How do you build a cult following for an egg-freezing clinic?
Gina Bartasi, CEO of Kindbody, a fertility startup that launched in New York City at the beginning of August, has a few ideas. For one, a bright yellow van stationed on a Friday in the middle of Manhattan and then on a Sunday in the Hamptons — offering free testing for the anti-Müllerian hormone (AMH) associated with reserves of healthy eggs. For another, never announce anything too far in advance.
Kindbody has one brick-and-mortar location so far, two blocks from Trump Tower. It’ll be open to patients later this month, and they’ll spend the next six months building a bigger flagship on 16th Street. To find out where the next pop-up event will land, or where the next “boutique retail location” will open, you’ll have to follow the company on Instagram. When making these real estate decisions, Bartasi told The Verge she asks herself two questions: “Where is SoulCycle opening up? What is Drybar doing?”
“Where is SoulCycle opening up? What is Drybar doing?”
Kindbody isn’t the first “boutique” fertility clinic to open in New York. It is the first, Bartasi says, to offer online scheduling directly, rather than through ZocDoc, and to launch an app. Within the next year, it’ll expand from egg-freezing and IVF to general gynecology, mental health, and nutritional services. Within the next five, it’ll employ its own obstetricians and have clinics set up across the country. All of this expansion will depend on emphasizing convenience, encouraging strong brand affinities, and creating consistency from clinic to clinic — you know, like SoulCycle and Drybar.
“Today’s millennial female is on social media,” Bartasi says. “When you look at this new and cool millennial female, our marketing plan is directly and intentionally and deliberately tied to what they want and are asking for.” They want a thrill. A week or a day’s warning that soon, they’ll be able to take an extra 20 minutes at lunch and find out what’s up with their ovarian reserves.
In other words, the most important thing for a cult-like brand to have is exactly what brands have been chasing since the beginning of the idea of “brands”: youth.
“What we want to do is help women live a life of no regrets”
While most fertility clinics view their patient demographic as women approaching their mid-to-late 30s, when the quantity and condition of a woman’s eggs typically decline, Kindbody wants women to find them at 25. If they start building brand loyalty then, they’ll come back at 35 and 42 and 50. “What we want to do is help women live a life of no regrets, and have children when they want them, on their own timeframe,” Bartasi says. “So, you have this continuum of care with this brand that you feel so closely aligned with.”
It’s a brilliant business idea. Women are staying in the workforce longer, moving up higher, making independent decisions about saving and investment and planning, for more of those crucial years when a person has to think about how to become responsible. Maybe they can be convinced to think of egg-freezing as a logical, savvy choice along the lines of researching mutual funds or charting a path from renting to mortgage?
Egg-freezing, her website promises, is the future. It’s “like freezing time.”
Egg-freezing is on the rise, quickly. According to the Society for Assisted Reproductive Technology, just under 9,000 women underwent egg-freezing cycles in the US in 2016, up from less than 500 in 2009.
But is it “like freezing time?”
“Egg freezing itself is a very powerful technology,” Pasquale Patrizio, director of the Yale Fertility Center, tells The Verge. “It’s giving an option, but what option? You’re not giving any guarantee. There’s no guarantee of a future chance of a pregnancy. It’s complex. And when I speak with women when they are planning to do it, I can see how much they are in turmoil on the choice.”
In a phone call, Kindbody’s first clinical hire, Fahimeh Sasan — who worked as an OB-GYN for 12 years at Mt. Sinai in Manhattan, and served as a consultant for Bartasi’s previous businesses — answers the same question. Is it like freezing time?
“It’s giving an option, but what option?”
“Sure, in some respects it is. In that, you are pressing pause on the quality and number of eggs,” Sasan tells me. “Hypothetically, say a 30-year-old who decides to freeze her eggs, we know that, generally — again, this is all general — generally, a 30-year-old woman has a good number of eggs and the quality of a 30-year-old’s eggs are better than they will be when she’s 35 or 36 or 37. So, generally, a 30-year-old who freezes her eggs is freezing her quality and quantity in that time. If she comes back at 38, she’s unfreezing her 30-year-old eggs. Again, all generalized.”
The Kindbody website doesn’t say “generally” after every clause. “Freezing time” implies a sure thing, or at least a really good chance. The American Society for Reproductive Medicine removed the “experimental” label from egg-freezing in 2012, following the advent of a new quick-freezing method — now standard — that made it much easier to avoid eggs being destroyed by ice crystals or damaged upon thawing. But in the same breath, the ASRM declined to recommend egg-freezing as a method for postponing reproduction, saying there hadn’t been enough research about its ethics, its emotional risks, or its effectiveness.
According to SART, only 20,000 American women have frozen eggs, and of those women, less than 15 percent have thawed them. That means there’s a miniscule pool of data to refer to: The most oft-cited favorable odds (60 percent chance of a live birth for a 36-year-old woman) come from a predictive model out of Harvard, with the scientists conceding in the paper’s conclusion that the numbers are likely too optimistic, given “the paucity of validation data” available from women who have actually used frozen eggs to try to become pregnant.
There’s a miniscule pool of data to refer to
There is even less evidence that freezing your eggs in your late 20s (or even at 30) is a sound investment. Your eggs may be in better condition at that age, but most research on frozen embryo transfers has used eggs that were frozen for a few weeks or months, and it was only in 2014 that the fertility center at NYU Langone had its first successful live birth with eggs that had been frozen for seven years.
The costs are prohibitive — about $10,000 per retrieval, which usually results in about a dozen eggs — but this doesn’t include the cost of hormone treatments (another $3,000 to $5,000), or storage ($400 to $800 per year), or the frozen embryo transfer you’ll eventually need if you want to use the eggs ($3,000 to $5,000). Conservatively, storing one batch of eggs for four years and getting one chance at using them will cost around $17,000.
None of this is covered by insurance, except in rare cases where a cancer patient’s fertility is threatened by chemotherapy, or in cases where the patient is employed by a new-wave Fortune 500 company (Facebook covers up to $20,000) or, since 2016, the US military.
None of this is covered by insurance
On top of that, the hormone shots needed prior to the procedure carry a risk of ovarian hyperstimulation syndrome, an extremely taxing condition in which ovarian blood vessels leak fluid and cause abdominal pain, blood clots, ovarian torsion, and alarming weight gain — in severe cases, up to 40 pounds in a matter of a couple weeks. It occurs in less than 5 percent of patients, according to the ASRM, but it is much more common in younger patients — women in their 20s or early 30s.
The Kindbody marketing strategy is “disturbing,” activist Tanya Selvaratnam, author of The Big Lie: Motherhood, Feminism, and the Reality of the Biological Clock, tells The Verge in a phone call. The marketing materials provide next to no information about the current success rates of egg-freezing and IVF, nor context about why it’s probably not the best choice for the vast majority of women.
“The name is ironic,” says Selvaratnam “Egg-freezing does nothing kind to your body. It’s an invasive procedure.”
The AMH testing offered at Kindbody’s pop-ups has debatable usefulness, too, particularly when it’s targeted at 25-year-olds. The most important factor in determining a woman’s fertility is her age, and AMH results outside the norm can cause undue stress for a woman who’s not ready to think seriously about reproduction. Sasan says Kindbody has been emphasizing to all of its pop-up attendees that an AMH test is just one indicator of a person’s fertility — “one piece of the puzzle, but a good place to start.”
“Egg-freezing does nothing kind to your body.”
But recent research puts it at a relevance level even below “just one indicator.” A study published last year by Anne Steiner of Duke University’s fertility center found that the hormone was not useful in assessing the “natural fertility” of women aged 30 to 44 “without a history of infertility, who had been trying to conceive for three months or less.”
“From a cynical perspective, companies like Kindbody are targeting younger women because it increases their profit margins,” Selvaratnam says, “And on a macro-level, we’re facing an increasingly aspirational society that is less grounded in reality, which allows Kindbody to step into the fray.”
Founder Bartasi has plenty of experience in the women’s health care startup space, all of it pretty thoroughly observed by the press.
In 2008, she founded Fertility Authority, essentially as a content site with forums, oriented around helping people find fertility clinics and sharing information about treatments. Then, in the fall of 2014, she attracted major attention in New York for a series of swanky cocktail parties promoting Fertility Authority’s spin-off egg-freezing company EggBanxx. The marketing techniques used by EggBanxx are familiar: The parties were criticized for supplying insufficient information about the risks and realities of egg-freezing — despite their claims of just “starting a conversation” — and for pushing a serious medical decision into a group drinking atmosphere, encouraging women to sign up for consultations after a couple rounds of cocktails. Unlike Kindbody, however, EggBanxx didn’t employ its own doctors.
Selvaratnam attended one of the cocktail parties, and told The Verge, “I got this postcard there that said ‘Break Free From Your Fertility,’ and I thought, someone needs to sue this company for preying on women’s insecurities and promising that if they freeze their eggs, everything will work out for them.” At the time, Bartasi responded to criticism saying, “Some journalists get paid on page views and I get that.”
In 2015, Fertility Authority merged with Auxogyn, a tech startup hawking a tool that could test the viability of an embryo prior to an IVF procedure. The post-merger company was called Progyny, billed as “the Uber for IVF,” and marketed to companies that wanted to cover the costs of egg-freezing and IVF for its employees, but at a reduced cost. The New York Post reported that the merger soured when doctors complained of Fertility Authority’s steep patient referral fees, which may have been a violation of New York’s public health law (a spokesperson for the Department of Health says the office never received any formal complaints). Things reportedly got worse after Bartasi realized the new tech wasn’t selling, telling Auxogyn chairman Beth Seidenberg that she should “chuck it into the Pacific Ocean.” Later, Bartasi suggested to the Post that vitrification itself was her company’s claim to a high-tech edge, despite the fact that it was already widely used and approaching recognition as standard.
“Entrepreneurs seeking to capitalize on women’s fears”
Patrizio, who is also a professor in Yale’s biomedical ethics program, co-authored a paper in 2016 that referred directly to the marketing tactics that were getting Bartasi in trouble. He and his co-authors called for new regulations for the burgeoning industry — particularly when it came to advertising and “the entrepreneurs seeking to capitalize on women’s fears of losing their reproductive chances if they do not ‘freeze their eggs,’ with statements such as ‘smart women freeze’ during martini infomercial cocktail parties.”
On this latest iteration of Bartasi’s vision, he tells The Verge that providing information is extremely important, but just one test “done in a van” can raise undue alarm. The test is fine, but not valuable alone. “Having inaccurate or incomplete information can be more damaging than having no information at all,” he explains.
Still, Kindbody is a step up for Bartasi.
For this project, she has a genuinely impressive roster of collaborators. Her head of product is Joanne Schneider, who started her career at Google and recently left Flatiron Health — a startup that collects oncology data at an unprecedented scale and sells the information to pharmaceutical companies. Flatiron Health was purchased in February by Swiss health care giant Roche, for $1.9 billion — the largest tech exit in New York City history. For the record, she says, selling Kindbody’s data would not be a good business plan.
“What we’re excited about at Kindbody is that we’re going to own the clinics, we’ll own the data, we’ll own the workflow. And we’re owning the technology,” Schneider told The Verge. “We plan to scale nationally quite quickly and have that volume of data. We absolutely want to learn what’s working and then apply it at scale.”
“We’re putting women back in women’s health care.”
The team is entirely women so far, and a couple of the big-name investors in Kindbody’s seed round — Halle Tecco (Techammer), Swati Mylavarapu (Incite) — are as well. “We’re putting women back in women’s health care,” Bartasi tells me, a line she’s fond of.
It’s not unfair for her to point out that her main competitors in Manhattan are all funded and founded by men. It’s also not unfair to say that an online booking system for a fertility clinic is a good idea. It’s not unfair to say that well-designed, cloud-based patient portals should be an industry standard. It’s not bad to design clinics that are pretty enough to make spending time in them not unpleasant. It’s not wrong to say that women deserve better than what they have.
“If it gets women to seek out the information, that’s a good thing.”
In fact, women’s health care has often been a crapshoot, largely because of its history of being controlled by men — the rate of deaths due to childbirth increased temporarily but sharply when doctors took over from midwives in the early 20th century. A more recent example: a study published by the Journal of Medical Internet Research in 2016 found that most of the “educational” information about polycystic ovarian syndrome published in women’s and teen magazines emphasized PCOS’s “hindrance to women’s social roles as wives and mothers” and “placed personal responsibility on women to improve their health.” It’s a condition that affects nearly 10 percent of reproductive-age women, yet meager recent research estimated that 70 percent of women living with it were undiagnosed.
So there’s good reason for women not to trust the health care system, and Kindbody is positioning itself in opposition to that. Serena Chen, of the Institute for Reproductive Medicine and Science at St. Barnabas, complimented Kindbody’s goal of steering away from “the patriarchal attitudes in health care,” pointing out, “Research shows people are reluctant to go see a doctor. A yellow van in the middle of New York City can raise awareness. Maybe it’s a little hokey… if it gets women to seek out the information, that’s a good thing.”
Kindbody’s third pop-up was in front of the brick-and-mortar Kindbody, on 54th street, between 5th Avenue and Madison Avenue.
After the first round, 4,000 women signed up for email alerts about Kindbody, and they filled the 100 appointment slots for the 54th street pop-up 18 minutes after it was announced. The scene was relaxed, women strolling up to sign in on an iPad in a pink case then take a seat on a couch covered in fluffy pillows, in a cool glass box full of candles and chunks of rose quartz. Kindbody employees wore matching yellow t-shirts reading “Own your: Story, Fertility, Future, Wellness, Ambitions,” and gave out brochures that read, “You have options,” with two options outlined below: egg-freezing and IVF.
No one seemed to be having a bad time, and administering this test in the street, for free, is a good way to get women to have a more public conversation about a subject that’s extremely sensitive, and can be painful and private, and more painful because of that privacy.
The laughing millennial women, the typewriter font, the yellow and gray
But there’s something eerily familiar about the Kindbody aesthetic — the laughing millennial women, the typewriter font, the yellow and gray, the declarations of “the future is female.” The use of the word “we,” and the use of the phrase “no regrets.”
Brooke Duffy, an assistant professor of communication at Cornell, specializing in the intersection of gender and digital media, tells The Verge, “I think it’s very telling that this is a campaign about fertility treatment but there are no images of families. They’re all individual women, making choices. It’s all about empowerment, and it’s all very strategic.”
Like Chen, she applauds the all-women executive team. Co-opting feminist messages for marketing purposes would be more disconcerting if it were to benefit a company run by men, Duffy says. She also points out that the marketing is “about” women’s bodies without getting into any of the details — it’s about fertility without showing a body that’s been through childbirth — and that it is clearly for a specific group of women who can afford very expensive things and are used to a style of marketing that asserts their self-sufficiency and intelligent decision-making, the blandest tenants of 21st century corporate feminism.
“It’s all about empowerment, and it’s all very strategic.”
“A brand will draw upon these larger political messages, whether it’s female empowerment or progress or right to choose, but are they really backing that up with tangible forms of political, social, and economic support?” she asks. “It’ll be interesting to see.”
At a certain point, giving anyone credit for “starting a conversation” feels ridiculous. If women need more information about their reproductive health, why does that require stepping to the side of the issue with an over-aestheticized fact-lite version of the thing? Are we supposed to believe that women are too stupid to do something of basic usefulness to themselves without the lure of a charming font and a branded tin of mints? The pop-up was gorgeous. It was an unselfconscious Instagram ad for unattainably expensive procedures, marketed as “empowering,” just steps from the locus of an administration who would love to render every single choice a woman could make about her body from birth to death unimaginably difficult. Although, of course, not so much for women like these.
“This is a critical moment in women’s health care”
“This is a critical moment in women’s health care and politics more broadly,” Duffy tells The Verge. “It is crucial to bring these messages to the conversation, but the way they’re doing it is this cutesy, commercial, Instagrammable aesthetic. Is painting a logo on a water bottle going to tap into these political issues or is this window dressing?”
Now that Kindbody has officially launched, director of marketing Rebecca Silver will start looking for more traditional advertising opportunities. According to Bartasi, Kindbody’s message will roll out first in print advertisements in Hamptons magazine, Vanity Fair, and Airbnb’s new sponcon glossy.
Bartasi strives to build a one-stop shop for women’s health, starting at age 25, improving access throughout the country to vital services and making it simple to go from your gynecologist to your therapist to your nutritionist. This is not a bad goal, especially if she can deliver on the plan to offer services at 40 to 50 percent below the standard rates for egg-freezing and IVF.
“We’ve got to be able to make it affordable for every American in this country that wants to pursue this as an option,” she tells me.
The price difference will supposedly come from “efficiencies,” like online booking and data collection that streamlines the process — no two-hour consults, no group meetings to come up with a patient plan. Just the computer, recommending a course of fertility treatment based on new research and what has worked for similar patients, reviewed and adjusted by a doctor, but reliant on data to speed things up.
“You’ll never be more fertile than you are today.”
It all sounds great, but the only way a plan like that is going to work is at scale. There needs to be far more than 9,000 women per year (nationwide!) making the choice to freeze their eggs if Kindbody is going to reap the benefits of data efficiencies. So, that’s where young women come in. No one’s going to force your hand, but as it says on the Kindbody website, and as it is, technically, broadly, impossible to dispute: “You’ll never be more fertile than you are today.”
At the pop-up, Silver asks me if I’d like to hop in the van and take a test myself. “I’m 24,” I tell her. “So?” she says.
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