Imagine this scenario: Rita and Dennis are trying to have a baby. Rita is 41. Dennis is 39. They’ve been trying to conceive naturally for 15 months and have had one miscarriage.
Based on those data points, and others---Rita’s body mass index, Dennis’s sperm count, and various hormone levels---when Rita and Dennis finally decide to seek fertility treatment, their physician will tell them that, based on the numbers, they have about a 2 percent chance of having a baby naturally, an 8 percent chance with the assistance of fertility injections, and a 24 percent chance if they consider in vitro fertilization.
In other words, they will hear that at best, their chances are slim.
What they won’t hear, says Dr. Piraye Beim, a molecular biologist by training, is the fact that after four cycles of treatment, their chance of getting pregnant with fertility injections shoots up to 26 percent, or that their chance of getting pregnant with IVF increases to 58 percent, or that, if they go through IVF with donor eggs, which is, albeit, not the easiest decision, their likelihood of getting pregnant is around 92 percent. And the reason they won’t hear it is because their doctor has no real way of proving it, at least, not precisely. Which is why Beim, who is CEO of the New York City biotech firm Celmatix, has been working on building a tool called Polaris that can prove it for them.
Polaris allows fertility specialists to compare a patient’s personal fertility metrics to a database of hundreds of thousands of other patients’ data. It then uses predictive analytics to calculate a patient’s most likely outcomes, based on other patients in the database who are just like her. Currently in use at 10 clinics nationwide, Polaris can predict a woman’s likelihood of getting pregnant, how that likelihood will change over time, the risk of multiple births, and other outcomes.
“It’s about giving people better clarity. Not perfect clarity,” Beim says, “but better, to help them make tough decisions.”
Rita is a fictional example, but in the United States alone, the CDC estimates that 6.7 million women struggle with infertility and miscarriages. Those who seek fertility treatment, and even those who don’t, know the process is grueling, stressful, and enormously expensive, especially since not all insurance companies will cover it.
And yet, Beim says one of the biggest problems with fertility treatment is that women drop out of it prematurely. In a study Celmatix conducted with Reproductive Medicine Associates in New York, the company analyzed the records of 6,000 patients. They compared outcomes from patients who discontinued treatment after two cycles to those who kept going. In the end, the study found that if those women had stayed in treatment one more month, 40 percent of them would have gotten pregnant. The issue as Beim sees it is those women have never seen these numbers. And while their doctors most likely have told them their chances will improve the more they try, Polaris's data can give that promise some legitimacy.
"Many couples come in with an expectation it’s going to be easier, and it's never easy to be told it's actually going to be harder," says Dr. Alan B. Copperman, medical director of Reproductive Medicine Associates of New York, who serves as an adviser to Celmatix. "But by inputting the data, and honing the predictive models, patients are given objective information that they can hopefully act on."
Of course, encouraging women to continue fertility treatment is a loaded proposition. After all, Celmatix gets paid by clinics depending on patient volume---big contracts can reach into the six figures.1 And fertility is a field some already find suspicious. Two years ago, for instance, The New York Times published the op-ed “Selling the Fantasy of Fertility," in which two women discussed their decision to stop fertility treatment.
“No longer under the spell of the industry’s seductive powers," it read, "we study its marketing tactics with eagle eyes, and understand how, like McDonald’s, the fertility industry works to keep people coming back for more.”
Beim says she is all too aware of this lack of trust. "Because so much of fertility treatment is out of pocket, patients are very close to the fact that they're paying for this treatment," she says. "You'd never think, 'What if my cardiologist wants me to do this surgery, so he or she can get rich?' But in the fertility field, that suspicion is there."
But both Beim and Copperman believe Polaris's approach should help engender greater trust between patients and doctors because it's based on data, to which patients rarely have access and will be free to interpret. They'll be able to see a concrete difference in likelihood between IVF and hormone injections and how each treatment increases their risk of multiple births. Meanwhile, Celmatix also is working on integrating other types of data, like genetic testing, which could help women discover whether they have a genetic mutation that would prevent them from getting pregnant with their own eggs before wasting time on IVF. Beim says even OBGYNs have expressed interest in using this tool to help women discover fertility abnormalities sooner.
"We should be giving women tools to proactively manage their fertility from a young age," Beim says. "It shouldn't be a reactive thing."
In the meantime, Copperman says he's already seen anecdotal evidence that this data is impacting how patients plan fertility treatments, sometimes skipping ahead to the type of treatment that is likely to be most effective, or, in other cases, choosing to forego treatment altogether, after seeing that their likelihood of conceiving is far lower than they'd hoped. "It’s not all about accessing more treatments," Copperman says. "It’s about transparency."
1UPDATE: 10:15 am ET 05/22/15. This story was updated to reflect that clinics pay an annual subscription fee to Celmatix.
