Fertility Forward
Fertility Forward
Ep 194: Navigating the Financial Challenges of Fertility Care with Angela Rastegar
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What if the biggest barrier to building a family is not medical, but financial? In this episode, Angela Rastegar, CEO and co-founder of Sunfish, joins the conversation to share how her own fertility journey inspired her to create a company designed to help patients better navigate the financial and logistical challenges of fertility care. Angela opens up about spending more than $50,000 out of pocket on her own treatments and explains how that experience revealed major gaps in fertility care that extend beyond the clinical side. The conversation explores how Sunfish helps patients manage the financial realities of fertility care, better understand insurance coverage, access personalized planning tools, and receive support throughout every stage of family building. The episode also dives into the emotional weight of fertility treatment, the need for more personalized care, and why having better guidance before and during treatment can make all the difference. Join us for an insightful conversation about reimagining fertility care and how Sunfish is helping reshape the patient journey.
Hi everyone, we are Rena and Dara, and welcome to Fertility Ford. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Ford podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
SPEAKER_01Today on our podcast, we are very grateful to have Angela Rastigar, who is the co-founder and CEO of Sunfish, a fertility fintech company that provides financial solutions, navigation, and planning tools for individuals and couples pursuing family building such as IVF, egg freezing, and surrogacy. And we are thrilled to have her also share her personal fertility experience with us. So thank you so much today for being here, Angela.
SPEAKER_02Thank you for having me. I'm excited to be here with you guys. Yes, we are so excited to hear your story and to talk about Sunfish because I know that is a product that is going to be so helpful for so many patients.
SPEAKER_01So yeah, we actually, this is I guess the official launch per se, but we are very grateful at R May that we are partnering with Sunfish. So take us back to how Sunfish came about and also if you are open to sharing your own personal journey.
SPEAKER_00Yeah, absolutely. Well, we're really excited to work with you as well. And I think for a lot of people in the fertility world, our mission and drive comes from a lot of personal experience. So for me, I've personally spent over $50,000 out of pocket for four egg retrievals. And I kind of started my own fertility journey about a decade ago and did my first egg retrieval when I was actually building another company. I'm a three-time founder. So didn't have insurance coverage for the process, didn't have a lot of support. It really felt like a full-time job. And as I was going through the process, I started thinking about ways in which things could be improved. You know, I grew up in Silicon Valley, worked at a VC fund. I'm very excited about innovation and the way technology can make things better for people, but I saw very little innovation being done in women's health and specifically for fertility. So left my work in Silicon Valley. I joined one of the largest fertility companies and eventually started Sunfish to solve a lot of those problems. So I can I can talk a little bit more about my own journey. But for me, I'm now such an advocate of these technologies. If I hadn't frozen my eggs back then, I really don't think I'd have the opportunity to be a biological parent because I've since gone back with my now partner. We tried to create embryos later on and had two rounds that resulted in zero. So I'm so grateful I froze my eggs because we do have some really healthy embryos from that process 10 years ago. And I didn't want anyone else to feel like they had to kind of navigate this process alone. So we have a really incredible team here. But yeah, I'm happy to dive into my own personal journey a little bit more if that would be helpful.
SPEAKER_02Well, I love what you what you shared. I mean, and you know, Dara and I both share our stories on here, and we feel so lucky to have so many guests like you that create something out of a challenge. So, you know, we'd love to know more about Sunfish and how your experience. It sounds like you spent a lot of money out of pocket, as unfortunately so many women and/or couples do, and you saw that there was a gap in care and sunfish came out of that.
SPEAKER_00Yeah, exactly. And I think it's so important to have these conversations because it can feel really lonely and isolating. So really appreciate what you guys do too, to just have conversations with all these experts about how things are improving. Yeah, so we started the company really with the idea of solving some of the financial barriers, but quickly realized, both from my own experience and the patients we were working with, that the support that was needed was a lot more holistic. So as I thought back to my own journey, you know, the first step was is egg freezing right for me? How do I pick a clinic? So we've built a clinic search finder to help people find top clinics around the country. Then my next step was, how do I prepare in advance of seeing a doctor? What should I be doing with my body, with supplements, anything like that? So we've built out evidence-based protocols to help people prepare for their journey before seeing a doctor. Then my next step was, oh my gosh, how do I pay for this? Does my insurance cover anything? So we've built out an insurance tool that helps people review their benefits, coaches that will actually talk through it with you, and a financial advocate here at Sunfish that will help you develop your own financial plan for your fertility treatment, including zero interest loans if you need it. Then I realized as I went through treatments, it basically becomes like a full-time job. I was like a project manager, scheduling appointments, hunting down medication. There were all these other costs beyond just what I was paying the clinic. So we've built a full support program that works with families before, during, and after their treatments all the way until live birth to help coordinate everything, negotiate discounts, including medication, and really guide you along every step of the process, including multi-cycle packages if you need that. And then for me after the treatments, I wanted to know: did I freeze enough eggs? Was that successful? So, a big part of what we've built at Sunfish is a very large predictive model using AI and historical data to help people understand their chance of success and the unique number of eggs that they need to freeze for them based on their biology, which we actually will guarantee. And this is a brand new product. If you do not freeze that target number of eggs, sunfish will include a free second cycle so you can bank more eggs, which is exactly what I wished I had had when I was going. I did two rounds of egg freezing back then. And then after the process, really understanding what else should be I be doing to think about building my future family. Where should I be storing those eggs? How do I ensure that I'm setting myself up for success in the future? We've added all of that too. So I really believe at this point sunfish is the most comprehensive solution that kind of works with you before, during, and after your treatments at top clinics to bring together all the things that I wish I had had as I was going through this process myself.
SPEAKER_02Okay, wow, so many questions. That sounds so amazing because I can't even tell you how many conversations I have with patients, you know, and I went through this myself, right? Just the stress of managing treatment, you know, and it feeling like okay, this is the full-time job I didn't want, and there's no salary and no benefits, and this is not what I want to be doing, but I have to, you know, just that and and also how that can really impact a relationship, you know, feeling like I'm doing all the work because I on paper and how the system is right, am the patient, my partner cannot help me with anything if there's, you know, a partner in the picture. And, you know, that leading to stress and tension. So I absolutely love what you've created. One of my questions, I guess, is how would a physician use this? You know, if a physician is gonna give you recommendations as to, okay, if this is your family building plan, you know, we think you should have X number of eggs. Like it almost almost sounds like this is taking some of the physician's role out of it.
SPEAKER_00No, I think the physician's still absolutely critical, and that's why we put so much thought into working with top providers. So we don't provide medical guidance, we work alongside clinics. And most doctors will recommend speaking to sunfish either before your first consult as you're kind of preparing, getting everything ready, especially that financial planning piece, which can take many people months. That's totally normal. Or right after that consult, once they've done their workup and put together a plan for you to kind of understand what treatment are they recommending, how many cycles are they recommending, we will then build on top of that to create your personalized package. So it's still really up to you and the doctor to set a target number of eggs or a target number of rounds if you're trying to get pregnant now. And Sunfish will create a personalized package based on that recommendation. So I see. So sorry, lots of questions, but yeah. So the medical workup comes first, and we actually will ingest everything that's done in your medical workup, in your fertility workup. So all of the testing and everything goes into our model to design those packages based on your doctor's recommendations.
SPEAKER_02Oh, okay, I understand. And does it also help? So I get a lot of times, you know, patients come to me and they're very stressed, you know, they're in an appointment and it can be a lot. You're getting a lot of information. And a lot of times, right, there's delayed processing. And so it almost sounds like this tool will be so helpful because you can refer back to it or even talk to somebody at Sunfish to get clarification that, okay, you know, I left the appointment, I was so stressed, or you know, I was afraid to ask questions, but what does this mean?
SPEAKER_00Yeah, exactly. And we really see that come to life. You're completely spot on. Our team spends on average about seven hours communicating with each patient before they start treatments, just because there's so many additional questions that includes kind of the content that we're sharing, helping to educate them. And once they start treatment too, let's say maybe your first round doesn't yield the results you think, or something happens, we can be that additional resource to kind of share like, hey, is this normal? What would most people do in your situation at this point? So it does become an extra coach. Again, really not touching the medical part, not touching like your injections or hormones or things like that that your doctor's in charge of, but helping with the overall process to be that additional resource.
SPEAKER_01I love that. Yeah, it sounds like there's a lot of support on the financial component, and then also support which I find interesting is kind of the data, you know, doing the research, the numbers of, you know, based on your specific situation, you know, do all the research. And this is typically the yield, and this is the typical suggestion based on your specific data.
SPEAKER_00Exactly. Yeah. And we prefer to customize that to your specific clinic too. But we really are passionate about outcomes transparency. Again, I spent a lot of time in Silicon Valley. I'm a big fan of using technology to solve complex problems. And there is a lot of historical data. We've actually built our predictive model against over 2 million historical data points to estimate each person's expected journey and the true costs associated with that in order to achieve your goal of either a certain number of eggs or embryos banked or a live birth. And we're really excited to share that. In the testing of our data, we found that our model has a 97% accuracy when we went back and back tested our analytics against patient cycles. So we're really able to help you predict what it is you need. Again, it's up to your doctor to talk through the specific treatment plan. But if you realize, hey, I think I'm gonna want to plan for two cycles, or I think I need to target this many frozen eggs or embryos, we can help create that custom package for you based on your doctor's recommendation and our analytics. Does that make sense?
SPEAKER_02Yeah, absolutely. I mean, this sounds like it's a tool that's going to help physicians as well, because it will provide a lot of clarity to the patients. And, you know, I feel super lucky. I have great relationships with physicians who, you know, connect with me and we collaborate. But even that, you know, it's still another ask for them, right? That stuff that is, you know, squeezed in in between. You can't bill for it. And it's it's just more kind of noise throughout the day. And it sounds like this program will really help with that.
SPEAKER_00It does. Yeah. The doctors that we work with really appreciate having this resource for their patients. It's basically like a benefit that their patients can get access to. And probably the most unique part of all of that is once we come up with that personalized plan, we develop a fixed price package for each patient that includes everything you're going to need at your clinic. So embryo transfers, embryo storage or egg storage, all of the treatments are included. And if anything happens during your cycle, we Sunfish will take on that risk. So you know exactly what you're paying. And if you don't achieve your goal, we will put our money where our mouth is. So either you can get a money-back guarantee if you're not successful at the end of your package, at the end of your program, or if you're freezing your eggs, we can include an additional second cycle, like I mentioned. So it's really unique in addition to all of the support. There's actually that financial protection, which for me was one of the most stressful parts. Like I'm paying all this money, but all these other additional bills are coming in six months later. I don't really know how to plan for it. If I, you know, need to take out financing, it makes it a lot more complicated. So we try to solve that and be just a great benefit at top clinics to provide all of that project management, logistical support, emotional support, and a financial certainty as you go forward with the process.
SPEAKER_01I wish we had this when we were going through our our own experiences. As I'm sure, you know, looking back, I'm sure that was something like which is amazing that you were able to take something that you saw wasn't there and and build upon what I'm also very impressed with is, you know, you started off with one thing and then you realize, okay, now what about what's another thing that we could work on? And it sounds as though Sunfish is is going to continue to evolve and change as AI changes. As we see there's more, I'm sure, more that we can do. I'm sure it's something that's, you know, you're gonna add.
SPEAKER_00Yeah, yeah. We are constantly growing. And I think it's really a testament to the team that we have. We have an incredible team. A lot of them are ex operators, have built other companies like myself, and also a lot of us have been through our own fertility journeys. So we're bringing a lot of professional expertise from health tech, fintech, having worked at fertility clinics even, and having been patients ourselves, which I think is important to combine both perspectives. Like as I'm going through my own family building journey, we're we're not parents yet. So we're still in the process. I keep uncovering and kind of seeing things from a different perspective of like, wow, it's one thing to talk about it from a business perspective. And I've at this point helped thousands of people go through their journey, but it's so different to be going through it as a patient and just realizing how stressful and intense every little decision is. So it keeps giving us new ideas as I'm going through it and my colleagues are going through their own journeys to constantly improve the product and add more to the scope of what type of support we can offer.
SPEAKER_02That's amazing.
SPEAKER_01So I see you have there's um an IVF success program, an egg freezing success program. So I guess depending on your needs, there are different programs that can help support you.
SPEAKER_00Exactly. Yeah. So depending on what you're trying to achieve, we can support you with egg freezing, embryo banking, or IVF if you're trying to get pregnant today. We even support journeys with egg donors, sperm donors, surrogates. So any type of family-building journey, if you're looking for medical support, we can provide that guidance. We're continuing to add new products, and our ultimate vision should be the intelligence layer for fertility care. So we have this predictive model, our data-driven model that's continuing to learn over time as we support more patients. We like to say every single patient that comes through helps us improve things for the next person. And we think that there's a big shift happening globally in how families are built, and people are really looking for more of that data and information. So it's just even in the time I've been in this field, it's been exciting to see. Like, I think 10 years ago, no one was talking about fertility planning, right? Like you go to your OBGYN, they ask you what kind of birth control you're on, but they're not asking you about your family building goals until there's a problem. That's the protocol, until you've been trying for six or 12 months. Those conversations don't even come up. But now people are starting to realize if I want to have a family, I should be proactively thinking about my fertility, understanding my diagnostics, understanding how to improve things and knowing when I might need to seek medical care if it's not working on my own. So that's really the conversation we want to help people have and kind of be that point where maybe you're not talking about this with your OBJN, but you have a trusted resource where you can get this information and help find wonderful providers if you do end up needing medical care, or maybe there's something you can do on your own before you reach your fertility doctor, too. So it's just been exciting to see these conversations evolve, and there's an actual space now where people are talking about fertility instead of it just being uh, oh no, it's not working, kind of afterthought that comes up.
SPEAKER_01It's less overwhelming that way.
SPEAKER_00Mm-hmm. Mm-hmm.
SPEAKER_02Well, and I love that you've created a work environment where people are able to be open and honest and I mean, talk about great sample size and people to create a product are those that are going through it and can see, okay, this was really bad. I want to make this better.
SPEAKER_00Yeah. Where are we getting stuck and where are we feeling those pain points ourselves?
SPEAKER_01You created something wonderful. What's the best way for someone who is interested to learn more about your company, but also to get started? Is it your website?
SPEAKER_00There's a lot of ways you can find us. So a lot of physicians and clinics will mention us or have us on their websites too. You can usually find us at your doctor. But if you're looking to get support, definitely come to the Sunfish website. In addition to the packages and programs that we offer, there's a ton of educational content as well as a searchable grant and discount database just in case you're looking for ways to save and you can set up time with one of our advocates who will kind of coach you through the process through there if you're working with one of our partner clinics. So definitely check us out on our website. We're also on social media and we'd just be so honored to be a part of anyone's journey.
SPEAKER_02Well, it sounds like anyone would be lucky to have you as part of their journey.
SPEAKER_00Thanks. I'm curious as you guys are talking to other innovative companies. You know, you have so many great guests come onto the pod. What do you see as people are going through the journey? What do you think is still missing from fertility care?
SPEAKER_02Great question. I think streamlined communication. You know, I think one of the biggest stressors is when you're getting different answers from different people, you know, whether that's on the financial side, whether that's on the medical side. And I think that leaves patients feeling very frustrated, right? That, okay, I was told this by one person, this by another person. I don't know who what to believe, I don't know what to do, right? And there's nobody I can talk to. So I see that as one of the biggest stressors, really, is just sort of the inconsistent communication, different answers, feeling like no one really knows me or my case because there's not one person on it, you know, this nurse doesn't know me. And, you know, patients just getting frustrated because they want the process to be streamlined. You know, they don't want to be chasing things down. They don't want to have to be figuring things out, they want it done for them. You know, that if this medication was supposed to be called into this pharmacy, it should have been done. I don't want to have to now call five times to get it done.
SPEAKER_01And I I would add to that just the personalized care component, I think the benefit of large fertility clinics is it's not their first rodeo and they know what they're doing, but sometimes you can feel like a number. So the notion of really getting more personalized support, that's what I think your company's wonderful with is sometimes you are left with a lot of questions. And not, I don't think patients necessarily feel rushed, but sometimes they leave feeling, okay, I may have a couple more questions, or especially in the financial front. So I think this is a great avenue. I mean, the the fact that you created this, and this is something that I've always thought that sometimes people need something a little bit more customized. And if they do leave feeling like, wow, I there's so many more questions, that there's like a one-stop shop per se that really can help make them feel more supported.
SPEAKER_00Yeah, I totally agree. I think those are both things that we see a lot. And when we think about your journey as you go through kind of the family building process, we usually kind of separate out starting treatment and staying in treatment because they're two very different challenges. So when you're starting treatment, I think we see a lot of people. Obviously, the financial piece is the biggest barrier to starting, but we also see a lot of people who are just seeking more information. Like, did I try everything? You know, I had a friend who just switched to IVF only to learn that. That she was mistiming her ovulation window and hadn't used like an ovulation tracker. So there's just a lot of tools out there before you start IVF to make sure that you understand your body, you've tried everything, you're putting your best foot forward. That's really where we try to help before you get to a clinic. But if you do need to speak to a clinic, we have our own medical advisory board and vetting system to really select best clinics, best-in-case clinics around the country, including RMA of New York. So with our program and with the top providers we work with, we're seeing much higher outcome rates for sunfish patients than general averages. So a typical pregnancy rate after a transfer is about 50.4% nationally. And with sunfish, it's over 70%. So that's 20 percentage points higher. Success rates, obviously early data, but I think all of that prep work helping people make sure they they are putting their best foot forward and finding the best providers is absolutely critical. Staying in treatment is a whole nother issue that's that I don't think is talked about enough. You know, you go through one cycle, and if it doesn't work, there's this huge emotional weight and financial weight to be able to continue treatments. Oftentimes at that point, if you've had some sort of employer benefit, maybe it's expired and you're trying to figure out what to do next. So that's another place that I've really seen our team shine and being able to help people budget for the whole journey and understand if a bump comes up in the road, how to navigate it together. You know, talk about what happened, whether or not there's any lessons learned from that first cycle, and how you're going to be able to plan for it. And so all of that combined, like the cost of multiple cycles, medications, et cetera, has placed a huge burden on American families financially that's made it really difficult to build a family. So we know the cost of becoming a parent is increasing, but what surprises a lot of people is the cost of building a family going through IVF is now the fourth largest type of debt that American families are taking on. So after buying a home, student loans, buying a car, fertility debt is the fourth largest in size that people are taking on. And I think a lot of that comes from people not having a plan, not really understanding the full costs, or not having the type of financial protection that a company can like Sunfish can offer you. So we really want to be bridging the gap both before treatment. So people feel like they've done all the discovery work, all the prep work to put their best foot forward and during treatment so they actually can stay in for multiple cycles if they need and get over the finish line.
SPEAKER_02Well, I love what you're doing because you're working with what I what I've now been calling the zero trimester, which is the time before, right? You know, we have sort of like the fourth trimester, which is, you know, kind of now being more talked about, right? The postpartum phase. But I really have started using the phrase zero trimester with my patients that like this is the time where there is a lot of actioning to do. And, you know, sort of quote unquote, the zero trimester can be so stressful for people because they don't know what to do. And so I love that you've anticipated those needs of like, okay, here, here's all the things to be doing when you first start contemplating family building. Here's the things to prepare for, here's some action items, and really set people up for success. And I think psychologically, one of the hardest things for people is I can't even tell you how many times people say to me, you know, I wish I had a crystal ball. If a crystal ball told me that it would take two years, fine, I'll wait two years. I just want to know. And it sounds like Sunfit is really providing kind of this planning and this lens and this anchor for people to really look to, which I think is so, so helpful because one of the things that's the most stressful is just feeling like you have no idea what's going on. You can't plan your life, everything's stuck, you're on hold. And so it sounds like you really are helping with sort of the organizational piece, which is so helpful mentally.
SPEAKER_00That's very, very well put. Yeah, we really want to be that full partner to people as they build their family. So sometimes my team will joke, you know, when you're buying a house, you have a real estate agent, or when you're applying to college, you have like a college's missions counselor. Like who's your person when you're building a family? Yeah. That's what we're trying to do, provide that support before when you're planning, when you're figuring out logistics, costs, et cetera. And then during the process, too, all the way until you go home with a baby. So if you are unsuccessful at any point before going home with a baby, Sunfish can provide that refund and help you get started to try again. But yeah, you're right. It's it's a big problem to solve. And it's been really exciting to see how much our company has evolved since getting started and just being able to add more and more support because it all goes together. We we quickly realized you can't just talk about financial support people plan on how many rounds they're gonna need, make sure they're getting the best prices and savings and discounts and supporting with all the logistics too. So I'm really proud of what we built, and it could not exist without incredible clinics and doctors like RMA of New York that we partner with as well.
SPEAKER_02Well, I'm so thrilled to have you be available for RMA patients and that you have taken your skills and expertise and dedicated it to creating this product, which is so, so necessary.
SPEAKER_00Thank you. And yeah, you're exactly right. Trimester Zero, that's the best way to kind of think in advance about how you're gonna prepare and set yourself up for success as you go through this very long journey. So thank you for giving us a chance to share our story. It's really wonderful to be able to hopefully help a lot more people in the New York area and beyond. We're we're available throughout the country.
SPEAKER_01And congratulations. This is your first baby, so to speak. Um and really, I think it's such a great uh addition in the space and very excited to see the continuation and how it evolves and changes over the years.
SPEAKER_00Thank you, girl.
SPEAKER_01How we always end our podcast is with words of gratitude. So, Angela, what are you grateful for today?
SPEAKER_00I'm grateful for communities where we get to talk about what the reality is of going through a fertility journey. It's really hard, it can be really all-consuming. So I'm grateful to have spaces like this where we can just have a moment to be in community with other people who are going through this process. I love that.
SPEAKER_02Rena? I guess similar. You know, I'm just I'm grateful for people like you, Angela, that, like I said, are taking your skills and expertise and experience to create something better. You know, because I think not just as women, but as humans, we deserve better. You know, this process is is really tough. And I'm so grateful for other people taking their own experience. And, you know, instead of being a victim or turning away from it, leaning into it and saying, you like I want better, so I'm gonna make that. So grateful for that.
SPEAKER_01But if I love that I was gonna say something similar in the same vein, I'm grateful for entrepreneurial spirit. Like I see that in you, Angela. And I I've been seeing that a lot more. My my daughter actually wants to be an entrepreneur, and just to see someone who has created something out of kind of seeing that there was a a lack, so so to speak, in the system to try to really be innovative and create something to really help people. It gives me hope for my daughter and future generations to really make this world a better place. And I love the fact that it's a personalized, customized, supportive business. And really, congratulations for everything that we've created.
SPEAKER_00Thank you so much. That's really beautiful.
SPEAKER_02Thank you, guys. We're so thrilled to be able to offer this to our MA patients, and we can't wait to see how this grows and how this changes care. Well, I'm excited too.
SPEAKER_01Thank you so much for listening today. And always remember practice gratitude, give a little love to someone else and yourself, and remember you are not alone. Find us on Instagram at fertility underscore forward. And if you're looking for more support, visit us at www.rmany.com and tune in next week for more fertility forward.