Fertility-Tech, Cake or Death and Storytelling

There's one thing, and one thing alone, that comes to mind for me: the ability to tell a story. When you're the founder of a company, when you're the CEO, your whole job is telling your story — telling it in a way that gets you employees, that gets you your first hire, that gets you your first check, that gets you your $20 million Series A. Your whole job is seeing that story and then telling it in a way that hooks people in. If there's one thing I bring into my job from the advertising world, it's that.

One of the things we specialised in as an ad agency was positioning. When you can position something in context and help people make sense of what it is, you immediately let them connect to it in a much more meaningful way. So we did a lot of work positioning technologies in terms of: what's the impact this has on people's lives? What's the change? That can be anything and everything — but you have to know your audience. Who are you talking to? If you don't know who you're talking to, who you're selling to, who you're pitching to, how are you going to craft a story that resonates with them? So the first thing I always look for is: who's your audience, and do you know them? What are they looking for? If you know that, let's go and craft the story.

One of the least appealing products we ever worked on was offshore oil and gas platform inspection drones. Buzzword bingo, I know — but let me break it down. When you have an oil and gas rig offshore — say in the North Sea, off Scotland — they run inspections. Usually they take a guy, hook him up, hang him off the side of the rig, and get him to look at what's called the jacket. What we did with this drone company was, rather than hanging a human off the side of a platform in the North Sea in horrible weather and 20-foot waves, you just fly a drone out and do the inspection remotely.

Is that a sexy product? Absolutely not. But when you're speaking to people who run oil rigs, one of the number one things in the oil field is a zero-tolerance culture around poor safety habits. They're safety-first. So the minute I know my audience — I know they're obsessed with safety, I know there are zero-tolerance policies — I can craft a story about how this is a leap forward in the safety of the operators doing the inspection. And inspection itself is critical to making sure the platform doesn't have any issues, which again bleeds into that safety story. We created beautiful campaigns off the back of that, that were really powerful for that audience. Now, if you're a banker down in London, do you care? No. So don't put that story in the Financial Times — that's not your audience. Know your audience, know where they're looking, know what they want to hear, and craft a story around that.

I'm never going to trash-talk colleagues and people in the industry — life is hard enough as it is. But the one thing I see that's pretty common is that people advertise the feature rather than the benefit. And boy, are people in healthcare susceptible to that. We talk so much about our innovation, our product, our idea — we really do. What we forget to do is position it in context: what's the benefit? What are people actually getting from it? I catch myself doing it. I talk about the Béa treatment kit as this incredible thing — but when people buy a treatment kit from us, they're not buying a piece of hardware. They're buying the chance to start a family. You have to understand what people are really buying from you. I see a lot of companies selling a feature.

It's a great question. I didn't necessarily feel like I was making the world a better place — I mean, is creating better marketing campaigns for wind turbines making the world a better place? Maybe not. But the people working on those things — I'd go to bed thinking, you know what, I did a good job on that campaign, I made their lives easier, I helped that team, I helped that human. It was a different scale of impact: making one person's life a little bit easier that day, as opposed to making a positive impact on the world. I've got to say, I prefer being able to make a positive impact on the world.

I met David completely randomly. I went to a networking event with my best friend's husband, and I met a lawyer there who introduced me to David — because she'd seen a Facebook post he'd put out looking for a co-founder. She and I had a great conversation, and she said, oh, I saw this post from David, you should connect. So she connected us. At the time I was trying to figure out what I wanted to do, working on a couple of different things, and David was still working full-time in the clinical world. So neither of us was really full-time focused on building something. But we got along really well. We probably started meeting in real life in late December, early January. And then on the 17th of March, the UK went into lockdown. I incorporated the company on the 30th of March — so Béa is very much a lockdown baby. As are many of the babies my friends had. Similar to the Béa company; different type of baby, but very much created in lockdown.

It was high-risk. It was really high-risk. And candidly, David's since moved on from Béa and back into the clinical world, where he's patient-facing again and doing what he loves. It's a high-risk move — you have to trust, you have to take a leap of faith, and you have to know that whatever comes, you'll deal with it then. If you try to mitigate for everything before it happens, you'll just get paralysed. Sometimes you just have to go. It was hard — it was lonely for the first 14, 16 months, just me working full-time in the company, trying to raise money. That was a whole other saga. It's a lonely and a long journey, and sometimes you just have to step into it and go.

Hate to agree, but — agree. I learned this the hard way when I started raising money for Béa, our pre-seed round. I opened in July of 2020. It took me eight months and 284 conversations to close that round. I started it by listening to Brad Feld's book on Audible three times. Then I sat down in front of my computer and Googled "how to raise money in London." I had no network, no contacts, I didn't know anything about it. I'd read a book three times, and I came into this as a non-technical female founder with no background in the problem space I was addressing. It was a hard round. A network would have at least made the jump-in a lot easier.

For sure. The biggest changes I saw in myself were in the way I told the story, the way I pitched, the things I focused on. I went into that process pretty naive — we all do if you've never raised before. Investors are looking for commercial opportunities, so I changed the way I spoke about the company and the opportunity in front of us. I learned to be bolder. There's a moment where the rejection is coming in so thick and fast — and because at that point it was just me, it feels like not only is the company, the product, the idea getting rejected, you are too. So you grow a really thick skin, you grow up fast, you learn a lot. And honestly, when you eventually close that round and get over that hurdle, you've really accomplished something. The first round can be the hardest, especially if you've never raised before. I have a huge amount of respect for founders who do it. It's a high bar and a tough thing to do.

So today we're not quite on the market. As we've learned, it takes a lot of time to build hardware — especially medically regulated hardware. We're launching in the UK market in July 2023. Right now we have a team of 12 incredible people — I think the team is the best thing about this company, it really is. We're just working on getting our first product to market: a full treatment kit that lets people perform artificial insemination at home. Then we'll look at moving into the US in 2024. So we're head down, purely focused on getting that over the line.

In terms of five years — there is so much to play for in the fertility world. I often liken what we're doing to what happened in dentistry. Dental care used to happen uniquely in a clinician's office. Now you go to the dentist, sure — but you can also go to Smile Direct Club and order a kit, Invisalign, and do what was only possible in a clinician's office in your living room, with these beautifully crafted consumer experiences. That happened in dentistry 10, 15 years ago. It's happening in dermatology now — you can see the race in the VC world to establish a category leader in clinical-grade dermatology delivered at home. Ro is raising $150 million to create a virtual skincare clinic. It's really happening.

The next sector of medicine where this transition to home-based care will happen is fertility. I'm so confident because all you have to do is look at the characteristics of the patient pain point versus the physician interest. Dental care, dermatology, fertility — these are not life-or-death conditions. It's not oncology, it's not cardiology. So physician interest is relatively low. But I guarantee you a teenager with acne is really desperate to solve that problem. A family trying to get pregnant is really desperate to solve that problem. The patient pain point is really high — these people can't get the care they need. So these sectors of medicine are ripe for innovation, ripe for startups taking clinical-grade care out of the clinic and adapting it to deliver in the home.

So where does Béa want to be in five years? We want to lead the home fertility care category. We want to create the category — which we're doing today — and then be out in front, leading it. Let's push the boundaries of what's possible in fertility care at home. Let's create an experience that empowers people from the day they decide they want a family to the day they have the family they always wanted — irrespective of who's in that family. It could be me and a cat and a baby. It could be families as we traditionally know them. It could be mum, mum and John. It could be you with a known donor. We don't care who's in your family. We care that you have the family you always wanted. And boy, would I love it if Béa could be the company that empowers people on their family-building journeys.

There are a couple of things in there I'd love to gently push on. Why do you need to go into a clinic to see an expert? Why can't you just have a consultation on your phone? And on there being multiple causes of infertility — well, if you look at the data, it's a third, a third, a third: male, female, unexplained. So you go into a clinic, tell an expert your lifestyle and what's been going on, and you either do a semen analysis, which rules out a lot of male-factor infertility — which, by the way, you can do at home — or a couple of blood tests on the female side, or it's unexplained infertility. These are all things that can be done at home.

The benefit of moving clinical care into the home, as much as is possible — and I completely understand there are many reasons to go into a clinic, and many people should be going down that clinical pathway, absolutely — but for those who don't need to, there's shame, there's stress. We see people in the US trying to decide how much of their money to spend on IVF versus how much to put aside for the baby they don't even know they're going to have via IVF. Do I blow all my savings on treatment to have a baby I then can't really afford to give much to? Do I hold back and not have the baby in the first place? Clinical care is invasive, it's expensive. Why shouldn't we try, as much as we can, to widen access and affordability to clinical-grade care, so everyone has a chance to access it — not just the few who can go through the doors of the clinic? That's a little of why I think it's so important to think more broadly about what can be done in the home.

I get this question a lot, and it's one of my favourites. I'm not going to speak too strongly here, because there are a lot of very strongly held beliefs in this area. Personally, I'm of the opinion that environmentally, the most responsible thing people can do is refrain from making babies. But societally, I believe the most responsible thing we can do is try to raise more responsible humans who are capable of solving the problems in the world that maybe we aren't — or that we created ourselves. Not fair on them, but there we go. In terms of where we're at as a society, I think it's perfectly important to think about total fertility rate and population replacement rates. There are many countries now that aren't replacing their population, and the impact that will have on future generations is not going to be fun — economically, it could be pretty catastrophic. So societally, I'm not going to say we have a responsibility to make more babies, but I think the societal impact of babies is net positive.

Maybe. The problem we address is affordable and inclusive access to fertility care. A lot of the time, those population-pyramid shifts happen where there are other forces at play — you've got to look wider than merely the problem of accessing clinical care. It becomes societal issues around women starting families later. The average age of first-time mothers in the US and UK is now over 30, 31. People are choosing to go into the workforce, women are getting educated, going to work, starting families later, having fewer children. Those aren't problems we're best placed to solve — those are big structural, systemic issues. It'd be great if we could solve them, but for now we're going to focus on making clinical care accessible and affordable. We'll start there.

Very good question. In the clinical world, there are forces at play beyond just the progression of technology. It's a bit of a tangent, but — a lot of the big fertility clinic chains are private-equity backed, so they're incentivised to be commercial entities. I was speaking to someone on my team yesterday who said the gross margin on fertility treatments in the clinic is 50%. So we could already make clinical care a lot cheaper than it is today. The average spend on fertility treatment in the UK is now up at £14,000 per couple; in the US it's $61,000. That's a lot of money to go and start a family.

What's really interesting to me on cost is that there's been a ton of investment in innovation in clinical fertility care, but we're not seeing a corresponding uptick in the efficacy of IVF. The global success rate of IVF has flattened off over the last 10, 15 years — it's sitting anywhere between 25 and 35%, depending on the data set. So despite all the innovation we're pumping into improving ART, we're not seeing a corresponding uplift in efficacy. What if we started instead to pour that money into optimising the technology so we can drive the cost of care down? Well — then you have a bunch of private-equity-backed fertility clinics making great margins. The incentives are in an interesting place in this sector when it comes to affordability.

Not to be too cynical about it — I honestly do think we're going to see reductions in the cost of clinical care. We're seeing new affordable entrants come into the UK, and Kindbody in the US, creating incredibly affordable fertility treatments. We're going to see market leaders in the clinical world setting price points that the industry then has to follow. I also think we should put some money into figuring out how to drive a step change in the cost of care, as opposed to perpetually just improving what goes on in the lab.

In terms of interesting ideas for companies, I don't have product ideas — but I have areas of medicine I think are fascinating, moving very quickly, and that could really do with more startups shining a spotlight on them. Again, first-trimester care — supporting people through that pivotal first step on the family-building journey. And I think there's a huge opportunity in fertility around looking at longitudinal data on an individual basis. When we look at data sets for female fertility — "fertility drops off a cliff at 35," et cetera — those numbers are based on huge data sets collected over many years. You're looking at an average. But fundamentally, your fertility is unique to you. So there's a pretty significant opportunity in looking at individual fertility: what are the changes I can make? How can I measure the impact of that change on my fertility? How do I track it — what kind of data am I collecting? Something around understanding individual fertility, and the changes you can make at any point in your life to optimise it — and then you aggregate that data, and it would be so powerful. For now I'm focused on Béa — maybe we'll get there — but I definitely think there's something around understanding the individual changes a person can make to their fertility and their ability to reproduce.

Really good question. I try to be quite thoughtful — which can often make you quite slow to execute when you're being too thoughtful. One piece of advice that really changed my life, changed how I operate, I sum up as "cake or death." I was lucky enough to have an advisor who lives in New York and has built and sold four companies — a serial entrepreneur. You don't really find the good ones who've done it four times successfully, but he's one of them, and we're lucky enough to be very dear friends.

We were walking around downtown New York, where it's not on the grid — once you get down towards Wall Street it's a bit of a warren. One of my favourite bakeries is down there, but I couldn't quite remember where. So we get to a junction and he says, left or right? I say, well, I don't know — you know where this bakery is, not me. He says, left or right? I say, okay, left. We go left, get to the next street, and he says, left or right? I say, I don't know where this is. He says, left or right? I say, okay, right. And he summed it up so beautifully. He said: when you get to a junction, it's not a question of choosing between cake on the left and entering a burning building on the right. It's never cake or death. Just make a decision — because it's your only opportunity to course correct, to move forwards, and to learn. I now tell this to my team: if we're not making decisions, we're not moving forward, we're not course correcting, we're not learning. And if you have to take three lefts where you could have taken one right — imagine the things you'll learn along the way. It's never a wasted journey, as long as you're always learning and always course correcting.

That was one of the pieces of advice I received early on that changed a lot for me. It took a lot of the fear out of the decisions I had to make. As a founder-CEO, your job is to make decisions, and it can feel so heavy — you've got a team you need to pay, and if you get it wrong you lose your team, you're not going to get to market, you're not going to raise, et cetera. That felt like such a heavy responsibility. But taking that away and realising that every decision is not life or death — it's an opportunity to learn and to move — suddenly made me a lot better at making decisions. That's the one piece of advice that made the greatest impact on me as a leader.

Yeah. Brad Feld's Venture Deals — if you're raising, that's the bible. The Hard Thing About Hard Things by Ben Horowitz — I read that about once a year. My favourite thing about reading it once a year is that different things resonate each time; it's a wonderful opportunity to reflect on where I am in the journey based on what's resonating most. Those two are really fantastic. First Round Review puts incredible content into the world. There's a newsletter I'm on called Wherewithal that's really great. We live in a lucky time — there's so much information out there. But my top two would be those: The Hard Thing About Hard Things and Venture Deals. And First Round Review is a pretty good spot too.

Sometimes I wish I was a little bolder. But then I reflect on that and realise that being a bit more intentional, thoughtful and slow is one of the things that's allowed Béa to be what it is today. So I oscillate on whether I do or don't wish I was bolder — but I definitely wish I'd developed a thicker skin earlier in the journey. That would have been helpful.