answer would provide me with some crucial information — whether or not my pregnancy was going well.
Earlier, a key number in this formula had been left on my voicemail by a nurse at my doctor's office: The level of my human chorionic gonadotropin (or hCG), a hormone the body starts making a few days after conception. The hCG number was supposed to be doubling roughly every 72 hours since then, according to a website I'd somehow Googled myself to — after I'd looked up what the heck this hCG thing was.
But I was missing one bit of information. "What we need to know," the nurse had said, "is when you got pregnant." Although I had a few rough estimates, based on, you know, having sex, I really had no idea. With my doctor's office now closed, it was up to me to master the sperm-egg algebra in this sticky, wood-paneled stall. I plugged in a few different potential dates, feeling for the first time in my life like my body was a foreign mass I happened to wear around me like a vintage sundress.
As I crunched the data, I started to see that even with the most generous calculations, my hCG wasn't behaving the way it was supposed to. There, with a faux-vintage Guinness mirror over my head, I realised that my pregnancy probably wasn't either.
I'd always known I wanted to have a family, yet I never experienced those maternal urges that everyone swore I'd start to feel as my biological clock ticked past 30. When my husband and I got married, that seemed as good a reason as any to get started. But I was still in no rush. During the winter I turned 35, I stopped taking my birth control pills. By summer, I was pregnant.
Or was I? The restroom maths I hoped I had calculated incorrectly was confirmed a few weeks later at the doctor's office, as she peered inside my uterus with an ultrasound wand. Even with my shameful ambiguity factored in around when I'd actually conceived, she should have seen a viable embryo, a tiny heartbeat flashing like an LED bike light. Instead, there was only a hollow ring. She shook her head. "No, I'm sorry."
She left me in the room to change, the image of my empty womb still on the screen. I slowly reached over for my clothes, completely blindsided. The pregnancy that I'd casually and somewhat ambivalently stumbled into had been snatched away from me by a grainy image on a black-and-white monitor.
And suddenly, all I wanted in the world was to be pregnant again.
Since nobody ever talks about miscarriages, I can't really say that there are a few things I wish someone had told me about miscarriages. But here are three things I figured out about miscarriages after I had one. I'll call them two truths and a lie.
First truth: Miscarriages are far more common than you might think. If you asked three women of childbearing age that you know, chances are at least one will have lost a pregnancy. The American College of Obstetricians and Gynecologists believes that up to one in five pregnancies will end in miscarriage. Many miscarriages are early, though, so sometimes women don't know they actually had one, attributing it to a late period.
Second truth: Most women will get pregnant again without any problems — miscarriage is not always a sign that something's wrong with you. Many miscarriages are the result of a random genetic abnormality that's determined at conception. Or as I like to think about it, a "bad egg" (or sperm!). As your body ages, you'll statistically have more bad eggs. That's why as you get older, your chance of miscarriage goes up.
And here's the lie: The miscarriage itself isn't the worst part. It's the days or weeks or months or years after it's all over, as you impatiently wait for the hormones to slowly evacuate your body, searching "miscarriage" on your phone in bed with the brightness level cranked way down so you don't wake up your husband, holding your hands over your abdomen as you sob quietly in the dark, wondering if you'll ever get pregnant again.
It was during one of those 2am. Googling sessions that I stumbled upon a story about Glow, an app that was helping women concieve. I'd seen plenty of those those cycle-monitoring sites: cursive logos, a URL with "fertility" or "ova" inevitably embedded in it, lots and lots of pink. They worked by helping you track certain subtle hints associated with ovulation, like a basal body temperature increase and a change in your cervical mucus. I thought back to the first time I tried to get pregnant, when I jotted down fragments of data every few days (ok, whenever I remembered) on the paper chart that came with my Target thermometer. This seemed like even more work I wouldn't do.
Glow was designed to stand apart from its wide range of competitors with clean graphics and colours other than pink (thank goodness)
But there was something about this one that made me keep clicking. First, it was good-looking: It was almost like it was designed to match the new look of iOS 7. It also talked to me like an adult. Instead of cheesy euphemisms and abbreviations for periods and intercourse, the information was presented in normal, grown-up language. But here was the real clincher for me: The app was blue and purple, not pink.
Plus, it had something called Glow First, a kind of crowdfunding savings plan for couples having trouble conceiving. We could choose to pay $US50 per month which would go into a fertility fund. After 10 months, most of the couples would get pregnant, statistically, and those who didn't would get to split the rest of the money for fertility treatments.
I downloaded Glow.
In over two decades of seeing reproductive health practitioners, not a single doctor had ever suggested that I track my cycle. When I had started to entertain the idea of getting pregnant, I asked one of my doctors for tips on what I should do, and she looked at me rather oddly and offered this sage advice: "Just have sex."
But as I would come to find, it's not actually that easy. The fertility window is already pretty narrow, and as you get older you're honestly only looking at a day or two when you can actually get pregnant. When you're 35, you don't have time to be casual about it. I realised that I had spent far too much of my life clueless about the happenings in my pelvic region. I wanted all the information laid out cleanly for me. Very quickly, and with lovely graphics that didn't offend my discerning taste, Glow managed to illustrate everything I didn't know.
The daily log tracks fertility cues as well as health information. The app actually made gathering information about cervical mucus (CM) pretty fun (well, as fun as it could be)
Using the app was enjoyable. I'd tap in my temperature and other fertility cues during my morning Instagram-feed viewing. Later, I'd fill in basic health information about my day — exercise, alcohol consumption, energy — while riding the bus. (Now the app syncs with fitness trackers to import all that data as well.) When I didn't log information, the app would ping me. But I didn't need the reminders very often. I became diligent about tracking. My husband was able to download the app, too, and have access to all my information. Dare I say, it was almost fun.
Right away I started to see patterns which surprised me. It turns out that even though I have a pretty average 29-day cycle, I ovulate really late, usually on day 17 or 18. Which means if I was going by the "typical" day 14 ovulation most women experience, I would have been missing my fertile window completely. In fact, this is one of the biggest insights Glow has gleaned from their users, says Jennifer Tye, Glow's head of marketing and partnerships: 50 per cent of women are incorrectly estimating their cycle by up to four days.
I was intrigued why Glow would know something so specific about its users until I learned more about the company's roots: Glow was actually started by PayPal founder and Yelp chairman Max Levchin, who had identified fertility issues as a problem in need of a tech solution. "We're a data company at heart, but we're taking these capabilities from data science and machine learning and applying them to the very real world issue of reproductive health," says Tye.
An infographic prepared by Glow showing where 20,000 of their users have conceived and how up to half of their users were incorrectly estimating their cycle length
The data-driven perspective also informs Glow's educational focus and the way it talks to its users. "Educating women before conception is something we feel very passionately about, and that includes both physical and mental health," says Tye. "We're able to to flag potential risks or concerns and we approach it with very personal perspective. If you start to look things up on the internet you can end up reading a lot of scary stuff, so the goal is to give you insights that are specific to what's going on with you." The personalised information is what helped the app immediately feel relevant and useful to me: I got daily links to studies about fertility over 35 or getting pregnant after a loss.
Some women do need medical intervention to get pregnant. But Glow can help diagnose some of those problems, says Tye. Certain fertility issues, like polycystic ovarian syndrome (PCOS), have symptoms like extra-long cycles which Glow's algorithm will isolate. A woman experiencing this might get a message telling her to ask her doctor about PCOS. Glow can then train the app to ask better questions related to symptoms that might be red flags.
The detailed information Glow is collecting can reveal very nuanced insights, like how often couples in their 20s are having sex during their fertile window or how long it takes for the average 35-year-old woman to get pregnant. In fact, Glow is presenting details culled from their first year of data collection at the American Society of Reproductive Medicine later this year. While they don't release figures for how many women have downloaded their app, Glow does have one number they're proud to promote: In less than a year, Tye says Glow has helped 20,000 women get pregnant. There's even a name for these successes: "Glow babies."
Glow now has tens of thousands of charts from women which they can analyse. The app collects questions about emotional health as well as physical health.
Talking with Tye, I started to see why my experience with Glow was so positive. The app gave me a series of tasks to do each day that made me feel connected to the process: I filled out my basic information, but the app also asked me how I felt emotionally and provided me with health tips. "I think there is that aspect, a feeling of accomplishment or like you have some control," says Tye. "You can see what you can change or alter about your behaviour."
Some of the nudges made me roll my eyes — I remember being annoyed by the app telling me repeatedly to eat a spinach salad, and my husband got a nice big pop-up on his screen reminding him to have sex while he had his phone out at work — but for the most part, the app provided useful daily meditations on my fertility. In a way, Glow felt like a game where I was taking incremental steps, every day, towards my goal.
I'm not saying that the information about how to get pregnant is somehow proprietary to Glow. But having it right here on my home screen, nestled next to Twitter and Google Maps, made it more appropriate to my daily lifestyle. I do almost everything else in my life on my phone. Why couldn't I use it to get pregnant, too?
When another birthday passed and I still wasn't pregnant, we had been ordered to begin the stressful process of fertility testing. I was subjected to endless ultrasounds to examine the health of my ovaries, had fluids injected into my cervix to test the openness of my fallopian tubes, and even had an MRI to monitor the size and shape of a large, unknown blob in my uterine wall, which was "probably" nothing to worry about. But they weren't sure. Each hypothesis the doctors floated by me was terrifying.
To make matters worse, I'd leave my testing with poorly-worded interpretations of my status stamped across my paperwork — Advanced Maternal Age, High-Risk Pregnancy, Elderly Primigravida — hints that I had made a horrible mistake by waiting so long to get pregnant. Yet once I downloaded Glow, the app delivered positive statistics for 36-year-old mums or linked me to studies on the average time it takes couples to conceive. It kept me going. I tracked and we tried.
Doctors never did decide what — if anything — was wrong with me. But due to all these mysterious factors which may or may not have been impeding my ability to conceive or sustain a pregnancy, I was recommended for intrauterine insemination, or IUI, which would possibly boost our chances of success.
On the day I went in for my final consultation to start the IUI process, the nurse jotted down information on my chart, asking me, as usual, the date of my last period. I told her the date. "But," I said confidently, "I ovulate pretty late. This cycle I ovulated on day 18." I knew this, without any doubt. I could show her on my app, I offered. She was looking at me suspiciously, but not because of my commanding knowledge of my body's follicular phase. She handed me a plastic cup and instructed me to pay a visit the restroom, just in case.
Just as I sat down with the doctor, the nurse knocked on the door with a huge smile on her face.
I was pregnant. Without the medical intervention that everyone had claimed I needed. We had done it ourselves. Naturally.
My slightly OCD personality makes me a natural candidate for living the quantified life, yet my fitness tracking up until this point had been a series of failed experiments. I tried several times to document my caloric intake through Lose It but ended up faking a lot of the data because I could never remember all the food I ate. I remember excitedly strapping on a FuelBand but then I rarely synced it. Here was an app that was all about something I loved to do — walking — but it never engaged me enough to update it. So I was rightfully suspicious about the effectiveness of an app that was pretty much built around cramming a thermometer in my mouth and observing the fluids oozing out of my body. Fun!
But I can honestly say that Glow has fundamentally changed the relationship I have with my health. I strongly believe in birth control, and that women should have access to the method of their choice for free. But once I understood how predictable my own cycle was, I realised that I probably didn't need it. All those years I popped pills without trying to figure out how my body actually functioned. In fact, the app works so well for regular old cycle-tracking that just as many women started downloading Glow to avoid getting pregnant. Glow redesigned the app to appeal to those users as well.
The new Glow Nurture app brings the same Glow approach to fetal development, with tracking and tips
Accordingly, Glow is developing more tools to support women throughout their reproductive lifetime. Earlier this year, Glow launched Glow Nuture, a pregnancy tracking app for monitoring fetal development and maternal health, which arrived just in time for me to start logging my own pregnancy symptoms. They're also working on a "kick counter" to track baby's movement, which I'll be needing as I roll into my third trimester. Glow is planning another app to support women experiencing post partum depression. And they're also working on one for loss, which would have helped me and all the other women desperately Googling during those sleepless nights.
In those long dark months after my miscarriage, I promised myself that I'd share my story publicly in the hope that more women would be able to learn from my experience, which is honestly still a pretty taboo subject. But by using Glow, I've already been able to contribute far more to the state of women's reproductive health than I ever imagined. Just by updating this app every day I'm compiling a useful dataset for Glow, which will help 20,000 more women have healthy babies — just like the one my husband and I will be welcoming into our lives in a few short months.
Pictures: Tara Jacoby