It is no secret that developed countries are facing a precipitous decline in fertility: in the UK, the live birth rate has halved since 1947, sperm count and motility have also halved; infertility affects 1 in 7 couples.
What is less obvious is how startups can best address the complex of problems and decisions that are often lumped together under this headline. At Mosaic, we meet many exciting young companies coming to market addressing reproductive health with a wide range of diagnostic and therapeutic modalities and business models, from male, female, couple and clinical perspectives. We decided to bring a small group of founders and scientists together to discuss a few key topics around the coming decentralization of fertility care.
As investors, it feels like a fertility Zeitgeist has arrived. The principal cause is cultural. Martín Varsavsky (founder of two fertility businesses) pointed out “the baby boomers didn’t have any problems having babies”, because they settled down and got on with it in their 20s. In a battle between psychology and biology, biology wins. As a result, a generation of couples are only starting to try to have children significantly after their reproductive peak. Today, the facts around low IVF success rates, not to mention its financial, time, and emotional tolls, are becoming better understood. This new awareness creates opportunities both for a new category of preventative approaches to infertility, as well as a radically improved assisted reproductive technology products.
Gametes are just the symptom, not the source, of the problem: infertility as an outcome has many aetiologies. There are eleven distinct categories of female infertility, many of which can start to manifest in adolescence. If “IVF is a band-aid”, as reproductive scientist and Clue’s Chief Medical Officer Lynae Brayboy put it, how do we avoid getting injured in the first place? Better diagnosis, management and treatment of the conditions upstream of failure to conceive, like PCOS, endometriosis or higher level metabolic disorders, is essential. For women, existing apps like Clue which build a trusted relationship with the customer years in advance of them even thinking about children are an obvious starting point. The period-tracking category in general is an early example of how technology companies can move the cultural needle, but there are clear limits to what software alone can achieve; the next generation of products will integrate molecular data so bring female reproductive health into much higher resolution. This new picture enables much more precise personalised monitoring and treatment pathways, informing healthcare and community-building.
Men don’t have such an obvious periodic cue to engage with their reproductive health, moreover, the “Mick Jagger” risk model of conception very late in life is a bias many share implicitly or explicitly. Studies show that older fathers contribute a significantly increased risk of severe mental illness to their offspring, due to accumulated genetic mutations. This data, like those on sperm quality, is little known and can be turned into brand-building opportunities for companies trying to get men to think ahead. Still, the challenge remains that the idea of being proactive about fertility for someone in their 20s is a very different question and value proposition versus a couple actively trying to conceive and unable to do so.
At the assisted reproduction stage, a patient not covered by insurance may end up paying tens of thousands of dollars before they conceive- or, very often, fail to. The process itself is far from as effective as it could be (Martín’s second fertility company, Overture Life is creating a reproducible embryology lab in a box to expedite it), but the implications of this out-of-pocket cost mean access to the process remains even more of a barrier to many. We discussed bringing better risk pricing to IVF: how to turn this huge lump sum bill into a Spotify-esque monthly subscription. Might the preventative and the therapeutic products potentially converge and complement at scale?
But essential to both approaches is the question: how do you get your customer to think - and pay - ahead? In the US, channels are opening via insurers. For insurers there’s a cost-based value proposition to be articulated which suddenly makes preventative tests more strongly incentivized; in addition, for employers, providing these services can support employee retention. Ultimately, there need be no contradiction between a beautifully branded, community-led consumer product and one distributed via insurers/employers; analogies with insurance products in other, far less emotionally salient verticals (e.g. car insurance) are clear.
We believe that the next generation fertility company will be built around:
• A long-term, engaged customer relationship that begins long before trying to have a baby– perhaps initially engaging on an endocrine topic of more immediate interest to a young person than fertility (e.g. skin, cognition, fitness, sex)
• Generating a personalized, longitudinal molecular dataset in a decentralized manner (using at-home kits), informing a digital concierge for in-person clinical care where appropriate
• A trust-building brand that translates the developing complexities of reproductive health science into something tangible, easy-to-understand, and motivating.
If you are building something like this, please get in touch.