Contributed: Why digital well being is fertile floor for reproductive care innovation
To today, reproductive care stays fragmented, costly and inaccessible. An absence of options to unravel 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 a couple of factors of recommendation for buyers and founders on this house.
Setting the stage
A confluence of things creates challenges for reproductive healthcare within the U.S. Struggling to recuperate 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 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 therapies, 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 12 months of making an attempt. And 26% of ladies on this group have issue getting pregnant or carrying a being pregnant to time period.
Many can not afford the typical IVF process price 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 costlier than in lots of different nations. Anecdotally, I’ve seen numerous 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 ladies of reproductive age stay in areas with out entry 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 medical provide/demand imbalance within the long-term.
“There are numerous entry limitations – 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 Drugs.
“Fragmentation of care can also be a problem,” stated Dr. Siobhan Dolan, an OB-GYN and medical geneticist at Mount Sinai Well being System. “Infertility is usually handled in personal settings, so as soon as a affected person is pregnant, there is no such thing as a easy method 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 opposed outcomes, to not point out numerous burdensome report 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 previous.
The issue is widespread. So what’s being performed about it?
Fertility care panorama
Startups are swooping in with modern options to sort out these long-standing issues, and the fertility tech market is heating up. A report $800 million was invested in 2021, in keeping 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, academic content material and group, and supplier enablement instruments.
International fertility market map
Observe: This market map will not be designed to be complete, and lots of corporations stretch throughout a number of classes.
At-home diagnostics and monitoring: This class is about empowering ladies to handle their fertility from dwelling. One subset of corporations delivers home-based diagnostics, primarily hormone testing and semen evaluation.
Many are female-oriented, similar to Famlee Well being, which offers nationwide fertility testing, telehealth and therapy, however more and more corporations are concentrating on males as effectively. This is sensible 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 dwelling.”
With the costly prices of IVF therapy, conception aides is usually a productive first step and various therapy path and choice, similar to IUI units, conception cups and even units that measure cervical mucus. Bea Fertility is offering an alternative choice for fertility therapy at dwelling with its clinical-grade ICI system.
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 vital a part of this ecosystem to assist ladies navigate the complicated therapy panorama. Body Fertility goals to be ladies’s devoted fertility and family-building advisor. It offers customized plans and ongoing help.
Reproductive care ideally begins effectively 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 totally free after they donate half of the eggs to a household that in any other case can’t conceive. It additionally offers help and schooling for everybody concerned alongside the best way.
One other firm, Blooming Eve, is specializing in vetted reasonably priced clinic partnerships and academic assets to extend entry.
“We’re streamlining the appointment reserving expertise for our customers, and the dearth of know-how adoption from the clinic’s facet leads to buyer dropout. If the person journey had 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 lots of corporations centered on constructing companies to package deal up and promote to employers or well being plans as a profit to members. Some corporations have developed modern financing options to fight the opacity and financial limitations 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 typically a standalone enterprise mannequin, startups concentrate on decreasing data asymmetry by peer help communities, academic 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 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 might be more than likely 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 fitting enterprise mannequin is difficult, as a result of the market is basically 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 solution 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 numerous startups fail as a result of they set their sights too rapidly on reimbursement and might’t generate sufficient income from shoppers to get them there,” stated 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 solution to show 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 every year, upskilling medical expertise is important for addressing demand.
To that finish, Mate Fertility affords a turnkey answer 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 isn’t solely extra geographically accessible, however inclusive and extra reasonably priced, we’ll proceed to lift consciousness and leverage development for change on this trade,” 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. Individuals 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 typically ignored. Nonetheless, they are often early adopters prepared to iterate with innovators alongside the best way. Shorter gross sales cycles and the power to “take a look at 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 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 L.A. Concurrently, sufferers get entry to broader specialty suppliers for extra complicated healthcare wants exterior of Tia’s scope, and there’s shared information and integration between the 2 care suppliers.
Bundling companies might be one other method for corporations 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 circumstances, 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 will not be ‘one-size-fits-all.’ Interval. We consider the bottom line 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 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 real-time, in-vivo monitoring of uterus readiness for implantation, emphasizes customization for girls’s particular healthcare wants.
“Discover distinctive strategies that apply notably to ladies, their anatomy, organs, morphology and therapy. Make the lady’s physique stand within the epicenter of reproductive well being medication, decrease the unwanted side effects and maximize sensitivity to its distinctive traits,” he stated.
5. Shift from ‘reactive’ to ‘proactive’ reproductive care
Most ladies proper after school will not be fascinated with reproductive well being in a significant method and do not have entry to the fitting assets. There are benefits to assembly ladies earlier of their reproductive journeys to permit for extra planning and keep away from the hectic organic clock.
“An absence of accessible, standardized proactive schooling and assets leaves even educated ladies unaware of their very own reproductive well being,” stated Lauren Makler, CEO of Cofertility. “Cofertility is working laborious 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 attainable – for schooling and prenatal care, in the event that they wish 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 stated.
We consider this ecosystem would do effectively to assume extra about providing holistic help companies to satisfy ladies 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 Sequence A investments in digital well being and tech-enabled companies corporations. Beforehand, she was a strategic finance affiliate at Genentech and healthcare administration marketing consultant at Accenture.
Ellen Bursey is at the moment finishing her MBA at Columbia Enterprise College, 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 marketing consultant at Kearney, specializing of their healthcare and life sciences apply.
