We’ve been talking a lot at Kindbody about “reinventing” women’s healthcare, specifically fertility services like egg-freezing and IVF. If you’ve never experienced these services before, you might be wondering: what is there to reinvent?
Let’s start with the obvious:
It’s too expensive. The high price of treatment has been widely reported, but the reasons why have been largely ignored. The ugly reason that fertility treatments are expensive is because they can be: people will pay everything they’ve got to have a baby. Insurance is usually not involved to broker the pricing down, and “celebrity” doctors are raking in $3 million+ a year, while their patients are taking out a second mortgage on their house. Meanwhile, the true success rates — holding age and biological factors constant — come from the embryologist in the lab who is someone you’ve never heard of making $100k. It makes no sense.
How to lower prices:
- Have each specialist work at the top of their license. Expensive Reproductive Endocrinologists (of which there are only ~1500 nationally) should focus on things only they can do: egg retrieval and embryo transfer procedures themselves. A (cheaper and more available) OB/GYN can do all the workup necessary and an (even cheaper) NP or PA can do much of the monitoring. Pass those savings on. The patients that want to see their doctor for each touchpoint can pay the higher price point.
- Save humans for the human stuff. Don’t have teams of staff on long phone calls with patients about appointment scheduling or reference materials. Use technology for the transactional stuff and save humans for the big decisions, the emotional outcomes, or the intimidating parts of the process.
- Just lower the price. The average price of an egg freezing procedure in NYC is $9–10k, but the cost to the clinic at volume is around $3k. Just literally lower the price. This will bring more patients to the table which is better for them and better for you.
The experience is fragmented. Your OB/GYN referred you to a fertility doctor. Your fertility doctor referred you to a nutritionist for your PCOS. Then you got pregnant at the fertility clinic. You went back to your OB/GYN to care for your pregnancy. You miscarried. You’re back to the fertility clinic. Your second cycle didn’t work. They referred you to a mental health therapist for your anxiety. You’re back at the fertility clinic for the third cycle. You’ve started doing acupuncture in case that helps. You are navigating all of this entirely alone and each provider is using different systems or no system at all.
How to deliver continuity:
- Vertically integrate. Bring each of the services, the technology, and the data under one roof. Pull in GYN services, nutrition, and mental health. Enable actual continuity of care.
- Invest in staff training. The risk of clinical efficiency is a factory-like atmosphere. You’ll always have more than one provider, so train them and all staff to document appropriately and read patient charts ahead of time. There’s nothing charming about pen and paper in this context.
Everything is opaque: pricing, chances, decisions, quality. You were quoted a price up front, but not told that medications and bloodwork were separate. You had no idea that your AMH and FSH blood results meant your chances of success were less than 5%. Then you did some googling and realized providers can’t agree which success rate markers actually matter. Got 35 eggs in one go? Is that a good thing? Or an indicator you were overstimulated, potentially affecting the quality of your eggs? Each doctor will decide, based on limited evidence, their own experiences, and the recommendations of others they are talking to.
How to bring clarity:
- Use data to inform clinical protocols. Use clinical data to learn what’s real and what’s anecdote. Everyone agrees fertility is predictive, and it’s time to agree on how to predict it. Establish evidence-based protocols and standardize them across clinicians.
- Contextualize data for patients. Sending patients their records is standard, but it’s time to do the harder work of properly contextualizing what they need to take away. An engaged patient has better outcomes.
Not enough empathy. The story is all too common. None of your embryos work and they say “this wouldn’t have happened if you were 23.” You miscarry and they say “call us back at your next period.” You are gay and your doctor says, “can’t you just try it the old fashioned way?” The lack of empathy is astounding and the paternalism many patients experience is not just a gender thing but also a doctor vs patient thing. The doctor knows and the patient doesn’t know. The patient can’t handle their own health data.
Also, controversially related: it’s run by men. The majority of fertility clinics are run by men and the majority of fertility doctors are still men.
How to improve service:
- Give female doctors ownership. More women than men are coming out of fellowship programs but it could take them years to be owners. We know that the majority of women choose a female doctor when given a choice. Give them a short path to decision making, pay them the same amount as the men, and give them equity in the practice.
- Incentivize doctors by customer satisfaction scores. Make it clear that customer satisfaction is important and pay doctors based on that. Hire doctors that believe this is the way to go.
- Cater the experience to different patient types. LGBTQ and single moms too often feel alienated in today’s experience. Changes to language and assumptions can go a long way. And while we’re at it: find ways to serve the black community, which is not only underserved today, but mostly just not served.
While this industry is known for innovation in the lab, it’s not known for innovation when it comes to patient experience or cost-effective operations. It’s about premium prices, without the premium experience.
Who am I to say these things? I’m a working professional woman in my 30s in NYC, and I’m surrounded by friends who are either struggling to conceive or worried about out how they’ll conceive later when the time is right. I also happen to be a woman building a fertility company with an incredible team of other women. And what’s clear to all of us is that the fertility industry should be doing a lot better.