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From the file

Big Egg | Big Egg is booming. Global birth rates are crashing and women are choosing to have children later in life. Private fertility clinics are drawing more investment than ever – and it’s easy to see why.

Hatching the egg

Hatching the egg

Meet the new generation of pioneers in fertility science, technology and ethics

In the 1970s and 80s, fertility science was brand new. Back then, the very idea of a “test tube baby” was a wild concept fraught with controversy as doctors and researchers pushed at the boundaries of scientific possibility. Decades on, the field has not lost that pioneering edge.

But the field is changing – and the focus shifting. The new fertility pioneers include tech experts and campaigners, investors and AI specialists. And with any luck they’ll continue to make the sector even more inclusive.

The High-Tech Embryologist

Name: Dr Cristina Hickman
Position: Chief Scientific Officer, Apricity

“I have a fascination with the science of how life begins,” says Dr Cristina Hickman, an embryologist and chief scientific officer at Apricity, an AI-driven fertility startup. Hickman started out as a marine biologist before training as an embryologist at the Roslin Institute for animal research, the facility where Dolly the sheep was created. She began working with human patients at Simon Fishel’s CARE Fertility Group, where she helped develop time-lapse imaging technology, an IVF “add-on” that’s still in its early stages but that looks promising based on existing research.

Labs use time-lapse imaging to monitor and photograph embryos in 10-minute intervals. Apricity hopes that artificial intelligence can be used to process the data collected and in turn predict whether an embryo will successfully implant. It’s also using AI to analyse patient information stored on the UK’s HFEA database and employing secure blockchain technology to collect data from partner clinics around the world. The aim is to give future patients personalised fertility predictions and treatment suggestions based on similar cases.

The Founder

Name: Afton Vechery
Position: Co-founder and CEO, Modern Fertility

Afton Vechery, the thirty-one-year-old founder of Modern Fertility, a mail-order fertility testing company, wants to make hormone testing affordable and accessible so that women can get to grips with their fertility levels long before they decide to have kids. As well as an at-home finger prick hormone test, the business offers users an online breakdown of the results and a chat with a fertility nurse to talk through the numbers.

Vechery knows a thing or two about the consumer potential in this area: before founding Modern Fertility she was a product manager at 23andMe, an at-home genetic testing business. And like 23andMe, Vechery’s new venture isn’t without controversy. Although the hormones that Modern Fertility tests for are a reasonable indicator of a woman’s egg reserves, they aren’t a brilliant predictor of whether or not a woman will be able to get pregnant later on.

Still, investors clearly rate the startup: it has raised $22m in funding, including $15m from Kirsten Green of Forerunner Ventures, the VC behind millennial-focussed Glossier.

The FemTech CEO

Name: Lea von Bidder
Position: CEO and co-founder of Ava

Lea von Bidder is another fertility tech wunderkind. In 2015, aged 27, von Bidder helped found Ava, a Swiss FemTech startup, alongside Pascal Koenig, Philipp Tholen, Peter Stein – all seasoned businesspeople. Earlier this year, von Bidder became CEO.

Ava’s product is a wearable fertility tracker bracelet and smartphone app which is designed to help women get pregnant. The tracker monitors skin temperature, pulse and breathing – among other measures – to establish which days in a woman’s menstrual cycle she is most likely to get pregnant.

The Gynaecologist 

Name: Dr Juno Obedin-Maliver
Position: Assistant professor of obstetrics and gynecology, Stanford University

Dr Juno Obedin-Maliver is among the world’s foremost experts on sexual and reproductive health for LGBTQ+ people, especially transgender people. Obedin-Maliver trained as a doctor at Stanford University where she is now a faculty member and co-directs the PRIDE study, America’s first large, longitudinal health survey of over 20,000 gay, lesbian, bisexual, transgender and non-binary individuals.

Her research focuses on the inclusiveness, accessibility and safety of pregnancy care for transgender and non-binary people; the inclusion of sexual and gender minorities in medical education and the quality of healthcare for LGBTQ+ communities.

Medical care and science, including family building and reproductive care, “has not caught up with people’s realities,” she says, something her research aims to change. LGBTQ+ families “need to be supported and yet our system is not built to support people.”

A practicing doctor, Obedin-Maliver also serves LGBTQ+ people seeking to build families now and in the future, helping them to choose the right course of treatment.

The Scientist 

Name: Professor Mitinori Saitou
Position: Department of Life Science Frontiers, Kyoto University

Within the next few decades, scientists will be able to take human skin cells and transform them into viable sperm and egg cells. This technology, called in vitro gametogenesis (IVG), could open up a world of possibilities for infertile and same-sex couples to have biological children related to both parents.

The technique sounds futuristic, but at Professor Saitou’s Kyoto University lab it’s fast becoming a reality. In 2011 his lab managed to grow mouse sperm from stem cells and use them to breed healthy mouse pups. A year later, they’d cracked how to make mouse eggs using the same technique. Two years ago, Saitou’s lab produced human eggs from blood stem cells and matured them in an artificial ovary created out of mouse cells. The eggs remained too immature to create a viable human pregnancy but the experiment was a massive breakthrough.

So we know they probably can. But should they create artificial human gametes? IVG will likely need another decade of research and several more of safety testing, but some medical ethicists are already concerned. The fear is that IVG will make possible the ultimate level of designer baby creation: testing an unlimited number of embryos and selecting the most desirable one.

The Ethicist

Name: Sonia Suter
Position: Professor at George Washington University Law School

Sonia Suter is the Kahan Family Research Professor of Law and Founding Director of the Health Law Initiative at GW Law. Before attending Law School she earned a master’s degree in human genetics, and her work combines those two strands: she focuses on legal issues in medicine and genetics as well as bioethics.

Earlier this year she was chosen as one of 17 essayists published in the Editors’ Choice 2020 edition of the Journal of Law and the Biosciences, for an article exploring emerging reproductive technologies (like preimplantation genetic diagnosis) and their ethical impact on future parents’ decision making – particularly when related to predictive information about embryos. She has also written extensively on IVG, mentioned above, and is a frequent commenter on reproductive rights in the USA.

The Financier 

Name: Dr Christina Jenkins
Position: Lead Investor at Portfolia Femtech Fund

When Portfolia launched its FemTech Fund back in 2018, it was the first venture investing platform in the US to invest exclusively in technologies and products focussing on women’s health. It has a broad focus: from pain management devices to fertility trackers via vaginal health start-ups, lead investor Christina Jenkins is keen to push forward a sector that’s historically been overlooked. Interest in – and demand for – FemTech might be increasing, she told Forbes earlier this year, but there’s still a way to go. Particularly for comparatively untapped areas like menopause and women’s life-long mental health.

Before Portfolia, Jenkins had a background in health. She earned a medical doctorate from Northwestern University and went on to serve as Director of NYC Health + Hospitals, the largest public hospital system in the US, and as founding CEO of its subsidiary OneCity Health Services.

The Campaigner

Name: Trystan Reese
Position: Founder of Trans Fertility Co.

Trystan Reese’s family is one of the most important pillars of his life. Reese and his partner Biff are dads of three: in 2015 the couple adopted Biff’s niece and nephew. A few years later Reese, a transgender man who was assigned female at birth, gave birth to the couple’s biological child, a baby boy.

Since starting his family, Reese has worked to campaign for family equality and reproductive justice for LGBTQ+ communities. Reese served as the Director of Family Formation at Family Equality, a nonprofit, and recently founded Trans Fertility Co, a resource and training hub for transgender people and healthcare providers.

A big portion of his work involves raising awareness about fertility preservation options for transgender people as transition-related hormone therapies and surgical treatments can lead to a loss of fertility for transgender men and women. Knowing that there are transgender people who did not realise that having a family was an option available to them is a great sadness for Reese: “I am motivated every day to change that reality.”

Additional reporting by Claudia Williams.

Next in this file

The golden egg

The golden egg

Young women are being offered the chance to delay the menopause. The question is: does it work, and does anyone even want it?

12 of 12