Future of Fertility_Gurjeet Singh: Audio automatically transcribed by Sonix

Future of Fertility_Gurjeet Singh: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Abby Mercado:
Hi, I'm Abby Mercado, an IVF mom, former VC investor, and CEO of Rescripted. Welcome to the Future of Fertility, a podcast dedicated to shining a light on the entrepreneurs and innovators who are changing the face of family building. With billions in funding over the past few years, we'll introduce you to the people, the ideas, and the businesses that are changing the fertility industry and in turn, millions of people's lives. The future of fertility is bright. Now let's get into it!

Abby Mercado:
Gurjeet Singh is the CEO of Oma Fertility. Oma Fertility is a full-service fertility clinic that combines AI and robotics in the lab and human-centered care in the clinic. Oma is not just an empathetic and affordable solution for families looking to grow. They're also a category disruptor with their sperm insights and technology. But the only 4% of sperm in a sample being normal, Oma's technology helps embryologists identify the most promising sperm cells to pair with an egg in IVF. We're definitely seeing an uptick in AI solutions in the fertility industry, but OMA is the first to build a clinic around AI. I'm so excited to welcome Gurjeet to the podcast. Welcome, friend. How are you?

Gurjeet Singh:
Thank you so much for having me. Great to be here.

Abby Mercado:
All right. So we started out the podcast with Gurjeet apologizing to me for having all of these boxes and his background. Tell me what, what's in those boxes?

Gurjeet Singh:
Yeah. So, you know, we had a remote company, and we have this one lab in San Jose where we have all this equipment. And today is the day when they decided to ship us five microscopes and six different manipulators. So all of these boxes contain sort of high-quality optical microscopes, and you can't see them, but like micro manipulators off to the side.

Abby Mercado:
I'm so excited to dig into exactly what that is and why it's important to Oma, because I know it's super important. But let's, let's start with you, Gurjeet. So tell me all about yourself. You know, with this podcast, we really like to dig into the stories and the why behind what we're doing in the fertility industry that needs so much disrupting. So who is Gurjeet? Tell us about him?

Gurjeet Singh:
Yeah, so I did my PhD from Stanford a decade or so ago, and my research there was funded by ARPA, who encouraged us to commercialize it, which is how I started my previous company, Ayasdi, and I grew the company. We built a AI-based, vertically specific enterprise software that we sold into the Fortune 500. I grew the company as a founding CEO and then I sold it in 2019 and coincidentally as a, quote-unquote, as I was on the beach, I heard of somebody in my wife's office who was going through IVF. They went through six cycles of treatments as a family, paid $45,000 a cycle and ended up not succeeding and had to file for a bankruptcy, which was very distressful, obviously, for them. But also my wife was helping them through bankruptcy proceedings and how to put their life back together. At the very same time, my now co-founder Sahel, was visiting us in the US as a family friend. He's a physician himself, and he had grown up in India, in Delhi, in India, him and I, where he had built a chain of IVF clinics where they do, see about 15,000 patients a year and did about 6000 IVF cycles a year at the time. And my wife and I started renting at home about the situation with our colleague. And he said, why don't you come see a clinic in India just so you have a sense of closure? So I went to India to see an IVF clinic, and when I first saw the IVF lab, I was just completely blown away. My perhaps naive expectation was that if somebody is paying $45,000 for a medical treatment, that there will be some science fiction going on behind the scenes. On the other hand, when I saw an IVF lab, it just looked like a high school biology lab. It had the same microscopes. These ones are better, by the way. The same microscopes, the same incubators, the same fridges that any good high school biology lab has. That was super distressful. I came back to the US, visited a bunch of IVF clinics here, and they were perhaps slightly cleaner, but they had the same equipment from the same manufacturers, the same protocols. And worst of all, they had the same success rates as a third-world country. So I just couldn't believe it. Very coincidentally, my co-founder, Kiran, had also just freed up from his startup, and he's a double ePhD from Stanford, I've known him for a long time. And so we all got to discussing and the more data we looked at, the more certainty we gained that it's a great market, from a fertility perspective, lots of people need it, it's unserved. And the only way of scaling this market is to build new technology that can help increase success rates and make IVF accessible to more people. And so that's, that's how we started Oma.

Abby Mercado:
Amazing. So what is it about? Why has there not been innovation in the lab side of the industry in the past 30 or so years? Why, is there something structural in the industry? Like why is it, just stayed static?

Gurjeet Singh:
There is something structural in the industry, right? From an economic perspective, it just doesn't make sense to sell devices into clinics as it stands. So if you just do the raw numbers, the US, as an example, has called it 500 clinics approximately. And so imagine that you want to build a device that you sell it to these 500 clinics. You would have to multiply 500 by a very large number for it to be worth it for somebody to invest in building a device that they can sell to 500 customers. So from an economic perspective, it's just not super feasible to start companies that can build devices that sell into these clinics. And so, in fact, that's what you see in IVF. And when you run an IVF lab like we do now, you see that all of these vendors who sell you stuff, most of the money is made on media, on consumables, because if you build a device that's a one-time sale, right? You sell it and you're done. So just from an economics perspective, it just doesn't make sense to build software or hardware and sell into existing clinics.

Abby Mercado:
Yeah, I feel like we're seeing a lot of disruption in the lab software space. But when you're, when you're talking about actual physical devices, few and far between. So.

Gurjeet Singh:
Yeah.

Abby Mercado:
That's really interesting. So your multi ... Founder, right, you've had a successful exit. I guess what were, what were some of your key lessons in exiting your first startup that you're applying to Oma just from founder ...?

Gurjeet Singh:
Yeah, absolutely. So I feel like as a founder, one thing that I did not realize, one of the most important things I believe that I learned was that you as a founder and a CEO in a, in a company, have so much freedom in crafting what the company can be and how it will grow and what it can be in the future. So I'll give you an example from Ayasdi. When we were a fairly young company at Ayasdi, we kind of lucked into selling seven figure deals into Fortune 500 customers. That wasn't necessarily our strategy, right? But it just so happened again, I was an academic starting the company, didn't know anything. I got so much help from so many people along the way and learned so much from them. But the first few customers that we got accidentally were these Fortune 500 companies that were happy to write us million-dollar checks. In fact, it was so bizarre that I did not really think that it was a big deal. I thought that was a default case that, you know, you build something great, you take it to a large, big company and they are happy to write your million-dollar check.

Abby Mercado:
So you're like a little, a lot of luck and a little bit of hard work.

Gurjeet Singh:
Yeah, that's right.

Abby Mercado:
That sounds like, we had a key customer that really turned us into a successful media company, let's say, about a year ago. And that was like the one thing that changed the course of our successs, I totally, I totally understand why that makes sense.

Gurjeet Singh:
But in the course of building the company, I realized that even though we had locked into that sales model and that's what we basically had then developed this elephant hunting sales model in which we would particularly look for customers to which we could sell multi seven-figure or multi eight-figure a year deals. And that was a good thing and a bad thing. The good thing was that obviously every cost, the ASP is high as the customers are paying you lots of money. The downside is that we have a relatively smaller set of customers then. So any customer turning away for any reason hurts really badly. Another downside was from time perspective, selling a seven or eight-figure deal takes 12 to 18 months. There is no rational way of shortening it in some sense. So we kind of also, I felt like we had also painted ourselves into a bit of a corner because of that sales model that we lucked into and weren't intentional about.

Abby Mercado:
Yeah.

Gurjeet Singh:
And on the other hand, had we decided that, hey, we want to sell $100,000 deals to thousands of customers, we could have built a company with our products that are some variation of it, and we have been successful with that sales model, which demonstrates sort of two very, very different ways of going to market with the same kind of core, core ideas and being successful with both. So that's the kind of leverage that you have as a co-founder and CEO at the beginning of the, or not even at the beginning at any point of the company that I sort of only appreciated in retrospect.

Abby Mercado:
Yeah. Ask a million questions, be intentional. So kind of in that same vein, it sounds like you spent some time, quote-unquote, on the beach thinking about what Oma would look like. So, kind of from soup to nuts, how, how long did it take for you and your two co-founders to notice the problem, conceptualize OMA, and then commercialize it, bring it to market?

Gurjeet Singh:
So it happened really, really quickly. So I sold my previous company in 2019, and basically this whole incident with my wife's co-founder and my wife, my wife's colleague started, call it six months after the sale. Very, very coincidentally, my co-founder still was in the US. My co-founder Kiran, had just left his previous company, and so we were all just sort of together in this moment where we were all sort of thinking about what to do next and how to build the next company and so on. And pretty much the problem fell into our laps. We raised our first round of financing in the middle of 2020, right at the peak of COVID.

Abby Mercado:
Fun time to raise capital.

Gurjeet Singh:
That's right.

Abby Mercado:
I think we were raising at that point too. So fun.

Gurjeet Singh:
Yeah, it was a great time to raise money. And then over the next or the last two years, we've basically gone from three people with a slide deck to a company where we have five clinics, where we are seeing patients across the US. We've built our first device, we've run clinical trials for it, the results are to publish soon. We are, the devices are registered with the FDA. The second opinion tool is already being used in the clinics. We are now into building our second device. So like we have done a lot in these past two years.

Abby Mercado:
Sounds like that. So a little bit about the founder story, and I give you my description of Oma, but would love to hear about Oma in your own words. What is it? What about the company?

Gurjeet Singh:
We, so we basically build machine learning-based robotic devices to help increase the success rate of IVF and to commercialize our devices. We are building a vertically integrated set of clinics, where we build technology that's exclusively for our own use. And there are three sort of important ideas that, that we are basing Oma on and our story on. The first idea is we want to get our families who work with us, successful in as few cycles as possible. That is really our North Star. We want to make sure that nobody has to go through unnecessary cycles, that we bring our technology to bear and get people successful quickly. The second idea is we want to make, we want to make care human center, where, when you talk to a lot of people who have gone through fertility care, even those who have been successful, they will tell you they felt like a number, that they didn't have any power, they felt they had no control. There's so much work to do in fertility, just the care delivery side of it. Having better access to a care coordinator 24/7 as an example, having access to medication instructions and on demand. Things ... There's a lot of low hanging fruit, which is super critical. So that's human-centered care. And ultimately, we want to make IVF accessible to more people. In the US, only 2.1% of all births happen via IVF, while in countries like Denmark, Israel and Japan, that number is between 6 and 10%. So any way you cut it, the US market is underserved by 4 to 5 X. We want to make sure anybody who wants to have a child via IVF can access the most advanced fertility treatments.

Abby Mercado:
Love it. I love this can component. Something that was really shocking to me in reviewing your website, and I think it's the stuff that I know, but it's a not that I haven't thought about in a little while, and that's 70% of IVF cycles fail. Was that, like tell us a little bit about that number. Is that, like obviously the numbers, I'm sure are pretty multifaceted, but what do you think? Like, can you pinpoint, like what of that is attributed to the lab? You know, that's maybe a hard question, but like, how do you think about that?

Gurjeet Singh:
What there is, but there are some statistics that can help. First of all, if you think about the average number of failures is 70%, right? But obviously it's super age dependent, for people who are relatively younger, women in particular, you know, the chances of success can be much higher. But if you compare the success rates, call it between the top 5% labs in the US versus the bottom 5% labs in the US, the difference in outcomes is as much as three X. So as an example, if somebody is less than 35 and they go to a top 5% clinic, the probability that they will succeed and have a live birth for IVF cycle is close to 75%. While if they go to a bottom 5% clinic, the probability drops to below 20%.

Abby Mercado:
Wow. My, my mouth is wide open. That is absolutely shocking. It's I mean, as the CEO of a consumer media company, I'm happy to say it, but it's also really difficult to read that part. So shout out to ... Make it a little easier for people to understand. But that's, that's, that's absolutely shocking. Well, thanks for breaking that sound for me. Well, so would love to you. I think like very, very specifically, you talk a lot about your sperm insight, product and technology. And it seems like that's a really big differentiator for, for you all kind of in the lab. So could you break that down for us and tell us a little bit more about that technology?

Gurjeet Singh:
Absolutely. As a backdrop, I want to break down the IVF journey into three components and then answer this question. So if a family goes through IVF, there's basically three parts of that journey. The first part is called gamete retrieval, where a physician works with the patients to, all the family, to essentially get their eggs and sperm cells outside the body. So that part is gamete retrieval. The second part is embryo creation. This is where the embryology lab takes over. This is no longer in the physician's domain in general. And in the embryology lab, the job of an embryologist is to essentially pick out individual sperm cells, match them with each egg, in particular fertilized egg, incubate the fertilized eggs, care for the embryos. If desired, biopsy the embryos to check for DNA abnormalities, and then recommend an order in which they can implant the embryos. So that's the second phase. And then the third phase is the embryo implantation back with the family, which is also clinical. So we, when we think about the lab part, right, we started thinking, okay, how, where do we make the biggest difference? How can we change the, how can we change the success rate and make them make the biggest difference? And the reason why those 70% of the cycles fail is because most cycles don't create enough embryos, right? That's the reason why most cycles fail. So now if you think about, okay, what do you do to create more embryos? Essentially, the most number of embryos you can have is equal to the number of eggs because eggs become embryos, right? So then how do you convert a higher percentage of eggs into embryos? So that was the question. And from a technology perspective, if you think of an IVF cycle, in a median IVF cycle, you're dealing with 10 or 20 eggs. And eggs are extremely precious, eggs become embryos. They are physically painful for the family, they are emotionally difficult, they are.

Abby Mercado:
Age dependent.

Gurjeet Singh:
Also, age dependent, exactly. So in some sense, with the eggs, you kind of get what you get and you have to use all the eggs that you can get your hands on. There is really no selection in eggs. On the other hand, in a typical held male sperm sample, there's 100 million sperm cells. Also in a typical healthy male sperm sample, only 4% of them are considered to be normal, according to the WHO classification of sperm cells.

Abby Mercado:
So can I just pause for a second? Like, why aren't more people talking about that? Like, it's just crazy to me, you know? Anyway, it's wild. That was a shocking statistic to see on your site.

Gurjeet Singh:
Yeah, I this part is less crazy. The crazier part is the fact that the sperm counts are declining at 2% a year. So, you know, today about 35 to 40% of all cases at the clinic are due to male factor infertility. But it's estimated that male factor infertility is going to overtake female factor infertility as a major cause in the clinics over the next decade, that means.

Abby Mercado:
Yeah, that doesn't, well, my family has male-factor infertility, so and that's why we went through IVF. So that and I think from an emotional perspective, like the isolation that we felt because of that was unique. Sure, so I'm glad that you all are talking so publicly about male-factor and.

Gurjeet Singh:
Absolutely. And I feel like there is a lot of, there's a lot of shame around it as well, which people don't talk about it, and men particularly. Anytime you question somebody's sort of ability to procreate, women in some sense at least are conditioned to think about it. And I'm not saying that's fair, but at least they're conditioned to think about it. Men, on the other hand, completely break apart as soon as they know. Oh, my God, it's something wrong with me, that's so, it's, it's definitely a thing that needs more education. And in fact, I feel like a lot of the onus of fertility is on women, which should not be the case. It's, it should not be the case. It's going to become a male problem very, very quickly in the near future.

Abby Mercado:
Yeah, I couldn't agree more.

Gurjeet Singh:
And so coming back, right? So the only 4% of the sperm cells are actually normal. Today, an embryologist looks at about 20 cells for about 10 seconds before they pick one to fertilize an egg with. And if you do the math in your head, the probability that you, looking at 20 cells out of 100 million, those 20 cells even containing one of the 4 million normal sperm cells, the probability is so abysmally small that selecting the best sperm cell is not a human scale problem. It requires a AI - machine learning.

Abby Mercado:
Yeah, like 100 million versus how many eggs you're going to extract. The numbers are so different.

Gurjeet Singh:
That's right. So selection on the sperm side actually matters.

Abby Mercado:
Yeah.

Gurjeet Singh:
That's what our first device does, is basically helps an embryologist pick the most promising sperm cell by helping them analyze on an average 20 times more sperm cells than they ordinarily would in a normal IVF situation.

Abby Mercado:
Okay. I feel like you probably don't get this question a lot, or maybe you do, I have no idea. But let's say you have, like I want to know exactly what goes on in the lab. So, and obviously it's like, ...., right? But like the things that you can tell me and you can tell. So let's say you have a, you know, there's a collection of sperm cells like you get the collect, like you're my embryologists, get this collection. What happens next?

Gurjeet Singh:
Yeah. So the process from their perspective is actually not different at all.

Abby Mercado:
Okay.

Gurjeet Singh:
So they process the sperm cell exactly as they would in a normal case. And I tell you how they do it normally as well. So they essentially trap the sperm sample by centrifuging it. So they spin it at a really high speed, that kind of separates the sperm sample into debris and sperm cells. And then they extract the sperm cells which are basically floating in this, are not floating, they're at the bottom of the, of the test tube. So they extract the sperm cells. That's kind of the sperm processing. And then essentially they look at, look under a microscope and pick sperm cells. So it's not super hard to do actually. With our device, the process remains exactly the same. They process the sperm cells exactly like they would in the past, except now when they look into the microscope, they see annotations that are on sperm cells and they can click on the sperm cells. They can see the detail video of this in real time. So it just sort of a, the process remains exactly the same, except we give them all this extra information. And sort of what we tell them is if you find a, maybe I can, can I show you a quick video. I know it won't be on the podcast, but I can.

Abby Mercado:
Yeah, that's fine. I'll pause for a second. Sure. Yeah. Why not? I'll ask more intelligent questions.

Gurjeet Singh:
So basically, this is what it looks like under a microscope, right? So essentially they see these sperm cells and what we tell embyologist is look for sperm cells with the green boundary. If you find one, like this one, click on it. And on the right hand side of the screen, you will see a detailed video of the sperm cell. If you agree with the assessment, pick up the sperm cell there and then in fertilized egg. So it's that simple to use. You will notice that it analyzes all the sperm cells in parallel. So all of them have these boundaries around them, which means that you, as an embryologist, can very quickly find out or is this one cell worth me paying attention to or not?

Abby Mercado:
Right.

Gurjeet Singh:
That simple to use.

Abby Mercado:
This is so cool.

Gurjeet Singh:
Yeah. .... to build it.

Abby Mercado:
No, okay, so. Restarting the podcast. So, so what I think is so unique about this technology and I think a lot of people maybe not so much anymore, but a few years ago people were so scared of AI because it was, like robots are taking over the world, right? But that's, that's not what your solution is. Like you're, you're arming embryologists.

Gurjeet Singh:
Exactly.

Abby Mercado:
With better information to make better choices and, yeah, no, that's awesome.

Gurjeet Singh:
Yeah.

Abby Mercado:
So is your clinical study on sperm insight or is it on something else?

Gurjeet Singh:
Is it on sperm insight. It's under peer review at this point, which is why we, we're not talking about the results yet. So we're hoping, hoping it'll be out and then we can talk about the results.

Abby Mercado:
Amazing. Well, I'm excited to read it. And so take in more when, when it becomes public. So tell me a little bit about like starting, starting a clinic. Like was that, you know, I think knowing you and like knowing you're and your co-founders' backgrounds, so like, I feel like the robotics side of the business was probably just super easy, but I assume like starting clinics came with some surprises. So we'd love to hear here about that journey.

Gurjeet Singh:
So first of all, I have to give a shout out to my co-founder, Sahil. You know, he had built a chain of clinics in India right before he came here to co-found OMA with us, right? So from he knew the operation inside and out. Obviously the US is a different country. So there was, there were some changes. But by and large, like we knew what to do kind of from the get go. But I'll tell you the the reason why starting our clinics was controversial was that, you know, in general, when you think about scaling companies, scaling a four walls business can be difficult, right? Because obviously you have to have a place, you have to get customers. It's a kind of a retail operation when you when you build these clinics. So that part was controversial and difficult. But what we realized is that running a vertically integrated company is so beneficial because otherwise we would just be another middleman. And that's, that's the thing that happened in fertility and many areas of healthcare, actually, all the time. Where, imagine that, if I built a new device and if I were selling the device into, I have it on your device, but if I were selling it to other clinics, then they would basically upcharge it to their customers, right? So it would become more expensive for people to use it.

Abby Mercado:
Yeah.

Gurjeet Singh:
And so then you become another middleman in this whole situation.

Abby Mercado:
Yeah.

Gurjeet Singh:
A lot of the healthcare startups I feel like are basically becoming more middleman as opposed to solving the actual problem from an end to end fashion.

Abby Mercado:
Yeah, absolutely. I, I feel like there's multiple founders who are probably listening to this podcast who I've said I'm, you're probably going to start a clinic some, someday, I foresee it. You know, it's just, it's very difficult to sell into clinics. Straight up, it just is.

Gurjeet Singh:
Yeah.

Abby Mercado:
There's so many quote-unquote vendors in the space.

Gurjeet Singh:
Yeah.

Abby Mercado:
You know, clinics are, you know, everybody is, you're trying to run a business, like they're trying to turn a profit, and it's difficult for so, so many reasons. So I think probably goes without saying that all of those problems and all that, that I just said that I love the vertically integrated model. It makes a ton of sense.

Gurjeet Singh:
Yeah. But I think, for example, just in the last year we have gotten out of the five clinics, you know, two of them just start, three of them just started recently, just two months ago, literally. So they are still ramping up, but the other clinics are already profitable.

Abby Mercado:
Wow.

Gurjeet Singh:
And in less than a year.

Abby Mercado:
Wow.

Gurjeet Singh:
So they have done a good job in that operation. And also from a vertically integrated perspective, right? Like, remember, the core reason why I started the company was because I knew somebody who literally went bankrupt trying to build a family. And they were not successful in doing that either. And so how would I look myself in the eye and say that, you know, that I've actually solved the problem without making sure that those kinds of things don't happen anymore? And that's part of the reason why our pricing is also ethical.

Abby Mercado:
Yeah, so tell me a little.

Gurjeet Singh:
... In the business.

Abby Mercado:
Tell me a little, so looking at your website, your pricing is transparent. I love that ICSI is thrown in. I think that's very on brand. Love it. How do you, I mean, it's clear, it's clear to me why you do it. It's ethical, that's fantastic. Consumers should know what they're buying, they know what they're buying, how much it'll cost and every other aspect of our economy. It should be the same with healthcare, especially if you're paying cash, which most patients are at this point.

Gurjeet Singh:
Yeah.

Abby Mercado:
What kinds of feedback have you gotten? Like what are risks associated with doing that, would love to dive into your thought process on just being so.

Gurjeet Singh:
Well, one piece of feedback that we get often is, this is so affordable, is there something wrong with it?

Abby Mercado:
Yeah, yeah. Cheap, cheap might not equal bad promise.

Gurjeet Singh:
Yeah. That's right. And that's the thing that happens all the time to us. People oftentimes approach us and say, hey, you know, where are you cutting corners? And then you're like, we're not really cutting corners. We are just not robbing you, right? Like, there's nothing, nothing wrong with what we are doing. We are bringing all this technology to bear. We are providing human-centered care. We have care advocates available 24/7, like we are, we are doing all the right things better than any other clinic does today. So that takes a lot of convincing ....

Abby Mercado:
Yeah. Where and looking at just kind of a blue chip and a blue chip clinic out there, where are you all cutting costs where they're not? I assume it's in the lab, but debunk, debunk that, that's not.

Gurjeet Singh:
Actually, we are not cutting costs in the lab either. It's more like our labs are not cheaper to operate than any other clinics lab today. Where, where we are making a big difference is that we are we have centralized everything in the company. So we have a central sales and marketing team, right? We don't have people on every side or doing local sales and marketing, which is what happens in a lot of clinics. We have centralized accounting, finance, IVs, a lot of this stuff that takes bandwidth and local attention, we have centralized. And so that's, that's part of the biggest part of the reason why we are able to sort of make it affordable.

Abby Mercado:
Yeah, that makes sense. Tell me, tell me a little bit about how, I know you're not vertically integrating everything, so I guess do you have your own EMR? Have you build your own EMR or do you use a third party EMR?

Gurjeet Singh:
We use a third party EMR. I have to say all the EMRs that we've evaluated are just terrible.

Abby Mercado:
Yeah, I agree.

Gurjeet Singh:
They're just horrible.

Abby Mercado:
Yeah, it's true. It's a big problem. So is interoperability.

Gurjeet Singh:
I want to avoid building our own EMR as much as possible because they still do, they're still useful for something. So for example, in our clinics, the EMR still has functionality built-in for reporting data to the CDC, and obviously it is HIPAA compliant. So there are still core functionality in there that is useful that I don't feel like it's a sort of big enough problem for us that we need to go solve it ourselves. But my God, aren't they terrible?

Abby Mercado:
Yeah, well, I'm excited to talk to you this time next year and I bet you anything you will have built your EMR.

Gurjeet Singh:
I hope to.

Abby Mercado:
We'll see. We'll see.

Gurjeet Singh:
Yeah.

Abby Mercado:
Yeah. Well, so, so how do you, as a relative newcomer in this space, how do you go about picking vendors in the space to help vendors like EMR? It sounds like it seems like you guys might have your own donor program, so you're not really outsourcing that. How do you decide what you're bringing in-house and what you're outsourcing, and how do you make those decisions when you are outsourcing?

Gurjeet Singh:
Yeah, So we, again, sort of the benefit of being a vertically integrated company makes a lot of these decisions really simple to think about. So, for example, if I think about the EMR, it's a very simple decision about, okay, is this something that's providing value that I don't have to invest in? Is it, sort of, you can make a financial decision if it does enough, basically, right? So similar to our donor program, yes, we have our own donor program, but we also happily work with donor agencies, with other donor banks, right, so we can choose to be promiscuous in that sense, in that we can work with as many partners as possible.

Abby Mercado:
Yeah. Yeah.

Gurjeet Singh:
And now that it makes sense.

Abby Mercado:
Right? I love that. So, that's a great perspective. Also, where, tell us where your locations are and why you selected those locations.

Gurjeet Singh:
Yeah, so we have five clinics in the US. One is based in Santa Barbara in California, one's in Saint Louis, one's in Atlanta, one's in New York City and one's in Long Island. And sort of how we selected these markets, we, we have a little model that I'm not going to discuss that.

Abby Mercado:
Fair enough.

Gurjeet Singh:
... All the markets in the US and figure out where we place our bikes.

Abby Mercado:
Okay, awesome. And you know, kind of a hot topic right now just in terms of I think we graduate like 40 fellows a year, 40 RTI Fellows a year, and that is not enough, as a lot of people know. So how do you, how do you handle physician recruitment? How do you think about this in the future? It's a big, it seems like a big problem.

Gurjeet Singh:
It's a huge problem. I have a few thoughts here. The first is for us, recruiting physicians has been, it is challenging, but I think it has generally worked out because, you know, our, we represent the next frontier in this industry.

Abby Mercado:
Yeah.

Gurjeet Singh:
And so every, anybody who sort of wants to be a part of changing the industry that they've have been a part of for such a long time, we are an attractive bet for them. So attracting physicians thus far has not been quite as much of a challenge. And what I see in the future, so there is a very famous person in the sort of IVF arena. His name is David Sabel. Have you heard of him?

Abby Mercado:
Of course. He's an active listener to the podcast. So. Hey, David, he's the best. He's been a mentor and a friend for a few years, so.

Gurjeet Singh:
Oh, that's amazing. So he has this capacity model, right, where essentially we have to build enough practice around physicians so that we can free them up to do more cycles per physician. So if you look at other countries like Spain or Israel or India, for example, where my co-founder operated his clinics, you know, there, physicians easily do, easily see, do over 1500 cycles a year. And they're able to do this because sort of from an operations perspective, they've built it in a way where that's where it's possible and you don't burn people out. So I feel like the US has to move in that direction. We have to in the US, there's nothing so special about us that we are, we are averaging 200 a year, while other countries are able to average 1000 to 1500 a year.

Abby Mercado:
Yeah, our success rates are the same.

Gurjeet Singh:
Yeah, exactly. Our success rates are the same. That's somewhat of a number two. If you look at some of the best fertility clinics in the US today, they're not run by a reproductive endocrinologist, right? They are run by OBGYNs, who have learned the practice and have become great at it. They are fully licensed to do it. So even though our entire focus right now is in hiring reproductive endocrinologists, board certified reproductive endocrinologist for our practices. But I do think that if the capacity continues to be a problem, I feel like some OBGYNs will have to start migrating into this area as well, and it'll be lucrative.

Abby Mercado:
Yeah, an unpopular-popular opinion for sure, but it's one I agree with.

Gurjeet Singh:
Yeah, I think it is.

Abby Mercado:
I'm sure.

Gurjeet Singh:
The writing is on the wall.

Abby Mercado:
Absolutely. And that's, I mean, aside of 90% of patients who need care, don't have access to care. And who is that actually all about? It's actually all about giving people, families their science. We have access to the science, why can't we give people access to that? So I think that's fundamental. Well, amazing. Obviously, what is going to make Oma successful is the patient. So as somebody who works with a lot of patients and works with a lot of people who are interested in accessible fertility solutions, how are you getting to the patients in, in a space that is so competitive? You know, every clinic in America, all 500 clinics in America, want the same, the same patient. How are you? What are you guys, going to be different in terms of getting to them?

Gurjeet Singh:
Yeah. So first of, a couple of things, first of all. I think if you, as I'm here in the Bay Area, if you call Stanford or UCSF for an appointment with a reproductive endocrinologist, there's probably going to be a rate of between 3 to 6 months before you can see a physician. So the competition is much less fierce in some sense. It's with their patients who, you know, everybody's biological clock is ticking. Typically, if they are seeking fertility care, it's because they are at a relatively advanced age and might not have very many other options and might not have too much more time. So in some sense, this is kind of, a bit of a problem of plenty, right? And that, this is a supply-side problem more than a demand-side problem.

Abby Mercado:
Yeah.

Gurjeet Singh:
So, you know, I think, knock on wood, it's not been that difficult to attract patients to our clinics, especially given the fact that we are the only clinic in the US that's using AI and machine learning in the actual procedures to make their outcomes better.

Abby Mercado:
And do you have your own model.

Gurjeet Singh:
Yeah.

Abby Mercado:
... To our clinics. Yeah. No, it's, that's, I totally, totally agree with that. I was just curious if you're employing any clever marketing strategies or anything, anything like that. But I think, I mean ultimately, I mean, given that the industry is still 65% cash pay and even if you are covered or if you do have some degree of coverage, like the key is having some degree of coverage, like it's, usually you're having to pay out of pocket to some extent, right, and like the rational economic buyer will prevail. So as long as you're able to prove out your success rates, which it sounds like you are then, providing accessible IVF solutions, it's going to win out in the end so. Well, so can you, I know that you have kind of two different technologies, two new technologies that you're excited about. Can you tell us anything about them or totally under wraps?

Gurjeet Singh:
They are, no, they are totally under wraps at this point.

Abby Mercado:
Yeah. No, it's fine. It's all good. Well, so ....

Gurjeet Singh:
... our technology that we have developed at this point is from, is from a year ago, right? We did that, so in this past year, we have done so much more.

Abby Mercado:
Yeah, yeah, yeah. Well, well, I'm excited to see what, what the future for Oma Fertility holds and all that good stuff. And so, you know, kind of as we close out the podcast, I ask every guest who comes on. Obviously, fertility is a market that is ripe for disruption, ripe for change. If you had to, quote-unquote rescript anything in the fertility industry, anything about the fertility experience, what would that be?

Gurjeet Singh:
I think the main thing that I would say honestly is I want people to be more open about their infertility struggles. It is, it is considered to be shameful. And people feel like they are at fault, there is so much guilt associated with it. That has to change. It's, you know, it's not a, it's nothing to be ashamed of. It's like some, as an example, like mental diseases have had this, had a moment where we feel comfortable talking about them. Not that they're easy at all, by the way, I recognize that it's a difficult topic, but at least people feel comfortable enough that they can talk about mental disease. But that transformation hasn't happened in fertility. So I feel that's, that's the thing that has to change.

Abby Mercado:
Well, we're doing all we can to get people talking more about their fertility struggles on Rescripted. So I, that's probably my biggest thing that I would rescript as well. Not what you ask, I ask you, but thank you for coming on with me. So well, Grujeet, this has been amazing. Where can people learn more about Oma Fertility.

Gurjeet Singh:
At OmaFertility.com.

Abby Mercado:
Amazing. Awesome. Well, thank you so much for coming on today. I'm just super excited to see where you take the Oma and just in awe of what you all have built to date. So thank you.

Gurjeet Singh:
Awesome. Thank you very much. Super kind of you.

Abby Mercado:
Thank you for tuning in to the Future of Fertility. We hope you'll leave here feeling empowered about all of the exciting innovations taking place in the fertility space. If you like today's episode and want to stay up to date on our podcast, don't forget to click Subscribe. To find this episode, show notes, resources, and more, head to Rescripted.com and be sure to join our Free Fertility Support Community while you're there.

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