One in eight couples, single parents by choice and much of the LGBTQ+ population in the United States seek out fertility services. Studies have shown that women experiencing infertility have experienced depression levels comparable to those receiving a cancer or HIV diagnosis.
This is all aligned with a much larger issue: The dismal state of maternal and child care in the United States.
In 2018, at 17 maternal deaths per every 100,000 live births, the U.S. mortality rate was double that of France and Canada, and nearly triple the number in the U.K. Moreover, mortality rates spike significantly for Black women, at 34 per every 100,000. According to the U.S. Centers for Disease Control and Prevention, 60% of pregnancy-related deaths in the U.S. are preventable.
Countries like Italy and Hungary offer some of the longest periods of leave, with five months covering 80% of wages and 100% of wages for 24 weeks, respectively. Twelve weeks is a popular time frame with varying amounts of the wages during that time covered by the employer, social security or both, but countries like Pakistan, Mexico and India all cover 100% for the period.
Without fertility services, any unexpected tests or NICU visits, on average, it costs between $5,000 and $11,000 to have a baby (without a C-section) in the U.S. That is just for the birth. While Rhode Island, Hawaii, New Jersey, California and New York have state-sanctioned paid maternity leave, there is no federal mandate that applies countrywide.
Barbara Collura, president of Resolve, a nonprofit founded to bring together women facing infertility, says individuals and couples often come to Resolve with a huge lack of understanding around an infertility diagnosis and what happens next. For people on these journeys, looking for answers often only leads the way to more questions.
“They certainly don’t know that their insurance may not cover things like egg donation or IVF,” she says. “Or they certainly don’t know the cost of gestational surrogacy and all this involved with that.”
Patients often have to learn about all this while having to make decisions, without much direction on where to go for resources beyond an OBGYN.
To produce a baby, a sperm, an egg and a uterus are necessary. Collura says in addition to figuring out what patients are working with on that front, they also have to consider finances and the route to take in order to have a baby.
“There are a lot of people who can’t afford what their best course of action is. So, the most affordable care may be subpar, but something they can afford. It’s a strange type of medical care where the people need it, but this cost issue plays into a very convoluted, not cookie-cutter path,” she says.
The spillover effects of poor education
“Notoriously across all cultures, women’s health is not talked about,” Kindbody chief medical officer and co-founder Dr. Fahimeh Sasan says.
“There’s just a lack of information out there. For example, up to 40% of the pregnancies end in miscarriage in the first trimester. The majority of women, when they have a miscarriage, truly think they’re the only one, and then they usually will come back to me and say they had a miscarriage, and five of their friends have, and they never discussed it.”
Dr. Sasan pointed to Michelle Obama as a glaring example of how women are taught not to talk about infertility. “She was a very popular first lady, and during the entire presidency, never shared how she actually had miscarriages and that her daughters are a product of IVF. This never came out until she released her autobiography.”
In the United States, sexual education and/or HIV education is only required in 38 states and the District of Columbia. Of those, only 18 states require the information to be medically correct.
This manifests a vast gap in scientifically accurate information not only for those trying to conceive but for policymakers as well, subsequently contributing to the condition of reproductive and maternal care in the U.S.
Americans cited medical reasons, their partner and expenses, but they also said the pandemic illuminated the lack of easy access to healthcare as reservations for having children. Birth rates in the U.S. hit a record low in 2020, dropping 4% from a year earlier following a steady decline since the 2008 recession. Population growth in 2021 is set to hit record lows alongside how COVID-19 has significantly inflated the death rate.
Within the country’s two-party system — Republican and Democrat, conservative and liberal — this lack of baseline factual scientific education around reproductive health and all it encompasses affords a lot of leeway for decisions around state sanctions to be informed by beliefs rather than biology.
And we’re beginning to see the implications of policing women’s bodies.
On December 16, 2021, the Supreme Court did not strike down Texas’ abortion ban on pregnancies beyond six weeks. It did, however, return the case to a federal appeals court, which has already upheld the law twice and allowed providers to sue the state.
Because a missed menstrual cycle is one way to detect a possible pregnancy, and average cycles range from 21 to 35 days, this leaves a very small window of time to discover a pregnancy, make a decision, and attempt to get an abortion under the current Texas law.
Mississippi is the latest state to follow suit, in the case of Dobbs v. Jackson Women’s Health Organization, where the state is against the organization’s last abortion clinic, and is trying to ban abortions after 15 weeks of gestation.
In extreme cases — that may become more common — women may be incarcerated for the death of the fetus. In October 2021, 21-year-old Brittany Poolaw was sentenced to four years in prison after miscarrying. Although doctors said her methamphetamine use may have directly resulted in the miscarriage, her trial only lasted one day and she was found guilty of manslaughter.
Reproductive rights advocates warn that the ruling against Poolaw is merely a preview of the direction we’re headed should the Supreme Court overturn Roe v. Wade, banning access to safe abortions. One could argue this is a direct result of reproductive health never being prioritized in the education system.
Collura pointed out how the lack of education also affects policymakers’ approach to reproductive healthcare. She argues that given universal care is contingent on medical necessity in the U.S., there is still the perception on the part of decision-makers that infertility is elective.
“If you have problems trying to have a baby or building your family, the perception is that it’s something that you’re gonna have to figure out on your own,” she said. And, not only are you left to figure it out on your own, in some states you may be persecuted for circumstances completely out of your control.
Financial considerations
To make matters worse, having a child — naturally or through IVF — is extremely cost-prohibitive.
The average initial IVF cycle costs nearly $20,000 out of pocket with medications and monitoring, and the cost of actually having a baby through IVF before any postpartum care or any specialized needs starts at over $25,000. And that’s if the first round results in a full-term pregnancy.
People taking the IVF route to parenthood on average spend over $19,000 for their first round, with each additional cycle tacking on about $7,000.
Kindbody’s founder and chairwoman, Gina Bartasi, and CEO of corporate, Annbeth Eschbach, both went through multiple rounds of IVF over a decade ago, and they said they each spent between $60,000 and $100,000.
Societal issues are out of its scope, but the company is trying to tackle the problem where it can make the most impact: cost and transparency.
Kindbody’s pricing is all readily available on its website for everything it offers. Listed under “IVF & Conception Care,” pre- and post-cycle IVF services are $15,500 without the cost of bloodwork or medications, which the site says can cost $3,000 to $6,000 if not covered by insurance.
“Having fertility care should not be something that should be only available to the top 1%, which is how it was for the longest time, and it shouldn’t be a cash-only industry,” Dr. Sasan said.
Kindbody’s approach is centered around being open with patients about their options around the costs. Dr. Sasan says there are discount programs patients can apply for on a rolling basis. “It’s really about educating people on that. Why would you not want to share that with patients you’re caring for? Why would you want to keep that a secret that there are discount programs for medications?”
The company is also working to negotiate better prices with the companies it buys from.
“We’re really making an investment for our patients, because why are the prices so astronomical?” Dr. Sasan said. She pointed out that in Europe, the same medicine costs about a quarter of the price it is sold for in the U.S.
The retention issue
As societal gender norms shift, changing fertility needs are also making their way into the workplace.
“Women across the country are waiting longer to have children because of higher education, because of career aspirations, waiting to meet the right partner, because of travel, because of finances, because of all of the above. They are waiting longer to have children, but our fertility is 100% most directly linked to our age,” Sasan points out.
Health and fertility have gained particular attention in the midst of what is being referred to as The Great Resignation, which has seen employees taking stock of their lives and careers, and leaving roles that have compromised their health, safety and peace of mind.
Employers trying to get ahead of this — or even catch up to the damage it’s done to their workforce — are seeing the value in fertility coverage for boosting retention. They want to keep their employees, so offering healthcare that takes care of their whole person and family is a solid avenue to that goal.
Eschbach mentioned an online forum she heard about that exemplifies how important these benefits are. “There’s a whole Facebook group organized around where to work if you want to have a child. [For example,] if you want to have a child, go work for Starbucks because they have benefits,” she said.
“Once your company offers a fertility benefit, you as an employee are going to be able to do something you never could have been able to afford to do before.”
Only 2% of self-insured employers were offering fertility benefits in 2020, and according to Eschbach, the data says 58% of self-insured employers will be offering them by 2023. “There’s an enormous shift happening because women are leaving the workforce, and we need to figure out how to keep them.”
“It’s a very powerful benefit for not just tech companies. Middle America companies are also now adopting fertility benefits,” Eschbach said. “I have heard from consultants that it’s one of the top three must-have benefits. There’s mental health, which you hear a lot about, musculoskeletal and fertility facilities.”
The longstanding lack of investment in mental health only exacerbates how taboo the topics around fertility have been. “Trying to conceive can be very complex. It can be isolating and very, very arduous. And when I say isolating, a lot of us who don’t want to talk about it feel very lonely and sick when you’re not sick,” Eschbach said, referring to the gaps in fertility and mental health services that are often not prioritized or included in traditional care services.
That’s where Kindbody hopes its healthcare benefit solutions can fill the gap. Dr. Sasan encapsulates Kindbody’s pitch to employers: “Let’s pad true fertility benefits as an adjunct value. Not archaic fertility benefits that require you to try for a year and only cover IVF for heterosexual people, but true fertility benefits that allow for fertility preservation, that allow for family-building for everyone, not just small portions of the population.”
Employers investing in these benefits are finally seeing how filling the gap in knowledge around these services can keep their employees happier and less burdened outside of work.
Much like the intention behind the transparency around pricing for patients, Kindbody’s pricing for employers is structured to make it easily accessible and easily understood by both employers and their employees.
“When [employers] buy services from us or our partner clinics, it’s one transparent rate instead of all these add-on services. Transparency is a big focus for us,” Bartasi said.
Making the taboo work for you
Reproductive healthcare being such a taboo topic has had its benefits for Kindbody as a business as much as it’s been an uphill battle for the industry.
When TechCrunch first spoke to Bartasi about her growth in the women’s health space at the beginning of 2020, she and other CEOs in the space mentioned how it had a togetherness about it.
As companies raised money and grew, visibility became less of a concern, however. Bartasi says it took a lot of educating to get investors to believe in the space.
She says potential investors would often ask her what could derail the business, to which she’d say, “I guess if women went back to the old way of having children, and they didn’t go to graduate school, didn’t go to med school or business school, and started having babies again in their early 20s — that’s what would cause the fertility world to come crashing to the ground.”
Kindbody’s efforts and subsequent success have highlighted a huge gap in the market, piquing investors’ and patients’ interest and driving demand. Celebrities like Gwyneth Paltrow, Gabrielle Union, and entrepreneur and author Hannah Bronfman, who have publicly talked about their own fertility journeys, have all invested in Kindbody.
Chief financial officer Meredith Whitley, who joined Kindbody in April 2021, feels that five years ago, Kindbody may not have had the interest it does today, but there’s enormous potential in the space. She attributes a lot of the growth in the last couple of years to the focus on women’s health and attracting and retaining employees.
“In 2019, roughly $140 million of capital was raised [by fertility startups]. In 2020, roughly $150 million, and so far this year over $1.2 billion. There’s a lot of focus and attention, and employers are adopting,” Whitley told me.
Whitley’s experience of working on Wall Street, as well as the lack of space for conversations around fertility or IVF, makes the mission very near and dear to her. However, she stands by the fact that if the business weren’t filling this gap and finding success, investors wouldn’t be lining up.
“No one is paid to invest with their heart, right? Yeah, people are investing to make money, and the fact is, there is so much opportunity,” she said.
“I’m not speaking for all the investors. They appreciate the mission. Many of them have [themselves] or have family who’ve gone through IVF, but people wouldn’t give them money to invest unless they were showing a return.”
Sadly, it always comes down to the bottom line, figuratively and financially.
Kindbody is doing what it can to address this immense problem as a company that has to answer to its investors. But despite highlighting that the fertility space is full of opportunity, its efforts only show that we’re barely scratching the surface of the problem when it comes to education and reproductive healthcare.
Kindbody TC-1 Table of Contents
- Introduction
- Part 1: Origin story
- Part 2: Business and marketing
- Part 3: Wider issues
Also check out other TC-1s on TechCrunch+.
