- Natural Cycles is an app that helps women track their fertility cycles so they know when they are most likely to become pregnant.
- After articles came out questioning the effectiveness of Natural Cycles, cofounder Elina Bergling had to figure out to improve and continue to provide its services.
- Natural Cycles has 1.5 million members, and in 2018 became the first FDA-approved fertility app to be used as a contraceptive, allowing it to move into the US market.
- This article is part of a series on growing a small business, called "From 1 to 100."
Bad press can make or break a startup. Natural Cycles, a Swedish-based company, has felt that pressure.
In the summer of 2018, stories came out from The Guardian and TechCrunch about unwanted pregnancies after using the fertility app, Natural Cycles, and its thermometer.
The headlines left some people nervous about using Natural Cycles.
"We had pushback from midwives in Sweden around women getting pregnant," said Elina Berglund, a former European Organisation for Nuclear Research (CERN) physicist who cofounded the app with her husband.
"That is the downside of working with contraception. Since no contraception is 100%, there will always be pregnancies," she said. "We very much empathize with all women that experienced an unwanted pregnancy but that is unfortunately what happens."
Even with the negative headlines in 2018, by December that same year, Natural Cycles became the first birth-control app to be FDA-approved as a contraceptive. And as part of an effort to capitalize on the potentially huge US market, Berglund and her husband now have an office in New York.
Venture capital investors at EQT Ventures, E.Ventures, and Sunstone Ventures have backed the company, which has raised a total of $38 million. And Natural Cycles has used some of that money to help it scale up to 95 staff at one point, but today the headcount stands at 60-70.
"[The negative coverage] had quite a big impact on the growth of the company," Berglund said. "Not so much on the ambitions though."
The team is growing once again. Increasing the team size further will likely depend on whether Natural Cycles can convince large numbers of people that its an app they can trust.
How Natural Cycles works
Natural Cycles claims to be around 93% effective under typical use, and 98 or 99% effective under perfect use. That could make it more effective than condoms, less effective than implants, and just as effective as the birth control pill.
"Unfortunately, some women will get pregnant on Natural Cycles because it's not 100% effective," Berglund said.
But, one of the main selling points for Natural Cycles is that it doesn't alter the body in any way. There are no hormones, and no injections. Women measure the temperature in their mouths in the morning when they wake up and then they enter that recording into the app. The app identifies the woman's unique cycle and fertility status.
"The algorithm runs in the background and returns a 'red day' if she needs to use protection that day because she might be fertile, or a 'green day' if she's definitely not fertile, and doesn't have to use protection," explains Berglund, who coded the app.
Users can sign up from home and receive the thermometer in the mail, or they can buy it from certain stores.
"We're in quite a few pharmacies, especially in Sweden," Bergland said. "We're also part of a program here in the US where we give Natural Cycles for free- to low-income women through certain clinics."
Standing out in the market
The app, which costs £49 per year or £6.99 per month in the UK, now has 1.5 million users worldwide. The UK has the most active users, with the US and Sweden behind them.
"The US is where we are growing the fastest at the moment," says Berglund.
The company's most successful innovations have come by considering their implications for users early in development. "Every product update and piece of research we conduct is prioritized based on how it will impact our users," Bergland said. "In the very few times we've strayed from this approach, the initiative fell flat."
Enlisting input from "key opinion leaders" (KOLs) is also table stakes for health companies, which can be a difficult and labor-intensive process. "While the customer always comes first, it's not always about the customer," Bergland said. "We've learned that - oftentimes the hard way - and have made sure to make an effort with other KOLs within our space [including] doctors and midwives. It's not easy, but it's necessary."
Berglund thinks American consumers are "a little bit different than the Europeans" and she's determined to figure them out. She's also meeting with the medical community as she looks to understand how to grow in the market further.