Rescripted_Future of Fertility_Carrot Fertility: Audio automatically transcribed by Sonix

Rescripted_Future of Fertility_Carrot Fertility: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Abby Mercado:
Hi, I'm Abby Mercado, an IVF mom, former VC investor, and CEO of Rescripted. Welcome to the Future of Fertility, a podcast dedicated to shining a light on the entrepreneurs and innovators who are changing the face of family building. With billions in funding over the past few years, we'll introduce you to the people, the ideas, and the businesses that are changing the fertility industry and in turn, millions of people's lives. The future of fertility is bright. Now let's get into it!

Abby Mercado:
Dr. Asima Ahmad is the co-founder and chief medical officer of Carrot Fertility, a global fertility care platform for women who are often at the center of fertility care decisions and consequences. Importantly, Carrot serves people of every age, race, income, sex, sexual orientation, gender, marital status, and geography. Having raised over 100 million in VC, Dr. Ahmad and her co-founders have built a powerhouse of a business, all based on the noble mission of increasing access to fertility care for people around the world. In addition to being chief medical officer of Carrot, Dr. Ahmad is a practicing physician and I'm so excited to dive in with her on why it's important for her to continue to see patients in the clinic, along with running a company, among other things. Thank you so much for joining Dr. Ahmad. I'm so excited to talk to you today.

Asima Ahmad:
And I'm very excited to be here! Thank you for having me.

Abby Mercado:
Yay. Of course. So first of all, you're in Chicago, right?

Asima Ahmad:
I am, I am, I live in Lincoln Park, yeah.

Abby Mercado:
Wonderful, cool. I'm here in Denver and, yeah, it's so nice to be talking to you today. Let's just dive into it first and foremost that what, this, what we really like to do in this podcast is really understand the founder's story, the founder journey, and you know, who these people are who are founding these amazing companies in the fertility space and in the women's health space. So let's start out by having you tell us who is Dr. Ahmad? Where is she from? Where was she raised? Was she major in in college, like all the things?

Asima Ahmad:
Oh, my gosh. I could go on and on. I'll try to limit it. So I am a Pakistani immigrant is actually born in Faisalabad, Pakistan. Came here when I was about a year old. I would say I've spent most of my life in the Midwest, though. I've moved around for medical training to the East Coast and the West Coast. But Chicago is what I would probably call home. Speak multiple languages. My first language was actually Punjabi, and I also speak Indian, Urdu. All these languages, all these languages are frequently spoken in South Asia. Now, what did I major in college? I think that was the question?

Abby Mercado:
Yeah, one of one of the questions. But like also, what were you interested in as a little kid? Want to know about Dr. Ahmad as a little girl?

Asima Ahmad:
Oh, yeah. I would say growing up, I have loved the fact that I have a, something that's different about me and unique about me that I bring to the table, I love the fact that I am South Asian. I love the culture, I love everything about it. And so I think one random fact that some people know and some people don't know about me is that I'm a huge Bollywood fan.

Abby Mercado:
Love it!

Asima Ahmad:
I've grown up watching Bollywood films like forever, and you could probably ask me anything about that industry and I'd be able to answer it. And then beyond that, one, it's funny because being South Asian, sometimes you'd think, this is like something that a lot of parents will tell their children, especially first-generation immigrants, is you're here to get an education so you can either become a doctor, a lawyer or an engineer, and that's it. And because of that, I actually did not want to do any of those professions. I was like, nope, I'm going to do something else. And of course, being the nerd that I am, I thought I was going to be a geneticist and work in the lab and study genetics. And it was actually during college that a couple of things happened. One thing was that I read this line that said, if you save a man, it's as if you saved all of mankind. And if you kill a man, it's as if you killed all of mankind. And to me, like, that put things into perspective, because the life of one person impacts so many individuals around them, like the world, around them. And so just by having an impact on one person, helping cure them of a disease or helping them, for example, build their family, it can make a large impact not just on themselves but on everyone around them. And so for me, that was an eye-opener. I was like, you know what? I actually think I might want to do medicine, and.

Abby Mercado:
That is super profound. Thank you for telling us. That's amazing.

Asima Ahmad:
Yeah. And I would say one other thing that helped guide my journey more towards women's health or reproductive health and fertility is I had an aunt in Pakistan who suffered multiple stillbirths and even had her first baby die within a day of life in the hospital over there. And so she had poor access to prenatal care, lost faith in the health care system because of the loss of her first baby, and so would deliver at home in a setting where she'd be, you know, monitored and all that with people who aren't professionally, professionally trained health care professionals, I would say in a sense. And so because of that, multiple stillbirths and then the last one, she had a postpartum hemorrhage and trying to get to her to the hospital was a challenge because they didn't have a vehicle readily available to take her. So by the time they found one, got her in the vehicle on the way there, she passed away on the way to the hospital.

Abby Mercado:
Oh my goodness, I'm so sorry.

Asima Ahmad:
So for me, like.

Abby Mercado:
Wow.

Asima Ahmad:
Thank you. But for me, her story again opened up my eyes to like, first of all, this is not just something that happens in a village in Pakistan, this happens globally. If you look at the maternal mortality rates in the US, we're very high compared to comparable nations and it just showed me that there's so many things that we need to address around pregnancy care, prenatal care, postpartum care to help improve outcomes, the pregnant person and the baby. So I think those were two things that played a key role in helping me go on this medical physician journey.

Abby Mercado:
Yeah, I was, I guess problem set, it seems like it's, like it almost seems minimizing to call it a problem set, but I had a postpartum hemorrhage. I'm a twin mom and my co-founder, who's also a twin mom, believe it or not, we have a lot in common, but we had access to care, like but I had a, I had two blood transfusions, it was, it got real there for a second. We had some really serious issues in our world as it relates to mothers and families. That's an incredibly profound reason to go into medicine, of course. So you became a physician. So I guess walk us through your journey on becoming a reproductive endocrinologist and what that took and how you landed where you landed specifically as a physician. And then obviously we'll dive into Carrot at, at some point.

Asima Ahmad:
Yeah, of course. So with those two things, I decided my focus was going to be around reproductive health, women's health, access to care. And when I so when I went to medical school and ... rotations for different specialties, as much as I tried to like other things, I was always pulled back and drawn back into obstetrics and gynecology. I thought that had a great blend of one. It was women's health, but two, it had a primary care component. It had a surgical component, and it had, like, it had lifelong care. You could see your patients for their early pap smears and talk to them about cervical cancer screening and sexually transmitted infections and barrier contraception and other forms of contraception. Then you would get to a point of, okay, we're ready to build a family, what are our options here? And then beyond that, going into menopause care and hormonal health and all that. And I noticed that when people would talk about family planning, they would think about contraception, right? They wouldn't think about, wait, there's this whole group of people that are having difficulty getting pregnant, so who's addressing that? And of course, like my focus was always global. And during my training, I actually did a master's in public health focused on global health. And I noticed that even globally, not much attention was being placed on the infertility side of reproductive health care. And if you actually look at it, the World Health Organization and recognized it as a disease in 2009, and so for many years, it just wasn't getting the attention that it should have. So at that point, I decided this is where I, this is where there's a need and this is where I'm going to go. Also, very much enjoy taking care of patients with cancer and cancer screening and discussion and all that and preventative care. And so it was a little hard for me because those were two areas that I felt really needed to be addressed. And I loved both patient populations quite a bit, but I decided to go the fertility route. So when you do that, you have to do four years of residency in obstetrics and gynecology, and then you have to apply to and match into a fellowship program for reproductive endocrinology and fertility, which is an additional three years. So, you know, the four years of medical school then I did that one year of the Master's, then I did four years of OB-GYN and then three years of, oh, yeah, yeah, and this is where I said, I like flip flopped across the East and the West Coast. For a part of it, I was at University of Chicago, so, you know, back home. And then for my master's, I did go to Harvard, so I was in Boston, which is actually where I met my husband. And then for residency, I was at Yale, so New Haven, Connecticut, and then for a fellowship at UCSF, so University of California, San Francisco.

Abby Mercado:
Awesome. I love how you described becoming, basically getting interested in the field of women's health and how it is for somebody on, who's practicing medicine. It's really a story of lifelong care, and I feel like that's something that we, we don't exactly focus on enough in the field of women's health. We, at Rescripted, we always say that from first period to last period, we want to be your educational resource and that, that really resonates to me, with me, just that, that element of lifelong care. There's always something to think about when it comes to a woman's body. How can we meet her where she's at, wherever she is in her life and her reproductive life cycle, that's awesome. So tell me. So here we are, Dr. Ahmad as a practicing reproductive endocrinologist in Chicago. So tell me a little bit about the founding story of Carrot Fertility. How did you meet your co-founders?

Asima Ahmad:
Yeah, so it was actually, so Tammy Sun, who is the CEO. I actually met her at the American Society for Reproductive Medicine meeting in 2015. So it was actually when I was a fellow, I think I had just started my second year and the meeting was in Baltimore. We met at an axis.

Abby Mercado:
Isn't it always, by the way? Oh, my goodness. Like we're like ACOG's in Baltimore. Like ... Was in Baltimore last year. Oh, my goodness. Here we go again.

Asima Ahmad:
Yeah, it's funny. I think I've been there a few times for ..., but it was actually an access-to-care session that was talking about providing fertility care in resource-limited settings or with, using cost-effective methods. And that was a, that was really important to me, again, with my focus on global health and global fertility, I was always looking for ways to be able to provide access in those limited resource settings and to figure out ways to do that, whether it be a limited resource, because there's not a clinic nearby or financial resources or not an embryology lab being available. And the, one of the speakers was actually one of my mentors and my fellowship director, Dr. Marcelle Cedars, who's also the President of ASRM this past year and Tammy actually got up to ask a question. And at that point I was actually sitting right next to where she was. And when she asked the question, then afterwards we both started talking to each other. And Tammy, she's been very open about this, but broadened the perspective of the patient and said, I froze my eggs and this is what my experience was. These were the issues even getting into clinic, these were my financial concerns. And then once I got into the clinic, this was what the experience was like, the pain points, the friction, the injections, the appointments. You have to do multiple vaginal ultrasounds and blood draws and all that. And I came from the physician's perspective and I said, this is what I'm also seeing in the clinic, and this is these are the phone calls that I get from patients in the middle of the night, and this is what they come to me stressed out about and the difficulties that they face and the difficulties as a physician that I face, where, for instance, if a patient walks into clinic, I'm ready to treat them and do their diagnostic work up right away. But then I now have to wait a month because they have coverage and we need to get pre-authorization and approval or we're ready to do stuff, but now that patient doesn't have the financial means to proceed. So we talked a lot about that and what could be a possible solution to improve access and also reduce friction and then also improve outcomes in the process. And that's how we started up Carrot. And I would say the other thing that, you know, helped me along this journey is I have polycystic ovary syndrome, it's also called PCOS. And I started having my periods when I was 12, but they were always irregular and even into my 20s, when I would talk to my health care providers about the fact that I had no idea when I was going to have my period. It could be months or I had acne and I had this hair growth, like many times I was dismissed. They would say, oh, you're too young, this is what happens when you're young, don't worry about it or you're South Asian, and maybe that's why you have a little bit extra hair here or there. And to me, I was like, no, I think there's more to this picture. And it was in my 20s when I read a little bit more about PCOS and learned a little bit more about, I was like, this may actually be what I have. And then I went to my provider and I said, I need a, I need an ultrasound. And when they did the ultrasound and they saw the polycystic appearing ovaries, which again is a little bit of a ..., it has to do with follicles and ovarian volume. But when they saw that, I was like, it clicked. I was like, oh my god, I think I have this, and then I was able to, in a way, diagnose myself because I knew the clinical criteria that you needed to meet to have the diagnosis. And so I think like it was something that could have been diagnosed so early on. And it's important because PCOS is not like a, it's not a condition that you have just when you're trying to get pregnant, if you have it for life and it increases your risk. For some people who have irregular cycles and frequent irregular cycles, the risk for uterine cancer, it increases the risk for metabolic syndrome, cardiovascular disease, like diabetes. And so it would have been important for me to know that early on so I could keep an eye on those issues and make sure that everything's under control and I'm managing it well. So for me, that also added like a little bit of a patient perspective to where I was like, You know what? I want to make sure that other people don't have to go through that and that when they, that we help them recognize some of these symptoms or irregularities, that may actually mean that they have a medical diagnosis that should be addressed and treated early on.

Abby Mercado:
Yeah, that's, yeah. So it sounds like you are, you and Tammy got together and really thought about this from multiple different angles. Also, Tammy stood up, asked the questions. She seemed smart. You were like, I have this personal story, then what happened? What was it like? What was it like at the beginning of Carrot? Like what were, what were the early days like? 2015, not a lot of people were talking about employee coverage and just benefits in this space. Did people look at you like you were crazy? What were things like back in 2015?

Asima Ahmad:
They were very different. Well, at last when you said did people look at you like you were crazy? Because I feel like that may have happened.

Abby Mercado:
Totally.

Asima Ahmad:
But yeah, in 20, so in 2015, we started, in the very start of it, we would meet up in a coffee shop and just brainstorm and we would spend hours there and when we would go to early meetings with potential investors, I felt like, and this was one of the biggest challenges, I felt like they didn't really understand this space. There was a lack of awareness around not just the topic of infertility, but also like around the broader scope of fertility. And it was actually around this time that we felt that human resources and benefits leaders, they gave us a, like they understood what we were talking about. They saw the value in Carrot in those early days, and almost every HR person that we spoke to was excited to work with us. There was a little bit of contrast in the very, very early stages, but as you can see over the years that has changed. I feel like fertility has become very common and you can hear about that topic in almost every household now.

Abby Mercado:
Yeah, so, you know, fast forward to today, you started Carrot. It's amazing, like huge company, I think I saw on LinkedIn you guys have 350 employees, like just such a powerhouse, such a force in this industry. So tell us about Carrot today and would also love to hear what differentiates you all from other folks who are also playing in this space?

Asima Ahmad:
So one of the key things is that when we started the company, we made a conscious decision that it was going to be global. And again, it was a little bit of a risk that we took early on because there was no other company in the space that was taking that global approach. But as time has evolved, we feel that we've paved that path for others to follow, and now Carrot's available in over 120 countries.

Abby Mercado:
Wow.

Asima Ahmad:
And.

Abby Mercado:
So cool, that's so impressive.

Asima Ahmad:
And one thing was also if you look at the US and you look at the variations in medical practice, even from state to state, you can only imagine what it may be like in different regions of the world or the way that you, you maybe do a workup or the treatment options or the medications available for certain things that you may use for someone in Chicago is going to be totally different than something that you would do for somebody in Mumbai, for instance. With the development of care, we wanted to make sure that we very deeply understood those variations of medical practice and had that education and knowledge to pass on to our members to make sure that they had the best experience possible. So not only did they have access to that care, but also the education and the guidance around those journeys they would have available at their fingertips the 24 hours a day. But also we wanted to make sure that we had that cultural competency component as well developed into it. I would say one of the other things that I think that we have that's unique is we do what's called a care plan for our care members. So when the member engages in their platform, they provide some background information. And these are very carefully curated pieces of information that we worked very closely on. And with that information, we're actually able to roll out a care plan that's personalized to them. And there's thousands of possible combinations that they could have that can recognize sometimes things that they might not even be aware of. For example, they could provide information, we could help them understand, not necessarily diagnose them because we're not performing consultations, but help give them information about potential things that they might have or risk factors that they might have that may impact their outcomes, and then guide them towards their next steps, which may be like, okay, going to a clinic or helping them find the right type of provider, if that means matching them with a provider that has the same race, background, language as them. And by doing so, it's been shown to increase compliance with care and outcomes, we can do that as well. So that's also something that we're really proud of and that's really unique to what we offer. But, I want to hear what you were about to say.

Abby Mercado:
So it's like, Doctor Ahmad, you make this sound so easy. You're like, oh, we're 120 countries, that's so impressive. What were some of just like DJ, real talk, like, what were some of the challenges with going global? I'm curious, like, like how was this actually rolled out? Did you have a playbook that in the US and then you said, okay, this will work in Germany? And was there like a facet of the business that didn't work? I would love to hear about some of the challenges.

Asima Ahmad:
I would say that we were building it all at the same time. It wasn't that we rolled something out in the US completely and then said that, okay, now we're going to roll this out in Germany or another country. We try to understand all of it as we were building it. And I actually had one of my mentors, Dr. Cheryl Vanderpoel, joined the company really early on as well, and she actually spent over a decade at the World Health Organization focused on infertility. So she also had a very deep understanding of fertility and medical practices by region. And so, again, like we, we try to build it out altogether. In terms of the challenges, I would say, I would say one of the biggest challenges is that things that are legal in one part of the world may be completely unacceptable in other parts. And to understand that and then to understand what's also acceptable for cross border care and how are those things changing over time. For example, you're aware of this, but in India there were people were going to India to be able to work with gestational carriers. That's not really, that's not really happening now. So things change over time. And so I think one of the biggest challenges is learning about the variations in practices in different countries, what's allowed for cross border care and how are those things changing over time because they're not static. And so staying on top of that, staying ahead of it was challenging, but also very exciting because again, that was something that we wanted to offer to our members.

Abby Mercado:
Yeah, and I think what's so important is hearing your and Tammy's and the rest of the folks that were there like pretty early stages. The decision you were very prescriptive about saying, okay, we're globally focused and we're going to build this company such that it is incredibly culturally competent. So I think if there's a business lesson here, it's make sure your mission, vision and values are all aligned at the get go. So I think that's it definitely rings true with Carrot. I know that your focus as chief medical officer is to essentially help with some of the clinical care navigation. What are some of the bigger problems that you see in clinical care navigation and how is Carrot helping its members ...?

Asima Ahmad:
I would say there's a lot of places that we help. So one thing that I touched upon was the Carrot plans and helping members recognize when they might have a medical issue that could impact their fertility, reproductive or honestly, overall health. So we provide the guidance and education there. The other thing is sometimes people already know that they want to seek care. They just don't know where to go. For example, someone could have like me, the diagnosis of PCOS or could have endometriosis, but then they wonder, okay, I live in this area, who would be the best doctor for me? Because there may be doctors that have the overall training to, to take care of them, but maybe one of them is specialized in PCOS or has a large patient population, and that's what they do every day, and they would feel more comfortable going there. So the other thing is just getting them into a clinic that meets their needs. And like I said, that could be medical need and diagnosis or it could even be the background of the provider. It could be the types of health care that are provided, for example, for some people, and this is actually something that became much more common after COVID, but for some people it's easier for them to do the consultations via telemedicine, over Zoom for instance. They can do that, or if they find that they prefer to be in clinic, then we can arrange for them to go to a provider that provides those services as well, so in-person plus telemedicine, so that's what we do. And then during the process of their treatment and you've probably experienced this as a patient yourself, I can just say, having gone through a recent pregnancy, I definitely felt this way, is that appointments are really short and you end up having questions that remain unanswered. One, because you ran out of time. Two, because you felt rushed or you felt like that that the clinician had to run out and do something else and it, just didn't feel like you were in an environment where you could ask that question or you remember those things later. And one thing that we do provide for all of our members is that ongoing support. So we have, they can access what we call the group of individuals Carrot experts, but professionals with backgrounds in REI, reproductive endocrinology and fertility, obstetrics and gynecology, mental health, nutritionist and dietitians, you name it. They have access to those individuals to do chats with around the clock, essentially. And that gives them that extra support that they need where, in that clinical setting they may have felt that they had some question that was unanswered or unaddressed, that they have that support and guidance available. Now, again, like we don't do the consultation, we do not provide medical advice, but it could be a question about what are the reasons that I could have spotting during pregnancy or what are the symptoms associated with endometriosis that I should look out for? How does endometriosis impact fertility? So those types of questions and education, the questions that they might have and we can provide education and guidance around and then after they achieve their goals and if that, for example is pregnancy, we also provide support postpartum so members can use their benefits towards doula for postpartum care, actually I used a doula for the first time postpartum. Yeah, for my postpartum health afterwards, and this was my fourth child. So that was going.

Abby Mercado:
Yeah, I was going to say, we should probably bring up the you are, you're a practicing physician, you're an entrepreneur with a very successful company, and a mother of four. How do you do it all?

Asima Ahmad:
It takes a village, so I actually have a great community of support and of course, a supportive partner.

Abby Mercado:
No, but I feel like that's a good, a good theme for this segment. Like it takes a village, with Carrot like you have this village behind your care team that's really helping supplement the questions that you might have, giving you educational resources, answering questions that you might have, etc. And I think that's important for anybody going through any type of fertility issue. Yay, Carrot! So, so mentioned, you're a practicing physician, why is it important for you to continue to see patients? How does this make you a better co-founder and chief medical officer of Carrot? Tell us a little bit about your perspective there.

Asima Ahmad:
One, I love seeing patients. It really brings me so much joy just to see them and help them get to that point of their family building goals, that's one. But I think the other thing is, and it helps me keep my finger on the pulse is that I continue to see the changes over time of what like, for example, when a patient came into clinic when I was a resident, they didn't talk to me about what they saw on TikTok and how that influenced what they were doing before they came in to see me, what they're doing with their lifestyle, what sort of supplements they're taking. And so seeing more and more just how misinformed patients can be coming into clinic because we have this sea of information around us through the Internet and through all these social media platforms, which for some reasons, I mean in some cases is great, but then it's so hard for them to then filter through that and distinguish like what is actually medically accurate and what is evidence based and what should I believe, because in many instances they may be following someone on social media who is not formally trained in a medical area and may, say that, okay, I want you to start taking these vitamins because they're going to help with, I don't know, preventing infertility or something like that. And so that's something that I continue to see more and more of and that helps guide what we're building, because I already knew that we needed a very strong educational component. But it shows me that there's still a need for that. And what do we need to expand on there? The other thing is I practice in a mandated state and you would expect that all my patients that coming into clinic would have coverage. But I would say about a third of them will either have like no coverage or they're self-pay or they're diagnostic only coverage, which to me is also, it's great that they have some coverage, but like it's diagnostic only so I can do their workup, but then once we figure out what's going on, now everything's coming out of pocket. And for some of them, that's where they stop because they say they can't afford to do anything else. And you know, what about the instance where I find that one of the like, for example, the female has blocked tubes or that the partner's sperm has a very low motility, it's not moving or the counts are very low and they have to do something like IVF, for example.

Abby Mercado:
Yeah, like you have a diagnostic.

Asima Ahmad:
...

Abby Mercado:
Yeah, you have a diagnosis, but like you want to do something about it and help them, but you can't. It's, that's so frustrating.

Asima Ahmad:
So I would say I still see the ongoing need for companies like Carrot that are able to give the employers the option to provide a fertility benet, and to provide coverage so that they don't have to go through that experience so that they can walk into clinic, they can do the full workup, they can do whatever treatment is best for them and their situation.

Abby Mercado:
Yeah, awesome, Interesting. And gosh, that's, what a racket, let me say here and ... saying like, you're not, really, so I'm going to, I'm going to flip it around on you. As a practicing physician, how does running a business make you a better doctor?

Asima Ahmad:
That's a really good question. As CMO of a growing company, you see how things evolve over time, like the company has evolved significantly over time. The things that I was doing to start are very different than I'm doing now. And I think that when it comes to being a doctor in a large clinical practice, I'm one of many physicians in our clinic, it helps me see how medicine, just how a company evolves over time, medicine continues to evolve over time, and the way that we practice continues to evolve over time and the way that we run a practice changes over time. And I'm a provider, but I'm also in a clinic, which in itself is a business, ao I think both of those experiences feed off one another, so I would say learn from both.

Abby Mercado:
Awesome. So, tell me, what are you most excited about in the field of fertility medicine right now? As a doctor, not as a business person.

Asima Ahmad:
I know so much.

Abby Mercado:
It's moving so fast. It's amazing.

Asima Ahmad:
So one thing and this is. Because I was, I always wanted to go into genetics, but I think one thing that has been evolving and just feel like in the blink of an eye advances is just the type of genetic screening and testing that we can do, for example on embryos. And I think that this is something that's going to continue to evolve. The question is like what will inevitably be allowed to be tested for versus not? Because that's when we start getting into that gray area. But that, to me, I find very exciting.

Abby Mercado:
Yeah, that's, yeah, it's super exciting. And like I keep going back to, I feel like we have a lot of people in our community who not, they're covered for IVF procedures and all these things, IUIs, like all the things, but they're not covered for PGT testing. Can you, is that connected to what you're excited about, like PGT testing in particular? And tell us like, should that be covered? Should it not be covered? Like how do you think about that as CMO's care.

Asima Ahmad:
I think PGT testing should absolutely be covered and there's different types. There's PGT-A, PGTM, PGTSR. For example, a PGT-A, you're looking for aneuploidy, which means like an abnormal number of chromosomes and an embryo with an abnormal number of chromosomes has a lower chance of what we call implantation, so a lower chance of the person getting pregnant and a higher chance of miscarriage. So for many people who may, for example, have gone through multiple miscarriages, it would be helpful for them to have access to that technology to be able to test for the embryos before, of course, if they choose to do. And then PGTM, where you're looking for a specific mutation, may also be helpful. Someone may, and this has actually happened to me personally with my patients is they'll come to me knowing that they have a specific medical diagnosis that they don't want to pass down to their children because, for instance, it may be autosomal dominant, meaning that if they just get that one copy from the one parent, the child could be affected by the disease. And so that way you can check the embryo before transferring it to try to prevent transmission to your children. So I think there's some really good cases for it being valuable to the, to like, ultimately result in better outcomes for that person and their family building, so I fully support it. I do think that, I'm not the type of doctor that says that everyone should do PGT. I think that the person should be fully informed on the pros and the cons around it. It's still a procedure that's done on the embryo, so there's that small risk of damage to the embryo in the process, there's a very small chance that the information that you receive regarding the embryo might not be accurate. It's not 100%. It's pretty accurate, but it's not 100%. So I think if, for example, the patient is fully educated and informed and makes a decision to move forward with it, I think it should be covered.

Abby Mercado:
Yeah. Awesome. Yeah. It's a, I feel like a lot of people look at it as one size fits all. It's like you're either for it or against it, which seems ridiculous, it's really multifaceted. Yeah, Ippreciate that, it's colorful, it's not black and white. So last kind of meaty question for you, Dr. Ahmad, recently Carrot launched into menopause, which was so exciting to see. Tell us a little bit about offering for menopause. How did you notice this as a problem? I'm curious, how easy or hard has it been for employers to latch on to this offering for their employees?

Asima Ahmad:
For me, again, maybe a little bit biased because I'm a reproductive endocrinologist by training, so menopause is very important and near and dear to me in terms of my training and my patient population. But we want, when we think about fertility health and reproductive health, women's health, and we talk about, we want to look at it as a lifelong journey. And included in that is hormonal health. And so we, we wanted to make sure that when we're, when, we don't just think about someone going through their 20s and 30s and what do they need during that time, but how can we support them into their 40s, 50s and beyond? And I guess I'll elaborate a little bit more about menopause and talk a little bit more about the other side. But in terms of are we getting support out there around menopause? Absolutely. You've probably seen it as well.

Abby Mercado:
Yeah.

Asima Ahmad:
I'm so happy to see that more and more people are coming out and talking about their own personal perimenopause and menopause experience, how they felt when they started developing those symptoms, how hard it was for them to find a provider. Many people talk about going from one to the other because it's not that it's not a branch of medicine that like you go and you do a menopause fellowship. There's a lot of physicians that have received some training on it, but it's not a specific type of specialty. And so you may see a physician that has some familiarity with it but might not feel comfortable managing it if one thing doesn't work for you and they have to transition to a different medication or to a different regimen. So we wanted to make sure that people received the support, education and guidance around menopause. And so we, in our offering have, for example, menopause group sessions where you can have a community and talk about what you're going through and learn from one another. We help our members find those certified, well-trained experts in the field of menopause. And in addition to that low testosterone, because again, like we saw that there was such a challenge getting in to see the provider. And I think when it comes to employers and other customers, we do find that they are hearing from their employees how important it is to have this as a part of their benefit and offering. I think it's been doing really well.

Abby Mercado:
That's awesome and super excited that employers are latching on to that, that seems really important and also fascinating and should be obvious that your community has been such an important facet of this offering for, for the members of Carrot.

Asima Ahmad:
And the way that we look at it, it's not, oh, there's fertility, and then there's this period of time and then there's menopause. We're looking at it as like a continuum and that more and more women are having children later in life, pregnancies above the age of 35 are more common and they have higher associated risks. And it's typically around their mid to late 40 seconds that women are starting to experience the first signs of menopause or perimenopause. So there's a lot of important considerations to understand, to discuss with your doctor. And we wanted to have this holistic approach. And so that's, and I think with our, the personalized care plans that we provide and that comprehensive approach that we take, that they get that support that they need.

Abby Mercado:
Yeah, it's a lot of associated nerves. I know that, that's my, I'm in my mid 30s and I'm in my child rearing years. But that's, that's my personal next phase and I'm already pretty anxious about it. I can imagine just all the benefits that you're providing to, to the Carrot community. Last question, I ask this to every guest, so Dr. Ahmad, if you had to rescript anything about the fertility industry, the women's health industry, anything that we've talked about today, what would it be?

Asima Ahmad:
It's funny because I think we use this phrase a few times today.

Abby Mercado:
Good. Yes, rescript is a made up word, so I'm glad you used it. That's great.

Asima Ahmad:
But I would say that fertility care doesn't just mean egg freezing or IVF, and it's not a one size fits all, which, so we were, we mentioned a few times. I would say depending on your diagnosis, preferences and journey, there's many options on how to maximize your fertility potential and reach your fertility and family forming goals, like, for example, for women who do not ovulate regularly, ovulation induction by taking oral medication for five days can sometimes help them ovulate and get pregnant with timed intercourse. Or, for example, for a same sex female couple, this can mean using a sperm donor and doing insemination or even something like reciprocal reproduction where one partner's egg is used for the embryo and the other partner carries the pregnancy. And at Carrot, we know that everyone's journey is so unique and we are here to educate them on their options, which in many cases may be something that's very effective but less invasive, so not a one size fits all approach.

Abby Mercado:
Awesome, it's multifaceted. Cool. So where can, if they don't know Carrot and they probably do because you all are just doing such good work. But if they don't know about Carrot, where can they learn?

Asima Ahmad:
Follow Carrot, Carrot fertility on LinkedIn, Twitter, Instagram or Facebook.

Abby Mercado:
Amazing, Doctor Asima Ahmad, Co-Founder and chief medical officer of Carrot, thank you so much for joining us today. This was so fun and just so fascinating to hear both aspects of the business, the medical side of it, and also the business side of it. So thanks for connecting those dots and looking forward to connecting with you soon.

Asima Ahmad:
Thank you. This was great. It was, it was a lot of fun.

Abby Mercado:
Thank you for tuning in to the Future of Fertility. We hope you'll leave here feeling empowered about all of the exciting innovations taking place in the fertility space. If you liked today's episode, don't forget to click subscribe and be sure to check out Dear (In)fertility, our popular podcast/advice column, where we chat with experts about all things fertility, infertility, and pregnancy loss. To learn more and to join our free Fertility Support Community head to Rescripted.com.

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