50 | FORBES ASIA NOVEMBER 2016
FORBES ASIA
END OF THE BIOLOGICAL CLOCK
His next company, a German applications service called
Einsteinet, failed quickly, personally costing him $50 mil-
lion. No biggie. The string of successes left Varsavsky
with a net worth that FORBES estimates at $300 million.
After lying low following the dot-com crash, Varsavsky
founded Fon, an outfit with an ambitious plan to cre-
ate a global network of “Foneros,” who would share their
Wi-Fi connections with one another, allowing users on
the go to connect to the Internet anywhere in the world.
The startup, which was backed by Google, Skype, Sequoia
Capital and Index Ventures, has grown to more than 20
million users, though it has yet to achieve its vision of
Wi-Fi ubiquity. After the company became profitable last
year, Varsavsky decided to step down as CEO (he remains
chairman) to focus full-time on fertility.
Prelude was oicially born in 2015. Varsavsky quick-
ly realized that the typical tech startup model wouldn’t
work. Because of regulation and other hurdles, he con-
cluded it would be best to buy into an existing fertility
clinic and egg bank. That meant he would need to seek
funding from private equity rather than venture capital.
He eventually settled on Lee Equity Partners, which fo-
cuses on middle-market transactions and had been eye-
ing the potential of the IVF business.
The IVF industry in the United States has everything
private equity likes—scale (about $2 billion annually) and
growth (more than 10% a year), along with being frag-
mented and having outdated marketing. It’s an industry
associated with failure: Roughly two-thirds of IVF cycles
produce no baby, according to the Society for Assisted Re-
productive Technology (SART). By freezing women’s eggs
before their fertility starts to wane, Prelude should be able
to tell stories of success. With its initial purchases—the
thriving RBA practice and My Egg Bank, which freezes
roughly 40% of all donor eggs in America—Prelude is al-
ready profitable, on revenue estimated at about $35 mil-
lion. And it’s poised for continued growth. “We intend to
expand nationally and partner with leading clinics in the
U.S.,” says Collins Ward, a principal at Lee Equity.
TECHNIQUES FOR EGG RETRIEVAL and freezing, of-
ficially called oocyte cryopreservation, have been around
for more than 30 years and were often used to preserve
fertility in cancer patients undergoing chemotherapy.
Women typically go through a course of fertility drugs
that stimulate the ovaries to produce eggs. Doctors then
extract the eggs with a needle that pierces through the
vaginal wall into the ovary. Because an egg, unlike em-
bryos, is a single cell made up mostly of water, the stan-
dard slow-freezing technique often produced ice crystals,
making the eggs unusable.
In the past decade vitrification, a new flash-freezing
technique, has vastly improved success rates, leading the
American Society for Reproductive Medicine to remove
the “experimental” label from the process in 2013. Howev-
er, the group issued a warning: “Marketing this technology
for the purpose of deferring childbearing may give women
false hope and encourage women to delay childbearing.”
As of now RBA, tucked in a suburban Atlanta of-
fice park, serves as Prelude’s nerve center. To visitors it
looks like a standard medical oice, with waiting rooms
and exam rooms along corridors painted in pastels and
adorned with soothing images. Behind the scenes several
technicians work inside a large lab, some staring into mi-
croscopes and some at computer screens, amid an array of
equipment that includes several large incubators. There’s a
mechanically controlled machine that allows a technician,
watching through a microscope, to use a tiny syringe to
pierce the membrane of an egg and fertilize it with sperm.
Next to the lab is a large storage room filled with cryo-
preservation tanks, wheeled 3-foot-tall units shaped like
R2-D2s. Each is filled with liquid nitrogen and preserves
embryos and eggs at –321 degrees Fahrenheit.
Until recently, the number of women who have chosen
to freeze their eggs to preserve fertility options was rela-
tively small (6,200 in 2014). But after Apple’s and Face-
book’s announcements of egg-freezing benefits and as
celebrities like Sofia Vergara and Kim Kardashian have
gone public about the procedure, fertility doctors are re-
porting a surge of interest.
There’s no dispute that banking eggs earlier in life im-
proves outcomes. RBA’s Dr. Zsolt Peter Nagy, who helped
pioneer vitrification techniques, says an egg extraction in a
32-year-old woman will typically yield between 15 and 20
eggs, which would eventually result in about 10 to 14 fertil-
ized eggs and 4 to 8 usable embryos. A 40-year-old patient,
meanwhile, would typically produce between 4 and 15
eggs but end up with fewer than 3 usable embryos—and in
some cases none. As a result, an IVF cycle with eggs from a
32-year-old woman has a roughly 50% chance of resulting
in a live birth, according to data from the CDC; the figure
drops below 20% for a 42-year-old woman.
But there are plenty of skeptics and critics. While egg
extraction and freezing is safe in most cases, the required
injections can cause swelling and discomfort. In a small
number of cases complications require hospital care. “Re-
trieving multiple eggs involves injections of powerful hor-
mones, some of them used of-label and never approved“WE NEED TO GIVE WOMEN
THE OPTIONS TO HAVE A
FAMILY WHEN THEY WANT TO.”