An Interview with the Developers of the 'Dot Fertility Tracker' App

Trying to conceive or avoid pregnancy is a lot easier nowadays thanks to mobile technology.

Hundreds — maybe even thousands — of fertility tracking apps are available for mobile devices to help women of reproductive age track their complete menstrual cycles, from their ovulation to their PMS symptoms, to their cervical mucus.

Although recent research has demonstrated that the majority of fertility tracking apps available on the market are not accurate enough to avoid unintended pregnancy or plan a pregnancy, many useful fertility apps are indeed out there — but it can be hard to know which app to choose in a sea of potential bad apples!

One of the few truly useful fertility trackers for mobile devices is the app called the Dot Period & Fertility Tracker —  a period tracker that can help women effectively prevent pregnancy or plan pregnancy based on their unique cycle lengths.

Created by a company called Cycle Technologies, this fertility monitoring app is based on the Dynamic Optimal Timing algorithm (hence the DOT in the title), which is currently being studied at Georgetown University for its effectiveness. This approach enables women to plan or prevent pregnancy easily and effectively by simply tracking the dates on which their menstrual periods start, allowing the app then to share individual conception risks or chances (depending on your goal) for each day of the cycle.

Can you tell us the story behind your mobile app? Where did the idea for your app come from? What served as your inspiration for the app?

Dot was developed as a result of our years of experience in working in global health and realizing that women are looking for effective, easy to use contraceptive options that don't cause side effects. We developed Dot to provide women with accurate information about their fertility chances and give them this information in such a way that they can actually use it to achieve their reproductive goals - whether that's to prevent pregnancy, plan pregnancy, or just better understand their reproductive health.

How did you build the content that's contained in the app? Does the information in your app come from evidence-based resources, such as scientific literature, peer-reviewed articles and case studies?

We worked with data scientists and reproductive health experts to develop the approach behind Dot. It uses an advanced algorithm to determine a woman's fertility risks based solely on her period start dates. To develop this method, we did extensive computer modeling and testing prior to launch. The app itself is now undergoing a full-scale contraceptive efficacy study conducted by researchers at Georgetown University's Institute for Reproductive Health. All of this research has been published in peer-reviewed journals.    

What impact has your app had on clinical practice so far? We'd appreciate if you could share some stats on how frequently your app is used worldwide.

Dot currently has approximately 100,000 active users worldwide.

What are the tools and technologies used to build your mobile app (both cloud- and client-side)? Was it native or cross-platform development? Did you consider other technologies?

We decided to develop Dot as a native application so that we could use all of the functionality of each platform.

What were the main challenges you had to overcome when developing your app? Could you please single out the biggest technical challenges, product challenges, marketing challenges, and support challenges?

The development of the method and algorithm took us a full 2 years to complete before we began app development. It involved extensive analysis and working with a range of experts to review and refine. It uses well established scientific research about reproductive biology and builds on this knowledge with an advanced statistical analysis.  In terms of the app itself, a key challenge for us was that we wanted to make the app intuitive and beautiful so that women from all over the world would want to use it, and be able to use it. The other key challenge for us is the actual testing and development of the evidence base. We have to be very thoughtful about conducting research to support all of our claims. We want users to understand the science behind Dot and feel confident that they are getting accurate information.

Could you single out the 3 biggest mistakes you made when developing the 'Dot Fertility Tracker' app?

I don't think we've made big mistakes, but we have had to make decisions that are not always universally liked. 

For instance:

• We have chosen to focus on simplicity and to make Dot as easy to use as possible, without distracting bells and whistles. There are users who want to track every detail of their lives and to see lots of fancy complicated looking charts. That's not Dot. 
• We have chosen not to collect extensive personal data on our users. In general, this actually improves the user experience as it doesn't require the internet connection and ensures their privacy. But if a user loses her data and hasn't sent it to herself through our manual data backup feature, she may be disappointed to find out that we don't have the ability to give it back to her — since we never see the data as connected to individual users. I think all app developers have to make decisions that are trade-offs for their users. Our goal is to make the experience great for our users, but also to be really clear about our vision and purpose: to provide people with fertility information that they can actually use to prevent or plan pregnancy.

When it comes to medical apps, sooner or later the issue of data protection and security always comes up. How do you make sure that user data is secure?

Privacy is an important issue. As mentioned before, we don't collect personally identifiable information from our users. We only collect aggregate analytics that allows us to understand how people are using our app, and improve the service. The only time that personally identifiable information is collected is if a user is participating in a research study in which she has agreed clearly to participate. For a study such as the contraceptive efficacy study that Dot is currently undergoing, that data is secured on HIPPA compliant servers by the researchers. Cycle Technologies does not see the participant information.

What's next for your app? Are there any new features, functionalities, or upgrades planned for future updates?

The contraceptive efficacy study on the Dot app is almost complete and as soon as that is done, we'll be looking at opportunities to expand its use and distribution by partnering with different international and local groups as well as translating it into multiple languages.

We are excited about the technologies and what they might hold for the healthcare and the future of medicine. What do you think this technology-driven, human-centered future holds for mobile health and how do your app plan to contribute?

We are excited to reach women directly with an actual contraceptive solution that they can access right through their mobile devices. Using machine learning, Dot is able to provide women with an accurate assessment of their fertility risks. It addresses many of the reasons women cite for not using birth control methods including side effects and misjudging their pregnancy risks. We think Dot will go a long way towards addressing unmet contraceptive need all over the world as a free, accessible, side-effect free solution that can be used both to prevent and plan pregnancy.

Could you share some word of advice with other mobile app developers? What steps they should follow in order to make a successful app?

The big piece of advice that I would give is to stay laser-focused on your vision but also listen to your users. It's a really hard balance to get right.

An update for readers who were hoping to install the Dot Period & Fertility Tracker: Unfortunately, Dot will no longer be available for new users from the app store. Existing users will be able to keep using this app, but it's no longer going to be updated. The creators do have further plans, which they're going to announce when they're ready, so check on their website for future updates.