The first time Ashley Binder went through a surgical procedure to retrieve her eggs for in vitro fertilization, she got some cramps and a bill from her fertility clinic she had to sort out with her insurer. The second time was no less uncomfortable, but instead of a bill, what showed up on her doorstep was a bouquet of flowers and a note of encouragement from her fertility coach, Nicole.
Like a growing number of Americans eager to conceive, Binder is choosing to navigate the complicated, costly, and emotionally charged world of contemporary reproductive medicine with the help of a company specializing in concierge fertility services. With curated networks of preferred clinics, personalized financing plans, breezy beach relaxation retreats, and teams of nurse coaches reachable by text, email, or video chat 24 hours a day, this crop of startups is filling a sought-after need in the modern baby-making experience—the human touch.
“This whole experience of going through infertility treatments can feel really kind of cold and alienating,” says Binder. Even at a clinic that she says provided great care, there was always a rush to be in and out of the exam room. Amid all the poking, prodding, blood-drawing, and ultrasounding, it was hard enough to get questions answered about her physical health, let alone how these treatments were making her feel. “It’s a really long and lonely process, and just getting medical advice isn’t enough for most women. It certainly wasn’t enough for me.”
In December 2017, Binder signed up with Future Family, a San Francisco startup that offers personalized financing plans to simplify any fertility-related doctor’s bills into a fixed monthly payment. It also gave her 24/7 virtual access to Nicole, one of the dozen or so registered nurses Future Family employs as dedicated fertility coaches. At that point Binder, who lives in Raleigh, North Carolina, had been trying to start a family with her husband for nearly six years. Their first forays into IVF were covered by her employer’s insurance plan, but after just one cycle she maxed out her lifetime benefits. With no eggs left to try, they were going to have to pay for the next round out of pocket—which costs around $20,000, on average. Binder had heard about Future Family in a meeting of her local infertility support group, and decided to give it a try.
Binder is exactly the kind of person Future Family’s CEO Claire Tomkins set out to help when she launched the company in 2016. A former Silicon Valley solar energy exec, she had spent years wading through the financial and medical complexities of IVF herself and was looking to create for other women the experience she never had. The company quickly had more interest than funds available and had to put customers on wait lists. After securing a $100 million credit line last year, Future Family was able to make its monthly plans accessible to many more people. But in the last six months, the company noticed something unexpected. About 70 percent of the people signing up for a free consult with a Future Family nurse—the first step in setting up a plan—had never even been to a fertility clinic.
“People are no longer starting their health care journey at a doctor’s office, they’re starting it online,” says Tomkins. “We didn’t realize people needed help to just take the first step.”
Capitalizing on the dearth of a trusted internet fertility authority, this month Future Family changed its approach. Instead of offering a free consultation ahead of a fertility financing plan, it now offers an annual membership of $199 that gets people started on their “pathway to parenthood,” as Tomkins puts it. The fee covers doctor matching within Future Family’s curated clinic network, and two and a half hours of time with a fertility coach. That might not seem like a lot, but compared with how much time people spend Googling for answers and sorting through the results—the top hits for searches like “Am I infertile?” include sites operated by British tabloids and lube manufacturers—Tomkins says it’s actually a pretty good deal. “It’s hard to get trusted information out there.” Then when members are ready, they can upgrade to a Future Family payment plan, which comes with unlimited coaching staff access.
Other fledgling firms have seized on the idea of shepherding customers out of the wild Google hellscape and into safer digital spaces. In 2016, a San Francisco couple launched FertiltyIQ, a website aimed at helping prospective parents assess fertility doctors and clinics. Besides the Yelp-like reviews and rating system, it also compiles statistics and scrapes new studies in the fertility literature to compile that data into easy-to-read chapters on things like getting pregnant with endometriosis, and what to do about genetic screening. Opionato, also in San Francisco, earlier this year began offering a $9.99 fertility assessment—a survey that asks questions about your age, weight, periods, sexual relationships, family history of disease, and past fertility treatments—and assigns you a “fertility profile” with information about your parenthood potential and limitations. For an additional $75, you can get matched up with one of Opinionato’s fertility experts for a 30-minute phone call, and access to them via email for follow-up questions for 30 days.
Carrot Fertility, yet another SF-based startup, works directly with companies like Netflix and Foursquare to provide customized fertility benefits to their employees. This includes people whose situations often fall outside of traditional insurance coverage, including same-sex couples, single parents, and women seeking proactive egg freezing. If your company provides fertility benefits through Carrot, you also get unlimited access to its full-time team of care navigators and legal experts.
Then there’s the growing world of boutique egg-freezing operations Instagrammable enough for their majority-millennial clientele. Take Trellis, a “women’s fertility studio,” with a flagship location in New York City and a plan to roll out nationally this year. Vogue describes Trellis as combining the convenience of concierge medicine with selfie-worthy Richard Serra-esque architecture and inspirational Michele Obama quotes. Or newest-comer Ovally, which whisks groups of young women away to Spain for egg-freezing operations that cost up to 75 percent less than in the US, with 100 percent more Mediterranean beach holiday vibes. The three-month-old medical tourism agency also assigns customers personal fertility coaches to guide them through the procedure, according to Forbes.
Crystal-clear pricing plans, curated glossy content, coaches available at your every beck and call: These services are lending a new psychological sheen to the often stigmatized challenges of infertility. They sell pregnancy as a luxury good—empowerment, not anxiety. But throwing a warm gauzy filter over a clinical experience doesn’t change the fact that fertility treatments are medical procedures, and crafting a personalized journey to parenthood can come with risks to your privacy.
“Creating greater access for people who have not had it historically and creating a friendlier, more emotionally aware support system for people going through the emotionally fraught process of fertility treatments is generally a really good thing,” says Karen Levy, a sociologist and lawyer at Cornell University who studies the social, legal, and ethical dimensions of emerging technologies, including digital fertility apps. “But if you change the context of medical information into something that no longer looks like a doctor’s office, you’re likely to destabilize assumptions about what kind of data this really is.”
Support service companies like Future Family, Opionato, and Ovally may employ nurses and fertility experts, but they themselves are not medical services providers. Which means that the data they collect are not subject to the Health Insurance Portability and Accountability Act, or HIPAA—the federal law that protects the privacy of medical records. Their privacy policies also give them wide berth to strip your data of identifying characteristics and share or sell it in aggregate to third parties, including advertisers, potential business partners, researchers, and regulators.
“Fertility data is loaded with super-sensitive, extremely intimate information,” says Levy. It’s not like browsing for shoes and then seeing Google serve you ads for those later. Things you tell a fertility coach or type into a fertility profiling survey will have details about your sexual preferences and activity, as well as health information that can make you vulnerable both emotionally and medically. That’s why Levy says it’s important to be aware that data breaches happen routinely, and that privacy policies can change at any time.
Future Family says the company is not currently recording any of its coaching sessions, or selling aggregated data in any form. Opionato also denied sharing or selling aggregated data at this time. A spokeswoman for Carrot said the same thing: “This is not and never will be our business model.”
This kind of personal privacy calculus has now just become a daily part of digital life. For people like Binder, the risks were more than worth it. In February, she finally gave birth to a baby named Eliza. She says she and her husband will be paying off the successful round of IVF over the next few years, as part of their Future Family agreement. But in the end, she says, it was having a person she could call when when late-night anxieties hit, or medication didn’t arrive on time, that turned out to be what she needed most.