Swiss entrepreneur Lea Von Bidder is one of Europe’s leading founders in femtech, an industry which seeks to transform women’s health and is pegged to hit $50bn by 2025.

She launched Ava, the startup behind the world’s first fertility tracking bracelet, in Zurich in 2014. While many other period-tracking players like Clue (founded in Berlin), Daysy (founded in Switzerland) and Groove, Glow, Kindara and Ovia (all founded in the US) have developed apps to track fertile days in a menstrual cycle, Ava is one of few startups using hardware to inform its mobile tracking (another is Sweden’s Natural Cycles, which requires users to take their temperature five days a week).

Ava’s £249 device looks like a blank-faced watch and can be worn at night to monitor nine indicators of fertility (resting pulse rate, sleep, breathing rate, perfusion, movement, heat loss, skin temperature, bioimpedance and heart rate variability). This allows its app to pinpoint the 5.3 most fertile days of a woman’s cycle.

Ava’s techniques have been validated in a study published in Scientific Reports (a journal from the publishers of Nature). To date it says it has helped 16,000 women conceive, with 50 new pregnancies now reported per day, and is now developing technologies to allow it to diagnose issues during pregnancy.

With €37.3m ($42.4m) raised and five successful clinical trials, we ask Von Bidder how she’s built a successful hardware business in an age of apps.

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The Ava fertility bracelet. Credit: Ava/James Bueti

Why choose to develop fertility hardware in an age of fertility apps?

It is not the ‘age of apps’ in diagnostics and medicine.

“The intelligence of an app is basically limited to your intelligence.”

Your body can give you obvious signals, like menstruation once a month or back pain, and you can track those on an app. But the intelligence stops there. It will never be smarter than the data you put in. An app might be better at calculating the data, or at analysing it. But the base intelligence of what information it has to come from you. That’s the limitation factor.

Building hardware is more expensive than software; how did you initially fund Ava?

We put in our own money for the first prototype, which took around nine months. It wasn’t much, it was around CHF 100,000 (€88,000), possibly less. But we also applied for a government grant early on, so a lot of our clinic work was financed by that.

Then we raised our seed round of €2.2m ($2.5m). Every single big company would laugh at that amount. It’s a crazy amount, especially when you consider that half of that probably went into marketing.

The Ava fertility bracelet and app. Credit: Ava.

Still, you managed to raise another 37m from VCs. Can you share any advice on how you did that?

Every investor has doubts investing in hardware, and rightfully so. But we made it clear that we are using hardware as a means to an end. We wouldn’t even say we are a hardware company, we’d say we are an AI company, we are a data science company, and we need to develop hardware in order to make that happen. I think this outlook has helped us.

“What’s really important for hardware founders is that the vision goes above and beyond the hardware itself.”  

Besides funding, what was the hardest thing about launching a hardware startup?

Looking back, we were delayed on a tonne of things. We delayed our launch initially because we just couldn’t get the hardware out—developing hardware you will constantly run into issues with components, manufacturing, import duties that you suddenly have, or times where your shipping provider doesn’t pick up the product.

Hardware is a flimsy thing. We’ve had every single problem in the book.

Ava founders Peter Stein (left), Lea Von Bidder (centre-left), Philipp Tholen (centre-right) and Pascal Koenig (right)

Is there a knack to managing hardware hiccups?

One of the things that was a game changer is that my cofounder Philip Tolan was running our hardware and operations himself. A lot of companies think they can hire that from outside.

Even though we don’t see ourselves as a hardware company we understand that it’s the base of everything we do. And we had an unbelievably talented person to take care of that. It’s about people. You need to really choose your partners carefully.

How easy was it to eventually launch your device?

I actually moved to the US very quickly to start building up the company there while my cofounders developed the product at the University Hospital of Zurich, our clinical partner. I had to do this because Switzerland is not actually a market

“Switzerland is not actually a market.”

When you are from Switzerland you have no chance, of course you can develop a product just for Switzerland but our market would have been far too small for that. Around 10 months later we launched our first product in the US.

Elina Berglund, CEO and co-founder of Natural Cycles

How important is independent testing in hardware?

Studies are terrible: they are difficult and expensive. But, if you are in the medical space,  there’s no other way: you can’t develop in the medical space without doing clinical trials, because you can’t make any medical claim without being able to prove it.

One of the issues we have in the women’s health space is people handling claims extremely freely which has led to women trusting fertility apps which are non-dependent on hardware (I’m particularly not pointing at Natural Cycles here because they have hardware and clinical studies). That issue annoys me because it drags down the credibility of the entire space which is desperately trying to find alternatives to traditional birth control. They are hurting progress.

Again, many of our trials have been part-sponsored by the government [through funds including InnoSwiss]. The tip from me would be that there’s actually quite a lot of governments that now have funds—and if there are no government funds, look to NGOs or family offices. The other option is doing joint venture and partnerships early on. There are lots of organisations outside of VCs that fund clinical studies.

We actually met Natural Cycles founder Elina Berglund recently who told us how she managed media backlash when women got pregnant using her appdo you have concerns about women using Ava incorrectly?

I think we’re making it a very strong point that we’re not a contraceptive, so no. We’re operating in a much safer space that other companies are.

What other hardware devices inspire you right now?

Breast Pumps!

Read more: Tania Boler, creator of the world’s first silent breast pump, talks sex, nudity and Google ad bans. 

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