How to Track Your Cycles Like a Pro With Rob Milnes

Welcome to Episode 7 of Season 7 of The PCOS Revolution Podcast:

How to Track Your Cycles Like a Pro With Rob Milnes

Today we are talking about everything related to fertility, tracking and ovulation. I am joined by the CEO of Fertility Focus, how will share his story and the tracking device that focusing on fertility monitoring.

This week on PCOS Revolution Podcast, I am having a conversation with Rob Milnes. Rob’s work in female heath care started in 1998. He has helped bring to market various products. Now he is focused on fertility. Rob and his wife struggled to conceive for numerous years. He went onto finance a business and complete the process to see it to launch to help with ovulation tracking.

We chat about a very common topic, tracking ovulation and tracking your cycles with PCOS. This is a common topic I see all the time. It can be a source of frustration for many women and couples.

During our conversation, Rob and I talk about different types of tests and trackers out there. We dive into the different resources available from fertility tracking apps and ovulation predictor strips. We also discuss specifically the differences compared to Rob’s tracker and how it is used. The only time it is not used is during menstruation.

Learn more about this technology, features including live ovulation prediction, the process of use and who this product is a good fit for during this episode of The PCOS Revolution.

READ the full transcript here:

Farrar Duro

Hello, everyone, and welcome back to The PCOS Revolution podcast. Today I have Rob Milnes with me and we’re going to talk about a subject that comes up over and over again in our clinic just about every week, and that is about tracking your ovulation and tracking your cycles with PCOS. So, Rob actually has a special expertise in this because his work in the women’s health sector started in 1998. With Sonic aid, the original UK fetal monitoring company, and he helped bring to market several groundbreaking products included automated antenatal monitoring, the FM 800 labor and delivery monitor, and a new transducer algorithms to more accurately detect the fetal heart rate. Now, he is actually attracted to fertility focus in 2007, and which was just in the process of spinning out the obvious sense ideas from the University of Bristol. Rob and his wife struggled to conceive for a number of years, and he saw something in the Ovusense technology, which could help save couples a heartache of not knowing why they can’t get pregnant. He went on to finance the business, build the offices prototype product and take it through clinical trials, and gain regulatory approvals necessary for sale in Europe and the US. I really think this is an important topic to talk about because without knowing how to track your ovulation, it’s really difficult, obviously, to know where you are in your cycle and to conceive. So welcome, Rob, thank you for sharing your time with us. Thanks for having me. So tell us a little bit about how this works as far as someone who’s not familiar with Ovusense, and who’s not been tracking their ovulation and why that’s important.

Rob Milnes

Sure. So um, as I said, as you said in the introduction, the original technology came from the veterinary school of Bristol University in the UK. And what they were trying to do is to detect rapid temperature rises. And they went on to develop some algorithms and some patents around the concept of tracking using a vaginal sensor. And that’s the core technology and are, obviously its product. So we helped develop that, from the prototype stage, set up a company to do that. And we’ve been on the market since 2013. That device has a vaginal sensor that’s placed in overnight, it takes a reading of temperature every five minutes with a very accurate thermostat. And what that allows you to do is download the data the next morning. And with our patented algorithms, we’re able to then determine the best representative temperature for overnight. By taking each of those temperatures from one night to the next we’re then unable to plot that graph over the period of the whole of the cycle. And were able to then predict ovulation up to 24 hours in advance and detect ovulation in real time. And the key to that is, that that means it works for women with variable ovulation timing with variable cycles, and obviously, therefore lends itself particularly well to women who have polycystic ovarian syndrome, diminished ovarian reserve and other ovulatory issues.

Farrar Duro

Very neat. So it’s relying on body temperature as opposed to LH readings and urine.

Rob Milnes

Correct. As you probably know, core body temperature is really tracking the relative changes in progesterone throughout the cycle. And it’s progesterone that’s released during the process of ovulation itself. And as a result of that, because we have tracking it so accurately, we’re able to do this prediction in real time. In other words, we’re able to see when ovulation is about to happen using the current cycle data, we’re then able to also confirm the exact date of ovulation. And that’s really key for understanding as you’re well aware, your luteal phase. That’s the point of ovulation on to the started the next period, how long that is, what’s happening to your progesterone throughout that phase in particular. Whether it stays high, which is what should happen, whether or not because your temperatures dropping, were able to see that your progesterone level is dropping as well. And that obviously, is indicative of perhaps a requirement to talk to your clinician to have further intervention, or simply to modify your diet to go along with a number of the programs that are out there to help women with PCOS, for instance.

Farrar Duro

That’s okay. And it tells you in 24 hours, you have about a 24 hour notice of when you will be ovulating with this particular monitor, correct?

Rob Milnes

Yes, So that’s in real time, thats the real time monitoring aspect of it the live ovulation prediction, as we call it, we also give you a fertile window at the end of every cycle, we take the data population that has been measured, and we predict forward an eight day fertile window. And that’s very useful if your cycles a fairly regular. But obviously, the less regular your cycles are, the less regular your ovulation is within a cycle. That’s less useful. And that’s exactly what other monitoring devices do. So all of the other temperature monitoring devices out there are able to detect the date of ovulation with varying degrees of accuracy. And they predict forward on the basis of the history in your cycle. The difference with Ovusensors, we don’t use that history alone. We also are tracking in real time, we’re seeing what’s happening to that progesterone level throughout the cycle itself.

Farrar Duro

Very neat. Yes. I would say that even if you’re not trying to conceive, you’re just seeing how your body’s working. I would think that would be so helpful. And a lot of times, our patients would say, this is not just for fertility, it’s to see how your luteal phase is, if it’s long enough, if your temperatures are high enough. So, could this also be helpful for determining if somebody has perhaps a sub clinical thyroid issue or that sort of thing, as far as if they’re chronically low, their temperatures.

Rob Milnes

I think possibly that the link between temperature and thyroid is less well established, and is more variable. We haven’t yet published on that type of information. We are about to publish at the American Society of reproductive medicine this year a new paper which will identify certain cycle patterns that are indicative of PCOS or indicative of a risk of miscarriage and things like that those are very key to understanding how Ovusense can be used in a clinical space in particular. That will be published in October this year, and that takes all the data that we’ve been amassing over the last three years of work. So over 50,000 cycles of data, around about half of our users have some kind of Bobby later issue. A large proportion of them have PCOS. And we’re able, therefore because we know the history that they’ve given us through the event tracking and what the cycles look like we’re able to match those two things up and we’ve been able to publish on that information.

Farrar Duro

Wow, could you give us a little summary ahead of time of your findings, or we have to wait?

Rob Milnes

Well, I can’t give you the exact numbers. That’s the thing that is embargoed by the ASRM. But what I can say is that what we’ve spotted is very typical cycle type patterns, which are indicative of luteal phase, phase defect. That’s not necessarily a woman with a short luteal phase, but a defect in the luteal phase. In other words, progesterone doesn’t stay high. And we have that that occurs in a very large number of cycles that we’re looking at, obviously, we’re looking, we have a population that is biased towards women who have ovulative issues. But that is a very prevalent issue. And I think that’s really key because we can do something about that clinically. And that’s really important, to see what you cannot, what we’ve also identified is a number of patterns, which we believe show the issues that surround Luteinizing hormone testing, for instance, for women. We have a cycle pattern that we’ve labeled “false start” where you get a rise in the temperature, which occurs earlier in the cycle. The temperature then goes back down again, and it then goes up towards ovulation later in the cycle. And that, we know from our previous trials, that’s associated with the early risers associated with a positive luteinizing hormone test, a urine strip test, when no Ovulation occurs within the next 48 hours. And we know from the literature that women with PCOS quite often have acyclical luteinizing hormone. That means it peaks at a different time in the cycle quite often very early in the cycle. And that’s what’s giving these false positives in luteinizing hormone. The key thing is, obviously, this is able to pick out that is not a real start of ovulation. So it ignores it. And it is then able to predict later on in the cycle, that population is about to occur

Farrar Duro

Very Nice. And that’s fascinating, because we often see this when patients will bring in their charts. And they also use Ovusense too and they’ll go Oh, I thought I ovulated here, but it looks like it was here. So definitely, it can impact your cycle as far as well. Sometimes we have patients whose spouses are traveling or the partners are traveling, and they’re only trying and the window that they think is their fertile window it’s actually not. I think that this is extremely helpful. I have to say, we are recording this in August, but this episode will come out in the fall. This study will probably already be out by then. So we can definitely we’re going to try to link to that also. And I think it’s very valuable information because you have thousands and thousands of charts and data. So, I really applaud you for getting this information out there and helping women and couples so much with this. So, for those who have never tried using any devices, can you explain a little bit more about what your type of software does and what this particular process is for someone who’s starting out?

Rob Milnes

Sure, if I just give a background to the types of devices, perhaps throughout there are really four categories. The first is the fertility tracking apps, they have no particular device associated with them, those are really just period trackers. And they will usually give some form of prediction of ovulation for the following cycle, but based on what’s known as the calendar method, and that’s particularly useful if you’ve got a very regular cycle and you ovulate at the same point in each cycle. We don’t say that those are useless apps, but there’s a reason they’re free. And there’s a reason that they work for women with a very normal cycle. Really, it’s just the same as charting your periods on a manual calendar on the wall, it’s the same kind of idea. That’s been been used for many years by women.

Rob Milnes

The next category is temperature devices, which are based on basal body temperature monitoring. Those are usually some kind of oral thermometer. So placed in your mouth once each day on waking, when your temperature is meant to be at its lowest point. That’s what Basal means. And you’re therefore trying to chart and you either do that manually or with the help of an app. Some of these devices have the thermometer linked to the app as well. So there are a little bit more convenient. They’re very good at detecting when ovulation happened in the past, so that again, nothing wrong with those necessarily for determining whether you’ve ovulated or not. They’re not as accurate at detecting the exact date and that’s simply because there’s a degree of noise associated with both oral and external temperature. So within that same category, we’d say our external temperature devices, so either a device worn underneath the bra strap, underneath the armpit or on the wrist. And those, again, are quite good at detecting when you have ovulated in the past. Not necessarily again the date. And there’s some data out there published with regards to the accuracy of those, but none of those devices are able to predict in cycle what’s happening within the cycle.

Rob Milnes

Then we have Luteinizing hormone strips, ovulation predictor kits, OPK, everybody calls him something different, or you just urine strips, those are good in determining and illuminating hormone peak. And they are very accurate at that. As we’ve discussed, the problem is, if you’re Luteinizing hormone peaks at the wrong point, in other words, it doesn’t peak with that normal accepted 24 to 48 hours and prior to population, then you get false positives. What we frequently find as well is that women who are using Ovusense will say that they get no positive results at all, with an OPK it depends on the test you’re using, how sensitive it is, it’s obvious there’s a cutoff point. And if your cutoff point doesn’t go above that particular cutoff, you don’t get the blue line or the smiley face or whatever the indicator is on that device. There are some monitors which use frequently used strips.

Rob Milnes

You can put those strips into a monitor and it’ll assess that or you can put it into an app. Again, those have the same drawback, they tend to be a little bit more accurate because they also use something called a E3G. They’re measuring an estrogen indicator as well as the Luteinizing hormone. And again, that’s useful if you have a normal cycle, and you don’t have ovulatory issues. Lastly, there’s the Ovusense of product. And those are all the home based products. As I’ve described, Ovusense is a vaginal sensor placed in overnight, taking core body temperature readings, and then you’re downloading in the morning. It is a similar idea to basal body temperature testing. But the big difference is we’re able to see that rise as it’s happening and then predict up to 24 hours in advance. And then really you get into clinical testing. So the gold standard accepted practices to take a blood progesterone or blood Luteinizing hormone. So both of those things that we’ve talked about tracking already.

Rob Milnes

The issue with both of those tests is they have to be timed right. So often, again, our users will say, Well, I went in to have my, it’s called a 21 day progesterone simply because as you know, your meant test seven days after ovulation and the accepted pattern of ovulation is that it happens on day 21. If you ovulate on day 14, because you have a 28 day cycle, well guess what, seven days is correct. But quite commonly, for women who have any kind of cycle disturbance, they will find that they’ll ovulate much later in the cycle. So they’ll get a negative blood progesterone when they go to the OB/GYN. But in actual fact, they may be ovulating. Then the real, real gold standard ultrasound, ultrasound is excellent at telling you as long as you do it often enough within the cycle when you’re going to ovulate, and if you’ve ovulated. Exact date and timing is very difficult again, because you have to have consecutive days of ultrasound really. So, that’s the kind of range of products that are out there right from those free apps, right the way through to ultrasound at your OB/GYN.

Farrar Duro

Very helpful. I often get asked that question, what’s the difference when you are monitoring your temperature vaginally versus orally, the temperature difference or that sort of thing?

Rob Milnes

Essentially, we’re measuring the same thing in theory, which is the body’s temperature. Core body temperature is what we’re seeing with the vaginal sensor. When you’re using an external thermometer, either orally or on the skin, you’re actually measuring the skins reaction on the external reaction to what’s happening in timely to the body. Now the issue with that is there’s a certain delay between the core body temperature and the skin and oral temperature. It’s a little bit later than actually is happening within the action of progesterone on the body itself. And the other issue is associated with the fact that there is noise in the signal, because as you well know, when you sweat, actually what’s happening is your skin temperatures cooling down.

Rob Milnes

And it’s doing that in order to lose heat from within the body. You’re actually getting an opposite reaction at the skin to what’s happening in the body. That doesn’t happen all the time. But essentially, what you’ve got, therefore, is noise in the signal. That noise is sufficient for you not to be able to detect the rise in advance using those methods. There’s one other problem, which is that if you’re using most of those methods, particularly an oral thermometer, those measured in gradients of point one of the degree and so it can get because we’re only looking for point three degrees Celsius as the rise for ovulation, you can be out by point one of a degree very easily using your oral thermometer. The Ovusense sensor is taking a reading in steps of point .003 degrees. So it’s taking very, very fine gradients of reading. And that’s really the crux of the technology idea added to our algorithm.

Farrar Duro

Okay, this is very helpful. And so usually someone will sleep with the sensor?

Rob Milnes

That’s correct. So yeah, but it’s only used overnight, that’s when your body temperatures is most stable. That’s why we suggest overnight, it’s obviously more convenient as well, we say that you have to have the sensor in for six hours, ideally six hours or more. But we can usually get away with about four hours of reading. So some women will take it out, if they go to the bathroom in the night, for instance, some will take it out. Most say that there is a degree of convenience with using it in that you can kind of forget about it, you don’t have to remember during the day to take your temperature or pee on a stick. And so there’s a degree of convenience. But obviously, there’s also a degree of invasiveness that our users are aware of. I think most of them are self selecting in the sense they say, Well, this is fine. I’m quite happy with the concept of using this. And once they do start using it, the degree of irritation that we’ve measured over over time and in the population is incredibly small. It’s less than 0.1% of our population has any kind of issue once they start wearing it. The key thing is you don’t use it during menstruation. So that’s the only time during the cycle when you’re not using.

Farrar Duro

That’s true. Usually the temperatures are pretty consistent at that point anyway, right with your menstruation or they should be there lowest, but is that what I guess, usually we don’t really measure temperatures anyway, that much during that time.

Rob Milnes

No, and and you’re quite right. And of course, any temperature differences that you do have have no particular effect on your ovulation, It’s too early in the cycle for affecting ovulation. So you’re not seeing the product of progesterone in the body using the product of essentially menstruation itself.

Farrar Duro

I was just wondering for those who are trying to use Clomid or fertility medications, how would that affect the temperatures, and I know that not everybody is getting ultrasounds at their gynecology clinic. They are expensive and sometimes not covered by health insurance. So, how have you seen this used as far as do fertility medications affect the temperature and the outcome? Or what do you see with that?

Rob Milnes

Clomid is fine. In fact, what you want to happen, of course with Clomid is that you get a temperature rise, because that’s indicative and the progesterone is going up, which is indicating ovulation is occurring. So it doesn’t affect it in any other way than you want it to. In other words, it creates the right reaction of population itself, the action of population. Other medications such as Metformin, Inositol, things like clothes, have no effects on the temperature curve. Thyroid medication sometimes do when you change them. If you suddenly start a thyroid medication or you stop it, that will have an effect on temperature. But if you are continuing with the same regime as previously, that’s fine. The only obvious one that is a problem is when you take supplemental progesterone.

Rob Milnes

And obviously what you hope is happening is that you get a temperature rise because you’re ingesting progesterone, are you using a topical cream, or using a suppository or a pessary’s and in all cases, we’d expect the temperature to rise as a result of projesterone from being ingested. And if you have a regime of taking your progesterone, when ovulation is likely to be occurring, then sometimes that masks the ovulation happening, or its masks ovusense from seeing that population. So that’s the only time when it’s questionable, because of what you’re taking from a medication point of view.

Farrar Duro

Right. And that’s usually when we advise our patients to start any kind of bioidentical progesterone, it’s after ovulation has occurred after they’ve confirmed it. In that case, they could see that’s happening within 24 hours and and then delay that use until after the’ve seen.

Rob Milnes

That’s correct. And then of course, it is useful, because what you’re going to see is it has that curve been sustained, or hopefully what tends to happen with medication, if it’s working well is you’ll then get another kick in the temperature. So, you’ll see your ovulatory temperature, and then you’ll see a secondary rise as a result of taking that supplemental progesterone.

Farrar Duro

And even more so if you’re pregnant. So, do you have do you have the case where some women prefer to continue tracking their temperatures when they’re pregnant? early, early pregnancy, I guess.

Rob Milnes

Lots and lots of users continue tracking throughout every cycle. Some as a result, see pregnancy therefore and the only thing we’d say is, by the time you see that secondary temperature rise, that’s still well, within that first two weeks that you’re waiting to see whether or not pregnancies happen. We would never advise a pregnancy test within that time, because it may give you false hope. That’s the only drawback to it. But you can definitely see, in a large proportion of women that there is a secondary rise associated with pregnancy, the progesterone that occurs naturally with the body during pregnancy, during the early part of the first semester. However, if you don’t get that secondary rise, it doesn’t mean that you aren’t pregnant. So that’s really key. And if you do get a secondary rise, it doesn’t mean you are pregnant, it can be a false positive or a false negative. Clearly, most of our customers are trying to get pregnant, they want to see that rise. So we just advise a little bit of caution in reading that signal.

Farrar Duro

Definitely. And if you see that secondary rise last for more than 16 or 18 days, that’s usually when we say it’s not a bad idea to check, to make sure. Take a pregnancy test. So, I think that, for PCOS, the whole frustration comes from when someone has been charting their temperatures for a long time, and they’re not seeing any change. And that’s why a lot of times the BVT charting can be frustrating. And they go, Oh, every day, I have to take this thermometer and then plot it. And then it’s just a straight line, you know, it doesn’t really show any change. Does this technology allow you to continue on for 60, 90 days? Actually graphing your cycle that long? Or is this made for shorter cycles?

Rob Milnes

The maximum amount of days that you can track is 280 days? It covers most of the population. We do have users that use it for longer than that, in fact, what we suggest is you just simply start a new cycle, even though you’ve obviously not had a period in between. And we have a whole range of women that ovulate maybe once or twice a year, but have only one period a year. You know, again, that’s a small percentage of the population. But we have that right down to people that appear to have completely regular cycles, lasting 28 days, they look in inverted commas, like a normal person in terms of their cycle length. But in actual fact, they have variable population because they do have PCOS, it’s estimated up to 50% of women with PCOS go undetected. So you’re probably aware of that statistic and therefore a very large proportion that are going on to fertility treatment with unexplained infertility or also likely to be to have PCOS that’s gone on to date.

Farrar Duro

Yet so important to note, because a lot of them will say, Well, I have perfect 28 day cycles, but nothing’s happening, that’s definitely frustrating. And perhaps, the LH stick might be positive, but it might not be a very strong ovulation, or we don’t know exactly what’s going on. But this gives a little more insight for sure because I think it’s measuring it for more longer period of time as well, not just for one reading when you wake up. I think that in the long run, this is definitely much more helpful than, and honestly, with paper, BBT charting with the apps, a lot of people don’t stick with it long enough or don’t complete a full chart. So it’s kind of an incomplete, like, they’ll come in and go, “here’s my chart, it’s like 10 days, like I don’t know, I can’t read anything from that”. It is helpful to be consistent with something and stay with something that you’re going to be using.

Farrar Duro

And hopefully it’s not going to be that long to reach your goal to become pregnant. But with PCOS we know it can take a little while to regulate the cycle and into work on certain things. Even if you are not trying currently to get pregnant, I think that knowing and learning more about your body is so important. This gives you time to kind of to get to know that if there’s something occurring like a luteal phase defect, like you mentioned with the progesterone is not stable during that second half. That’s something that you can do something about for sure. And indefinitely, a lot of women will go on to the big guns before really figuring out what’s going on with their bodies a lot of times and it’s what we see. So with that do you see any anyone who does not benefit from this type of monitoring, or is this pretty much a good fit for most women with PCOS.

Rob Milnes

It’s a good fit for all of the women that we have seen with PCOS. I think, if you have very erratic temperatures, then it still works very well. You talked about flat lines on BBT charts. But the other problem is you get very erratic temperature, so you can’t see a pattern very easily. So it’s worked very well, for those women. The only exception is where somebody may have diminished ovarian reserve. So you tend to get a much slower curve with that. And we would maintain that still useful. Because if you don’t know that you have a what we call a slow rise in your temperature curve, then you probably don’t know yet, you may have diminished ovarian reserve. The issue is that it’s kind of bad news, or it looks like bad news. And you absolutely need to seek the advice of a physician or further advice from services that are helping to support women with those issues. And you know that there is a crossover, obviously, between women with PCOS and diminished ovarian reserve, and particularly for them, you know, it’s very difficult to use Ovusense to get pregnant. But then what it’s telling you is, you have an issue that needs sorting anyway, so still useful in that regard. But it’s kind of bad news, as far as we don’t know that that’s difficult for the user.

Farrar Duro

How that would look?

Rob Milnes

Literally looks like a slow rise. So we’re looking for this .3 of a degrees Celsius rise about .54 degrees Fahrenheit, from top to bottom of the point of ovulation itself. And if that takes place over more than save six days, then that’s really an indication of a slow rise. And that may be an indication that there’s no ovulation taking place or ovulation happens slowly, it’s fairly logical when you look at it. Progesterone is being released, but it’s not being released as fast as the body needs to in order for a follicle to to burst. So it’s a fairly indicative pattern, and it tends to repeat. As soon as you’ve seen it once, it’s quite likely, it’ll repeat again. But again, this is the other big learning point, every single cycle is not only individual for a user, but it’s quite common that the cycle type will change from one cycle to the next for user. And we’ve certainly seen evidence that well-known thing of alternating ovaries creating different cycle patterns. So we see evidence of that as well. Whilst if you see a slow rise, and that’s, as I said, .3 of a degree or .54 of a degrees Fahrenheit, over maybe maybe 6,7, 8 days, then that’s possibly diminished ovarian reserve, but we tend to ask people to wait two or three cycles before confirming that that might be the case.

Farrar Duro

Okay, yes, we’ve definitely seen this on BBT charts as well, at some cases, and I know it can be frustrating, because our population tends to be over 35. A lot of our patients. I think that that is really one of those also great factors to learn about as well as early as you can to start doing something about for sure. This has been extremely helpful. I feel that so many of our listeners are going to get so much information out of this, they will be able to fast track their fertility and also understand their bodies a lot more clearly by using Ovusense. Also, learning a little bit more about what could be helpful for them and their individual situation. So, definitely, I’m looking forward to reading your research. And by the time this episode comes out, we’ll have that link as well posted to that. I really appreciate your time with us. Thank you so much. Thank you. Thank you, everybody for listening. Have a great week.

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Episode Spotlights:

  • The original technology ([1:45])
  • Live ovulation prediction ([4:34])
  • False positives ([8:59])
  • Using the software and the process ([10:33])
  • Issues with tests ([15:09])
  • Monitoring temperature vaginally vs orally ([16:35])
  • Using the sensor overnight ([18:45])
  • Fertility medication on outcome ([20:54])
  • Women tracking during early pregnancy ([23:15])
  • Maximum amount of days you can track ([25:20])
  • Who is this monitoring a good fit for ([28:24])

Resources Mentioned In This Episode:

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