Why Male Fertility Matters More Than You Think | Ashwin Ramachandran

0:00 Frances Goh: We acknowledge the traditional owners of the land on which we record and pay our respects to their elders past and present. We recognise their continuing connection to land, waters and culture.

0:10 Makenzie Thomas: The NUScript is a podcast created for educational and awareness-raising purposes only. The conversations you'll hear are not intended as medical advice. Please speak with a qualified healthcare professional for any personal medical concerns or decisions.

0:27 Ashwin Ramachandran: We got told early in the process, there's no example of a hardware product in healthcare that's ever successfully exited Australia into other markets. Objectively untrue. We've seen the likes of Cochlear, ResMed, CSL. There's plenty of examples, but I think there's a general lack of awareness. It's worth emphasising that to build a company out of Australia isn't necessarily at the cost of giving people the Australian discount on valuation, the Australian discount on talent and everything else. It's worth emphasising that there are businesses out of Australia in healthcare and hardware that can scale internationally. And if it's not an investor in Australia, it'll be an investor anywhere else in the world that'll put money in.

1:05 Makenzie Thomas: Welcome to the halfway point of season 1 of The New Script. I'm super excited about this episode because we are opening up the conversation on male fertility.

1:16 Frances Goh: When it comes to pregnancy, it's not just women who make it happen. Sperm plays a crucial role, and its impact is bigger than most people realize.

1:25 Makenzie Thomas: Ash was such a delight to chat to this week, and since we recorded, his company Sapiem was named Australia's most innovative company in health industries for 2024 by the Australian Financial Review.

1:36 Frances Goh: Let's dive in.

1:38 Ashwin Ramachandran: You're listening to a Day One FM show.

1:41 Frances Goh: We are so excited to be interviewing the amazing Ash, the founder and CEO of Sapiem, a groundbreaking at-home male fertility diagnostics company helping millions of men around the world take control of their reproductive health. With a track record of raising over $215 million for healthcare and life sciences startups, Ash brings deep expertise in tech commercialization, venture capital, and global market strategy. Prior to Sapien, he held leadership roles across startups, the UN, and Australia's tech investment space, bringing a truly global perspective to solving one of healthcare's most personal challenges. Ash, thank you so much for sharing your time with us today. I know I've just shared your bio, but would you like to introduce yourself in your own words?

2:26 Ashwin Ramachandran: Yeah, for sure. And thanks for having me, Fran McKenzie. Really appreciate it. My background, I started off in research, doing research effectively on astro-bio and whether or not human populations could ever survive long-term space missions. And then went into asteroid mining and trying to evaluate the economic impact of mining asteroids and whether or not you would ever be able to mine for resources that would be actually valuable for us. And then eventually private equity work, writing checks out of balance sheets of large pharmaceutical companies into venture-backable, PE-backable healthcare and life sciences startups, and ultimately consulting work before starting Sapien.

2:59 Makenzie Thomas: What a rap sheet, what a CV. Can you take us back to how you went from asteroid mining to venture capital to consulting and then to Sapien and where the idea for Sapien started?

3:11 Ashwin Ramachandran: Yeah, a huge portfolio of mine in corporate venture capital was actually equine sperm and working across horse sperm, specifically across reproductive areas. And when my uncle went through male fertility diagnosis in the United States for the first time, I thought to myself, it'd be appropriate to go into an IVF clinic and get a test of my own. But what you notice when you walk into an IVF clinic is a myriad of women who are making a very conscious decision to go through IVF and the diagnostic tests that they're doing, they're piling up. And then the men who are involuntarily there, and every single person has to get a sperm analysis. And it's a very archaic process. If you've tried to go into a clinic and get a sperm analysis yourself, couldn't help at the time but make the comparison between the fact that 20 years ago women had to do the same thing with a pregnancy test, go through an OB-GYN office and go through a very uncomfortable process. But today you could go to a Coles or a Woolies and buy a singular pregnancy test for less than $4. And that. Didn't exist across male fertility, and I thought it was important to make it happen.

4:02 Frances Goh: Love that, Ash. And can you expand a little bit more on how the current fertility services really aren't addressing the needs of families and individuals who are undergoing treatment or exploratory investigations?

4:14 Ashwin Ramachandran: Look, I think every healthcare practitioner is really trying, but I think what's really happening in the industry, unfortunately, is particularly in fertility, there's a lot of private equity consolidation happening at the moment where every single IVF clinic that you've heard of is probably being owned by a larger network or owned by a private equity fund. And when you try to commoditize something like IVF, and I think there's significant benefit to commoditizing diagnostics, just like the pregnancy test, because it becomes cheaper and accessible for everybody. But at the same time, you want to keep experience intact. And oftentimes when you commoditize something so quickly and over such a short period of time, you tend to forget that experience is a significant contributor that needs to be worried about. And you are seeing increasingly that fertility clinics aren't necessarily thinking about the experience experience factor within IVF, and that's what I think needs to be improved on. And, and hence one of the reasons why we partner with IVF clinics is we let them be good at what they're currently doing, which is the procedures and the science behind it, and we take away the diagnostics, which I think is an excellent and incredibly important part of the process, but still needs to incorporate a significant proportion of experience to it. That's where I think the system can be improved, and that's where I think we play as a business.

5:20 Makenzie Thomas: Yeah, definitely, because When we talk about experiences, particularly like when it comes to fertility and family planning, at the end of the day, it's people who want to start a family, they want to have kids, or they're facing some kind of barriers to expand their family, and they don't really know what's going on. And so bringing it back to the people at the forefront in that experience is definitely, uh, essential. And so could you talk us through the social stigmas, um, around, uh, fertility, particularly for men, um, and facing those fertility challenges, and then how you're also removing some those barriers.

5:54 Ashwin Ramachandran: Yeah, I mean, I'm going to throw back to my time exploring male fertility for the first time, and I don't think I would have been as comfortable talking about it 3 years ago, to be fair with you. And last year I was on Channel 9 talking about sperm samples. I don't think I would have done that 3 years ago. But the reality is oftentimes you don't grow up ever having a conversation about fertility as a man. I think female fertility is so common as a conversation area, and male fertility is mythologized. There's no conversation about it. You don't ever grow up speaking about it with your parents or peer network. And then most most men find out about the fact that a sperm analysis is important for fertility, or that they play a significant role in, in getting the couple pregnant, at the time they're at a GP office or an IVF clinic, already unable to get pregnant. And that's a pretty bad time for someone to learn about fertility and their role in it. And that's why it becomes very difficult for most men to go from, I've never heard about it, to I'm going to participate in it freely, because there's not enough time for most men to digest the fact that fertility is important for them and in the couple. And I think that's why there's a significant proportion of men that are still unwilling to participate. Uh, to be fair with you, I think there are quite a few men that want to father a child, that have very deep connection to the idea of being a parent, but don't know how to express it. And I think societally that, that there's an issue, and I think we need to improve on it and the way we communicate about it. And I think younger people need to be more freely introduced to the concept of fertility, and there's a systematic change that needs to happen, but it's going to take a long time. And that's where we play a role as a business, where we not only work with IVF clinics and make it more accessible and affordable for male patients. But on the flip side, we also make it easier for the female partner that's going through something as difficult as IVF to bring in their male partner and have an easy enough test done to introduce the concept of fertility to their male partner, so they'll engage more freely moving forward.

7:40 Frances Goh: There are so many things going through my mind right now based on everything you've said, and I almost want to like go through each sentence and pick it apart. But if I zoom out, I think, Ash, I just want to say what you're doing is so wonderful. To have you as a man, a male, also bringing this conversation to light and representing for this generation. Because what a great point in time for us to at least start that conversation, normalize it from a younger age. It's really wonderful. And so would love to turn to the innovation now. And I'm learning so much from you right here and through the research we had to do. prior to this conversation and have learned that there are so many factors that can influence the overall quality of sperm, including count, concentration, motility, morphology, the pH levels, and the volume. Um, how does understanding all these different elements of sperm quality impact a person or a couple's fertility journey? Can you help to break it down for us?

8:39 Ashwin Ramachandran: Yeah, so I think contrary to a pregnancy test, which is the example I love using quite a lot, a pregnancy test is binary. It tells you whether or not you're pregnant. But a male fertility assessment or a sperm analysis is multifactorial, so it goes into multiple areas, the likes of sperm count, which I think a lot of people are familiar with, and then it goes into volume, concentration, and motility, which is your sperm's ability to swim, morphology, which is the shape and size of your sperm and whether or not they look normal, pH, whether or not the sperm sample, the semen sample, is acidic or basic, and the fragmentation levels, how much of your DNA is fragmented. There's so many different components, and each of these plays a significant role. For instance, someone could have a significantly high sperm count but a reduced motility, which is your sperm— you've got a number of them, but they're just not moving, or they're not moving correctly. And that can impact whether or not you can fall pregnant as a couple. Because most people are not introduced to the idea, getting across the different parameters can get quite difficult, which is why I think most healthcare practitioners, and even us as a company, we make it a point to elaborate on every single parameter when a patient's reviewing a report. Because oftentimes when you go into a lab and get a report, it's, it's a few numbers on a sheet. I think we make it a point to, through our 16-page report, give people an elaborate overview of what the what the parameters mean and how it can actually impact their fertility. Worth noting also that most of male fertility parameters actually can be changed through lifestyle, about 80 to 90% of it. And the quickest time that someone will need to see between a bad result and a good result is about 6 days. And sperm also have a cycle similar to egg cycles, and— but the only difference is sperm regenerate, and you've only got a certain fixed proportion of eggs. Um, sperm regenerate every 3 months. So every 3 months you could have completely different fertility results.

10:20 Makenzie Thomas: Wow, that's really, really interesting. And lots of— lots more questions around that. And so why is bringing this conversation and bringing men into the fertility conversation been so powerful for families and so important for women's health as well?

10:37 Ashwin Ramachandran: There's 2 ways to think about it. One, I think it's made it a lot easier for women in general when it comes to fertility and IVF specifically, because a lot of women will oftentimes have a conversation with us and say the most difficult part about the IVF process was getting my male partner in for a sperm analysis, because all your life as a female partner you've been told that you need to worry about fertility, and the male partner's just figured out they need to worry about it, right? So they haven't caught up to how you're feeling emotionally about something, and they want to contribute and they don't know how to. So you'll find across a number of men, we chat to them, they say to us, I really want to contribute because I feel so bad about the fact that my partner is going through so much, but I don't know how to, right? And, and you also recognize in areas like miscarriages, for example, and there are plenty of studies that demonstrate that men have long-term emotional emotional constraints and impacts as a result of a miscarriage, because oftentimes they don't feel like it's their place to speak about it and speak about how devastating the impact is for them. So I think having these conversations and getting people involved, getting a result and a diagnostic result earlier in the process gives people a lot of comfort. And I think a little bit of anxiety is worth, um, the trade-off, which is effectively having insight into your fertility. Flip side, where I think it gets even more interesting, is men think about healthcare for the first time as they're about to become fathers. Right, and introducing them to a diagnostic that gives them a lot of insight in the process actually opens them up broadly to access other types of healthcare services, whether it's cardiovascular or, or, you know, just genetically. Maybe they just feel like their bones are too weak and they need to have a chat about it. Those just become easier points for them to discuss when they start with something like Sapien.

12:11 Makenzie Thomas: Yeah, and I can imagine that, you know, giving them a window of in the next 3 months you can improve the quality of your sperm is actually quite empowering. They can be a part of that journey and they can do something very practical and tangible to help their— grow their family and help their partner at the same time.

12:26 Ashwin Ramachandran: Always. And we always make it a point as well to connect them to the right practitioners in place in case they've got anatomical issues or things that require more than lifestyle changes as well.

12:35 Makenzie Thomas: Yeah, absolutely.

12:37 Frances Goh: It's actually an amazing space where more and more research is emerging about sperm health's role in pregnancy and those outcomes. Can you talk us through what we know in this space and, and some of that emerging research?

12:49 Ashwin Ramachandran: There is quite a lot of research that's happening. It's worth noting also, funnily enough, that the whole of Victoria, I think a couple of years ago, only had 124 donors. So sperm donors are quite limited. So we don't always have access to sperm samples, even though they're abundantly available in population, just not available for the purposes of research. So whilst we are seeing shortages, we're also seeing exorbitant amounts of research coming out from large universities and pharmaceutical companies in this space. One thing that's very interesting to note is the quality of sperm samples and how it affects pregnancies and how it affects childhood health. And we are seeing research paper that draws direct connections or, you know, somewhat correlation to gestational diabetes and miscarriages and congenital heart disease and childhood cancers. And I think there's some contention around what the negative bit is, but I think there's general consensus that poor sperm quality causes negative outcomes in pregnancies and childhood health. What people are arguing about is exactly what the negative bit is, right? So I think, I think it's safe to say that the better sperm quality, or thinking about preconception health as men, is quite integral to the health of the pregnancy and the health of the child.

13:58 Makenzie Thomas: Yeah, absolutely. And there's lots more research to be done in that space, it sounds like. So I guess coming to the product side of things now, can you walk us through exactly the experience with Sapien? And when a customer comes to you, what they might— what are steps that they go through and what that, uh, journey is like.

14:18 Ashwin Ramachandran: Yeah, so patient can go online and buy a product directly from our website. They get shipped within the day or two. They have the kit and they collect a sample at home on a Monday or a Tuesday, and then they ship it back to one of our partner IVF clinics or lab chains across the country, and they get their results back within 3 days. The entire process can be as short as 4 to 5 days, uh, contrary to, say, if you were to go into an IVF clinic and you're booking in an appointment to go into, into a lab for analysis, it can take anywhere in the UK up to 8 weeks, and in places places like Scotland, up to 3 years. So there's quite a, quite a range when it comes to how easily accessible sperm samples or sperm testing can be, rather. And with Safein, it's $149 if it comes with a healthcare practitioner referral, can be as cheap as $100 after a rebate. And going into a lab is sometimes hundreds of dollars, if not thousands.

15:05 Makenzie Thomas: And you operate in multiple countries, right? Um, you've expanded quite quickly.

15:11 Ashwin Ramachandran: We've had to for a number of reasons, but, uh, we do operate across the, the United States, the UK, parts parts of Europe, Southeast Asia, and Australia. And, um, primary reason for that was we just wanted to make something accessible, available to a lot of people very quickly. And we're the only male fertility diagnostic to be operational internationally. And that has been quite beneficial because we've been able to service many patients across multiple markets.

15:38 Frances Goh: Would love to delve into your personal journey and founder life. What's it been like stepping into the founder role having been on the investor side for so long?

15:50 Ashwin Ramachandran: It's different. I'll tell you that much. And I think as an investor, you're very invested, for lack of a better word, into everything that you invest in. I've used the word invest quite a lot in this sentence, but the reality is you spend a lot of time caring about the businesses you invest in, but also a lot of it is hypotheticals and you're interacting with other people that are doing the work. But as a founder, you experience it deeply. And it feels very different to associate yourself to one business and to put your reputation behind it, your effort behind it, and to hire a team of people that are all reliant on you and their own efforts to be able to build something from the ground up. And that is very rewarding when things go well and very stressful when it doesn't. Because people have got children, they've got mortgages and other things, and you personally feel responsible for them. And that's not something you feel as an investor oftentimes. And the other thing to note as well is I've, I've never felt more fulfilled doing something. And that's worth noting for a number of reasons because I had great fun as an investor diving into different business models and different things. There's a novelty of it all is very exciting, but you never get to see anything through from start to finish with the exception of seeing it through, through someone else's eyes. But as a founder, you get to do it yourself. And I think that, that, that is very exciting. And to hear the patient stories and how you've created an impact in individual lives, you don't think that far and that deeply when you start a company. And to see how it evolves across patients and clinics is, is quite satisfying.

17:10 Makenzie Thomas: Yeah, absolutely. I can imagine. And how has the experience been going from writing the checks to asking for the checks, especially in healthcare as well?

17:22 Ashwin Ramachandran: You've always got a power and information asymmetry as a founder and an investor. You're always on the receiving end as a founder up until, you know, you flip the tables at one point and you've demonstrated enough value. But it is quite complicated in healthcare for a number of reasons, particularly in a novel area like male fertility testing, because, you know, If you're looking at something that there's a lot of competition in, for example, AI scribes, it's easy to say, say within a couple of years' time based on revenue and based on a few other factors, who the winners are going to be, or it's easy to make a better bet. On the flip side, when you're looking at creating a whole new category, there's not enough competition in the market to benchmark businesses. There's not always an easy way of saying who the winner is going to be because the category's being created for the first time. And when the investor doesn't have the right expertise across healthcare, And I think also a lot of investors confuse digital health with medtech and diagnostics. And I think that the lack of nuance and understanding of it is actually quite detrimental when it comes to investing in healthcare, because the timeline for expected returns is quite different across each of them, and the expected capital that needs to go behind building something like that also vastly different. I'm not saying investors don't get it. There's a lot of investors that do get it, and, and there's a lot that don't. I think picking the right investor at the early stage is going to be quite critical depending on the type of business you're building.

18:40 Frances Goh: Yeah, it sounds like there's a big education piece there on, on one side, but hopefully they will learn quickly once they understand the opportunity and recognize it.

18:50 Ashwin Ramachandran: Yeah, and usually investors are quite curious by nature, so they are open to learning. So spending the time with them also is quite helpful.

18:57 Frances Goh: Absolutely. And speaking of learning, Ash, I understand that you personally don't have a clinical background. So what has that experience been like in founding a company healthcare, and how have you brought clinical experts along the journey?

19:10 Ashwin Ramachandran: I, I thought it was going to be a lot harder than it actually turned out to be, to be honest with you. And I think there's, uh, there's this idea in the population that healthcare doesn't innovate or is averse to innovation. But I think deeply being involved in the system, I can tell you that there's multiple facets of healthcare that are innovating quicker than most other industries. And if you look back 20 years or 50 years ago, our life expectancies look fundamentally different. Our ability to triage and our ability to offer care has looked fundamentally different and better by but on the receiving end, most patients have a problem when they're sitting 11 hours in the emergency department. All that— all you feel is, is the bureaucracy and the admin and the negative aspects of healthcare, and not the positive sides, which you do feel on the flip side. Telling clinicians, when you can demonstrate a product that has unequivocal accuracy and solves a real problem for both patients and clinics, solves a fundamental efficiency problem, there is a significant proportion of people that will back you from the very beginning. I do remember, however, camping outside of my clinical director's offices for days to get them to meet with me. So I'm not saying it's easy. All I'm telling you is, uh, when you can demonstrate value, there will be a lot of people that will come support you. We've started off very difficult and in a tough spot, but over the years have managed to get some of the key opinion leaders in the market to really back us. We've been able to put product in, in some of the world's largest IVF clinics, and the clinics also get to independently test and validate the products themselves. So there's a lot of trust that is built as a result, and therefore the adoption is easier.

20:39 Makenzie Thomas: Yeah, absolutely. And I can hear you talking about demonstrating value and then also trying to, I guess, improve some of those efficiencies in a system that has been built in a certain way for— and it's existed in that state for quite a while now, and it's definitely improved over the years. But coming back to that, the experience that we mentioned at the very start of the podcast, have you had any resistance to changing that system or just implementing and integrating some of those efficiencies, um, either on the clinical side or from some of the larger IVF companies that are out there, anything like that?

21:15 Ashwin Ramachandran: Yeah, plenty. When we didn't fully understand how to pitch the product or didn't fully understand the value that we were adding to clinic and the urgency of that value, there was a lot of resistance in the market because people are going, well, you know, most clinicians will attest to the fact that their lives are not particularly easy, especially right coming out of COVID or during COVID when the company was started. Everybody had to think about far more than their own jobs as a clinician, and everybody felt a significant sense of relief when, you know, we introduced the product. But later down the line, the reality was at the very start, people went, I don't really understand what you're selling me or why this matters or why the patient needs to do something at home when they could just come into the clinic and get a test. There is a lot of resistance when people don't fully understand what the value is. And to be fair to them, we didn't fully understand how to communicate it. But over the years, we found, um, a couple of clinicians that were interested enough in the product that were willing to try it. And, uh, that feedback and the fact that people were adopting the product quickly trickled down into other clinics wanting to pick the product up. And quickly we started to recognize what value we were adding for the first time to both the clinic and the patient. And now we can communicate it more effectively. And so closing an IVF clinic deal was a lot more quick today than it was, say, 2 years ago, where an average deal took about a year 2 years ago, and now we're under 3 months.

22:30 Makenzie Thomas: Yeah, the early days of finding your kind of value proposition as a founder in healthcare could be really challenging. Do you have any advice for founders in that space that might be listening and how they can nail that pitch quicker, I guess?

22:46 Ashwin Ramachandran: Now, now the pitch for selling product.

22:49 Makenzie Thomas: Yeah, or just getting that value piece right, um, earlier.

22:52 Ashwin Ramachandran: Yeah, I think, I think the one thing to note actually that we, we really struggled with the early stages was when people keep talking about product-market fit, oftentimes when you don't see product-market fit, the gut instinct to something is to change the product. But we didn't because we didn't have the money to change the product and build a different one, and we believed in the science we built. So we changed our market, we went out to a different country, and we sold product there when the industry looked a little bit more consolidated, a little bit more saturated, and there was an IVF clinic for every of patients in the market. We went, all right, maybe let's try a different country. So I don't necessarily think it's always down to your product and how you're pitching it. It could also be who you're pitching it to. Um, and we sold our first ever deal in the UK and up until then we'd sold absolutely nothing in Australia. I came back from the UK after we closed the deal and within the next 3 days we had a deal in the country, in Australia. And that fundamentally changes things because, um, yeah, I would focus on more than one factor. Your product may not always be the issue. It might be the market or how you're pitching it. There's a variety of factors that Yeah, that's, that's an awesome insight.

23:51 Makenzie Thomas: I love that. I'll definitely, uh, draw on that in the future as well.

23:55 Frances Goh: And Ash, I think we're getting great insight into your hustle nature, which is amazing. And, you know, hearing about some of the learnings, the trial and error, um, camping outside, you know, um, the door of someone that you want to speak with. I would also love to hear perhaps, um, a time when something has not gone to plan but taught you an invaluable lesson. So one of the ways I like to frame this is perhaps what's one of favourite failures? You know, we don't really believe in things being a full failure. You know, there's a lot of talk in startup world about failing forward or failing up. So yeah, can you share a key lesson?

24:31 Ashwin Ramachandran: I like favourite failure, actually. This, this might actually be my favourite failure. Uh, we started off pricing the product at $398, right? Because we thought to ourselves, you know, end of the day, and we want to make a bit of margin on the product, and in fertility everything's too expensive.

24:47 Frances Goh: Expensive.

24:47 Ashwin Ramachandran: A cycle is about $11,000 sometimes. So this is probably the cheapest thing the customers bought that day. And convenience is very, very important to most patients. So they'll, they'll end up buying things. But what you realize is labs at the time were selling the kit, like they, they, they, they were selling semen analysis for about $200. And we built a massive waitlist of patients online that wanted to try the kit. And when we launched our price, we actually became a very strong funnel to send patients to labs. because people were going into labs to get the $200 test. And I remember going, why aren't people actually picking a more convenient option? But I think what we failed to recognize at the time was you cannot ever separate accessibility from affordability if you want mass adoption. And I think far too many healthcare companies start in the convenience sphere. They effectively go, this is a more convenient way of getting a pill, and it works for a certain period of time. Until there is something that is cheaper, because all you're doing by offering a convenient product and spending advertising dollars on it is creating awareness across the population, destigmatizing it, and allowing someone that is selling the exact same product for a cheaper price point with reasonable experience to pick it up, right? So we lowered our price quite significantly. We're now $149, and I was saying to you earlier, with a Medicare rebate, it's just over $100, right? We're cheaper than going into a lab, and that massively increased uptake, because what we failed to recognize was it's important to provide people with convenience for sure, but not at the expense of two vital things: accuracy and affordability, right? So it always needs to be accuracy, which is like accurate, which is the baseline of any healthcare product. And then two, the other two things that underpin a healthcare construction is affordability and convenience. So that trifecta really works well for us.

26:29 Makenzie Thomas: Awesome.

26:30 Frances Goh: I can really see that on like a graph or a quadrant happening. So well answered. Great. I love that favorite failure. Thanks.

26:37 Makenzie Thomas: Thanks. Let's switch gears now, and because it sounds like you're an incredibly busy person having built, um, Sapien in just over 3 years and running around all over the world, so how do you prioritize your energy and well-being, um, as a founder and as a CEO of the company?

26:53 Ashwin Ramachandran: And it's a funny question. I think actually physically I feel healthier today than I did 3 years ago, and I had to very make a very conscious decision to do that because otherwise I was getting very jaded and tired. But flip side, I think what people don't necessarily understand, you could talk to anybody that even people that haven't founded a company and they'll probably agree with you that starting a company is very difficult. But most people, including myself, couldn't necessarily tell you how difficult it was going to get. The good moments were great and the bad moments were awful. And we had moments where investors had pulled out of something or we had an investor go bankrupt and that effectively, like, I couldn't sleep for 6 weeks. I had extreme anxiety. And I think what people don't necessarily talk about enough or in the right context is how shit this all can end up being from a mental standpoint.

27:37 Frances Goh: Mm-hmm.

27:37 Ashwin Ramachandran: The only solution to that I've found that actually works for me is to surround myself with people that will actually listen and have some kind of empathy, uh, on what I'm actually saying. And I know, uh, you know, my parents listen to it, and I've got friends and family that want to talk to me about it. It helps to a great extent, but you always want to find people that understand truly what you're talking about, the magnitude of the crisis. Because usually if I tell Mum about something, she'll be like, okay, just quit. 'Quit if it's hurting you that much.' Yeah. She's like, 'I think it's important to worry about yourself first.' She's like, 'Just quit.' And I'm like, 'It's not that simple.' I think you put too much of your identity behind something and you really want to see it through because it both resonates with you personally and also it's helped and impacted so many people. And the promises that you make as a company to both population and to investors, it comes back to either reward you greatly or make you very fearful. And I think addressing it with the right people and building your network of friends and people that truly understand what you're talking about is very important.

28:33 Frances Goh: Mm-hmm.

28:34 Makenzie Thomas: And do you mean like business mentors and things like that, like trusted advisors that are in it sort of alongside with you, or friends that really understand, or a mixture of both?

28:44 Ashwin Ramachandran: I think a mixture of both. Look, I've found benefit from business advisors and people that give me, like, draw pathways for me, but I find even more value in tough situations from people I can just ring up and have a conversation with and even just complain to, and people that understand acutely where they— what, what I'm experiencing and where I'm coming from, and that understand that quitting is not necessarily an option for me. I think that really helps more than anyone that can give you advice or anyone that can talk at you.

29:14 Makenzie Thomas: That makes total sense.

29:15 Frances Goh: I think having founder friends as well, um, who have that similar life experience, lived experience, and are on the journey but at a different point in the cycle is, is really Wonderful. So Ash, would love to hear now from your perspective, and in your own words, why do you feel your work is so important, not just for the men and the people that they are choosing to build their families with, but for healthcare systems as a whole?

29:40 Ashwin Ramachandran: I think fertility is a, you know, a fundamental health issue across the population. It is a public health crisis, and we're at the point where, you know, we're disproportionately addressing one half of that equation. We're talking about women's health and we're talking about women's fertility, and rightfully so, because I think there there is a significant proportion of women's health, women's fertility that needs more emphasis. But on the flip side, men's fertility is pretty important, effectively, because it is one of those areas that is starkly declining over the last 40 years. We've seen a 50% decline in sperm count over the last 40 years, and we're seeing a continuous decline of 1 to 2% every year. And we're moving towards— I know the news will tell you it's a population collapse, but I don't think we're there yet. But the reality is we're moving towards a very dire environment where the predictions are that 50% of the population will need artificial reproductive techniques like IVF to conceive in the next 20 to 25 years. And that's a pretty negative environment for us to move a population towards. And so when I think focusing on men's fertility, I think focusing on men's fertility in isolation isn't necessarily helpful. It's viewing men's fertility as one, one of the most important things in building a family together with female fertility that progresses us as a population. Thinking about healthcare, thinking, thinking about the right infrastructure from a medical standpoint, thinking about the right kinds of foods we eat, the right kinds of medications we're provided. Mm-hmm. Setting, those all inherently improve the population and our ability to move towards a more naturally conceiving environment where people aren't necessarily always using medical resources to conceive a child.

31:11 Makenzie Thomas: Absolutely. I love that you're leading us away from the dystopic kind of language around it, uh, to something a little bit more inspirational, um, and, and bringing both people into the, into the mix, because it does take, um, there are two parts, um, to creating no, a baby, an embryo. So that's an important part of the discussion. And so what are you most excited about in the next 12 months for Sapien?

31:34 Ashwin Ramachandran: To be fair with you, I'm most selfishly excited about building my team out. And the reason why I say that is because I think we've seen really good adoption across the world when it comes to Sapien as a product. We've really understood how to deliver the science, and we've got KOLs and clinics all around the world using it on a daily basis. We, we help patients all the time, and that's all very exciting. But on the flip side, we also get to build a very exciting team, a team that gets to go outside and sell a product that's really going to change the way we, we look at diagnostics and fertility, impacting both men, women, and the broader IVF environment. Um, and also too, I think, um, this all gets a lot harder when you work with people you don't like, right? And I think, I think that's pretty important because as we build the company across multiple markets, I'm effectively working 5 time zones any given right? And, and I just need to know that if I'm going to wake up to a 3 AM call from someone in the UK, then I'm going to wake up to speak to someone that I actually want to work with. And, and that makes a huge difference because end of the day, we're all working towards the same goal and might as well work with people you like.

32:36 Makenzie Thomas: Absolutely. I love that answer. We haven't had one like that yet, which is really cool. Definitely.

32:41 Frances Goh: I feel that way about Mackenzie. She and I get to hang out here, talk to awesome people like you, Ash. It's the best.

32:47 Ashwin Ramachandran: That's fantastic.

32:48 Frances Goh: And so would love to ask, I guess, before we get to our last question that Mackenzie will ask you, we've asked you so many questions and you've been so open and forthcoming in your stories, in all the amazing information that you know. Is there anything we haven't asked you that you'd love to share?

33:06 Ashwin Ramachandran: Yeah, I mean, look, the, the interesting thing about fundraising and hardware products in Australia is it gets complicated. The environment appears dire, and I think there's a lot of negativity around it, people talking poorly about the venture capital market, about people's understanding of healthcare. And I've done that myself, and I think it's worth noting that I've also complained. But I think this is one of those moments where I think it's worth emphasizing that there is always a clear pathway when you build a product that people want. I think I've struggled with that quite a bit, because when I felt like I built something people wanted and no one was giving me money, money. It just feels annoying and it feels frustrating. It feels like you want to go scream at a wall. But flip side, you continue trying. And we got told early in the process there's no example of a hardware product in healthcare that's ever successfully exited Australia into other markets. Objectively untrue. We've seen the likes of Cochlear, ResMed, um, CSL. There's plenty of examples, but I think there's a general lack of awareness, and we haven't seen those examples recently enough, right? So people don't necessarily think to highlight them as, as success stories from Australia. I think it's worth emphasizing the success stories. It's worth emphasizing that to build company out of Australia isn't necessarily at the cost of giving people the Australian discount on valuation, the Australian discount on talent and everything else. It's worth emphasising that there are businesses out of Australia in healthcare and hardware that can scale internationally. And to put forward a clear enough plan and communicate that with clarity does a lot for you. And if it's not an investor in Australia, it'll be an investor somewhere else in the world that'll put money in.

34:36 Makenzie Thomas: Yeah, I love that. It's definitely a message that a lot of the hardware medical device medtech startup founders need to hear. So I appreciate you adding that in. Into the mix. The last question that we always like to end on is, if you could rewrite the script on men's health— we normally ask women's health, but we'll reframe it for this one— men's health, fertility health, let's broaden it a little bit, what would be one thing that you would change?

35:00 Ashwin Ramachandran: I think talking about healthcare in general, but focusing on men's health and women's health, I would shift the focus away from optimizing for the already optimized population in the market and reaching the genuine millions of men and women who are falling through the on a continuous basis. And what I mean by that is I think we're giving far too many healthy people continuous glucose monitors, and we're testing hundreds of biomarkers across population. And, and I personally find that that's not necessarily indicative of strong healthcare, it's just lifestyle theatrics, right? What you really need at a population level, and true prevention for me, is about making healthcare diagnostics accessible. Because about 80% of all healthcare decisions are made on the back of a, of, of a diagnostic. And the simplest of them at the moment is a protein pregnancy tests. You make such vital decisions in healthcare on the back of a thing on a $4 test. And you also need to reduce the friction around it. And, um, we need to be able to catch dysfunction early in people that will not post about it. And the other thing to know is most men haven't even been to the GP in 5 years, right? So, and they think the fact that their knee hurts or they have hair fall is just because of age, and it's not necessarily a signal of something. So if I could rewrite the script, I think it's going to be to stop rewarding health anxiety body and start building systems that quietly intercept decline before it becomes a disease.

36:17 Makenzie Thomas: Oh, that's a podcast in itself. I love that answer, Ash. No, that's really interesting. There's, there's definitely a lot more work that can be done in that space, and I hope it comes through because the insights from that and like the data that you could capture and then the actual things that you can start to shift with those insights would be incredible. So that's a great note to end on. Thank you so much for joining us today. It's been a interesting conversation. We've loved having you on.

36:42 Ashwin Ramachandran: Thanks for having me, for sure.

36:44 Makenzie Thomas: Absolute pleasure.

36:47 Frances Goh: Thanks for listening to The New Script. If you enjoyed the episode, make sure to follow or subscribe wherever you get your podcasts and leave us a review if you're feeling generous.

36:56 Makenzie Thomas: We'd love to hear your thoughts, feedback, or guest suggestions. Drop us a line at hello@thenewscriptpodcast.com.

37:03 Frances Goh: This podcast was proudly produced by by Day One, the podcast network for founders, operators, and investors. Learn more at dayone.fm. Until then, keep rewriting the script.

37:13 Ashwin Ramachandran: Bye.