Contributed: Why digital well being is fertile floor for reproductive care innovation

To at the present time, 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 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 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 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 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 year of trying. And 26% of girls on this group have problem getting pregnant or carrying a being pregnant to time period.

Many can not afford the average IVF procedure cost of $15,000 to $20,000 for one cycle. Fertility companies 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 therapies within the U.S. stay costlier than in lots of different nations. Anecdotally, I’ve seen plenty of households select to obtain remedy outdoors 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 go away 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 plenty 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 considered by many as elective, leaving sufferers to pay for it nearly fully 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 is no such thing as a easy means for prior data to be documented within the well being system EMR the place the supply will happen. This could result in medical challenges and adversarial outcomes, to not point out plenty 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 delivery at 30 years previous. 

The issue is widespread. So what’s being executed about it?

Fertility care panorama

Startups are swooping in with progressive options to sort out 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 will 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 neighborhood, and supplier enablement instruments. 

International fertility market map

Be aware: This market map just 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 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, reminiscent of Famlee Well being, which supplies nationwide fertility testing, telehealth and remedy, however more and more firms are concentrating on males as effectively. 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 residence.”

With the costly prices of IVF remedy, conception aides could be a productive first step and different remedy path and choice, reminiscent of IUI units, conception cups and even units that measure cervical mucus. Bea Fertility is offering another choice for fertility remedy at residence 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 ladies navigate the advanced remedy panorama. Body Fertility goals to be ladies’s devoted fertility and family-building advisor. It supplies 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 section, particularly as extra ladies resolve to delay being pregnant. Cofertility’s mannequin permits 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. It additionally supplies help and schooling for everybody concerned alongside the way in which.

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 aspect ends in buyer dropout. If the consumer 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 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 progressive financing options to fight the opacity and financial boundaries of fertility therapies. One such instance is Sunfish, which gives low-rate financing choices and monetary advocacy for fertility therapies.

Schooling, content material and neighborhood: Whereas much less usually a standalone enterprise mannequin, startups deal with lowering info asymmetry by means of peer help communities, instructional content material and programmatic programs on reproductive well being — assume Rescripted or FertilityIQ. 

Knowledge analytics, AI and provider-enablement instruments: Lastly, an more and more essential section 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 photographs to establish embryos which might be most 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 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 will be an effective way to check choices on payers’ goal populations and show the answer works earlier than going B2B.

“The one method to get there may be to take a step-based method. Begin with a DTC product that persons are keen to pay for out-of-pocket – we have seen plenty of startups fail as a result of they set their sights too shortly on reimbursement and may’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 method 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 each year, upskilling scientific expertise is important for addressing demand.

To that finish, Mate Fertility gives a turnkey answer for OB-GYN clinics trying to upskill workers and introduce new fertility care companies, whereas taking a fee on extra service income.

“By partnering with OB-GYNs, increasing our clinic depend 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 section has been too usually ignored. Nevertheless, they are often early adopters keen to iterate with innovators alongside the way in which. Shorter gross sales cycles and the flexibility 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 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 advanced healthcare wants outdoors of Tia’s scope, and there may be shared knowledge and integration between the 2 care suppliers. 

Bundling companies will be one other means 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 powerful 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 lady’s individualized wants

Girls’s well being just isn’t ‘one-size-fits-all.’ Interval. We imagine the bottom line 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 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 ladies’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 girls’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, 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 faculty usually are not occupied with reproductive well being in a significant means and do not have entry to the precise assets. There are benefits to assembly ladies earlier of their reproductive journeys to permit for extra planning and keep away from the demanding organic clock.

“A scarcity 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 deal with 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 must always welcome them into the healthcare system as quickly as doable – 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 imagine this ecosystem would do effectively to assume extra about providing holistic help companies to fulfill 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 Collection A investments in digital well being and tech-enabled companies firms. 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 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 marketing consultant at Kearney, specializing of their healthcare and life sciences follow.