Interview | Headspace's Chief Product Officer Shares Her Fertility Journey

From Nina (Head of Product at Doveras): In honor of National Infertility Awareness Week 2023, Leslie Witt shares part of her journey to parenthood story.

Leslie was an IDEO legend and as I've gotten to know her, she is many other things — a mom, a gardener, the Chief Product Officer at Headspace Health, a fierce advocate for women's health, and an advisor at Doveras Fertility. 

Nina: Leslie, thank you so much for joining me today! Most people know you as the Chief Product and Design Officer at Headspace Health, one of the most beloved mental health companies. 

But if there's any theme that our readers (I hope!) have observed over the last few years of this newsletter, it’s that our job titles rarely capture the things that shape our work and lives. So to kick things off, outside of work, what is holding your attention these days?

Leslie: Oh I love that question! Thanks for having me Nina, I’m excited to dive in with you. 

In terms of what’s holding my attention, top of the list has to be my 11-and-half-year old twins, Grey and Ella. It's an exciting moment to watch your kids find their passions and lean into something that you can tell just really speaks to their heart, which for both has happened over the course of the last six months. For my daughter, it's acting. She has scored her first role in a local community theater production of Percy Jackson, which is really fun. We can't wait to see her on stage. For my son, it's drumming, which he does from about 6:00 AM to 9:00 PM! Just to see their passions ignite and the beginnings of their adult selves emerge is awesome. 

But beyond that, I'd say the other thing holding my attention (and also holding my sanity!) is gardening. I'm a complete plant-ophiliac these days. Now that the rains have stopped in California, spring is in full bloom— my fava beans and sugar snaps are being harvested and I’ve got 20 some tomato plants at the ready!

Nina: I had no idea about your green thumb!

Leslie: Oh, yeah. You have to come over! Quick plug, I'm on the board of directors for the Filoli Historic House and Gardens, which is an absolute gem in the Bay Area! So for those who are local, if you haven't visited, check out Filoli. It's awesome.

⁠Nina: I’ll have to check it out next time I’m in the Bay! I always love hearing about your kids because you’ve been quite public about your family building journey. ⁠

To give some context to our readers, Leslie is also on the advisory board of Doveras, a new fertility health and pre-pregnancy care company helping more people build the families they want (and where I now lead product!). We just launched our first digital product that looks at the latest clinical evidence to help aspiring parents answer the question: what kind of lifestyle and behavioral changes can be made to improve fertility potential and reproductive outcomes?

Leslie, would you be willing to share a bit about how your experience has informed the perspective you bring to what we’re building?

Leslie: Absolutely. The problem you all are solving at Doveras is near and dear to my heart, so it was a no-brainer to come on board! 

The World Health Organization released a report a few weeks ago saying 1 in 6 people experience infertility globally. 1 in 6. I was one of those people. The punchline of my story is a great one, I’m lucky to have my two amazing kids. But the path there was maybe less than ideal. 

Up until I stumbled into this fertility journey, everything had just unfolded like clockwork for me. You might be able to tell this from my professional self, but I'm a bit of a planner. I went to grad school, then got married a year and a half later at 28. We thought we’d wait two years to try to have kids and then I would be pregnant at 30.

Right on target, right on time, I turned 30 and I got pregnant. All was working according to plan. When I was about 13 weeks pregnant, my husband took off on a work flight to London, and about three hours later I started to bleed. It was confirmed the next morning that I had miscarried. 

I think everyone experiences miscarriage differently, and because it became something that I experienced multiple times, I'd say each miscarriage was different. But I was able to contextualize that first one in the frame of, "Hey, 25% of all pregnancies end in miscarriage," and really maintain a fair amount of optimism. 

So much so that three months later, I was pregnant again, and then I miscarried again. About six months later, I was pregnant again, saw that little beating heartbeat of hope, and then it ceased and I miscarried again.

By three losses, I knew something was for-real wrong. Only then was the medical community willing to say, "Okay, now you are a multiple miscarrier." But unfortunately, I was labeled an “idiopathic multiple miscarrier,” which is fancy language for they didn't know why I was miscarrying — which doesn't mean there weren’t reasons that I was miscarrying, but simply that the set of known logics and things that we could check for weren't what applied to my situation. 

I went on through miscarriage four and through miscarriage five, and I did start to think of them that way — as miscarriages rather than pregnancies — which is really sad in retrospect. The first three were pregnancies that I lost and the last two were just miscarriages to me. I anticipated the loss so deeply that a level of deep pessimism really infused all things. 

After five, I couldn't keep doing it. At that point I felt like we had to throw the kitchen sink at this, so we did IVF with preimplantation genetic diagnosis (PGD) and immunosuppression — everything that we knew would help our chances, and it did. 

So through my sixth and final pregnancy I got my awesome twins. Like I said, the punchline of the story is amazing, and I feel lucky. I know for many there isn’t always the happy ending to the story that I got.

⁠Nina: You called yourself a “planner”, and I think many of our Doveras members would describe themselves similarly.

One thing that can therefore be challenging is the sense of losing control over your life and body. Was there anything you did that helped you regain a sense of agency and self?

Leslie: Well one thing is to find the small everyday empowerments. I wish Doveras had existed when I was going through my experience. Everyday, evidence-based choices about your lifestyle absolutely puts more power in the hands of the folks who are on this quest.

The evidence-based part in particular is important. There is a lot of information out there that can compound the confusion, and I remember it was challenging to know what, and who, to trust (and I can imagine this has only gotten harder for people in my shoes today with so many Instagram influencers sharing their anecdotal stories!). 

So I love that Doveras started by reviewing and synthesizing over 100,000 clinical studies and shares the most relevant studies behind any behavioral change recommendation. I think this goes a long way with the sense of controlling the things you can control and feeling confident about it — in both its actual value from a health and fertility outcomes perspective and from its emotional and psychological value, which we know are interconnected.

And I actually think this goes for both people who are planning to get pregnant and for those who may be struggling. I love that you’re designing for me all those years ago — someone experiencing fertility challenges as part of that 1 in 6. But you’re also designing for the 5 in 6, because at the end of the day, we don’t know which way the dice will roll, and taking control of your fertility and health is good for everyone. 

For this group of people who are about to start trying or actively trying, the evidence is clear that these lifestyle changes can help improve chances of pregnancy via sex and a whole host of other positive reproductive outcomes. I think it’s exciting that in some cases, these behavioral interventions might be helping folks reduce the risk of finding themself in that 1 in 6 group experiencing challenges. 

Nina: I appreciate that. Honestly as I’ve come on board, I was really surprised by how compelling the scientific evidence is for these lifestyle medicine approaches to fertility and chronic conditions that can cause infertility.

And yet, this research doesn’t seem to be included in our medical system’s approach to reproductive health. That’s a challenge I think is really interesting to design for.  ⁠

But, it’s one thing to be able to show people the relevant behavioral changes for them to make, and it’s another to actually support behavior change that can lead to outcome change.  You’ve been so helpful here.

Can you share a bit about your philosophy on design for behavioral change? I know this is Headspace Health's bread and butter! 

Leslie: At Headspace, behavioral change is something we’re thinking about — and designing for — all the time. How do you understand what readiness someone has to make change? How do you help them establish and align to a goal, and provide the guardrails and the guidance to get them from expression of intention to their own desired outcome that includes new habit formation? And then how do you prove out — with evidence and measurement — that what they’ve done has actually helped? We focus on stress and anxiety reduction as well as better sleep at Headspace, but the mechanics of marrying human understanding with digital structure are very similar in most behavioral change efforts. 

Fertility journeys are particularly interesting when it comes to designing for behavior change. I remember from my own experience, sometimes I’d be ready to throw spaghetti at the wall and try everything and be so great about my routine. But then other times I’d just want to eat pizza and give up on all my healthy habits. So there is a lot of stop and start to design for. 

Nina: As a designer at heart, I'm curious if there were other moments in your own fertility experience that you would look back on and say, "I would design that differently."

Leslie: I think designing for those small everyday empowerment is huge, but I’d also say a more empathetic and accessible system as a whole is a big need in the women’s health and fertility space. 

I hate to trot out some of the worst moments, but those in a lot of ways feel the most ripe for redesign. One of them has been particularly resurfacing for me, given all of the constriction of women's access to reproductive health rights that has been happening across the U.S. and more broadly over the last set of years. 

I made a choice with my doctors to use pills to medically induce the actual miscarriage itself. It turns out that the pills that are abortifacients are the same pills that help you have a medically-induced miscarriage. These pills not only save you from a surgical procedure, but they also make it less likely that you will have uterine damage that would make it harder to get pregnant. So there's all sorts of reasons why it's a better way to go for a good number of people depending on how far you are along.

Right after I learned that I'd lost my first baby and that the baby was no longer living, I went to the pharmacy to get the prescription. The pharmacist — and this is in the Bay Area, California — looked at me and said, "What exactly is it that you intend to do with these pills?" I said, "Well, first of all, it's none of your business, but if you must know, it's so that I can get rid of the dead baby that I'm carrying." 

I’m sorry — I didn't realize I would get so emotional recounting these old tales, but I think what this experience revealed to me was a deep lack of empathy, a deep lack of understanding, and also an overstep of institutional boundaries.

I think that we have to figure out ways that known care holders and stakeholders within the system can have more empathy. I don't think this pharmacist was meaning to do harm, but she lacked context. I disagree with her judgment, writ large, independent of context, to ask me this. But she was, in some ways, empowered to ask these questions by a larger care system.

So that one stands out as another redesign moment. For me, it knits infertility into the broader frame of women's reproductive rights and asks how might we ensure that access is sustained for all people in ways that are both private and supportive.

⁠Nina: That ecosystem is critical, and another important node within it for many is their partner. But we often hear that partners can have a hard time engaging with the fertility journey.

I was surprised to learn through our private beta that three-quarters of our members wanted more support from their partner (and was proud that 91% of people felt our program positively impacted their relationship). ⁠I’m curious how your husband felt during all of this?

Leslie: Yes, one of the principles that really excites me about Doveras is that you're actually thinking about the couple and providing information for what the spouse could and should do, which I think was an incredibly missing part of the infertility journey. 

My husband talks about it quite often actually. He felt like as soon as we got labeled and put in that “multiple miscarrier” category, he ceased to exist. A major bias we experienced was this focus on a singular parent, and that parent tends to be female. 

Why is this the case when we know that this division doesn’t support an overall action plan and outcomes! Plus, it was deeply frustrating for both of us and really reinforced the notion that you were in this alone. 

Nina: To wrap up, I’m curious what advice you have to people who might be going through something similar today.

Leslie: I’ll caveat it by saying it's up to everyone's personal discretion and their own desire for privacy versus publicity — but the guidance of “don't share that you're pregnant until the second trimester because you might miscarry” I think really does disservice to the fact that if you miscarry, you will probably really need other people's support. It puts it into a position of shame, even if unintentionally.  

So I believe, hey, if you want the support of your mom, your sister, your best friend, whomever it is, bring those people along the ride with you as early as possible so that they can support you both in the joy and the sorrow is essential.

Nina: Thanks Leslie.

Leslie: Thank you! I'd be remiss if I didn't say that this was just the journey to the starting line. Then, man, oh man, has it been a wild journey of ups and downs over the last 11 and a half years, and hopefully for many more years onward. 

So I hope that for all of the Doveras members and the many, many more out there, that they get to whatever that starting line looks like for them.