Contributed: Why digital well being is fertile floor for reproductive care innovation
To at the present time, reproductive care stays fragmented, costly and inaccessible. An absence 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 couple of 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 better 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 on account of 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 therapies, protection remains to be inadequate. Amongst married girls within the U.S. ages 15 to 49 with no earlier births, 19% are unable to get pregnant after one 12 months of attempting. And 26% of girls on this group have problem getting pregnant or carrying a being pregnant to time period.
Many can not afford the common IVF process value of $15,000 to $20,000 for one cycle. Fertility companies are often not coated by public insurers both. Just one state Medicaid program covers any fertility therapy, and no Medicaid program covers synthetic insemination or IVF.
“Even taking insurance coverage out of the equation, fertility therapies within the U.S. stay dearer than in lots of different international locations. Anecdotally, I’ve seen quite a lot of households select to obtain therapy 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 girls of reproductive age stay in areas with out entry to fertility care, and the overturning of Roe v. Wade may depart 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 quite a lot of entry obstacles – 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 considered by many as elective, leaving sufferers to pay for it virtually utterly out of pocket,” mentioned Dr. Michael Solotke, an OB-GYN at Northwestern Drugs.
“Fragmentation of care can also 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 isn’t a easy manner for prior data to be documented within the well being system EMR the place the supply will happen. This may result in medical challenges and hostile outcomes, to not point out quite a lot of burdensome document switch.”
Compounding these components is the truth that reproductive points are steadily rising as extra girls are delaying being pregnant, with the brand new median age for giving start at 30 years outdated.
The issue is widespread. So what’s being completed about it?
Fertility care panorama
Startups are swooping in with revolutionary options to deal with these long-standing issues, and the fertility tech market is heating up. A document $800 million was invested in 2021, in line with PitchBook.
The market might be segmented into the next 5 classes: At-home diagnostics and monitoring, digital-first care supply and coordination, fertility advantages and affected person financing, instructional content material and group, and supplier enablement instruments.
World fertility market map
Observe: This market map isn’t designed to be complete, and lots of firms stretch throughout a number of classes.
At-home diagnostics and monitoring: This class is about empowering girls to handle their fertility from house. One subset of firms delivers home-based diagnostics, primarily hormone testing and semen evaluation.
Many are female-oriented, reminiscent of Famlee Well being, which supplies nationwide fertility testing, telehealth and therapy, however more and more firms are focusing on males as nicely. 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 house.”
With the costly prices of IVF therapy, conception aides could be a productive first step and various therapy path and possibility, reminiscent of 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 machine.
Digital-first care supply and coordination: Fertility-treatment supply spans a continuum of fashions bolstered by brick-and-mortar, hybrid options, and digital session and training platforms. Care coordination is a crucial a part of this ecosystem to assist girls navigate the complicated therapy panorama. Body Fertility goals to be girls’s devoted fertility and family-building advisor. It supplies personalised plans and ongoing assist.
Reproductive care ideally begins nicely earlier than a lady is planning to conceive. Egg donation and freezing is an up-and-coming phase, particularly as extra girls determine to delay being pregnant. Cofertility’s mannequin permits girls to freeze their eggs at no cost once they donate half of the eggs to a household that in any other case can’t conceive. It additionally supplies assist and schooling for everybody concerned alongside the best way.
One other firm, Blooming Eve, is specializing in vetted inexpensive clinic partnerships and academic assets 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 person journey have been extra seamless, clinics would have extra clients, and we’d all win ultimately,” mentioned Anastasiia Timon, cofounder of Blooming Eve.
Fertility advantages and affected person financing: Given the prohibitive prices of fertility care, there are a lot of firms centered on constructing companies to bundle 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 obstacles of fertility therapies. One such instance is Sunfish, which affords low-rate financing choices and monetary advocacy for fertility therapies.
Schooling, content material and group: Whereas much less usually a standalone enterprise mannequin, startups deal with lowering data asymmetry by means of peer assist communities, instructional content material and programmatic programs on reproductive well being — assume Rescripted or FertilityIQ.
Information analytics, AI and provider-enablement instruments: Lastly, an more and more necessary 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 determine embryos which are most definitely to reach 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 proper enterprise mannequin is tough, 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 might be an effective way to check choices on payers’ goal populations and show the answer works earlier than going B2B.
“The one option to get there’s to take a step-based strategy. Begin with a DTC product that persons are prepared to pay for out-of-pocket – we have seen quite a lot of startups fail as a result of they set their sights too shortly on reimbursement and may’t generate sufficient income from customers to get them there,” mentioned Brittany Hawkins, CEO of Elanza Wellness.
Gathering ample medical and monetary proof to make a compelling case for reimbursement can take years. Gaining adoption from customers paying out-of-pocket first is a extra expedient option to exhibit 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 crucial for addressing demand.
To that finish, Mate Fertility affords a turnkey resolution for OB-GYN clinics trying to upskill employees and introduce new fertility care companies, whereas taking a fee on further 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 are going to proceed to boost 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 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 usually ignored. Nevertheless, they are often early adopters prepared to iterate with innovators alongside the best way. Shorter gross sales cycles and the flexibility to “check and study” are useful options of those partnerships. Throughout the supplier panorama, we are able to discover examples of startups efficiently approaching regional well being methods which are agile and open to co-creating innovation options.
For instance, Tia Clinic has partnered with Cedars-Sinai to increase entry in L.A. Concurrently, sufferers get entry to broader specialty suppliers for extra complicated healthcare wants outdoors of Tia’s scope, and there’s shared information and integration between the 2 care suppliers.
Bundling companies might 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, slightly 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 vital. 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 girl’s individualized wants
Ladies’s well being isn’t ‘one-size-fits-all.’ Interval. We consider the bottom line is in creating ultra-personalized options that meet girls 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 girls’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 ladies’s particular healthcare wants.
“Discover distinctive strategies that apply significantly to girls, their anatomy, organs, morphology and therapy. Make the girl’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 faculty aren’t interested by reproductive well being in a significant manner and haven’t got entry to the proper assets. There are benefits to assembly girls earlier of their reproductive journeys to permit for extra planning and keep away from the demanding organic clock.
“An absence of accessible, standardized proactive schooling and assets leaves even educated girls 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 type of human-centered ecosystem for fertility care and third-party copy.”
Reproductive well being shouldn’t be handled in a vacuum, however slightly built-in into the broader preventative healthcare and upkeep plan.
“As soon as an individual is pregnant, we should always welcome them into the healthcare system as quickly as potential – for schooling 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 consider this ecosystem would do nicely to assume extra about providing holistic assist companies to satisfy girls the place they’re.
Concerning the Authors:
Dana Solar is a healthcare investor at OCA Ventures, a Chicago-based enterprise capital agency, the place she focuses on Seed and Collection A investments in digital well being and tech-enabled companies firms. Beforehand, she was a strategic finance affiliate at Genentech and healthcare administration guide at Accenture.
Ellen Bursey is at present 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 guide at Kearney, specializing of their healthcare and life sciences follow.
