Contributed: Why digital health is fertile ground for reproductive care innovation

by | Mar 17, 2023 | Health Blog | 0 comments

To this present day, reproductive care stays fragmented, costly and inaccessible. A scarcity 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 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 better 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 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 year of trying. And 26% of ladies on this group have problem getting pregnant or carrying a being pregnant to time period.

Many can’t afford the average IVF procedure cost of $15,000 to $20,000 for one cycle. Fertility companies are often not lined 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 international locations. Anecdotally, I’ve seen a number of 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 women of reproductive age live in locations without access 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 a number of 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 fully 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 personal settings, so as soon as a affected person is pregnant, there is no such thing as a easy method 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 adversarial outcomes, to not point out a number of burdensome file 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 start at 30 years outdated. 

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

Fertility care panorama

Startups are swooping in with modern options to deal with these long-standing issues, and the fertility tech market is heating up. A file $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. 

International fertility market map

Notice: This market map just isn’t 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 residence. One subset of corporations delivers home-based diagnostics, primarily hormone testing and semen evaluation.

Many are female-oriented, resembling Famlee Well being, which supplies nationwide fertility testing, telehealth and remedy, however more and more corporations are focusing on males as nicely. 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 is usually a productive first step and different remedy path and choice, resembling 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 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 remedy panorama. Body Fertility goals to be ladies’s devoted fertility and family-building advisor. It supplies customized 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 section, particularly as extra ladies determine to delay being pregnant. Cofertility’s mannequin allows 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 assist and training for everybody concerned alongside the best way.

One other firm, Blooming Eve, is specializing in vetted reasonably priced clinic partnerships and academic sources to extend entry.

“We’re streamlining the appointment reserving expertise for our customers, and the shortage of expertise adoption from the clinic’s aspect ends in buyer dropout. If the person journey had been extra seamless, clinics would have extra clients, and we might 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 numerous corporations targeted on constructing companies to bundle 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 gives low-rate financing choices and monetary advocacy for fertility therapies.

Schooling, content material and group: Whereas much less usually a standalone enterprise mannequin, startups concentrate on lowering data asymmetry by way 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 vital section 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 can be most certainly 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 appropriate 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 could be a good way to check choices on payers’ goal populations and show the answer works earlier than going B2B.

“The one strategy to get there’s to take a step-based method. Begin with a DTC product that individuals are prepared to pay for out-of-pocket – we have seen a number 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 adequate 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 strategy to reveal 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 each year, upskilling medical expertise is crucial 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 rely 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 boost consciousness and leverage development 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 be capable 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. Nonetheless, 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 will discover examples of startups efficiently approaching regional well being programs which can be agile and open to co-creating innovation options.

For instance, Tia Clinic has partnered with Cedars-Sinai to broaden 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 knowledge and integration between the 2 care suppliers. 

Bundling companies could 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, 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 inside the first 12 months?

4. Tailor choices to every girl’s individualized wants

Ladies’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 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 way of 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 lady’s physique stand within the epicenter of reproductive well being drugs, decrease the uncomfortable side effects and maximize sensitivity to its distinctive traits,” he mentioned. 

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

Most ladies proper after faculty usually are not fascinated by reproductive well being in a significant method and do not have entry to the appropriate sources. There are benefits to assembly ladies earlier of their reproductive journeys to permit for extra planning and keep away from the worrying 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 arduous 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 somewhat 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 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 imagine this ecosystem would do nicely to assume extra about providing holistic assist companies to satisfy ladies the place they’re.

Concerning the Authors:

Dana SunDana 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 corporations. Beforehand, she was a strategic finance affiliate at Genentech and healthcare administration guide at Accenture.



Ellen BurseyEllen Bursey is presently 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.



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