Closing the gaps in hormonal healthcare with Sylvia Kang from Mira

Research is completely lacking when it comes to information about women's hormonal health. There's nearly no data continuously tracking it, meaning with fertility issues arise, it can be a medical guessing game to find a solution. Today's guest is working to compile data and help women find the care they need. You're listening to Found, TechCrunch's podcast that brings you the stories behind the startups. Today we're talking to Sylvia Kang, the CEO and co-founder of Mira, a women's health company that is providing home hormonal testing. I'm Becca Scutac, and here to talk about all the ways the medical system is failing us as women is my amazing co-host. Dominic Midori Davis, and of course, before we get into our conversation with Sylvia, we have our two troops in a lie, and at the end we'll tell you which one of these statements isn't true. All right, so listen carefully. Is the lie that Sylvia reads 200 books every year that Mira has collected over 30 million hormonal data points from users, or that Mira is covered by health insurance? Oh, listeners, you'll have to keep listening to figure out which one of those things is a lie and which are true. But before we get into our conversation with Sylvia, a reminder to rate and review the show, you can do so wherever you are already listening to this episode. So super easy for you, super helpful for us. Sounds like a win-win to me. And without further ado, here's our conversation with Sylvia. Hi Sylvia, how's it going? Good. How are you? Becca and I see you too. Nice to meet you as well. It's great to have you on the show, and I feel like what your company is building is very in tune with these larger conversations we've been having recently across the US about reproductive rights and fertility and things of that nature. So glad to have you on today. Sure, thank you. Why don't you start by telling us a little bit about your company, Mira? Yeah, so Mira is the hormonal house company. So we started this company about 2017. The reason being that I have so many friends, just like my background, I have a lot of education. I graduated from a Columbia University with the Mastering Biomedical Engineering and the Cornell MBA. I was working a 14500 company as the business director, and we never had a time to consider to start a family. And then when we started to do that, it's really past 30 years old, and we found that, although you know, there were so many activity trackers, like a Fitbit for your general house, and also we're already sending people to move in whatsoever, you know, 21st century, but the female hormone tracking and fertility understanding was still really, really lucky. So there's only solution like obligation predictor kit. So they tell you one line versus two line view by naked eyes. If you're obvious, you're not. However, the hormone, you know, the female hormone really changed so much. The interpersonal variation is huge. Intercycle is also variation is also huge. So people don't get pregnant with the audition predictor kit because your hormone fluctuates, because of many other reasons. And then they were sent directly to IVF, which is a very painful process and caused like a $30,000 per cycle out of pocket, and with only 33% chance of success. So they really gap over there. And then I was thinking, I should do something, you know, for other women to understand better about our house and to really, you know, have more understanding, more education, being more prepared for life. So that's where we started Mira. We started Mira with the analyzer, the monitor, we call Mira Abonator. It's basically radar for hormone tests, and we test multiple hormones like from LH estrogen, progesterone, FSH. So those are all the key female hormones in the cycle. So we tested urine samples. So users can do that easily at home. They don't have to go to the lab to do the blood joint and they got all the readings quantitatively because we use the technology that's the same as the lab tests, the same effect technology. But we were able to innovate that technology and shrink that into something so small and in your palm, like that size. And it's very affordable as well. So the users can test that at home and they can get a continuous hormone reading. And from there, they can understand when they are ovulating how their cycle really look like, you know, before women never had a view into how my cycle really looked like. And only so, oh, I'm about to ovulate. They were not about to ovulate, you know, even that answers kind of ambiguous. And it's another also identified if they have a condition like a PCOS or close to main house, egg quality, you know, those issues are really affecting fertility so much. And then from there, you know, there's an app we conduct as a data as the hormone test to our app. So in the app, we interpret the data for them. And we recently also launched the fertility hormone house clinic, which is basically a virtual consultation. So we're looking to mirror data and then the users can talk with a coach to understand what the hormone means, what's it can they do because, you know, a lot of improvement you really need about your hormone, about the women's house in general, as in your lifestyle. And that part is also very under-investigated and people didn't pay attention before. So that's basically what mirror does. And I wanted to take a little bit of a step back too, because I know you mentioned a little bit of that as to why you guys decided to launch this company. But I'm curious about the timing. Was there a moment that made you decide this is the time to launch this? Why was the timing right when you decided to launch this? Exactly. So I think there's multiple factors behind that. So one factor was, as I mentioned, I was getting to 30 years old and I found so many friends just like my background. They're not gonna start families. They're not gonna have a kid before 30 years old. And in December, we already coached to 35. And that was a huge challenge. It was probably like 70% of the women around me were going through IVF or IUL. So successful natural pregnancy was really, you know, decade. I think this is probably because of the late maternal age for sure because women now really, you know, focus more on their education, on their career. So they have a better control. They have a, you know, better decision about, okay, when I will be ready to have a kid. And other things like, you know, back in 2017, I think it was a IoT device and the tracking, you know, basically to put the data into consumers' hands. I think that was the trend at that time. I think it now still should be a trend because we should trust our consumer. But that was actually a little bit controversial at that time because some doctors don't want to do it. I talk with a doctor when we started me, a voice of customer. And it's just like, I want like product like this because it's gonna keep my patients too much data. They're gonna ask me so many questions. They're gonna increase my workload. But, you know, that was really the concept of the feeding, you know, that's at time. But I didn't believe in that. I feel like, you know, our consumer education is there. You know, we could understand and it's our data. Just like you go to see a doctor, you should own your test results. You should understand, you know, what's happening so I can control my body. So that was the goal was kind of like a driving force behind this. But as I mentioned, there were so many people really just focusing on the general health, like a white horse sign tracking. There was Apple Watch, fake bands, there's many others. Now they probably don't easy standing more. Like many activity trackers at that time. But nobody was doing women's house. Also at that time, women's house wasn't even a concept. Not a concept, not the industry we talk about it. We have events about this and we have investors about women's house as well. But at that time, they were nothing. So when I was starting the company talking to the investors, I have to say, oh, we're like a IoT device, but we're tracking fertility. We're like a consumer hardware or we're like, you know, consumer product. So it's really even difficult to find the definition like the segment of the market where you can fit in. So it was quite challenging at that time, but that also showed like a there's really a gap over there and we need to do something. So it's so interesting to hear that you got that feedback from a doctor and based on what you just said about how you guys really at the time, especially didn't fit a specific category like, what other early feedback did you get as you were reaching out to potential hires, potential investors and just like other people in the space about this? Yeah, I think there's different feedback, which is also very interesting. So when I talk with a consumer, I think it's surprisingly most of them understand what the hormone means and we started with the more like a fundamental, like a basic hormone such as LHS for your ovulation and then estrogen to understand fertile window and then later we got into a progesterone. I was, you know, suspicious at that time. I'm like, okay, I, I, it might be fine, but when I got to progesterone or FSH, there might be challenging on the consumer side about, you know, what is this doing for me? So I probably need to do a lot of education, you know, which will be very expensive for a director to consumer business, but actually know they knew about this. Many people knew about this. Even you talk technical term, you don't talk about the meaning behind that. I don't talk about, oh, this is to confirm ovulation for progesterone, but you talk about, you know, this is just to test your progesterone level people are putting for this. They understand that term. So I think on the consumer side, there is a segment, at least there's segment of women, you know, they have higher education, they have delayed maternal age and they really, they're really desperate trying to come save, but as we mentioned, there's a lack of help, lack of tools and even research. So there's a really need, you know, all kinds of solution. So there is definitely a very strong pulling demand from a consumer side and is enough from the provider side. That's kind of like what I said. So either a doctor's cycle, I don't want to say this because it's going to increase my workload or they're like, what I'm going to do with the hormone data. They're just like, you know, blind because their education was also not on hormone number or like a continuous hormone tracking. Their education is based on life, you just test hormone once per month and you know, okay, this is ovulation. This is a pregnancy. That's it. And regarding how your hormone pattern really affects your life and what is the medical meaning behind that, we didn't have research because women were excluded from research for so many years and this is impartially because our hormone fluctuates and those researchers worry and the hormone fluctuation can affect the research results. So we're excluded. Yeah. And so there's a little understanding doctors were not adjuking in that way. So they're kind of like confused about, you know, what is it really trying to do? What is the value going to provide it here? And the one was talk with investors. That's another different story. Most investors are male and I had to take a really long time to. explain what this is and basically going from a physiology, one or one, you know, what is our age? What is our religion? Astrology? Why do we need to track that? Why is there a difference? Interperson variability? Why is that significant? And I still remember some cases that's so interesting. So I think some male investors are really significant in the impact by their personal experience. If their wife was very easy to get pregnant, they were like, "I don't need this product." It's not great. I don't trust this. But some of you know, had trouble to get pregnant or went through IVF and they were like, "Yeah, I really need this." So you know that there's really no market concerns about these real little education across the board. And it's really interesting. I mean, do you think that pitching a women's health company like this is easier today than it was in 2017? Because I know that there's been a lot of attention on the women's health market and there's been a lot more funding in the space. Do you think that it's still quite difficult or do you think it's gotten a bit easier? I think it's got a little bit easier, but it's still challenging. So obviously, the fund reason is always challenging. And it got easier because at least I'm aware, there's a few funds that's dedicated to a women's house. And there's a managing director where investors there are also female. So they focus on this market and they have done their research. Basically, they have seen, you know, there's some company, you know, can grow a little bit bigger like us, you know, someone basically already movers, they were successful, right? So they're not like, you know, tiny opportunities. There's no access to the road. It's not like that kind of trend. So there's a little bit confidence in the market. There's some success case and they dedicate funds for that. So that's relatively easier. But at the same time, it's also challenging because women's health still, I think it's at the early stage. It's not as early as when we started that in 2017. That time was not existing, basically. But still, you know, it's not the mature investment segment because you haven't seen any company focusing on women's house in the IPO and they become so significant or they got, you know, really fantastic access. And I think another limitation is like a lack of research. When you're lack of research and there's a little innovation you can do, you can make the customer experience or whatever, even like, you know, house care systems, maybe the workflow will be better. But, you know, if you want to have a blockbuster product in this market, I believe there's so many things we need to break through. Like we're basically to understand scientific meaning behind so many things, such as, you know, some really privating problem like PCOS. How do we treat that? There's no way to treat that. There's no way to cure that. But how do we have a protocol, maybe, to show some lifestyle change in together with some drug? Can make it better? We don't have a set answer about that too. And even for another really popular one, endometriosis, maybe people got that condition. And we don't even have the set way to diagnose that. I just diagnosed endometriosis with ticks years. And that's a painful process too. So, you know, there's many things that's basically, the company, you know, startup company can innovate a business model, can put the resource together to make something that's better. But we need to have the scientific backup and that part is still lacking. Yeah. And sort of going off of that, with the science research, and as you've mentioned, definitely when you guys were launching the product, talking to some doctors, had some like mixed opinions about this as well as didn't have as much info on the research. What was it like actually being able to develop the product? Then like, were you able to find doctors that could kind of help you with these different things? Or like, what was that side of the house? Like actually getting the science right when this is an area where there is not as much research as you'd imagine? Yes, that's correct. So we did find some doctors who trusted this. And they probably saw, you know, some potential application and is there data practice? And they are also aware, you know, many patients they have a called angst-planned infertility, which means both partners don't have any problem or least our medical capability right now cannot but I know saying a problem. But they're just not able to get pregnant. Right. So it's called an angst-planned infertility. And basically, it's your unlucky. And there's no way to treat that. You know, what should I do? How can I improve? There's no way. But you know, when people are trying to conserve, they're pretty eager and there's strong anxiety behind this motivation. But how can I have a better control? There's no way. So there are where. There is the very significant percentage of couple trying to conserve our in-house status. So they're curious. You know, there's some doctors that curious more from a research, first research perspective. Say, if I can't see their hormone data, maybe I can find something. Maybe I can, you know, prescribe something and give it try. It's more from that way. And then rather than, oh, yeah, there's a sat-matical protocol. So it's going to be useful for us. And for us, you know, we chose to actually do it with consumer because, you know, based on our initial feedback, consumer has much stronger polling on this than the other sectors of the industry. And also going from the same reasoning, you know, we feel like, you know, the consumer generally have a good acceptance on the testing more about their hormone. And then we started from hormone testing. So we didn't start from something like a diagnosis, whatsoever, because there's even no data before us. I really, we searched about the paper, about, you know, continuous hormone tracking, like all these major hormones, how that looked like as a profile. Even that was really difficult. We found something on Wikipedia, which is average. One chart, average. They all the women should fall into that. But then later, you know, when we had the real data, now we have more than, we have more than 30 million hormone data right now, more than 130,000 users. And then we found that there's almost like, probably less than one percent of women will have exactly the same hormone chart as what's on Wikipedia today. So there was no data. And then we started collecting data. And then we collected so many data. And then we realized, okay, we can do something over there. And that's the time we started improving the AI. And obviously, AI work with our medical advisors and their medical inputs there too. And they're trying to learn, trying to go from existing data. And the data by this individual hormone pattern, hormone cycle, and then make a personalized prediction. And then we started to put them into category. And we say, okay, so maybe you have a longer follicular phase. You have a shorter due toughest. You know, due toughest has a, in the dessert, a condition for that. Call a due toughest deficiency. They're gonna affect the fertility. Or you're a hormone, you're a higher lower, but so ever. And we give that information to user. Now if you go to the mirror app, you can see that we call the chart comparison. So you can compare your chart, which is the same population group, like you, you know, like your age, your house condition, how long you have been trying to conceive, and you see it's like that. That same group. And see how your hormone is compared to them. And what might be the implication? Again, we still don't know what is the diagnosis over there. Because, you know, we're still, you know, we need to do more research. But at least we can find some pattern. And then we can suggest a user to try and say, you know, change some lifestyle. And maybe take some supplements and relax, take care of your sleep, but so ever. That's what our coaches are doing. And then see how the hormone is improving. More from this conversation right after a quick break. I'm really curious because I want to know how the pandemic impacted your business. Because I imagine that you got a lot more, I don't know, everyone was at home and everything went online. How did the pandemic impact the business? Yeah, it's a really good question. The doctor is a pandemic helped us a lot. Because at the pandemic times, patients can't go to see their doctors. And there's another sick person online help remote help. Our concept is basically remote monitoring. There's a remote monitoring for a house. There's many remote monitoring companies, but really something for women's house before us. We saw a very fast, actually very dramatic sales increase during those two years, like 2020 and 2021. And I think that got carried on interestingly. Because after that, I think people start to realize, yeah, by looking at this, I can have a better control. I have a better understanding. Everyone's to have that. So you have a condition, you try to reach a goal. You don't want to rely on doctor. Everything goes in your doing per day. And they realize, yeah, this is a new way. I own more about my house. I have some understanding, more education. And then they just carry on. So I feel like the pandemic actually helped the industry, the consumer behavior, to move more to like, you know, controlling their house condition or controlling more information, more by themselves. And I know you mentioned earlier about how, of course, treatments like IVF and processes like that are super, super expensive and super prohibitive to the majority of people who would want to access something like that. Looking at how you guys have priced your products, it's not $10, but it probably can't be $10. So I'm like, curious how you guys think about pricing these so that you are getting that group of people who need these solutions they can't pay for IVF. They don't necessarily have access to some of the higher costs, things that are already on the market. But of course, you guys have to make money at the end of the day. You are a for-profit company. So how do you guys think about sort of navigating that line when a lot of the issue in this space is about worth resource and knowledge access? So we position based on the outcome. IVF and OPK, OPK is a lower end. IVF is a higher end. They all have the same outcome is based for you to get pregnant. And then obviously IVF costs this so much more. But the OPK, yes, is much cheaper. But it's probably not gonna help certain people reach the goal. So we did a lot of market research in a one-shot that 80% of the women trying to conceive think OPK is not giving them what they want. So they're basically confused by OPK. They probably saw positive lines all the time or positive negative, positive negative. You don't know what that means. And it doesn't help them to improve over time. It just one-time test. So that opportunity cost, for them, is much much higher. I think that the opportunity cost really the reason driving people to spend more. Because sick people, you know, women like in 33, 35, don't have too much time. If you go to a doctor, you say, doctor will say, you're 33, yeah, try for more more year. If you're not pregnant, go to IVF. If you're like in 36, whatsoever, you try for six months. If I say go to IVF immediately. Otherwise, you don't have time. And 35 is probably not the most scientifically because we lack of research. But industry-wise, like medical-wise, doing their practice 35 is like a cuddle. So basically, if you're close to 35 and you're not getting pregnant, you don't have time. And you know, each cycle goes really fast. It's an awesome thing. You can try 10 times per day. you try once and it takes a cycle. You only have probably 12 cycles per year. So that opportunity calls it really high. And then now obviously we launched the product with some pricing based on market compared to competitors and whatsoever. But gradually we start to collect the data about the success rate for our pregnancy. So we have pretty high success rate. We help people to understand what's the reason behind their infertility, how easy it can improve whatsoever. And all causes nowhere compared to IVF. Obviously we're different technologies than IVF. But say our users, obviously like probably 80 percent of them can get pregnant within like a 3 to 6 months. And that cost, you know, probably will only be like $4 or $500 a maximum. However IVF per cycle can cost 30,000 dollars. So basically we want the users to go through us before they go to IVF. And also on the other side, in later in the business, we start to collaborate with IVF clinics. And we found that actually there's a really strong bridge over there. We're not like an alternative for IVF. But we're like the enhancing IVF. We have a formal profile. The doctor understands much better about how a cycle can be effective for these patients to go through the IVF. And also the patients are patient keep testing with Mira during IVF, during IUI. So that will lower the IVF cost for the patient. You know, the basically don't have to do that many blood drawings. And then it's much more convenient and it's much more cost than that's also like a very strong incentive for the patients. Now does the company like this work at all of insurance companies? So for now, the trying to con say of use case is not covered by insurance, but we're covered by the FSA-HSA. And we also work with the fertility benefit company because this is also very interesting. Fertility itself in general, which is not covered by insurance, there's no code for that. But I think this is also a legacy issue, you know, you think of fertility problems, not the condition. Obviously, you don't have research, you cannot demonstrate this is a condition, you don't know what's really what wrong. However, it's definitely something you don't medical attention, right? So since there's the newer company like Maven, like Carrot, we work with both of them. So they cover our product for their employers. And so they wanted to ask you because I literally was just talking to a company about this earlier this afternoon was about the FDA approval process. She had some interesting things to say about how she was like in theory, we have this trial, and when we finish the trial, we could file then. But she was like, but we don't want to for all of these reasons. And we like want to be really specific about like when we do file to have the best potential outcome. I'm so curious about that with you guys. What was that process like? How did you know when it was time to do that? And how did that all play out? Well, obviously well, because it went through. Sure. Yeah. Sure. Yeah. So everything we do is a medical device. So we have to work with FDA closely and every product we have on the market is there being compliant with FDA registration. Yeah. And that process also is definitely a starting curve for any startup. As a medical device company, I have to have really rigorous quality management system. So the process needs to be in place and we follow the exactly very tight design control process and keep all the files, design control files, design history files, all this being exactly compliant to what FDA needs. So that's just something, you know, as a medical device, we have to be responsible for our consumer. Make sure they're safe. So that's the highest goal for sure. And then another interesting thing I noticed in the working with FDA is like also going back to women's house. I think this concept is so new. And it's sometimes difficult to find the predicate. You know, this is stuff we're doing here. There's no people have done that before. For example, our concept is really to bring some lab tests into patient's hands and give them a user AI, use coach makes a consumer, you know, be able to understand what's going on and improve their life. However, there's no such a company like a product like that before. And all the testing tests before us are like a new lab test. Because they're like, you know, I have a huge equipment. I put in a server like a $30,000. I put it into the lab course lab and you draw the blood. You test over there and send your result. So that's a model. If we do something similar to that, we can use them as a predicate, which will make the registration process much easier. But if there's nothing like that, we have to go through a process called a D-Novel, which means we have to work with FDA first to identify what this is and you need to be signed with a class. And to work with FDA to understand what is a risk level and we have to prepare so much data and the FDA will understand, okay, this is a scope we're trying to do. And this is your intention of reducing your classification and then based on that, you have to provide me xyz documentation to our proves is safe. The cleanly code is that's a fact, but whatsoever. So that process is much longer. I think this is probably a challenge for many women's house startup. Because, you know, as a startup, this is cost a lot. It's a long-term process costs the time and money. But I think that's something general, you know, people are facing in this industry, but we just have to work with FDA and go through that. I wanted to go back to something you mentioned before, which was AI, of course. We're obviously in the midst of some AI revolution. And so I wanted to know, when did you decide to start using an implement AI and kind of how does that process work, especially with the amount of data that you guys use for your products? Do you have someone that like specifically trains the AI or like how do you manage all of that and also when did you decide to start using it? So we want to use the AI, actually at that time, it wasn't called AI, it's called a smart algorithm. We want to use smart algorithms. We started company in 2017 because we know we've got the data, the users will ask you what can I do with the data, is it definitely some help over there. And then we gradually, you know, correct more and more data, we developed something like some basic algorithm at the beginning. And then we start to improve that. We constantly improve that. And then we got our medical advisor on board and they work on the medical input, basically, you know, really trying to mark at what kind of hormone pattern you really means what, or you know, what information we can give safely. We don't want to over-climb. We want to say, oh, you're diagnosed with the problem, which unit is not. So we want to say something like, you know, what you do, what does this mean? Is this you fall under what percentile of your say identical group population? And you know, what is use of rap flag? Sometimes people have PCOS have for you in a very obvious hormone pattern. And they don't know they have PCOS. They're just trying to conserve and they don't have results. So then we can give them some rap flags. They say, hey, maybe you want to check with your doctor, this might be the case whatsoever. So we start to identify those patterns, medically. And we incorporate them into the algorithm and algorithms learn from existing users, become a database, become a big bunch of data. And then every single new user coming here, and we give them a higher weight. So the algorithm will be tailored to this specific person as well. So the algorithm start to evolve in that way. And later we start to add features like the personalized recommendation personalized the reminder or like, you know, some products and lifestyle change, whatsoever. So AI gradually go from a not just on the abolition prediction or cycle interpretation, but more become actionable guides for them. So you test the hormone, go through AI, and then give you a outcome, which is what you should do. And this is exactly our consumer need. And then try this, and then this will go from a feedback. And see, next cycle, you did this, and see, did your hormone change, if we're something different, and what else can you do? And then eventually, and we started to look at this data, and then we saw, okay, there is medical meaning behind this. There's a clinical meaning behind this. And then we started to have a like research interest from a research institution, university doctors. They're like, I really want to research what are the formal, actual hormone pattern for PCOS. So, right, there's four kinds of PCOS, but how do they actually look like what drug can help them to improve? And how effective those drugs are, how effective my treatment protocols are. And we started to have also collaborations on this. And then obviously, everything is hyper-complying, and we de-identified all the data we collect, but they can look at from the broad perspective, say, how can this help with my clinical research? That's so fascinating. Like, you started this, and everyone was like, we actually don't have the research on this. And now they're like, actually, could we have access to that research that you done on this? That's so funny. Thank you. Switching gears a little bit, though. We always like to ask you, go, come on, to show this. But what was it like going from working at a large company to launching your own in a different space? Did you ever imagine you would be an entrepreneur? What was it like making that decision and sort of taking that lead? Yeah, I think that's a very good question. It was really different from working with a big company versus something I started by myself. I wasn't actually like a born and then decided I need to be an entrepreneur, but I knew I want to do some things that's very impactful. I knew that. So when I was at my previous company, it was still corny, so 14500-a company. And I started as a product manager after MBA, and I was a probability to be a business director in my 20s. So that was really exception in the, like, you know, 14500 big company because all my peer as a business director, they were like in their 40s. I was the youngest. I still remember the average age for that group for the director and above group was like a 45 years old. And I was 29 the year I was promoted. So I knew that I was, I'm a person really, like, I'm really results driven. I really want to say, you know, what I can deliver, what they can impact. And I also go to very detail. I work super hard to make things happen. Basically, I deliver things. I stay so tightly with my commitment. If I say something, I need to deliver, I will for sure deliver. I'm also really disciplined. And also, I'm really curious. I read so many books every year. Now I still read about 200. Yeah, this year about 200 books. I've been here. So on all kinds of topics. So, you know, based on that, I feel like, you know, working for one company is great. I learned so much from corny, but I really want to have a bigger impact, you know, with all these resources in my head. I know. and it's my network and you know I bought a wrap from book, my personality, maybe there's something I can do by myself so that will make a direct impact on consumer or on something, basically. I just want to see that results more directly. So that's the time I started Mira, you know obviously as I mentioned before, I identified as the really huge gap. Nobody was talking about women's house, but at the same time I know it was challenging, but you know nobody was talking about me, you have already moved her advantage and there's a market need, so where their consumer needs that, nobody talking about this, obviously funding will be difficult, but if we run this correctly, right, and there's maybe there's an opportunity. So that's the time we started. So after I started company, I realized I don't know anything because everything I learned from big company is great, but it's the way to work on the small companies so different. We took so many, you know, trial and error, and because we didn't know, you know, I learned everything from scratch. The way at the corning, I was managing a B2B business, and here is D2C, everything's completely different, and even just really simple thing, I said I won't do some user interview, well as a corning, I can ask a sales team to do it, but here we don't have a sales team, just me, so how can I find some consumer who wants to talk to me, even just like a really tactical thing, are very difficult, but we have gone through all these, you know, we learn, you know, talk with other people, try different things, and the collective results, analyze him by mind, and say, oh, what has gone okay, and what went wrong, and reflect, and go try again, try again. I don't know how many cycles we have gone through, even just showing in the product development, right? So our monitor has iterated four times before we send that to the market. The first monitor got to the consumer hand is four times, that's a hardware iteration, you know, it's pretty difficult, it's like a long-term big investment, it's not like a software, which is faster. Yeah, so we have gone through so many of that, but I think I chose the right path. I think this path is, startup is never easy, it's very stressful, but we make the impact, and I make the decision, I was able to use all the resources in my mind, what I learned, and I have the autonomy, and I can, most importantly, I can't help people, so I think, you know, this career really fits my personality and my background. And how big is your team now? We have about 120 people right now in the company. And how would you describe your leadership style? Yeah, so I'm a really curious person, but I also really care about our teams career development plan. So obviously, as a startup company, our culture is like we're really fast pace and we're innovative, and we're also very open-minded, because I'm a curious person, and I think I hire many people who are also curious, we're open-minded, we learn from the market, we learn from the other people who started segment of business before us, and then always trying to tater our approach, and this startup culture of like trial and error, keep testing, keep challenging yourself, reflect, analyze, I think, and never gonna go away soon. So we still, you know, operate in that way, but at the same time, we try to build Mira as a family, especially for our female employees. We have so many female employees, I think 80% or 85% of our leadership right now, leadership team are female. And this is like what I aware, so obviously, because when I was at corny, I was probably 95% of our male, so like white male, right. So at this company, we really try to build a culture that we encourage female to speak out, and we also provide things like hormonal house benefits, so they can take seven days off per year just to check anything, like if they have PMS, where they wanna see their OB, their pregnant, their not pregnant, whatever hormonal related, you know, female house, you know, they wanna, basically they wanna see doctors, they wanna have a consultation, and they can take time off, and we encourage our team to really grow and to speak, and every single person in your company has this career development plan, and every manager reviews with some every six months. So we never leave anyone saying, "Oh, you're just here, do the task, and you're done." It's not like that. So really wanna people to grow with the company, really build a family, build a culture, especially for our female employees and female leadership. And we're pretty much right about a time. So I did wanna ask you one final question. You guys have grown to where you are. It's been seven years. Women's health has changed quite a lot in that period of time. And one thing that also has changed is sort of how we've been discussing this area, things like IVF, things like reproductive rights, things like fertility, especially now. I'm curious how you think about the company going forward now when the national conversation has changed so much about it. I know I don't need to tell you. We've seen things over the last year, states trying to ban IVF, states they want people to have more kids, but they won't give them access. It's such an interesting time for the space you're building in right now. How do you guys think about that and sort of how do you use what's happening around you to sort of help propel you guys forward for the next few years? So our next goal is, I think we want to get this to impact that even more people because women's houses are so important. And as I said, we started from consumer, but we need to have more impact on the downstream and the other segment of the industry. For example, the healthcare system. And as that is a long-term story is challenging, they're going to take time. However, to really change something, we have to have number one research and clinical data. And number two, we have to have a healthcare system to adopt that, which means we have to find the use case and the work with the doctors and can be in the IVF industry, can be in the OB, whatsoever. And doesn't have an insurance payer to work with more pairs, not only is the fertility benefit providers to get these two more patients' hands. And that will really, I think, generate a much bigger impact that is we really drive women's houses to the new level. It's not just like, oh, consumers trucking this at home and doesn't know, it's good to know. It's not just good to know. It's not what you must have, what you must understand. So we're actively working on that. And as I said, this will take some time. And another angle we're trying to go is that we try to expand the more out from the, you know, understanding, we're differentiated doing trying to conceive because we did the survey. And it's a nice 80% of women feel like they were not prepared when they started thinking about trying to conceive. Actually, the hormone goes with you for your entire life. Like, for example, your main opposing, that's another really stromping point and really underserved the market as well. People don't understand what's happening. Just know they're same time. You've got the hormone replacement survey, but, you know, some people don't feel well, and some people feel always harmful. You're going to increase risk of for cancer, whatever. There's many controversial topics over there. And even let's go down the road. If you go even earlier, there's many conditions like hormone imbenesies such as PCOS, endometriosis, or even just like a painful period. And all this affects us. You know, our survey show like a lot of people being impacted by this from a work absenteem. Like, they have to take this off to take care of their painful periods where to, you know, really understands the hormone imbenesies see doctor. And this didn't happen during IVF, we're trying to conceive. It's like an earlier in the journey, or, you know, after you have gotten going into menopause, we propose part of it in menopause. So there's so many things we need to do in order to address the hormone in the house on the effective way across many stages of women's health. So that's another thing, I think, not only us, but all the women's health startups should move into. Definitely. Well, unfortunately, we are out of time, but thank you so much for coming on the show, Sylvia. This has been fun. Thank you so much, Becca. And that was our conversation with Sylvia before we dive in too far, Dom, what was the lie? Lie is that mayor is covered by health insurance. It is not covered by health insurance, which isn't exactly surprising. Right. I feel like none of this stuff is covered by health insurance, which Sylvia talked about, like, even like IVF, it's like you get no help there either. Yeah. I was also interested in hearing that she was saying that they work with some of like the employee benefits providers. And there's a lot of interesting stuff happening with those providers and like them helping with IVF and I've always kind of wondered how those business models math out on the back end because these things are so expensive. I mean, I only asked the question because I want it to know if she had any stories about fighting with insurance companies, like we all do. And I just wanted to see if she had like any anecdotes there. But I guess not, or maybe the lack of is a good commentary on women's health in America. Yeah. And I mean, she talked about it a couple of times throughout, but even since they got started, which in the grand scheme of things was not that long ago, like 2017 is not like 2005, just how different the women's health space is and how when they applied for like FDA approval, there just wasn't very much data in the women's health space for the FDA to go off of for this. Whereas now it's like one companies like them do get approved, then the FDA does have more data and then things do start moving in that direction. So it is interesting to like talk to her about how that space has changed because even them being as successful as they have been and what they've done so far is going to pave the way for more companies in the space in the future too. Every time I cover a company in this space, I'm always shocked to remember that like the entire medical profession was just made without women in mind. Right. And when we were having this conversation, I was just like, I was holding my stomach and I was like, doctors don't know what's in here. They don't know how like life is impacting me because this is in so wild. The lack of data around women's health because we've been seeing the impacts of women not being taken into consideration in this field and just knowing that even as recently as 2017, there was still like not a lot of data and still so much confusion around this space. I thought it was really, really interesting that she said that when she was going to investors that usually it was the investors who maybe had fertility issues with their other, with their partners were the ones who really, really kind of grasped this issue versus the ones who didn't have issues conceiving or whatever. And so I thought that was really interesting because it shows still like all of this stuff is still boils down to a ban understanding. to handing our problems. - Yeah, I know. No, and it's crazy too, and she started talking about how like, mirror obviously can't diagnose you with fertility issues. It can't diagnose you with anything. But she was saying that so much of this is just like pattern matching, and then like people, they figure out if they have a condition from that that they can go and talk to their doctor about or like plan their, you know, schedule of trying to get pregnant around these patterns. And it's like, it's just patterns. And like they're literally collecting data on like people's hormonal patterns, and they've been able to see like success with like, it's just, it's crazy how little information there is about this, 'cause it's like, have a company can literally come in and just like match data points and be able to like make these improvements. It's like, "Geez, imagine if we had a whole medical field focused on this." - No. - So you can get a lot done. - Why wasn't anyone doing this? Is literally what people in tech say they do all the time is just match data points. - Right. - It's really funny because there's this meme on the internet where there was something like, there's this new AI tool that's been developed to detect, I guess, like breast cancer in its early stages. And there was someone who was like, this is what we want AI for, not like the random stuff that a lot of people are building. Which of course, you know, innovation is fun, but it's like, get on this. We need stuff in more innovation in this field. And so that also reminded me of this company because it's like, this is what we want AI for. This is what we want more innovation for. - Exactly. I did think it was funny too when we asked her about AI. And she probably didn't mean this to sound like shade to AI companies, but it did in a way that I found kind of fun. Where she was like, well, yeah, we use it, but back in the day, we called it a smart algorithm. Like, like, yeah, we're using it. Everyone else has this whole time. I don't know why we're like making the deal about it now. I love a good medical company that reminds us that they've been using AI for like this whole time. - I know. - It reminds me of the viral discussion about founders mode. And there are people who are just like, oh, see mean like just like running a company, like how people have been doing it. Like what is this? And but everyone's like, it's revolutionary. And people are like, this is what it, like you're just running a business. And so like, I love a medical company reminding us that they have been using AI and the whole transformation, the revolution has just been rebranded into something new. - I know. I'm interested to think about kind of like what happens with companies like Mira from here. Because you wonder if like more people put emphasis on the women's health space, they have all that data. Do they get to like license it to research it? Like do they get some like huge other business out of this down the line? Because they do have this huge pool of anonymous data. I know she mentioned thinking about expanding in ways like metapause or like other conditions that are in the hormonal space that affect women. But I'm like, any company that builds this huge database and has clearly like done it correctly, like already anonymized it. Or they have it like all set up people signed off to like have it in this pool of information. I'm like, curious what happens with that data in the future. Could this be used for good? Oh my gosh, well, gah. I mean, like I'm shocked, like big insurance is gonna get their hands on it. And so many things are gonna pop up as like pre-existing stuff. They're gonna use this data against us, obviously. Use for good. I don't know, we have to see the US medical system being used for good. - Oh, I know. - I'm not gonna go to rant. I'm not gonna go to rant. - We have to go. - We have to go. - Fingers crossed. - Found is hosted by myself, TechCrunch Senior Reporter, Becca Scootac, alongside Senior Reporter, Dominic Mendoori Davis. Found is produced by Maggie Stammitz with editing by KELP. Our illustrator is Bryce Durbin. Found's audience development and social media is managed by Morgan Little, Alissa Stringer, and Natalie Christman. TechCrunch's audio products are managed by Henry Picavid. Thanks for listening, and we'll be back next week. (upbeat music)