Building the Google Maps for the fertility journey
My chat with Lauren Berson Sugarman, CEO & Founder of Conceive
Today’s chat is with Lauren Berson Sugarman, CEO & Founder of Conceive, a startup focused on changing fertility outcomes.
Sar: I’m admittedly not knowledgeable about the important problem you are trying to solve. You use the analogy of Google Maps for the fertility journey to explain what Conceive does. What factors contribute to the stigma around fertility? We have a collective tendency to go after the easy and obvious explanations, but that’s often lazy and perpetuates the problem.
Lauren: When you can’t get what you most deeply desire in life—if you’re trying to conceive, to become a parent—the anguish, frustration, and grief you feel are so poignant it can be hard to describe. It’s like mourning the loss of someone you haven’t met yet. Couple this with the trope from sex-ed that you can blink and get pregnant—and when you realize you can’t, it can be extremely painful. The wanting takes over your life. It becomes hard to think of anything else.
If you’re on meds or going through assisted reproductive technology (ART) procedures like IVF, there are the physical implications—weight gain, discomfort, pain, and acne. Not to mention all the poking and prodding.
There is the mental impact—from hormone changes to medicines that can make you feel crazy and the mental load of appointments, self-blame, and the tendency to search for a problem. There’s a deep solitude and isolation for those who don’t have a network or support system. And because this is often hidden in the shadows, it’s difficult to figure out who we can connect with. When I first went through this in 2017, I felt completely alone until I spoke up. And then it was like the floodgates opened. I heard from friends, strangers, and people I hadn’t heard from in decades—all reaching out and saying, “your story sounds like mine; can we talk about it?”. For many, depression levels reach that of cancer patients. We feel less than “not a woman”; it’s a downward spiral.
Now let’s talk finances: Nearly 75% of patients have zero coverage; it wasn’t until 2018 that the WHO deemed infertility a disease that results in disability, and payers are just starting to follow suit, state by state (only 19 states require some semblance of coverage, and with the overturn of Roe v. Wade, we may be going backward). As much as our replacement rate is suffering, most of the world still sees having a child as a “nice-to-have” versus something that should get support and coverage.
Then there are the very real cultural implications of speaking up. You noted the stigma in India. In many cultures, it is commonplace to have children early, and it is seen as strange if you don’t. Research also shows that infertility is particularly stigmatized within the Black community, often leaving Black women silent.
And lastly, there are the professional implications of talking about fertility. I’ve been in executive rooms where women were taken off projects because they were pregnant. Can you imagine if these boardrooms had a “headstart” on knowing who would become pregnant? While this is starting to shift with more people talking about infertility, we haven’t changed anything until we have men and women discussing it at equal rates (since infertility affects men and women at equal rates).
Sar: What do you wish more people knew about the brewing fertility crisis in the States?
Lauren: We’re talking about a disease that impacts one in five women, resulting in stagnating population growth in the US and many countries worldwide. Very few of these women have coverage to afford treatments or the holistic care they need to get through something this overwhelming. We need to make free or subsidized fertility coverage universal. Everyone deserves to have the family they want. It shouldn’t be something reserved for the privileged or wealthy.
But it’s not just women—fertility affects men and women at equal rates, yet our fundamentally paternalistic and misogynistic society perpetuates it as a women's issue. This often means that couples can go a year or longer without even considering male factor infertility. It’s cheap, easy, and pleasurable for men to get a semen analysis. This should be your first line of defense when trying to conceive!
There is very little holistic support to help with the mental pain and anguish patients go through. This is where Conceive comes in. After completing our 8-week program, our members have had a 77% increase in feelings of support.
Sar: You went through a long and challenging fertility journey yourself and are now committed to helping others not feel lonely and confused in their journeys. You have spoken to hundreds of women to do your research. You likely went into it with strong views. Did you come across stories, ideas, or challenges that didn’t resonate with your experience and that added to your perspective on the problem?
Lauren: One of the things I didn’t quite understand until really mapping it out in detail, doing the research, and talking with hundreds of patients, was the complexity of the fertility journey itself—and how the fundamental lack of research dollars in the space lends itself to a murky, a gray area in medicine. But the biggest aha was identifying that due to this complexity, many patients get stuck along the way, wasting time on something—either the wrong treatment or doctor—without progressing toward meeting their goals. For example, our first member had been diagnosed with endometriosis and PCOS, and had a blocked fallopian tube, yet wasn’t seeing a fertility specialist. This is very common. Or other members have done 6-7 IUIs in their mid-30s, which from an efficacy/cost standpoint doesn’t make sense (can cost up to $30k, which is the same in some cases as two rounds IVF—which has much higher efficacy rates). They’re much better off progressing to IVF. Still, others were experiencing debilitating cramps that weren’t being acknowledged in their care. After their fifth IVF cycle, they got a second opinion from one of our REI advisors and found out they had adenomyosis—which meant they weren’t ideal at 40 to carry a baby to term. It just made me realize how many decisions need to be made in a fertility journey and how often they aren’t made, or someone else makes the decision for us. We want to empower people to map their way when trying to conceive rather than feel like they’re playing a game of choose your own adventure.
Sar: Let’s talk about the first three months of Conceive. What early ideas or assumptions, or instincts about how you approached the problem were you wrong about? What did you get right?
Lauren: I underestimated how prominent patient advocacy would need to be in our solution. It’s now starting to circulate more how women are often misdiagnosed and underdiagnosed, how pain is often ignored, and how paternalism in this space results in suffering or a missed opportunity to have children. For example, one study found that women were diagnosed on average four years after men for more than 700 diseases. Many members told me that on their second miscarriage, their doctor suggested waiting to test to see what went wrong until the third time around—it almost felt like hoping for a third time! Why should we lose a pregnancy three times before getting the support and answers we need? While, on the whole, most miscarriages are due to chromosomal issues, knowing that helps us process and remove the self-blame that is so damn ubiquitous for women on this journey.
Doctors are overloaded with patients on a less severe scale, and our early adopters—all bright, research-driven, dynamic women—struggle to ensure they understand the solutions. They have 15 questions, and only a few get answered due to time constraints, “doorknob conversations” when the doctor is halfway out the door, and what I call “the politeness fallacy”—a tendency to think we need to people-please versus get the answers we deserve.
Sar: My read is Conceive’s product philosophy boils down to 3 things. First, having the right information at the right time minimizes pain and confusion. Second, having a group of like-minded peers on a similar journey minimizes loneliness. Third, having access to the right experts for personalized and professional guidance minimizes missteps. You combine content, guidance, and community. What am I missing? Which part of the puzzle has been the hardest to get right as you think about productizing these pieces?
Lauren: It’s important to understand that the alternative to Conceive is essentially nothing. It’s 2 am google rabbit holes, Instagram black holes, stories from acquaintances or friends, books, blogs, or triggering online forums—all of which cause a lot of stress and ultimately amount to not a lot. You’re piecing together information from sources you don’t even know are reliable, and at the same time, you’re told you should come back in 6 months to a year when you’ve tried for that long. But what happens if, in all that time, your fallopian tube is blocked? Or your husband’s semen has no sperm? We live in a modern era when it comes to getting answers about your healthcare. We’re trying to bring fertility in line with the times. Unfortunately, it’s hard not to think that if it wasn’t thought of so much as a “women’s issue,” it might be getting more research, and we’d have more progress. We’ve dedicated ourselves to this cause.
Sar: Conceive is a virtual program. What’s been challenging in terms of mechanics?
Lauren: In many ways, we’re the anti-forum. Online forums—the likes you find on Reddit or Facebook Groups—are often these open-ended abysses with little structure and no authority. They give people that reassurance that only relatable first-person accounts can do, but they can be an abundance of misinformation, and they’re certainly not always safe spaces. We wanted to create a community of peers on similar fertility journeys who can feel supported and know that the advice they’re getting is backed by leading practitioners in their fields. Navigating the sensitivities around fertility can be challenging in our cohorts. For example, when one person gets pregnant, people in the group can feel both incredibly happy for them and sad for themselves. Trying to navigate that line between hope and managing expectations while not being triggering can always be a challenge, but our coaches are trained to do exactly that—and they do it incredibly well.
Sar: What personas are most popular today?
Lauren: Our initial customers tend to have two different personas:
Our first is someone deep in their fertility journey—perhaps years in. They may have had multiple failures–a loss, disappointment, failed transfers, etc. They’re at a crossroads. They’re looking for what to try next after feeling like they’ve tried everything. They are often very data-driven, have a whole medical team, and are looking for that extra level of support and guidance. They are overwhelmed by their research and want someone to help them understand the noise and what to rely on. Or they just need to feel seen and heard by people going through a similarly tough time—remember that we often suffer infertility in silence.
Then you have the kind of people new to trying to conceive. Often this is when you have the least support since you may not have seen a fertility expert yet. This persona is learning about the nature of fertility, often more or less from scratch. Here, we offer a robust and trustworthy alternative to the futile 2 am Google rabbit holes. Finally, they have someone to guide them with the “Conceive Basics”—the things you can do right away when you try to conceive that doctors (or Dr. Google) may not tell you.
In order to serve these two personas, we’ve worked hard to create flexible options with our two subscription plans. With Conceive Plus ($29/month), they get a personalized dashboard with fertility advice, recommended articles, the ability to submit questions to an expert, and access to our free fertility learning events. With Conceive Premium ($129/month), they get all of Conceive Plus, with an on-call fertility coach, a peer support group, and one-on-one sessions with medical experts. Plus, a fertility plan to take to their medical team. This is a much more hands-on/bespoke option. So depending on where you’re at with your fertility journey, we have options for you.
Sar: What kind of people do you think Conceive is not the right solution for?
Lauren: We aren’t yet supporting those solely pursuing fertility preservation, but we work with great partners like Cofertility and Legacy to help.
Sar: Can you talk about the explorations before settling on your current pricing? I’m also curious about contextualizing the price point regarding how much people typically spend on their fertility journeys. I think people justify the price to save wasteful spending later.
Lauren: We priced Conceive akin to cohort-based courses while building our digital product. A flat $549 fee. The value we provide is at the utmost—with 24/7 coaching from peer coaches and nurses, live sessions with REIs and doctors of Chinese medicine, and 8 live sessions with a cohort picked for you. We then found that because fertility journeys can be so unique, circuitous, and often unpredictable, we found it made more sense to break this down into smaller monthly subscription payments ($29/month for Plus and $129/month for Conceive), which allow our members to continue to have ongoing support at the level they desire. And we support our members through pregnancy, as the questions and anxiety don’t stop there.
Sar: You provide your customers access to nurses, fertility experts, and coaches of Chinese medicine. Can you talk about how you work with them?
Lauren: Our nurses and peer coaches are on the front lines, fielding our 24/7 chat. They are part-time, given these are not traditional 9-5 jobs. They split the burden depending on the question. Each member’s assigned a team of experts. Our advisory board includes reproductive endocrinologists, doctors of Chinese medicine, embryologists, and more to help fuel our product, programming, and content and to host events and live sessions with our members.
Sar: How do you think about the role of the partners of your customers?
Lauren: When our members have a partner involved, it’s key that we think about how we can help them holistically–including that relationship. An infertility journey can take over completely, stripping away most of the beauty of life for many. Relationships suffer. We think about a world in which Conceive can bring in men and women all the same. Society places the brunt of the fertility journey on a woman’s shoulders to navigate for two. So, for now, we have workshops focused on better explaining where you’re at with your partner—and thinking about ways to delegate and share the burden.
Sar: How do you think about progress and track impact?
Lauren: We’re maniacally focused on changing outcomes—helping our members get pregnant faster, reduce costs, uncover diagnoses, and help them feel less anxious and more grateful. Outcomes are our north star metric, in addition to growth over time. We’re super proud that in a short time, 73% of our members have become pregnant since joining, and 27% uncovered new relevant diagnoses that impacted their treatment plan. We also have many Conceive babies already!
Sar: You were recently at the ARSM conference. What was the most memorable takeaway?
Lauren: What continues to be so powerful is how much clinics and REIs are leaning in and want to be able to support their patients more holistically. This was one of my earliest findings during my research period. They see the vast toll these journeys take on their patients and do not have the time to support them in the ways they’d like to.
Sar: What’s been much harder than you realized as the founder and CEO?
Lauren: I’m at a time in my life where my passion, skill set, and relationships, all came together in this perfect concentric circle where I can work on the problem I care most about (that is extremely underserved), with an incredible team to boot. It’s my life’s work. This means there are times when I forget to celebrate the small victories with an eye toward just moving forward.
It’s also incredibly hard to say goodbye to talented humans who may not be the right fit for the team or the role. This will never get easier as I care deeply about the people I work with and their livelihoods. But we must focus on finding the team that is the best fit for us at the stage we’re at.
Sar: What were the naysayers saying when you started?
Lauren: That it’s a saturated space—one of the most laughable comments. Has anyone seen that map of martech saas companies? I think there are like 1 million. In fertility, there are probably hundreds of companies, and very few—if any—have brand equity. We just had the first two unicorns in women’s health—Tia and Maven Clinic. To say that this space is saturated is just an excuse by those who don’t understand or don’t care to.
Sar: What is least understood about how a16z operates?
Lauren: While I can only comment about my time there since the firm has changed SO MUCH since I left in 2018, I’ll say they do everything in their power—and the business model is fundamentally set up–to support the portfolio companies in nearly every way they need help, from marketing to deal-making. I helped facilitate deals worth millions of dollars for many portfolio companies. I’m proud of my time there and the impact I was able to make in the trenches in the early days with many of our portfolio companies.
Sar: What are you closely following these days outside of work?
Lauren: Outside of my fitness routine, which keeps me sane, and my time with the little love of my life, Elle, my three-year-old, I am starting to get back into making music. I played the piano as a young girl and took a bunch of lessons when I first moved to San Francisco, but I haven’t played since.
Sar: Let’s end with an important question. I don’t like bubble tea. Tell me why I’m wrong and should be more open to it!
Lauren: Sar, it’s not nice to yuck someone else’s yum—, and I certainly can’t force you to like something you don’t! But alas, I’m sorry you don’t like bubble tea. Can you please share which teas you’ve tried and what you don’t like about them? Generally speaking, if you like creamy sweet tea or coffee, you’ll love traditional milk black tea with tapioca. That’s my go-to, although I generally order it with much less sugar (25%). It’s one of my favorite things in the world.
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