June 12, 2020 by Mackenzie Timbel
In January of 2020 I accepted my first “real” job working for an early stage startup creating a tech solution for an industry I knew nothing about: fertility. As a recent college graduate with no partner and a strict user of birth control, the concept of people trying to have a baby was one in which I had zero personal experience. But as with any new job, especially the first “real” one, I threw myself into becoming educated and diving deep into what fertility treatments are all about and the present state of the industry.
This research took me on a winding road of investigation. I became knowledgeable about the uses and physical effects of fertility medications used during in vitro fertilization (IVF), the growing demand for fertility treatment due to changing social norms, and the technological antiquity of fertility clinics. I’ve heard devastating stories of failure as well as triumphs that ended with growing families. While I most definitely have not seen it all, I think I have learned enough to know what is happening in the industry and what needs to change. These are three key observations and my three ideas for guiding the fertility industry into the future.
After about a month at my new job, I was given the assignment to write an education section on our mobile application outlining the purpose and effects of commonly used fertility medications. Three weeks later, I finished a forty-five page informational report. I felt as though I had gone to graduate school to be a fertility pharmacist. Medical concepts are inherently complicated especially to an untrained mind; but, the information out there for patients is downright incomprehensible at times. The reality that it took me weeks of focused learning and sorting out misinformation to fully understand the way fertility medications work is disheartening. Not every person doing treatment has the time or resources I have to educate themselves. Without that education, getting your diagnosis and beginning treatment is like jumping into a very deep swimming pool in the middle of a lightning storm only knowing how to do the doggie paddle.
Women spend their adolescence and early adulthood becoming intimately familiar with their menstrual cycles and what they feel like. However, I challenge the average person reading this piece to describe how the reproductive endocrine system works during a normal menstrual cycle when the body prepares just one egg. What even is the endocrine system? Fertility treatments like IVF completely upend the reproductive system to give absolute control of the cycle to the doctor via a slurry of injections, pills, and suppositories done at home. The goal is to retrieve multiple viable eggs from a woman in a single cycle.
The truth is simple. Fertility treatments are complicated. Advancements are helping doctors change protocols to be more successful; nevertheless, those improved protocols are rarely less complicated. The way treatment protocol is communicated needs to change in order to weed out the plethora of misinformation and confusion on the internet that is currently the chief informant of patients once they exit their doctor’s office.
When you have the flu, you go to urgent care for a Z-pac. When you break a leg, you go to the emergency room for a cast. Why is it that when our mind is hurting we have deemed it unnecessary or an expensive luxury to see a mental health professional? Beyond the abysmal record of mental health care in the U.S., the mental health effects of being told you need help to conceive or might not be able to have a biological child are relatively ignored during fertility treatments.
Many clinics attempt to address this issue by partnering with licensed therapists and providing referrals. While this may seem like progress, those therapists are an extra cost on top of an already cripplingly expensive treatment. All of the onus is on the patient to decide that they need mental health support, often considered a big hill to climb alone. Fertility clinics have historically been focused on addressing the physical needs of its patients to increase the likelihood of having a baby; however, that is certainly not addressing the entire issue.
A study published in 2020 showed that patients who have participated in a multi-week mental health program during their fertility treatment are nearly four and half times more likely to get pregnant during treatment than those who do not participate. That study paired with the fact that most fertility patients choose a clinic and physician by considering the rate of live births per total treatments makes the business correlation obvious. Integrated mental health care for all patients is in the best interest of the clinic because successful treatment rates will improve–driving more new patients to the clinic because of their favorable track record.
When I think about my future, I catch myself only considering the big moments: jobs, moving to a new city, partners, marriage, and kids. Before my position working for a fertility startup, I never considered that the former might take up so much of my “reproductive” age that when I have created a life that is ready for a baby, I won’t be able to have one naturally.
In 2019, women in their thirties had more babies than women in their twenties. This statistical shift is largely attributed to women prioritizing career and skill building activities before wanting to start a family. As women have babies later in life, they are faced with the aging of their reproductive system that can leave them struggling with infertility, a condition designated as a disease by the World Health Organization.
The stories I’ve heard over the last five months all illustrate a loss of identity in conjunction with an infertility diagnosis. The disease isn’t actually life threatening but it is “life threatening” in the sense that it disrupts or completely destroys the dreams people have for families. Those dreams are oftentimes defining for that person or couple and an infertility diagnosis asks them to reexamine and even cancel those dreams.
I’ve heard stories of people not sleeping for weeks for fear that their partner will leave them because they have infertility—a worry that seems disproportionate to everyone but the people who have experienced this disease. I’ve heard stories of people skipping the baby showers of their best friends just because they cannot face the joy of having a baby because it is not their joy. Finally, I’ve heard stories of people trying for years both on their own and with medical help and ultimately being unable to have a biological child. Struggling through infertility without the social support of friends forms rifts that are difficult to bridge because, upon reflection, your stories forked away from each other when one person got pregnant and the other couldn’t.
After reading this, I hope those who are just having a baby consider for a moment what else might be going on with that friend who just sent regrets that they will be unable to attend your baby shower. Give them a call, ask them what’s going on and then, just listen.
The winding path continues. After observing challenges in the fertility industry and trying to understand what the core issue is at the heart of a tangled system, I have three ideas that will help the industry redefine itself.
The first IVF baby was born in 1978, over 40 years ago. And yet, whenever I tell people about my new job in fertility tech, they all mention the same few names that were the major players in the late 80’s. While new faces are emerging within the bubble of fertility, those names need to break out beyond the bubble and become known not just to those who are suffering from the disease but to all who are engaged in the women’s health landscape. As those new, younger, daring, tech-savvy and diverse faces emerge, they will need to push the industry into the future with new norms, better technology, and heightened understanding of the patient experience in order to fight a disease that affects an increasing number of people each year.
It is my opinion that innovation like artificial intelligence or robotics will not find a major foothold in fertility treatment in the immediate future. However, by applying technology that is already familiar but using our improved knowledge of computers and data analytics, I believe the fertility industry can change dramatically for the better.
For example, mobile app technology can completely transform the way that patients adhere to complicated medication regimens that change daily and can include over fifty injections of different medicines over a single treatment cycle. The advent of big data analytics to the diagnosis and treatment of fertility-related illnesses opens a large avenue for research in the infertility area that could beckon in revolutionary discoveries.
Finally, electronic medical records (EMRs)--potentially the least appealing technology ever--are the backbone of the medical industry and the constant companion for medical professionals. If EMRs are clunky and difficult to use, how can we expect innovation focused medical care from providers? EMRs need to be modern, specialized tools that are integrated with the patient’s technology landscape and designed to disperse and gather reliable information to and from patients. Technological advances will certainly change the way patients receive treatment. It is those changes that will make way for real medical advancement in the fertility field and enable doctors to provide hope and remedies to people faced with the prospect of being unable to start a family.
My strongest opinion about the future of the fertility industry revolves around creating awareness for people like the person I was five months ago getting ready to start my first “real” job. I knew nothing about fertility treatments.I only knew what IVF stood for because of Amy Schumer talking about it with Oprah on the Super Soul Conversations podcast. I did not know that infertility will affect 1 in 8 couples in the U.S.
In addition to demystifying the disease and the treatment to help women make earlier and better choices about their reproductive health, fertility awareness is also about the camaraderie of women. It is a disease we all could find ourselves dealing with for a myriad of reasons both situational and physical. It’s heartbreaking to hear stories of the toll that infertility exacts on friendships and relationships. Infertility is a silencer.
If, in the future I have to deal with an infertility diagnosis, it is my hope that when I tell my friends, “I’m struggling with infertility,” they don’t respond with, “What does that mean?” As women, I think we can do better together and the pathway forward starts with cracking a book, or a website, or calling a friend and starting the conversation about fertility.