Contributed: Why digital well being is fertile floor for reproductive care innovation
To today, 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 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 mostly not a profitable line of enterprise in hospitals resulting from 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 remains 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 girls on this group have problem getting pregnant or carrying a being pregnant to time period.
Many can’t afford the common IVF process price of $15,000 to $20,000 for one cycle. Fertility companies are normally 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 therapies within the U.S. stay costlier than in lots of different international locations. Anecdotally, I’ve seen plenty of households select to obtain remedy 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 places 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 plenty of entry obstacles – 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,” stated Dr. Michael Solotke, an OB-GYN at Northwestern Medication.
“Fragmentation of care can be a problem,” stated Dr. Siobhan Dolan, an OB-GYN and medical geneticist at Mount Sinai Well being System. “Infertility is commonly handled in personal settings, so as soon as a affected person is pregnant, there isn’t any easy method for prior information to be documented within the well being system EMR the place the supply will happen. This could result in medical challenges and antagonistic outcomes, to not point out plenty of 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 outdated.
The issue is widespread. So what’s being carried out about it?
Fertility care panorama
Startups are swooping in with progressive options to deal with these long-standing issues, and the fertility tech market is heating up. A report $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, instructional content material and group, and supplier enablement instruments.
World fertility market map
Word: This market map is just not designed to be complete, and plenty of firms stretch throughout a number of classes.
At-home diagnostics and monitoring: This class is about empowering ladies to handle their fertility from residence. One subset of firms delivers home-based diagnostics, primarily hormone testing and semen evaluation.
Many are female-oriented, comparable to Famlee Well being, which offers nationwide fertility testing, telehealth and remedy, 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 residence.”
With the costly prices of IVF remedy, conception aides could be a productive first step and different remedy path and possibility, comparable to IUI gadgets, conception cups and even gadgets that measure cervical mucus. Bea Fertility is offering an alternative choice for fertility remedy at residence with its clinical-grade ICI gadget.
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 ladies navigate the complicated remedy panorama. Body Fertility goals to be ladies’s devoted fertility and family-building advisor. It offers personalised plans and ongoing help.
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 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. It additionally offers help and training for everybody concerned alongside the way in which.
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 dearth of know-how adoption from the clinic’s facet ends in buyer dropout. If the person journey had been extra seamless, clinics would have extra clients, and we might all win in the long run,” stated Anastasiia Timon, cofounder of Blooming Eve.
Fertility advantages and affected person financing: Given the prohibitive prices of fertility care, there are lots of firms centered on constructing companies to package deal up and promote to employers or well being plans as a profit to members. Some firms have developed progressive financing options to fight the opacity and financial obstacles of fertility therapies. One such instance is Sunfish, which gives low-rate financing choices and monetary advocacy for fertility therapies.
Training, content material and group: Whereas much less typically a standalone enterprise mannequin, startups concentrate on decreasing info asymmetry via peer help communities, instructional content material and programmatic programs on reproductive well being — suppose Rescripted or FertilityIQ.
Information analytics, AI and provider-enablement instruments: Lastly, an more and more essential phase has emerged round utilizing AI to make higher remedy choices and handle back-end processes in fertility clinics. Life Whisperer applies AI on 2D embryo photos to establish embryos which might be most probably 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 fitting enterprise mannequin is difficult, as a result of the market is basically self-pay and plenty of startups are struggling to acquire reimbursement for reproductive care companies.
Launching with a DTC providing could 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 may be to take a step-based method. Begin with a DTC product that persons are prepared to pay for out-of-pocket – we have seen plenty of startups fail as a result of they set their sights too rapidly on reimbursement and may’t generate sufficient income from customers to get them there,” stated 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 technique to show market traction whereas extending money runway for early-stage startups.
2. Upskilling is essential 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 gives a turnkey resolution for OB-GYN clinics seeking 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 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 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 typically ignored. Nevertheless, they are often early adopters prepared to iterate with innovators alongside the way in which. Shorter gross sales cycles and the flexibility to “take a look at and be taught” are useful options of those partnerships. Throughout the supplier panorama, we are able to discover examples of startups efficiently approaching regional well being techniques 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 may be shared information and integration between the 2 care suppliers.
Bundling companies could be one other method for firms to get their foot within the door with employers. For instance, framing an answer as a part of a maternal care bundle, somewhat 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 powerful 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 throughout the first 12 months?
4. Tailor choices to every lady’s individualized wants
Ladies’s well being is just not ‘one-size-fits-all.’ Interval. We imagine the secret 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 via 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 remedy. 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 stated.
5. Shift from ‘reactive’ to ‘proactive’ reproductive care
Most girls proper after faculty are usually not eager about reproductive well being in a significant method and haven’t got entry to the fitting sources. There are benefits to assembly ladies earlier of their reproductive journeys to permit for extra planning and keep away from the irritating organic clock.
“A scarcity of accessible, standardized proactive training and sources leaves even educated ladies unaware of their very own reproductive well being,” stated Lauren Makler, CEO of Cofertility. “Cofertility is working arduous to handle this and to create a brand new form of human-centered ecosystem for fertility care and third-party replica.”
Reproductive well being shouldn’t be handled in a vacuum, however somewhat 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 training 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 imagine this ecosystem would do nicely to suppose extra about providing holistic help companies to satisfy ladies the place they’re.
In regards to 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 advisor at Accenture.
Ellen Bursey is presently finishing her MBA at Columbia Enterprise College, 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.
