A few years ago, Afton Vechery visited a clinic to estimate the number of eggs left in her ovaries. She wasn’t infertile; she wasn’t even trying to get pregnant. But Vechery knew she wanted to have kids eventually, and even though she was still in her 20s, she was curious about what her timeline might look like. One simple blood test later and she had a snapshot of her egg count—along with a $1,500 bill.
Vechery had spent two years working as a product manager at 23andMe, the genetic testing company that perfected the art of mail-order, spit-in-a-tube health testing. So it frustrated her that while you could donate a small amount of saliva to find your risk for Alzheimer’s or trace your family lineage continents away, you couldn’t figure out your fertility options without a series of appointments with a reproductive endocrinologist and a very expensive test.
Now, $7 million in venture capital later, Vechery thinks she can change that. Her startup, Modern Fertility—launched last year along with co-founder Carly Leahy—offers fertility testing on-demand. Today, it will begin selling a $199 at-home testing kit, with all of the conveniences of the one sold by 23andMe. Women can order the kit online, collect a finger-prick of blood at home, and mail it back to a lab, where it will be analyzed for nine hormones related to ovarian reserve and reproductive health.
“We see a world where getting fertility tested is as routine as getting a pap smear,” says Vechery.
The Modern Fertility testing kit is just one of several new products crowding the health tech space for women. There ovulation trackers modeled after Fitbits, sleep sensors that tell women when to try for a baby, and mail-order tests that offer the answers to their fertility for a prick of blood. It’s too soon to tell whether these start-ups represent a revolution in women’s health technology or the Theranos of the ovaries. Either way, they show that Silicon Valley has found its next conquest: women’s ovaries.
A quick history in women’s fertility testing: There is no single factor that defines whether or not a woman can conceive a child. If a woman has trouble getting pregnant, she can be tested for a panel of hormones related to reproductive health. The gold standard, sometimes called the “egg timer test,” measures anti-müllerian hormone, closely correlated to the number of eggs left in the ovaries. That, and other tests, can help paint the picture of someone’s reproductive health and her options for getting pregnant.
As women get older, egg supply declines. Statistically, this starts to happen around age 35, when a woman enters “advanced maternal age.” But some women lose their eggs sooner—sometimes due to factors like thyroid health or body fat percentage—and others can birth healthy babies well into their 40s. “Every woman’s trajectory is different,” says Dr. Nataki Douglas, an OB/GYN and infertility specialist at Columbia University, who is also on the medical advisory board for Modern Fertility. “I see women at ages less than 35 with difficulty getting pregnant.”
Giving women information about their ovarian reserve before they planned a pregnancy was almost unheard of until recently. Start-ups like Modern Fertility want to these tests available to women as young as 25, so they know about their fertility before it’s “too late.”
“A few decades ago, when women were having all the kids they were planning to have by 24, it wasn’t something you had to think about,” says Vechery. “But now that we’re extending the age at which we might start [having kids], that’s where [early testing] could become really impactful.”
Modern Fertility is courting women who are young, and who likely already measure their health with smart watches and log their periods with apps. Fertility tracking offers yet another data point. Since a single snapshot of hormone levels or ovarian reserve can’t tell young, healthy women very much, the company recommends re-taking their test every nine to 12 months. The goal is to track fertility markers over time, creating an individualized “fertility curve” that gives women more information about their own ovarian reserve, when they’ll likely hit menopause, and options for egg freezing or IVF.
“Tracking these levels over time is where you get the most value,” says Vechery. “Each woman has a different metabolism, she has a different fertility curve. And so to track that, to get all of those tests done in the same way, and build an experience with your results compared to thousands and thousands of over women? That’s really powerful. That’s where the innovation is going to happen, and that’s where we’re focused.”
Modern Fertility isn’t the only start-up encouraging younger women to consider their fertility. Opionato, a new digital platform offers fertility advice, launched in 2016. “We assume by default that we are fertile until proven otherwise,” says Maja Zecevic, the company’s founder. Subscribers can pay for phone calls to experts, information about egg freezing, or advice about getting pregnant. Zecevic specifically chose not to offer testing, which she says can be reductive in terms of a woman’s overall reproductive health. “Fertility is much more than just a single test number or score.”
Other products claim to bring health technology to women hoping to conceive right away. Earlier this year, Bay Area-based Mira Fertility introduced a $100 ovulation tracker. The palm-sized device pairs with a smartphone and uses disposable wands, sold separately, to measure levels of Luteinizing hormone in morning pee. The app stores this information and uses a proprietary algorithm to predict ovulation over time. “This is different from the traditional methods that you can buy in a pharmacy which provide only a binary ‘yes’ or ‘no’ answer,” says Sylvia Kang, Mira’s COO.
Another company, Early Sense, makes a $199 disc that slips under a mattress and captures data like heart, breathing, and movement during sleep. The data is then synthesized in a smartphone app, which can predict a six-day “fertile” window for women hoping to conceive. Other devices claim to predict ovulation with a wrist wearable, or a temperature sensor worn in the armpit, or an earbud.
It’s not clear that these gadgets work any better than old-fashioned methods, if they work at all. Dr. Mary Jane Minkin, an OB/GYN and clinical professor at Yale School of Medicine, says heart rate, basal body temperature, and other physical changes can be markers ovulation (for example, a woman’s temperature goes up about half a degree during ovulation). But those changes are so slight and can be influenced by so many other factors that using them to pinpoint ovulation is about as likely as a woman who is carefully tracking her menstrual cycle. “If they’re accurate, great,” Minkin says of the new devices, “but I don’t know why you’d need an app to do this.”
“We see a world where getting fertility tested is as routine as getting a pap smear” — Afton Vechery, co-founder of Modern Fertility
Then there are the blood tests. Egg-Q, which launched in 2016, sells a $249 test that measures AMH levels, the hormone associated with ovarian reserve. Another company, called Let’s Get Checked, offers the same AMH test for $139, or a separate “female hormone” test for $129. Modern Fertility tests for nine hormones associated with fertility, including AMH, follicle stimulating hormone (which kick-starts ovulation), estradiol (a hormone produced by the ovaries), and thyroid stimulating hormone (a marker of thyroid health).
Each of these hormones can tell women something about their reproductive system, and AMH has long been used as a surrogate marker for egg count. But some doctors believe that issuing AMH tests for young, healthy women can be pointless, since levels for women under 40 tend to be the same. One study from 2017 found that the relationship between AMH and fecundity is often overstated, and can give women too much or not enough hope about their future fertility options. There’s no correlation between ovarian reserve and a woman’s ability to get pregnant right away (you only need one egg to conceive), and no way to evaluate the quality of the eggs that are left through hormonal tests. “None of these tests are as far as absolute fertility,” says Minkin. “It’s a guide.”
In other words: No test can answer the question “am I fertile?” Instead, like so many other health-focused start-ups, they offer a set of numbers and data points—the quantified ovary.
Modern Fertility’s co-founders acknowledge that “hormones aren’t the whole picture.” In a blog post from March, they explain some of the limitations behind hormonal testing and describe fertility as “a complex puzzle with many pieces.” To hear them tell it, Modern Fertility is not so much a health start-up as it is a movement to embolden women to ask the right questions and start a dialogue about their reproductive futures—not just whether or not they can get pregnant now, but what their own bodies can tell them about when they’ll likely hit menopause, and what their stock for egg freezing might look like.
“We really see the information gap as the biggest issue in fertility today,” says Vechery. “We talk all the time about how Modern Fertility is really an educational tool. It lets you have the discussion with yourself, your healthcare provider, with the honest interpretation from top doctors, the most up-to-date research studies, to give you the information you need.”
The fact remains that Modern Fertility, like other fertility-focused start-ups, mostly sells a sense of security in numbers. Just like a genetic test can’t tell you much about your ideal diet or skincare routine, testing for hormones can’t tell you when you should get pregnant, how easily it will be to conceive, or whether the eggs you freeze will turn into children later on. Blood testing isn’t a crystal ball.
Still, the market is there. “Women are saying, ‘Yes, I want to know this stuff,’” says Leahy, Modern Fertility’s co-founder. In the two weeks after the company launched, it collected over $70,000 in pre-orders for its at-home testing kit. Now, those women—and more—will be able to take the company’s at-home blood test. “Is it going to predict everything? Probably not. But we’d rather have the information.”