The fertility industry faces a staggering imbalance: over 12 million Americans experience infertility, while only 1,300 fertility specialists exist to serve them. For Traci Keen, co-founder and CEO of ONTO Health, this gap represents both a systemic failure and an opportunity to rebuild how fertility care is delivered from the ground up.
In this episode of The Growth Layer, Traci shares how ONTO Health is addressing the access crisis through provider education, patient support tools, and a reimagined clinical model that prioritizes early intervention over acute care.
From Finance to Fertility: An Unconventional Path
Traci's background in accounting, finance, and operations might seem far removed from healthcare innovation, but it proved essential to understanding the structural challenges limiting fertility access. After years in consulting, she sought work that offered both intellectual complexity and meaningful impact.
Her entry point was Mate Fertility, where she served as head of finance. Mate pioneered a model of partnering with OB-GYN clinics to build micro embryology labs, proving that full-service fertility care could exist outside traditional REI centers. While the model showed promise, Traci witnessed firsthand the friction points that made implementation difficult: lengthy timelines, substantial upfront costs for providers, and gaps in clinical education that left doctors uncertain about scope and execution.
These experiences shaped the foundation for ONTO Health's approach. Rather than requiring massive infrastructure investments, ONTO focuses on incremental education and tools that fit within existing workflows.
The Problem with Stage 3 and Stage 4 Care
Traci uses an oncology analogy to explain the current state of fertility treatment: most patients arrive at clinics already at stage three or four infertility, when interventions are more complex, more expensive, and outcomes are less certain.
What's missing is attention to stage zero (family planning conversations), stage one (early concerns about conception), and stage two (initial challenges). These earlier stages offer opportunities for lower-cost interventions and better outcomes, but they require upstream awareness and education that the current system doesn't provide.
The gap begins with provider knowledge. OB-GYNs, who serve as primary touchpoints for women's reproductive health, receive fewer than five hours of fertility or infertility training during their medical education. Primary care physicians receive even less. In many parts of the United States, patients don't have access to an OB-GYN at all.
This creates a disconnect: patients assume their doctors know how to guide them through fertility questions, but those doctors often lack the training to do so. Even planting a seed about family planning or fertility preservation can change the trajectory of someone's care, but those conversations rarely happen.
Building Education That Fits Clinical Reality
ONTO Learning, the company's microlearning platform for practitioners, addresses this training gap through modular, accessible courses designed for real-world adoption. The platform offers two pathways: individual courses that clinicians (MDs, NPs, PAs, RNs, MAs) can take at their own pace, and comprehensive packages for community hospitals or networks looking to activate entire fertility service lines.
The curriculum was developed by Dr. Lena Copians, a dual PhD and MD with a background in microbiology and reproductive endocrinology, alongside Amy Saraphini, a lifelong adult educator. This partnership brings together clinical rigor and instructional design, ensuring the content is both medically sound and genuinely usable.
Traci emphasizes that doctors want to learn, but they need content broken into actionable pieces with tools that support real-time application. ONTO is building an AI-powered RN support tool that sits on a provider's desktop or iPad, allowing them to prompt it mid-appointment when a patient asks an unexpected question. The tool pulls from ONTO's curriculum to deliver standardized, evidence-based answers, reducing variability and increasing provider confidence.
A similar tool is in development for patients. Traci acknowledges that many turn to forums like Reddit for information because they lack access to trustworthy, real-time answers. By offering patients an AI-powered resource grounded in clinical guidelines, ONTO aims to reduce the anxiety and misinformation that often accompany fertility journeys.
Addressing Attrition and the Patient Experience
Between 56% and 64% of patients who walk through fertility clinic doors never make it to treatment. This isn't because they don't need care. It's because the process is overwhelming, confusing, and far longer than most people anticipate.
Traci describes the typical timeline: if a patient hasn't been worked up by a fertility-knowledgeable provider, the clinic starts from zero. This means testing tubes, checking for polyps, running diagnostics, and completing pre-treatment requirements before care can even begin. By the time treatment starts, patients are often exhausted, financially strained, and emotionally depleted.
Earlier intervention changes this equation. If patients receive initial screenings and education from their OB-GYN or primary care provider, they arrive at specialty clinics already informed and partially worked up. This reduces time to treatment, lowers costs, and improves outcomes.
Operating a Clinic as an Innovation Lab
ONTO Health owns and operates a clinic in Colorado, which serves as both a patient care center and an internal testing ground for new tools and workflows. The clinic allows the team to identify friction points across the patient and provider experience, then develop technology to address those challenges.
Traci describes this as building a new operating system for how fertility clinics function. The goal is to create efficiencies that benefit both sides: better patient experiences and more streamlined internal operations. While the team is focused on refining this model before expanding, Traci acknowledges that additional clinics or joint ventures may follow as they prove out the concept.
Personal Experience Informing Systemic Change
Traci and her wife have been navigating their own fertility journey for about a year, an experience that has reinforced many of the systemic issues she's working to solve. From communication breakdowns with external labs to unexpected complications during egg transfers, the process has been far more complex and time-consuming than anticipated.
One example: after deciding to transfer frozen eggs from another facility to their Colorado clinic, three of the straws arrived in a non-FDA-approved shipping container. The lab had no obligation to disclose this, but Traci knew to ask. She wonders how many patients would never know to follow up on such details.
These experiences fuel her conviction that patients need better information and that the industry needs clearer standards. While organizations like CAP, the Joint Commission, and the FDA provide oversight, much is still left to individual clinics and clinicians. This variability can lead to inconsistent care and outcomes.
Reducing Friction to Unlock the Market
Traci draws a parallel to Shopify's early days. When the company sought venture funding, investors claimed the market was too small, pointing to only 50,000 online shops in existence. Shopify's founders understood that the market wasn't small; friction in setting up an online store was artificially constraining it. By removing that friction, they unlocked massive growth.
The same principle applies to fertility care. The market isn't small. The barriers are. By reducing friction on both the clinical enablement side and the patient experience side, ONTO Health believes it can expand access and outcomes in ways the current system cannot.
Traci also references Nike's role in popularizing running as a personal fitness activity. Before the company published educational content about running, few people considered it an accessible form of exercise. The shift in public consciousness that followed created an entirely new market. ONTO's work on provider and patient education aims for a similar cultural shift around fertility awareness and early intervention.
Looking Ahead
The fertility industry is undergoing transformation, and the future will not resemble the present. Traci is building ONTO Health in alignment with where the industry needs to go: toward earlier intervention, better education, reduced costs, and improved outcomes.
She acknowledges the tension between innovation and responsibility, particularly in a field where reproductive endocrinologists have historically guarded scope. But she's also seeing increased willingness among specialists to collaborate on expanding access, recognizing that if they don't help shape that expansion, the results may be less controlled.
Traci closed the conversation with a tribute to a colleague from Conceivable Life Sciences, a company building the world's first robotic embryology lab. He passed away shortly before the interview. His work, and his push to unlock true scale in fertility care, continues to inspire her own.
Key Takeaways for Operators
- Friction points reveal opportunity. Where patients and providers struggle, there's potential for innovation that can expand the market.
- Education alone isn't enough. Training must be paired with tools that support real-time application and activation.
- Early intervention changes outcomes. Moving conversations upstream reduces costs, improves results, and decreases patient attrition.
- Provider enablement matters as much as patient education. Expanding access requires equipping generalists with confidence and resources to guide patients earlier in their journey.
- Personal experience can inform systemic solutions. Founders who understand the patient journey from the inside bring invaluable perspective to building better systems.
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The Growth Layer is a conversation series from Future Digital exploring how real growth happens in health, wellness, and family brands. Each episode pulls back the curtain on the pivots, decisions, and behind-the-scenes discussions that shape category-defining companies. Subscribe for more founder stories and growth lessons from leaders transforming care.
