Project Description
D.C.’s new dating question: Do we freeze embryos
At 32, Tessa Mills and her husband were having trouble conceiving. They had spent two years trying and gone through a battery of tests. Mill’s husband’s semen analysis came back with a few abnormalities. Their clinician recommended three cycles of IUI (intrauterine insemination).
During an IUI, healthy sperm are separated from the rest of the semen and concentrated into a solution, which is then placed directly in the uterus. The catch was each IUI was $1500 and Mill’s insurance only covered $500 worth of fertility treatments. She stumbled upon PherDal, a fertility startup that sells $200 kits for an at-home ICI (intracervical insemination)—essentially a syringe to place sperm directly in the cervix. Within a month, Mills was pregnant. She attributes her success to PherDal. “The medical community was not offering us good options,” she says. “While insurance is good about covering fertility testing, it can be very behind about covering fertility treatment.”
Treating infertility can be a long and expensive process. An IUI can cost anywhere from $200 to $4,000 and have a success rate of 10% to 30%. In vitro fertilization (IVF), when a doctor fertilizes an egg in a lab and then places the resulting embryo back in the uterus, has an over 50% chances of success but it can also cost up to $30,000.
PherDal and fellow startup Proov are partnering with telehealth company Wisp to make their fertility products available to a wider audience. Both are offering something attractive to couples struggling to conceive: affordable, DIY fertility. Wisp CEO Monica Cepak notes, “fertility has constantly come up” as an area customers are interested in.
Patients can buy products from Proov and PherDal, as well as Wisp’s own prenatal gummies—directly from Wisp and consult with a provider if they wish, but it’s not required.
Proov offers at-home hormone and ovarian reserve test for women ($99), or an advanced kit which adds on a semen analysis kit ($169.99). PherDal sells the first FDA-cleared, sterile, at-home insemination kit. Both were started by scientists who felt let down by the medical community when they ran into infertility.
Amy Beckley, Proov’s founder who received her PhD in pharmacology, was told she had unexplained infertility but later found out she had a progesterone problem the doctor never tested her for. To remedy this, she designed Proov’s kit to test for four hormones, rather than not just one, which is standard for most ovulation kits.
PherDal founder Jennifer Hintzsche, who has PhD in bioinformatics, was diagnosed with unexplained infertility and then given paperwork for a $10,000 loan to pay for an IUI. Instead, she did her own research and found out about ICI, a process that’s not offered at most fertility clinics. She cobbled together an at-home ICI kit out of lab supplies, and within two months she was pregnant. After it worked, she started PherDal, which received FDA clearance in December 2023. While there’s no clinical study yet on how effective the kit is, Hintzsche says she originally sold 200 proof of concept kits and 34 pregnancies resulted from them.
These treatments can be easier to pay for, and more immediate than waiting months for an appointment at a doctor’s office. The DIY solutions also promise a modicum of control over a process which offers none.
However, control doesn’t necessarily translate to efficacy, and fertility experts say that people pursuing home treatments—which may not be informed by a consult with a physician and don’t incorporate physical exams—might be operating with incomplete information.
Dr. Elizabeth Dilday, a reproductive endocrinologist at fertility clinic CCRM, says diagnosing infertility in women requires a deep dive into a patient’s gynecological and medical history, as well as a physical exam with bloodwork, and an ultrasound and hysterosalpingography to evaluate the effectiveness of the uterus and fallopian tubes. It’s difficult to get exact percentages of infertility diagnoses since they vary depending on the area, but Dr. Dilday says some of the most common diagnoses in are ovulatory dysfunction, blocked fallopian tubes, and unexplained infertility.
Once a diagnosis is established, treatments run the gamut from timed intercourse, inducing ovulation, an IUI, or an IVF. Most fertility clinics do not offer ICI. “It’s ineffective,” says Dr. Michael Alper, the cofounder of fertility clinic Boston IVF, and an associate professor at Harvard Medical School. “There’s no advantage over intercourse. IUI is different because we’re concentrating the sperm and placing it directly in the uterus.” (According to a 2022 study, ICI live birth rates are 38% compared to 56% for IUI within an eight-month span.)
Difficulty conceiving can also be caused by a variety of issues with fertilizing an egg classified as “male-factor infertility.” Diagnosing it includes a three-pronged approach: lab tests for hormone testing, a semen analysis, and a physical exam. Dr. Peter Tsambarlis, a urologist and assistant professor at Northwestern’s Feinberg School of Medicine, says that while at-home semen analyses do a fairly good job of counting and measuring sperm, the quality of analysis can vary from lab to lab. “An at-home semen analysis can provide reassurance that everything is fine, but if it’s not, go to a doctor and get an actual semen analysis,” he says. Meanwhile, roughly 40% of his patients who struggle with infertility have dilated veins in their scrotum—something that’s only apparent during a physical.
While direct-to-consumer fertility products may provide answers for some patients, clinicians caution against leaning too heavily on them. “The biggest predictor of pregnancy is age of the female partner,” says Dilday. “If the products aren’t working, don’t wait or delay getting professional help. Time is of the essence and a few months may change one’s outcomes.”
A clinician has the added benefit of providing education and a tailored treatment plan along with the diagnosis. Tsambarlis points out education is a big piece of the puzzle too. “You’d be surprised about what men don’t know about fertility and ovulation,” he says, while also noting he has had patients who have had a vasectomy and then wondered why they are having difficulty conceiving.
However, doctors recognize cost can be a significant barrier. Alper recommends an initial consult to help patients understand what might be causing the problem. Alper says a fertility specialist consult will cost about $300, which she says is comparable to an at-home kit, with the added benefit that “you’ll be talking to someone who understands the whole picture. Trying to figure it out on your own is like trying to fix a car yourself. It might work, but you don’t have the knowledge of someone who has done it many times and understands the full context.”
In the future, Wisp plans to offer higher-touch products and services including prescription medications clomid and letrozole which can stimulate the ovaries to produce multiple eggs. It will also partner with an at-home blood draw service so patients know when they should take the medications. “There is a subset of women who will need IVF,” Cepak says. “But there are plenty of people who can be helped by other, less expensive options. If we can help them avoid a lengthy and expensive trip to the IVF clinic, that’s a huge success.”
