Contributed: Why digital well being is fertile floor for reproductive care innovation

To at the present time, reproductive care stays fragmented, costly and inaccessible. A scarcity of options to resolve these issues has led to the proliferation of startups making an attempt to plug care gaps. 

After talking with over 75 fertility tech corporations and clinicians, we distilled just a few factors of recommendation for traders and founders on this house. 

Setting the stage

A confluence of things creates challenges for reproductive healthcare within the U.S. Struggling to get well from the COVID-19 pandemic, hospitals are going through elevated stress to chop prices. Obstetrics is usually not a profitable line of enterprise in hospitals as a consequence of comparatively decrease reimbursement charges and staffing shortages; thus, sure hospitals are shifting the amount combine to extra worthwhile procedures (i.e. knees, hips and spines). Sadly, this places obstetrics on the chopping block. 

Though employers and well being plans are more and more subsidizing prices of fertility remedies, protection continues to be inadequate. Amongst married ladies within the U.S. ages 15 to 49 with no earlier births, 19% are unable to get pregnant after one yr of making an attempt. And 26% of ladies on this group have problem getting pregnant or carrying a being pregnant to time period. Many can’t afford the typical IVF process price of $15,000 to $20,000 for one cycle. Fertility companies are often not lined by public insurers both. Just one state Medicaid program covers any fertility remedy, and no Medicaid program covers synthetic insemination or IVF. 

“Even taking insurance coverage out of the equation, fertility remedies within the U.S. stay dearer than in lots of different international locations. Anecdotally, I’ve seen a number of households select to obtain remedy outdoors of the U.S. due to this,” mentioned Dr. Kathy Ku, Stanford MD/MBA and digital well being investor.

To make issues worse, round 18 million ladies of reproductive age stay in places with out entry to fertility care, and the overturning of Roe v. Wade might go away much more in a lurch. Closing clinics in about half of states will exacerbate the medical provide/demand imbalance within the long-term.

“There are a number of entry limitations — restricted insurance coverage protection, excessive copays, not sufficient clinicians, bodily distance to factors of care. On high of this, fertility care has separate challenges given it’s considered by many as elective, leaving sufferers to pay for it nearly utterly out of pocket,” mentioned Dr. Michael Solotke, an OB-GYN at Northwestern Medication.

“Fragmentation of care can be a problem,” mentioned Dr. Siobhan Dolan, an OB-GYN and medical geneticist at Mount Sinai Well being System. “Infertility is usually handled in non-public settings, so as soon as a affected person is pregnant, there is no such thing as a easy means for prior information to be documented within the well being system EMR the place the supply will happen. This may result in medical challenges and antagonistic outcomes, to not point out a number of burdensome file switch.”

Compounding these elements is the truth that reproductive points are steadily rising as extra ladies are delaying being pregnant, with the brand new median age for giving delivery at 30 years outdated. 

The issue is widespread — so what’s being carried out about it?

Fertility care panorama

Startups are swooping in with revolutionary options to deal with these longstanding issues, and the fertility tech market is heating up. A file $800 million was invested in 2021, based on PitchBook

The market will be segmented into the next 5 classes: At-home diagnostics and monitoring, digital-first care supply and coordination, fertility advantages and affected person financing, academic content material and neighborhood, and supplier enablement instruments. 

International fertility market map

*Notice: This market map isn’t designed to be complete, and lots of corporations stretch throughout a number of classes. 

Fertility market map

At-Residence Diagnostics and Monitoring: This class is about empowering ladies to handle their fertility from residence. One subset of corporations delivers home-based diagnostics, primarily hormone testing and semen evaluation.

Many are female-oriented, akin to Famlee Well being, which gives nationwide fertility testing, telehealth and remedy, however more and more corporations are focusing on males as properly. This is smart given male issue fertility is current in roughly 50% of instances. One such instance is Legacy, which permits males “to check, enhance and freeze their sperm from residence.”

With the costly prices of IVF remedy, conception aides generally is a productive first step and various remedy path and choice, akin to IUI gadgets, conception cups and even gadgets that measure cervical mucus. Bea Fertility is offering another choice for fertility remedy at residence with its clinical-grade ICI machine. 

Digital-First Care Supply and Coordination: Fertility remedy supply spans a continuum of fashions bolstered by brick-and-mortar, hybrid options, and digital consultations and training platforms. Care coordination is a vital a part of this ecosystem to assist ladies navigate the advanced remedy panorama. Body Fertility goals to be ladies’s devoted fertility and household constructing advisor, offering personalised plans and ongoing help. 

Reproductive care ideally begins properly earlier than a lady is planning to conceive. Egg donation and freezing is an up-and-coming phase, particularly as extra ladies resolve to delay being pregnant. Cofertility’s mannequin permits ladies to freeze their eggs without cost after they donate half of the eggs to a household that in any other case can’t conceive, offering help and training for everybody concerned alongside the best way.

One other firm, Blooming Eve, is specializing in vetted, inexpensive clinic partnerships and academic sources to extend entry. 

“We’re streamlining the appointment reserving expertise for our customers, and the shortage of know-how adoption from the clinic’s facet ends in buyer dropout. If the consumer journey have been extra seamless, clinics would have extra prospects, and we might all win in the long run,” mentioned Anastasiia Timon, cofounder of Blooming Eve.

Fertility Advantages and Affected person Financing: Given the prohibitive prices of fertility care, there are lots of corporations centered on constructing companies to bundle up and promote to employers or well being plans as a profit to members. Some corporations have developed revolutionary financing options to fight the opacity and financial limitations of fertility remedies. One such instance is Sunfish, which gives low-rate financing choices and monetary advocacy for fertility remedies. 

Schooling, Content material and Group: Whereas much less usually a standalone enterprise mannequin, startups give attention to decreasing info asymmetry by means of peer help communities, academic content material and programmatic programs on reproductive well being — suppose Rescripted or FertilityIQ. 

Information Analytics, AI and Supplier Enablement Instruments: Lastly, an more and more essential phase has emerged round utilizing AI to make higher remedy selections and handle back-end processes in fertility clinics. Life Whisperer applies AI on 2D embryo pictures to establish embryos which might be almost certainly to achieve IVF. Alife’s AI-powered platform streamlines the end-to-end IVF course of for clinics, together with optimizing dosing of FSH (follicle-stimulating hormone), grading embryos and performing multi-clinic KPI monitoring.

1. Pursue the direct-to-consumer pathway to unlock reimbursements down the street

Determining the best enterprise mannequin is difficult as a result of the market is essentially self-pay, and lots of startups are struggling to acquire reimbursement for reproductive care companies.

Launching with a DTC providing will be an effective way to check choices on payers’ goal populations and show the answer works earlier than going B2B.

“The one technique to get there’s to take a step-based strategy. Begin with a DTC product that individuals are keen to pay for out-of-pocket — we have seen a number of startups fail as a result of they set their sights too shortly on reimbursement and might’t generate sufficient income from shoppers to get them there,” mentioned Brittany Hawkins, CEO of Elanza Wellness.

Gathering adequate medical and monetary proof to make a compelling case for reimbursement can take years. Gaining adoption from shoppers paying out-of-pocket first is a extra expedient technique to show market traction whereas extending money runway for early-stage startups.

2. Upskilling is important for addressing the fertility supply-demand imbalance

Since solely 40 to 50 new reproductive endocrinologists graduate annually, upskilling medical expertise is important for addressing demand.

To that finish, Mate Fertility gives a turnkey resolution for OB-GYN clinics seeking to upskill workers and introduce new fertility care companies, whereas taking a fee on extra service income.

“By partnering with OB-GYNs, increasing our clinic depend and sustaining medical being pregnant charges round 20% above nationwide averages, whereas offering entry that’s not solely extra geographically accessible, however inclusive, and extra inexpensive, we’ll proceed to lift consciousness and leverage progress for change on this trade,” mentioned Traci Eager, CEO of Mate Fertility. 

Along with the demand and provide hole, digital well being investor Dr. Anna Nakayasu shares that “the time it takes to get a referral can be inhibiting entry. Folks ought to simply be capable to drop by a fertility clinic after they have any concern associated to fertility.”

3. Embrace self-funded small and midsize employers as innovation companions

The SMB employer phase has been too usually ignored. Nevertheless, they are often early adopters keen to iterate with innovators alongside the best way. Shorter gross sales cycles and talent to ‘check and study’ are useful options of those partnerships. Throughout the supplier panorama, we will discover examples of startups efficiently approaching regional well being programs which might be agile and open to co-creating innovation options. For instance, Tia Clinic has partnered with Cedars-Sinai to develop entry in LA. Concurrently, sufferers get entry to broader specialty suppliers for extra advanced healthcare wants outdoors of Tia’s scope, and there’s shared information and integration between the 2 care suppliers. 

Bundling companies will be one other means for corporations to get their foot within the door with employers. For instance, framing an answer as a part of a maternal care bundle moderately than purely as a fertility profit facilitates integration with the broader suite of employer advantages. 

With many employers pruning down their ecosystems of advantages and companions contemplating robust financial circumstances, proving significant ROI is essential. The query stays, with most employers re-assessing their advantages stack yearly, will there be significant near-term ROI throughout the first 12 months?

4. Tailor choices to every lady’s individualized wants

Girls’s well being isn’t ‘one-size-fits-all.’ Interval. We imagine the hot button is in creating ultra-personalized options that meet ladies the place they’re of their reproductive well being journeys.

The trade additionally must do a greater job disseminating that there are alternatives outdoors IVF and offering the suitable triage and conception suggestions. Moreover, cultural sensitivity and competency turns into particularly related when inequities are so pronounced inside ladies’s well being.

Tsafrir Kolatt, CEO of Fertigo Medical, an organization that goals to extend IVF success charges by means of real-time, in-vivo monitoring of uterus readiness for implantation, emphasizes customization for girls’s particular healthcare wants.

“Discover distinctive strategies that apply significantly to ladies, their anatomy, organs, morphology and remedy. Make the lady’s physique stand within the epicenter of reproductive well being medication, decrease the negative effects and maximize sensitivity to its distinctive traits,” he mentioned. 

5. Shift from ‘reactive’ to ‘proactive’ reproductive care

Most girls proper after school aren’t interested by reproductive well being in a significant means and haven’t got entry to the best sources. There are benefits to assembly ladies earlier of their reproductive journeys to permit for extra planning and keep away from the worrying organic clock.

“A scarcity of accessible, standardized proactive training and sources leaves even educated ladies unaware of their very own reproductive well being,” mentioned Lauren Makler, CEO of Cofertility. “Cofertility is working exhausting to handle this and to create a brand new sort of human-centered ecosystem for fertility care and third-party copy.”

Reproductive well being shouldn’t be handled in a vacuum, however moderately built-in into the broader preventative healthcare and upkeep plan.

“As soon as an individual is pregnant, we must always welcome them into the healthcare system as quickly as attainable —  for training and prenatal care in the event that they need to proceed the being pregnant, for high-risk obstetrical companies if that’s what they want or for abortion companies if that’s their path,” Dr. Dolan mentioned.

We imagine this ecosystem would do properly to suppose extra about providing holistic help companies to fulfill ladies the place they’re.

Concerning the Authors:

Dana SunDana Solar is a healthcare investor at OCA Ventures, a Chicago-based enterprise capital agency, the place she focuses on Seed and Sequence A investments in digital well being and tech-enabled companies corporations. Beforehand, she was a strategic finance affiliate at Genentech and healthcare administration advisor at Accenture.



Ellen BurseyEllen Bursey is presently finishing her MBA at Columbia Enterprise Faculty, the place she interned at OCA Ventures, Cofertility, and Google. She can be a Flare Capital Scholar.  Previous to Columbia, Ellen was a administration advisor at Kearney, specializing of their healthcare and life sciences apply.



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