Making Babies in the 21st Century - Martin Varsavsky #TOA18

What an introduction. So, Martin, why don't we, on that note, talk a little bit more about where you're from. You were born in Argentina, and then where did you grow up?

I was born in Argentina, and then there was kind of like a civil war when I was a child in Argentina, so we had to flee. My cousin got killed, and my dad and I almost got killed, and Senator Moynihan gave us refugee visas. That's when the US was a kind place and hopefully will be a kind place again. Let's all work for that. And so they gave us refugee visas and they got us out of the Argentine military dictatorship into the New York of the early 80s, which was sort of like the taxi driver New York. So that. Are you talking to me? You're talking to me? So it wasn't like New York now with de Blasio, but it was another war zone, but it was a little better than Argentina. And then I lived in New York for many years, and then I moved to Spain, a country that I love. I became a citizen of Spain. I made Spain my home. And now our life is between Spain and the US because Prelude, the company that I am the secretary chairman of, and I was the CEO until recently, spaced in New York. So I guess my life now moves between Madrid, New York, also Berlin, because I'm on the board of Axel Springer here.

So you didn't always work in technology, and especially not around women's health. What prompted you to. What was the transition into that space and what?

Well, I'm a tech entrepreneur, and I build companies based on ideas that new technologies that I think are going to become very commonplace, but are not. So at the time, for example, I was one of the earliest builders of WI fi networks with the company phone, which is now in Germany, telecom phone. But I know WI fi sounds so common now, but believe me, in 05, wifi was just a hack on a PC, right? And so it's technologies that are new and I think that are going to change the world. So in terms of having babies, I mean, I think obviously sex is great, but sex is not great to make babies in your 30s and 40s. In fact, a third of the people who make babies having sex in their 30s and 40s fail and never get to have one. In America, at least 19% of women never get to have a baby and 22% only get to have one. Right. And so I came to the conclusion that sort of like sex was broken as far as reproduction was concerned. Of course sex was great to have it but the technology of sex to make babies was not working. And it wasn't working because people were having children later in life. And so I have seven children myself, but the last three I've had using technology, right? And the youngest baby, Ben, he's one, and he was born out of the whole technology stack that we use, meaning frozen eggs, frozen sperm, genetically tested embryos, single embryo transfer, genetic testing of the parents. And Ben is a wonderful little boy. And the use of technology to fix things that don't work could be the story of my life. The use of technology to make babies became the story of my life when I started having children in my 40s and 50s. And I just. When something works for me, I just say, I should build a company around this.

Right now, it is a rather controversial issue that in some companies in the US it is now offered as the hottest perk to have reproductive benefits or have benefit packages where you can freeze your eggs and do IVF at ivf. How do you feel about that?

Well, in Germany, they should do the same thing. I think the idea is this. Should you offer women to freeze their eggs? Should that be a benefit paid for by companies? Right. Obviously, it is in many cases in the United States and some of our clinics, like Pacific Fertility, we used to be a clinic that only dealt with infertile people, like infertile people who wanted to have babies. That was our main activity, and it's still our main activity. But now 30% of the cycles we do are actually on people who are fertile. Right. So you would say, well, why should fertile people go to an infertility clinic? And the answer is, because at one point we will all be infertile. Right. And so we took a proactive approach, which is that if you want to have children in your 30s and 40s and it's going to fail a third of the time, why not freeze your eggs and men freeze their sperm and so you can have healthy babies whenever you're ready. Apple, Facebook, Google, Microsoft, many technology companies send us patients, right? Our patients come a lot from technology companies. And if a company offers fertility benefits like egg freezing, but no maternity benefits, you could say this company just wants to enslave women. But that's not the case at all. These companies offer benefits for maternal care, child care. In Germany, by the way, the state is mandated a lot of maternal benefits. And still in Germany, very few people are having babies. It's kind of like we spend our lives trying not to have babies. So then when we want to have babies, many times we can't Right. But in Germany, there's mandated maternity benefits by law. So Europe in general and Germany in particular would be a great place to do something like this because you still have the benefits, but you can't have the children. So the combination of having the benefits and the children, I think is an ideal combination.

So you're giving young women an opportunity to freeze their eggs at a younger age?

Well, not young. I don't want to confuse people that our main. The main group of women who do this are 22. The main group of women who do this are between 32 and 37, something like that.

Why is it so important to freeze your eggs during that time?

Well, look, as I said, I have seven children. I don't consider myself a statistic because I'm the only person who I know who doesn't believe in and has seven children. Right. So it's not very common for people who don't believe in God to have seven children. I actually believe in parenthood, and I love. I've been holding little hands for 25 years. Right. But I'm not saying everybody should be such a fan of having children. Having one or two is what most people want. Sometimes three. Okay. So our technology gives people options. It doesn't mean you stop having sex to make babies. Of course, you go on having sex to make babies and you go on with your life. And maybe you'll never have a child, but it's very sad to wake up one day in your 40s and want to have your second child. That's called secondary infertility. I mean, infertility is the leading cause of depression, like the leading cause of consultation, psychiatric consultation for women in their 30s and 40s. It is pretty sad to want to have a baby and to can't have a baby. So we want women to have more options in life. It doesn't mean they have to use the eggs. It means they have more options. And then there's another big issue, which is divorce. Like, half of the people who get married get divorced. It's sad, but just the way it is. And many in their 40s rebuild their lives. Men in their 40s have babies at 3 times 300% the rate of women in their 40s. Why should men have that advantage?

That's a really good point. I never thought about that. So do you think there's any moral consideration around freezing your eggs and using ivf?

There's not. I think there's always a moral consideration in absolutely everything we do in life. If we decide to drive a Diesel car. That's a moral consideration if we decide anything we do has a moral or ethical component. But the question is, should this be allowed or not be allowed? So religion plays a role in this. Religion plays a role in this. But no, religion is against freezing sperm or freezing eggs. The issue comes with embryos. Like it's embryos that some religions, not all religions, some religions have issues with discarding embryos. Right. So we also have a Christian program in our clinics for people who have those beliefs. And we make one embryo at a time, and we always use the embryo. So with that concern taken out of the equation, I still have to meet people who are against what we do. But some people are against discarding embryos. And again, you don't even need to be religious for that. You may have feelings about that. And like I said, we can either freeze them, keep them frozen forever, or we can only make one at a time. So you never discard an embryo. You make one. You try it. You make one, you try it.

So you do not implant multiple embryos at the same time.

Exactly. We are against. I mean, if somebody really wants multiple embryos, we can't say no. But we advise for single embryo transfers because multiple pregnancies, I mean, we want to help people have healthy babies when they're ready. And of course, twins are great and triples are great and quadruplets, whatever, but they certainly more dangerous for the mother and the babies. There's also some proof that multiple pregnancies are more dangerous for the mother and for the babies. So it's better to do single embryo transfers.

So how important is genetic screening in this.

Well, Prelude has become, let's say, the largest chain of clinics in the United States offering genetic screening also. Right. And genetic screening, what happens with people in their 30s and 40s is that maybe 70% of the embryos they make will never become a baby. And it's a problem because humans, because a lot of people wrongly believe, they say, oh, I got pregnant, but then I flew and I lost the baby. I got pregnant, I went skiing, and I lost the baby. Well, it's not that. It's not flying, it's not skiing. People are completely confused about what miscarriages are. Miscarriages come most of the time for something called anuploid embryos, which are embryos that would never become a baby. They try to develop, but their chromosome, the number of chromosomes is not the right one. 23. And they spontaneously miscarry. Okay, now you can do genetic testing of embryos and find out which embryos are likely, very likely to miscarry. So you avoid miscarriages. You can also do genetic testing of embryos to avoid abortions. Because now the way things work here in Germany and in many places in the world, Germany is very unusual because in Germany, genetic testing of embryos is not allowed, which is allowed in most other countries. And it's not allowed maybe because of the Nazi past, but it's a big mistake not to allow genetic testing of embryos and allow the alternative, which is abortion. So what happens now is they say, oh, you shouldn't test embryos, but then it's okay to test pregnant women in their four month. And they say, oh, there's something wrong with your future child. Let's have an abortion. Well, everybody should make their own choices. But we can all agree that it's better. I think there's not a single person in this room who would say, I'd rather be at four months to win an abortion than just not choose the embryo that I was going to abort. If you can test on embryos that never became a pregnancy, why should you go through pregnancies and abort? And there's tens of thousands of clinical abortions because of this. So by the way, of course I'm pro choice and women should do whatever they want with their bodies and they should make their own decisions. But we can all agree that abortion is sad. Nobody goes happy to do an abortion. So genetic testing prevents abortions and. And genetic testing prevents miscarriages. So why not allow it?

Yeah. I'm wondering how do you support the emotional side of this journey if a woman or a couple comes to your clinic and wants to go through the process of egg freezing and IVF treatment? Because these treatments are quite intense. And what does the emotional support side look like?

Well, the. So I started Prelude, but I resigned as CEO and this woman, Susanne Herzberg, who's a fantastic CEO, we appointed her to be CEO and we appointed almost an old woman management team. So I kind of. I mean, it's not that men are not part of having children. Of course we're part of having children. But the journey is more painful for women in the sense that women are the ones who are pregnant. And even in the egg freezing process and the sperm freezes process, a guy just masturbates watching something on the iPad, generally for inspiration, and then they freeze the sperm. But a woman has to go through two weeks of injections and has to go through sedation for the egg retrieval. And that's just the beginning of it, it's kind of interesting in parenting because the sperm is like one of the smallest cell, probably the smallest cell that we make, and the egg is the biggest cell we make. And the egg does all the work to make an embryo, not the sperm. So guys have it easy even from the sperm. And so how do you support women who are going through this? So first of all, you have a woman managed company that deals with women in this journey. And then we have found that the best way women can support, can get support. I mean, I want to do a parenthesis here. My wife who did this twice, she says that this doesn't compare to a bikini wax. Okay, so it's not. Women do already a lot of things that are painful and uncomfortable. Okay. I don't want to make it sound like this is like the most difficult thing a woman can do. It doesn't compare to root canal, according to her. I'm not a woman, so I can't say what it. But I'm just quoting her, but it is uncomfortable. You have to give yourself injections for two weeks and you have to go through this 10 minute egg retrieval process. And so the best way we have found is for women to tell the story to women, a peer network of women. I think, guys, we don't have much to say because we're not getting the injections and we're not doing the egg retrieval and we're not getting pregnant, at least not yet. And so it's a woman issue.

Do you as a company feel it's important to support women on that journey? Because, I mean, it's not just two weeks. You have to go through several cycles of this. In most cases.

No, you don't have to go through several cycles in most cases, but you have to go through two cycles. I mean, in egg freezing, for a woman of 35, it would be ideal. She gets like 20 eggs. She may get 20 eggs in one cycle or she may need two cycles. It's very rare that you may need more than two cycles to get something like 20 eggs. It is. I mean, again, my wife should be here because I'm speaking on the spot of women now. But what Nina says, what? And I asked her, but how difficult was this? And she said, well, compared to what it is to give birth, if this is about giving birth and having a child, if pain is 100%, this is like 0.1%. Because then comes being pregnant, having the child waking up at night, I mean, taking your child to the pediatrician at 3 in the morning. This is about Having children. Nobody said having children is easy. I think having children is the most rewarding thing you can do in life. But like most rewarding things you can do in life, it's not easy. So we're not going to pretend this is easy. We're going to say it gives you more options in life. Sometimes we say, look, it's eight hours of your life because when you count the five visits plus the retrieval is around eight hours. And we say it's eight hours of your life for a lifetime of optionality. Right. So I mean, eight hours includes, by the way, the trip to the clinic. If you didn't include the trip to the clinic, it would be like an hour and a half of your life. And you can say, well, I would maybe relate it to going to the dentist. Do we want to have teeth? Yes. Do we go to the dentist? Yes. Do we like going to the dentist? Not really. I wish they invented an anti cavity vaccine. But, you know, no pain, no gain, Right?

That's a good way of looking at it. So I mean, it is a very emotional journey to think about having children, planning ahead, wanting to give yourself options in the future. Is there. And there's a lot of focus on women's reproductive health, of course. Is there a consideration for men's reproductive health and sperm tracking or anything that influences the quality of the sperm that the partner should be educated on? When a couple goes on this journey.

There'S a lot to be said about men and reproduction and men are under the wrong impression because men, we are like binary. So if you look at 20 year old couples, couples in their 20s, half of the infertility cases are because of men. But if you look at couples who are 38, then maybe 80% is because of the women. Right. And if you look at couples who are 41, maybe 90% because of the women. But men, even though we're binary and some of us work and some of us don't, meaning some of us have motile sperm and sperm and sperm count and whatever. The problem is that men are great contributors to severe mental illness. Really, we are? No, in general, but also in the case of fertility, there's many large studies that have been done that show. There was a study done in the Nordics that showed that when men in their 40s have babies with women in their 20s and women in their 20s, also other women had babies with men in their 20s. And they compare the mental health of the babies whose fathers were older, just the fathers, the mothers were all in their 20s, the babies of Older fathers had twice the rate of severe mental illness. So I do recommend to all the guys here in their twenties to freeze their sperm. It is super easy. You just go with your iPad and you have your sperm and you keep that sperm from when you were in your 20s, okay? Because autism, there's now an epidemic of severe autism, children who never learn how to speak, schizophrenia, manic depression, obsessive compulsive disorders. Like, it is very interesting how this new because we never in history of humanity had babies so late in life. I mean, we used to die by the time we now have babies, right? I would be dead if I was a person in the 1700s, most likely. And so now that we live to be 85, 90, and probably as soon as we hack the genetic code, whether we like it or not, the that we then are going to be programmed to be at 25 for 500 years. In a society where things are changing so much, to have that window of 25 to 35 or 20 to 35 to safely reproduce is just too narrow a window.

So I always think education is everything and there's not a lot of access, at least in the US to find good education around reproductive health and your choices. So, for example, a lot of health insurances don't cover a visit to the OBGYN if you wanted to get informed around your reproductive health and your options. So all of this is an out of pocket expense, at least in the U.S. yes. So all of this is out of pocket.

Expand in Germany also. It's an out of pocket expense.

Good to know. So now all of this costs money and it's how do you feel about this, that health care is not integrating education in this so that women at a younger age have access to education and understanding what their choices really are?

Well, I think that there's obviously a flaw in this design, which is that it's expensive to do this. And we don't want a society where only wealthy people can have babies, even though surprisingly, we live in a society where generally poor people have babies, which is very interesting because we think that having babies is very expensive. But then the least wealthy of society doesn't think that way. Right? So there's a paradox here. And the question is, how expensive is it? But what we did at Prelude is we launched a subscription service. So you pay $199 a month, which in Europe we could probably do it for €99amonth because medicine in Europe is much less expensive. So you would pay €99 and you get the egg freezing the embryo making, the genetic testing, the embryo transfers. It becomes like a subscription, like you pay 99 Euros a month. We also do it for couples, like couples who are married but want to have a child later in life. So we are trying to make it more affordable. In terms of education, women are doing a very good job telling other women. So women who tend to preserve their fertility. Before, women were very secretive, and now millennials are very vocal. They're very vocal about whatever it is they're doing, right? And so actually, in this case, it really works. There's almost a contagious effect. A woman, 32, she freezes her eggs. She tells her friends, her friends do it. We see at our clinics a lot of networks of girlfriends. Who one does it, they advise, the others, the others do it too. Should there be more education about this? Of course there should be more education, because we need to bridge people's biology with people's psychology. Like, when people are fertile, all they want to do is not to get pregnant. I mean, if they spend all their life trying not to get pregnant, and then when they're ready, they're not pregnant. Sorry, they're not fertile, so they don't get pregnant. And so it's like when your psychology, the psychology and the biology, we try to bridge it. We try to make a bridge between yourself and your future self.

Do you think that it changes relationships? Like the quality of relationships, or maybe even do people couple later in life now because they think they're buying themselves time?

I think relationships are about finding the person you're in love with, about finding the right person. And some people, including friends of mine, have found them in their teens, 20s, 30s, 40s, 50s. There's not a date to find the right person. But relationships are finding the right person, falling in love and being in love and staying in love. But fertility is not about that. Fertility is about 16 to 30. Like the biological clock has nothing to do with relationships. It's like there's something wrong. Humans design in an evolutionary process where they would all mostly die very young. And now we don't die young, and we're decoupled from our biology, and we're trying to breach these. So I think women who free sex don't have a gun on their head to marry the first idiot at 33 or 35, you know, that's not a bad thing. I don't want women to have a gun on their head.

Yeah. So what happens if somebody. So it's a subscription model Prelude. So what happens if somebody can't make the payments anymore, for whatever reason. What happens to the eggs?

Well, it hasn't happened. The. Because we're a new company. We're two years old. We started raising $200 million for this company, and this year we'll do 180 million in revenue. So we have a lot of. And we have actually 5,000 babies born out of frozen eggs. I don't recall people coming to me and saying, hey, this woman can pay for the storage. Should we destroy her eggs? I don't think we would. I don't want to say this, because maybe somebody tells me, but I would feel awful about doing that. It's their ex. Like most people I know. But what could totally happen is somebody has babies, having sex and say, I don't want my ex anymore. I don't want to pay anymore. Look, I have all these babies now. And they will say, of course, fine, don't pay. And yes, in that case, we will discard her eggs. I guess it's kind of like. But to do that to a woman who really wants to have children, that's very hard.

Could somebody give their eggs to somebody else, too?

Well, that is called egg donation. Again, it's illegal in Germany, which I don't understand why. All over Europe, it's legal. So if you're a German guy and your sperm doesn't work, you still become a dad. But if you're a German woman and your eggs don't work, go and complain to the government, but you're not allowed. Or. Or fly to Spain or fly to Austria or fly to Denmark or fly to anywhere, because here it's not allowed. I mean, there's serious things that have to change in Germany. About this I don't understand. My wife is German, and half of my family is German, and I talk with them about these things. It doesn't make sense. So in Germany, it's not allowed. But in the States, of course, there's a lot of women who are egg donors, and there's a lot of young women who help older women to have babies. They get paid for doing so, but they don't get paid. Like, I mean, it's a combination of money, yes, but also altruism. It's a beautiful thing to do for other women. In Europe, a lot of men do that. They help other men with donating sperm. But in Germany, certainly, it should be legal to. To donate eggs.

Interesting. I also want to make sure that we take some time to ask questions from the audiences. There was a question of, is there an age where it's Genetically better to have children or an optimal age to have children?

Well, it's confusing the question because your genes are your genes at any age. Right? So it's not about your genes, but it's about other things in the biology. If you tell me what's the ideal age to become a parent? It's the 20s, right? That's the ideal age. But frankly, most people want to work or party in their 20s.

So you should freeze your eggs in your 20s, go party in your 30s.

20S, early 30s. Look, a woman who's 37, she can of course freeze her eggs. 38. It's a question of math and probability. So as the older you are, maybe you need two cycles or three cycles, but it should be done ideally early 30s, late 20s. That's a good time to do it. I mean, in Germany there's clinics who do this. That part is allowed. So, yeah, yeah.

There's an interesting question from the audience. Doesn't your example prove more and more than health and therefore a better life? Is different, defined by money?

That what is defined by money?

The health. And where did the question go? Health and reproductive rights are defined by money.

Well, not in places that have national health systems. So for example, in the case of Germany, IVF is covered many times by your insurance, or in Spain, but for some cycles and not in the case of. So In America, there's 18 states that force insurance companies to give fertility insurance. So if you live in Massachusetts, that's not the case, but if you live in Georgia, that is the case. So it depends on the decisions that are made by the political system to support or not support this. For example, in Israel is the only country I know where egg freezing is also covered by the state. So should egg freezing be covered by all health insurance? Of course, I believe it should. But unfortunately I have to say that in some of these cases, yes, if you have money, you can have children later in life in some cases, in some states, or if you don't want, work for these corporations.

Incredible. Thank you. We're at the end of our time, so this is very informative. I really appreciate you being here. Thank you.

Thank you.