Modern Fertility (YC S17) is a proactive way to test fertility at home(modernfertility.com)
modernfertility.com
Modern Fertility (YC S17) is a proactive way to test fertility at home
https://modernfertility.com/blog/launch/
40 comments
Also, if you or your partner have ever had a STD/STI please be aware that this can affect your fertility. I was recently talking to a OB/GYN and he was telling me that one of the saddest things he has to do is inform a person that they are sterile due to an untreated STD/STI from their younger years when thoughts about fertility were the the furthest thing from their mind.
Yes!
Wow- really appreciate you sharing your story (and thanks for the kind words). The main reason we started Modern Fertility was to give women the tools to start the conversation about our reproductive futures.
I think it is so important for stories like this to be shared and to start a transparent dialogue. We see celebrity pregnancies on the cover of magazines but typically no backstory about what went into them. Thank you.
I think it is so important for stories like this to be shared and to start a transparent dialogue. We see celebrity pregnancies on the cover of magazines but typically no backstory about what went into them. Thank you.
I love what you're doing, but a piece of advice - please don't oversell and mislead women by suggesting you can tell them 'how many eggs they have' (text taken from your home page).
You know well that this is not possible at all. 'High/medium/low' is about the best you can say. Please don't mislead people in this way and diminish what is otherwise a really good product.
You know well that this is not possible at all. 'High/medium/low' is about the best you can say. Please don't mislead people in this way and diminish what is otherwise a really good product.
Thanks for digging in! We share exactly where the science is and what these tests can and cannot tell you. We can't count the exact number of eggs, and we do report in buckets which are impactful and have clinical utility. One of the hormones we measure is AMH which is a well validated proxy of ovarian reserve. There is a lot of literature on AMH but Hansen et.al.2011 is one of my favorites- they counted the number of eggs (primordial follicles to be specific) in the ovaries of women who were already having their ovaries removed for other medical reasons and found the their AMH levels strongly correlated with follicle count.
I repeat: you’re misleading women by telling them you can tell them ‘how many eggs they have.’ (These are the words you use on your website)
There is no way to count the number of eggs exactly but your statements seem to suggest you do this. This is just wrong - the best you can do is give a very wide range.
Also you say AMH levels are well validated as a proxy for ovarian reserve - the science on this is far from what I’d describe as ‘well validated’. Please speak to 5 gynaecologists and let me know if all 5 agree with your assertion. (That it is the best measure available is not the same as saying it’s wdlk validated, please be clear on this).
There is no way to count the number of eggs exactly but your statements seem to suggest you do this. This is just wrong - the best you can do is give a very wide range.
Also you say AMH levels are well validated as a proxy for ovarian reserve - the science on this is far from what I’d describe as ‘well validated’. Please speak to 5 gynaecologists and let me know if all 5 agree with your assertion. (That it is the best measure available is not the same as saying it’s wdlk validated, please be clear on this).
Thanks for the feedback on the AMH language. We are always trying to find the best way to simplify the science. In regards to AMH, great question! AMH is known by the clinical community as the best marker for ovarian reserve. I know everyone doesn't have access to peer reviewed journals so here are a few quotes: Podfigurna et al 2017: "AMH level is recognized to be the one of the most reliable markers of ovarian reserve [60–65]. AMH is mainly produced by granulosa cells of the pre-antral and small antral follicles and AMH levels decline with age. AMH level, especially in comparison with FSH level, was considered to be very stable across the menstrual cycle, but more recent studies have shown a slight decrease in AMH concentrations in the luteal phase [56,57]. Moreover, unlike other tests of ovarian reserve, such as AFC and FSH, it has sufficient specificity and sensitivity [58]. AMH concentration correlates with age and AFC" // Leader and Baker 2014:"Hundreds of clinical studies confirm that adding serum AMH testing to a complete ovarian assessment provides a powerful tool to help provide better healthcare for women. The benefits of this testing can optimize fertility treatments; help lead to earlier diagnoses of PCOS, POI, POF, and certain autoimmune conditions; provide the opportunity for better planning for procreation and menopause; and allow for better medical decision-making by monitoring ovarian damage from exposures to medical or surgical therapies. Although challenges with variability in AMH results make the provided practical steps a prerequisite for appropriate interpretation of the testing, the clinical benefits of testing more than justify this additional effort." We have a great post on the science behind ovarian reserve testing here: https://modernfertility.com/blog/ovarianreserve/
> We are always trying to find the best way to simplify the science.
Please don't.
Just be honest and try to actually solve the problem of explaining science in layman terms rather than doing away with the explanations and complexity altogether.
Please don't.
Just be honest and try to actually solve the problem of explaining science in layman terms rather than doing away with the explanations and complexity altogether.
Our OBGYN also told me AMH level is a good indicator of ovarian reserve. I did dig in deeper and found quite a bit of official resources backing this claim. Is there any supporting evidence on why it's not "well-validated?"
Do you have any plans to offer male fertility testing as well? As the OP noted, male fertility is also a factor in pregnancy and in our patriarchal society we often place the burden and blame on women for issues with conceiving. I’m sure there is a great feminist marketing campaign waiting to be done for a product for males.
I’d certainly use it.
I’d certainly use it.
How are you thinking about the increased growth of egg freezing? Is this something that is going to tell more women to freeze their eggs? From what I'm told by doctor family members, it's expensive and not necessarily a guarantee.
I believe egg freezing is not the right decision for everyone. It is not a guarantee/ insurance policy, but it does help with the odds. We (women) should be understanding our bodies as a first step and hormone levels combined with other factors (finances, emotional state, family planning goals etc) should be included in the decision to freeze or not to freeze. We started Modern Fertility to help women navigate these decisions.
> How are you thinking about the increased growth of egg freezing
The actual number of babies that have been born worldwide from frozen eggs is only around 2,000, and most of those were done either to prove out the concept or else due to some specific medical condition (e.g. about to get chemo). Despite the fact that you read about it in the news all the time and it feels like everyone is doing it, the number of babies born to women who decided to just pre-emptively freeze their eggs is probably only a couple hundred, accounting for literally 0.00% of babies born each year.
The actual number of babies that have been born worldwide from frozen eggs is only around 2,000, and most of those were done either to prove out the concept or else due to some specific medical condition (e.g. about to get chemo). Despite the fact that you read about it in the news all the time and it feels like everyone is doing it, the number of babies born to women who decided to just pre-emptively freeze their eggs is probably only a couple hundred, accounting for literally 0.00% of babies born each year.
Nonsense. Where are you getting your stats from?
It just needs to be made clear to people that no matter how much else may have changed, 35 is not the new 25 when it comes to having kids.
The only message I got when I was in my early 20s was “you have plenty of time! Make sure you’re established first!” Now it’s very unlikely that I’ll have as many children as I would like, and if I do they’ll have to come in much more rapid succession than I would prefer.
The only message I got when I was in my early 20s was “you have plenty of time! Make sure you’re established first!” Now it’s very unlikely that I’ll have as many children as I would like, and if I do they’ll have to come in much more rapid succession than I would prefer.
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The age range of 21 to 40 needs to be expanded greatly in both directions. Well, really the limit should go away.
This fall my wife goes over the limit. She might be pregnant with a 12th kid already though, so she'd be excluded. We'd like an estimate of how many more kids we'll end up with.
A histogram would be great, for example: 17% chance of no more, 40% chance of 1 more, 23% chance of 2 more, 11% chance of 3 more, 4% chance of 4 more, 3% chance of 5 more, 2% chance of at least 6 more...
This fall my wife goes over the limit. She might be pregnant with a 12th kid already though, so she'd be excluded. We'd like an estimate of how many more kids we'll end up with.
A histogram would be great, for example: 17% chance of no more, 40% chance of 1 more, 23% chance of 2 more, 11% chance of 3 more, 4% chance of 4 more, 3% chance of 5 more, 2% chance of at least 6 more...
We are working on it! No matter what age you are, the tests are the same. We worked super hard to have age specific content for the range of 21-40 but are excited to expand this. Women need information about fertility through their entire lives because it impacts so many aspects of health and wellbeing. Our next step is to expand our age range to over 40.
Its a good idea, but I wonder how accurate your results will be. HCG tests (done via blood samples) are notoriously bad as a predictor for how many eggs are actually in the ovaries. Its a very broad indicator yes, but nothing more than that.
This is really quite different from say testing a mens sperm where you can accurately count the exact number to the nearest million.
Have you compared your accuracy with an HCG test? What is the delta between your home test results and an HCG test?
This is really quite different from say testing a mens sperm where you can accurately count the exact number to the nearest million.
Have you compared your accuracy with an HCG test? What is the delta between your home test results and an HCG test?
Hi! Are you referring to human chorionic gonadotropin (hcg)? If so, HCG is used in pregnancy tests not an ovarian reserve test. We do not test for HCG.
This is a great idea. I work in clinical diagnostics at a large academic health care center and the prices billed to patients are absurd once you see the actual costs of the testing. What’s your strategy to decrease the testing cost compared to reproductive endocrinology clinics? Is it simply a lower markup?
Thanks! Totally agree- this was my exact experience (billed $1500). Today, women typically get these tests when they are having issues and we are making them available to women before they start trying to conceive. There are only ~500 infertility clinics in the US so when you think about the volume of testing they do vs. a general healthy population being able to access these tests, we get different economies of scale and can pass on these savings. We have invested a lot in our processes to support this scale.
Given that you are dealing with medical data that falls outside of HIPAA what are you doing to ensure that PHI remains secure?
Great question! All of our data is securely stored and we take privacy very seriously. Modern Fertility employees can only access user data via an internal administrative portal to which access is strictly controlled and monitored and two-factor authentication is required. Access is reviewed on a regular basis. Data is stored in a de-identified manor. All Modern Fertility employees who handle PHI are required to complete a HIPAA training hosted by HHS.gov.
Quick note: "Millenial women" should be "Millennial women" (note the missing "n")
Great product! Are you talking to companies who might want to offer this as a benefit to their employees?
Yes! We are already working with a few companies who are offering Modern Fertility as a wellness benefit. If you are interested you can email [email protected] and we will schedule a quick demo and get you setup in <20 minutes. Thanks so much for asking.
Any plans for a male version?
Male factor is 50% of the equation and it is really important for both women and men to understand that from an education perspective. We are customers ourselves for our female fertility test and understand the female market well, but are interested in learning more about if males would proactively test / store their sperm.
Happy to chat with you about this. I've been through 4 IVFs and have severe male factor infertility, so sadly I know this space all too well. Mens market is trickier - the existing method for home testing for men is too clunky. You need to produce a sperm sample into.. a test tube. Then put it in warm water. Then wait. This is too dirty and too much work.
There is a roundabout way to do this without a sperm sample. Pen prick, blood in a container, ship it out to a lab and then do a karyotype test on it. That'll pick up around 50% of infertility cases. To cover the rest, you'll need to do a sperm test. Also, the 'hook' that gets men in has to be more than just 'check your sperm count'. Men mostly couldn't care less about their sperm count. Something like 'check if you're at risk of passing on a rare blood disease' is a much better hook.
There is a roundabout way to do this without a sperm sample. Pen prick, blood in a container, ship it out to a lab and then do a karyotype test on it. That'll pick up around 50% of infertility cases. To cover the rest, you'll need to do a sperm test. Also, the 'hook' that gets men in has to be more than just 'check your sperm count'. Men mostly couldn't care less about their sperm count. Something like 'check if you're at risk of passing on a rare blood disease' is a much better hook.
As a man, I would certainly buy it. If my wife and I can't have kids, then it could be either of us with an issue. And I'm no more inclined to go to and pay for a lab test than she is, I imagine.
As far as I'm aware male fertility decreases a bit with age, but there's no such thing as menopause and ovulation for men. So I doubt there is as much of a market for a male version. Besides, our male egos are way too fragile to risk learning we have fertility problems ;-)
Also your hormones may be fine, but your sperm can still be bad, e.g. your testicles can't get too warm.
Also your hormones may be fine, but your sperm can still be bad, e.g. your testicles can't get too warm.
> So I doubt there is as much of a market for a male version
Sperm count has been cut in half in the last 40 years in the West. Sperm motility and morphology has also seen precipitous declines, along with increasing DNA fragmentation issues.
Male factor infertility is definitely a problem, but even attempting to discuss environmental estrogens is "men's rights activism" so we ignore it. To the extreme psychological detriment of women who tend to accept blame for fertility failures.
There is a problem in developed countries - that goes far beyond warm testicles - that we are ignoring. For reasons.
Sperm count has been cut in half in the last 40 years in the West. Sperm motility and morphology has also seen precipitous declines, along with increasing DNA fragmentation issues.
Male factor infertility is definitely a problem, but even attempting to discuss environmental estrogens is "men's rights activism" so we ignore it. To the extreme psychological detriment of women who tend to accept blame for fertility failures.
There is a problem in developed countries - that goes far beyond warm testicles - that we are ignoring. For reasons.
There’s a reason the alt-righters have gotten so far with using the term “soy” as an insult.
congrats guys :)
Markets have been really bad at coming with solutions (a) for chronically vulnerable groups, (b) for problems which develop over too long a time period to become urgent, and (c) by replacing reactive efforts with proactive efforts. MF seems to check all three of those boxes, while making sense as a business. Cool.
Can you say anything about how you expect these kinds of proactive diagnostics to interact with the existing insurance ecosystem, which tends to pay for diagnosis but varies a lot on treatment?
Can you say anything about how you expect these kinds of proactive diagnostics to interact with the existing insurance ecosystem, which tends to pay for diagnosis but varies a lot on treatment?
Thanks for the kind words! Infertility is not federally reimbursed and if a company happens to cover infertility as a benefit, women have to wait until they are having issues (and "try" for 9-12 months) before these types of tests are covered. We started Modern Fertility to bring these tests to women earlier in life at a much more accessible price point. Some HSA/FSA plans cover Modern Fertility.
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Congrats on the launch! I'm a big fan of the candid and fair discussion of fertility literature on your site. More healthcare startups should be doing exactly that.
I admit as a career-minded professional, I underestimated how quickly the reproductive window closes biologically and how much higher the risks are for Mom and baby as the years pass.
My wife and I went through IVF and learned quite a bit, e.g.: You may have to wait a year before an insurer will begin to cover treatments or you may have to scrounge for cash to pay for them. Once you find a clinic, there's a multi-month process to get started. Maybe you miss a dose of the IVF drugs due to an illness and have to postpone for a cycle or two. In the case of IVF, you may not get viable embryos or they may not implant. If they do implant, there's a scarily high risk of miscarriage.
And if you want to have more than one child you need to factor in the 40 weeks of pregnancy, recovery, and adjusting to sleep deprivation before you get to start the whole process again. On their own, these are small delays, but compounded they can take up years, and if you're starting in your mid-30s and working with a five-year window, they can make the difference.
It took my wife and me two years of financially and emotionally draining treatments before we had success. Our second run was smoother, but our first child was diagnosed with Leukemia (she's good now) at the start of my wife's 2nd trimester. Had we waited another quarter, it's very likely we would only have had one child. I can say unequivocally in my career there has been no bonus, promotion, or professional recognition that comes close to matching that value.
Despite our challenges, we were lucky. We met a couple that struggled with infertility. Turned out after a lot of testing, the husband was sterile. The wife wanted to carry a child from an egg of hers fertilized by a donor. The man didn't want to raise a child that wasn't his biological offspring, so they split and she had to renter the partner market in her mid-30s under extreme time pressure.
Apologies for the overly personal PSA, but I wish I had this information in my twenties. If you want children, you need to treat the process with all the seriousness you treat your career. This product is a great tool to do so.