🔮 2023 recap—and ➡️ to 2024
The changing definition of infertility, a hot fertility market, and what's coming next
Greetings, and happy new year, friends! It’s time to ask the question that has been filling your inbox for weeks: 🔮 what will happen in 2024? My wish when it comes to fertility will be no surprise to long-time readers: I hope that culturally, the burden of infertility shifts farther off of women’s shoulders to include men. In the good news column, there is a growing number of companies tackling male fertility and sperm health and testing. Sperm is making more media headlines than ever too so perhaps 2024 will finally be its year.
Before we look ahead, we’ll recap 2023’s biggest headlines. And a quick request before our journey through time: take a millisecond to chime in below on this newsletter’s topics and direction.
The biggest fertility headlines in 2023
The definition of infertility changed
The banner headline post-ASRM, the fertility industry’s biggest conference, was a major update to the clinical definition of infertility. This matters more than you might think, as many insurance plans use the official ASRM definition to determine who qualifies for coverage. Its previous iteration covered only the traditional narrative: when a man and a woman can’t get pregnant after a year of unprotected sex if under 35 and 6 months if over 35. Here is the shiny, new version:
“Infertility is a disease, condition, or status characterized by any of the following: The inability to achieve a successful pregnancy based on a patient's medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.”
Note that the definition is more inclusive, so it (theoretically) should expand access to care for the LGBTQ+ community, single parents, and those with medical conditions. I say theoretically because these bureaucratic declarations take a long time to trickle through the system. One example: the WHO declared infertility a disease in 2009, and it took another eight years for the American Medical Association (AMA) to formally acknowledge it and create billing codes. Even now, categorized as a disease, with all of the codes, insurance doesn’t universally cover it.
WHO reports 1 in 6 people globally is affected by infertility
Far beyond previous estimates and a Western-centric population, the WHO released a staggering report stating 17.5% of the world population will, at some point during their reproductive years, experience infertility. The 133 studies it chose to analyze out of an initial 12,241 were performed between 1990-2021. The population least likely to experience infertility lives in the eastern Mediterranean (10.7% of its people), and the highest was the western Pacific at 23.2%, with the Americas trailing slightly behind at 20%.
You can read the full report for details, but intro by the WHO’s director general kind of says it all:
“This report, the first of its kind in a decade, reveals an important truth: infertility does not discriminate. For millions around the world, the path to parenthood can be difficult to access, if not impossible. Globally, an estimated 1 out of every 6 people are affected by the inability to have a child at some point in their life. This is regardless of where they live and what resources they have.”
Fertility-centric companies are the first 🦄 in women’s health
In 2022, Maven achieved a huge milestone: it was the first women’s health company to achieve a billion-dollar valuation. Kindbody followed Maven into 10-figure territory in 2023. Beyond offering employer benefits, their models are very different; Kindbody operates brick-and-mortar clinics, and Maven is entirely virtual. But a focus on fertility is central to both, and proving to be a huge retention and recruitment tactic for their customers. Maven’s report on fertility and family benefits gets into these details, and if the growth in 2023 is any indication, it’s a trend that will only grow in 2024.
🔮 2024 predictions
Consolidation (and extinction) is coming
2023 was a rough year for startups and funds. Many companies that retrenched to wait out the market will need to raise in 2024, so competition will be fierce. Between the sheer number of companies seeking capital and the higher standards investors now demand, expect to see a number throw in the towel. In healthcare, point solutions will be the first to go, as venture capital—especially in this market—won’t pursue smaller returns. Whether it’s an acquihire or acquisition, strategics will get their pick of high-potential companies that can’t raise. It’s also a great time for PE-style rollups—perhaps one will spawn the fertility clinic of the future.
Venture is going through its own reckoning, with associates and partners receiving pink slips and playing musical firms. Others are returning to ops or leaving the profession entirely. LPs are raising the bar, and emerging, first-time fund managers, who serve a crucial purpose at the early stages, are losing out to investors with track records. LPs check books should start to open back up later this year, but in the meantime, the market will be tight.
Even in a down market, the fertility market is 🔥📈
As an ex-operator and founder, I am a firm believer that constraints push teams to think creatively and do more with less. Rather than placing bets on existing companies with slow growth, funders will look to the fresh batch of startups founded during this “venture capital winter” hoping the next Apple, Amazon, or Uber will rise. When it comes to healthcare, fertility will continue to be a hot area. The global fertility services market is predicted to grow from $47B in 2022 to $54B in 2023, and by 2027, hit $90B. There are already two billion-dollar companies, and plenty of unmet demand for others to meet. As an investor, I am personally excited about what this new era will bring.
Fertility’s middle ground will emerge
It’s no secret that even for those who can afford infertility care, there are not enough reproductive endocrinologists, reproductive urologists, or fertility clinics to serve the massive number of people who need it. Also, we’re learning that maybe not everyone who turned to IVF actually needed it. So, as couples wait their turn for an appointment, what can they do? There are already companies—Mosie Baby, Proov, and Legacy among them—that work with fertility benefit providers and go direct to consumers. Considering many people already have to pay out of pocket for fertility services, and these lower intervention solutions can save money and time—for patients and the system—a marketplace for at-home infertility triage makes sense.
📖 My reading in 2024
To anyone thinking about writing a book, if you’re not already a voracious reader, it’s one of the best ways to improve your writing. One of my goals in 2024 is to read 60 books. My tastes are eclectic, and if you want to follow along, I’m on GoodReads and Storygraph. If you’re reading something amazing, send it!
🫡 One last thing…
Hearing from readers is the most rewarding part of my author journey. My favorite recent anecdote is from a mother who bought Fertility Rules to talk to her adolescent daughter about her period. Her daughter read that chapter (and many others), highlighted interesting passages and words she didn’t know, and then they discussed it. It turns out there was a lot her mom didn’t know either. I knew the first audience would likely be couples thinking about conception or those who encountered infertility, but I always hoped this use case—using Fertility Rules to give our kids the education we never received—would be a thing, too.