Future of Fertility_Pam Pure: Audio automatically transcribed by Sonix

Future of Fertility_Pam Pure: 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:
Pam Pure is the co-founder and CEO of Posterity Health. Posterity Health, where men go to manage their fertility is the only digital platform specializing in male fertility that empowers not just with information but with actionable steps to improve your overall health and fertility. Posterity meets men where they are making it easy and comfortable, and they're the only one-stop shop that exists for male fertility. Pam is one of those people I love chatting about wild ideas with. It's obvious from her background that she's an executer, but it's pretty clear to me that she's a visionary as well. As regular podcast listeners know, male factor infertility is close to my heart, which is why I'm so excited to welcome Pam to the podcast. Welcome, Pam. Thanks for joining me today.

Pam Pure:
Great to be here. Thank you for having me, Abby.

Abby Mercado:
Awesome. Well, let's go ahead and dive in. So why don't you start out by telling us about yourself? We want to know all about Pam. What's your background? Where are you from? Where did you grow up? How did you get here? All the things.

Pam Pure:
Yeah. Thanks, Abby. So I grew up in upstate New York, a little town called Schenectady, left and went to college at the University of North Carolina. It was in the mid-late eighties, and when I graduated, I happened to fall into a job in healthcare technology. Actually worked for a company that was building software to automate the hospital, kind of the first electronic medical records and grew up in the healthcare and technology space, first working in hospitals, then physician offices, and then post-acute care, home care, skilled nursing, and have always been right in the middle of technology and healthcare.

Abby Mercado:
Awesome. And so how has, how have you seen the world evolve as it relates to technology needs healthcare? Yeah, like, you know, obviously you have a ton of experience in that realm. Like tell me about that, how it's evolved?

Pam Pure:
You know, it's crazy when I think about it and that when I started in the business, the only thing that was automated was Bill. That was produced at the end of the process after a patient was already seen, everything else was in a paper chart. And if you walked into a hospital or a physician office, you saw the paper charts everywhere. So it's really been an evolution from a billing process to actually having physicians with software that can prevent some medication errors that can allow them to follow what's been happening with a patient with a chronic condition. And I'll tell you, the last ten years have been fascinating, actually seeing patients engage in their own care using technology. And that's really become a personal passion for me because people just want organized access to information about their health. And for the first time, we can use technology to provide them with that access.

Abby Mercado:
Yeah, I think what I've become particularly impassioned by is EMR interoperability, and in particular interoperability in the fertility space seems like it's very much still a challenge. So I hope, I hope that that, that gets better soon. I was just talking, talking with a friend about that and just how it's, it's a shame for patients when they don't have the best access to their medical records and just to information, so.

Pam Pure:
Yeah.

Abby Mercado:
Yeah.

Pam Pure:
We clearly have a long way to go. We've only scratched the surface on what can happen and what you, what we can do with the information if we have access to it and it shouldn't have to be so hard. So I think it takes people like you, people who are really advocating for the couple to have information at their fingertips to make the right decision to really drive the industry forward, just feels good because I believe it's happening and we can speed it up.

Abby Mercado:
Yeah, I think you're right. So let's dive in to Posterity. So would love to hear the founder story and how this idea was formulated, how you noticed the pain point and ultimately how you, you took the leap to start this company.

Pam Pure:
Yeah, it's, it's a really fun story for me to tell. So as I mentioned, my background was in healthcare technology, and this all happened when COVID hit us in 2020, in March. And I was home from work and I was actually running a war room for a group of healthcare companies, provider, and technology companies who are trying to figure out what are we going to do with all of our patients? What are we going to do to continue taking care of people? How are our physicians going to be safe? And my husband, the co-founder, Dr. Barry Cohen, is a reproductive urologist. And so he was down the hall taking care of his patients on the phone and talking to them about their fertility issues. And one evening at dinner, I said, Barrett, I'm putting telehealth technology in a lot of physician offices right now in behavioral health and autism to really help people connect. Would you like to see your patients using telehealth? And so we turned telehealth on for his fertility patients, and it was just so energizing to watch him. First of all, the female partner was home, so she started to attend the visits. And so instead of ten-minute visits where the male wanted to just run out of the urology office as quickly as they could, now you had the couple discussing fertility with an expert, and really those sessions went from 10 minutes to 45 minutes. We started getting calls from other states. Hey, I hear you're helping couples on telehealth. You know, how can we get my husband tested? What can we do? Or my husband has a male fertility issue, can you see us? And it was just so interesting to watch the dynamics unfolding in the office down the hall that I started actually researching the fertility space, which was a new space for me. You know, learning things like there are only 200 reproductive urologists in the country, people often wait 8 to 16 weeks to see one, but maybe even more importantly, that most males don't even get tested for 12 to 15 months into the conception process, if at all. And it just seemed like an area ripe for change, ripe for innovation and high potential to help a lot of couples. So that's how we dove in, and that's kind of how Posterity Health was born at the dining room table.

Abby Mercado:
Amazing. Well, so, I'm curious to hear, so only 200 reproductive urologists in the US. What is, I think on this podcast, we know a lot about reproductive endocrinologists, but tell us a little bit about kind of the state of play before Posterity for a reproductive urologist.

Pam Pure:
Yeah, I think, you know, the reproductive urology field scarce highly trained resources. About 40% of them are in academic medical practices, the rest of them tend to be in large urology practices that have a male fertility specialists. And so what you'll find is most of those physicians are extremely busy when they have an opening in their calendar, a general urology patient can fill up the time. And so there's a long waiting list and a huge access problem. I mean, it's still amazing to me there are states in this country that don't have a single reproductive urologist in the state. So what it means is there's generally a lack of information about the specialty. There's a lack of information on the fact that sperm really does matter and that couples who are having reproductive issues should be evaluated, both partners, not just the female partner, both partners should be evaluated. And then when you start looking at that as the best practice and care recommended by ACOG and ASRM, you can quickly conclude there's not enough physicians out there to support the process. So our goal in starting Posterity was to really dramatically improve access by using telehealth technology, using at-home testing, to develop our own training program for nurse practitioners that we could take nurse practitioners and PAs who worked in urology and really take them through an accelerated training program to support male fertility patients and by getting that critical mass of clinical experts together, it really allows us to extend our reach and touch so many couples that just wouldn't have access to care.

Abby Mercado:
That's awesome. So, let's side a little bit more into the model. So you mentioned that there are, that you all are big into telehealth, I know that you're licensed in many states helping a lot of families and a lot of men and many states in the US. But you also have a bit of a brick-and-mortar model as well. Just maybe walk us through the business and tell us how it works.

Pam Pure:
Yeah, no, it's a great question. And so our goal is to make male fertility care available to all couples who are trying to conceive and depending on their stage in the conception process, really depends on whether they need to be seen in person or virtual care or at-home testing works. So a big part of our business is partnering with OB-GYNs. So when that couple shows up for the very first time and says, hey, we're having an issue, that OB-GYN can just hit a button and then we take over with the male, we'll send them information on male fertility, we'll give that couple access to our digital platform to really provide a lot of engagement and education material on the role of sperm. We'll send an at-home semen analysis kit to that couple so they don't even have to leave their home and can get that initial assessment done quickly and very affordably. So in those cases, you know, majority of those patients have a normal semen analysis, and they are great with a digital experience and education. And so that's kind of our OB-GYN package where, again, providing the education, giving males tools that they can use in the privacy of their own home and sending that at-home semen analysis to their house instead of forcing people to go to a fertility center or a lab for what can be an uncomfortable collection is a core service that we provide, so that's one aspect of our business. When a male is diagnosed with an abnormal semen analysis, sometimes they're very simple things that can be done around lifestyle and behavioral changes, other times they really need evaluation and care. And when we get into the evaluation and care process, that patient is either seen by one of our physicians or NPs, or we'll order a fertile ultrasound that can also be used in, in addition or instead of the physical exam to make sure that patient is actually seen. And then we order the lab work and other diagnostic testing required to really understand what's happening with each individual patient. We're not an out of the box, call us and we'll send you for $99 a month for fertility care. Each patient is a little bit different, and in all of our situations, there's an egg and a female partner involved. So understanding the other half of the fertility journey is really important in making sure that we can provide the best care.

Abby Mercado:
Yeah. Awesome. Thanks for breaking that down. So just given your model, it's clear that you partner with a lot of brands in the fertility space. So for instance, sending, you know, working with various labs, sending various test kits, etc.. How has that been for you all? And do you have any learnings?

Pam Pure:
Yeah, actually, I feel like I have learnings every day. So I, number one, I would say, being new to the reproductive health space, I'm just overwhelmed with the emotion and compassion in the space. And people are here for a reason, and they are very sensitive to the job that we've all signed up to do, and to me that's incredibly energizing. It's just really understanding the emotional journey that couples are going through as they're going through treatment, I think is so incredibly important. And I would say that emotion is pervasive in that space, and it also serves as a really great foundation to build a partnership. People want to do the right thing, and they're looking for partners that can help increase their success rate. So I've found the space to be very welcoming. I, quite honestly, sometimes people are nervous about changing, especially if they have high success rates or they have something they've been doing for a very long time. And so I think in terms of building partnerships, I'm really proud of the partnerships that we've built over the last 18 months and the people that I've had the opportunity to work with and meet in the space. I think, in general, there is a compassion and empathy around our mission and the journey that couples have to take to, to move forward. And, you know, I think people are very welcoming. They're looking for new ideas and new areas where we can get better and help more couples. Honestly, I would have to say that some people have been doing things a certain way for a very long time. So inserting the male in the process or adding additional testing or, or changing the process is not something that you accomplish overnight. But I think there is a seat at the table for the male. And I think there is, I actually find this a very welcoming space. People are very focused on the couples, very compassionate and empathetic about the journey that these couples, our patients, are on. And there's something very energizing that really creates energy within our company and personally is very motivating, if you can just help one more family have a child. And so I would say in general, people are very welcoming, looking for new opportunities, expanded ideas in terms of how to help people, and then, you know, trying to push the male into the process in a way that the burden is no longer solely on the female partner and that we can unite the couple at the beginning with an integrated care team, I think is really the future.

Abby Mercado:
Yeah. Yeah, I certainly agree with that. And especially given my my own personal experience, we had a, I think, so, my, my family, we had male-factor infertility. And we, we were initially told to do sperm testing by our OB-GYN. However, we, essentially the result that we received at our fertility clinic and the evaluation that we received at the fertility clinic and later from a reproductive urologist, it was much more dire than, than we had been led to believe. So I think that arming OB-GYNs with the Posterity solution is, it's, it can actually be a lot, a lot easier to solve things with Posterity and then maybe receive a referral out from Posterity to a fertility clinic. If I have that right, that flow correctly.

Pam Pure:
Yeah, that's, that's definitely the flow. And, you know, Abby, both of us going through our own fertility journeys, I had an ectopic pregnancy before I had my three sons and at the time it was a little while ago, nobody talked about anything. You were just out of work, like no one knew what happened. And so seeing this evolution of openness, I think gives me hope that including the male and reducing the stigma around bringing the male to the table earlier in the process only gets us to a better and healthier place. I think it's helped both of us in our journeys, and I see it every day. As a matter of fact, our most frustrated patients are couples who've been trying to have a child for a year and a half, two years, and they finally do that semen analysis and find out there is a significant issue and they kind of look at us and say, why didn't anyone tell me to get tested? And that's heartbreaking and easily avoidable, so I think we're making progress.

Abby Mercado:
Yeah. Yeah. That was going to be my next question for you. Like, obviously there's, there's stigma around any type of infertility diagnosis, but there's so much stigma around a male infertility diagnosis. And we'd love to hear a little bit more about how, obviously you're bringing men to the table earlier on, which are so, so necessary, given that so many infertility cases are due to male-factor infertility. But how else is, how else is Posterity breaking down the stigma and just really improving this experience for everybody?

Pam Pure:
Yeah, you know, it's a great question. And we have, I think, a lot more work to do. But again, I definitely see progress. I think part of this is, step one, education. I think people don't realize that about 50% of the time a male has an abnormal semen analysis, that 60% of the time we can improve the outcomes and improve the sperm quality. And so I think people don't understand how, how prevalent male factor issues are or the fact that they're treatable. And so not thinking you're the first person who was ever azoospermic is a really big burden that a lot of men still deal with today in 2022, because the openness and the discussions around male infertility are, are just not where they need to be. So getting that education out, getting more information out about treatable conditions and how changes can be made, I think will invite more males to actually step forward and be tested. And, you know, I think, as I said, I think we have work to do. I have to say two sons in the 30 to 35 demographic and in seeing a lot of their friends, what I hear from them is, gosh, we wish we knew earlier, a lack of education, but there's still the guy that just doesn't want to do the semen analysis or just is so incredibly ashamed or embarrassed by a fertility issue that they're paralyzed. And those are the people that we just need to help them push through this.

Abby Mercado:
Yeah. Yeah. Well, I'm glad that Posterity is there to help out. So I think, and correct me if I'm wrong, but I think the statistic is a third of infertility cases are attributable to the female, a third of fertility cases are attributable to the male, and the remainder is attributable to both. And I've, I've heard, from multiple sources, that male-factor infertility, just given, just lifestyle factors, is set to surpass anything going on with the female and the next decade or so. Can you validate that? And also what are we going to do? That is really bleak.

Pam Pure:
Yeah, no, you know, it's a great question. And if you had all of our physicians on the call, I think you would, you know, some feel like there's a dramatic decline in sperm quality. Others feel that the decline may not be as dramatic, it may just be that more people are being tested. And we're starting to see issues that have been here for a long time. I think the first step is really to get tested and to understand where we are. And then I think as people realize that sperm really does matter, it starts to push the industry to treatment. And the great news is there are a lot of things that can be done to improve sperm quality and some basic things like, you know, totally non-judgmental, if people want to smoke marijuana, in most states it's legal today, but it clearly impacts sperm quality. Same issue around obesity, is true with males and females. And so there are a lot of lifestyle and behavioral changes that can be made that we see every day dramatically improving sperm quality. About a third of the males that we see have a hormonal imbalance, which means with medications, we can typically see a dramatic change in sperm quality and sperm count. And for some patients, there is a medical or surgical procedure that can be completed to allow that couple to conceive. So getting people into treatment, getting people to think of cryopreservation earlier in the process, I think all of those things will allow us to proactively deal with what may be changing fertility at both the female and the male.

Abby Mercado:
Yeah. One thing that I saw in your site that was really interesting to me was, you know how, your focus on recurrent pregnancy loss. Can you just break that issue? I think it's a common misconception that a miscarriage might, women blame themselves all the time, like, it's my fault that I miscarried this pregnancy. But can you advocate, educate the listeners on why this is also a male issue?

Pam Pure:
Yeah, you know, there's a big difference between the ability to get pregnant and the ability to stay pregnant. And sperm quality, sperm DNA is important to get pregnant, it's also important to stay pregnant. And so there's been a lot of research and more needs to be done in terms of how sperm quality impacts an embryo's ability to turn into a healthy live child. And with DNA fragmentation testing and some other testing that's now available, there are actually surgical procedures that can be done to extract sperm earlier from the male, allowing couples to conceive and actually maintain a full, healthy pregnancy. So we see so many couples going through this, we see so many devastated couples, and so many females feeling responsible that we've actually designed a consult specifically for couples who have experienced multiple miscarriages or failed IVF cycles to really dig into that male's history, their DNA, and really try to understand if there's anything that we can do on the male side that would lead to a different result.

Abby Mercado:
Yeah. So interesting and such a valuable service that you're preventing couples trying to conceive. So, also you recently raised, congratulations, back to more of the business, less of the science and the offering, but where, I think we're in a recession. Well, what was it, you know, curious A, what was it like raising in this environment? And then, B, kind of flipping the script a little bit? What kind of financial partner were you looking to bring on and how has this partner already added value?

Pam Pure:
Yeah, no, it's a great question. So I've been on the business side of healthcare for a long time, you know, I was tallying up how many companies we bought and sold over the years and fundraising. And I will tell you this environment was probably the toughest I've lived through just because it was changing so dramatically as we were going through the raise. You know, there was so much money being, I'll use the word thrown into healthcare without really a lot of due diligence, without as much in-depths review of companies that we've traditionally seen just because it's been such a hot segment. And so as the world's readjusted over the last six months, people have pulled back and the valuations in our space have been extremely high. So in, in those situations, things change even more rapidly. So we decided to stay true to who we are and what we believe we can become and the role that we played. And we just worked diligently to educate potential investors on the market, on the need to provide these services. We have a very focused plan that our investment will go to the hiring of additional reproductive urologists, nurse practitioners, other experts in a space that's in dire need of experts. And our technology platform, which is really, I think key to getting males to engage, is allowing them to do it at their own time, in their own space, and have the ability to ask questions or to learn about fertility issues. So looking at those two core components of, of our funding, I think made it easier for our partners to step up realizing that those were enduring and sustainable differentiators for us. In terms of what we're looking for in a partner, it's, you know this, you run a startup. There's a lot of uncertainty in terms of exactly how quickly things are going to grow, exactly what the products and services are going to look like. So we wanted someone who could provide more market insight for us so we can make those changes and transition in the most accelerated manner so that limited our VC pool to people who are focused on healthcare. We also wanted people who had done the brick and mortar digital combination of building a company so we could be there when we needed to be there, but also be available through telehealth and build a business that would scale. And so those were the partners that we looked for. We had our first board meeting two days ago with a team of three investors, Distributed Ventures, WVV out of Wisconsin, and FCA out of Nashville. And I will tell you, for me, it was really energizing, new ideas on the table, introductions into new players, support to accelerate our technology platform. And, you know, what I want is a team of employers and investors and customers who's really committed to figuring out how to include the male in the process, and I think we've found that with this investment team.

Abby Mercado:
That's awesome. That's good to hear. It's like, I once heard that, well, I once joked in a startup that I worked that once upon a time that hosting a board meeting is kind of like driving on ice, until you get out of the car you don't realize how stressful that might have been, but then it feels so good and you feel so energized when you're, when you're off and back to work and just refreshed by all the ideas that were discussed, so congrats on getting that under your belt for sure.

Pam Pure:
Yeah, and I think Abby, for me, being a little older and wiser, not just in the mission of the business, but in the support you need as a leader is, picking the right people is so critically important. And for me personally, being able to have dinner with my board members and feeling like I was with a group of people that I genuinely enjoyed, I respected, I felt like they were really emotionally engaged and charged in our success. And so picking on the personal side was as important to me as picking on the economic side, because I think bringing those two things together is really where you get the supercharge.

Abby Mercado:
Well, well said. That's so important. And I know that so many founders, so many entrepreneurs screw it up and aren't as focused on fit. And that's so important when you're putting together your board and the people who are going to be by your side with, with resources and what have you along a really hard journey. I'll admit that being an entrepreneur is an incredibly difficult journey, so. Also what is, I think, second to last question, so, you know, curious, what's, what's one risk that you've taken that has really paid off in ... journey?

Pam Pure:
You know, it's an interesting question, but I think the biggest risk we took was hiring great clinical people before we had enough patients to fill up their schedule. And as you know, these are expensive hires, but we believe our real differentiation is the experts that we can put in front of patients and the experts that we can team with REIs and OB-GYNs. And so hiring the best clinical talent is kind of job one, and so we have been able to hire five fabulous reproductive urologists very quickly. We've been able to surround them with nurse practitioners and PAs who really understand urology and are quickly learning reproductive urology. And we just made the decision, hey, this is an incredible opportunity to build an A-Team and we'll be able to fill up their schedules. So you kind of take that, sure, you've done it a lot too, you kind of take that deep breath, this is what we have to do to make it grow, and I hope we can find the people. And so we've been very lucky, and those great people are really attracting, you know, patients from all over the country that really trust us to provide great care.

Abby Mercado:
That's awesome. Great, great answer. I think we've all had risk like that where you're, you're certainly spending more than you're bringing in from a revenue perspective, and that's like the scariest thing that you can do. And, you know, and frankly, in a fundraising environment like that we have right now. So kudos to you for being brave and having that payoff. Well, so, Pam, as we close, I always like to ask this question to our guests, but what's one thing you would rescript about either the fertility industry as it exists today or just the fertility experience?

Pam Pure:
I think what surprises me is how many people need care and how many people actually get care. And part of it is a reimbursement issue, and part of it is an education issue. But every fertility center I go to is so busy, every physician is so busy, but I still run into so many couples who don't get care. And, you know, I think access is a huge challenge for the country and finding more, more entry points for couples to really get advice, to really get counseling and support and to really get help. These are medical issues. And I think we're making progress. I think there is a lot of change happening, but we see a lot of people who may not have IVF as an option and or may not have other treatments as an option. And then people who can't even afford the $400 visit to come in and really be evaluated. And so I think when I look at the industry and aggregate, I feel like there are so many people that are underserved. And I'm hoping that we'll be able to evolve using technology, some of the new treatments that are coming to just be able to support more people and make fertility care available and more inclusive.

Abby Mercado:
Yeah, yeah, I think that's a saying, a $400 consult, so, so, still many people can't even afford that, like that is, that's right .... So let's do something about that, shall we? ...

Pam Pure:
Yeah.

Abby Mercado:
Well, thank you so much for coming on to the podcast today. What, where can people learn more about Posterity Health.

Pam Pure:
Yeah, we have a web page, PosterityHealth.com and we also have the ability from that web page to contact us and very interested in learning more about the space meeting people who are interested in our services and helping more patients. So Abby, thank you for your time and thank you for helping us get the word out.

Abby Mercado:
Amazing. Amazing. Well, it's been a pleasure, Pam, And I'm sure we'll we'll chat soon. Thanks again.

Pam Pure:
Thank 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 liked today's episode, don't forget to click subscribe and be sure to check out Dear (In)fertility, our popular podcast/advice column where we chat with experts about all things fertility, infertility, and pregnancy loss. To learn more and to join our Free Fertility Support community, head to Rescripted.com.

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