It’s uncommon for an embryologist to own equity in a clinic-lab company, at least here in the US. This week, Griffin hosts Alison Campbell to discuss where her career started, and how she earned her current role as equity stakeholder and business influencer as the Chief Scientifc Officer of the UK’s largest fertility care provider, CARE Fertility.

Listen to hear:

What it is like when an embryologist becomes an equity partner of their group or practice.
The unique advantages a lab director can bring to the practice.
The potential for fertility clinic networks to become early stage investors in fertility startups
The differences in opportunities for embryologist education opportunities between the US and UK
Dr. Campbell’s viability test for companies that want to sell to CARE Fertility. What the 3-4 who advance to demo do to get there.

Dr. Campbell’s info:

LinkedIn: https://www.linkedin.com/in/alison-campbell-85669831/

Website: https://www.carefertility.com/

Transcript

Griffin Jones 00:03

What perspective are lab directors able to bring to a partnership that might not be there otherwise?

Dr. Alison Campbell 00:19

Well, the lab director role is critical in terms of the quality of the embryology practice. The services offered the standards in the laboratory and also the efficiencies of for laboratory. And I think as a an international profession, embryologists are quite collaborative. So I think we're important in that we can set up collaborations and there are examples of us doing that. And on an international scale. So I think that brings a lot of synergies across the world. And it brings better standards and treatments for our patients.

Griffin Jones 00:57

That folks, you too can own a piece of a company we almost never talk about that on this show. We talk about partnership for physicians, what they have to do in order to be able to own equity in their practice groups. We talk about entrepreneurs and the importance of owning equity. We almost ever talk about that in the lab context. I have had Bill van Juran from Fertility Center of San Diego, who owns part of that group. But we have almost never explored this option that changes today with my guest, Allison Campbell. She's the Chief Scientific Officer for CARE Fertility. It's the largest fertility group in the UK, Dr. Campbell got her master's in medical science in art back in the 90s from the University of Nottingham, and a few years back, she got her PhD in developmental biology and embryology from the University of Kent. She started off from the inception of care fertility in 1997. And now is their chief scientific officer, as they are a much larger group financed by private equity through Nordic capital making their first acquisition into the US. We talk a little bit about that we talk about the what it's like for an embryologist to become an equity owner in their company. Whether it's the practice group or the lab or the umbrella company that joins the two, we talk about the advantages and ideas that a lab equity owner might be able to bring to the practice. In the case of Dr. Campbell, it was time lapse imaging all the way to the artificial intelligence program that Kara fertility is using now to automate their workflow reduce time, and ostensively improve outcomes. For you folks that are on the startup side, we talked about what it's like for companies like care to actually be investors in the early stages of these IVF lab startups. And I suggest a possible infrastructure for that, like how US fertility has and I ask Alison, her perspective, as someone who is called on by many of you companies trying to sell to her to her peers, both at her company and other places, she suspects she gets about 20 requests for demoing their product or service over the course of a year. And then she might actually demo three or four of them. We're not even talking implementation. We're just talking demoing, maybe three or four out of 20. I asked her what those other 16 or 17 don't have, and hope you're interested in her answer and that you're interested overall, in this interview with Dr. Allison Campbell, Dr. Campbell. Allison, welcome to Inside reproductive health.

Dr. Alison Campbell 03:26

Thank you. Thanks, Griffin. Nice to be here.

Griffin Jones 03:30

I explained just before we started that you're one of only a handful of guests that I've had on from the UK, and I hope to have more. You are the chief scientific officer at Care Fertility, which, if I understand correctly, is the largest fertility provider group in the UK. And can we maybe start with just how did you get to that position, give us a little bit of background on how you came to where you currently are. And then I want to ask you some questions about the future of the lab and the marketplace on the other side of the Atlantic.

Dr. Alison Campbell 04:06

Great. So yeah, well, I was a very ambitious young scientist, passionate about embryology and fertility. And back in the early 90s. When this when I was in my early 20s. There weren't really many opportunities. There certainly weren't many degree courses that specialized in embryology or clinical embryology and IVF. So I managed to muscle my way in to a small IVF clinic in Nottingham, with Professor Simon Fishel and then I did the master's degree in assisted reproduction technology. So that was the first the worldspace master's degree. So from there, a few of us broke away and set up CARE Fertility. So that was 1997. And we've just grown since then. So I was a regular embryologist became a lab director and then group lead as we got more clinics, and then I was appointed Chief Scientific Officer last year.

Griffin Jones 05:07

It was the world's first master's degree in embryology at that time, was it specific to assisted reproductive technology? Was it in more general embryology what type of master's degree was it at the time?

Dr. Alison Campbell 05:22

Yeah, it was a master of Medical Sciences in assisted reproductive reproduction technology. So very specific, very human focused, of course, we stood animal models and, and the practicals often included animal models, but it was focused on human embryology and assisted reproduction. So it was perfect for me.

Griffin Jones 05:44

So you were part of the group that formed CARE in 1997, you were named Chief Scientific Officer last year, it sounds like a lot of growth in the last two and a half decades. Tell us a little bit about that.

Dr. Alison Campbell 05:58

Yeah, and lots of growth. So we had a bit of a growth spurt early on and say in the first five years, we, we had four or five clinics across the UK. And then we sat tight for a while, and then private equity got involved, and that was silver fleet. And we started to expand get more clinics in the UK and into Dublin, Ireland, then we sold on to Epson, it's for silver fleet, when and Bo Mark capital. That's right. And then last year, Nordic capital took over. So now with Nordic behind us, we have plans for internationalization. And we have recently merged with IDF life in Spain, so three clinics in Spain, and also in North Carolina, USA.

Griffin Jones 06:55

Part of the reason that you and I became connected was because my company covered a story on care fertility is acquisition of rich fertility in North Carolina. And so the biggest group in the UK coming to the US, I didn't write the article, but I read it. And that's part of how you and I became connected. But even before that, someone told me to speak to you. And it was someone from the UK. And they mentioned to me that lab personnel lab directors tend to be more involved in the business of the fertility groups in the UK than is the case in the US. And there are a few exceptions. In the US, there are a few lab directors that are part owners are partners in the clinic in the entire or the parent company that owns both the clinic and the lab. But I can only think of a handful. And so is it the case that there are more lab directors that are partners in their firms in the UK? And was that the case for you?

Dr. Alison Campbell 08:07

Yeah, it was certainly the case for me right from the beginning. And I negotiated my way in, I felt I had a lot of value to add. And and I'd say it's not especially common, but there are a few examples. In Europe. We've got Laura, for example, at Janiero life. So she is a stakeholder shareholder. And so there are a few examples. And I think it's really important I think we have we can earn you and that's we've demonstrated, and also in the UK, which doesn't seem to be the case, in the US at least. embryologist can have a significant professional status we we can qualify to be comparable with our medical colleagues. So I'm a consultant embryologist. So it's a membership of the Royal College of pathologists, which gives us parity with our medical colleagues, which is not possible in in many places. And I don't think that's possible in the US. So I think that helps

Griffin Jones 09:07

parody, in what sense

Dr. Alison Campbell 09:10

in terms of qualifications and consultant status. So it's, the Royal Colleges were traditionally established in the UK for medics, but we got into the Royal College of pathologists as a profession some years ago. So it's quite rigorous assessments and portfolios and then to be used. But if you get to that, then we are of equivalent standing in the eyes of the utility in the UK at least.

Griffin Jones 09:41

You talked about it being valuable to have lab directors as partners in the business. What perspective are lab directors able to bring? To what perspective are they have directors able to bring to a partnership that might not be there otherwise?

Dr. Alison Campbell 10:04

Well, the lab director role is critical in terms of the quality of the embryology practice, the services offered the standards in the laboratory and also the efficiencies of for laboratory. And I think as a, as an international profession, embryologist are quite collaborative. So I think we're important in that we can set up collaborations and there are examples of of us doing that. And on an international scale, so I think that brings a lot of synergies across the world, and it brings better standards and treatments for our patients.

Griffin Jones 10:43

It's funny to think of embryologist, lab directors not being a part of the business ownership, because it's half of the process. It as you when you ventured into this partnership, how did you undertake that. So the common I don't want to say, I'm thinking of a particular word that I'm gonna have the editor edit out my, my fumbling here, Alison. But there's a common axiom among physicians that we weren't taught business in medical school, and that we had to figure this out, all on our own after. And as I might make the assumption that that was the case, in a master's degree in human reproduction, that you weren't learning about income statements and bit and Mark sales and marketing and human resources and every other thing that is required in owning and managing a business. How did you decide to take you said that you negotiated in early on? What made you feel that you could do that? And what did you do to start to go through the learning curve?

Dr. Alison Campbell 12:07

Yeah, that well, it's a great question. And and I think we've got to say that successful businesses and management teams need all different skills coming to the table. So not every clinical embryologist has the same skills that I have. And I don't have all that business acumen necessarily that has been taught. So some of it comes naturally. And I, I had, I felt I could bring innovation and ideas. And I had a track record of doing that. So that clearly answer value. So I think that it's, it doesn't have to be to have to be an equity and stakeholder to, to bring that to the table. But I felt that I could and I should be rewarded for that. And I think it's really important for our profession to have people at that level to champion that what we're doing as a as a discipline, because the work is really demanding, we know that there's a lot of stress in healthcare generally, and particularly in the IDF lab. The work that we do is very intensive and it's very valuable. We've got to be focused all the time to give our patients the best outcomes and and we need to be rewarded for that.

Griffin Jones 13:27

I want to plant some ideas in younger embryologist said right now that this is a possible career track for them. It is clearly possible in the UK and even though it's not common in the US it does happen there know about every country for every audience member listening, but I want to plant a little seed in young embryologist mind that this is a potential career path for them. What did you find to be the steepest part of the learning curve of being a partner?

Dr. Alison Campbell 14:00

What it is, is talking the language of business I find didn't come especially naturally. So just being put in front of a board or when we were going through the sales to be in those management review those meetings were you talking to potential buyers and, and private equity to get involved with that was challenging, I would say for me personally, and because of my background, but I was there for a purpose, which was to be able to explain some of the great work that we're doing and some of the ideas we've got and the value that we can add to the business. So as long as I've got the right content beside me together, that that's not a problem.

Griffin Jones 14:40

Did you seek out any particular mentors? Did you take any courses? What did you find most helpful in getting up to speed?

Dr. Alison Campbell 14:51

I have quite honestly I'm quite an independent person. And I've read a few books blackbox thinking and so what's your view Few TV shows. So it's more of seeking out information that would I felt would benefit me personally in that arena and and talking to colleagues. But there aren't that many that I could liaise with that sort of directly relate to my position. So, in terms of clinical embryology, so I was talking to my business colleagues, the finance team, and and just learning from each other as I've gone along, I don't forget much. So I, I collect information and experience as I go along. And I have done all my career, which is more than 25 years now.

Griffin Jones 15:33

Well, now lab directors that are looking to take an equity in their company young embryologist are considering partnership in their practice lab companies as an option now they have you to consult with they have someone that has, has gone through this before. So they do have a colleague to liaise with Now you talked about some of the ideas that you had in the beginning that as a, as a senior embryologist to lab director that you had some ideas to bring to this new venture? What were some of those earlier ideas?

Dr. Alison Campbell 16:11

Well, probably one of the best examples would be 2011, when I started to see time lapse imaging, arriving on the scene, and it's not, it makes it easier. If you're in my position and you have a big group of clinics, then you don't have to be as active to seek out possibilities and collaborations because people will come to us, which which makes things a little bit easier. So in terms of horizon scanning, a lot of that words done because people are seeking us out before we sometimes have seen what's what's coming. So time lapse was one of those examples. So I have knock on the door. And straightaway, I could see the potential. And there were lots of cynics, even my seniors at the time, well, is this is this really just pretty pictures? Or can we do something useful with it. So I had to fight really hard in the early days to get that established. But we did and we introduced it across our clinics. With military operation, I would say it was so an rigorous the way we implemented it, because I could see the benefit of analyzing these time lapse videos, which are taken of every embryo every 10 minutes or so throughout the whole culture period. So the distinction between that practice and standard embryology which is still in place in many labs across the world, it's the normal waited to do IVF. The difference was dramatic. So you can either have a couple of snapshot images or records of your embryos developing, or you can have a continuous live feed of the embryo development, which at that time in 20 lavena, we didn't really understand. But if we approached it like we did, and we annotated very particularly what we were seeing, and we would collate an extensive database, and be able to use that data to develop algorithms to predict outcomes. So where we are now fast forward to 2023 is a live birth prediction algorithm based on all of that data. And that was about half a billion single images of embryos. So 10s of 1000s of embryos and half a billion images, we have put into this machine learning system and developed an algorithm to automatically annotate those embryos now, so that's a massive time savings for us, and to predict live births, so we can select embryos more reliably. So it's it's been a huge success story.

Griffin Jones 18:53

I want to talk more about that predictive algorithm. You don't have to do all of the horizon seeking because being a large group, people are coming to you. And I'm assuming that that means the folks that are in the booth set the entries and the ASRM that the folks that are selling their services, they're of course, calling on you and they're calling on you pretty aggressively. And so you have lots of solutions being pitched to you at different times. And you saw the value in time lapse imaging early on. You mentioned that some of the seniors were skeptical at the time. And I think this is germane to the conversation for embryologist that might become partners that might become equity owners in their parent companies. Because especially if they're the first they are going to be seeing things that perhaps the clinicians aren't seeing and they're going to have to be persuasive. So what were they cynical or skeptical about? And talk us through how you persuaded them

Dr. Alison Campbell 20:00

Yeah, that well, the cynicism came around, it's a new device, it's really expensive. And we know how much she loves embryos, Allison, you just want to watch them all day and all night. So that was the challenge. And, and they weren't the only people saying that. And a lot of people were saying, well irregular incubator costs five to 10,000 pounds. And this device costs 5060 70,000 pounds. So really, it's how can we justify that. So we had to have the foresight to say, Well, if we have these devices, and we develop algorithms, we'll be able to sell the spaces in this time up device to our patients, and improve their outcomes and give them videos of their developing embryos. So they can start their baby album much earlier. So all these different benefits. And there's the theoretical benefit that even without the algorithms and the data, this device will be a better incubation environment, because we don't need to disturb the dishes with the embryos. So they really say and that the environment is discontinuous and maintained. So I had to be really tenacious, when I'd never really done a business plan before. So I had to rely on the company who wanted to sell a device to support me with that, and negotiate getting some free devices in for a period whilst we evaluate to make sure it does what we expect it will do. So and then we did that relatively quickly. The the chief financial officer actually said, over my dead body Campbell, will you have one of these in your lab? So that made me grit my teeth and say, Alright, I'll show you. So yeah, we did. And now we've got more than 20 of the devices that come solo on laboratories and every day of the week, we're using them to select embryos more confidently, and you didn't you

Griffin Jones 22:01

didn't have to kill the chief financial officer to prove the point.

Dr. Alison Campbell 22:05

Exactly. Then we stayed friends.

Griffin Jones 22:09

At You talked a bit about a trial period for evaluation. And that might be part of the question that I have of, you're seeing the value of time lapse imaging on the horizon, you and then at some point, we get to a military operation in terms of how rigorous the implementation was. Talk to us a little bit about the the trial period in that it very often doesn't go from salesmen come to us, they've got the device, they've got the solution, and boom, it's in the network, just like that. What was it tell us a little bit about how you prove the concept that it could be implemented at scale? Yeah,

Dr. Alison Campbell 22:55

so we got the device probably on the scene or return arrangement and the three months and then I pushed, pushed it to six months. And I thought, well, the quickest way to get some data would probably be through the PG, PG PG ta cycles, because we've got outcome euploid, or our new quota, that binary outcome, if we wait for clinical practice or live births, that's going to take us too long, and the clock's ticking and a need to show the benefit soon. So with only 100 embryos, we'd started to build a an aneuploidy risk classification model, which we then validated on some different data, and it seemed to be effective. So I published that quite quickly. And so already, we could show that we could distinguish embryos that were euploid or aneuploid. Based on them. Morpho kinetics are based on the time they reach different cell stages. So that that was the strategy and and it worked, because we could demonstrate that quite quickly. And so based on that, we invested in more devices and built the datasets. And recently, we're Nordic capital. I've been amazing last year and invested a lot of money in machine learning technology so that we can automatically annotate these embryos rather than sitting like we have done for almost 10 years, annotating the videos.

Griffin Jones 24:22

And all the while the company care fertility is growing in the United States, and probably everywhere else. There's great variance to how much certain partners are involved. I've worked with practice groups where all of the partners are involved in every decision. I've worked with large practice groups where they break up their partners into different committees to be responsible for I've worked with practices where really the managing partner is calling all of the shots and the other partners don't care. And I shouldn't say they don't care, but they're not involved in a lot of the different verticals of decision making in the business, be it HR marketing or purchases or anything else. And I suspect that variance would be the case as we start to see if and when we start to see more embryologist becoming equity owners. For you. How involved were you in the growth of the company geographically in terms of we should go into this market? This we should consider taking on this group? Was that something that you were focused on? Or were you focused almost solely on building out the lab capacity?

Dr. Alison Campbell 25:45

I was I was involved in terms of being aware of the conversations being aware of the work that was going on by external parties to to understand the markets across the world and where our best opportunities might be. And I could contribute in a way that okay, I know that lab, I know those people and in that clinic, and I've heard is quite anecdotal, and just just general industry in Tao was quite useful in in some occasions, so about the rules and regulations in different countries will make a difference if we've got these products, and we're big on donation. Well, in this country, donation isn't legal. So if those sorts of bits of information that I could contribute.

Griffin Jones 26:31

So at the time, were you under, at the time, in 2011, perhaps was there different rules in Ireland, with perhaps EU guidance than there was in the UK? Or at the time was the UK under the same EU guidance? What was the variance going from country to country in the beginning?

Dr. Alison Campbell 26:56

Well, with Ireland and the UK, we were both were under the EU tissues and cells directive. But that was quite differently interpreted by the UK regular regulator, the hfpa. And the Irish regulate to the Irish medicines board as it was then. So the focus, at least in the UK was more about patient consent and, and quality of treatment and information provision. It's much broader than that. But basically, whereas in Ireland, it's all about the safety of the tissues and cells. So there was quite a different emphasis, even though the overarching rules and regs were similar. But we managed to navigate our way through that, and it's worked out really well.

Griffin Jones 27:41

Do you now have to do the same thing with Spain and the United States?

Dr. Alison Campbell 27:47

Yeah, we have to understand that. Yeah. The backdrop the regulatory backdrop, and the treatments that are permitted to be offered. And we need to understand how how they do business in Spain and how they do business in the US and and try and find synergies and yeah, so it's an exciting time.

Griffin Jones 28:07

What differences are noteworthy, in your view

Dr. Alison Campbell 28:10

noteworthy differences? Well, one, one is with Spain and the UK, in Spain, surrogacy is illegal. So that's a big difference. And donation of gannets is anonymous, in the UK and not in Spain. So they are quite different. So there may be synergies there. There are UK patients, many UK patients go overseas for treatments for various reasons. One being that they don't want to donor anonymity. So there's a possibility of synergies there. So it's all of those sorts of things that we need to get our heads around. And we do that as part of the due diligence. But now we're really early days into the integration. So we're, we're looking at all of those things now.

Griffin Jones 28:58

So that could be one difference. The word Anonymous is all but void from the nomenclature in the United States. In fact, I think if you say anonymous donor at SRM Summit, someone from the legal professional group will jump you. It has been ingrained in us the last two years that we no longer use the word anonymous to describe donors that the realities of genetic testing of consumer genetic testing of ancestry.com and 23andme and the combination of that with the prevalence of social media has all but completely wiped out the concept of anonymity. So is that still part? Is it still in the legal and common nomenclature in reproductive health in the UK to talk about anonymous donors?

Dr. Alison Campbell 29:58

It is yeah, on We probably use non identifiable as more commonly in our, in our patient communications and our documentation. But it's a it's an interesting year this year is now the first year that children from donation 18 years ago, they're becoming 18 years of age and they can now go and find out some information about their, their donor that was used to create them. So it's not entirely non identical, but at least at the time of treatment, it currently it has how it is it's not identifiable. But once the child gets to 18 years old, they can find out identifying information on the top 10.

Griffin Jones 30:44

So that's a difference been in the United States and one that you'll share. see plenty of now that care fertility is in North Carolina in the United States. And I read in the article that one of the reasons talked about the generals shortage of embryologists and I saw that you all have an academy for embryologist and I thought that might be part of the solution. But I wondered, does the UK not have the same shortage of embryologist that that everywhere else does, it seems to me like they had. And so do you have the same shortage of embryologist as other parts of the world have seen? And tell us a bit about what you're trying to do to solve it?

Dr. Alison Campbell 31:32

Well, yeah, there is considered to be a shortage of clinical embryologist. But there are several training routes that in the UK that embryologist can follow. So in terms of the government, the national training scheme that the scientist training program, the places are quite limited. And so and that's a three year master's degree part time with a clinic with an accredited laboratory and all on the arteries of our accredited for this STP training. But there are limited places so we can also train embryologist slowly through a six year route to get state registered. It's so there are structured training schemes. So I am not personally concerned about a shortage of the workforce going forward. And we've also established a master's degree ourselves. Last year it was launched. And in the year actually, by coincidence that the world's first master's that we talked about that I did start. So when that was good timing ready, so we can continue to offer a master's degree training. So I don't think we've got a big problem in the UK, it just seemed that in the US, there is a big shortage, probably because that first generation of embryologist that stayed with the in the field. And there hasn't been a great transfer of information and responsibility. And there hasn't been any false structured training programs that have brought the next generation on at the pace they need it to be brought on.

Griffin Jones 33:05

So are you bringing some of the folks from the US over to your program in the UK?

Dr. Alison Campbell 33:11

Well, that's that's a distinct possibility. Yes, that's what I would like to do bring them over to our masters and chair training facility, and they can neither have just personalized training. It depends what they need. So I'm looking into different opportunities to bring people over from the US to answer and also to send our guys over to them. Because as long as I can demonstrate their qualifications and competency, which I can, then they could work under a lab director, we know IUs lab.

Griffin Jones 33:44

Are you looking at the possibility of doing that with embryologists that come from groups that are not care owned?

Dr. Alison Campbell 33:53

Well, yeah, our training courses are open to anybody really around the world. So that's absolutely a possibility. It's more difficult for us to send our trained embryologist into other US branches to work unless they're part of our company. So we're exploring the visa situation, which is a bit of a minefield at the moment. So we're exploring what what that might mean, but I don't envisage we will be able to send trained scientists all over the place. It's just into our sister clinics.

Griffin Jones 34:27

Yeah, but that's a barrel of monkeys. So I want to talk about how you decide to implement some of the solutions that you see on the horizon. I'm hoping that I can get an answer out of you that is a lot more specific than what we look at the solutions that are out there and we choose what is ultimately going to be best for outcomes. I would like to get an idea of your vetting process because there's gonna be a lot of people listening to this episode from genetics companies from lab equipment company is from people that want to sell to us specifically, and that want to sell to your peers. And I would love to give them a little bit of insight into how your vetting process works. Because I walk the booth section, the exhibit, section it all of the conferences that we go to, and I see a lot of great solutions or seemingly great solutions. And I see a lot of them struggle with getting adoption and with being able to sell into groups. And so part of the reason is because you have a system in place, you're you have plans, and perhaps not everybody can add the value needed to be added at scale. Talk to us a bit in the level of detail that you can about how you that new solutions that are coming on the marketplace.

Dr. Alison Campbell 35:57

Yeah, and there are so many, so many new solutions, so many startups, so many AI products, lots of different automation products, the cloud. And so how would you bet them? Well, ideally, I want to get my hands on it. So I want to demonstrate that it works in our own hands in our own laboratories. So it depends how far developed it is. If it's sort of still a prototype, then I have to use my gut most often and think, right? W this has potential, would we get a return on investment if we invest time, and potentially money and resource into this, this new device or whatever it might be? So lots of questions, depending on the stage the product might be at, but certainly want to demonstrate in our own hands wants some evidence that it's reassuring that that is going to work. And then we'll have a play with it. So we can either do that in terms of just an evaluation quite rough and ready, just yet some user feedback, is it saving your time? Is the protocol easier to follow them? Do we like the suppliers? Are they supportive? Or else we could get involved in a clinical trial? Which is also interesting, but what's in it for us short term, medium term long term, if we get involved? Is there an equity stake possible it's a startup? Do they really want us to put effort into it and and support them beyond their scientific training board. There are lots of different ways that we think about it. But at the end of the day, we need to make sure that these potential new products or services that we're buying, are going to add value. And we're going to get the return on our investment, it's going to save time, it's going to make life sweeter or simpler in the laboratories. And most importantly, it's going to improve outcomes. Even if we're talking about marginal gains, any improvement, we want it. So that's been in a nutshell, what I would be thinking

Griffin Jones 38:05

do you can you possibly quantify even in the ballpark? How many requests you get in a given year for you or your team to demo a product?

Dr. Alison Campbell 38:19

Probably 20.

Griffin Jones 38:23

So that's plenty of those 20 How many? Do you think that you actually go on to demo not even implemented scale, but just demo?

Dr. Alison Campbell 38:32

Probably three or four?

Griffin Jones 38:36

What did those three or four have that the other 17 or 16? Don't.

Dr. Alison Campbell 38:44

They? They have either phenomenal testimonials from people that I would trust. And they potential to save a lot of time, their potential to improve outcomes, or the potential to reduce costs.

Griffin Jones 39:10

They all say that they have all of those things settle down. I'll say we will save you so much time it will save you so much I've got and we're going to improve outcomes. What is it about those that are and we're not even at the implementation phase yet? What is it about those 16 or 17 that they they might fail to convince you that they have the ability to save time and cost and improve outcomes?

Dr. Alison Campbell 39:42

Yet well there's absolutely lots of smoke and mirrors and you see when you walk around ashtray often these big banners Oh, this is the best new thing. It's great. And when you dig deep, there is nothing to see it's just somebody's idea. And it's it's very premature. So a lot of them I find all Perimetry law. And so I decide whether to stay in touch. Tell me where you are in 12 months time or go away? I'm sorry, we don't have time to spend on this at the moment. So very polite, but some. Yeah, it is difficult. There's a lot of, there's not a lot of substance behind many of the products that are offered to us to evaluate, they may not even be physically ready. So it's is we have to do it as efficiently as possible, because it does take time. We need information. We need quick meeting facts, figures, and, and timelines and take it from there.

Griffin Jones 40:39

It sounds like how far advanced the concept is, is a predictor of how likely they are to to be taken seriously and be demoed. For those that are still very premature. What is it that they're trying to get you to do? Or they're trying to get you to be their guinea pig in some way? What is it that they're trying to get a group your size involved in? If they're not ready to? To provide the solution? What is it that they want you to do?

Dr. Alison Campbell 41:14

Well, often they want guidance. I think they want markets in towel they want they just want to test the water. Are we heading in the right direction? Is this a good idea? There's sort of free market research, I think is often what they're trying to get

Griffin Jones 41:31

it Yeah, that makes sense. A little bit of free consulting and some of your intelligence. Tell us a bit about when it makes sense to to take equity, because I think that could be a useful solution for some of the groups and of course, any entrepreneur has to decide, is this something that we actually want? Are we going to do a fundraise anyway, and it could make sense to have one of our potential customers be our one of our investors? They have to make that calculation on their end, on your end are that not not speaking and you personally don't even care fertility, but more broadly on the fertility companies that fertility clinic network with fertility lab network? side? When does it makes sense to take equity in a potential lab startup?

Dr. Alison Campbell 42:30

Yeah, well, it's a good question. And I've spoken about it like it's something we do every day of the week. And we really do not, there are not many examples of us doing this. But I think it I imagine it isn't now hooked. But I think there's, I think there's something really, that this has potential. And I think, as we get bigger, there will be more opportunities to work like that. And, and more synergies. So I think cam in the one example that I can talk about, without naming too many names, is, yeah, it's a new technology. And we're involved, it was a small local company that I thought had a great idea wasn't gonna cost us very much. The equity wasn't free, which I think in some cases had been negotiated because of how much we could bring to the table, the know how, and the expertise and the trials and all of those things. So I think that's something where we could explore it with you potential partners. But in this case, and we made a small investment, got a small bit of equity, just to show our commitment, and to support this, this small startup in getting what they needed to get, and keep going. So yeah, I think there are many different ways that we could approach this. And it's about what you bring to the table and what you're prepared to dedicate to a new potential product. We have. There are owned products, a few of them, and it could in this automated annotation. And we have been talking about potential commercialization and potential partnerships. Because we've got the product we've invested in it, we've we've used a lot of scientific knowledge and data. And that's our contribution. And it, it's our IP, that if we were to commercialize it, then I could see advantages in finding a partner with the know how to, to do that to not just to sell it and to distribute it worldwide foot to certify to regulate it to get it accredited as a medical device, which is effectively what it is.

Griffin Jones 44:39

In that particular case. Did you find it interesting that they were pitching you their product? And you all found it interesting enough that you wanted to invest a little in it or did they approach you to invest in take some equity in the company?

Dr. Alison Campbell 44:57

Well, the the first approach was not we didn't discuss equity, it was just getting to know each other looking at the product thinking of the potential. And then it was probably my idea to say, right, well, why don't we talk about us being a shareholder in your company, because we were prepared to put a bit of time and effort into this and, and show that we should be your exclusive partner had the time being so it was that it was a bit opportunistic, I'm honest.

Griffin Jones 45:26

I wonder if that opportunism is going to be something that we see a lot more of from fertility networks, from management service organizations, and maybe even something that you end up leading for care fertility in, in the United States, you're now contemporary us fertility has an innovation fund. My friend, Dr. Eduardo Harrington, is the director of that fund. And I don't know if it's just Angel seed money, rounds, but they they have a fun for this type of thing. And I could see that being adopted from a lot of different networks. So we are an early stage company, and you're looking for us to bring your market to scale. Oh, you're trying to get some free market research for us? Well, maybe in exchange for this, and they have an ecosystem for this care fertility have that E N any of that ecosystem? Now? Is there any plans to to build it? Or is this a seed being planted that maybe we have a very different conversation here from now?

Dr. Alison Campbell 46:36

Well, we have a Research and Innovation Board, which discusses all potential opportunities. So it's quite a senior, he's very senior board and with the director of clinical governance, and

Griffin Jones 46:49

but do they have a fund of here's how many millions of dollars we have to be able to take equity in different companies that and a term structure for here's the rounds that we buy in, under what terms? Does that ecosystem exist yet?

Dr. Alison Campbell 47:04

Not yet. No, that's not not that sophisticated, yet.

Griffin Jones 47:09

You're welcome care of fertility, even though you've probably there's probably been lots of discussion of it at some level or not. I'm gonna pretend to take credit for it here from from a single podcast episode, whether anyone believes that or not is is up to them. I want to talk a bit about the solutions that you're now implementing, which have to do with the predictive algorithms for live live birth. Tell us more about that. And how did it come to be and what's coming next.

Dr. Alison Campbell 47:46

So we've we're on version six of our predicted algorithms, we call it care maps are they the maps stands for morphic genetic algorithms to predict success. And it's built on 1000s of embryo transfers, where we know the live birth outcome positive or negative. So it's very predictive of life birth, so it ranks embryos, it gives them a score of one to 10. If you get a score of 10, your chance of live birth is approaching 60%. And then the scale goes down to a score of one you like birth chances less than 5%. And remembering that lots of embryos generally look very similar. So we've got these scores that absolutely helpless, choose the best one first time. So it's an amazing tool is sophisticated, and it's automatically generated now, so takes seconds to get this information on each embryo. So going forward, we've automated the annotation element, we're still using a statistical prospected me validated algorithm to generate the score go forward, we are likely to make this more accurate and sophisticated, maybe implementing more artificial intelligence to give us this accuracy and speed, because we've got the data. So it is an exciting time, everybody's talking about AI. And then I'm really proud that we've got our own tool that is AI based. And we now need to try and see whether it's effective outside of our group, or our UK group that trained this model. So we can get take it to reach we can take it to Spain, and we can start to understand whether it's transferable or if we need to calibrate it, which is it's possible, calibrate it for different clinics. So loads of work still to do on that. But yeah, we're ahead of the curve, I would say.

Griffin Jones 49:43

Whether it's this tool or whether it's other technology in the lab, I often ask people, What do you see as the biggest changes happening in the next five to 10 years in the lab? I don't want to ask you that. I want to ask you shorter term. What do you see as the biggest change? judges in the next 18 to 24 months in the lab,

Dr. Alison Campbell 50:07

that I will, it will be artificial intelligence, directing what we do directing our choices, directing which gametes should be used, are going to give us the best chance how we should time, everything. So, all of that data, it's all about the big data we've been collecting over the last 20 years, and some more rigorously than others, but that data will inform exactly how we do what we do and when we do it. So the time intervals between each of the procedures could be optimized, based on this data based on the evidence we've collected with this data. So I think there's gonna be a lot of that coming out in the next year or two. And, and it's all good because it's going to make things much more automated, and efficient and effective. Everything checks a lot of boxes.

Griffin Jones 51:02

As it does as it makes the workflow more automated, as it makes decision making more efficient as it improves the time intervals required to devote to the embryology process, as and after it does those things. What does the role of the embryologist evolve into?

Dr. Alison Campbell 51:27

Well, lots of embryologist saw getting a little bit nervous about robots taking over. But I don't I'm not concerned about that. I think we're always going to need embryologist we need the scientific inputs, we need the personal communication to some extent with the patients. And that's not going to go away. I think the embryologist lines should get simpler and easier with these new tools and algorithms and automation systems. So I'm not worried about that, like some people aren't. And I think we just got to embrace it. Because we want this continuous improvement. We need the efficiencies. And we need the results.

Griffin Jones 52:08

Dr. Campbell, you've given us so much in this episode, I wanted to even unpack more. But there's so much that we could happily invite you back for a second episode for you talk to us about partnership track or embryologist and lab directors, which is something after 170 Odd episodes, whatever it is that never talked about. We've talked to us about technologies emerging in the lab from time lapsing more than a decade ago to artificial intelligence. Now you've given great coaching for those folks that are trying to sell into the lab. And you've given us something to think about in terms of different geographies and regulations as groups expand, and how we steal and use embryologist in different places. I'm going to let you decide which of those threads or anyone that you want to use as an umbrella for all of them of how you'd like to conclude today.

Dr. Alison Campbell 53:18

Well, I think I'd like to compared by by just saying that the future of assisted reproduction technology is bright. I think the internationalization that we're seeing is a really positive thing, that we can all come together with our expertise and experience and drive things forward at a faster rate. So I think businesses will benefit employees will benefit and patients will benefit from this. This forward. Dr.

Griffin Jones 53:52

Dr. Allison Campbell, thank you very much for coming on inside reproductive health.

Dr. Alison Campbell 53:57

Thank you. Thanks for having me.

54:00

You've been listening to the inside reproductive health podcast with Griffin Jones. If you're ready to take action to make sure that your practice thrives beyond the revolutionary changes that are happening in our field and in society. Visit fertility bridge.com To begin the first piece of the fertility marketing system, the goal and competitive diagnostic. Thank you for listening to inside reproductive health