Why now? Infertility is a crisis. Women’s healthcare should be a basic right.

Published in

Chicago Ventures

5 min readAug 8, 2022

Now is the time to invest in women’s healthcare startups. We’ve hit an inflection point where the fertility care market is shockingly inefficient and women are losing their right to basic healthcare.

There are only 1,700 reproductive endocrinologists in the US, while there are 6.1 million women experiencing infertility. On the flip side, the overturn of Roe means that women in at least 26 states could lose the right to receive an abortion or related services. Further exacerbating the problem, 19 million women of reproductive age live in contraceptive deserts, lacking access to basic contraceptive care.

Affluent women will continue to have access to the care they need. But the journey can be especially difficult for women of color, people living below the poverty line, and those in rural areas. Black women are three times more likely to die from a pregnancy-related cause than white women. And between 72–81% of abortions in Mississippi, Texas, and Louisiana were received by minority women — meaning they will be disproportionately affected by the trigger laws in these states.

No matter your opinion on the legislation, it’s evident that the overturn of Roe will impact women’s access to medical care. In one case, a 10-year-old rape victim in Ohio had to cross state lines to access a two-pill medical abortion. Afterwards, Indiana’s attorney general told media he intended to investigate the Indiana obstetrician for failing to file required reports. The decision on Roe has also spurred questions around the legal medical response to a miscarriage, as the procedures and medications are identical to those of abortions. Protocols around IVF are in question as well, due to the personhood rights of embryos. Clinics are questioning whether they’ll be criminally prosecuted for discarding embryos.

The medical establishment doesn’t have a great track record either. It wasn’t until 1987 that researchers were even encouraged to include women in clinical research studies. We’ve been avoiding advancements in women’s health for far too long.

Working on startups is a capitalist pursuit at its core. But the people leading these companies are also imagining a better future — one that’s often more transparent, egalitarian, and easier to navigate than what we have today. We’ve fixed the inefficiencies in financial markets, social networks, and advertising many times over. Now, let’s turn some of our attention to the massive opportunities in women’s health.

Seeking improved patient outcomes

At CV, we prioritize healthcare products that produce demonstrable clinical outcomes. Healthcare products that focus simply on utilization (like testing) lead to less impactful patient results than those measuring meaningful outcomes.

In the case of an IVF care platform, for example, the core success metric should measure how many women get pregnant after accessing care rather than the number of women who pay for testing.

Given our conviction that there are still significant problems to solve in this space, we did a deep dive into fertility health. We broke startups into four groups — (1) virtual care, (2) testing and tracking, (3) mental health, and (4) fertility treatments. It’s worth noting that up to 50% of infertility cases can be attributed to male factor infertility, which we did not explore in this project. We hope to see more founders innovating in these verticals, with the end goal of improving clinical outcomes.

Virtual Care startups are already a well-funded category of women’s health. To form a wedge, early-stage startups need to focus on a specialized need that’s unsolved by the wider ecosystem — like access to contraception, abortion care, or prescriptions. Despite all the funding, it’s needlessly hard to get access to basic care. Getting a referral, finding a specialist, and scheduling an appointment are all manual and fragmented tasks that require time and devotion. We’re especially excited to see teams solving problems for rural communities that will increase access to often non-existent care.

Virtual Care startups: Choix, HeyJane, Kiira, and Zuri.

Testing and tracking have historically been the easiest piece of fertility health to productize. There’s no FDA approval required to provide at-home hormone testing, which led to a wave of D2C startups in the space. The most well-known exit has been Modern Fertility, acquired by Ro for $225 million. Startups in this space usually fall under the utilization category. In most cases, reproductive endocrinologists will require their patients to re-test once they schedule a consultation. We’re watching out for solutions that can service an acute need, lead to diagnoses or treatment, and incentivize buy-in from providers.

Testing / Tracking startups: Eli, Noula, Mira, Hormona, Oova.

Mental health care is an acute need in the fertility space. Talk to a woman struggling to get pregnant at 39, or an 18-year-old who needs an abortion. They’ll likely both be anxious and looking for more support than their primary care provider can offer. Even so, survival will be difficult for companies in this vertical. The barrier to entry is low and they’ll run into the dating app problem where retaining users is at odds with providing quality care. Once a woman gets pregnant, for example, they may no longer need a specialist outside their primary care doctor or generalist therapist. To gain sustainable traction, early startups will need to either service a specialized diagnosis or aim to capture the entire women’s health market.

Coaching / Mental Health startups: Elanza, Frame Fertility, Expectful, and Canopie.

Fertility treatments like egg freezing and IVF are inefficient and prohibitively expensive for many. There are over 6M women in the US experiencing infertility, and only 1,700 reproductive endocrinologists. Successful IVF with an egg donor costs an average of $72,000 in California, and 70% of women go into debt to undergo treatment. Startups in this category are starting to design services that increase access through payment plans and telemedicine. We’re looking for innovations that can reduce the cost of treatment and create a more optimized market for those struggling to conceive. Startups in this space could become increasingly essential depending on the regulation and laws around personhood rights of embryos.

IVF / Egg Freezing startups: Lilia, Rescripted, and She’s Well

Call for startups

Now is the time to fund startups working towards improved health outcomes for women, regardless of income level, circumstance, or geographic location. Technology can’t solve everything, but it can greatly improve the experience and accessibility by reducing costs, modernizing the process, and providing effective virtual care models.

We’re looking for startups and founding teams where…

Software is core to the business and is designed to scale. We’re less likely to fund hardware R&D, FDA approval, or physical clinics.
A team that understands how to improve patient outcomes. The founding team has a trained medical professional and/or a healthcare-specialized business leader.
The product improves access, cost, or quality of care. You understand incentives for who pays and why they’re incentivized to do so.

Reach out if you’re starting something new in the space. We would love to hear from you!

–

Sources and further reading:

Why now? Infertility is a crisis. Women’s healthcare should be a basic right.

Seeking improved patient outcomes

Call for startups

Written by Chicago Ventures