Afton Vechery, Modern Fertility, on making personalized fertility more accessible

In this episode of The Pulse Podcast, we interview Afton Vechery, CEO and Co-Founder of Modern Fertility, a reproductive health company making personalized fertility information more accessible. We discuss Modern Fertility’s founding story from getting to the first 100 users to finding the best GTM strategy and building the proactive fertility category from scratch.

Prior to founding Modern Fertility, Afton worked in healthcare private equity, strategic operations at various health tech startups, and led Product at 23andMe. Afton is a graduate of Wake Forest University with degrees in Neuroscience, Business & Entrepreneurship.

Founded in 2016, Modern Fertility is the women’s health company making personalized, proactive fertility information more accessible to women everywhere, whether they are trying for kids or not. Modern Fertility raised their Series A in 2019 from Forerunner Ventures, First Round Capital, Maveron, and many other leading investors.

Start — 08:00: Crash course in entrepreneurship in high school

• Afton’s first startup at the science fair: Afton shares that she feels lucky to have had an early introduction to entrepreneurship. When Afton was in high school, she led a science fair project focused on her well water issue in her community in Maryland. There she got an early insight into the world of how science could impact the public. Given the broken incentives within the public health system, she realized no one was going to act on the findings of her project. So she decided to start a water quality testing company in high school and came into school early and spent her lunch breaks distributing water bottles. Luckily this initiative led her to get a scholarship focused on entrepreneurship, so Afton was essentially an EIR and had to start companies to stay in college.
• Learning from healthcare investing to early operating at healthcare startups: After college, Afton decided to go deeper into healthcare by working at a healthcare private equity fund in New York, which is where she had her first introduction into the fertility and infertility space. She loved the intellectual stimulation of investing but missed the operational component, so she made the tough decision to leave finance and join the earliest possible company. She became employee number one for an autism behavior phenotyping company that ended up getting sold and then she worked at a breastfeeding startup called Willow Pump, and helped them raise $16M from Johnson and Johnson. Her next career step was to help 23andMe relaunch their consumer experience while they were shut down by the FDA. While she was at 23andMe, she realized that she was waiting until later in life to start her own family, and this led to Afton founding Modern Fertility.

08:00–14:00: Modern Fertility’s founding story

• Understanding her own fertility: While Afton was at 23andme, she became curious about her own fertility, she remembered the baseline tests that she had learned about back when she was in private equity. She had explored the broader women’s health and reproductive health landscape, and got the opportunity at the age of 22 to really understand the business, the science, and the emotional aspects of infertility.
• The world before Modern Fertility: Afton tried to get the baseline tests done at her OBGYN. Unfortunately they shared that because she was not actively trying and failing to conceive, they would not provide her a test. Afton had to go to an infertility clinic to get the testing done, which was about $700 for their initial appointment. It took her months to coordinate her test and when she finally got her result, she was diagnosed with PCOS, which impacts one in ten women. She began starting the conversation with her friends, friends of friends and eventually then hundreds of women about their experience, and realized that they were in the midst of a pretty massive cultural transformation that was happening real time where women were finally starting to talk about their fertility in ways that they hadn’t in previous decades.

“I began starting the conversation with her friends, friends of friends and eventually then hundreds of women about their experience, and realized that we were in the midst of a pretty massive cultural transformation that was happening real time where women were finally starting to talk about their fertility in ways that they hadn’t in previous decades.”

• Modern Fertility’s early beginnings: During her days in private equity, Afton was talking to women and infertility clinics and was amazed that no one had ever told them that fertility declines with age, and no one had ever told them that IVF wouldn’t work for every single person. Today there is no test that exists today that’s going to tell you if you are going to be able to have a child or not. But what Modern Fertility can do is help women understand more about their baseline and detect potential red flags to help women understand their success in IVFs or egg freezing if they decide to go that route. They also help women understand their menopause timeline as women are not waiting until later in their life to start families. Often women’s menopause transition and desire for either your first, second, or third child might overlap, so understanding where your body is is quite impactful in women’s decisions about having children. Afton shares that they wanted to build Modern Fertility in a way that would resonate with women: moving fertility into mainstream wellness, creating something that de-stigmatizes infertility and building a platform that women actually want to engage with.
• Finding their right first institutional investors: Afton put her own life savings into the company to start which she would not necessarily recommend to everyone interested in starting their own company. They quickly realized that they needed more capital for the R&D side to progress the business and started having early venture discussions. Back then the venture community was a confused by the product and the notion of flipping fertility to be more proactive rather than reactive. Afton shares that they were fortunate that they found a handful of investors that really understood the vision that they had.
• Finding the right co-founder is like dating: Afton shared that there are many ways to start a business but she alway knew she wanted a co-founder and having someone to start a company is a lot more fun. The founding team dynamic is so important and so while she was actively co-founder dating, Afton would actually pay people out of her savings to work with her on specific projects. She shares that this was a great way to simulate what it was like to work together. She knew that as someone with a finance ops and product background, she was looking for someone that could lead brand content and the creative side of the equation. When Afton started working with Carly, she felt like they were the perfect combination of their skill sets. They were connected through “one of the most epic introductory emails of all time”, through one of their mutual friends.

“I was actively co-founder dating. I would actually pay people out of my savings to work with me on specific projects. This was a great way to simulate what it was like to work together”

14:00–20:00 Modern Fertility’s offerings

Modern Fertility’s goal as a company is to continue to provide their customer with all of the products, tools and services that she needs to have a better process and ultimately outcome, whether that was kids or whether that was broader reproductive health:

• Take-home hormone test: Modern Fertility provides a simple take-home test at home and works with board-certified physicians in 47 states that will review your test for appropriateness. Before you take the test, you also have a custom quiz and guide that helps you understand your fertility baseline through questions about your period, birth control, menstrual cycle. Then Modern Fertility will give you guidance on when to test and walk you through the entire whole testing process, and provide step by step instructions. The test is a simple finger stick, where you put a few drops of blood onto a card, and then send it back to Modern Fertility’s CLIA-accredited lab.

You can order your test here for $159: https://modernfertility.com/shop/hormone-test/

• Customized report on your fertility baseline: In just a few days, you will get access to your results. Afton shares that the digital product they customize every word and sentence based on hormone levels, age and self-reported medical information. They will share a customized report of your fertility baseline, and help you measure and understand red flags, success with IVF, egg freezing menopause onset, and how lifestyle factors can influence your fertility.
• Weekly Egginar seminars and Modern community: Consumers will also get access to a weekly webinar led by an IVF nurse and a slack community with moderated channels with women that are exploring all topics related to reproductive health access to a 1-on-1 consult with a fertility nurse.
• Semi-quantitative ovulation test: Modern Fertility trackers LH (luteinizing hormone) in urine to actively understand whether they are ovulating or not. Typically, ovulation tests are used if you’re actively trying to conceive to pinpoint when you’re ovulating to time intercourse or insemination. But Afton shares that in their customer base a lot of women have been on birth control their entire lives and are using their ovulation test right when they go off birth control to understand and answer the question of whether they are ovulating. Modern Fertility provides this solution at an accessible price point.
• Other products: Modern Fertility also launched early detection pregnancy tests and a free app that includes a cycle tracker to record ovulation and pregnancy testing. They also recently launched a prenatal vitamin. Afton shares that she’s been taking it herself and also shares that taking a prenatal vitamin up to a year before you are pregnant allows the folic acid to build up in your body to prevent neural tube defects in your future child. Even for those not looking to conceive, taking prenatal vitamins does wonders for your hair, skin and nails!

20:00–28:00 Building proactive fertility category from scratch

• D2C go-to-market strategy: Afton spent a lot of time thinking about their go to market strategy especially from the perspective of starting a category from scratch. Her thesis was that in order to create proactive fertility as a category, they need to have a direct relationship with their customers, which would enable them to iterate faster and increase their feedback loop as well as have an authentic conversation around fertility with their consumers.
• Choosing not to go B2B: When they started they got a lot of feedback from VCs that they should really consider the B2B channel. They even had employers reach out to do education events. What they realized early on was that employers who were looking for fertility services were looking to check a box or to provide something more than covering IVF or egg freezing. Afton thinks for any early stage company it’s really about determining where you want to start. She shares that it’s hard to build a OB/GYN B2B business model and nail direct-to-consumer all at the same time and it became very apparent to them in the early days to prioritize one go to market strategy. They decided to focus on physician-mediated DTC channels. As Modern Fertility scales, Afton shares that they will have a multi-pronged distribution approach. For example, last year, Modern Fertility launched in over 1500 Walmart stores!
• Getting their first 100 users: Modern Fertility started their beta test with a mobile phlebotomy service where they paid a phlebotomist to go to consumers and do a traditional blood draw. Afton shares that in DTC it’s finding the fastest and most highly scalable channels up front, which in today’s age is Facebook or Google.
• Behind the scenes on the diagnostic test: Although it is not novel to use a small amount of blood to get diagnostic results, it has never been brought to the fertility and infertility space. There are only 500 infertility clinics in the US which limits the natural number of women who can fit through those doors. Afton shares that their concept was novel in terms of taking these tests out of the infertility clinic and bringing them to the masses. Early on, they determined that accessibility was a big part of their mission and this meant they wanted the tests to be done at home. When she looked at existing solutions they were not willing to stand behind any existing solutions. Modern Fertility decided to build their own validation study showing that finger prick and traditional blood draw could be used interchangeably.
• Publishing clinical results and proving the science: Currently Modern Fertility is the only testing company that has published a study to this scale around these hormones in a top peer reviewed medical journal. They presented at the American Society for Reproductive Medicine, and it was later reviewed in the New England Journal of Medicine. From day one, it was essential that we really had a science and the clinical nature of these tests just as a core part of the company so they made the decision to really take the time to do these validation studies and publish their results.

“From day one, it was essential that we had a science and clinical nature of these tests as a core part of the company. And so we made the decision to really take the time to do this validation, study and publish it.”

• Fundraising early vs late stage: Afton shares that in the early stages, VCs are making bets on you, on the industry, your ability to pivot and figure things out within the industry. As you scale later in the company, a CEO told Afton recently that data is the only thing that can save or kill your company. In the later stages past the seed stage, the attention becomes focused on traction, gross margin, LTV to CAC and other metrics that affect your ability to raise subsequent venture funding.
• Modern Fertility in 10 years: Afton shares that her definition of success for Modern Fertility is for every person with ovaries in the world to understand their body so that they can own the decisions impacting their body and future, whatever those decisions might be. She envisions fertility hormone tests to be as ubiquitous as a pap smear.

28:00–33:00 Hot takes on women’s health

I asked Afton for opinions that not many people would agree with, here are her hot takes!

Hot take 1:

“I would say that one of the hard things to think about upfront, especially when operating in the women’s health space is incentives.

When you have an insurance company, they don’t want to pay for a pregnancy. But if they do pay for a pregnancy, they want it to be a low risk pregnancy as opposed to a high risk pregnancy. Who are the big decision makers in the space? How do they make their decisions? How do the dollars flow? There are honestly a lot of incentives that are really misaligned. It’s important to have honest discussions with experts in this space to understand the flow of dollars, especially when going from zero to one and thinking through that business model.”

Hot take 2:

“I think that egg freezing procedure that provides many options for women. But I don’t believe that it is going to be the procedure that gets mass adoption in the US or world. I think it is incredibly expensive and invasive. When you look at even at companies that cover it, the amount of women that are pursuing that as an option today, I think that there needs to be a lot more work done.

I’m very excited about early stage technologies that are focused on fertility preservation or extending our reproductive career “

Some technologies in development she mentions are IVM (in vitro maturation), ovarian tissue preservation and stem cells. An exciting time for fertility science!

33:00–End Advice for those interested in digital health startups

“Getting experience at an early stage company is incredibly valuable. It’s also not for everyone - the pace and the autonomy is a roller coaster of a job. I think it is a really important decision that an internship just gives you the ability to try it out before you commit fully. It’s an awesome way to think about curating your resume and deciding how you want to spend your career.”

…and yes, Modern Fertility is hiring, so check out any internship or full time roles on their job website: https://modernfertility.com/careers!

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