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 trying 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 area. 

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 strain to chop prices. Obstetrics is usually not a profitable line of enterprise in hospitals because 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 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 issue 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 normally not coated 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 numerous households select to obtain remedy exterior 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 reside 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 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 considered by many as elective, leaving sufferers to pay for it nearly fully out of pocket,” mentioned Dr. Michael Solotke, an OB-GYN at Northwestern Medication.

“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 personal settings, so as soon as a affected person is pregnant, there isn’t a easy manner for prior information to be documented within the well being system EMR the place the supply will happen. This will result in medical challenges and opposed outcomes, to not point out numerous burdensome report switch.”

Compounding these components is the truth that reproductive points are steadily rising as extra ladies 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 achieved 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 response to PitchBook. 

The market may 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

Be aware: This market map just isn’t designed to be complete, and plenty of corporations stretch throughout a number of classes. 

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

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

With the costly prices of IVF remedy, conception aides could be a productive first step and different remedy path and possibility, similar to IUI units, conception cups and even units that measure cervical mucus. Bea Fertility is offering another choice for fertility remedy 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 vital 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 gives personalised plans and ongoing help. 

Reproductive care ideally begins effectively 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 at no cost once they donate half of the eggs to a household that in any other case can’t conceive. It additionally gives 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 expertise adoption from the clinic’s facet ends in buyer dropout. If the consumer journey have been extra seamless, clinics would have extra clients, 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 various 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 progressive financing options to fight the opacity and financial boundaries of fertility therapies. One such instance is Sunfish, which presents 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 info asymmetry by peer help communities, academic 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 vital 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 determine embryos which might be almost definitely 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 precise 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 may 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 prepared to pay for out-of-pocket – we have seen numerous 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 technique to reveal market traction whereas extending money runway for early-stage startups.

2. Upskilling is vital 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 presents a turnkey resolution for OB-GYN clinics trying to upskill workers 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 business,” 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 typically ignored. Nonetheless, they are often early adopters prepared to iterate with innovators alongside the way in which. Shorter gross sales cycles and the power to “take a look at and be taught” are useful options of those partnerships. Throughout the supplier panorama, we will discover examples of startups efficiently approaching regional well being methods which might be 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 exterior of Tia’s scope, and there’s shared information and integration between the 2 care suppliers. 

Bundling companies may be one other manner for corporations 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 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 inside the first 12 months?

4. Tailor choices to every girl’s individualized wants

Girls’s well being just isn’t ‘one-size-fits-all.’ Interval. We consider the secret’s 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 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 ladies, their anatomy, organs, morphology and remedy. Make the girl’s physique stand within the epicenter of reproductive well being medication, reduce the unwanted effects and maximize sensitivity to its distinctive traits,” he mentioned. 

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

Most girls proper after faculty will not be excited about reproductive well being in a significant manner and haven’t got entry to the precise sources. There are benefits to assembly ladies earlier of their reproductive journeys to permit for extra planning and keep away from the traumatic 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 laborious 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 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 potential – 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 consider this ecosystem would do effectively 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 Sequence A investments in digital well being and tech-enabled companies corporations. 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 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 guide at Kearney, specializing of their healthcare and life sciences follow.