To this present day, 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 firms and clinicians, we distilled a number of factors of recommendation for traders and founders on this area.
Setting the stage
A confluence of things creates challenges for reproductive healthcare within the U.S. Struggling to get better from the COVID-19 pandemic, hospitals are dealing with elevated strain to chop prices. Obstetrics is mostly not a profitable line of enterprise in hospitals attributable to comparatively decrease reimbursement charges and staffing shortages; thus, sure hospitals are shifting the quantity 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 year of trying. And 26% of ladies on this group have problem getting pregnant or carrying a being pregnant to time period. Many can’t afford the average IVF procedure cost of $15,000 to $20,000 for one cycle. Fertility providers are often not coated by public insurers both. Only one state Medicaid program covers any fertility treatment, 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 variety of households select to obtain therapy exterior of the U.S. due to this,” stated Dr. Kathy Ku, Stanford MD/MBA and digital well being investor.
To make issues worse, round 18 million women of reproductive age live in locations without access to fertility care, and the overturning of Roe v. Wade might depart much more in a lurch. Closing clinics in about half of states will exacerbate the scientific provide/demand imbalance within the long-term.
“There are a variety of entry boundaries — restricted insurance coverage protection, excessive copays, not sufficient clinicians, bodily distance to factors of care. On prime of this, fertility care has separate challenges given it’s seen by many as elective, leaving sufferers to pay for it virtually utterly out of pocket,” stated Dr. Michael Solotke, an OB-GYN at Northwestern Medication.
“Fragmentation of care can also be a problem,” stated Dr. Siobhan Dolan, an OB-GYN and scientific geneticist at Mount Sinai Well being System. “Infertility is usually handled in personal settings, so as soon as a affected person is pregnant, there isn’t a easy manner for prior data to be documented within the well being system EMR the place the supply will happen. This will result in medical challenges and antagonistic outcomes, to not point out a variety of burdensome document switch.”
Compounding these elements is the truth that reproductive points are steadily rising as extra women are delaying pregnancy, with the brand new median age for giving beginning at 30 years previous.
The issue is widespread — so what’s being performed 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 document $800 million was invested in 2021, in accordance with PitchBook.
The market could 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 group, and supplier enablement instruments.
World fertility market map
*Be aware: This market map isn’t designed to be complete, and lots of firms stretch throughout a number of classes.
At-House Diagnostics and Monitoring: This class is about empowering ladies to handle their fertility from house. One subset of firms delivers home-based diagnostics, primarily hormone testing and semen evaluation.
Many are female-oriented, resembling Famlee Well being, which supplies nationwide fertility testing, telehealth and therapy, however more and more firms are focusing on males as properly. This is smart given male factor fertility is present in roughly 50% of cases. One such instance is Legacy, which permits males “to check, enhance and freeze their sperm from house.”
With the costly prices of IVF therapy, conception aides could be a productive first step and various therapy path and possibility, resembling IUI gadgets, conception cups and even gadgets that measure cervical mucus. Bea Fertility is offering another choice for fertility therapy at house with its clinical-grade ICI system.
Digital-First Care Supply and Coordination: Fertility therapy 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 complicated therapy panorama. Body Fertility goals to be ladies’s devoted fertility and household constructing advisor, offering customized plans and ongoing assist.
Reproductive care ideally begins properly earlier than a girl is planning to conceive. Egg donation and freezing is an up-and-coming phase, particularly as extra ladies determine to delay being pregnant. Cofertility’s mannequin allows ladies to freeze their eggs free of charge once they donate half of the eggs to a household that in any other case can’t conceive, offering assist and schooling for everybody concerned alongside the best way.
One other firm, Blooming Eve, is specializing in vetted, reasonably priced clinic partnerships and academic sources to extend entry.
“We’re streamlining the appointment reserving expertise for our customers, and the shortage of expertise 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’d all win ultimately,” stated Anastasiia Timon, cofounder of Blooming Eve.
Fertility Advantages and Affected person Financing: Given the prohibitive prices of fertility care, there are numerous firms centered on constructing providers to package deal up and promote to employers or well being plans as a profit to members. Some firms have developed revolutionary financing options to fight the opacity and financial boundaries of fertility remedies. One such instance is Sunfish, which provides low-rate financing choices and monetary advocacy for fertility remedies.
Schooling, Content material and Group: Whereas much less typically a standalone enterprise mannequin, startups give attention to decreasing info asymmetry by way of peer assist communities, academic content material and programmatic programs on reproductive well being — assume Rescripted or FertilityIQ.
Knowledge Analytics, AI and Supplier Enablement Instruments: Lastly, an more and more vital phase has emerged round utilizing AI to make higher therapy selections and handle back-end processes in fertility clinics. Life Whisperer applies AI on 2D embryo pictures to establish embryos which can be most probably 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 highway
Determining the suitable 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 providers.
Launching with a DTC providing could be a good way to check choices on payers’ goal populations and show the answer works earlier than going B2B.
“The one strategy to get there may be to take a step-based strategy. Begin with a DTC product that persons are keen to pay for out-of-pocket — we have seen a variety 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,” stated Brittany Hawkins, CEO of Elanza Wellness.
Gathering adequate scientific 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 strategy to display market traction whereas extending money runway for early-stage startups.
2. Upskilling is crucial for addressing the fertility supply-demand imbalance
Since solely 40 to 50 new reproductive endocrinologists graduate each year, upskilling scientific expertise is important for addressing demand.
To that finish, Mate Fertility provides a turnkey answer for OB-GYN clinics seeking to upskill workers and introduce new fertility care providers, whereas taking a fee on extra service income.
“By partnering with OB-GYNs, increasing our clinic rely and sustaining scientific being pregnant charges round 20% above nationwide averages, whereas offering entry that isn’t solely extra geographically accessible, however inclusive, and extra reasonably priced, we are going to proceed to lift consciousness and leverage development for change on this business,” stated 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 also be inhibiting entry. Folks ought to simply have the ability to drop by a fertility clinic once 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 typically ignored. Nonetheless, 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 methods which can 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 complicated healthcare wants exterior of Tia’s scope, and there may be shared information and integration between the 2 care suppliers.
Bundling providers could be one other manner for firms to get their foot within the door with employers. For instance, framing an answer as a part of a maternal care bundle quite 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 situations, proving significant ROI is essential. The query stays, with most employers re-assessing their advantages stack yearly, will there be significant near-term ROI inside the first 12 months?
4. Tailor choices to every lady’s individualized wants
Ladies’s well being isn’t ‘one-size-fits-all.’ Interval. We consider the hot button is in creating ultra-personalized options that meet ladies the place they’re of their reproductive well being journeys.
The business additionally must do a greater job disseminating that there are alternatives exterior 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 way 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 therapy. Make the lady’s physique stand within the epicenter of reproductive well being drugs, reduce the unwanted effects and maximize sensitivity to its distinctive traits,” he stated.
5. Shift from ‘reactive’ to ‘proactive’ reproductive care
Most girls proper after school should not interested by reproductive well being in a significant manner and haven’t got entry to the suitable sources. There are benefits to assembly ladies earlier of their reproductive journeys to permit for extra planning and keep away from the annoying organic clock.
“A scarcity of accessible, standardized proactive schooling and sources leaves even educated ladies unaware of their very own reproductive well being,” stated Lauren Makler, CEO of Cofertility. “Cofertility is working exhausting to handle this and to create a brand new type of human-centered ecosystem for fertility care and third-party copy.”
Reproductive well being shouldn’t be handled in a vacuum, however quite 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 doable — for schooling and prenatal care in the event that they need to proceed the being pregnant, for high-risk obstetrical providers if that’s what they want or for abortion providers if that’s their path,” Dr. Dolan stated.
We consider this ecosystem would do properly to assume extra about providing holistic assist providers to satisfy ladies the place they’re.
In regards to the Authors:
Dana Sun 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 providers firms. Beforehand, she was a strategic finance affiliate at Genentech and healthcare administration advisor at Accenture.
Ellen Bursey is at the moment finishing her MBA at Columbia Enterprise Faculty, the place she interned at OCA Ventures, Cofertility, and Google. She can also be a Flare Capital Scholar. Previous to Columbia, Ellen was a administration advisor at Kearney, specializing of their healthcare and life sciences apply.
