Latest / Giant Robots Smashing Into Other Giant Robots / 514: The New Frontier of Fertility Treatment: Technology, Telemedicine, and Hera Fertility
Transcript
- WILL: This is the Giant Robots Smashing Into Other Giant Robots Podcast, where we explore the design, development, and business of great products. I'm your host, Will Larry, and with me today is Thiv Paramsothy, Founder and CEO of Hera Fertility. Hera Fertility is a telemedicine-first provider for couples who want to boost their chances of conceiving. They deliver convenient testing, affordable at-home meds, and concierge care, helping patients overcome infertility with better odds and faster turnaround time at only a tenth of the cost of IVF. Thiv, thank you for joining me. THIV: Thank you for having me. Super excited. WILL: Yeah, I'm excited to talk about this. And I know this is a huge issue, so I'm excited to hear kind of your heart behind it, why you started the company. But before we dive in that, tell me a little bit about you. THIV: So, I was born and raised in Toronto, always loved technology and looking at different softwares and all that, but never good enough to code. But went to Waterloo, which is a fancy tech school up in Canada. That's where I really developed my passion for healthcare and tech. So, at that point, it was called, like, something nerdy like health informatics, but now people call it digital health. From there, I kind of learned what was going on in the health system, what could be better about it, and that's kind of where I wanted to focus on in my career. And then, after college, I was realizing quickly that I wasn't a corporate guy, did it for a bit, and I realized I was very much an entrepreneur. So, I started doing startups after that, and I'm now in my third one. But all my startups really focus on how do we better the healthcare system and how do we make it better for patients? WILL: I absolutely love that because I have three young kids, and it's absolutely frustrating at times dealing with the healthcare system because, I'm just going, to be honest–sometimes it's who you know or what type of money you have and things like that. And it's frustrating that it feels like, at times, you have to be at this right spot at the right time to get the certain healthcare, so I really appreciate that you are diving into this and trying to solve a huge issue. THIV: Yeah, I hear you because I see that so often. That's a lot of times what inspires me to go off and do my startup. At that time, like, Hera, exactly that was one of the reasons why we started Hera. But the way I look at it is that if you look at the healthcare system we have, it's incredible the miracles we could do and the solutions that we have and how we can save people's lives, how we can treat them to live longer. But a lot of times just getting your foot into it and finding the right care is the difficult part. And don't get me started on the barriers and obstacles that are there, from cost to just pure access. So, that's what really motivates me because, in my mind, I'm like, oh, this should be available to the masses, and that way, you know, society grows. Everyone is happier. And I think then we move along and become better. WILL: Yeah, definitely. Were there friends, family that were going through this that kind of helped you, like, say, "I need to create this company to help the healthcare?" or what was the reason behind starting Hera? THIV: Yeah. So, with Hera, what happened was I was at that age where all my friends and family were moving to the next chapter of their life and wanting to build a family. A lot of them were coming to me and talking to me and telling me this. And I've become that person where a lot of times, if they need any advice on where to go, what clinic to attend, or what doctor, I try to help there because that's kind of where my mind goes to. I'll know where the right doctor is or which is the best one, even though I'm not a doctor. I've just worked with so many of them. And so, many of my friends would come to me and share those stories. And I started to hear it more and more. And then, as I was following along in their journey, I realized, like, how hard it is for them to even enter in and get seen by someone; a lot of times, it's like a 6, 12-month wait. Then, on top of that, being able to pay for a lot of these treatments, $20,000, $50,000; if surrogacy, it can go all the way to $100,000. And then, lastly, like, just how inconvenient it is. One of the things that I was shocked by was, like, how many people had to quit their jobs to go through treatment; 1 in 5 is the latest stat to go through something like IVF. So, all these things are against them, but what really stood out to me was the people that needed help for fertility were probably the most driven and resilient people. And, look, I'm an entrepreneur. I have to be resilient, but I think these people are even more resilient. And so, for me, I was like, there's got to be a better way for people that are going through infertility. That's really what drove me to start a company, quit my job, do the whole shebang there. WILL: I wanted to paint a picture because I'm kind of tearing up already thinking of some of the people who've gone through that journey because, like you said, it is not an easy journey. Can you paint the picture of kind of what that journey looks like? Because, from my experience, I know it's not like, oh, I need to go get IVF. It starts way before that, many doctors' appointments. It's a whole thing. I want the audience to kind of hear the whole story and paint that picture of what someone who needs IVF or anything in that category what they're going through. THIV: Where my mind goes to is think of a couple who, like, just got married or been in a long-term relationship, and now they've decided that they want to start having kids. What typically happens is, you know, usually, you just go, yeah, we're going to try, and then that's what they do for that time. And so, they're happy. They're excited because this is, like, a new chapter. And what I picture is as they're trying, they just keep trying. And they're, like, constantly every month or every so often when they're checking, using pregnancy tests, they're just seeing the negative result, negative result, negative result. And so, that just keeps happening over and over again. After that point is when they go, okay, maybe we need to seek some help. What ends up happening is they go to a doc, and a doc goes, "Hey, just keep trying." That's literally the advice you have to give. That's based on the guidelines. So, no test. Nothing. It's just the fact that it will happen on its own. Don't stress. And so, they keep doing that, and they keep seeing negative results. And that happens for a long time. Most people end up doing is they spend about three to four years on this journey. And where it really tests you, it tests your, you know, relationship with one another. It really questions yourself. You know, on the woman's side, like, they feel lonely. They feel like when they go to events, they see other people celebrating. They're getting pregnant. They're frustrated as to why. So, it puts emotional toll there. And then, also, for the man, it puts a lot of pressure and makes them question their masculinity. This ends up happening. From there, they start getting testing done. It just becomes very clinical. They start understanding, okay, they may need to now do some sort of treatment. It becomes like a job, another job for a lot of times. And that's what we kept seeing with people, and I saw for many people as I was helping them on their journey. It's really a stark contrast to what, I think, most of us have in our head of, like, when you want to build a family where it should be joyful, and loving, and exciting, and easy. It's not. It's a hard path for people where you have to be resilient. So, I hope that that paints a picture. That's what I feel, and that's what motivates me to keep trying to figure out a better way and why we started Hera. WILL: Yeah. The people I've talked to and been around that's kind of the same story. And you're spot on when you say they start questioning themselves. Like, "Is it me? Did I do something wrong?" And it's heartbreaking because you're like, "No, you did nothing wrong." And so, yes, I am so glad that you shared that and that you're doing something about it. So, can you kind of go into what is Hera doing to help the situation? THIV: What we are doing we're a telemedicine-first provider. So, what we do is, one, is that through our app, you're able to access the care you need right away. So, that means if you are being told, "Keep trying," but you want to know if there's something wrong, we have testing there. If you want to know, is there things that I could do or take that will improve my chances? We have our supplements and medications that we can provide to you and deliver to you and have you follow a treatment plan. If there are more things that we need to do, like go to a clinic and get IVF, through our app, you're able to do that. We're able to find you and coordinate all that. But really, we're a companion as you go along in this journey to sift through and provide the solutions that you need. The big thing that we've been really focused on, because we've learned this through our research, and my co-founder ran a fertility clinic for 20 years, is that most people think if you are having trouble, you have to go through something invasive like IVF, or you have to keep trying. But really, what's happening is that only 5% of infertility cases need something like IVF. And what you actually can do is that with a special set of medications taken in a certain way with our plan that spells it out for you, you can be successful. Improve your odds two to three times is what we've been seeing. So, that's really where we're honing in on: Can we improve your chances of getting pregnant? And that has all these different pieces to it. And so, I think that's what our members really like is that, one, they get educated on what's going on and what they can do and pick options. But then they know that if they're with us and they're following our instructions and taking the medications and everything, it will improve their chances. And so, then, hopefully, they can get pregnant. WILL: I love that because there's nothing more frustrating than knowing your body and knowing, hey, something's wrong, and someone's telling you, "Oh, just keep trying, like, just keep doing it." So, I love that you're stepping in and educating them because I feel like, especially in our healthcare, a lot of issues that I've seen is because people are not educated on, hey, that's not the right path to be going down, or there's another way to do it, and you just didn't know that. So, I'm glad that you're offering that next step. That sounds amazing. THIV: Thank you. I think you said it the best right there. It's that next step. People want to do something. The most frustrating that we kept seeing and hearing from people is just being told to do the same thing. Isn't that the definition of insanity? WILL: Yeah [laughs]. THIV: For us, we want to provide something so they could take that's safe, reliable, and has shown effectiveness. And along that, they could talk to someone and make sure and be reassured as they go along in this journey, as they have more and more questions, what else can they do, and just really feel empowered on this infertility journey. WILL: That's awesome. So, how long have you been around? How long have you been a company? THIV: We're getting up to two years. Our two-year anniversary is coming up. So, we started in April 2022 really testing out what could be the right solution here. You know, as someone who has done a few startups in my past, the first rule I would say is you never fall in love with the first idea, but you go off and test it, and find out, and interview, and keep iterating. And so, we did that for some time and learned so much. I think I've talked to now thousands of people on their fertility journey. And, you know, as we were going along, we realized we had something special with this telemedicine-first approach. And so, we launched officially in August, I believe it was 2023, our app with the clinicians and everything after beta testing it for some time. And now, we have a group of patients going through our program in about 12 states, and we are expanding as we go along. We'll hopefully get to the 50 states by the end of the year. WILL: Wow. By the end of the year, that's amazing. THIV: Yeah. Because we're getting a lot of people wanting it in all parts of the country, but we wanted to really focus on the areas where you won't have that access. So, to your point earlier, you know, a lot of people we've seen so far were telling us, "Hey, I don't have a fertility doctor near me. It takes me five hours to get to one, let's say. And so, I feel hopeless. I feel like I have to do that, and I shouldn't have to." And so, that's where it's this piece of, like, knowing where you're supposed to be going or getting access and not having these barriers in front of you. And so, for us, we're really focused on those states where access is a big issue for these services. And so, we're in Texas. We're in Kansas. We're launching in New Mexico now, places like that where you won't see too many fertility clinics in a lot of areas. WILL: That's very interesting, and I'm glad you brought it up because I was going to ask you about that because I know you kind of specialize in the telemedicine portion of it. And I'm from Louisiana, so kind of familiar with Texas, and I used to live in Kansas. And so, those places are not the most...there's parts that are rural, but not the most rural parts, so it's interesting that a fertility doctor can be five hours away. That just blows my mind that like, you know, you're not talking about Montana or anything. You're talking about, like, Texas and Kansas that, you know, five hours is a long time. And the amount of times you have to visit the doctor for that, yeah. THIV: For fertility, there's a lot of visits. You're going there pretty often. Especially if you're going to do IVF and having to do multiple rounds of it, you could be going there for months. And so, yeah, there's just...the reason behind this, and this is fascinating to me as well, is there are only, like, about 550 clinics that specialize, like, fertility clinics in the U.S. And most of them are actually concentrated in the metropolitan areas, and I think the stat is, like, 50% of those are in 6 states. So, the remaining states really get a few of them. I think New Mexico has, like, two or three fertility clinics. And so, these clinics have the specialists, and they do as much as they can. But if you're not nearby one, it's really hard to do that consultation, to learn from them, to find out if there is something wrong. And so, now you still are in this gap of like, is there something wrong with me? Because it could be a simple solution, right? And if you overcome it, you can get pregnant. So, that's where we see–can we be hyper-focused on those areas where someone is maybe two hours or more away from the nearest fertility clinic? And we really want to focus on that access piece because people should get access to this. So, that's why, with our telehealth solution, we have our own clinicians who will be able to assess. For the testing, we'll send you kits to be done at home, or you can go to a nearby lab, and we'll get the results that way. Give you a set of medications or treatments [inaudible 16:11] we'll actually send it to you. WILL: Oh, wow. THIV: That's how we're trying to be much more convenient and accessible because that way, you're doing a lot more at home, and these barriers that are currently in front of you are gone. And people are able to get care. WILL: That's amazing. Mid-Roll Ad: As life moves online, bricks-and-mortar businesses are having to adapt to survive. With over 18 years of experience building reliable web products and services, thoughtbot is the technology partner you can trust. We provide the technical expertise to enable your business to adapt and thrive in a changing environment. We start by understanding what’s important to your customers to help you transition to intuitive digital services your customers will trust. We take the time to understand what makes your business great and work fast yet thoroughly to build, test, and validate ideas, helping you discover new customers. Take your business online with design‑driven digital acceleration. Find out more at tbot.io/acceleration, or click the link in the show notes for this episode. WILL: Let me ask you this because it kind of sounds like the concierge portion of it, which is amazing. How are you able to do that portion of it but do it cheaper than the streamlined way of doing it? THIV: So, I like to look at this in two ways; one is the business, right? How do we make sure the economics make sense? And then the other is how do we make it so that the patient experience and care is optimal and satisfactory, right? Or excellent, I should say. So, the way that we thought about it, and I went around and interviewed and observed so many different care models, like, the ways that these different clinics are working, so be it in a hospital, in a traditional clinic. In the earlier days, I would go and do all of that. You really have to think about is there a better way that we can do it but still have the same success and outcomes? And so, the first thing I noticed is that technology needs to be at the core of all of this. It checks off both of those buckets. The economics and the business will thrive because of that because you can introduce efficiencies, you know, streamline a lot of the operations, do automation. So, that was core to us. So, we were very careful and selected a good vendor to work with on the EMR side and then built on top of that. And then, from there, technology also helps from the patient side because of all the places, like, I was interviewing, none of the clinics really had, like, an app, or they kind of had something where you would email someone. You would still call, and it was very old school. But what we heard is that patients had so many questions after, before, middle of the night. And so, we were like, how do we make it so that they feel like they can reach out to us, talk to us at any point? And so, that's why we created the app. And you can message us at any point, and then there'll be someone there to help if you need anything or to answer any questions. So, that's on the technology. Then staff people wise the thought, and other companies have done this, but concierge care, you know, people have thoughts about it, but what's really good is that it's really about, how do I make sure that the patient is getting the best experience and getting the answers that they need? And really, it's about making sure you have the right team there who's available around the clock to answer those questions who are fully trained. So, we hired a lot of people that had gone and worked in the fertility space. Like, my co-founder knows so much about fertility because she's worked there from the beginning. And so, that's really helpful and is able to answer a lot of these questions that come up immediately. But then we staffed it so they're available around the clock so we can be available for the patient. And then from there, I think the business model makes sense because we're providing this extra support; patients are willing to pay for it. We've built it so that it's not transactional. And it's more about a long-term engagement so that way people pay us on a membership basis for certain services. And so, at the end of the day, we've, essentially, and I hope this makes sense, is that we try to not replicate what a typical clinic would do and, which is, like, bill for each service. And we try to think about it: how can we build a long-term relationship with this person who probably will be here for some time and then build pricing and a business model around that? I think that's why it's working. You know what I mean? WILL: Mmm-hmm. THIV: And I think that's so important because if we just replicated it, it wouldn't have worked. Things would fall apart. The economics wouldn't make sense. And then the last thing I'll say is that clinicians-wise, we didn't want to have doctors just there like everyone else thinks, but we actually have nurse practitioners or APPs. And we did this because there was more and more research, and we tested this out for long-term engagement; patients love the nurse practitioners. The doctors are great. They play a role. But I think the quarterback in all of this is that nurse practitioner. So, that's where, I think, I'm super excited. We're hiring a bunch right now. They are really the quarterback. And we have a good clinical team to make sure everyone feels equipped. And if they have questions, they're able to answer it with docs. But we take cues from these nurse practitioners. So, I think that really helped on the business side and the patient experience side. And that's why we, you know, we have five stars on our satisfaction. People love us. Yeah, it's a long-winded answer to that, but we really thought about how to build this properly. WILL: That's perfect because...and I'm thankful that you explained it because what I got from what you said was not only are we able to do it cheaper, but we're able to increase the amount and the quality of care that they're getting. Like, 2:00 in the morning, you have a question; you can get it answered. Like, you can't get that anywhere else. Like, sometimes you have a question, and it may take 12 to 24 hours to even get that answer. So, that's amazing that you're staffed around the clock. So, it sounds like, hey, not only are we going to do it cheaper, but we're going to be better at the quality that we give you. So, that sounds amazing. THIV: Yeah, exactly. And I think that way, what's key here is, currently, in the market for this kind of services, you're paying so much money. A lot of times, insurance doesn't even cover this. So, I've seen people who couldn't get their dream, which, in reality, people's dreams is to have that family, to have that child. And they couldn't do it because of money, you know, maybe it's the Canadian me, but I hate that fact of, like, money stopping you from getting the care you need. WILL: Same. I'm with you 100%, yeah. THIV: Right? WILL: Yeah. THIV: And so, for us, it's like, if we can make this cheaper, we can make the prices cheaper, too, and people can pay and afford it and get their dream. And so, that's really why we did it this way. It's not so that we make more money. It's so that, you know, we build a sustainable business. But now, patients have an affordable option in front of them. WILL: Yeah. Can you, and just ballpark it, like, what is the normal cost usually for this versus what Hera provides it for? Can you explain that? THIV: Normally, people who are going through this would have to spend, ballpark, 15,000 to maybe 25,000. The upper end is, I would say, 50,000, and I'm not including surrogacy in this. But it's a lot of money. People are getting their second mortgage. They're getting, you know, GoFundMes. There's so much that they're doing for this. The worst is when money is blocking you from that dream. So, that amount is typically what we've seen. And that's what my co-founder has told me she would be seeing that from each of her patients and when she was at that clinic. But the way that we've approached it and how much we charge, patients are typically paying us at most around $1,000 to $2,000. WILL: Wow. THIV: And so, we're able to effectively do it and at least be an alternative option for them, and that's affordable. And so, I'm always excited when I see patients who come to me, and they're like, "Oh, it was so expensive." or "I thought it was going to be so expensive, and this is so doable for us." That's the difference right there. WILL: Wow. That's a huge difference. Wow. THIV: [chuckles] Yeah. And I hope that this changes, like, the conversation. I've seen other markets or in the past where, you know, things were so expensive, and then these new startups were coming in and really making it so that it becomes competitive. And the incumbents have to change their prices, too, and get innovative. My goal is to bring down that, you know, current average cost of 10,000, 20,000 and so that it becomes much more affordable. And so, that could be done by improved technology, more competitors, all those things that we know about. That way, you know, as more and more people are having these issues with infertility...it used to be 1 in 8. Now it's like 1 in 5 or 1 in 6, even. We need more and more of this kind of care so that people can live out their dream, and let's make it affordable so that they can do that. WILL: That's amazing. And I really hope you reach that goal because I think especially in healthcare, we need more of that. We need the competitors that are driving the price down instead of driving it up. So, that's amazing that you're creating that. THIV: Thank you. That's why, you know, we have competitors, but I love it because a couple of years ago, there wasn't as many people in this space. And it keeps growing more and more. As more and more people put their attention to this, I think we'll see really good solutions so that people have options. Obviously, I'm biased. I would love for in 5 years or ten years, you know, if someone is having trouble, they're going to think of Hera. And they're going to download our app and talk to someone right away and know what they can do so they can be closer to that dream of theirs. WILL: Yeah, definitely. And I'm glad you mentioned the 5 to 10 years. So, I know you mentioned, hopefully, by the end of the year, you're going to be in all 50 states. What's the next step? What's the next goal for Hera? THIV: Yeah, it's a great, great question. I think about it all the time. I think for us, what we wanted to do is really, like, right now, we are early days, and we're learning from every patient we see. What else can we do? How can we help you? Fifty states is one target or milestone. I think there's a lot more we can do on the product side. For instance, we're going to be launching a male infertility program. That's probably the first of its kind out there where we specialize on the men side of things and bring them into the conversation and have them be actively involved. So, that's a big one. But we're going to keep doing more and more of solutions and products, so really strengthen the solution that we have here so that you come to us, and we have everything that you need. I would say next after that is really partnering with more and more of the clinics that are already there. And I say this because we're part of the health system. Yeah, business tells us to be competitive, and that makes sense. But you also are taking care of patients, and you need to partner where maybe you don't have the services for, but someone else does, or for continuity of care. And so, you need to be part of the system. And I think that's key for any kind of healthcare company that's starting up. And so, that's, I would say, level two. I like to think of, like, in games, like, the different levels. I would say after that, as we grow and become integral to the system and be that solution that people go to when they're in need; we'll evolve to, like, going into the employer and health plan side of things and then be able to say that it's part of your insurance and health plan. And then it's a no-brainer now to sign up with us because someone else is paying for it, which is great. So, that's kind of how we're evolving, but I want to make sure...and I think something that I've heard in your other episodes, but I'm a big believer of talking to the people that are using your solution and learning from them, and identifying where there may be gaps that you can help address. And so, as we evolve, we're going to keep talking to them. I always give out my cell phone number and tell any of our user who wants I'm like, "If there's something we could do better, let me know. Tell me directly." And so, I want to make sure that's clear that we'll see what our users tell us, what we should be focusing on. WILL: Wow. I love that. That's amazing. Let me ask you this in kind of closing it out is, like, so that's kind of five years. Do you have anything that you want to promote, like, what you're doing right now? THIV: Yeah. No, I think the big thing is we are constantly working on our product. What I would say is if there is anyone who is either fertility curious, or going through their own journey, or who has gone through this in the past, please reach out to me or, use our solution, talk to our clinician. I think it's so empowering once you meet with our clinician to understand what your options are and what you should do. If you're not in one of our states, then let us know, and we'll put it on the list and bump it up. So yeah, like, please come to our website, check it out, join us, try it out as well. We're all about trying to help people get to that goal of theirs, their dream. WILL: I love it. And we'll include it in the show notes, but in case they don't have the show notes in front of them, tell them how to get to your website, how to contact you, how to get the information. THIV: Yeah, for sure. So, you can go on our website. It's herafertility.co. And on there, you can sign up for our services and sign up for our app. But if you have any questions before signing up, you can schedule time to talk to one of our fertility advisors, and then, yeah, you can always reach out to me. I'm on LinkedIn under Thiv. And Twitter I check every so often or X. And you can email me at any point at thiv@herafertility.co. WILL: Awesome. Well, it was great chatting with you, and I've learned so much. Keep doing what you're doing. And I hope that you're successful because you're doing some amazing things. THIV: I really appreciate that. WILL: You can subscribe to the show and find notes along with a complete transcript for this episode at giantrobots.fm. If you have questions or comments, email us at hosts@giantrobots.fm. And you can find me on Twitter @will23larry. This podcast is brought to you by thoughtbot and produced and edited by Mandy Moore. Thanks for listening. See you next time. AD: Did you know thoughtbot has a referral program? If you introduce us to someone looking for a design or development partner, we will compensate you if they decide to work with us. More info on our website at: tbot.io/referral. Or you can email us at referrals@thoughtbot.com with any questions.