760 Lauren Makler: Co-Founder & CEO of Cofertility

0:00I am unwilling to give up, but I will start over from scratch as many times as it takes to get where I want to be. You just want to make sure you will get knocked down, but just make sure you don't get knocked out. So your only choice should be, go focus on what you can control.

0:18Kara Goldin:Hi everyone and welcome to the Kara Goldin Show. Join me each week for inspiring conversations with some of the world's greatest leaders. We'll talk with founders, entrepreneurs, CEOs, and really some of the most interesting people of our time. Can't wait to get started. Let's go. Hi, everyone. Welcome back to the Kara Golden Show. Today, I'm joined by Lauren Mackler, who is the co-founder and CEO of CoFertility, which is the innovative human-first fertility platform that's transforming how we think about egg freezing and donation. And after launching Uber Health, where she helped millions of patients get access to care, Lauren took her talents and her deeply personal fertility journal into the startup world, once again, co-founding this company that she cares very deeply about, and this time to build a new model for reproductive care.

1:25Kara Goldin:And Lauren is helping women freeze their eggs for free when they donate half. We'll get into that business model, but she has been recognized by many of the top press and more for building something that is scaling impact while putting dignity and transparency at the center of the experience. So I can't wait to dive into how she's done this and the model that she is breaking and scaling and how co-fertility is shaping the future of fertility care. So welcome, Lauren. So nice to meet you. You too. Thank you for having me, Tara. Very excited. So, okay. So for those who are not familiar with your company, Co-Fertility, and how it's different from traditional egg donation or egg freezing models, can you share a little bit about it?

2:20Yes. So like you mentioned, at our core, we help women freeze their eggs for free and store them for free for up to 10 years when they donate half of the eggs retreat to intended parents who need the help of an egg donor to have a baby. So we are really solving a problem for two different groups of people. On one side, we know that egg freezing is this incredible science that exists, right? It allows people to preserve their fertility in time and have a child later in life should they need the help of frozen eggs to do so. And it's amazing it exists. The problem is just that it is so cost prohibitive.

3:01It is something that is between$15 ,000 and$20 ,000 to go through the process with medications, the retrieval costs, and then storage on top of that. And so we know the best time to freeze your eggs is the younger you are. So it's really when you can least afford it. And we wanted to help make that more accessible. On the other side, we have intended parents who need the help of an egg donor to have a baby. That could be someone who struggles with fertility challenges. Maybe they met their partner later in life and have diminished ovarian reserve or a same-sex male couple, a cancer survivor, any number of reasons someone might need the help of an egg donor to have a baby.

3:41And it turns out that existing egg donation options are really falling short. So intended parents struggle to find a donor who reflects their own background or who is really aligned with the values in which they're hoping to grow their family. And so traditional egg donation is done actually through cash compensation, where a donor is paid anywhere from$10 ,000 to$100 ,000 for donating her eggs. And this takes that out of it entirely. And so our solution is really, you know, killing two birds with one stone and helping bring access on both sides.

4:20Kara Goldin:So the moment or experience that made you realize you had to build this company, if you think back, like what was it? Well, it's interesting. I actually was, I was building Uber Health just a few years ago, and I was diagnosed with an incredibly rare abdominal disease. I'm one of 154 people on the planet to ever get it. I was told that I had basically masses growing throughout my abdomen and pelvis and would need a number of surgeries to remove the disease. They said it was very likely I would lose my ovaries in the process. And as someone who wasn't yet ready to be a mom, but always knew I wanted to be a mom, I was like, well, what will my options be?

5:06How will I have kids someday? And they told me, you know, don't feel comfortable freezing your eggs at this moment because we don't know how a rare disease will respond. And so egg donation might be your best bet. And so I am a total planner and decided to look at all things egg donation. And I was shocked by what I saw. Frankly, this idea of cash compensation felt to me just seeing that like the more specific you get with what you're looking for in a donor, whether it's her heritage or hair color or education, the more the cash compensation goes up and up and up. And so to me, I was like, wait, this is surge pricing for egg donors, right?

5:46Like what is happening? It just felt really transactional and misaligned for me. I also thought it was crazy that these donors were billed as anonymous when at-home DNA testing exists. It just didn't make any sense to me how this was how the space worked. And so my sister decided that she would freeze eggs and donate them to me in case I needed them someday. So I ended up going through three major surgeries knowing that if I woke up with no ovaries, at least those eggs would be there waiting for me. Total miracle, I ultimately didn't end up losing my ovaries. and went on to have my child without using my sister's eggs.

6:26The minute I held her in my arms, I just thought, this is it. Like, I don't want to do anything else with my time than help other people have babies. And so that was it.

6:38Kara Goldin:I love this. So when you were, I guess, what are the barriers that exist for starting a company like CoFertility? And you have dealt in the healthcare space in your previous role. But I would imagine, I mean, there are other things that maybe you hadn't run into before. Yeah. So with co-fertility, I think this was the first time, you know, trying to build something in reproductive health during a time where reproductive rights and access to IVF and family building is like on a big political stage. It is a time where so much of this is debated and questioned in many different settings. And this posed a big question for investors as we started to put this out there.

7:38We had to figure out, like, how do we navigate this business when certain states might block access to IVF? And what does that mean for operations and how do we handle it? And so our team really prides itself on being nimble and, you know, making changes and, you know, following the guidance and following what's happening in the space so that we can move really quickly. But healthcare is hard. We joke sometimes hard is our moat, right? Like, I think that sometimes the harder it is to build what you're building, the less likely other people are going to try to compete. And so I think maybe that's the last half full way of thinking about it, but I try to keep that perspective when I can.

8:20Kara Goldin:I always share with non-entrepreneurs, non-founders that I'm so fascinated by the backstories and the things that the founders have and the operating team has to do in order to make a business run. And I mean, I've gone back, I was obsessed early on and worked for a little startup that was a spin out of Apple and was obsessed with Steve Jobs. And I'll go back and listen to him speaking about the company and you never hear about the hard, hard things that we later find out were going on. on. And, you know, it was part of the reason why I really wanted to start this podcast, because I think there are a lot of things where it's almost therapy for founders where you get to talk about like, you know, you can't really talk about from a consumer perspective, like, okay, this is what I'm working on today so that you can have this.

9:19Kara Goldin:But there are, there are so many things. It's wild. My co-founder, Hallie, encourages me often to write them down, right? To like put pen to paper on some of the hardest things that we go through. And for two reasons, I think one, I mean, it makes a great story someday, but more so I think, I think about like proof of past performance when I'm going through something that's really hard. And it's helpful for me to look back at, oh, we navigated that one, or we got through that. And, you know, if I can see it there in a single list, it helps me sort of look at the next hard thing that's ahead of me and think like, ah, like we got this.

10:00We've done it before.

10:01Kara Goldin:Yeah, definitely. So the process for a consumer wanting to use co-fertility, what happens? Yeah. So it's a different process on either side. But if you are interested in our split program, we call it. So that's the person who is freezing their eggs. You start with a simple questionnaire on our website. So cofertility.com, and you share a bit of information with us to make sure you qualify for our split program. And the qualifications, I wish that I could make them myself, but they are set forth by the FDA and ASRM, the American Society of Reproductive Medicine for egg donation. And so these are things like age, someone must be between the ages of 21 and 34 to donate eggs, certain family medical history, lifestyle, behavioral factors, you can't smoke cigarettes, things like that.

10:56Once you get through that process and qualify, and it's like a deeper application process, you have a one-on-one call with someone on my team. So it's a Zoom call where we get to meet you. And it's a sort of an opportunity just to ask any and all questions because donating eggs is a big decision, right? This is not something that should be taken lightly. It's something that someone should really be thoughtful about. And so we want to make sure that they have enough touch points with our team to really understand what they're doing. And then from there, you create a profile and you're listed on the platform to match with intended parents.

11:32And on the other side, when you are an intended parent, you create an account with CoFertility. You have the opportunity to have a free consultation call with a member of my team who helps with what we call matchmaking to help you find your match and to help you find an egg donor. And once you feel confident that you found the right person, we essentially sign what we call member advocate to manage the match. And that member advocate will meet with both sides and basically break down what the entire process looks like from start to finish. And we have a tech platform that enables that whole journey for both sides as well.

12:10So once that gets initiated, then they go through the egg retrieval. The donors half get sent to long-term storage and the intended parents get to create embryos right away. And so at that point, once they have embryos created, the intended parents can move forward with what in IVF is called a transfer, where sort of implanting the embryos so that they can move toward a pregnancy. And it's been really incredible to have that come to fruition. And we just had our 50th co-fertility baby born. And many more pregnancies on the way. So it's really exciting to now have intended parents getting to that point where they're sending us baby photos.

12:56Like, what is better than that? Nothing.

12:59Kara Goldin:That's incredible. So do they then go to a center or how does that process work? Yeah. So CoFertility partners with a number of fertility clinics across the U.S. And oftentimes, an intended parent is able to do this entire process staying with their current fertility clinic. Or in other cases, we will make introductions to some of our favorite fertility clinics so that they can move through the process really quickly. But for those who are on the egg freezing side, we really act as that first step in the fertility journey. We call it, we talk a lot about what we call the big sister effect. And maybe this is named after my own big sister who donated her eggs to me.

13:46But it's really an ethos that we have as a company that we want to be that really approachable first step in someone's fertility journey because we know that it can be really intimidating to set foot in a clinic that's been designed for people who are struggling with infertility when you're looking to proactively freeze your eggs, right? And so we are that first step.

14:14Kara Goldin:And like obviously it will range because you are working with different partners. But what, for somebody who is actually going to go through this process, you know, in either side of things, what is the range in pricing? Like, obviously, it'll vary based on the state and the clinic and all of those things. But is there like a range that it would be? Yeah. So on the egg freezing side, if you participate in the split program, It is literally zero dollars. So from end to end, the retrieval, the medication, any part of the process, including the storage up to 10 years, entirely free. Like we won't even ask for a credit card.

14:59On the intended parent side, like you mentioned, it certainly does vary based on a number of factors. But on average, we see an intended parent's entire experience roughly being in the$35 ,000 range, which is less than what they would pay elsewhere because they are not paying the donor cash compensation. There's zero dollars of cash compensation. So that's like the whole process, including the retrieval, the medication. and getting the eggs.

15:30Kara Goldin:How does this vary for you based on different states? You're based in California. So does that like help you? I mean, in any way? So I'm based in California. Our team is spread throughout the country. We're a fully remote company, which I really love as an entrepreneur and that it doesn't limit me in terms of finding the best talent to join my team. So And as a mom of two very young children, being able to work from home is a plus. But we have partners now in almost every state on the clinic front. And so we are able to make this happen in any state. I think what we see in terms of pricing is that where clinics have more competition, they have to keep their prices low or lower to compete.

16:24And so if you're in a geography, I think LA is a great example, or Chicago that has a number of fertility clinics, they have to keep their eye on each other and make sure their pricing stays competitive. Where we see the prices get higher is often in what I call a fertility desert, where there's maybe only one fertility clinic or a couple fertility clinics, and they can sort of do what they want because they're the only game in town. Interesting.

16:50Kara Goldin:So you have experience working inside of a large company, but you started kind of a, you know, Uber Health was my senses. It was a smaller business within a large company, but still you had the backbone of a very large company. All of a sudden, you're starting, co-founding, co-fertility. What lessons maybe did you take from your big company experience? And I will preface this by saying, in my opinion, not everyone can do that, right? Not everyone can take that experience and go start something. It's a choice, and it's hard. It's often harder than they ever thought, but I'd love to hear. So I think I had a unique experience with Uber in that I joined in 2013 when it was around 200 employees.

17:49And then I stayed until 2021 when it was about 20 ,000 employees. So I really saw an insane transformation there. And I think we really held on to the startup mentality for a very long time at Uber. And then my experience with Uber Health was as what I call an intrapreneur, where I got to take something from a seed of an idea and put it down on slides and pitch it around internally. And I had to get comfortable with the idea of hearing no. Right. So early on in pitching Uber Health internally, I had people say, and I quote, you really need to find a new hobby, Lauren. Uber is never going to be in health care.

18:33Right. Or you should really find another niche. Right. Like a lot of people said no. And I am relentless. That's like one of my personality traits in that I just like kept going until I got in front of the right people on the executive leadership team who were like, wait, what? Of course, we're going to build this. Like, yeah, go for it. And so I think that conditioned me for what it is to be a real entrepreneur. I think that if you are somebody who can't handle hearing no or takes offense to it or really has a hard time getting back up, entrepreneurship is not cut out for you. So I think like that experience at Uber helped me to sort of think about the no.

19:17Literally, I hear no. And my first response is just you wait. Like, like, I have a list of people that I have just you waited, you know, and so I think like that's something that certainly is very valuable. The other thing I think that came from Uber is this idea that people who are, I don't want to say old school, but I guess old school is the answer. I think like when they are in a space that's been done a certain way for a long time, they have a hard time accepting something new and disruptive. And so occasionally we'll come across that in the fertility space where they've been doing egg donation a certain way for a very long time.

19:58They have been doing it under this anonymity guise, or they've been doing it with cash compensation. And they see co-fertility come in, and our donors are amazing. They are highly educated, super ambitious, really excited to help another family. We're limiting the number of biological half-siblings. They're meeting the intended parents. We're really doing something very different. And sometimes I will hear the response of a clinic, or I'll hear the response of someone who's been in the space for a while. and I'll tell my team, it's giving taxi right now. Like it is so taxi. And that just, my team knows like, oh, when we hear taxi, like we know how we have to respond and we know what our response, like how we're gonna show up in this conversation.

20:42So I take that with me every day.

20:46Kara Goldin:I love that. How did you find your first users or egg donors and what were their reactions originally to this model? You know, it's interesting. Another thing I learned at Uber Health or at Uber rather and Uber Health is the value of a soft launch. I think a soft launch before you have eyes on you from press and important partners gives you the opportunity to sort of test and iterate on any part of the experience, whether that's the messaging or the contracts or the steps of the process, like any part of it. So we, before we launched Covertility publicly, we had soft launched for about nine months ahead.

21:29And we did the same thing with Uber Health, about nine months soft launch, so that we could get their feedback. We initially found them by running ads on Instagram or having a few like influencers posts what we were doing. But we, we were really honest with them. We said, Hey, we're launching this thing. This is what we have so far. Your feedback means everything to us. And so, you know, we'd love for you to give us feedback at every single touch point that to the extent you're open to it. If you're not comfortable with that, like, we'll come back to you once we've hard launched and, you know, once we're further along.

22:06And I think people really like respect the honesty and are excited to help. And so that went a long way for us. We laugh now about how many different iterations we have of our initial funnel and experience because we learned so much during that soft launch. Yeah.

22:25Kara Goldin:And I think it's the, to your point, too, the ability to kind of look at those things and figure out what's working and what isn't working. and maybe it's going to work later. And it doesn't mean it's a bad idea, but being able to figure out what is the focus in order to move it forward. What's been the most surprising thing you've learned from your community, whether it's donors or parents? The most surprising thing has certainly been the excitement around participating in egg sharing, right? Like I, before we started co-fertility, I did not know, I thought, Like, wow, yeah, I mean, that makes sense.

23:07Like, why wouldn't egg donation be done through an egg sharing model? But I didn't know if that meant other people would do it. And what we have found, and we did an initial survey to, like, find out if this was of interest to people. And we had, like, a thousand people respond in less than 24 hours. All women between the ages of 21 and 34. And 66 % of them told us that they were interested in egg sharing. And so that was enough for me to like completely dedicate my career to this. And that has only proven to be true. Not only are these women signing up for it, they are going through with it. They are excited about it.

23:47They're telling their friends about it. And they are proud of the experience and feel like honored to do it. And so I'm kind of like moved by that every day and get really like, you know, I think that when we see the babies born on the other side, it's just like another reminder of, whoa, this is working.

24:10Kara Goldin:Love it. So how do you think about this last question? How do you think about the future of reproductive health like more broadly? I mean, whether it's in the U.S., globally, where is it headed? Yeah, so I think about it. I think this space is headed toward choice in all things, right? I think women want to be in the driver's seat as much as possible, and they want to have options. And so I think solutions that provide them with options are absolutely where we're headed. And that's why we care so much about what we're building. I think the other piece of it is that when you are building in fertility care, at least, like it is absolutely has to be thought about as like a three legged stool, right?

24:57Someone has to be able to handle it emotionally. They have to be able to handle it financially and they have to be able to handle it physically. And so solutions that think about that whole, all three of those aspects are the ones that are going to be more successful. So we're always thinking about it through that lens. And there's so much to do in this space. So we're really excited to make it happen.