As a PhD candidate at Weill Cornell Medical School, Piraye Beim spent much of her time trying to figure out why a particular cancer drug was lifesaving for some patients but useless--or worse--for most. She had no idea what she was up against until a visiting professor said to her, "Do you realize you're competing with the three largest pharmaceutical companies in the world?"

Eventually, Beim moved into the genetics of reproduction. She did her postdoctoral work in the U.K., and realized the challenges in this field were similar to the ones in oncology: Some women, who would have expected to be fertile, were having great difficulty having babies, even with in vitro fertilization. Others, for no known reasons, responded very well to treatments. Beim, given her background, couldn't help but ask: Who is looking at the genetic differences between the women who carry healthy pregnancies to term and those who don't?

"It was like crickets," Beim says. "It was not a thing."

Beim decided to make it a thing, and believed that a startup would be her fastest route to success. Rather than competing with the largest pharma companies in the world, she'd be competing with only a few academic groups.

That quest has landed Beim and Celmatix, the New York City-based company she founded in 2009, in an exploding field that seemed sleepy just a few years ago. Genomics and sequencing companies raised nearly $600 million in U.S.-based funding in 2017, up from only about $50 million in 2011, according to venture fund Rock Health. Phin Barnes, a partner at First Round Capital and an investor in startup Modern Fertility, says the number of pitches he sees from companies addressing women's health care has increased about 10 times in the past five years.

"Women have a worse experience in the health care system than men," Barnes says, and  their most intense experiences often occur in between their post-college years and their mid-30s, when he sees many of them found startups. Meanwhile, women are waiting longer to have children, increasing the demand for technological advances that can help them do so.

Many of the new women's health care startups, such as Modern Fertility and Future Family, let women order hormone-based fertility tests without having to see a doctor first and then deliver the results directly to them. Other startups, such as Eve by Glow, offer apps allowing women to better track their own fertility. One app maker, Kindara, even sells a Bluetooth-compatible thermometer, making it easier for women to track their basal body temperature every day.

Beim is eager to applaud startups that are making data more accessible, but Celmatix is going well beyond that step. The company has isolated 32 genetic markers that provide otherwise undiscoverable insight into various conditions affecting women's fertility.  

A long road to a developed product. 

For the first two years of Celmatix's history, Beim slept mostly on friends' couches. That's not because she was broke, says early investor Cory Ondrejka--it's more that she was so obsessed with her company that she "didn't problem-solve around her housing situation."

Beim was touring lab space in New York, aghast at how expensive it was, when she realized she didn't actually need her own lab--she could outsource the genetic sequencing and use Amazon Web Services as her server farm. Beim's lawyers did her first patent application on spec, assuring her she could pay once she'd gotten funding. She raised an angel round in 2010, and her first institutional round a year later. She's now raised more than $56 million and has about 110 employees.

At the end of 2017, Celmatix's first genetic test, called Fertilome, became widely available. Primarily offered through fertility clinics, the $950 test requires a blood or saliva sample and indicates risk factors for women who may be struggling with their fertility. It could show that a patient has twice the baseline risk of endometriosis, for example, or a threefold risk for early menopause.

The baseline risks for some conditions are very low, and some say that just knowing someone has an elevated risk isn't that useful. Beim couldn't disagree more. "We think women find this empowering," she says, noting that there are plenty of practical steps women can take if they discover they might have difficulty conceiving. For example, they might make different lifestyle choices, seek out an employer who offers generous fertility benefits, or investigate egg freezing. 

Aimee Eyvazzadeh, a reproductive endocrinologist, has ordered more than 100 Fertilome tests, although she says she is careful about using the test with the small percentage of her patients who have severe anxiety disorders. When she gets the results, she says, she has always been able to tweak the treatment in some way. (Eyvazzadeh is not affiliated with Fertilome.)

"Let's say I see someone is at elevated risk for recurrent pregnancy loss," she says. "Well, there is something I can do. There is a protocol to decrease the risk of recurrent pregnancy loss." She says the protocols are just tweaks to what her team is already doing, but without the test, they would have a tougher time knowing which tweaks to make. Although no test can guarantee success, Eyvazzadeh nonetheless offers what is perhaps the ultimate recommendation: "I have had many cases where patients have struggled, they don't know why, I do the test, and they have a baby."