Nature Is Sexist. Can Advances In Longevity Biotechnology Help Restore Reproductive Equality?
Evolution is a great concept. As AI scientists we use it all the time to develop better algorithms rewarding and punishing them according to their actions in simulated environments. But when nature does it to us it feels very cruel. Our objective is to master our environment, compete, reproduce, take care of our young, the young of our young, and then gracefully decline and die. And when it comes to females nature is especially unfair as they carry much of the burden of reproduction and caring for the young. And while males can reproduce almost as long as they can live, the female reproductive period is limited and while they generally live longer, after reaching menopause they need to adjust to the new realities as their bodies shift gears.
Aging is generally unfair but it is especially unfair to women.
By 20 weeks, a female fetus has a fully developed reproductive system; by the time this fetus is born, she will have approximately one million eggs. Yet, by the age of 30 a woman will have lost 90 percent of those eggs. What’s more, by the time a woman is 40 years old, roughly three percent of a woman’s eggs remain. As time continues on, this girl-turned-woman ages and so do her ovaries, but at a pace five times faster than any other human organ. Menopause lurks around the corner, with the onset between the ages of 40 and 60. This brings an onslaught of unfavorable symptoms including but not limited to fatigue, anxiety, vaginal dryness, and low libido. A taboo of a topic. Fact is, there’s not a lot about women’s reproductive health that is not taboo. From painful menstrual cycles to assisted fertility, to menopause, women suffer, and often suffer alone.
To make matters worse, there are serious medical consequences of menopause that go beyond “symptoms.” Menopause causes medical diseases including osteoporosis, heart disease, and dementia.
Whether female or not, nearly everyone can relate to being ill. However, the severity of illness caused by a complex amalgamation of hormonal changes that has been historically beyond a woman’s control is likely hard to relate to unless having lived experience. But female-related struggles do not cease at the health level, the issues permeate beyond a diagnosis.
Women are accustomed to either a healthcare provider or family member discussing fertility in some capacity. They may be informed about the “decrease in chances” of conception that comes with age; or, the higher probability of a genetic disorder for their unborn child should they choose to wait much longer to become pregnant. This pressure is fueled by an underlying fear – a fear that all women possess in some way. The ticking “biological clock” chimes louder with each year and women are met with a decision they feel they must make – and soon. It can consume a mind: What if I waited too long and can no longer have children? How can I balance my career and my family? Should I freeze my eggs?
It’s fairly possible that by the time a woman finishes college, earns well-deserved promotions, builds a career, establishes financial stability, or demonstrates exceptional emotional maturity, she may have been failed by her ovaries. Critical career moments seemingly coincide with the time in a woman’s life when she needs to decide whether or not to have children. This has women caught in the crossroads of compromise. Or, the reality might spark an interest in leveraging an alternative method.
The technology of egg freezing has existed since the 1980s; however, in the past decade, technological advances have improved the efficacy of the method. Even so, the process of freezing eggs is cost-prohibitive and only a small percentage of corporations offer it as a medical benefit. Beyond the cost alone, the success rates are not overwhelming. While different fertility clinics vary on the percent of successful pregnancies, the average is 20%.
Much can be accomplished in a lifetime, especially since our life expectancy is increasing. If a woman’s average life expectancy is 80 years in the United States, is it not peculiar that her family planning needs to be achieved by her 30s? This point is dramatized when looking at men’s capability to produce sperm (spermatogenesis) throughout a lifetime without the existence of premature reproductive aging. If overall life expectancy is increasing, and it has consistently over the past decade, we must realize that without extending female reproductive life, we are worsening gender inequality.
In recent years, the phenomenon of opting out of bearing children has burgeoned. In fact, the Census Bureau accounts for the United States having the slowest increase in population since the Bureau began making population estimates in the 18th century. From 2020 to 2021 year, the United States population grew only 0.1 percent. This is a significant socioeconomic concern.
We have witnessed this unraveling at the seams amidst the COVID-19 pandemic. Since September 2021 alone, 300,00 women have left the workforce. As people have been pushed to work remotely, women have reportedly assumed the responsibility for both domestic work and childcare. It is no mystery as to why women are departing their places of work, as detrimental as it may be. These cumulative departures over the past two years will be costly to the United States economy, costing around $650 billion each year. These departures also threaten women’s financial independence and set back the clock on pay equity. Women are more aware than ever that the social construction of “having it all” may very well be false. The cards seem stacked against women both in health and in career parity.
But it is not all doom and gloom – there are women writing a new chapter for their time on this earth, just as women have done before them. But this time, it involves money.
While the richest men in the world may be worth trillions, women have shattered enough glass to be worth billions, and they’re putting it to good use. Women’s wealth is increasing as the recent Forbes America’s Richest Self-Made Women article demonstrated by the notable cutoff increase to $225mm: a $75mm increase.
These women have earned their stripes as founders, co-founders, CEOs, public figures, artists, and much more, and many are taking a stand for women by making impactful decisions about their employees’ health care choices, as demonstrated by Whitney Wolfe. Others, such as Anne Wojcicki, have taken successful healthcare companies public, while simultaneously acting as a lead investor in the female reproductive and fertility space. Women are starting new venture firms, creating powerful networks, and are investing in companies with female leadership.
It makes sense women are investing in companies that serve women. It’s a true demonstration of women supporting women. And getting older is no longer a deterrent, instead, it’s a second life. From the comeback of Sex & the City to the influx of Botox use, to in vitro fertilization (IVF), women are creating their options rather than waiting for better options to come their way. Consider Viagra. This was a problem worth solving for men and thus scientists pursued solutions. Have we thought about the female equivalent of Viagra? What if just as erectile dysfunction can be circumvented, so too can menopause?
What is surprising, is that there are very few research institutions and companies going after female reproductive longevity and inequality. I personally got interested in the field when Nicole Shanaghan, at that time the founder and CEO of ClearAccessIP, an AI-powered IP management company that helped manage the IP of Insilico Medicine, got into this field from the philanthropic angle. That was around 2017-2018. She helped establish the research institutes on this subject at The Buck Institute for Research on Aging, and at the National University of Singapore. The Buck is, without doubt, the most reputable and productive non-profit research institution focusing exclusively on aging and with support from BiaEcho, their brilliant CEO, Dr. Eric Verdin set up a research center in record time. The center is now led by Jennifer Garrison, who I hope to interview for one of the follow-up articles.
However, on the commercial front, the situation is even bleaker. I would not be able to name even a dozen companies aiming to extend female reproductive longevity. It is not easy to start a company in this field. It requires very specific talent and experience, established animal models, regulatory pathways, expert investors, and pharmaceutical partners. It resembles the field of AI-powered drug discovery in 2013.
To understand this field a bit better, I recently chatted about this topic with Dina Radenkovic, MD, a longevity physician and entrepreneur, who has recently revealed her new company Gameto. And while I do not know much about their technology and can not make any claims in this area, the team looks impressive. Dina joined forces with Martin Varsavsky, a leader in the fertility space and founder of Prelude Fertility and Overture Life. Gameto is women-backed with six female investors: Maryanna Saenko of Future Ventures, Deena Shakir of Lux Capital, Deborah Jackson of Plum Alley, Kristina Simmons of Overwater Ventures, Viktorya Tigipko of TA Ventures and Caterina Fake of Yes VC. As a medical doctor with a background in aging, Dina is intent to position Gameto as a company redefining the narrative around female reproductive longevity and making it more around health and longevity. Gameto is applying the advances of cellular reprogramming to offer solutions for both menopause and fertility. This may just offer the optionality women are looking for and Dina hopes they might be able to make women suffer fewer health problems in their later life.
“When ovaries are termed ‘geriatric’ by many traditional medical criteria, the rest of the body is certainly not and this creates conflict for people pushing them to make compromises they may not wish to make. I hope our technology can in the future empower women and also make the second half of our lives, the best one.” said Dr. Dina Radenkovic, CEO of Gameto.
Every woman has a unique story to be told, but it is the cumulation of these stories that evoke fundamental change about how women choose to live. A selection of Gameto investors chose to share their sentiments on the essentiality of investment in women’s reproductive health –
“Women's health is one of the highest potential and most important investment areas. It's been underfunded, and because of the acceleration of science/tech, now is the time. Gameto combines a powerful mission to make the biological clock option with strong science.” Said Kristina Simmons, Founder & Managing Partner of Overwater Ventures who previously worked at Lululemon and Khosla Ventures.
Deborah Jackson, CEO of Plum Alley, a venture capital firm formed by previous Wall St. executives who are backing women in STEMM – such as Jennifer Doudna, Co-Founder of Mammoth Biosciences and Mary Lou Japsen, CEO of Openwater – shared, "The health of a woman's ovary is one of the fundamental drivers of her health over her lifetime, in addition to giving her the ability to conceive and make healthy offspring. As a woman, mother of two adult daughters and investor in frontier technologies, I have long been searching for breakthroughs that prioritize the uniqueness and brilliance of the female body. If we prevent disease and extend healthy living for women because of the work of Gameto, we will make one of the most profound scientific advances that is possible for all of humanity."
Deena Shakir, Partner at Lux Capital and investor in Gameto, recently wrote about this topic in Forbes and it seems her predictions may be coming true. She has shared that, "Transformative innovations in women’s and family health not only advance health equity, but can also improve individual family finances and contribute more broadly to economic productivity."
“Beyond the clear need in IVF/oocyte freezing, we are deeply excited about the prospect of a better standard of care for women undergoing menopause. The suffering caused by menopause is not a biological imperative, and the many complications that come along with menopause, particularly early-onset menopause, can be entirely avoided.” - Maryanna Saenko and Steve Jurvetson of Future Ventures venture fund that led Gameto’s series A and backed an aging company Cambrian Biopharma as well as Neuralink, Deep Genomics and Space X.
While Gameto is still in the early days, solving the problem of accelerated ovarian aging for women’s health and equality is a worthy cause, and a problem worth discussing.
There is a new season of women bound together by life experiences and by the realized necessity of optionality. The option of having a successful career without foregoing having children. The option to leverage biotechnology for relief from menopause or infertility. The option to discuss reproductive health without being shamed or silenced.