Fertility re-Frame: Expanding access through innovative virtual care

The journey to parenthood can be complex, often leaving individuals and couples feeling confused and unprepared. Many people reach adulthood unaware of underlying conditions that may impact their fertility, only discovering these challenges when they begin trying to conceive. Healthcare providers, particularly OB-GYNs, frequently face limitations in time and resources to adequately address fertility concerns during routine appointments. On average, OB-GYNs receive only 2 to 4 weeks of fertility training during their residency programs, contributing to a lack of confidence and bandwidth in providing comprehensive counseling. This confluence of limited patient education, constrained provider time, and a growing desire for proactive fertility understanding has created significant gaps in the healthcare system.

Compounding these challenges is a nationwide shortage of specialists. The United States has only approximately 1,200 reproductive endocrinologists, with the vast majority concentrated in urban areas, leaving many in rural regions and “care deserts” underserved. This highlights a critical need for innovative solutions that can extend access to quality fertility care beyond traditional in-person settings.

Frame is a virtual care platform designed to bridge these gaps, offering comprehensive family-building support through education, coaching, and virtual care services. Founded in 2021 by Jessica Bell van der Wal, Frame aims to empower individuals with the knowledge and resources they need to navigate their fertility journey proactively.

Between growing up through public health and entering early-stage digital health 15 years ago, Bell van der Wal thought she knew healthcare, how to navigate the intricate care system and how to apply her knowledge to her own health. However, when the time came for her to start her own family at 37, she was shocked by how much she didn’t know about gaps in the system that became poignant as she dealt with Polycystic Ovary Syndrome (PCOS) and other underlying fertility-impacting chronic conditions.

DHI contributing writer Katie McMillan talked to Bell van der Wal about how her collaboration with OB/GYNs, fertility clinics, and primary care teams is providing virtual care, coaching, and care navigation for patients who seek improved connection to care and a smoother fertility journey.

DHI: What sparked the birth of Frame, and what you have learned along the way?

Bell van der Wal: In 2021, during the pandemic, my partner and I were home with our newborn and starting to think about what we wanted to do with our lives. We really wanted to work on something that was mission-driven, and I couldn’t get the fertility journey out of my head. We started down the path of building the company in late 2021 and the original thesis was “How do we help to educate people earlier on in the family building process so that they don’t feel so conflicted and confused?” I didn’t want other people to end up like me – totally shocked and unprepared. 

Our original product was focused on education and coaching, and it has evolved significantly since then. We tested Frame in the employer space as a benefit, but what we kept coming back to was that doctors loved it, particularly OB-GYNs. We had a whole clinical advisory board that helped us build out this product so it was valuable for both patients and providers. 

The OB-GYNs we worked with continuously told us that fertility was one of the most frequent topics that patients would bring up at the end of their annual visits. They were asking, “What should I do about my fertility? Is there any way to know how fertile I am?  I think I want a baby next year, what should I do to prepare? Or I’m struggling to conceive, I’ve been trying for 3 to 6 months, what do I do?” 

Often healthcare providers don’t have the confidence or bandwidth to provide this counseling during a 20-minute visit. They were lacking high quality educational materials. As a side note, I was surprised to learn that on average, OB-GYNs receive 2-4 weeks of education about fertility training during their residency programs. So, the lack of provider education plus provider time, and the patient desire for more education and a place to understand the overlap between their health and fertility lead to a really great place for Frame to add value. We found a space for early conversations with patients in partnership with providers and also for facilitating care that comes out of these conversations. 

Between 2021 and 2022, Framed extended the business to move into virtual care, not just health education and coaching, and we refocused our business to work with provider groups. Now we work with many OB-GYN offices and directly with fertility clinics. 

How do patients start working with Frame? What doors can they walk through?

Bell van der Wal: We tested the concept via D2C originally to see if people wanted this information, and the answer was yes. There is a direct-to-consumer door that people can walk through, pay for our services, and work with us directly – that will always remain. It’s important to me from an access to care perspective, it’s important because friends refer to their friends, and it’s a great place for us to try out new service offerings. 

When it comes to accessing Frame thought medical providers, there are a few options. Providers can have a referral link on their website so patients can proactively self-serve, or if patients bring up an interest in understanding their fertility during a regular in-person care visit, we have deeply integrated with electronic medical records so providers can invite patients to use Frame via their patient-portal apps. 

What’s the ideal time for someone to start engaging with Frame?

Bell van der Wal: Generationally, we are seeing this conversation moving earlier and earlier. As an elder-millennial I didn’t think about my fertility until we were in the thick of it. In our minds, understanding your fertility should be part of your regular preventive care so that we are actually screening for underlying fertility-affecting issues and risk factors earlier. We work with patients that are curious, but ideally patient engagement should start before you are actively trying to conceive so that your health is optimized pre-pregnancy, which is going to impact your health as a pregnant mother too. PCOS, thyroid conditions, or hormone imbalances don’t only affect your ability to get pregnant, they also impact your overall health.

Have you considered incorporating wearables or biometric data to inform fertility readiness or identifying fertile windows during conception?

Bell van der Wal: We have worked with a few of the ovulation tracking companies, and we are in discussion with some of the wearable providers as we speak. I do see a lot of value in this data being incorporated into this data for a whole host of reasons. Wearable data definitely helps to stimulate a more comprehensive discussion between the patient and the provider, but I also think it’s more and more how people want to understand their health. I see a lot of opportunity for synergy here. There are many antiquated ways to understand when you are fertile, and these aren’t easy for women! Gen Z is going to be hungry for new ways to understand their bodies and wearables will be part of that. 

How does Frame support health equity?

Bell van der Wal: The partnership with B2B providers is very essential to what we do, save time and expand access to care. There are capacity constraints with our existing healthcare workforce. There are only 1,200 reproductive endocrinologists in the US and the vast majority of them are in cities. In addition to having an REI (reproductive endocrinology and infertility) shortage we have an OB-GYN shortage, and we have to find ways to serve women in more rural areas and care deserts. Frame is helping to extend care in places where people only really have PCPs. I also firmly believe that virtual care can’t live on an island and we have to integrate with existing care pathways so women can get the care they need when they need it, where they are. 

Katie D. McMillan, MPH is the CEO of Well Made Health, LLC, a business strategy consulting firm for health technology companies. She is also a curious researcher and writer focusing on digital health evidence, healthcare innovation, and women’s health. Katie can be reached at [email protected] or LinkedIn.