Issues in Embryology: How Wall Street is Making Egg-Freezing (and Feminism) a Hot Investment

For a significant period of time, egg-freezing was known as a procedure for women approaching their forties or for those with specific medical conditions. But in the past few years, the demographic of women pursuing egg-freezing has started to change. Now, it’s become more common for career women in the 20s to undergo the procedure as a precautionary measure.

In fact, since 2009, there has been an 11-fold increase in the number of patients who have undergone the oocyte cryopreservation (OC), the technical name for the procedure.

And as the number of millennial women seeking egg-freezing services has grown, the market has evolved. Egg-freezing startups have appeared as alternatives to hospitals and fertility clinics, using social media to reach their audience, who are increasingly interested in taking action to boost their chances of being able to have a family at later ages.

This new category within the fertility treatment realm separates itself from the traditional hospital route with claims of being less costly, more accessible, more tech-oriented.

Kindbody—a fertility, gynecology, and wellness clinic based in New York—is one of the new leaders in the fertility startup space. They are breaking the mold set by traditional clinics at every level, from their social media presence to their digital-based booking to their all-encompassing list of in-house services.

The inclusive, educational approach that these new fertility clinics present is a breath of fresh air for modern women, who are tired of tip-toeing around the stigma that surrounds the subject of women’s health.

“What we want to do is really start a public conversation about fertility and reproductive health that really has not existed in our society because these topics are often behind closed doors and very forbidden,” Dr. Fahimeh Sasan, the organization’s founding physician said. “We think that the more men and women talk about reproductive health and fears and all the things that surround this topic, the less scary this topic becomes.”

While their feminist mantra and tech-savvy presentation certainly has an appeal, critics have questioned the true benefits of going to a fertility startup versus an established hospital. So, we sought to understand how these startups differentiate themselves from hospitals and traditional clinics.

Fahimeh Sasan, MD is the founding physician of Kindbody (@WeAreKindbody) and one of their practicing OB/GYNs in New York. Dr. Sasan did her residency in obstetrics and gynecology at Mount Sinai Hospital and has been practicing for 12 years. She is passionate about breaking the stigma surrounding conversations about female fertility and helping women better understand their options for the future.

Carmela Rea is the CEO of Eggfund (@my_eggfund), a fintech company also based in New York, that helps women finance their fertility journeys. Prior to founding EggFund, Rea was the president of a global media company and left her position to work on EggFund full-time. She envisions a world where having a family is attainable for all who wish for one.

Carmela Rea experienced the frustration of navigating infertility first hand when she and her husband pursued IVF. During the process, she realized how convoluted, stressful, and expensive the entire experience was.

“I wish somebody had come to me 10 years before and told me that I shouldn’t take my future family building for granted—and to get ready emotionally, physically, and financially,” Rea said.

Rea is one of 6.1 million women—one in 10 women—in the United States that experience infertility. Her journey with IVF didn’t work out, but thankfully, she ended up becoming pregnant with her daughter Elizabeth naturally, who was born in 2018.

During her fertility journey, as bills began to rack up, she realized that the majority of families wouldn’t be financially able to pursue the same option. To freeze your eggs through a hospital, you will pay somewhere in the tens of thousands of dollars—on average, $30,000 to $40,000.

“Cost continues to be the greatest hurdle,” Rea said. “It’s always about the cost. And until we resolve the issue of affordability we are going to continue to have this problem.”

But one of the major benefits of going to a non-traditional fertility clinic is that they charge much less than hospitals and traditional clinics for the same services and they are transparent about pricing.

For instance, Kindbody only charges $300 for an egg-freezing assessment, $6,500 for egg-freezing, and $600 per year in storage costs, plus the cost of medications to complete one cycle. In total, it adds up to about $10,000 to $13,000 (plus the storage costs each year.)

“Our prices, across the board for any of the fertility treatments, are about 40 percent less than your typical, traditional [fertility] center,” Dr. Sasan said.

But how is the startup able to provide its services for a significantly lower price point?

“This industry, for a long time, has been a cash industry that was just for the top 1 percent of people,” Dr. Sasan said. “As a result, since insurance didn’t cover it, physicians and companies just charged whatever they wanted.”

While there are significant savings, many women still can’t afford to go down the egg-freezing route, as most U.S. healthcare plans don’t cover the costs of fertility-related care.

For many families, that means putting it on a credit card or receiving funding from a company like Eggfund, which provides financing for all kinds of fertility-related services for women who can’t afford to pay out of pocket.

But now, more and more companies, including tech giants like Google and Facebook, are adding fertility services to their coverage, and more states are beginning to mandate some form of coverage for fertility services. For instance, since January 2020, New York has required all Large Group insurance providers to cover up to three cycles of IVF for people with a medical diagnosis of infertility. As fertility advocates push for benefits legislation, there is a potential that other states may make similar moves.

Another one of the major differences between going to a hospital or traditional clinic and going to Kindbody is the patient’s experience. The process of investigating your fertility through a traditional fertility clinic is as follows:

First, you make an appointment to see your gynecologist. Then, the gynecologist refers you to a fertility doctor. Then, the fertility doctor will send you to a radiology center or a different location to have bloodwork or genetic testing performed. Then, you return to your fertility doctor to evaluate the results, get the treatment you need, and hopefully become pregnant.

The process is a revolving door of appointments with various third parties, which is not only difficult to arrange, but very time consuming, which is especially frustrating for women who already feel like they are racing against a ticking clock.

“And in between their various appointments, no one has taken care of their mental health or their nutritional needs—or any of these things,” Dr. Sasan said.

Kindbody has rewritten the script by bringing every step up the process under one roof. “So, the gynecologist, the fertility doctor, the nutritionist, the therapist—every step of the way that you would need in the fertility journey is all taken care of in the same place,” Dr. Sasan said.

The idea of offering all of a woman’s health services in the same place seems intuitive, yet is largely unprecedented until now. For patients, this is another major game-changer.

Startups may be more affordable and more flexible with clients than traditional options, but critics still have some concerns.

One of them, highlighted by the American Society for Reproductive Medicine (ASRM), is that there is a “false security is highlighted when planned OC is referred to as an ‘insurance policy’ for future childbearing.”

“Many women are doing this just for the peace of mind. They’re paying for that chance,” Rea said. “I think one thing that needs to be more transparent is perhaps how many times you might have to cycle or freeze to get to a viable embryo. The reality is once you dive into the statistics, it’s usually more than one cycle.”

According to ASRM, at age 38, a patient must store 25 to 30 oocytes to have a reasonable chance of having one child, which likely takes multiple cycles of treatment (depending on the patient.) So, investing in one round of egg-freezing may not suffice if you want a high chance of being able to have a child by birth later on down the line.

“How successful a woman’s egg-freezing process is and how many cycles of egg-freezing a woman needs to do will depend on her ovarian reserve at the start of her process,” Dr. Sasan said. “So, if your ovarian reserve is good, meaning you have a high egg count, you’re more likely to get more eggs per cycle. If you have diminished ovarian reserve, you’re going to have less eggs. It is very individualized.”

Essentially, there is no way of knowing how many rounds of egg-freezing you might need to have a high probability of being able to achieve a live birth down the line until you are seen by a physician.

However, Kindbody and competitors like Extend Fertility both explain the factors that influence your fertility on their individual websites. As long as patients are managing their expectations based on the conversations they have with their physicians, then misconceptions and disappointment can be avoided.

Another common concern about fertility boutiques? The simple fact that they are startups. In a realm that is dominated by hospitals and clinics, critics have questioned the stability of these new companies.

But Dr. Sasan’s emphasized the experience of the medical team at Kindbody. “Sometimes when people think of startups, they think of launching something like a new gadget for the first time, but we are certainly not a ‘startup’ when it comes to medicine,” Dr. Sasan said.

Its physicians have had a minimum of 10 years of experience on the job since their highest level of education was completed. “All of our providers are all seasoned, starting from our nurses and medical assistants to our embryology team,” Dr. Sasan added.

For a startup launched in August of 2018, Kindbody has come a long way. And it shows no signs of slowing down. Before the end of 2020, they will open a second location in Manhattan and a location in Los Altos, Calif. In 2021, they will also add locations in Seattle, Atlanta, and Austin.

“We are very passionate about continuing that growth because the only way you can effectuate change in women’s healthcare is by being the provider and bringing the care to people,” Dr. Sasan said.

Nina Chamlou

Writer

Nina Chamlou is an avid writer and multimedia content creator from Portland, OR. She writes about aviation, travel, business, technology, healthcare, and education. You can find her floating around the Pacific Northwest in diners and coffee shops, studying the locale from behind her MacBook.