Mommy and Data

In 2009, Piraye Yurttas Beim, a molecular biologist from Texas, started pitching investors on her vision for a new kind of women’s health company. The startup she had founded, Celmatix, would bring the power of big data and cutting-edge genetic testing to bear on a problem that had long resisted comprehensive understanding and reliable treatment: infertility. Beim was 30 years old, and she had recently completed her Ph.D. at Weill Cornell Medicine in New York City. She found herself surrounded by women in their thirties who, like her, were highly educated, successful in their careers, and childless. She kept hearing stories from friends and colleagues who failed multiple rounds of fertility treatment, and they didn’t know why. “Very few of my friends just got pregnant with no issues or miscarriages. Most of them had harder paths than they thought they were going to,” Beim told me. “The universal feeling was, ‘Why didn’t anyone tell us this was a possibility?’”

It was a bad time to go searching for startup capital. The U.S. economy was still reeling from the global financial collapse, and investors showed little enthusiasm for backing a women’s health company, especially one with interests as esoteric as genetic testing for infertility. “What I was hearing from the investment community was, ‘This is so niche. We go after things like diabetes,’” Beim recalled. Venture capitalists couldn’t get excited about a business that catered only to women. Being a female founder trying to make inroads in the notoriously male-dominated tech world likely didn’t help; just 2 percent of venture capital dollars go to female-led startups. “The math suggests that maybe the fact that I was a woman may have made it a bit harder,” Beim told me. “I don’t know. I’ve never fund-raised as a male.”

Ten years later, however, the cultural and economic landscape has shifted. The conversations Beim was having with her friends around the dinner table about balancing career and family have pushed forcefully into the mainstream. Today, more women are working and pursuing higher education than ever before, and they are waiting longer to have children—if they decide to have children at all. According to the Centers for Disease Control and Prevention, the birth rate in the United States has fallen to its lowest level in 30 years, and the number of American women having children in their thirties is now greater than the number of women having children in their twenties.

As a result, women’s infertility can no longer be considered “niche.” Today, one in six couples in the United States has trouble conceiving, and 7 million women seek infertility services every year. Egg-freezing, once an experi​­mental procedure designed for women with serious medical conditions like cancer, has become a major industry worth $1.9 billion. Despite the demand for fertility treatment, however, women still lack good, detailed information about their reproductive health, and the treatment options available to them are expensive and often unreliable. Although medicine has made great strides over the past 20 years toward helping couples have children, the chance of having a baby through in-vitro fertilization (IVF) remains low: just over 20 percent for women under age 35, according to the CDC, and just 4 percent for women over 40. Twenty percent of couples who struggle with infertility never learn the cause.

In response to these cultural changes, Silicon Valley, once again flush with cash, has set its sights on women’s reproductive and sexual health. In recent years, “femtech” companies have brought to market a wide array of products and services that are advertised as helping women along the path to self-determination
and healthy, sustainable lifestyles. Women can now purchase menstrual cycle tracking apps and gadgets (“Fitbit for your period”); organic, chemical-free, reusable, and home-delivered feminine hygiene products; at-home fertility tests; urinary tract infection-preventing pink-lemonade powder; apps that deliver birth control and antibiotics (for the UTIs that can’t be prevented); and much more. The research and consulting firm Frost & Sullivan recently predicted that the femtech market will be worth $50 billion by 2025.

A common thread among these companies is agency: giving women an opportunity to participate in a fundamental, and at times mysterious, biological function. Ida Tin, the founder of Clue, one of the most popular period-tracking apps on the market, touts her product’s ability to help women “discover how to live a full and healthy life,” as she writes on her company’s web site: “Every single data point you enter and share empowers you to be in charge of your health.” Modern Fertility, which offers a hormone test that allows women to estimate their egg reserves, advertises itself as a reassuring answer to a question that causes many women an enormous amount of stress: Will they be able to have children later if they wait? “Whether you’re years away from kids or thinking of trying soon, we’ll guide you through your fertility hormones now so you have options later,” Modern Fertility says on its web site.

Celmatix similarly offers women “peace of mind,” “clarity,” and the ability to “be proactive” when it comes to their reproductive decisions. It’s a message that has resonated with investors and made Celmatix a leader in the femtech industry. In 2016, Fortune named Beim one of the 15 entrepreneurs disrupting their industries. In 2017, Fast Company deemed it one of the most innovative companies of the year. And in 2018, Business Insider placed it on its list of startups that Silicon Valley venture capitalists predicted would “boom” that year. Overall, Celmatix has raised $72 million in funding.

It’s possible to view the whole notion of femtech as little more than a modern gloss on the health and beauty industry, applying a veneer of feminism and technology to age-old appeals to women’s anxieties and insecurities. (Example: Fur, a line of pubic-hair grooming aids.) With her scientific background, however, Beim believes she can truly help women better understand what is going on with their bodies—and maybe even help them have children. “We aren’t trying to create an existing model, like an Uber for X,” Beim told Fortune. “We have built something entirely new.”

The idea for Celmatix came to Beim soon after she had completed her Ph.D., as she was finishing the first year of a postdoctoral fellowship at Cambridge in 2009. She was living in a small apartment under the eaves of a building that overlooked the river Cam, and she rode her bike each morning to the Gurdon Institute, a research facility specializing in developmental and cancer biology. The decoding of the human genome in the early 2000s sparked incredible advances in cancer diagnosis and treatment; doctors were able to analyze tumors on a molecular and genetic level and create personalized treatment plans for their patients, offering more effective remedies with fewer side effects. Beim had spent her years at Weill Cornell studying the connections between genetics and cancer, trying to figure out why a particular cancer drug was lifesaving for certain patients but useless, or worse, for others. “I was really on the front lines of the precision medicine revolution in oncology,” Beim said.

Beim wondered how these scientific advances were being used to treat infertility, but to her surprise no one was studying it. She feared it would be decades before women would have the same kinds of detailed diagnoses cancer patients now receive. “There’s no reason why we should approach women’s health two decades into the post-genomic era the same way that we did in the pre-genomic era,” she told me. So she de­cided to shift her focus from cancer research to women’s reproductive health. “I had this ‘Aha’ moment where I realized, this is not happening in this field,” Beim said. “This is my calling.”

Beim dropped out of her postdoc at Cambridge, moved back to New York, and spent the next several months sleeping on friends’ couches while she launched Celmatix. She traveled light, whittling her belongings down to what could fit into a single suitcase.

In order to build its genetic test, Celmatix had to document the known connections between fertility and genetics. There is little information about how various aspects of women’s health—medical history, family history, lifestyle choices—contribute to or correlate with fertility, so Beim set out to build a data set from scratch. She hired scientists and researchers to scour medical journals for relevant information, and she partnered with fertility clinics around the country to combine their patient information into a single database. Until that point, the information available to fertility doctors was limited to the data from their individual clinics, as well as their anecdotal experience. By combining information from multiple clinics, Beim hoped to be able to calculate more accurately whether, when, and how a couple would get pregnant. Celmatix’s data set is now the largest database about reproductive health in the world.

In 2015, the company released its first product, Polaris, custom software that allows fertility clinics to compare a couple’s health information with the data Celmatix had collected and develop an appropriate treatment plan. Polaris can forecast how likely a couple is to get pregnant using different treatment methods—intrauterine insemination versus in-vitro fertilization, for example. It can assess the probability of twins or triplets. And it can calculate the probability of having a child when couples repeat treatments or move on to new ones. In 2018, Celmatix also launched MyFertility Compass, a free online tool that offers couples similar information.

Not only can this analysis help fertility doctors pursue more effective treatments, it can also help couples plan financially. If a couple has a better chance of conceiving after one round of IVF than three rounds of IUI, for example, Celmatix might suggest that a couple try IVF sooner, because doing so could save money or allow for more rounds of treatment. Alan Copperman, the medical director of Reproductive Medicine Associates of New York, one of the top fertility clinics in the country, uses Polaris to help couples set expectations. “There’s so much anxiety that goes along with fertility treatment,” Copperman said. It can be grueling, with high physical, emotional, and financial costs. With Polaris, you “can’t always fix it, but you can help them see what their journey is going to look like or what it’s going to take to achieve success.”

Right now, Celmatix’s data only addresses fertility, but the company has a partnership with the genetic testing firm 23andMe that gives Celmatix access to a cache of data about other elements of women’s health as well. Beim told me she hopes to eventually help women navigate not just fertility, but their lifelong health. “From the first decision she’s making about what contraceptive should I use, or how do I manage my endometriosis, all the way out to the menopause transition,” she said. Beim has big ambitions. “This is the beginning.”

At the same time that Beim was launching her business, she was also reckoning with her own family planning. Not long after she founded Celmatix, she went to a friend’s dinner party. There she met a venture capitalist named Nicholas Beim, who, among other projects, was supporting entrepreneurs in Turkey, where Piraye was born. Three months later, she joined him on a business trip there; two months after that, they were engaged. Within eleven months of meeting, they were married.

Beim was 32 at the time, and just as they had approached their relationship with alacrity, she and Nicholas knew they wanted to start a family right away. Shortly after their honeymoon, Beim found out she was pregnant. The couple happily shared the news with family and close friends. Their early enthusiasm turned to grief, however, when the pregnancy ended in a miscarriage. As a scientist working in women’s health, Beim was well aware that 15 to 20 percent of pregnancies end in miscarriage. Still, she was devastated.

The couple kept trying to get pregnant for another year and a half before Beim went to see a doctor. She looks back on this time as a period of avoidance that she now wishes she could take back. “Not knowing doesn’t make it change or go away,” she told me. A hormone test revealed that she had diminished ovarian reserve—a condition that affects between 10 and 30 percent of women who experience infertility. Women with diminished ovarian reserve have fewer eggs, and it’s harder for them to get pregnant, either naturally or with IVF.

Beim sought a second opinion. That doctor diagnosed her with endo­metriosis, a painful disease that can also affect a woman’s ability to have children; about 40 percent of women with endometriosis find it difficult to get and stay pregnant. Beim’s doctor, however, advised her to try to conceive naturally for six more months before investing in IVF. Beim researched natural ways to boost her fertility and made changes to her diet. She was pregnant with her first son within a month.

Because Beim knew her egg reserves were low, she and her husband decided to expand their family as quickly as possible. Beim gave birth two more times in the next three years. She now has two sons, ages 4 and 5, and a daughter, who is 1. Photographs of Beim from early articles about Celmatix often show her holding her round belly or nuzzling an infant. Beim has spent most of her years as CEO pregnant or breastfeeding.

Beim cites her own miscarriage and accelerated family planning as a huge influence on Celmatix. “I had three kids in four years, in part because I understood my metrics and I understood that if I wanted to have a family, then I wasn’t going to be able to space my kids very far apart,” she said. “If I had had this information earlier in my life, there are other things that I could have miti­gated. I could have lived a much healthier lifestyle. I could have started my family much earlier so I wouldn’t have had to get it all done under the gun before I fell off a fertility cliff. It worked out for me. But it could have not.”

Many tech startups are closely identified with their founders, and it certainly doesn’t hurt Celmatix to have Beim serve as the company’s face: a woman who, by closely analyzing her own health, was able to make informed decisions and overcome her fertility problems to have the family she wanted. This is the narrative that Beim is selling: In the face of uncertainty and the dreaded biological clock, Celmatix can give women valuable information, a sense of control, and a path toward motherhood.

But Beim’s story also highlights some of the contradictions that she and Celmatix embody. Celmatix aims to disprove the idea that older women can’t have healthy children or that infertility is the result of poor lifestyle choices. The “fertility cliff” that women supposedly hit when they turn 35 isn’t an insurmountable obstacle, the company suggests, but something that can be navigated on an individual basis through science and data. For some women, however, having more detailed information about their fertility doesn’t necessarily lead to feelings of empowerment; knowing more about one’s reproductive limitations can just as easily cause anxiety and grief. Neither Celmatix nor any other femtech company can avoid the fact that fertility changes as people age, for both men and women. Despite Celmatix’s assurances, the biological clock is real, and the outcomes aren’t always as positive as they were for Beim.

In 2017, after eight years of development and a lengthy approval process, Celmatix finally released its proprietary ge­­netic test, called Fertilome. By examining 49 variants in 32 genes, the test can help identify a variety of fertility disorders, including polycystic ovarian syndrome, endometriosis, recurrent pregnancy loss, and primary ovarian insufficiency—a rare condition that occurs in approximately 1 percent of women and causes premature menopause. The test requires a simple blood or saliva sample. Women can request it through a physician for $950. Patients receive a detailed report on each of their tested genes, indicating a strong, moderate, or weak risk for a reproductive condition.

Beim was one of the first women to take the Fertilome test. The results confirmed what her doctors had suspected: She had genetic markers associated with endometriosis and primary ovarian insufficiency, as well as alterations in key genes that make it harder for her body to regulate inflammation, which affects whether an embryo will implant cor­rectly in the uterine lining.

Fifteen months after the test launched, more than 100 doctors around the country had ordered it for their patients. One of Celmatix’s customers is a 35-year-old woman named Amie, who requested that her last name not be published to protect her privacy. A nurse at a neonatal intensive care unit in San Jose, California, Amie always knew she wanted to have children. “At least one boy and one girl,” she told me. She had never really experienced any menstrual issues until she was 29 or 30, when her period became irregular. A specialist diagnosed her with diminished ovarian reserve, one that was “more reflective of someone who might be menopausal.” No doctor was able to tell her what might be causing her condition or how to treat it.

When Amie got married in 2015, she and her partner decided to try to have children right away—“because I knew there might be some challenges,” Amie said. A year of trying came and went. Then, in 2017, she visited a fertility doctor, Aimee Eyvazzadeh, in San Ramon, California, who suggested that Amie take the Fertilome test. The results showed that Amie had a genetic variant that may decrease follicle stimulation—the cause of her low egg reserves. “There was nothing that I could have done to prevent it,” Amie said. “It gave me a lot of closure.”

It also gave her doctor new ideas for treatment. Because Amie’s ovaries don’t naturally produce mature eggs, Eyvazzadeh stimulated her ovaries with oral medications and estrogen patches. An ultrasound revealed one promising follicle. “The doctor said, ‘This is your golden egg,’” Amie told me. She got pregnant using IVF and gave birth to a baby boy in May. Her baby is already sporting a double chin and “juicy thighs,” Amie said. She said she’s enjoying every aspect of motherhood so far.

Things don’t always go so well, however. Leah Kaye, formerly a reproductive endocrinology fellow at the Center for Advanced Reproductive Services at the University of Connecticut School of Medicine, told me about a patient at the clinic, Elizabeth (not her real name), who is 38 years old. She and her husband had tried intrauterine insemination three times without success before moving on to two failed rounds of IVF. At that point her doctor recommended that Elizabeth try the Fertilome test. It suggested a genetic variant in Elizabeth’s androgen receptor, which could potentially influence the function of her ovaries and uterus. In response, her doctors prescribed a course of progesterone and some additional androgen before transferring the next embryo. The procedure was a success—Elizabeth got pregnant for the first time, with twins—until it wasn’t. The pregnancy lasted just seven weeks. Elizabeth hasn’t been back to the fertility clinic since.

I remarked to Kaye how wrenching Elizabeth’s story was. Her response was gentle and open-minded. “We try to remind our patients after a setback like this that families can grow in all sorts of ways, not just the more conventional ways we learn about growing up,” she said. “When a couple wants to have a family bad enough, we always reassure them that they will make that family, in one way or another, even if it wasn’t by the exact route they initially envisioned.”

That honest acknowledgment of the limits of biological science runs counter to much of Silicon Valley’s sloganeering. For all its innovative science, Celmatix isn’t offering a cure, much less a treatment, for infertility. For now, the most Celmatix can do is give doctors a hint about what might be wrong. All the doctors I spoke with emphasized that Fertilome may help an experienced reproductive endocrinologist identify new pathways or tweaks for treatment, but no one could say for sure whether this information would lead to the birth of a healthy baby. Brian Levine, the director of CCRM New York, part of a respected chain of fertility clinics, calls Fertilome “a highly refined Ouija board.” It might point women in the direction of answers—but it might not.

There are reasons to be skeptical about the booming femtech industry. In 2014, a company called Ovascience claimed to have identified “egg precursor” cells, which it said could improve a woman’s chances of conceiving children and even pause or reverse the biological clock. In 2016, Wall Street valued the company at $1.8 billion. Yet no reputable studies have been able to support the company’s claims, and scientists have expressed doubt about whether such cells even exist; in late 2016, Ovascience’s valuation dropped to $47 million. In 2015, another company raised more than $160,000 on Kickstarter to produce the world’s first “smart” menstrual cup, outfitted with a Bluetooth sensor that would signal when the cup needed to be emptied. The campaign went viral and garnered favorable coverage from Fortune, Slate, Jezebel, and others, but more than two years after the cups were supposed to ship, the company is still doing preliminary testing.

Period-tracking apps have also caused controversy. In 2015, Glow, a popular app backed by PayPal co-founder Max Levchin, claimed that it had helped more than 150,000 couples get pregnant—a figure that experts criticized as questionable. A year later, Consumer Reports showed that Glow’s lack of security features exposed women’s data to significant privacy threats. (The company quickly moved to correct this.) A 2016 study in the Journal of the American Board of Family Medicine found that many popular period trackers did not accurately predict when women were most fertile. Then, in 2017, a much-hyped Swedish fertility tracking app called Natural Cycles was certified in the European Union as a contraceptive after a major study found that it was 99 percent effective at preventing pregnancy during “perfect use” and 93 percent effective during “imperfect use”—roughly on par with more established forms of birth control, like the pill. By tracking a woman’s basal temperature, the Natural Cycles app makes predictions about when a woman is most likely to be ovulating and gives either a red light or a green light on whether it is safe to have unprotected sex. Soon after, a Swedish hospital reported that 37 women who had recently sought abortions there were using Natural Cycles as their sole form of birth control. The Swedish government investigated, ultimately determining that the number of unwanted pregnancies was in line with the product’s advertised “typical use” failure rate. Despite the controversy, the Food and Drug Administration approved the app in August for use in the United States.

The shadow of Theranos also looms over health care startups. Elizabeth Holmes, Theranos’s CEO, convinced the world that she had developed the technology to perform dozens of medical tests with a single drop of blood—claims, it turns out, that were complete fabrications. Last March, the Securities and Exchange Commission charged Holmes with massive fraud for deceiving investors, and in June a federal grand jury indicted her on several counts of criminal wire fraud.

Celmatix is no Theranos: The Fertilome test passes muster in New York state, which has some of the strictest requirements in the country, and the company works closely with doctors and the academic community, exhibiting the sort of transparency that Theranos resisted. “Their leadership is outstanding, their science is incredible,” said Levine. “Piraye is brilliant. Every time I talk to her, I feel smarter.”

Beim is confident that Celmatix is helping women who are struggling to get pregnant. “The dream when we started was that babies that would not exist without us all showing up at work every day and working our tails off for a decade would exist one day—and we’re there,” she told me. “If what we’re doing makes it a little bit more likely that women can get to have as many healthy kids as they want, on their own terms, it’s worth it.” Yet many fertility experts remain concerned that we still don’t know enough about how genetics affect fertility for Celmatix’s testing to be truly useful. “The difference here is having knowledge versus the wisdom of how to apply it,” said Francisco Arredondo, a reproductive endocrinologist and owner of three fertility clinics in Texas.

Ten years after Beim founded Celmatix, the femtech industry is awash in companies whose products range from the significant to the superfluous. For all the startups focused on diagnosing or treating a serious health condition, such as infertility or endometriosis, or developing a new form of birth control, there are others that are simply trying to ride the current feminist wave to a generous payday.

All of the money currently being invested in femtech might be a sign that Silicon Valley finally considers women as individuals whose needs and desires actually matter. But it is equally likely that venture capitalists see women as little more than lucrative sources of revenue—as consumers, rather than patients—and that tugging at the fears and anxieties women have about their bodies and life choices can be a strong marketing hook.

Beim, for her part, is earnest about her desire to help women, and forthright about the limits of what she’s been able to accomplish so far. “Is Fertilome, like, ‘We planted the flag, mission accomplished?’ No,” she told me. The detailed diagnoses and treatments she hopes to offer women are still some ways away, at the very earliest.

Yet it’s clear that Silicon Valley startups need not be as mendacious as Theranos to cause harm. Even companies that cast themselves as high-minded can have a detrimental impact on society, as Facebook’s recent scandals illustrate. Tech firms have forged their identities around the idea that they can solve the world’s problems through disruption and innovation, through the amassing of personal data and the achievement of scale—promises that seem increasingly dubious as time wears on and the effects of their products on the real world are revealed. Why would products for women’s health be different?

The stakes could hardly be higher than they are with fertility. Millions of women who are delaying having children want to know if the gamble they are making—waiting for better circum­stances, without knowing how their fertility will age—will pay off. “We’re talking about the most sensitive topic I can think of: your fertility and your ability to reproduce,” said Levine. Femtech companies have provided avenues for women to discuss their desires, fears, and experiences with friends and doctors, and to combat the stigma associated with infertility. That alone represents a form of empowerment. But even as fertility startups market themselves as sources of clarity and answers, the science still cannot—and may never—say with certainty when, how quickly, or if a woman will get pregnant. Given that reality, it may be challenging for Celmatix and other femtech firms to make good on their promises to women—and live up to their own ideals.