infertility
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Startups should look to state-of-the-art tech to tackle diseases affecting women
Startups devoted to reproductive and women’s health are on the rise. However, most of them deal with women’s fertility: birth control, ovulation and the inability to conceive. The broader field of women’s health remains neglected.
Historically, most of our understanding of ailments comes from the perspective of men and is overwhelmingly based on studies using male patients. Until the early 1990s, women of childbearing age were kept out of drug trial studies, and the resulting bias has been an ongoing issue in healthcare. Other issues include underrepresentation of women in health studies, trivialization of women’s physical complaints (which is relevant to the misdiagnosis of endometriosis, among other conditions), and gender bias in the funding of research, especially in research grants.
For example, several studies have shown that when we look at National Institutes of Health funding, a disproportionate share of its resources goes to diseases that primarily affect men — at the expense of those that primarily affect women. In 2019, studies of NIH funding based on disease burden (as estimated by the number of years lost due to an illness) showed that male-favored diseases were funded at twice the rate of female-favored diseases.
Let’s take endometriosis as an example. Endometriosis is a disease where endometrial-like tissue (‘‘lesions’’) can be found outside the uterus. Endometriosis is a condition that only occurs in individuals with uteruses and has been less funded and less studied than many other conditions. It can cause chronic pain, fatigue, painful intercourse and infertility. Although the disease may affect one out of 10 women, diagnosis is still very slow, and the disease is confirmed only by surgery.
There is no non-invasive test available. In many cases, a woman is diagnosed only due to her infertility, and the diagnosis can take up to 10 years. Even after diagnosis, the understanding of disease biology and progression is poor, as well as the understanding of the relationships to other lesion diseases, such as adenomyosis. Current treatments include surgical removal of lesions and drugs that suppress ovarian hormone (mainly estrogen) production.
However, there are changes in the works. The NIH created the women’s health research category in 1994 for annual budgeting purposes and, in 2019, it was updated to include research that is relevant to women only. In acknowledging the widespread male bias in both human and animal studies, the NIH mandated in 2016 that grant applicants would be required to recruit male and female participants in their protocols. These changes are slow, and if we look at endometriosis, it received just $7 million in NIH funding in the fiscal year 2018, putting it near the very bottom of NIH’s 285 disease/research areas.
It is interesting to note that critical changes are coming from other sources, and not so much from the funding agencies or the pharmaceutical industry. The push is coming from patients and physicians themselves that meet the diseases regularly. We see pharmaceutical companies (such as Eli Lilly and AbbVie) in the women’s healthcare space following the lead of their patients and slowly expanding their R&D base and doubling efforts to expand beyond reproductive health into other key women’s health areas.
New technological innovations targeting endometriosis are being funded via private sources. In 2020, women’s health finally emerged as one of the most promising areas of investment. These include (not an exhaustive list by any means) diagnostics companies such as NextGen Jane, which raised a $9 million Series A in April 2021 for its “smart tampon,” and DotLab, a non-invasive endometriosis testing startup, which raised $10 million from investors last July. Other notable advances include the research-study app Phendo that tracks endometriosis, and Gynica, a company focused on cannabis-based treatments for gynecological issues.
The complexity of endometriosis is such that any single biotech startup may find it challenging to go it alone. One approach to tackle this is through collaborations. Two companies, Polaris Quantum Biotech and Auransa, have teamed up to tackle the endometriosis challenge and other women’s specific diseases.
Using data, algorithms and quantum computing, this collaboration between two female-led AI companies integrates the understanding of disease biology with chemistry. Moreover, they are not stopping at in silico; rather, this collaboration aims to bring therapeutics to patients.
New partnerships can majorly impact how fast a field like women’s health can advance. Without such concerted efforts, women-centric diseases such as endometriosis, triple-negative breast cancer and ovarian cancer, to name a few, may remain neglected and result in much-needed therapeutics not moving into clinics promptly.
Using state-of-the-art technologies on complex women’s diseases will allow the field to advance much faster and can put drug candidates into clinics in a few short years, especially with the help of patient advocacy groups, research organizations, physicians and out-of-the-box funding approaches such as crowdfunding from the patients themselves.
We believe that going after the women’s health market is a win-win for the patients as well as from the business perspective, as the global market for endometriosis drugs alone is expected to reach $2.2 billion in the next six years.
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Kindbody raises $15M, will open a ‘Fertility Bus’ with mobile testing & assessments
Kindbody, a startup that lures millennial women into its pop-up fertility clinics with feminist messaging and attractive branding, has raised a $15 million Series A in a round co-led by RRE Ventures and Perceptive Advisors.
The New York-based company was founded last year by Gina Bartasi, a fertility industry vet who previously launched Progyny, a fertility benefit solution for employers, and FertilityAuthority.com, an information platform and social network for people struggling with fertility.
“We want to increase accessibility,” Bartasi told TechCrunch. “For too long, IVF and fertility treatments were for the 1 percent. We want to make fertility treatment affordable and accessible and available to all regardless of ethnicity and social economic status.”
Kindbody operates a fleet of vans — mobile clinics, rather — where women receive a free blood test for the anti-Müllerian hormone (AMH), which helps assess their ovarian egg reserve but cannot conclusively determine a woman’s fertility. Depending on the results of the test, Kindbody advises women to visit its brick-and-mortar clinic in Manhattan, where they can receive a full fertility assessment for $250. Ultimately, the mobile clinics serve as a marketing strategy for Kindbody’s core service: egg freezing.
Kindbody charges patients $6,000 per egg-freezing cycle, a price that doesn’t include the cost of necessary medications but is still significantly less than market averages.
Bartasi said the mobile clinics have been “wildly popular,” attracting hoards of women to its brick-and-mortar clinic. As a result, Kindbody plans to launch a “fertility bus” this spring, where the company will conduct full fertility assessments, including the test for AMH, a pelvic ultrasound and a full consultation with a fertility specialist.
In other words, Kindbody will offer all components of the egg-freezing process on a bus aside from the actual retrieval, which occurs in Kindbody’s lab. The bus will travel around New York City before heading west to San Francisco, where it plans to park on the campuses of large employers, catering to tech employees curious about their fertility.
“Our mission at Kindbody is to bring care directly to the patient instead of asking the patient to come to visit us and inconvenience them,” Bartasi said.
A sneak peek of Kindbody’s “fertility bus,” which is still in the works
Kindbody, which has raised $22 million to date from Green D Ventures, Trailmix Ventures, Winklevoss Capital, Chelsea Clinton, Clover Health co-founder Vivek Garipalli and others, also provides women support getting pregnant with in vitro fertilisation (IVF) and intrauterine insemination (IUI).
With the latest investment, Kindbody will open a second brick-and-mortar clinic in Manhattan and its first permanent clinic in San Francisco. Additionally, Bartasi says they are in the process of closing an acquisition in Los Angeles that will result in Kindbody’s first permanent clinic in the city. Soon, the company will expand to include mental health, nutrition and gynecological services.
In an interview with The Verge last year, Bartasi said she’s taken inspiration from SoulCycle and DryBar, companies whose millennial-focused branding strategies and prolific social media presences have helped them accumulate customers. Kindbody, in that vein, notifies its followers of new pop-up clinics through its Instagram page.
In the article, The Verge called Kindbody “the SoulCycle of fertility” and questioned its branding strategy and its claim that egg freezing “freezes time.” After all, there is limited research confirming the efficacy of egg freezing.
“The technology that allows for egg-freezing has only been widely used in the last five to six years,” Bartasi explained. “The majority of women who froze their eggs haven’t used them yet. It’s not like you freeze your eggs in February and meet Mr. Right in June.”
Though Kindbody touts a mission of providing fertility treatments to the 99 percent, there’s no getting around the sky-high costs of the services, and one might argue that companies like Kindbody are capitalizing off women’s fear of infertility. Providing free AMH tests, which often falsely lead women to believe they aren’t as fertile as they’d hoped, might encourage more women to seek a full-fertility assessment and ultimately, to pay $6,000 to freeze their eggs, when in reality they are just as fertile as the average woman and not the ideal candidate for the difficult and uncomfortable process.
Bartasi said Kindbody makes all the options clear to its patients. She added that when she does hear accusations that services like Kindbody capitalize on fear of infertility, they tend to come from legacy programs and male fertility doctors: “They are a little rattled by some of the new entrants that look like the patients,” she said. “We are women designing for women. For far too long women’s health has been solved for by men.”
Kindbody’s pricing scheme may itself instill fear in incumbent fertility clinics. The startup’s egg-freezing services are much cheaper than market averages; its IVF services, however, are not. Not including the costs of medications necessary to successfully harvest eggs from the ovaries, the average cost of an egg-freezing procedure costs approximately $10,000, compared to Kindbody’s $6,000. Its IVF services are on par with other options in the market, costing $10,000 to $12,000 — not including medications — for one cycle of IVF.
Kindbody is able to charge less for egg freezing because they’ve cut out operational inefficiencies, i.e. they are a tech-enabled platform while many fertility clinics around the U.S. are still handing out hoards of paperwork and using fax machines. Bartasi admits, however, that this means Kindbody is making less money per patient than some of these legacy clinics.
“What is a reasonable profit margin for fertility doctors today?” Bartasi said. “Historically, margins have been very, very high, driven by a high retail price. But are these really high retail prices sustainable long term? If you’re charging 22,000 for IVF, how long is that sustainable? Our profit margins are healthy.”
Bartasi isn’t the only entrepreneur to catch on to the opportunity here, as I’ve noted. A whole bunch of women’s health startups have launched and secured funding recently.
Tia, for example, opened a clinic and launched an app that provides health advice and period tracking for women. Extend Fertility, which like Kindbody, helps women preserve their fertility through egg freezing, banked a $15 million round. And a startup called NextGen Jane, which is trying to detect endometriosis with “smart tampons,” announced a $9 million Series A a few weeks ago.
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Extend Fertility banks $15M Series A to help women freeze their eggs
Fertility services are raising venture cash left and right. Last week, it was Dadi, a sperm storage startup that nabbed a $2 million seed round. This week, it’s Extend Fertility, which helps women preserve their fertility through egg freezing.
Headquartered in New York, the business has secured a $15 million Series A investment from Regal Healthcare Capital Partners to expand its fertility services, which also include infertility treatments, such as in vitro and intrauterine insemination. The company has also appointed Anne Hogarty, the former chief business officer at Prelude Fertility and vice president of international business at BuzzFeed, to the role of chief executive officer. Hogarty replaces Extend Fertility co-founder Ilaina Edison, who had held the C-level title since the business launched in 2016. Edison will remain on the startup’s board of directors.
Extend Fertility, in its New York cryopreservation and embryology lab and treatment center, completed 1,000 egg-freezing cycles in 2018.
“A lot of amazing things have happened for women over the last century,” Hogarty told TechCrunch earlier this week. “Now, women are permitted and encouraged to seek higher education, pursue a career, follow their dreams and end up with a partner who’s the right partner, not just any partner. Doing all those things has pushed the window for when women want to start a family from their 20s to their 30s and unfortunately, one thing that has not changed in that time is the biological clock.”
Hogarty explained Extend’s fertility services are more affordable than other options because the service was built specifically with egg freezing in mind, and the company later expanded to offer infertility treatments, whereas other services were established to provide IVF and other infertility treatments and integrated cryopreservation tools later.
“We are really purpose-built to be an egg-freezing-first company, where many legacy institutions that were providing infertility services have legacy costs that come with … inefficiencies bred over decades and outmoded technology in their labs that may not be the most efficient and effective,” she said. “We have a state of the art lab with the latest equipment.”
“It’s the classic innovator dilemma,” she added. “Infertility services are extraordinarily expensive and reproductive endocrinology is a new area of medicine. There are a lot of people and institutions that have been taking inordinate amounts of money for their infertility services so they weren’t looking to serve this population of women looking to preserve their fertility.”
One egg-freezing cycle with Extend costs women $5,500, and additional cycles come at a sticker price of $4,000. Each cycle includes a fertility assessment, private consultation, anesthesia and any monitoring a patient may need during their cycle. The costs don’t include medication, however. Extend can prescribe medications — which typically cost between $2,000 and $5,000 for fertility patients — but they still need to go through a third party to get their prescriptions filled and paid for.
For reference, FertilityIQ, an online platform for researching fertility care providers and treatments, says the typical cost per cycle for egg freezing is more than $17,000 in New York City or $15,600 in San Francisco. Most egg-freezing services, including Extend, do not accept insurance, as most insurance providers don’t cover the steep costs of fertility or infertility treatments.
Some companies, however, are beginning to offer benefits that cover these costs. Facebook and Apple, for example, began subsidizing egg-freezing procedures for employees in 2014. Spotify and eBay, for their part, will pay for an unlimited number of IVF cycles.
Hogarty said Extend’s price point makes it one of the lowest-cost players in the market.
“We want as many women as possible to benefit from the advances from egg-freezing technology,” she said.
Extend Fertility, which has previously raised $10 million, plans to use the latest investment to open labs in new markets and expand its infertility services.
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Legacy freezes your sperm so you don’t have to
Legacy is tackling an interesting problem: the reduction of sperm motility as we age. By freezing our sperm, this Swiss-based company promises to keep our boys safe and potent as we get older, a consideration that many find vital as we marry and have kids later. Legacy, which exhibited in Startup Alley at Disrupt Berlin 2018, was chosen as the wildcard company to present its services onstage during Startup Battlefield.
How does it work? Well, the company delivers a system for grabbing sperm. The material is kept in a specially made container and shipped to a nearby clinic where they then test the sperm and place it in cryogenic storage. You can then make a withdrawal when you’re ready for babies.
“Our unique at-home solution allows men to have their sperm analyzed and frozen at a clinic without leaving their home or having to meet with a physician,” said founder Khaled Kteily. “All clients receive a full fertility analysis, including personalized recommendations using our machine learning-driven technology.”
Kteily ensures us that our special sauce will stay safe over the years.
“Our core values of privacy, quality, and security ensure discretion, anonymity, and the highest level of quality for all our clients, including multi-site storage, whereby our clients’ deposits are stored in multiple tanks in multiple locations at high security.”
The company offers three packages: Bronze, Gold and Platinum. The $1,000 Bronze package requires you to take your sperm to a clinic where it will be tested and cryogenically stored. The Platinum plan costs $10,000 and ensures the company will keep up to six samples of your swimmers indefinitely, affording your genetic material practical immortality.
Kteily founded the company after a friend looked for solutions to sperm storage while facing cancer treatment. Realizing there was nothing that looked trustworthy or usable, he used his background in health and entrepreneurship to build Legacy.
The company has raised $250,000 and they are profitable. Kteily sees his company as the “Swiss Bank” of sperm storage.
“Male fertility has declined by 50 percent. Every 8 months, men produce a new genetic mutation that gets passed on to their children. Birth rates around the world are plummeting and men are responsible for infertility in 30-50 percent of couples. Meanwhile, you can freeze sperm indefinitely with no loss in quality — through Legacy, without having to leave your home and at a tenth of the cost of egg freezing,” he said. “We treat our clients as a private bank would — our core values of quality, privacy and security ensure our clients are taken care of at every level.”
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