Medsider: Learn from Medtech and Healthtech Founders and CEOs - Taking the Stress Out of Conception: Interview with Béa Fertility CEO Tess Cosad

Episode Date: January 24, 2024

In this episode of Medsider Radio, we sat down with Tess Cosad, a femtech enthusiast and CEO of Béa Fertility. Béa offers effective, hormone-free, affordable, at-home fertility treatments and ovulation tracking as an alternative to traditional clinic-based offerings. Before Béa, Tess founded Emberson Ventures, a B2B marketing agency, and Hers By Design, a femtech company. She was also the first woman to lead a digital marketing-focused accelerator program in Saudi Arabia.In this interview, Tess delves into the challenges and triumphs of launching a consumer-facing product, the importance of a solid design team, how to be comfortable making decisions with imperfect information, and the lessons she learned about being a CEO while raising funds.Before we dive into the discussion, I wanted to mention a few things:First, if you’re into learning from medical device and health technology founders and CEOs, and want to know when new interviews are live, head over to Medsider.com and sign up for our free newsletter.Second, if you want to peek behind the curtain of the world's most successful startups, you should consider a Medsider premium membership. You’ll learn the strategies and tactics that founders and CEOs use to build and grow companies like Silk Road Medical, AliveCor, Shockwave Medical, and hundreds more!We recently introduced some fantastic additions exclusively for Medsider premium members, including playbooks, which are curated collections of our top Medsider interviews on key topics like capital fundraising and risk mitigation, and a curated investor database to help you discover your next medical device or health technology investor!In addition to the entire back catalog of Medsider interviews over the past decade, premium members also get a copy of every volume of Medsider Mentors at no additional cost, including the recently launched Medsider Mentors Volume IV. If you’re interested, go to medsider.com/subscribe to learn more.Lastly, if you'd rather read than listen, here's a link to the full interview with Tess Cosad.

It's that sort of knife edge as a CEO, especially as a venture-backed company. Your job is to make decisions with imperfect information as quickly as possible every day. And that can feel really, really hard. And the point of making decisions is not to get it right. The point of making decisions is to move forward, to course correct, and to learn. And if you can do those three things, over the long arc, you will get to where you want to go. Welcome to Medsider, where you can learn from the bright, founders and CEOs in medical devices and health technology. Join tens of thousands of ambitious

doers as we unpack the insights, tactics, and secrets behind the most successful life science startups in the world. Now here's your host, Scott Nelson. Hey everyone, it's Scott. In this episode of Medsider, I sat down with Tescozad, co-founder and CEO of Baya Fertility, a startup specializing in at-home fertility treatments and ovulation tracking with the goal of providing an effective and affordable, to IVF. Prior to Baye, Tess founded Embersome Ventures, a B2B marketing agency, and hers by design, a Femtech company. She was also the first woman to lead a digital marketing focused accelerator program in Saudi Arabia. Here are few the key things that we discussed in this conversation. First, prioritize design, especially if you are targeting the consumer market.

Be as simple as possible. Don't leave room for your audience to infer or make assumptions about your product and position and frame it strategically to your target audience. Second, Keeping your initial team lean and agile is a great advantage. However, it's crucial not to overlook instrumental roles. Missing key players and pivotal functions can lead to various delays across the entire business. Third, fundraising is a numbers game, and it doesn't get any easier as you progress to larger rounds. But repeating and refining your pitch, countless times allows you to clarify your company's mission and communicate the opportunities ahead. Okay, so before we jump into this episode, if you're listening to this show, I'm going to make the assumption that you're a dedicated pro looking to learn from the best.

in the business. If that's the case, which I think it probably is, I've got some exciting news related to our premium memberships. First, let's talk a little bit about MedSider Playbooks, your ticket to going from zero to 100 with your company or your career. You see our team as handpicked collections of the most insightful interviews with the brightest founders and CEOs, people like Nadine Yard, CEO of CVRX, and Mike Carousie, a serial med tech entrepreneur and general partner at Lightstone Ventures. These proven leaders share their strategies and tactics for running a successful startup. Whether you're looking to master capital fundraising, early stage development, tackle regulatory challenges, understand reimbursement, or maybe even

position your venture for a meaningful exit. Medsider Playbooks have got you covered. And the best part, all of them are available to our premium members. Get instant access to these valuable resources at Medsiderradio.com forward slash premium. Again, that's medsiderradio.com forward slash premium. Okay, here's the second thing. I completely understand that fundraising can be one of the most daunting tasks for any startup, especially in today's environment. That's why we've created a meticulously curated database of investors right at your fingertips. explore a wealth of VC funds, private equity firms, angel groups, and more, all eager to invest in medical device and health technology startups. Access to this database is a premium member exclusive, so don't miss out.

But that's definitely not all. When you become a Medsider premium member, you'll get access to every volume of Medsider mentors, where the brightest founders and CEOs share their invaluable learnings, plus you'll unlock the entire archive of every Medsider interview dating back to 2010. So if you're serious about advancing your career or your startup and want to tap into this treasure trove of knowledge, it's time to consider becoming a Medsider Premium member. Visit MedsiderRadio.com forward slash premium to learn more. All right, without further ado, let's jump back into the interview. All right, Tass, welcome to Medsider Radio.

Hi, Scott. Great to be here. Yeah, likewise. Looking forward to the conversation, especially considering kind of the area in which you're working on and sort of the very consumer kind of bias towards Bayez approach. So this should be a fun discussion. So I recorded a brief bio on yourself at the outset of this episode.

But for those listening, if you can kind of provide a kind of an elevator pitch on your background kind of leading up to co-founding Baya, that would be great. Sure. Yeah. So it's not your usual story. I'm actually not a scientist. I'm not a clinician. I'm not a medic.

I am shock, a marketer. And decided to build Bayer fertility with. an embryologist a few years back. And the sort of genesis of my journey was getting into women's health and sort of having a general obsession with things that just don't seem fair to me. And if you look at people going on a fertility journey,

it doesn't really feel to me like there's anything less fair in the world than some of the things that they have to go through to build their families. And I had created an ad agency, was sort of coming out of that, looking for my next step, and just thought, gosh, do you know what, this journey, having seen some friends go through it, is it's horrendous. It's horrendous and we've got to do better.

And it was wild to me that given that there's sort of an old clinical treatment that's been around for years and years, it was wild to me that no one had brought that back to ease the burden of families going on this journey. And so just it felt like a real no-brainer for me. That's great. the one of the trends that I often see with a lot of entrepreneurs that come on the program is this sort of obsession or just curiosity around trying to solve this. There's this thing

that I have a problem with or is a challenge and it's like you can't get out of your head, right? It's like this has to look better, this has to work better, et cetera. It seems like just a kind of a natural kind of trend that I see. It sounds like that's the case. That was certainly the case with you and your co-founder. But take us back to kind of early 2000. Because I think you're almost four years into the making now. We're recording this in kind of Q4 of 2023. So almost four years in. Give us a sense for kind of what the product is today, right, as you're launching it.

And then we'll kind of have the opportunity to kind of go back in time and learn a little bit more about your journey across various functions of the business. Yes. So we're coming up on four years, which is, was it sort of actually feels wild to me. The first year of Bayer really was trying to figure out, do we actually have something here? Like, is there a problem here? Do we have something? Does this technology work? Why did it go away?

If it's so effective, why is it not being used today? And so it really took about a year to go on that journey of discovering that actually we really do have something here. And then going and raising money for it. Yeah, I'd never raised money before. That was sort of a first for me. And I just remember reading a book on it. the same book three times. It was so good. And then I sat down and I googled how to raise money in London. And I just went from there. And it was the beginning of COVID. Everyone was locking down.

No one knew it was happening. And we were just kind of working away and building this thing. And it was a really wild journey. And that was really the first sort of year of Bayer. Then my co-founder George came onto the team, came into sort of into Bayer. We made our first hire who's UX researcher and designer. And we really just started building from there and building the medical device. So whilst coming up on four years, really as a team, we've been together for sort of three, two, two and a half, nearly three years. So we're a young team to have built, tested, developed, manufactured and commercialized. a medical device. It's been, it's been quick. Yeah, I certainly want to double click kind of on that,

on that timeline later on in the conversation, because it is, it is fast. I'm always impressed by, by startups that are, are able to make that much progress in such a short amount of time. But give us, I mean, if I'm, if I'm, if I'm, if I'm, if I'm, if I'm, if I'm, if I'm, let's pretend I'm a, I'm a, I'm a, give me a sense for kind of what, what the product is, or maybe, maybe, maybe the better, maybe the better, maybe the better sort of way to frame this up is if I'm, you know, let's, I'm interested in your product, right? And, and, and how do I, what is it? What is it? How do I get it? give me a high-level overview of kind of what that looks like currently.

Ninth graders, interesting framing because we do sometimes talk about sex education and how it really misleads us and sets us up to fail today. But the treatment is called intracervical insemination, ICI. Really what it is is a pretty simple fertility treatment that involves taking semen and placing it onto the cervix and holding it there using what we call a cervical cap, what you can kind of think of as like a silicon egg cup almost. So we use an applicator so you pour your semen into the cap, which is folded inside the applicator. And then you use that applicator to insert the cap into the vaginal canal where you deploy it onto the cervix.

It is, it's, I mean, really it's the de facto, the original, the sort of OG fertility treatment, as it were. you know, before IVF was commercialized, if you were struggling with fertility and you went for treatment, this was what was on the menu. Got it. So the technology, it sounds like, has been, because I'm familiar with the space, right? So the technology has been around for a while, but did you, did you find a way to sort of like make it better, kind of package it up in a more consumer-friendly way? Like you kind of touched on this previously, like, you, does this technology still work, right? And so give us a sense for kind of like that sort of maybe the origins or the underlying kind of, I guess,

kind of technology play on this on Bayes. Yeah. So the whole, really there were two maxims that we went into product development with. And it was no intercourse. And it has to be able to be easily used at home. Anyone has to be able to use this at home. And the no intercourse part felt really important for two reasons. One, most couples when they're struggling with infertility, it's the intercourse part of the equation that's the most stressful. So we just wanted to get rid of that. And two, not every family gets started with intercourse. You know, we have a ton of people who start their families with donor sperm, physical limitations, vaginismists, you name it. There's a ton of reasons why intercourse just needs to be taken out of that story for people who are struggling with infertility.

In terms of the design process, I mean, gosh, we went through, we've done 16 human factor studies and sort of gone through run the whole gamut of different types of usability study. we've had 90 different print prototypes of the device to get to one that was sort of ergonomically easy to be inserted by yourself and a partner. We've, I mean, gosh, I've personally tested a lot of these devices on the experience. And, you know, there isn't an iteration of the product that's been shipped out the door to a user

that I haven't personally tested, that we haven't obsessed over the instructions for use. And it's been a really interesting and a pretty involved process, actually. I remember the first human factor study we did, we set up in a we work. And obviously, you know, we work, we thought, we'll pick a meeting room that has sort of curtains so that no one has to see, you know, be seen by their colleagues in a we work meeting room with a giant female pelvis using a, you know, insertable medical device on this. So we booked the meeting room based on the images, went in and realized that it had a full,

last wall facing an atrium where the elevators were on the opposite side of the atrium. So people were coming in and looking around. And it's just, I think there's just so many moments in the development of Beah where we just laugh and laugh and laugh. But I think in all seriousness, we've been obsessed with creating an instruction for use and experience and something that people just feel comfortable using at home.

Got it. And is Baye, Is Baye the first of its kind, the first of like it's kind in terms of the ability to use it at home? Like previously, if I'm a patient, do I go into a clinic? Is that kind of the only way this has been offered, you know, historically? Yeah, good question. So there have been a couple of devices that have been designed for home use. Curiously, one of them is not on the market anymore.

And all of the rest are all centered around intercourse. So you have intercourse and then you insert something into the vaginal canal. Now, the reason we went to the trouble of designing an application, is to enable you to find the cervix. It's not obvious where a cervix is. You're not immediately going to land on it just by inserting something with your hand. And so it was really important to us

to make sure that we designed something that actually really was as true as possible to the core of what ICI is as a treatment. So, you know, we avoid the vaginal canal, which is an acidic environment, not great for sperm. We designed an applicator to allow you to place the cap directly onto the cervix and exposed semen to the cervical mucus. There's sort of a whole host of things.

We ship you two applicators in a single treatment kit for use on consecutive opulation days because there's some data to suggest that that gives a better efficacy. So everything that we've created comes together to form a full cycle of treatment in a way that actually doesn't exist today. That's cool. And if you're listening to this

and don't get a chance to get to the full write-up on MedSider.com to read through kind of the highlights of this particular discussion with tests. Definitely encourage you to check out the website. In fact, you know, if you're listening, you may be interested in this topic altogether. Bea fertility, so bea fertility.com is the website. You can definitely go and learn a little bit more about the company, but also the technology as well. And, you know, we touched on the timeline earlier just a few minutes ago, tests. But even more amazing, considering the number of human facts.

actor studies and sort of design efforts that went into this, into the device yet, you know, within two or three years, you know, you're, you're effectively launching the product. So that's, that's great. I mean, that's awesome. That's, I love to, I always love to see teams that move, that move fast, right? Thanks. So that's great. So, um, so we're, again, we're recording this in, in, in Q4 of 2023. And you are launching this correctly in the, in the UK then, currently? We launched. We launched in Q3. So it's live. It's live.

Okay. Very cool. And is, I'm presuming the US is on your roadmap is, you know, do you have a rough timeline on when this might be available in the States? Yeah, the US is really the biggest market for us. So we are in process with the FDA now. It's a 510K category. It's a class two device.

And we're currently working through some of the studies and some of what the FDA requires of us in order to do a submission in May. looking to be cleared by the back end of 2024. Got it, back into the 20thier. Okay, about a year from now or so. Very good. And again, BayaFertility, B-EAFertility.com is the website. We'll link to it in the full write-up on MedSiter.com as well.

But let's use this opportunity to kind of go back in time a bit and talk about, you know, some core functions that every, you know, health tech, mettech startup, you know, goes through in their life cycle. And maybe let's start with design, right? since we already kind of touched on this a little bit, you know, when you, every entrepreneur goes through this,

right, when you've got very limited capital to work with in the very early years and you're trying to move quickly, you're trying to iterate as fast as possible. Your team is clearly able to get a lot done in a short amount of time with what seemingly isn't a lot of capital in at this point.

So when you think about kind of the journey, especially in those early years, are there a couple things that really stand out that allowed your team to kind of sort of fire on all cylinders? I'm sure it wasn't perfect, right? But you were able to accomplish a lot in a short amount of time. So it gives a sense kind of for what, you know, what either mistakes that you made and quickly overcome or just things that worked extremely well for you in those early days. Yeah, I mean, I think the things that I'll sort of start with what did work and then move

to what didn't work. But in terms of some of the things that worked incredibly well for us is our, you know, my co-founder, George and I, our first hire was a UX researcher and designer. So right from day one, it was we prioritized the user experience. You know, and within three weeks, she did her first human factor study on a word document version of the instructions for use to better understand, you know, how are people interpreting this? So I think one of the things that we did well was have a really core, tight team for the first few months that was ruthlessly focused on design and user experience and sort of validating that. We knew the technology works. We know from the data that we've got a treatment that works. We know that we can build this thing.

And the sort of challenge was building it in a way that is incredibly human that hasn't been done before. And so I think a tight, small team, you know, right from day one, we were forever coordinating, you know, most startups, Slack, etc., all of these things. But we're in touch all the time. You know, we're all watching live streams of the human factor studies that are being done. we're always learning, always sort of jumping and collaborating on stuff. And so that was really something we did well. It was sort of build a team very deliberately geared towards design and user experience. Just on that note, before you take, before you, it sounds like you're going to mention

one other thing, but that, so I think a lot of, a lot of, you know, founders, CEOs would be listening to this and they're like, okay, my first hire probably needs to be like a mechanical engineer, right? Or someone in that type of capacity, but you went straight to UI or human factors. it seems a little bit unique. Was that an obvious choice back then? Or did you just realize that's like a fundamental thing that we absolutely need to get right? So let's let's throw sort of resources at the bottleneck, right? Or the major constraint here. Yeah, I wish I could take credit for that. Honestly, I knew that we needed a designer. I knew that we needed someone who had a ton of experience

in human factors work, in research work, and design work. It's by luck that we met and came across the perfect person for the role, she's still with us now. And I think to sort of retrofit some logic to something that kind of happened by luck, with the mechanical engineer versus the UX, the UI role, we knew we had print prototypes, we had a concept, we knew that there would come a point in time in product development where you no longer really need the mechanical engineer part because you've done the mechanics and they're not going to change, especially once you sort of get to design freeze, you're not changing that stuff. But the experience around using the product is forever going to be evolving and changing. And so for me, it made total sense

to prioritize someone who could build the experience and evolve that as we evolve the business, as opposed to the mechanics side of things, which comes to a natural end point once you're at design, freeze, and into manufacturing. Got it. That makes sense. I stole your thunder a little bit, but you were going to mention one of the thing that kind of really, either that worked really well, maybe, or you were going to, you know, mention a mistake that you were, you know, I think I was ready. I was cruising straight into the mistakes, Scott.

So you saved me there. I think one of the things we probably didn't get very well. I mean, there were really two things. I think we got a, we sort of went over our skis a little bit and engaging with the FDA. We did that way too early. You know, we sort of thought, gosh, okay, we've got this concept and we're ready. And I think that is emblematic of actually the bigger thing that we did not get right, which is to bring on board regulatory people.

So it underestimates the wrong word, but I think early on we thought this is something that's important. This is something we need to do. But this is something that maybe we should bring in a consultant for. Looking back, if I could do it differently, the regulatory person that we have in the team now if we had brought him on as employee number two fundamentally different path, a different level of regulatory sort of awareness. I think we wasted a lot of time and a lot of money on different consultants and people who came in. And a lot of the time you ask a regulatory question and the answer is it depends. So you need someone on your side of the fence who really deeply understands

what you are building and who understands those dependencies and who can lead on that side of things. So I think the mistake we made there was was waiting too long to bring that in-house as a key hire. I got it. That's a really good point because I think sometimes it's easy to sort of, for those key critical functions, right, at an early stage, it's easy to kind of wait until maybe you absolutely need to. And then you underestimate, and I'm saying you, I'm referring to myself too, you know, I'm speaking firsthand. You under, you're going to underestimate the sort of the natural onboarding, right, that's required. You can't expect someone to kind of jump in within a week kind of thoroughly understand kind of how your technology, how you got here,

whatever things you considered. I mean, that just takes a bit of time, right? And so kind of more preaching to myself here is that, you know, if you're listening to this, don't, don't underestimate that sort of that onboarding, that transition process that that's required, right, for anyone to kind of, to bring onto your team. But you mentioned something to us just a bit ago that you said, we engaged with FDA too early, right? And that is, that's interesting because a lot of, a lot of founders or, you know, founder or CEOs would say, engage as early as possible, right? And I think it's always a balance, right? Because you can't, you can't go to FDA and not have sort of a clear path or clear questions that you want answered,

right? But also, you don't want to, you don't want to wait, you know, too long either, right? So, so you're, you know, what you move forward kind of directionless, if you will. So give us a sense for kind of what you meant by that. Yeah, I think when I say too early, I don't necessarily mean in our timeline, I mean in our knowledge. So, you know, you approach the, FDA when you have a path, you sort of have a bit of a clear path and an understanding of where you want to go and you have some clarifying questions. We're going to go in this direction. Do you approve? For example, we approached the FDA asking what the path was as opposed to asking them if the path that we believed was the right path was going to be acceptable to them. And that is wholly,

from my perspective, not the right time to approach the FDA. Because it, right there in a sort of pre-submission, they lay out a path and you end up getting stuck on something that you may not have necessarily needed to do had you just got a little bit more information. So I think it's a fine balance and there's a tipping point. It's not about where you are in the journey. It's just about how much knowledge you have. And at the time that we approached the FDA as a team, we were so early in the journey. We were so young in our understanding of the regular.

pathway, that it just wasn't the right time. Got it. That makes a lot of sense. And your point about sort of maintaining this kind of lean, fast-moving team, like internally, I won't name names, but I just had a conversation last week with a friend of mine. I had caught up with him in probably four or five years, right? So it's been a while, but he's working on his own startup. And they're in that process of laying the foundation for their clinical strategy.

And he mentioned as he was evaluating, you know, kind of this path to build out a clinical team internally versus, you know, kind of wholesaling, wholesale kind of giving handing that off to a CRO. He was like one of the things that really stood out is, to him kind of through that assessment process was the desire, the intention to kind of keep their team small and lean internally. And if they tried to build out too fast, it would just fundamentally change the culture of kind of how they make decisions, how they operate. And I thought it was a really good point. It reminds me of like, you know, just the importance of, you know, hiring slow, right? not making decisions slow, but hiring slow, right, in the early days to keep your team small

and nimble, right? Because you not only have to wear a lot of hats, everyone has to wear a lot of hats, right, but it's so crucial to have a team that's kind of, you know, firing on all cylinders. And it's hard to do that with, you know, a lot of people, a lot of cooks in the kitchen early on, you know. Totally. Totally. And when you need to be nimble and you need to make hard decisions and you need to move quickly, the more people that you need to coordinate and move in that direction the longer it takes. I think there's a real argument for for keeping a very, very small team. The way we ended up doing it is we have a very small regulatory team. We have one regulatory person, one quality person, but we have a network of consultants who know us well, who we leverage

as and when we need them. So we can gear up really quickly when we need it and then we just sort of put it down when we don't. And it helps us, it really helps us focus on what's, the core priorities are for the business. Yeah, that's a good point. I want to, I want to transition to almost a second part of this, this same kind of topic, which is designing devices for, like, in-home use or consumer use. And I guess the question is not necessarily related to consumer use specifically, but I think a lot of entrepreneurs miss the point of, or miss how critical it is, how critical design is, right, for, for the, in terms of, in terms of the end user. experience, and it doesn't necessarily have to be a consumer, right? It could be the end user could be a

physician, a clinician. And you've obviously arrived through a lot of iteration at a device that's likely, I mean, it sounds like it's very, very intuitive to use. So when you think about kind of that process, you touched on, you know, numerous, numerous human factor studies and what, were there a couple like key learnings through that, through that process that, you know, in retrospect, you look back on, you're like, yeah, those, you know, I would definitely do that again. Or, you know, maybe I would change this or change that a little bit next time like my next, my next go-round. Yeah, it's a really great question. Hey there, it's Scott and thanks for listening in so far. The rest of this conversation is only

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