
Modern Fertility (YC S17) is a proactive way to test fertility at home - aaffttoonn
https://modernfertility.com/blog/launch/
======
replicatorblog
An excellent, important product — and stellar branding! While this product is
a massive technical improvement, its biggest value might be getting couples to
think about fertility earlier.

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.

~~~
aaffttoonn
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.

~~~
shouldifakeit
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.

~~~
aaffttoonn
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.

~~~
shouldifakeit
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).

~~~
aaffttoonn
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/](https://modernfertility.com/blog/ovarianreserve/)

~~~
shouldifakeit
> 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.

------
robbiemitchell
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.

~~~
Alex3917
> 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.

~~~
shouldifakeit
Nonsense. Where are you getting your stats from?

------
evrydayhustling
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?

~~~
aaffttoonn
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.

------
dabbledash
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.

------
souprock
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...

~~~
aaffttoonn
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.

------
shouldifakeit
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?

~~~
aaffttoonn
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.

------
gataca
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?

~~~
aaffttoonn
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.

------
vedtopkar
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.

------
pg_bot
Given that you are dealing with medical data that falls outside of HIPAA what
are you doing to ensure that PHI remains secure?

~~~
aaffttoonn
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.

------
faitswulff
Quick note: "Millenial women" should be "Millennial women" (note the missing
"n")

------
narenst
Great product! Are you talking to companies who might want to offer this as a
benefit to their employees?

~~~
aaffttoonn
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
info@modernfertility.com and we will schedule a quick demo and get you setup
in <20 minutes. Thanks so much for asking.

------
jontas
Any plans for a male version?

~~~
aaffttoonn
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.

~~~
shouldifakeit
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.

------
garrettlangley
congrats guys :)

