Bringing women’s health in Europe to the forefront

Starting with fertility

By Dinika Mahtani and Sophia Bendz

Now that Elon has said it, we hope that everyone is listening.

He’s right — the replacement rate is 2.1 live births per woman in developed countries. In 2019, the total fertility rate in the EU fell to 1.53 live births per woman — the lowest number of births since 1979.

We’re now past the reality of this becoming an economic issue within the next decade. Let’s discuss some other incredibly sad statistics that have led us to this point.

The pressures facing the NHS and other government healthcare providers in Europe have accelerated materially over the past three years in the wake of COVID. The result has disproportionately impacted women’s health. With midwife shortages in the UK at an all time high, an up to 3 year wait for IVF treatments, and menopause oft neglected, the demand for alternative solutions to women’s real life problems could never be higher — and more imminent.

In comparison to the US, Europe’s healthcare system varies per country and the solutions must be built with public healthcare provisions in mind. For example, in France, extensive state child care and mandatory early-childhood education have helped keep female-employment levels high. In many other countries within Europe, this is not the case. In the UK, for example, privatization of healthcare has been on the rise.

At Cherry, we’re thinking deeply about the need for solutions to support a woman’s journey through the critical stages of her life given the reality of the situation, which can’t be solved by governments alone, private companies alone, or technology alone.

We’re building a series covering fertility, personalized healthcare, and later life support for women’s health which, we hope, will result in supporting more founders building in this space in the UK and Europe.

Let’s talk about fertility

Over the past several years, women have had to more proactively think about their fertility as the average age of first time mothers increases — today, higher than ever at 30.7 years old. However, this is not without a cost.

• The financial burden on young women undergoing IVF treatment is very high, with no guarantee of a successful outcome. Most NHS clinics provide one IVF cycle for free, but average treatment times take 8–9 cycles over 18 months. One cycle of treatment can cost between £5,000–10,000.
• The mental burden on women (and their partners) before, after, and during IVF is also very high, as studies have found that the process itself is associated with increased levels of anxiety, depression, and stress. Productivity losses associated with mental health costs employers in Europe €124 billion per year.
• £2bn is spent on IVF treatments alone in Europe, with egg & sperm freezing, surrogacy treatments, total spend topping £4bn a year.
• Egg freezing was the ‘hot new perk in the Valley’ in 2017, but has yet to translate into benefits for non-techies or become adopted more widely in Europe.
• But it’s not just women. There has been a 50% global decline in sperm count in men over the past 60 years, with the proportion of men with a normal total motile sperm count decreasing by 10% in the last 16 years.

So, what ideas are we yearning to see at Cherry?

Improving financing — and access

We are looking into how fertility financing and insurance solutions can enable more access to these services for families. Future Family is an example of one of these platforms in the US. Within the UK, Gaia Family provides personalized insurance and payment plans for fertility and IVF treatment. There is plenty of room for fertility services to expand both within and outside of the workplace. While technology companies have provided employee perks like egg freezing services in the last few years, the accessibility of these services need to be more widespread.

As already mentioned, each cycle of IVF is very expensive. By reducing the amount of cycles needed for success, we can immensely improve the cost burden of IVF. Founders and companies working to improve the outcomes of IVF are a key part of democratizing access to it as well. Looking at Alfie Health in the US and ImVitro in France, solutions involving AI to improve IVF outcomes are already underway and, no doubt, more can be done.

“Time is of the essence for IVF patients, with up to 25% of patients giving up after their first failed IVF attempt,” ImVitro founder and CEO Alexandra Boussommier-Calleja tells us. “This goes to show how difficult this journey can be. At ImVitro, we want to reduce this time to pregnancy and use AI to personalize decision-making and maximize everyone’s chance to conceive in as little time as possible.”

Care and breaking down barriers

We are also very excited about companies that are working to democratize access to fertility care and treatment. Fertility Care and Family Planning Services are out of reach for most families due to prohibitive costs of treatment. Therefore, any technology that breaks down accessibility barriers to care, and specifically online clinics that offer specialized quality fertility care at a fraction of the price, will play a meaningful role in the future of European healthcare.

Companies like Tia Health offer comprehensive female health care services that go beyond just gynecology and also include primary care, mental health, and wellness. We are confident that there is still plenty of room to offer similar comprehensive services for couples looking to start a family. Kindbody in the US, which offers both virtual and in person comprehensive fertility care and treatment, is yet another example and we’re keen to see more innovations in Europe emphasizing ease, convenience, and support along family planning.

And it must be said that any conversation around fertility and family planning should not be limited. Male fertility support is another aspect of fertility planning that is out of reach for most families. Studies have shown a global 50% (!) decline in sperm count in men over the past 60 years. There are fortunately a growing number of companies working to make sperm analysis and freezing more accessible and affordable. Manual, one of Cherry’s own, seeks to improve men’s health across a spectrum of issues, including some with direct effects on fertility. Mojo in France has built an AI assisted sperm assessment and selection platform helping save costs by improving the outcomes of IVF.

George Pallis, founder of Manual puts it well, stressing the importance of a unified approach to family planning. For men, he says, it will be impactful to, first, make them more aware of their health and, then, offer support along providing options to test blood hormone levels and analyze and freeze sperm.

“Fertility problems can be devastating for a couple, and statically infertility rates are continuing to increase,” George says. “Often the approach has focused on female-focused care rather than a unified approach addressing both male and female factors. We know men and women are equally likely to contribute to fertility problems, and — worryingly — studies suggest sperm counts for men have more than halved over the last few decades. There are various potential causes, but the spotlight is increasingly on environmental and lifestyle factors. It is vital that addressing men’s health is seen as an important part of tackling the infertility equation.”

Benefits that *actually* help

Employers have used healthcare benefits for a long time as a way to attract and retain top talent. In recent years, we have seen companies begin to include fertility benefits, specifically around egg freezing, as a mechanism to retain female employees. At Cherry, we know that the next step is for employers in all industries to start thinking about these benefits and more — going beyond egg freezing to also include comprehensive fertility benefits and services that address all aspects of a couple’s fertility journey.

Susan Lin, partner at Felix Capital and co-investor behind several portcos, ascribes this need to changing expectations around work over the past couple of years. Employees want benefits that are aligned with their values and “actually helpful.”

“We’re increasingly seeing the workplace as a community, especially after the last two years when the boundaries between work and life have continued to blur,” she explains. “Employees are increasingly expecting more from their jobs beyond compensation. They want benefits that are actually helpful, and mission and value alignment. There’s a huge role employers can play in distributing affordable, tailored, and consumer-friendly healthcare solutions, especially ones supporting their more vulnerable populations. And by offering better support around menopause, chronic conditions, or new parenthood when people can drop out of the workforce, companies also demonstrate that they concretely care about retention and D&I. We’re thrilled to partner with Peppy and others building better, more accessible and affordable support for people globally.”

We think companies like Peppy Health have indeed been doing great work in this space, offering employee care from fertility, to menopause, new parents, and more. Carrot is another company we admire in the space offering global fertility benefits to employers. We hope companies like these inspire more founders to build out ideas into viable solutions that can help companies support their employees.

Optimisitic for the future

And, yet, this is all just scratching the surface.

While we celebrate both the small steps and larger strides that have been made to combat some concerns evolving along fertility, team Cherry cannot wait to see — and deeply encourage — more solutions to tackle this multi billion euro/pound/dollar problem.

“The time has never been better to build and invest in companies innovating for the future of family,” Deena Shakir, partner at Lux Capital, tells us — and we couldn’t agree more. Behind Alife and Maven, she comments on the particular opportunies ranging from transformative AI and vertical software solutions to revolutionizing IVF efficacy, efficiency, and equity and to comprehensive women’s and family health solutions.

The time is now and we’re optimistic that the contemporary issues that have arisen will spark both the urgency and innovation needed to find solutions.