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

To this day, reproductive care remains fragmented, expensive and inaccessible. A lack of solutions to solve these problems has led to the proliferation of startups attempting to plug care gaps. 

After speaking with over 75 fertility tech companies and clinicians, we distilled a few points of advice for investors and founders in this space. 

Setting the stage

A confluence of factors creates challenges for reproductive healthcare in the U.S. Struggling to recover from the COVID-19 pandemic, hospitals are facing increased pressure to cut costs. Obstetrics is generally not a lucrative line of business in hospitals due to relatively lower reimbursement rates and staffing shortages; thus, certain hospitals are shifting the volume mix to more profitable procedures (i.e. knees, hips and spines). Unfortunately, this puts obstetrics on the chopping block.

Although employers and health plans are increasingly subsidizing costs of fertility treatments, coverage is still insufficient. Among married women in the U.S. ages 15 to 49 with no previous births, 19% are unable to get pregnant after one year of trying. And 26% of women in this group have difficulty getting pregnant or carrying a pregnancy to term.

Many cannot afford the average IVF procedure cost of $15,000 to $20,000 for one cycle. Fertility services are usually not covered by public insurers either. Only one state Medicaid program covers any fertility treatment, and no Medicaid program covers artificial insemination or IVF. 

“Even taking insurance out of the equation, fertility treatments in the U.S. remain more expensive than in many other countries. Anecdotally, I have seen a lot of families choose to receive treatment outside of the U.S. because of this,” said Dr. Kathy Ku, Stanford MD/MBA and digital health investor.

To make matters worse, around 18 million women of reproductive age live in locations without access to fertility care, and the overturning of Roe v. Wade could leave even more in a lurch. Closing clinics in about half of states will exacerbate the clinical supply/demand imbalance in the long-term.

“There are a lot of access barriers – limited insurance coverage, high copays, not enough clinicians, physical distance to points of care. On top of this, fertility care has separate challenges, given it is viewed by many as elective, leaving patients to pay for it almost completely out of pocket,” said Dr. Michael Solotke, an OB-GYN at Northwestern Medicine.

“Fragmentation of care is also a challenge,” said Dr. Siobhan Dolan, an OB-GYN and clinical geneticist at Mount Sinai Health System. “Infertility is often treated in private settings, so once a patient is pregnant, there is no simple way for prior records to be documented in the health system EMR where the delivery will occur. This can lead to medical challenges and adverse outcomes, not to mention a lot of burdensome record transfer.”

Compounding these factors is the fact that reproductive issues are steadily rising as more women are delaying pregnancy, with the new median age for giving birth at 30 years old. 

The problem is widespread. So what is being done about it?

Fertility care landscape

Startups are swooping in with innovative solutions to tackle these long-standing problems, and the fertility tech market is heating up. A record $800 million was invested in 2021, according to PitchBook. 

The market can be segmented into the following five categories: At-home diagnostics and tracking, digital-first care delivery and coordination, fertility benefits and patient financing, educational content and community, and provider enablement tools. 

Global fertility market map

Note: This market map is not designed to be comprehensive, and many companies stretch across multiple categories. 

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