Testing the Boundaries: Modern Fertility’s Mission to Move the Fertility Space Forward

Afton Vechery, Co-Founder & CEO of Modern Fertility

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Modern Fertility is a reproductive health company making personalized fertility information more accessible, so women can own the decisions impacting their bodies and futures — whatever those decisions may be. Since launching in 2017, the San Francisco-based startup has commercialized at-home hormone tests to help consumers find power in their fertility information and help them get proactive about their reproductive health. In 2019, the company raised $15 million to expand their product and research investments. Co-founder and CEO Afton Vechery connected with The Pulse writer to discuss the company’s inception, mission, and progress.

The Pulse: Will you give us a bird’s eye view of your career path and how it led you to founding Modern Fertility?

Afton: My backward-looking perspective is that each step in my career has given me different learnings that culminated with founding Modern Fertility. In reality, each time I made a career jump it was part gut, part research, and a decision to move forward. After college I joined a healthcare PE firm where I identified healthcare sectors that were growing and had consolidation potential. I focused on women’s health due to personal interest and led the diligence for an investment in a network of IVF clinics and labs. This gave me a chance to learn the business of infertility, at least through a PE lens. I learned not only about the science of infertility, but also the emotional side — I talked with women who weren’t aware of fertility declining with age or that IVF doesn’t work for everyone. I was stuck not just by the compounding growth of this sector, but by how infertility was a massive industry that nobody seemed to be talking about. I felt like I had a unique window into this secret world.

Then I moved to SF and worked at a few personalized health and women’s health companies. After falling in love with product, I joined 23andMe and ran their consumer tools division, helping relaunch the product after it was shut down by the FDA. It was at 23andMe that I learned the value of owning your own health information. It was also during this time that I realized I was waiting until later in life to start a family. I tried to pursue the fertility testing I’d learned about earlier in my career and saw in infertility clinics, but my doctor wouldn’t order it since I wasn’t actively “trying and failing” to have children. I ended up going to an infertility clinic to access testing, and it was an all-around challenging experience. There were months of appointments and tests that I was trying to time my highly irregular cycle, dense, hard-to-understand interpretations of my hormones, and a surprise $1,500 bill at the end. That said, when I finally got my results, it was empowering to understand my timeline and make decisions with my partner and doctor.

But the aha moment for Modern Fertility came later, when I was sharing my testing experience with friends, family, and other women. Pretty soon, I was talking to hundreds of peers and friends of friends who all felt in the dark about their reproductive health. I recognized the cultural shift we’re in the midst of: women are demanding more information about their bodies and wanting to think proactively about their fertility. This catalyzed the question, ‘How do we start a fertility information company that empowers women to own the decisions that impact their bodies and futures, whatever those decisions might be?

The Pulse: Will you describe the products Modern Fertility has launched to help achieve this mission?

Afton: The first product we launched was the Modern Fertility Hormone Test. We took the same testing done in a clinic and made it accessible at home at a fraction of the cost. It’s a finger prick test and that measures between 2–7 hormones, depending on the type of birth control a woman may be using. This snapshot allows us to provide women with a baseline understanding of fertility and how it’s changing over time, including their ovarian reserve (AKA: egg count), hormonal conditions like Polycystic Ovary Syndrome (PCOS) and Premature Ovarian Insufficiency (POI), potential success with IVF, your fertile window and menopause onset, and more. We have customized age and result-specific reports for each hormone and we offer a 1:1 consultation with a fertility nurse to answer questions about your results. We recommend customers do annual hormone check-ins to look at rates of change. Just like how our metabolisms decline at different rates, our fertility does too. The Modern Fertility test can flag changes that look quicker than expected.

After we launched our Fertility Hormone Test, a lot of community members were asking us which ovulation and pregnancy tests they should take. So, we did a deep dive and looked at these tests for hormones measuring our monthly cycles and ovulation. We brought to market a semiquantitative ovulation test that helps pinpoint your most fertile days through urine. It provides deeper levels of information about your ovulation patterns than the industry’s standard tests, and thus works for all types of bodies, regardless of if your cycle is “average.” Our product includes 20 urine strups which are easily scannable with Modern Fertility’s app so you can measure your ovulation over time. I’m not actively trying to conceive and I’m still obsessed with knowing when I’m ovulating; it’s empowering to have this information. In the pregnancy test category, you see two types of tests; you can test on the first day of a missed period, or 5- 6 days before it. Modern Fertility launched the latter type — we offer an early detection test, which pairs with our app. It’s also very, very fairly priced. Pregnancy Tests should be for everyone! Our Ovulation Test and Pregnancy Tests are sold on our site, and also through nationwide Walmarts and on Walmart.com.

All Modern Fertility products come with free access to resources and information that empower customers to start thinking about their fertility proactively. We host a weekly webinar that walks people through the hormones we test and why they matter, and customers have constant access to our online community where people are talking about everything from their test results, to work, IUDs and mental health. We try to maintain close ties via our community, social, and emails — we are obsessed with talking to people with ovaries to understand how they are thinking about their health and what they think we should build next.

The Pulse: Modern Fertility uses the term “clinically neutral” to describe the fertility information provided to customers — what does this mean for your strategy and offerings?

Afton: It’s important to us that all the information we provide is clinically neutral, meaning we do not offer medical advice (that’s between you and your doctor) and would never tell a person what to do with their body (that’s between you and yourself). In spaces that lack clinical information, you’ll often find stigma and coercion. This has been the case in the fertility industry for far too long, but these decisions are significant and highly personal. We like to emphasize that egg-freezing, IVF, a certain pill or life plan might not be for everyone, but personalized, clinical information to help you make these decisions is unanimously useful. Information is for everyone.

What we will do is work with our medical team and advisory board to synthesize medical guidelines and literature. Imagine the way your best friend might share information with you, if they were an OBGYN. Our goal is to help you parse through the complicated science and provide a stance that is straightforward and proven. You should be empowered to make your own fertility-related decisions, and we tee up the information to help you do so.

The Pulse: In addition to making fertility tests more accessible, Modern Fertility is making big investments in research. Can you tell us about the research gaps you see and how you’re trying to fill them?

There is an incredible dearth of women’s health research, with a particular increase in studies over the past two decades. But more specific to fertility research, the fertile patient population is not well-studied. Of the ~3500 pieces of literature published annually, the large majority focuses on people who present to infertility clinics, inherent to the reactive nature of this industry. Research has discovered predictive tools that help us proactively evaluate risks in many areas of healthcare, but we don’t have that in fertility — it’s a total black box. Think about the way fertility care is set up: today’s system is based on trial and failure. About 1-in-6 couples will have trouble getting pregnant, and at least 1 in 4 pregnancies end in a miscarriage. These couples try for 9–12 months, and then only when they fail can they get help with next steps (and that’s if they have insurance coverage). In reality, there are tools and information that could be used before the try-and-fail process to help people understand their fertility and get ahead of issues.

Since Modern Fertility is trying to help the fertile patient population navigate health decisions, this research gap is a big focus for us. When we launched, we wanted to make fertility information accessible through testing, while also moving this space forward through research and continuing to improve the quality of this information. We now offer the ability for customers to consent to have their anonymized data used in peer-reviewed research. With this data, we’re working on building better predictors of fertility and uncovering new nuances in the fertile timeline. We’re combining biomarker information, self-reported lifestyle information, and more. We’re tying this information together in what we believe is the largest set of fertile patient data, and using it to determine better predictors of future fertility that equip women with more and better info. This can all influence what the trying-to-conceive process looks like in the future.

Independent of this research on our proprietary data set, we’ll partner with organizations and leaders outside of our immediate community with complementary expertise to better understand different cultural elements of fertility. For example, we partnered with the LGBTQ+ dating app HER and the prominent gender research Mere Abrams to research LGBTQ+ fertility and family planning, and we partnered with SoFi to look at how fertility, money and careers are interlinked.

The Pulse: It’s exciting that your tests empower women to take action on two fronts — to access their own fertility information and to contribute to a research mission that could benefit lots of couples in the future…

Afton: Right — it’s one thing to market our products, but we also want to convey that important research is occurring in the background. Every time a customer purchases a product, they’re tying into a broader research mission. They’re not only gaining information for themselves, they’re helping future generations of women have access to more fertility information than we have today. When the fertility information gap is one of the most pressing issues facing women’s health and our broader society, I see engagement with research advancements as a form of activism.

The Pulse: Modern Fertility makes testing feel approachable and empowering. It seems like the community you’re building is a core part of this strategy — can you tell us more about the community?

Afton: We had a ton of customers telling us they wanted to talk about their test results and engage with others, so we needed to find a way to facilitate these powerful conversations. We launched our community on slack, which has now evolved to about 15,000 women talking about their fertility, their timelines, and sharing in a general support system. Fertility was already something that’s bubbling up into group texts for so many women — our community captures this conversation on a much bigger scale.

As we’ve cultivated this community for our customers, it has also become a way for us to maintain an open line of communication with customers. I think we’re just getting started in terms of how we should leverage the community as part of the Modern Fertility experience. We’re a physician-mediated, direct-to-consumer company, but as we’ve built this community, we are now tied into these conversations. It’s important to invest in this type of two-way dialogue; we’re a better company for it.

The Pulse: Modern Fertility has pursued a direct-to-consumer strategy since launch — what was your rationale? As you think about future growth, will you consider partnerships with doctors or other healthcare stakeholders to reach new customer segments?

Afton: I believe that as an early stage company, you have to choose what muscle you’re developing. We launched with a physician-mediated DTC approach because we wanted to have a direct line of communication to customers and we thought a grassroots strategy would enable us to bring this important information to more women more quickly. It has been interesting to see how DTC is opening up other channels with physicians like OBs, PCPs, and reproductive endocrinologists. We have seen evolution here, with doctors now reaching out to us and asking if they can recommend Modern Fertility for their patients, and wanting to learn our process and how we can fit into their workflows. This has been really encouraging for us. I’m confident that starting this Modern Fertility as a physician-mediated DTC has enabled us to be really intentional as we consider next steps in new channels.

As we grow, we will remain focused on one of our founding principles: to be intentional and honest about the way the end-to-end care pathway occurs for our consumers. We see perverse incentives in the fertility space; this is a vulnerable self-pay patient population in large part, and we’ve seen companies monetize relationships in ways that don’t have consumers’ best interests at heart. It’s important to us — and aligned to our mission — to be intentional and honest about the way we provide value to our customers. This requires extra thought and effort to execute but has been part of our thinking since Day 1. It’s an area where we won’t compromise.

The Pulse: You’ve seen a ton of exciting success since launching Modern Fertility. Based on your experience, what is one skill you would encourage aspiring entrepreneurs to focus on developing?

Afton: When it comes to aspiring entrepreneurs, I encourage people to commit to just getting started, and taking the first step no matter how small it may be. Starting a company can feel big and daunting, but taking one step in the right direction might not. That was how I started Modern Fertility — I started by reading research papers, then talking to physicians, then finding a brand expert counterpart (I met Carly Leahy through what we call, the most epic email intro of all time), and pretty soon, we had a company on our hands. Interestingly enough, one of the hardest first steps for me was telling my friends I was starting a company. That made it real, and made me feel accountable.

I also encourage aspiring entrepreneurs to understand what gives them energy and figure out how they can get as much mileage out of that as possible. For me, I have endless energy for the problem Modern Fertility is working to solve, while another founder might love the process of building something, or the entrepreneurial journey. Understanding this is key, because there will be time when things are really hard, and knowing where you can source energy to keep going will be critical.

Interviewed by Tara Sullivan, January 2021.

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