It’s not a secret that finally, after years of being overlooked, women’s health is having its moment. According to Frost & Sullivan’s report, the femtech (female technology) market revenue is expected to reach $1.1 billion by 2024, growing at a compound annual growth rate (CAGR) of 12.9%. The report states that, through solutions targeting early diagnosis and leveraging connected healthcare services, these technologies can reduce healthcare costs, decreasing the overall cost burden of a country while elevating healthcare standards and quality of life for women. But it took a long time for female healthcare to be where it is today.
Ever since the FDA (The United States Food and Drug Administration) in 1977 issued a guideline banning most women of “childbearing potential” from participating in clinical research studies (since certain drugs at that time were causing serious birth defects), women weren’t included (at least not enough) in medical research. In 1985, new guidelines were issued to encourage more inclusion of women in studies. However, even that wasn’t enough to close the gender gap in medical research – analyses found that women were still seriously underrepresented in important studies on common diseases such as heart disease. Finally, in 1993, the FDA issued a new guideline which was followed by Congress writing the NIH inclusion policy into Federal law through a section in the NIH Revitalization Act of 1993 titled Women and Minorities as Subjects in Clinical Research.
Fast forward to today, women’s health as a category has gone beyond just healthcare, is hugely impacted by the use of technology, and is all but a niche – it affects more than just females – fertility, for example, is not just a women’s issue, despite the misconception that (in)fertility is still a largely female problem (40-50% of all fertility problems are due to the male factor).
The femtech industry has generated just over $376 million in venture capital across 57 deals in 2020 and some of the largest exits in recent years include femtech companies – Progyny’s $130 million IPO in 2019 and Bayer’s acquisition of KaNDy Therapeutics in 2020 for $425 million. $688.8 million has been invested in digital health companies targeting fertility and pregnancy/motherhood through H1 2020, which represents 65% of all femtech funding. The potential of it is massive – female health is not just female health, it affects men, children, and whole families as women are primary caregivers more often than not. Female health is a public health issue and should be treated as a priority.
Below are three startups leading the way in innovation in this space, proving that no area within the femtech space is saturated with innovative companies and that there is still so much growth potential in this market.
Breathe ilo is the world’s first fertility tracker that uses breath analysis to identify a woman’s ovulation pattern and fertile window in a way that is easy and comfortable. Its technology is based on measuring the PCO2 parameter, which means the partial pressure within the carbon dioxide. Simply said, the device measures a decrease in women’s breath before ovulation. What most women don’t know (I certainly didn’t!) is that they have a type of hyperventilation 4-5 days prior to ovulation. Through consistent daily use, the breath analysis tracker enables women to understand their body and cycle phases better. Additionally, the breathe ilo app, which is compatible with iOS and Android, features a calendar that displays a clear overview of fertile days and a cycle diary to learn more about individual cycle patterns and also enables users to document further cycle symptoms like breast tenderness, PMS, cervical mucus, or headaches to help prepare women for their next cycle.
“The technology behind our device means women no longer need to track their cycles by urinating on a stick or by measuring their temperature early in the morning. All they need to do is simply breathe into the device which will display the result in just 60 seconds on the mobile phone, with no consumables or maintenance needed. Another positive thing is that you can use it at any time of the day, which makes it accessible for every woman, even those who have no daily routine,” Lisa Krapinger, CMO of Vienna-based Carbomed Medical Solutions, the company behind breathe ilo, shares with me in an interview.
The idea for this type of product came from Prof. Dr. Ludwig Wildt from the University Clinic Innsbruck, who dedicated decades of research on the relationship between the female cycle and CO2. Something that started as a side project for the breathe ilo’ co-founder and CEO Bastian Rüther. “Investing in combined hardware and software products needs brave investors. First of all, the funds needed until profitability are usually higher than in pure software products. Furthermore, the skill set of the organization needs to be much broader and the organization will be much more complex because of managing all the supply-chain complexity. Our latest round was a Pre-Series A round of $3.6 million, led by the AWS Gründerfonds, one of the largest Austrian Venture Capitalists, with the participation of our existing shareholders,” he shares with me.
“We want to continuously improve breathe ilo and make it truly accessible to every woman. Unfortunately, there are a variety of different diseases such as PCOS, which haven’t been well researched. Therefore, we are trying to research different areas to try and have a holistic view of women’s health. We really want to help all women to fulfill their desire to have children, even if there are physical impairments. However, this requires very expensive, time-consuming studies. Furthermore, in the future, we would also like to provide breathe ilo for natural contraception and further breath analysis applications. We have achieved to make breath analysis tremendously affordable and can really see a mass market for it, so I think we are on a good track to revolutionize cycle tracking,” concludes Krapinger.
Among the 1.9 billion women of reproductive age (15-49 years) living in the world in 2019, 1.1 billion have a need for family planning, that is, they are either current users of contraceptives – 842 million use modern methods of contraception. Approximately 160 million women (17%) use IUDs (intrauterine devices) globally – varying in market share between countries, IUDs are the most widely used long-term, reversible contraceptive method in the world. Yet there has been no OCON Healthcare innovation in the IUD space since the 1990s with current devices using a deficient delivery platform invented in 1970.
OCON Healthcare, an Israel-based company is here to change that. Its first product is the IUB™ Ballerine® – the first and only 3D intrauterine device shaped for women’s anatomy and is a long term, reversible, hormone-free contraceptive method replacing the 2D traditional T-shaped IUDs. But contraception is not the only reason for OCON’s innovation in this space. On top of the IUB™ Ballerine®, any drug or substance that can be introduced into the uterus can be potentially put on the flexible, smart memory shape IUB™ (Intra Uterine Ball) frame to be non-invasively delivered to the uterus and treat various medical conditions, replacing invasive procedures.
“Abnormal Uterine Bleeding (AUB) affects up to 25% of women globally with a $1B annual addressable market, more than 70% of women develop uterine fibroids by the age of 50, which is 9 million women in the U.S. alone, and hormone replacement therapy, of which the market size was valued at $21.8 billion in 2019, are all areas we are looking into and in which we are developing innovative solutions to cater to women who need them,” Keren Leshem, CEO of OCON Healthcare, shares with me.
Leshem joined the company in September 2019, and very quickly put the company on the trajectory of growth. The company now has 100,000-plus women who had the IUB™ Ballerine® inserted by their doctor and this innovative contraceptive is currently sold in 30 markets in Europe, Middle East, Africa, and Latin America. It’s a company led by women for women, as Leshem says, with 85% of its team being women now, including their newly appointed Chairwoman, California based life science VC leader Dr. Anula Jayasuriya.
“In 2020 OCON raised a total of $4.5 million in funding from both internal and external investors as well as non-dilutive government funding for their R&D projects. To date, the company has raised almost $20 million and our investors include Pontifax VC, Docor VC, Rhia Ventures, Merchavia Investments, and other angel groups. “This year, for the first time in my life, I’ve witnessed the fundraising process being done completely online. It’s weird to have such a connection and find amazing support when we haven’t met personally with the teams in the U.S. that placed their confidence and money on us,” adds Leshem. The company is now actively raising a Series B round to bring their innovative platform to the USA, so investors, what are you waiting for?
Eli is a Canada-based startup developing a hormone tracking product designed to be used at home. From the user’s perspective, there are three simple steps. You take a saliva sample with the cartridge, you insert it in the small portable device that captures your daily hormone fluctuations, and shortly after, the app provides powerful information tailored to you. This information includes your hormonal profile and precise fertile days. With this data, customers can achieve different goals, including avoiding pregnancy naturally or conceiving a baby. The product will initially be available only for people trying to conceive, while Eli’s team complete the clinical and regulatory work for the contraception use-case.
Fertility is a booming market, with 1 in 7 couples who experience infertility. This number is still growing because we are waiting longer than any generation ever to have children, and fertility declines with age, but the effects of age are much greater in women compared to men. In their 30s, women are about half as fertile as they are in their early 20s, and woman’s chance of conception declines significantly after age 35. Male fertility also declines with age, but more gradually.
So what makes Eli’s product so unique? “We first asked ourselves what the ideal solution would look like and asked the same question to hundreds of women and dozens of physicians. It was clear that we had to make no compromise on ensuring it’s effective and delightful to use, in addition to being hormone-free and non-invasive. That process led us to build technology from the ground up because no existing product met all of those criteria. The technology’s ability to measure multiple hormones (instead of proxy variables like temperature or cervical fluid) and to have saliva as an input (instead of urine or blood) is some of the elements that make our product unique. Because we built the technology by keeping contraception in mind, it was critical for the product to be reliable and simple to integrate into a routine that you keep for a long time. Measuring hormones can give the effect we were looking for, and using saliva is the foundation for delivering the best long-term experience,” explains Marina Pavlovic Rivas, co-founder, and CEO of Eli.
But it’s not only about fertility, for that matter. After using hormonal contraception for years, many women just want to stop at some point, not for the sake of getting pregnant, but because of many other reasons. Although hormonal contraception is one of the most significant advances of the last century for women and all of society, up to 51% of women using hormonal birth control report unwanted side effects. The problem is that when you want to avoid hormones and invasive devices, you’re left with very few effective options. That means you either continue to use a method you no longer want to use or opt for a less effective option, and both cases should be unacceptable. Women’s contraceptive needs have evolved, but innovations to meet those needs haven’t followed. On top of that, “hormones are at the root of so many transitions and conditions women experience, and yet they are still a black box for most of us,” Rivas adds.
Since the company’s creation a little over a year ago, Eli has raised over $2 million. This includes a $1.5 million seed round that the company closed in December 2020. Vectr Ventures led the round with the participation of 2048 Ventures, Real Ventures, Techstars, Panache Ventures, Ramen Ventures, MEDTEQ+, and serial entrepreneur Steven Arless, who also joined the board. Before this round, Eli received around $700,000 in external funding. Most of it came from equity-free sources, such as government programs rewarding companies developing breakthrough technologies. It also includes an initial investment startup received in fall 2019 a few weeks after starting the company from Techstars and Real Ventures, via Techstars Montréal AI. Both investors subsequently invested in Eli’s seed round.
“No one could have predicted the challenges of raising during a pandemic. We were aware that some stats were not favorable even before that new context. Only 90 Latina founders have ever raised $1-plus million, and less than 3% of all VC funded companies have a woman CEO. However, it turns out that the pandemic reduced VC funding for female founders even more. With a 48% drop in funding to female founders from Q2 to Q3 2020, it hit its lowest since 2017. We were operating for a few months only when the global health crisis hit. It certainly added a layer of complexity at first. As a deep tech company with a hardware portion, we couldn’t become entirely remote because we still needed to work with specialized equipment and controlled testing environments in the lab. We now have been running for longer under the global pandemic than in the pre-COVID era. It turns out that the current context holds several opportunities that accelerated our operations and amplified the need for our product,” concludes Pavlovic Rivas.