A light micrograph of ovarian follicles.

At its peak, Viagra generated $2 billion in annual sales. After its fast rising debut in 1998, it gained market share more quickly than nearly any prescription in history. In the two decades since, Viagra has racked up tens of billions of dollars in revenue and become ubiquitous in culture for men getting their mojo back. 

Female sexual dysfunction drugs have not fared as well. The first medication, Addyi (flibanserin), was approved by the FDA 17 years after Viagra hit the market. Despite fervent anticipation, sales totaled only $8 million. Why was Addyi such a let-down?

It certainly wasn’t due to a smaller market size. In fact, the market for women is larger. While only 1 in 10 men report experiencing issues with sexual arousal, for women the number is twice as high. Nor was it because of a lack of funding from capital markets. The day after the FDA approval, Valeant acquired Addyi for $1 billion.

The reason Addyi didn’t become a commercial success is the same one that disadvantages the entire femtech arena: a lack of robust early-stage science and therefore good products. While Viagra affected well-understood mechanics of male erectile dysfunction – relaxing blood vessels of the penis to cause an erection – Addyi aimed to do something more difficult by stimulating the brain to ignite sexual desire. The neurobiology of sexual desire is scarcely understood, to the extent that even the drug developer couldn’t articulate the exact mechanism by which Addyi worked. As a result, the drug had such a low efficacy (and excessive side effects) that the FDA had twice rejected it from entering the market. In the clinical trials, a woman using Addyi on average had one more “satisfying sexual encounter” per month, in comparison to those on a placebo. Not much of an improvement for a drug that came with the hefty price tag of $800 per month (2x the price of Viagra) and a long list of serious side effects.

Why is science hindering women’s health companies?

Simply put, we’ve just recently started studying female bodies. It was only in 1993 that the National Institutes of Health (NIH), mandated women to be included in clinical trials. Before that, the male body was the “medical norm”, with almost all medical research – including drug and diagnostic development – conducted exclusively on male bodies. Despite clear evidence showing sex differences in how bodies break down drugs. In 2016, the NIH revised the policy to include pre-clinical research and specified that researchers should acknowledge sex differences and run basic science experiments on both male and female mice. Until 6 years ago, a researcher could treat female reproductive organs and the hormonal cycle as either irrelevant or confounding variables when developing biological knowledge and medical know-how.

Yet even with these changes, women’s health attracts only a minuscule percentage of all science funding. In 2019, about 11% of all NIH funding went to conditions that solely, differentially, or disproportionately affected women. A recent study confirmed these results: in 3 out of 4 cases where a disease afflicts primarily one sex the funding patterns favor men. In 2019 alone, there were 5.8 times as many publications on erectile dysfunction than all of female infertility.1

If our legacy systems won’t fund the early-stage science then we’ll have to. That’s why we launched Repro Grants, a ‘fast grants’ style program to accelerate female reproductive science. We’ve brought together leading researchers to award $25-100K to the most ambitious and novel research projects from menstrual health to menopause. These grants are purely philanthropic and no strings attached – and come with no claims whatsoever to any IP. 

Modeled after Impetus and Fast Grants, the application takes 30 minutes to complete and applicants get a decision within 21 days. In the last 4 weeks, we’ve received an overwhelming number of proposals (465 to be exact) from leading universities across the globe. 

We’re excited to fund the next generation of scientists. Because where only a few have gone, a lot is left to discover. Will we decode the sources of 1 million (per year) miscarriages and alleviate heartache from expecting families? Will we uncover the fountain of youth by deciphering the signaling pathways of rapidly aging ovaries? Will we unlock potential cures for dreadful endocrine conditions like endometriosis? 

We just might! But what is certain: as long as we fail to fund research at the earliest, most fundamental levels, we cannot expect to magically deliver safe, effective, and life-saving products for women. If we succeed at bridging the research gap, the world will look drastically better. Our aspiration for Repro Grants is for it to not only improve the well-being and health of half of the world’s population but also fund a future Nobel laureate or two.

All the best,
Sara / Fifty Years team

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Thank you to our founding donors for catalyzing this program! 🙏 We’re raising up to $1 million more in philanthropic donations to support breakthrough science in female reproductive health.

Open Collective Foundation questions:

1. What did you accomplish during 2022? How did you use money?

We’ve established Repro Grants as 501(c) under the fiscal sponsorship of the Open Collective Foundation, crowdsourced and contacted 250+ labs working on female repro health, and built an application structure and review process. We launched Repro Grants on Nov 17th (covered by Forbes) and by the end of the application period, we had received an overwhelming number of research proposals (465 to be exact)! As we get closer to New Year our scientific reviewers are busy reviewing the applications (no money spent yet). Stay tuned for the grant announcements very soon!

2) What challenges did you face during 2022? What did your Collective learn? How did you change or grow?

The economic downturn wasn't the greatest environment for fundraising making it difficult for us to hit the $1M target. But we hope that the urgent demand from the scientific community (demonstrated by the application flow) will make it easier for us to go back and raise more capital to be able to support this incredible science! We genuinely didn't expect to receive such a high number of applications, so in preparation for the next round, we'll have to find ways to automate more of the review process.

3) What are your plans for 2023? Anything exciting coming up?

So many! We're excited to publish our inaugural grantees! SO many amazing teams working on solving problems that affect millions of women's lives - endometriosis, ovarian aging, infertility, limited contraceptive options. We're happy to also announce that we're committed to doing a 2nd iteration of Repro Grants next year!