Fertility treatment is the latest form of healthcare to populate the market for digital applications. We look at three companies that are looking to carve out a bespoke niche for themselves in what is becoming a busy space.
In 2019, almost 53,000 patients had around 69,000 fresh and frozen in vitro fertilisation (IVF) cycles and around 5,700 donor sperm insemination (DI) cycles at licensed fertility clinics in the UK, according to Human Fertilisation and Embryology Authority figures from 2021. IVF birth rates in 2019 were three times higher than in 1991.
Yet, while the technology may have improved over the past three decades, treatment is an arduous process as is the stress of trying to get an accurate diagnosis for unexplained infertility. Meanwhile, rates of successful pregnancy remain low, despite the advances. At least one of the companies we approached is hoping to improve diagnostics to make it easier to pinpoint fertility problems. Others are looking to create some transparency for the treatment process. And the leaders of these companies all feel a personal connection to the technology they have developed.
Diagnosing issues before treatment
For Dr Helen O’Neill, a researcher for 15 years who is both a Lecturer in reproductive and molecular genetics at University College London and CEO and founder of Hertility, the decision to set up her company was based on a decidedly personal motivation. The catalyst came from years of running her own research group and realising that while technology was allowing scientists to examine reproductive genetics in granular detail, the average woman had no insight into her own hormones and physiology.
“I was lecturing about pretty dire statistics and the sheer prevalence of reproductive conditions, and you can’t help wondering, is this going to be me?” she says.
O’Neill believes identifying the reasons some couples fail to conceive is a question of having the right data to make a reasonable start, so she set out to develop a way of allowing all women to have a comprehensive insight into their own fertility, potentially years before they are ready to start families.
With up to one in six couples experiencing infertility, O’Neill said she was motivated by her experience of looking to build a clinical trial to test a predictive algorithm of a patient’s risk factors for a range of conditions – from recurrent miscarriage to Polycystic ovary syndrome (PCOS) – and by the realisation that current clinical practice was based on such poor data sets. Hertility got ethics approval for a trial of the algorithm just before the pandemic shut everything down.
“We put together a website and converted everything online,” O’Neill recalls. In a short time, the company had 7000 women registered to participate in the clinical trial, filling out a detailed medical assessment and taking a home blood test that was mailed to them. The results built out the predictive algorithm, which can screen for 18 of the most common conditions related to gynaecology and fertility issues. The first part of the algorithm is based on the health information, and on self-reported symptoms, while the blood result adds hormonal markers that help the algorithm provide 54,000 different clinical scenarios based on millions of data points.
“Because of the insidious nature of symptoms relating to menstrual health, many people will not realise these are symptoms of hormonal imbalance,” she said. “It’s hard to extrapolate the impact of hormonal imbalances versus lifestyle behaviours.” With 272,000 woman who have done the Hertility assessment, the company has data on the prevalence of diagnosis and symptoms. And because everything is online, via a digital interface, participants are more likely to be honest in the assessment about drinking or drug habits than they might be with a consultant they are seeing as they try to conceive.
Hertility has a dual function: fertility knowledge for those not yet ready to start families, so any issues can be addressed in good time, and advice and assistance for those actively trying to conceive. “We use the health assessment both to engage and educate people and reassure them that they are not alone.”
Optimising personal data
Making personal data more useful and transparent for patients and clinicians to improve the chances of success is a focus for another fertility start-up, Fairtility. Fairtility’s main solution is CHLOE (Cultivating Human Life through Optimal Embryos), an AI-based decision support tool designed to improve outcomes for clinicians and their patients on the reproductive journey. Fairtility does this through its “transparent AI,” noting that transparency is critical when AI intersects with human life.
“There’s not a tremendous amount of standardisation among protocols and procedures and this is where technology really has a role to play,” says Gabrielle Heilman, Patient Care Specialist at Fairtility and a fertility nurse with nearly two decades of experience. “We are using real-time imaging and using data and AI and looking at millions of data points about the embryo, and with the power of AI we can get more accurate analysis and new insights that contribute to the decision-making process. We understand the responsibility that practitioners carry to ensure that we don’t miss any vital information that could determine whether a patient goes home with a baby. CHLOE is designed to do just that, automatically, objectively, instantaneously and with more accuracy and precision. This should be the gold standard.”
Although patients are generally extremely educated, they are not trained embryologists, Heilman says. “By sharing CHLOE, clinics allow patients to be more engaged in their process. We’ve been getting very positive feedback from patients in dozens of clinics globally that use CHLOE.
By “eliminating the unknown”, providing more clarity and explaining why a given embryo transfer is unsuccessful, CHLOE is designed to reduce the number of cycles an individual patient goes through in the future. While CHLOE EQ currently focuses on embryo quality assessment, the company recently launched a new CHLOE offering, CHLOE OQ, which looks at egg quality.
“Now, when women go through egg freezing, they are banking something for the future and hoping for the best. We will be able to take all of the data points and decide whether another retrieval cycle is needed when you are doing fertility preservation,” Heilman adds.
Support during a long journey
Josh Gottesman, the co-founder of Embieapp, which helps couples manage their fertility treatment, is like many entrepreneurs in the space in that he has had first-hand experience with the challenges of infertility, after going through five years of treatment with his wife.
Gottesman recalls carrying around “two huge folders chock full of pdfs and numbers” as he and his wife visited doctors and clinics in both the US and Israel. Every new visit meant starting over with explanations to doctors and efforts to find details about oestrogen levels on specific days, he told Digital Health. The Embieapp organises all treatment data and results in a single place, stores fertility history and diagnoses and includes a calendar to track medications, appointments and symptoms, ensuring that patients are taking the correct dosages at the correct time.
“The app creates order and a sense of clarity around what to take when,” he said. In addition, it offers community forums to provide support to those undergoing treatment cycles.
A premium version of the app, released in January, also features tailored insights to ensure that, as Gottesman says, “if you are a 25-year-old woman with PCOS, you won’t get the same information as a 35-year-old woman with endometriosis”.
In July, the company opened the Embie Clinic, which provides nurses and doctors with tools enabling digital workflows, data analytics and real-time monitoring of patients.
“It brings the same organisation and simplicity we give to patients, to clinics,” Gottesman says. “It optimises the entire clinic experience with personalised connected care and reduces the administrative and cognitive load for clinics.”
Streamlining the process for clinics also saves time for patients, who don’t need to wait for personal medical history and treatment data to be inputted into the system. Automation and tools like push notifications for patients save a minimum of two and a half hours per patient cycle by making it easier to change medication based on the results of an ultrasound, indicate reactions to side-effects and reduce the delay between a clinic receiving results and those results coming to the patient.
“As an early-stage company, we need to focus on doing one thing very well – streamlining and optimising the whole process, collecting data sets while improving patient experience,” he adds.
In the near future, however, technology should enable the company are to expand its range of services, reveals Gottesman: “We hope to use machine learning to produce data-driven insights.”