Breaking Down Infertility

Infertility is a growing problem facing over 1 in 6 couples. What can we do to tackle this issue?

Male sperm count is down 50% over the last 50 years. Today, 26% of women have PCOS, which is the leading cause of infertility. PCOS is polycystic ovarian syndrome. You get cysts on your ovaries and so it’s one of the leading causes of infertility and it’s now hugely where – again, practically didn’t exist in the 70s. You look at, in the past 10 years, the number of miscarriages has gone up 10%.

Justin Mares on Invest Like The Best

I was running across the 14th Street overpass last summer when I heard Justin Mares talk about the impact of microplastics on male fertility. It stood out to me at the time for two reasons: I had just finished coaching my students through their moonshots where several groups were looking into microplastic removal and filtration and my partner and I were in the midst of trying for our first baby.

Fast forward to today and I’m about to be a first-time father. Thankfully we didn’t experience any issues, but suddenly being made aware of the challenges people have planted a seed in my mind. Six months later, I started researching infertility and writing this piece.

Over the last 20 years, we’ve seen an increase in infertility rates among couples, depending on where you get your data. But more importantly, they are higher than they need to be. 

What if we never had to worry about infertility being an issue? 

This might be a moonshot mindset, but I find it a more optimistic and useful way to approach the problem if we truly want to address it. What would need to be true for fertility to no longer be an issue? I’ll explore that in a future essay.

Fertility rates, measured as the average number of children a woman has, have been dropping around most of the world, for reasons like rising costs (kids are damn expensive), more access to education for women, and as a result more working women. When we combine this societal shift with rising infertility rates, we’re in a situation where less and less people want to have kids, and those who do are increasingly unable to. To me, this is a problem worth solving if only to make a difference to those who want to have children. But what makes this situation more dire is the potential population crisis coming. This is something I don’t know enough about but seems important and not too far away.

Based on my research and understanding to date, reports show a range of 6 – 9% infertility between the 1980s and 2010s, whereas today rates are closer to 10-12% with some sources putting it as high as nearly 17%. The means 1 in 6 couples who are trying can’t have kids. As Justin mentioned, there has been more than a 50% decline in sperm counts in men dating back from the 1970s to today. It’s clear this problem is growing and one people are paying attention to, especially as women have children later in life which introduces its own age-related fertility issues.

And the wild part about infertility is all of the upstream and downstream effects. There is a growing hypothesis that modern lifestyle factors, especially in developed nations, are contributing to a whole host of health issues including infertility.

In many ways, infertility is the outcome of other decisions and genetic circumstances, not the problem itself. Infertility is just a node in a complex web of your own personal health, something I find personally exciting. The current fixation on all things health and diet (microplastics, inflammation, obesity) also have indirect, and maybe direct, effects on fertility. A better, healthy lifestyle can go a long way to help with fertility, but obviously can’t prevent everything. In the next post we’re going to try to dissect this and figure out what we can do about it.

Not only is the problem growing, but people are looking for solutions. This is an important problem that people are willing to spend a lot on.

  • Fertility clinics are an estimated $33BN globally and expected to continue growing. We have startups like Maven, a modern virtual women’s health clinic, now valued at $1.35 billion, with over 100 clients (businesses offering health services to their employees) and has raised over $200MM in funding.
  • Infertility treatments are around another 1.5BN and continuing to grow. In the US there’s been an increase of ~60% in the last 10 years for ART (assisted reproductive technology) procedures. As the assortment available continues to widen, I expect to see this grow as well.
  • And then we have more consumer fertility “assistance” products emerging. We can look to period tracking apps Flo and Clue to get a sense of how popular these spaces are. Flo has over 300m downloads and $800M valuation with revenues exceeding $100M, while Clue has raise almost $60M and has around 11 million users. It’s unclear how good of a business these are, but they are a hot space.

In addition to all of these, there are a bunch of exciting and new technologies that are starting to emerge to create a future where nobody has to worry about infertility such as:

  1. Lab-grown eggs and sperm
  2. Synthetic embryos
  3. Three-person babies
  4. At-home sperm-testing

While most of these are years away from the mainstream, younger generations starting to face those realities will throw money and science at the problem. This represents a huge opportunity to make an impact and I want to learn more about it.

What’s Next

In this deep dive, I am going to cover:

  • The problem and causes of infertility
  • Existing solutions
  • Potential new ideas worth exploring
  • Promising scientific developments
  • Startups working on these ideas

What I hope to do is break down the problem of infertility in a way that someone, maybe you, could start to think about interesting ways to solve the problem. It’s such a wide problem that we are seeing people focusing on anything from improved fertility clinics to fertility predicting tools, all the way to lab-grown eggs and sperm cells. There are options for software ideas, AI tools, hardware products, and new physical clinics, not to mention medical interventions. The future of fertility is going to be crazy exciting and I’m excited to take you on this journey as I learn more about it.

Who am I?

Nothing more than a curious individual.

My background was previously in product & tech helping companies launch new digital products and businesses. I’m currently coaching students on solving global problems. I enjoy learning about new things and occasionally convince myself to hit publish. Over the next few weeks, I’ll be researching and publishing each of these sections.

I plan to approach this as much as possible from the position of curiosity, understanding, and opportunity. I’m not a scientific expert nor am I intending to become one. I’m taking you on this learning journey with me. I’ll be writing to help me understand the issue more deeply and be able to come up with potential ideas to improve the situation.

The next post in this series is live.

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