Launch HN: Legacy (YC S19) – we help men test and freeze their sperm
I'm Khaled Kteily – and I helped found Legacy (https://www.givelegacy.com/). We help men become fathers through sperm testing, sperm improvement, and sperm freezing.
To do this, we built an at-home sperm testing kit. Using our kit and courier services, we receive your semen sample at our labs. From there, we analyze your semen for a variety of parameters, most notably count, volume, concentration, motility, and morphology. This helps you understand your fertility.
If the analysis concludes that your sperm are healthy, we then offer you the option to freeze at rates more competitive than a traditional clinic. If we find low counts or poor motility (the sperm's ability to swim), we'll provide you with lifestyle recommendations based on your analysis and a survey you completed. If necessary, we'll connect you with our urologist on staff or a reputable fertility doctor in your area.
Men often assume they'll have no issue procreating. We also often assume we can have healthy kids at any age. But these assumptions aren't always true. In fact, approximately 1 in 10 men face infertility, as do approximately 1 in 7 couples. In each case, infertility is medically defined as "not being able to conceive within 12 months of actively trying." What's equally important is your ability to produce healthy sperm is not necessarily permanent. Things like testicular cancer, dangerous careers, or serious accidents do happen and as you get older, the quality of your sperm declines each year.
I didn't plan on starting a male fertility company. A few years ago, I had an accident that led to second degree burns on my thighs from some very, very hot tea. At the time, I was just grateful to not have had any permanent damage. But when a friend was diagnosed with cancer and froze his sperm before starting chemotherapy, I decided to proactively freeze my sperm, and that's when I realized just how much the process of testing or freezing your sperm today sucks (I am more than happy to talk details about this!)
My work experience was extremely helpful in starting a company like Legacy. I worked at Oliver Wyman as a Health & Life Sciences consultant, studied public health and public policy at Harvard, met with successful entrepreneurs through the World Economic Forum, and learned a lot at UN Women about how the world thinks about fertility and family planning.
The timing also made sense. In 2017, a major meta-study was released, showing that male fertility had declined 50-60% in the past 40 years. And society is changing! People are older. Couples meet later. They get married later. They try to have kids later. Non-traditional families are much more common than they used to be. Men no longer see themselves as the hands-off breadwinners, but want to be actively involved in raising healthy kids with good values - I know I do.
Even if you don't know whether you want kids, if you've at least thought about having kids one day, we can help you understand your fertility and ensure that you have a strong viable sperm sample for future use. Plus: your sperm quality is a great overall indicator for your health, so you'll get an important insight into how healthy you are today.
I've been part of the HN community ever since I decided to become an entrepreneur, and I really value this community. I'm very much looking forward to hearing your reactions, feedback, and questions, and to hearing your experiences in this space, which is so intimate and important to so many of us.
EDIT: We are operational across the United States, and are actively working on international expansion to Canada, Europe (via Geneva & London), and the Middle East (via Dubai).
104 comments
[ 2.8 ms ] story [ 190 ms ] thread>a friend was diagnosed with cancer
A small rationalist plea — if you’re considering having offspring, biological or digital, please seriously consider the ethical implications of intentionally creating consciousnesses that can and will experience these kinds of suffering.
My daughter is the most precious being in my life, but I can’t shake the feeling that I brought her to this world on purely selfish reasons and now she’ll be faced to suffer in this ever convoluted planet and I won’t be there to help her for most of her life.
I might be wrong, but please consider this before you bring a life to this world.
You could make a rational and logical decision to have children and then get hit by a bus the day after they are born.
PS many of us are Canadian so we get this question from friends. A temporary measure, once the borders re-open, is to simply drive anywhere across the US border, have it picked up that day, and then return to Canada.
- low-birth rate
- high education
- high per capita income
> we then offer you the option to freeze at rates more competitive than a traditional clinic.
We are able to assist in the transfer of your sample from your current clinic to our long-term storage facility. We just require some completed paperwork in order to facilitate. If you're interested in this, you can email sarah@givelegacy.com!
As I'm understanding your question, I don't think it would be right to balance or have a target for the ethnicities or races of sperm that we receive. Could you tell me more about how you mean it?
If so, then can you talk about which names you like more and they can do better. If you weren't in the market to begin with, then it might not matter for them.
As a marketer (and the growth person on the Legacy team), I've learned you can't build a strategy or business that appeases everyone. Ultimately, a name is just a name.
Ultimately, we are working to help hopeful fathers build families.
Nothing about the name as it is now will stop me from becoming a customer, my decision will come down to the results of my research and the answers to my questions.
It is only while posting this that I am making the negative connection to things like "legacy code," but the concepts are distinct enough to me that they might as well be different words.
1. Clinic-level analysis: Most other solutions offer a basic analysis (count, concentration, volume + some motility). Our analysis is a comprehensive assessment that evaluates count, conc, volume, motility + morphology, which gives patients and their doctors the information they need to make decisions around treatment options
2. Personalized lifestyle recommendations - sperm health can be improved since sperm is regenerative. We provide all of our clients with data-driven personalized lifestyle recommendations for sperm health improvement.
3. Multi-geography storage - for every sample we receive, we split it into 3-6 vials and then distribute those vials to two different storage locations as an added measure of security. We get a lot of really good feedback about this from our clients.
4. Telehealth appointments - all clients have the option to speak with a specialist after they receive their results in order to learn more about their sperm health.
5. Client experience - we pride ourselves on providing a superb client experience. Each client receives a dedicated client service advisor to guide them through the process and answer any questions they have.
Wish I had heard about you in the spring, would've picked your org solely because of your georedundancy option mentioned in a sibling comment.
This sounds minor but actually affects a lot of the way we do our work e.g. we ensure rigorous analysis, we take extra de-risking steps around cryostorage, we call clients to share bad results because it's more humane to do, we connect them to our urologist on staff, etc. etc.
One of the things I find annoying about existing companies is that I can't see how my data is doing. For digital data, I can monitor to see how my data is doing, but all I know about existing companies is that they will tell me if something fails.
I'd like to see live monitoring data from your freezers. Is that something you'd share?
We get a lot of monitoring information, both on the way to the cryostorage facilities (everything from humidity to temperature variance to battery level of our trackers), and we similarly get daily or weekly checks of the frozen sperm (like manually checking on levels of liquid nitrogen).
We hadn't considered making this information front-facing, although I understand why you'd ask that. What would you be most interested in seeing? Would 'last checked' and 'current temperature' be enough for you to feel it is secure?
- When it does go down, how long does it take you to catch it?
- Are you doing active "chaos monkey"-style testing such as intentionally turning off random systems and ensuring your backup procedures detect and solve the problem before the samples are destroyed?
- Given the current deterioration rates in your industry and your facility under normal operation, what is the probability of a sample surviving 10 years? 20? 30? What about after accounting for the possibility of equipment/system failures?
THAT SAID, you can plan for all kinds of issues - power outages, natural disasters, human error, technical error, etc. - but you will never be able to bring risk down to zero.
For this reason, we also offer multi-site storage, whereby we divide samples into multiple tanks across multiple locations. AFAIK, we are the only company in this space to do so.
I'd avoid these straw men, trust your customers to understand risk management.
> you can plan for all kinds of issues - power outages, natural disasters, human error, technical error, etc
Great, I'd love to see this risk modeling. Which sets of components would need to fail in order for a sample to be destroyed? Which components have failed? How often? Are the failures correlated?
What legal risks exist for the customer in your industry? When things go wrong in that way, how does it happen?
Do samples degrade over time? How fast? What is their viability rate?
I will state up front, I'm not trying to police language, just pointing out that deciding specific keywords up front affects how people find your business online or how it's talked about through referrals.
1) Should you ever decide to expand your business to include eggs, the importance of branding and search results is much more efficient by targeting families instead of retrofitting the keywords.
2) Say for instance, the mother is just as interested in their partner's sperm as the "man" is. Here gendered language can be both useful and detrimental to specific targeting campaigns based on the keywords.
3) Storing sperm is beginning to reach wider availability for transgender women under some plans. Most forgo the process altogether, because guess what, most transwomen suffer economic discrimination as it is and can't afford it. Would you ever consider an LBGTQ-centric campaign towards offering assistance for this community? I think it's a really great idea since I'm already going to be referring your business to my community since you're significantly more affordable but obviously I have not tried you yet. There's also people with sperm who don't identify as men.
Point is, I'm only hesitant to refer because some people are more sensitive at being gendered through a service. I'm not trying to be all like, "hey MAN, you should totally freeze your sperm here, DUDE" while someone is just beginning transition. Not saying that's what you have said or done in anyway, but having not experienced your service I can only be concerned at the possibility. No pun intended, more sterile language that is more focused on families is a better story and more inclusive of various backgrounds. I'd have to go through your customer journey before I'd make any reasonable recommendations to my community but I'm already keen on referring you simply because you seem the most economic and high quality. Just the option alone to be able to self-service and not dealing with anybody instead of going to a clinic where there's even the possibility that they might oscillate between whether you should deal with male or female employees and then offer you pornography mostly targeted for straight men is a jarring experience that is fixed by your service.
From my own shopping experience with these services and consulting with others, the amount of effort it takes to compile statistics on price and storage duration from competitors is difficult. Good job making it obvious and easy to digest.
Your price points are definitely attractive considering most of the people I know jump for a $5000-6000 option at a local clinic that only stores for average 10 years. You're doing a lot of good things here. The branding feels warm and family-friendly versus the clunky and tragic design of most clinics. I definitely get the feeling I'm shipping something extremely sensitive with a responsible entity that isn't just going to disappear overnight.
Good job! Best of luck to you in your endeavors. Seems extremely thoughtful.
The whole question of will they cover it, won't they cover it, will they sabotage me, won't they sabotage me is not a silly question anymore if federal protections for patients are increasingly politicized, just looking at the past few months alone. I was only able to push for certain policies in what is covered or offered at all through my provider by basically defeating their arguments with "I won't be your patient next year if the government makes it okay for you to deny me. You need to offer these services now or I will have to seek care outside your system and make it more expensive for you to care of anyways. Work with me here, I'm trying to not die."
I'm sorry to hear about your fertility clinic experience - it feels like they are still living in the stone ages.
I am really sorry to hear about your past experience at a fertility clinic. One of the many reasons we are offering an at-home solution is for this exact purpose... performing such a personal process in a clinic is often times scary, unsettling, and uncomfortable (and sometimes downright humiliating - especially when interacting with people who have intolerant views).
Our brand is something that we've given a lot of thought to and that we continually discuss as a team. We work with many different clients who are using our services for various reasons. To your point, we've found that many of our clients are part of the LGBTQ community and are preserving their fertility prior to starting hormone replacement therapy.
I have personally spoken to many of these clients and have heard similar feedback to yours. We, clearly, still have a lot to learn about our clientele - their backgrounds, goals, needs, experiences with fertility, thoughts around family planning, etc.
I would love to set up an LGBTQ-centric campaign for the community, and I will make sure we do soon.
Thanks again for your awesome feedback! And if you would like to try the service, please message me at khaled@givelegacy.com, if you're open to giving us this kind of honest feedback, I'd love to get you a free kit.
PS in this field.... puns are always welcome.
Thinking about the types of people who would be interested in your service, I would lean hard into serving the trans community specifically. I can't think of a better way to demonstrate trust than being archivist of choice for people who are planning to stop making sperm.
My partner and I knew we were done having kids before I started transition earlier this year, but if that had not been the case, a service that was more private, especially one that was specifically inclusive, would have been invaluable. I've had negative experiences in other areas of healthcare, and I really would have felt hesitant to go to a sperm bank in person, for the same reasons others here have mentioned.
Before I started my transition, preserving my sperm was a top priority. At the time, my financial situation was dismal, and it took me almost a year to save up enough to afford it. That’s a whole year my transition was delayed.
When I finally went through with it, the whole experience was pretty awkward. The folks at the cryostorage place were nice, but I felt like I was not 100% welcome. The actual “sample collection” process was very awkward and uncomfortable.
If there had been a trustworthy service like Legacy back then, I definitely would have jumped on it.
As it stands, the site and branding definitely feels targeted totally to men, which isn’t super welcoming to people in my position. It’s a sad fact that I have to deal with feeling unwelcome a lot when it comes to healthcare related things, so if I have to go through that I’d at least like to be able to do it from the comfort of my own home, not needing to physically interact with someone.
If you did find a way to balance your branding to make trans people feel more comfortable, I think that would be a wonderful thing and I think there is a pretty large market there. As odomojuli said, I think using more “family-centric” language would be a great start. If you don’t feel comfortable explicitly catering to trans people, fine, but lowering the emphasis on “MAN” would go a long way.
We live in an age where men can AND do become fathers without a female partner. Both through adoption and through surrogacy. Given that, it would be a disservice to such men who deeply desire to be fathers.
e.g.
* https://www.cbc.ca/news/canada/calgary/chan-surrogate-gestat... * https://www.theguardian.com/society/2020/jan/29/i-always-wan...
What are the privacy protections around DNA and other personal information inherent to sperm collection and storage?
Do you offer jurisdiction options?
We have agreements with our cryostorage providers to automatically transfer ownership of the assets to them in case Legacy ever did not exist in the future. So you would work directly with them and have the choice of either keeping the sample frozen there, or transferring it to a facility of your choice. We would help facilitate this to the greatest extent possible.
We do not yet have jurisdiction options, but I will say that I originally incorporated the company in Switzerland to benefit from their strong stances on privacy, and the "nuclear bunker option" is one that we are serious about setting up in the future. FWIW, nuclear bunkers are actually extremely common in Switzerland, this is a country-wide policy (https://www.swissinfo.ch/eng/prepared-for-anything_bunkers-f...), so it's not a crazy idea to set up a cryo-facility in one.
For privacy, I'll start just by saying that I've been a privacy advocate for as long as I can remember, am a user of Protonmail, Signal, VPNs, etc. I know how important data privacy and am only interested in working on a company that is designed to be privacy-focused from the beginning. As far as I know, we are the only company that is HIPAA-, GDPR-, and CCPA- compliant.
Most importantly, we do not sell your data. We outline our data collection in our privacy policy (on the footer of the website)
That reads pretty much as "good luck with that!" to me, I'm sorry. People would pay you exactly because they would never have a facility of their choice and in case it goes sour they would probably have to face a ridiculous price tag from some other new company not truly interested in keeping their sperm but that just happened to be part of your risk hedging or simply of a insurance deal.
In a worst case scenario, folks could keep their sample frozen where it is and pay retail rates at those facilities instead of the wholesale rates we offer.
We are real people who care a lot about the people who are using their service, and their ability to have kids in the future. We would genuinely do everything we could to support.
Not having kids but good look with your business :).
That said, when you are going through the thawing process, you will lose about 50% of the frozen sperm. That's why we do a post-thaw count and motility check 24 hours after freezing, to make sure we know exactly how much of your frozen sperm you'll be able to use in the future.
By the way - if you are going the IVF/ICSI route in the future, of all the sperm you've frozen, you really only need one healthy sperm per attempt, as the sperm is injected directly into the egg. This is the latest technology in sperm and is very commonly used nowadays.
Healthcare + startups = bad
We catch up from time to time and I can imagine us partnering down the line. Notably, we do already partner with major female fertility companies in this space to offer packages for couples (like with Ava Fertility, a very rigorous and data-driven company that helps women track their ovulation periods)
I'll just add that we actually do testing & freezing as two linked but independent offerings. So Lilia matches the freezing component of what we do. A company like Modern Fertility (also YC) is closer to the testing component of what we do.
How do you keep the sample fresh for transport if it's collected at home?
ps. In case anyone was wondering I went with collecting at the clinic, and boy do I have some fun stories from that experience!
Not gonna lie, I'm kind of dying to hear them.
To clarify, since it's relevant, I'm a white guy, my wife is Asian, and the nurse that checked me in is Black. What she handed me was a porn DVD of hardcore Asian porn. I guess she just assumed since my wife was Asian, that's what I was into. I saw in the drawer and there was a variety of choices, but I was never asked.
So I get into the room. To the left is a sink for hand washing with a small counter next to it. In front of me is a very standard office chair, but with a fresh absorbent pad on it (like what you put down when you're house training a puppy). In front of the chair is a 20 inch old-school CRT (this was in 2014, so it was old even then) with a built in DVD player. To the left of the chair is a huge rack with porn magazines.
I evaluate my situation, and decide I'm not going to use the chair, or touch it, or touch anything in the room that I don't have to, because I don't know why it just didn't seem right. Luckily I was smart and brought my laptop with me, so I pop that open and set it on the counter. Attach to the wifi and... all the porn sites are blocked. Apparently they use the same filter as all the other medical offices.
Luckily, being the enterprising engineering that I am, I bounce an SSH session through my home server.
So I start doing my business. I'm standing there with hand occupied, facing the door, when it opens! Apparently the nurse forgot to flip the sign to say "occupied" and also forgot to warn me to lock the door (protip: Always lock the door!). She turned back around and ran out, but I had to start over so to speak.
I finished up, sealed up the sample, washed up, rang the little bell, and the nurse collected my specimen. She was the consummate professional and didn't say anything about the walk-in.
I then went and sat in the waiting room while the doctor impregnated my wife.
ps. This story is a lot better when told in person after a few drinks.
This cracked me up.
When you think about it he also bounced the sperm through the clinic.
Anyway, generating that sample was something I did at home, but it was still an odd experience driving it to the doctor's office, ringing the bell for the receptionist, and handing over the sample (inside approved collection container which was inside a brown lunch bag as I recall).
Weird for me, but if your a medical office receptionist, you're used to receiving all sorts of samples.
Beautiful phrasing.
Amusing side note, the doctor was a woman and devout Christian, who believed that she was simply a conduit for God's work, and if you got pregnant it was because God guided her hands well.
Also interesting was that she had the highest success rate of all the doctors in the clinic.
Sperm can actually survive fine for 1-2 hours hours when kept near body temperature, so a 1-hour courier service is sufficient (and it usually takes less than 60 minutes). If there were any issues, we'd know when it arrived at the clinic.
For anyone outside of major cities, we do overnight shipping with Fedex's biohazardous materials division. We use a transport medium that keeps sperm alive for up to 48 hours during transit. You add it to the sperm, it protects it during that period, and it gets washed out (via centrifuge) when it arrives at our clinic. It's not perfect - you can expect to lose approx. 10-15% motility during that time, but is particularly useful for folks in rural areas or far from fertility clinics.
PS Always love hearing other folks' clinic stories... my favourite is hearing how clinics have their pornography stolen ALL the time and have to frequently re-stock.
I wrote up my story in the sibling comment since someone asked: https://news.ycombinator.com/item?id=23851310
First and foremost: sperm quality is an indicator of overall health, and the two are closely correlated. This is both good and bad.
Good because living a healthier lifestyle improves sperm quality. Bad because there is no easy fix to improve sperm quality. Supplements are fine, and there is some limited research to support them, but they are not a panacea.
We brought on a sperm expert from Harvard - Dr. Mariel Arvizu - to create a protocol to assess and evaluate the lifestyle of our clients and create personalized recommendations based on what we believe is highest impact.
We bucket our recommendations into categories like nutrition, sleep habits, etc. and reference WHO or other trusted resources when possible.
We also get you in touch with a urologist (we have one on-staff) to do a consult if needed. He can discuss your specific case and provide insight.
Lastly, it depends on the results of your analysis. For example, morphology (how "normal" your sperm is) can be significantly impacted by things like using saunas, hot tubs, etc. or even from having the flu. There are simple and easy changes you can make to address things like that.
Sperm takes about 2.5-3 months to regenerate, so any changes you make today will be reflected in your sperm analysis after that time period.
In brief, you want to focus on improving your overall health as that's closely correlated with sperm quality. If you have more specific, medical questions, I'd be happy to connect you to our urologist for a short (free) consult.
I'm curious because testes have ACE receptor sites, so it's fathomable that it could cause wide-spread sterilization, or at least lower sperm counts.
In brief:
1. Theoretically, yes. The testes have the second-highest number of ACE2 receptors, after the lungs. This could explain why men are more likely to get COVID-19 than men.
2. In the short-term COVID-19 is likely to decrease sperm quality, similar to the flu. this we can say with reasonable confidence, but it's nothing particularly scary.
3. We don't know if there are longer-term effects. We've already heard about potential scarring in the lungs, for example. What is the same was true in the testes? After all, some viruses like Zika CAN have longer-term effects.
The fact is, there has been no conclusive research yet, so we are running a study ourselves to try to identify some preliminary evidence.
First, we are not owed children. No one has the right to a child. Children are human beings, thus persons, not property. IVF commoditizes human life. The result is an assault on human dignity. If anything, the child has certain rights that the parent owes the child in this regard, among them the right to be conceived by parents who do not view her or him like an object to be produced. Attitudes like these also have pernicious consequences. If the weakest among us are not given basic human respect, then it undermines the foundation for all other human respect (insert your favorite social cause here).
Second, IVF often involves the fertilization of multiple embryos. The result is that the remainder are aborted and thus murdered.
I would discourage people from making use of IVF. I also encourage Khaled to rethink engaging in an immoral business such as this.
There are various lesser known surgical procedures that can increase chances of pregnancy, but putting those aside, sometimes we must accept that we aren’t going to have children. Consider adoption. Furthermore, freezing sperm generally indicates a selfish attitude toward procreation that goes back to my first point. I.e., ask yourself why you’re freezing your sperm. Are you prioritizing something above having children like a career or convenience? Are children being treated as an afterthought? You would be better off having children earlier when you have the energy to raise your children.
IME, it takes about 3 weeks of consistent effort to get one's swimmers to go away. Maybe you know what is it about "3 weeks" in the spermatogenesis process?
[0] https://en.wikipedia.org/wiki/Heat-based_contraception
(edit IMO -> IME)
But yes heat-based contraception would be a good bet. Saunas, hot tubs, tight underwear and your laptop on your lap 24/7!
You always want to be using 2.5-3 months to be on the safe side. There's no guarantee anything you do will take effect before then. Happy to connect you to our urologist if you have more specific questions!