Ep 4: Martin Varsavsky

This is a global original podcast. I'm Lionel Barber, host of what Next Coronavirus has changed the World we Live In. Join me as we hear from influential voices from across the globe. Forward thinking discussion on politics, the economy and our health. How will this pandemic reshape our future? I'm joined today by Martin Warsavsky, one of Europe's most successful entrepreneurs. Martin is a serial innovator. He's managed projects ranging from fiber optics to renewable energy and autonomous vehicles.

Raising eggs and square arm is a way to achieve a certain type of gender equality because then women can have babies in their 40s and sometimes in their 50s.

Today we're going to talk about his special project, which is personalized fertility care, or as he says, managing your biological clock. Martin, this really is a revolutionary development, not just for women, but for parenting in general. Tell us how it works.

Well, first of all, thank you for having me, Lionel. It's great to be here. And thanks to everyone who's helping with the podcast and with the video. In order to explain what's happening now in the world of human fertility, it's interesting to go back to how things used to be. So the generation known as baby boomers born after World War II didn't have much problem having babies. That's why they were called baby boomers, because they had their babies in their 20s. And if we were done with having babies in our 20s as humanity, we wouldn't have problems. I mean, would have problems. Maybe 5% of people would have problems, but not a third of people would have problems. And the reason why a third of people are unable to fulfill their maternity or paternity needs is because they try to have babies in their thirties and forties. Humans are not designed to have babies in their thirties and fortyties. That doesn't mean that it's not possible, but it means that it is less likely that you'll be successful. What we've done at the Prelude chain of clinics, which is owned by Inception, the company that I'm the chairman of, and I'm the founder of Prelude. What we did at Prelude is to organized a method by which people could have babies whenever they were ready and have healthy babies whenever they were ready. This method, which we call the Prelude method, is basically consisting freezing gametes when you're fertile, freezing eggs and sperm in your 20s or early 30s, then to make embryos when you're ready, maybe in your late 30s or 40s, then to genetically test the embryos to make sure or to increase the chance that you'll have a healthier baby and then to transfer one at a time so you don't have multiple births or twins. That's basically what's known as the prelude method. And that's how we can help people have healthy babies when they're ready.

Let's just stop there because that's an awful lot to just digest and think over because it has many implications both the way the sort of human life cycle, the question of choice, et cetera. Now first of all, how did you think of this idea? What was the process and the iteration?

Well, my three youngest children were born out of IVF and the youngest one out of frozen eggs and frozen sperm and genetically tested embryos and everything that I just described. I would say that I certainly started in this field as a patient. I was a tech entrepreneur before working in other fields like green energy and telecoms and consumer Internet. And I went in the field as a patient. I mean it helped that I studied four years of pre medicine in my university and I'm comfortable with medicine even though I've never made it to doctor. I kind of failed my way into entrepreneurship, but I feel comfortable reading papers on human fertility, on biology. And so when I looked at the incredible amount of people who are failing to achieve their parental objectives, I, I thought of this method which is really not so original, but it's a lot of things that existed but put together in a systematic way in order to have babies when you're ready. Some countries like the UK have unusual regulations, for example, until recently, and it may still be the case, you were supposed to use the eggs you froze within 10 years, even though there's probably the eggs you froze could be used by your great grandchildren. But there's no biological reason why eggs in liquid nitrogen expire in any way. I hope that changes. But in other countries like the US you can keep your frozen gametes as long as you want. That gives you a chance to beat the biological clock. And men should freeze their sperm too, because men, while they are fertile later in life, they're much greater contributors to severe mental illness when they start having children in their 40s and 50s. There's other reasons to freeze sperm.

Tell us about the changes, if you like the cultural sociological changes which lie behind this, that people are having children later and it's no more baby boomer time.

Well, I think there's a lot of that relates to gender equality. Like I'll give you one example. Depending on the country, around half of people who get married get divorced. But those who get divorced and Are men tend to be able to rebuild their families in their 40s and 50s without much of a challenge. But women who want to rebuild their life in their 40s and 50s have real challenges and sometimes impossibilities in becoming parents. Freezing gametes, freezing eggs and sperm is a way to achieve a certain type of gender equality because then women can have babies in their 40s and sometimes in their 50s. I also think that there's a lot around these for implications to society about genetic illness. There's people who tend to carry, who carry mutations, monogenic mutations like Tay Sachs or cystic fibrosis or sickle cell anemia or thalassemia or, well, even my wife as one of them, called pcd. Then when you marry someone who has, or marry or whatever have children with someone who has those same mutations, then your children, one in four of them have this illness. With genetic testing, you can have healthy babies and avoid illnesses that could in some cases kill your child by the age of five. So there's a lot of implications about having healthy babies. Some people worry that there's also implications about having designer babies, meaning that you could have babies who are better looking, smarter and so on. The technology is not there yet, but I admit that this is a concern, a valid concern, and you wouldn't get into that. Yes, I think that it is one of the dangers of this technology. In our case, we promote it for avoiding illness and not to get a better looking baby or child or one that will do better in university exams. But not all cultures feel the same way about these. For example, my Chinese friends would love to have genetically engineered babies and generally don't think of that as a problem. And they already had genetically engineered babies in China, the first ones with crispr. There's a danger that this technology goes. Well, I was going to say the wrong way, but for the Chinese it may not be the wrong way, but in a way that's culturally unacceptable to most of us. But so far the only thing that is done that is culturally unacceptable to some is, is gender selection. In America it's legal to say, I would like a boy or a girl, and you choose a boy or a girl. Something that is not legal in Europe. Is gender selection a form of designer family? I guess so, because you can have three girls, you want a boy or you have three boys, you want a girl. But we haven't seen any systematic bias against girls in the United States.

Martin, how do you respond to those who might argue that you have to let nature take its course? So even Though you're not encouraging designer babies as such, you are not allowing nature to take its course by intervening with genetic selection or genetic intervention to. To prevent unhealthy babies. How do you respond to that?

Well, I understand that people. Some people feel like that. And some people would avoid IVF and egg freezing and any of these technologies. Some people would avoid it because they believe nature should have its course. Some people would avoid it because of their religious beliefs. Like some people, Catholic Church, like the Catholic Church openly has spoken against ivf. Now, some people believe we're working against God, but some other people believe we're doing God's work. And people believe all sorts of things. I mean, I'm active in social media, and I receive praise and criticism for what we do. All I can say is that there's certainly no obligation to have babies this way, and people can choose having babies anyway they want or not have them at all. The question is, should society offer a choice for IVF and egg freezing and embryo testing? And I think certainly society should offer a choice for people to do these. And in any case, if we were going to an extreme of being doing nature's way, when we used to be abiding by nature's way, even as late as the 1800s, the life expectancy was in the 30s, 40s. We could go to an extreme and say, well, why don't we just die in our 30s and 40s as an average of the population? But I think most people would rather not die in their 30s and 40s living the way nature made us to live without medicine, because that would be just to say, let's live without medicine. It doesn't seem to be a prudent and advisable way to go. And in fact, in many cases, it's illegal. Like in many countries, it's illegal not to vaccinate your children or to live in a natural way.

Martin, you talked about the desirability of having choice in this area of personalized fertility care. How is your offering geared to helping people who are perhaps not so well off? And you're avoiding the scheme, just being for the privileged and wealthy.

Well, that's a very valid criticism. And in fact, I'm building another company called Overture that tries to democratize IVF. Because I agree with you. At 53,000 average cost per baby in the United States, even though sometimes paid for by insurance, but sometimes out of pocket, it is hard to say that we're helping everyone to have a child. There's few people in the large population. There's A small group of people. Maybe we can help half the population, but not the other half. So I take that criticism. And we're working on a new company called Overture, which is automating the embryology lab in order to make IVF and egg freezing much more affordable. Lower the cost, increase the efficiency, so anyone who would like to have a baby can have a baby, which would be my objective as an entrepreneur.

What about the failure rate? That's almost built into every system. What's your success failure rate look like?

Well, the failure rate of IVF on one IVF is very high. In fact, the success is around 40%. Depending on age, it can be higher or lower. But on the average age of the people who show up at our clinics, the first time is 40%. But if you take it as a group of cycles, then maybe you get to a success rate of 80%. 70, 80%. That still means that some people, not an insignificant number of people, pay for IVF and never get a baby, or pay more than one IVF and never get a baby. It's the minority, but it's there. I have advocated in the past that we should try to evolve to a system that you don't pay for ivf, that you pay per baby. I think that would be quite fair. That would mean some type of insurance or socialization of the risk. I'm an investor in a company in the UK called Access Fertility that does exactly that. So you pay more per cycle, but you don't pay. You get your money back if you don't get a baby. And I think that's a wonderful thing that Access Fertility does, and I think we should evolve into that because it is kind of sad to give up your life savings and never get a baby. And that's exactly what we should try to avoid.

Martin, we're obviously still in the middle of a pandemic. Maybe it's eased a little bit and obviously the vaccination is. Is rolling out, certainly in the uk. How do you think fertility patterns have shaped out? During the pandemic, there are stories of women worrying about not being able to get IVF treatment because all the focus is on tackling Covid.

Well, it's very interesting because at the beginning it was really bad for Inception prelude the situation of our clinics. We couldn't see any patients and we had to pay everyone. We couldn't see any patients. I would say we were at risk of bankruptcy. Being the largest fertility group in the United States, we went through a horrible situation early in the pandemic. Surprisingly, later on in the pandemic, the situation got much better. It got much better because of working from home. Working from home, which became like a new standard. Everybody works from home turned out to be an opportunity for women to do IVF and egg freezing at rates that we had never seen before. This is because one of the biggest problems to do IVF and egg freezing is skipping work is the fact that a woman has to leave maybe six times during two weeks. She has to leave work to go and do the ultrasounds and so on, the egg retrieval. Now, they don't need to tell anyone they're doing this. They don't need to skip work. For us, it was a pattern of great difficulty, followed by a pattern of very high demand. Now, in general, what about the people who are making babies having sex? And it's interesting because it wasn't clear what people would do when they were locked up at home. Would they make babies or not? And it turns out that the statistics are coming out, and they didn't. They were very anxious about the situation created by the pandemic. And the number of babies conceived during lockdown was surprisingly low, considering how frequently they had a chance to make a baby. Right. But it seems that the anxiety over the state of the world prevailed over the convenience of being at home.

Well, it was also about touch, wasn't it? Because if you think somebody's been out and they come back, if they'd been traveling at the beginning or. And you come back to the house and everybody's talking about social distance. Of course, I'm not a scientist, Martin. I'm just making this up.

Well, you're not. Nobody knows. But I would imagine that concerns over health, and they're giving birth at a hospital during a pandemic, getting Covid while pregnant, all these concerns must have been in the mind of people when they chose not to have babies. So I think you're onto something there.

The other broader picture, Martin, is that in the west, perhaps not so much the United States, but certainly in Europe, the low birth rate is a problem in terms of demographics. Do you want to talk a bit about that and how maybe personalized fertility care can tackle that problem?

Yes, because it is surprising how people think. Right. People think that the world has too many people that were close to a billion people, that there's just too many people in the world. And the work we do at my companies is maybe not good because it adds more people to the world, and we should be just less people. And we should do that also for environmental reasons. Now, what people don't understand is the world is headed exactly in the opposite direction. The population of all of Europe, the population of Russia, the population of China, the population of Korea, Japan, the United States, it's all at lower than 2.1 fertility rate, which means that 2.1, just the population stays the same. And you have countries like the uk, like the us, like Germany, Well, Japan has a fertility rate of like 1.2. There's an incredible. The population in all the developed countries and in much of the undeveloped world is getting older. And there's also a crisis of pensions because very few young people pay for a lot of old people. So other than Africa, which is a continent where the population is still growing tremendously and some portions of the Middle east, but not everywhere the rest of the world is going to a population implosion.

And it's striking that you mentioned China, because most people look at China and think there's so many Chinese, it's the largest population, actually, India is the largest population. But China at 1.3 billion, I think it is around that they do have a demographic problem. Look at going forward.

Yeah, because they had the one child policy for so long. And it's interesting because the one child policy at the beginning sounded like a horrible thing to force people to have one child. But in Europe, we have the one child policy without asking, because when you look at how many children people have, it is such a low number. For example, to give you a sense in Europe last year of women who turned 45, which is believed to be the last age at which they could possibly have a baby having sex, you see a generation of women who, when they were in their 20s, they said that on average they would like to have between two and three children. That was achieved only by a third of those women. And two thirds of those women failed to meet those targets. Around 22% had no children and around 20% only had one. So that's 42% who had only zero or one. And the rest of the women mostly had two. Right. So having no children or having one is becoming common for about half the population. And so it is shocking how the west went voluntarily into something close to a one child policy. And the Chinese, when they were told they could have more children, they had a different problem, which is fertility, because many were already past their fertility time to have more children. Many have economic concerns because one of the best contraceptives is paradoxically wealth. And when societies get wealthier, they tend to have many less children. So right now we have the crisis in the world.

Why is that, Martin? That people get wealthy and they have fewer children?

People historically used to think of children as their pension system. They thought I would have a lot of children and the children will fund me when I'm old. And now they focus on the cost of raising children because they have a pension anyway. And so they focus on the cost of raising children. By the way, having said this, the Biden administration passed a bill which absolutely shocked me in a positive way, which is a bill that will cut child poverty in half and will give $300 per child. Even by the way, during pregnancy, when your child is coming, you start getting paid. I think that will have an incredible effect on birth rates. In fact, the only European country which has decent birth rates, not even great, but at least they're still lower than 2.1. But the highest is France. The reason why France has the highest birth rates is because they are the country that does the most to help you when you have a child. They have this system called a creche where you can leave your babies and go to work. Because in most other countries universities free. But childcare is super expensive because university students vote and therefore they demand. But babies and 5 year olds don't vote. Right. So what Biden did will help increase the birth rate in the United States.

Let me ask you about Europe. Do you think that there is a kind of anti science bias on the European continent? If you think of the moves back and forth on the AstraZeneca vaccine concerns as well for historical cultural reasons in Germany about genetics, is this a general problem and could it be a problem for your ambitions to expand your product and offering in Europe?

To some extent, yes. Even though I believe that in America there's more anti science people than in Europe. In Europe there's a different kind of anti science people. In America there's religion versus science and in Europe there is hard to describe, for example radiophobia. Right. The fear of radiation and the close down of the nuclear power stations in Germany, which actually is going to kill so many more people in terms of CO2 emissions, pollution, catastrophic weather. Yeah, nuclear waste is a problem, but the alternative is much worse. And then the level of pollution that there is in Germany is already incredibly high. Angela Merkel is a scientist and most people in Germany believe in science. I'm a citizen of Spain, but my wife is German and I'm very familiar with culture in Germany and the board of Axel Springer, the media company in Germany. And I see how people think in Germany and they're mostly for science but sometimes they fall for myth. I knew people that when Fukushima happened, slept under metal tents in Berlin, thinking that the radiation from Fukushima would hit them in Berlin. Crazy things like that. I would say Europe is pro science, but occasionally falls into hysteria, like with the AstraZeneca vaccine. As you said, the AstraZeneca vaccine has been approved by the European Medications Agency, but by the British agency, by the Canadian agency, by the World Health Organization. And now all these European countries don't want to administer it, which means more death, more illness, more economic hardship, more debt. It is hard for me to understand sometimes European countries fall into these unscientific moments when normally they're not so unsante. Unscientific compared to that of the United States.

Martin, you're a native Argentinian, educated in New York at Columbia, New York University, lived many years in Spain, married to a German. You have seven children, but you've also got eight other children, companies that you've built up over the years. So I just have to ask you, what is it in your genes and your genetic makeup that makes you so innovative and such a successful entrepreneur? We'd like you to share your secrets with our listeners.

Well, I can't answer that because first of all, I don't know if it's in my genes, but maybe one day we'll discover that there's some entrepreneurship or at least genes that make you want to do things all the time, which I certainly seem to have that. I also seem to have a number of habits that are different from most people that make me maybe more productive. But having said this, I think that what happens to me when I build a company is that I can't imagine the world without my company. I'm obsessed with this thing in the field of fertility now, I think following human fertility is one of the biggest problems. And I think starting a family is the nicest thing. Obviously, like you said, I have seven children. I love being a dad. I want other people to be a parent. And I just become obsessive about these things and I want to pursue them. And I can't imagine myself not being this way. And it doesn't seem to slow down with time because my most productive years in my whole career have been the last four, which were between the ages of 56 and 60. And it's the time that I created the most companies. So I, I and the most value. So I think that, I think that it's something that I, that I have. If I believed in God, I would say God made me this way, but unfortunately, I don't. So I don't know how to answer this question.

Martin, you've answered all the other questions with fascinating insights. It's been a great pleasure to talk to you again. Thank you.

Thank you for having me, Lionel.