DISCLAIMER: Today’s Advertiser helped make the production and delivery of this episode possible, for free, to you! But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the Advertiser. The Advertiser does not have editorial control over the content of this episode, and the guest’s appearance is not an endorsement of the Advertiser.
We bring back fertility entrepreneur Dr. John Schnorr to share his experience and advice for building companies in the fertility sector without investor money.
Tune in as Dr. Schnorr talks about:
Some great examples of how he’s proven concept (both functionality & market value)
The conditions for bootstrapping without a proven concept
How Cycle Clarity gave equity to early employees (and how you might be able to do the same)
The pros & cons of hiring top-down in the accountability chart (And bottom-up)
Dr. John Schnorr
LinkedIn
Cycle Clarity
LinkedIn
Facebook
www.cycleclarity.com
www.cycleclarityconnections.com
Transcript
[00:00:00] Dr. John Schnorr: I would say that importantly, I think you need to really be a master of that domain and know what the market is you're trying to hit and understand the details of that market. I had an advantage there. I think that you should set a financial limit on what you need to have happen before you put in your next hundred, $200,000. Like, you know, I need proof of concept and I need this to do X, Y, and Z. And if we don't get to that, I'm going to rethink whether or not I'm going to put in the next 200, 000 again, using examples. And so I think always stepping back, seeing where you are, figuring out what that financial commitment is, what our progress has been.
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Announcer: Today's advertiser helped make the production and delivery of this episode possible for free to you. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health nor of the advertiser. The advertiser does not have editorial control over the content of this episode and the guest's appearance is not an endorsement of the advertiser.
[00:01:23] Griffin Jones: He's back and we're talking about bootstraps. first conversation with Dr. John Schnorr was a popular one. We talked about the IntegraMed autopsy where Dr. Schnorr's group had been a part of the IntegraMed network and he talked about the collapse of that, what his entrepreneurial rebirth was like, and this is a sequel to that conversation.
And we talk about bootstrapping. Bootstrapping a company in the fertility sector. There's been a lot of companies in the fertility sector that have raised lots of money and some of them have done well, but others have really struggled to be able to prove what their business model even is, and some of them have gone bust.
We talk about what it's like to build companies in the fertility sector without investor money. What are the conditions for when you should bootstrap? When the total addressable market is smaller, when the concept isn't proven, when the money that you need to raise is less than what you could do by putting in a couple years of sweat equity or self funding.
Dr. Schnorr gives some really good examples. about how he's proven concept, not just the concept of functionality, but the concept that this is something that people in the marketplace are willing to part ways with their dollars for. It gives a really good example about why he had to shorten the length of his product's performance by six or eight X, even after it was a four or five X improvement of the status quo.
It wasn't good enough for 50 percent of the marketplace. He talks about why. He also gives a really good example of fertility clinic workflow. It seems like something small, but is embedded into the structure of how fertility clinics operate and makes it really difficult to adapt to change. It isn't just as simple as people don't want to change.
And I think that example that he gave illustrates it as best as any I've ever heard. John lays out how cycle clarity gave equity to their early employees and how you might be able to do that as a bootstrap company. He and I debate the pros and cons of hiring from the top of the accountability chart versus from the bottom of the accountability chart, having more smaller seats versus having more senior people doing more things.
And we each give our tips for how to solve the chicken and egg issue that comes with entrepreneurship and especially bootstrapping. I give my tips for constraints around pre selling. as a means of self funding and ask Dr. Schnorr for his thoughts on the topic too. You might have to bootstrap now in the fertility field.
The era of free money might be over. Oh well, partner. Might be a tough go for a couple years, but you'll end up owning a lot more of your company, which we hope is a really successful one. Enjoy this conversation with Dr. John Schnorr. Dr. Schnorr, John, welcome back to the Inside Reproductive Health podcast.
[00:03:56] Dr. John Schnorr: I'm so grateful to be here. Thank you for inviting me.
[00:03:59] Griffin Jones: It's like a sequel to your first conversation because the first interview was an, it was an REI's entrepreneurial rebirth, and we're going to talk about more about what that venture has been like. And we're talking about bootstrapping. Will this be, will this sequel be as good as the original?
Will this be the Godfather 2 to the, to the Godfather part one?
[00:04:18] Dr. John Schnorr: I guess all of the audience will know, and maybe they can tell us in a couple of weeks.
[00:04:22] Griffin Jones: We'll try our best not to let them down. So it's specifically, I want to talk about bootstrapping companies. That's what you've done to this point. So your, your, your business as a clinic, coastal fertility in the Carolinas.
We talked a little bit about last time we talked about your relationship with IntegraMed. And that's not the business that I'm talking about this time, more your new venture cycle clarity. We're not talking necessarily about the features and benefits of cycle clarity today, but you up to this point, as far as I know, have bootstrapped it is, is that right?
Have you taken out any investor money up to this point?
[00:04:56] Dr. John Schnorr: I have not. No, we did get a grant from the state, a very small amount of money just to encourage people to start businesses in the area. But it was a very small grant that helped us early on with kind of our kind of proof of concept, but a very, very small amount of money.
[00:05:11] Griffin Jones: Well, the reason why I think we should be talking about this now is because I think more people are going to have to bootstrap in the coming years for a decade or so. We saw a lot of VC money flying around because if you can borrow money, it's one or 2 percent rates and those limited partners want a much bigger rate than what they're getting in the stock market.
You're going to see. More money in venture capital. But if interest rates are 7 percent or, or whatever, and you have some of that money drying up, then you're likely going to see less venture capital money. And I've had some other, I had Dr. Santiago Mune on the show who runs a, uh, Basically a venture firm for fertility startups, and he said it's dry out there.
So I think people are going to have to do bootstrap down whether they like it or not. Why did you decide to do that though? Because you still probably could have gotten in on that era of free money. You chose not to. Why?
[00:06:10] Dr. John Schnorr: Yeah, it's a great question. We started CycleClarity in 2019. At that time, it was a dream that had some patent protection that we were able to acquire or to develop.
And at that time, we needed a proof of concept and needed to move forward. I think there was an ability to get some seed round funding at that time. We did some preliminary talking with different seed round investors, and I think there was a lot of interest. But what was clear to me is, is that It was going to be a relatively limited amount of money that typically I think a seed rounds three, 400, 500, 000 for a seed round.
And it was going to be smaller than we probably really needed to do to get the job done. But number two, there was going to be a lot more time and effort into finding the right seed round investor, uh, doing the due diligence, doing all that work. And I honestly, A, had the ability to self fund and seed round myself, basically is what we're talking about.
And I could save time doing it, meaning I could spend time on the product and the team and the platform and the development, whether than the time to go out and court money and kind of get some investors to kind of go along with it. So I had enough belief in what we were doing. I had enough belief in my ability to know the market, which I think is really key.
I think if you don't know the market and the needs and the challenges and demands, you can end up with a product that misses the market. And I think that would be a big painful lesson to learn as a seed investor. And I think trying to bootstrap it myself, knowing what we had, knowing the team we had, developing, increasing confidence in the technology over time gave me the, the ability to move forward with confidence as our own investor.
[00:07:53] Griffin Jones: Do you think that if you had not owned a fertility practice for a couple of decades, been an REI for a couple of decades that you ever could have bootstrapped the company that you're starting now?
[00:08:04] Dr. John Schnorr: I think financially, yes, but I think you just wouldn't really have true insight is to the demands on a reproductive endocrinologist day to day in his or her lives to know really what the limitations are, what the problems are.
What problems need to be solved and it's just not my viewpoint on the problems, but you get a connection of three, 400 other reproductive endocrinology, as you know, well, and get converse with them and share problems and understand how they're solving them. And I think it gave me the confidence that this was a good place to invest some of our resources.
[00:08:41] Griffin Jones: So there's a little bit of a lesson there of aligning with one's core competency in order to be able to bootstrap it is not necessary there because there's a million problems out there in the marketplace, and many of them will probably be lucrative. But there's something to be said. That allows you to bootstrap for going to, uh, to build something that you know.
Do you think that you could have even started PsychoClarity if you had not been an REI and not owned a practice? Even if, if it weren't bootstrapping, if you had somebody else's money, could you have done it?
[00:09:17] Dr. John Schnorr: Wouldn't be real easy and it would be much more expensive because we used our own patients for the ultrasound images that got de identified that then got used for the training.
So we had our own data and images that we could work with, but actually very important. as the platform developed, I could use it in the office with the patients and understanding is it developing in a positive direction? Is this something that actually is going to be beneficial to, to clinicians and patients at the end of the day?
which gives you increasing conviction throughout the journey that this is a positive experience, this is going to become something. You could see its strengths and you could see its weaknesses and you could see it develop from month to month and year to year. And something that's been quite interesting is I like to journal what I've been doing just to remember what we were doing a year ago and two years ago and three years ago.
And to go back and look at where we were a year ago It shows how amazingly we've grown over the last year and over two years and over three years, literally three years ago, we didn't know if this was going to work at all. And if artificial intelligence was ever going to be able to see a follicle in the ovary.
Now we've gotten to the point that not only we can see the follicles, the ovary, we can do it with 94 percent accuracy and we can do it in less than 30 seconds. It used to take us five minutes to get a result process. Now we're doing it in about 30 seconds. And it's amazing to see that evolution with time.
What do you journal about? You know, everything. About meetings, like you have a big, important meeting, you know, that talks about an IT challenge and that kind of stuff. I put in kind of notes about who I met with, what the challenge was, how we're going to try to solve that, you know, what platform we're going to use to do that, what we think the cost is going to be to do that.
And it's, it's good to be able to go back to that. So when you get into that same conversation about, for example, how do we track follicles within the ovary, that's one of our challenges is. the same follicle will be in 10 different frames of an ovary. How do we track that same follicle through the ovary?
And it's a fairly complicated algorithm that looks to see how much overlapping there is from image to image and what the size is and what the degree of confidence is and, and all that little minutiae matters. And You know, at some level I'm functioning as the CEO and the CEO needs to be able to understand all aspects of your organization and help prioritize resources and troubleshoot problems.
And you need to have a real granular understanding as to how your organization works, what your strengths are, what your weaknesses are, what your problems are and how you're going to solve those. And journaling to me, is a tool for that where I can go back to that conversation, you know, six months ago and with really granular clarity, know what was said, who said it, how we're going to fix it and reflect back on that conversation.
So you're ready as you develop forward with tracking or whatever the issues are you're working on.
[00:12:16] Griffin Jones: So you journal based on when there's an event that or an event or something that goes off in your head that merits journaling as opposed to like a calendar frequency, like on the first of the month or the first of the quarter calendars,
[00:12:30] Dr. John Schnorr: I journal, I personally journal sentinel events like if something big's going on and we had a big meeting, I'm going I'll put notes about that meeting so I can reflect back on it.
And you know, it's, it's good for that minutia, but it's also good to look back at the progress of your company over time and to realize last Thanksgiving, for example, we were still solving these problems that you now look at and you say, God, that would, that seemed like that was a year or two, three years ago.
We're well past that. We're moving on to what the next star. And, you know, I think what we're learning over time is that the problems get smaller. You know, earlier on, there can be a lot of big problems that would derail you completely. And this will never work like the ultrasound machine, not being able to transmit the images efficiently, or maybe just one manufacturer being able to do it.
But the other manufacturer is not. And as you get. further down the road and eventually put more and more resources into it and understand in the clinic, this does work and this does work accurately. And it's a benefit to the patients and it's a benefit to the physicians and it's a benefit to the embryology lab.
You start to get increasingly conviction that this is meeting the market demands, that this is a product that fits the market well, and kind of gets you further down the road where you can actually then start. working with it in physician clinics, getting their feedback, making changes. And over time, we're finding that the feature changes that are requested from the clinics are smaller and smaller as we meet more and more of the demands.
And There's a lot of really great ideas out there that initially were revolutionary. And now the ideas that kind of come in to our platform are smaller little tweaks, which are very positive, but not as heavy of a list, don't require as much engineering and really actually enhance the output of the platform at the end.
[00:14:20] Griffin Jones: That's probably a way of thinking about proof of concept that makes it more tangible that I hadn't really thought about that. The part of proving concept is that the problems get smaller and smaller. That's probably a good sign. I want to come back to the topic of proving concept. But first, what, in your view, are the conditions for when someone should bootstrap?
If these things are true, that means that the company should probably more likely bootstrap.
[00:14:49] Dr. John Schnorr: Well, I think a, I think you should have, of course, the financial resources that you can bootstrap comfortably. I wouldn't underestimate the resources needed that it's probably going to be twice as much money as you thought it was going to be at a bootstrap.
I know you're shaking your head. You've been there yourself. You understand that. So I think you need to prepare for the long run. I think along the way you need to understand, you know, is this product truly something that's going to meet the market? Meaning if I were developing something in gastroenterology and I'm a reproductive endocrinologist, I wouldn't have near the confidence to invest my own resources in it if I wasn't able to monitor the output and outcome and how it's developing over time.
So I think that would be good. And I would say, do you have the time to do it? Because, you know, I'm a full time reproductive endocrinologist. I don't mind working hard, which is why I'm kind of working cycle clarity after hours. And, and, you know, I would tell you, I probably put in six hours a week doing cycle clarity.
I think my wife would tell you it's really 12 hours. That's probably true. I mean, the time commitment's gigantic, but I think that eases off a little bit over time as you've solved more and more problems over time and you start gaining some clinical efficiencies, but also get a good team around you that can support you.
And I think that's really the key to success and bootstrapping is having a good team around you.
[00:16:08] Griffin Jones: My brother and I used to backpack across the world when we were in our 20s and my brother always said, lay out all your clothes before you pack it, lay out everything you're going to bring on your bed, and then bring half the clothes and twice the money.
And, and so it's a, you know, Like half of the, it's probably half of the business plan and twice the money of, of what you're, of what you're going to need. Um, so there's a couple things that I, that I, I think you're pointing out that I, I've been writing down. Um, I think it's important to, uh, I think it's important to bootstrap.
If you really don't have the concept proven yet, um, I, we, we see so many. companies that have gotten a lot of money, tens of millions of dollars, sometimes even more. And they don't have a solid proof of concept of what it is that they're selling yet. And I know that there's a lot of technology companies that it would be really hard if not impossible to bootstrap because of the development costs that go into it.
So I understand not everybody can bootstrap, but I do think there is something to be said for that. I still would want to. Have more of a proof of concept of like knowing exactly what it is. I'm going to sell before I raise 25, 50, 75 million. So I, I think that's a piece of it. I also think if the total addressable market isn't that big, that you should probably bootstrap because you might not, you might not end up with the next Uber Airbnb, but you could still have a pretty decent.
Small size business. And I sent you, and do you remember the article I sent you like a month ago about it was, it was from this newsletter that I subscribed to called got acquired. And they told the story of some business that I wrote down the numbers that I could remember, but it was like a 2 million revenue business.
That had about 400 K in EBITDA and the person wanted to sell, but they had raised 2. 5 mil and, and so anything that they would have raised and anything that they would have sold it for would have gone to that, to the investors. And that's. When you think about it, that's a pretty lousy deal for both the investors and the entrepreneur, because the investors that day, that after the, the, the time value of money lost over that time period, even if they break, even they've lost money and the invest or the extreme of the entrepreneur has toiled for those years and has nothing to show for it.
But. If they didn't take that to begin with, if they could have made up for that 2. 5 million by sweat equity and slower and small pace and pre sale deliver, pre sale deliver, then that's a six and a half EBITDA and you're making 400k profit a year. Like that's a good small business for a lot of people.
So for you, when, when you think about cycle clarity, like. You don't have to give us exact figures, but how big of a venture do you want this? Or how, how small of a venture are you okay with it being?
[00:19:09] Dr. John Schnorr: Yeah, I think it's a great question. And I think more than anything is, is I just want to see it through the journey.
So of course I want it to be a 5 billion company. I mean, everybody wants it to be a 5 million company, but. I, you know, I think it's going to be what it's going to be. We're, we're trying to make the best product we can for the market and then figure out, you know, how it enhances efficiency in the market and what it's worth is in the market.
So I think we'll know that as we get further down the road and your points, a good one is that a significant amount of equity is given up to seed round and a round and B round and. You know, we have had some of those discussions and realize what those numbers look like. And I'm doing my best to give that equity back to the employees themselves so that it encouraged them at a cycle clarity level to work a little bit harder.
And the further I can get us down the road with internal funding, the better we can be when we do want to get some, say a B round funding or even C round funding, depending on how we're going. But, you know, we've got a product now that I think has. product market fit. I think we have happy customers who were doing well.
We're learning from it. And the question becomes, you know, if we were to get a lot of funding, what would we do with that now? And would that really spin us out in a positive direction? And we're continuing to have those discussions to figure out what the next step is.
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[00:21:55] Griffin Jones: Maybe this is in line with what you said. You had the ability to self fund, but I think even for those people that don't have the ability to self fund, maybe it's, maybe it's a couple of years of doing something else as opposed to having the money right off the bat to self fund.
But do you think that there's a, there's an amount that's too small to raise? Like, I think two and a half million dollars is probably. And anything below that is probably just not even worth raising. I know that's that's probably an arbitrary call. Probably depends on the type of business and and all that type of thing.
But it's like, man, I wouldn't want to give away any piece of my business like for two and a half million dollars, I guess. And, you know. I don't know do you think can you put better rules around it than I can
[00:22:41] Dr. John Schnorr: yeah I mean I think I think it depends on how much money you're going to need to get a product to market you know I mean I think if you can get a product to market with three hundred thousand dollars you should probably do it on your own to your point if you're a big database company and you're going to compete with Oracle and you're going to need a lot of money to do it.
30 million to get to market. You better go ahead and get some, some venture capital and seed Monday to help get you through that. But you know what we had done along the way is just kind of figured out what our number was and ended up, it ended up being twice that, which I guess it always is. But you know, we kept seeing progress through it and it kept developing in a positive direction.
It kept being usable and you know, I didn't want to fool myself. So I wasn't trying to make these decisions about usability myself and We did beta testing with Michael Levy, who was incredibly helpful. I'm really impressed with Michael and his vision and his ability to see technology. And we worked with other doctors within the community who used it and loved it.
And so that just further emboldened me that this was headed in the right direction and we should continue to. Invest in it and move forward and invest in our team. I think you're never better than the team around you. We got an amazing group of engineers that have been great. Medical device specialists to go out and innovate, chief operating officer, who's amazing, a team around us that just gets better day by day by day.
And I love seeing that happen.
[00:24:02] Griffin Jones: Tell me a bit about the rules that you've learned for proving concept. You talked about it first. It started off as a problem that you wanted to solve for yourself as a provider. Then you approached other providers that, you know, like Dr. Levy, tell us about how you prove the concept.
[00:24:18] Dr. John Schnorr: Yeah, so I started with just an idea. I think it was Philadelphia at the ASRM. I met with Michael Levy and I said, Hey, Michael, I got this idea that I think we can see follicles with AI. And, you know, I think it'll improve pregnancy rates. That's really what I said to Michael is we can better, more accurately do that.
And this was lunchtime. And Michael said, you know, John, I agree. You might be able to do that. He goes, but the value really is the clinical efficiency, right? to him, the value was not that we were necessarily going to improve pregnancy rates, but that we could do it quicker and more efficiently. And that's, of course, somebody who runs the largest fertility company in the United States and, and knew the value of clinical efficiencies.
And so we focused on that. That was the first thought we then needed to figure out who was going to help us. Kind of see this follicle with AI and even more importantly, who's going to track the follicle through all the images. And by serendipity and luck, we ended up with an AI company that specialized in tracking a football with AI go across the goal line so that they could predict when a score happened or not.
So they could track something over a video series. they looked at what we had and said, yeah, that should be able to work. And so with a relatively small amount of money, we were able to take about 300 images and which is a small number and train them. And they were able to show with some crude output that they could track this follicle across it.
That then started with COVID. COVID happened around then. And so we were all kind of locked in our homes, which is a great time for us to be. Annotating thousands and thousands of images and follicles and using kind of images that came from coastal fertility that we completely de identified and then we would show all the follicles and develop it.
That was probably a nine month journey of kind of annotating every follicle. I felt it needed to be done the right way so I as the physician viewed every follicle that was called a follicle and approved it and that resulted in what we called proof of concept is that we could with accuracy of greater than 90 percent figure out where the follicle was and how it was growing and so that showed that we could do it.
Now the next challenge was getting the data off of an ultrasound machine and securely transmitted to the fertility center and the data analysis center where we could see these images and provide them back. There was a whole separate team that helped us do that, and that was our third kind of piece to the platform we needed to make things work.
[00:26:51] Griffin Jones: How much familiarity did you have in the A. I. Space before you started working on the concept? Did you know those sports guys at all or so? Okay, so you had the fertility space pretty well covered in terms of knowledge and connections. Then you had to develop those knowledge and connections in the A. I. space. What was that like?
[00:27:13] Dr. John Schnorr: That was a challenge because it's a whole different language with a whole different set of people. And so I think we got lucky with one of the first people we started working with that they had the competency to do what we needed to do. I had a conviction that if you can see a breast cancer with AI on a mammogram, that you can see a follicle on an ultrasound, to me they're much easier to see.
And so I had a conviction that this was something that would work out. And we had many, many meetings with people international who were eight hours apart time zone wise where, you know, I'd be trying to grab an empty conference room at the ASRM to do a video meeting with our group who's doing our AI training and understanding.
And it was interesting and fun. And then in the middle of COVID, literally I was on video calls with a group in China who were in the middle of COVID, you know, where COVID all started to the best of our knowledge. And. Talking with them in the middle of COVID about annotations and ultrasound machines.
And it's really interesting how the whole world becomes so small when you're able to telecommute and discuss all these things and collaborate together. So it really took a lot of people from all over the world to help get us to where we are.
[00:28:22] Griffin Jones: So that's how you prove the concept in terms of functionally.
It could work. How did you prove, or maybe still are proving how it, it it is valued in the marketplace that people are willing to part way, part ways with money for it.
[00:28:39] Dr. John Schnorr: And that's its own challenge, right? I mean, you're, you're smart to bring that up because you can create your own technology that works just great at coastal Fertility.
But not everybody's coastal fertility. That's probably good that not everybody's coastal fertility. Everybody does things a different way. And, you know, I think everybody wants to innovate. Like if you sat in a room with a hundred physicians, he said, who wants to innovate? I think all 100 would raise their hand.
But what we find is everybody wants to innovate, but nobody wants to change. Like if I said to you this is going to really make things better and you're going to have a better outcome because, you know, maybe MAs can do the scan and not the ultrasonography would be more accurate, but you're going to have to do the ultrasound first and draw the blood second on a patient.
That's just an example. You don't have to do that. But if I said, You're going to have to do the ultrasound first and draw the button second blood second, but they're used to drawing the blood first. That's a gigantic change for a clinic, particularly if you're a high volume clinic. And you might say, well, why is that a big deal?
Well, probably because the room for phlebotomy is right next to the reception area. And the ultrasound machines are on the other side of phlebotomy. So now you got to walk patients through phlebotomy to ultrasound, to ultrasound, and then bring them back. You know, all of a sudden this becomes a bigger problem than you would think it was.
And so we had to learn very quickly that every practice is different. Every practice sees and does things differently. And we need to be flexible on the cycle clarity end so that we can address all those things. And so one example is it used to take us three to four minutes to process an image. And while it sounded crazy, I went back to team.
I said, guys, we got to do this in less than a minute. We got to drive this number down and leave it to our great engineering team. We literally are processing images now in 30 seconds, meaning that you can be doing the ultrasound, push the first save button. And by the time you're done, the first image is already done.
And by the time you hang up the probe and help the patient up From laying down, the second image is done and you can show them all the results that revolutionized what we did, because no longer do you have to draw blood first or draw blood second, you can draw blood anytime you want. You're going to get results back instantly and be able to make instant decisions.
And so that was forced on us by the market who just did things in different ways, and we need to accommodate for that. And so that has been a change and that's something we've had to work on.
[00:31:00] Griffin Jones: Why was that in, why was three to four minutes insufficient in the market size? Why, why, you know, because you would think, oh, if it normally takes 15, 20 plus minutes, three to four minutes, that's a four to five X improvement.
Great question. Uh, but why was, why was that not sufficient?
[00:31:17] Dr. John Schnorr: Great question. At Coastal Fertility, we draw the patient's blood. We do their ultrasound, an ultrasonographer does their ultrasound, we then review the results about four hours later, we look at the ultrasound, we compare it to the blood work, we make a decision, and a nurse calls the patient back with the decision.
At least 50 percent of all clinics, the doctor is doing the ultrasound. They want to make a decision in front of the patient that might be a preliminary decision so that when the patient leaves they already know what they're doing so they don't need a call back. And so therefore if you're going to be efficient you need to do the scan, you need instant results so that you can show it to the patient and say we're going to do the same medicine and come back in two days.
But you couldn't do that if you had to wait three and a half minutes for the ultrasound. You already wanted to be in the next room and starting on the next patient and that really disrupted flow.
[00:32:11] Griffin Jones: I love this. This is where companies are actually made in terms of proving their concept because everything is great.
Theoretically, right? We could come up with all sorts of businesses that sound great on paper. It's actually finding out when you're trying to get people to pay money, what the challenges are. And that isn't something that I would have expected either. And you weren't even expecting it as it didn't sound like, Oh, 50%.
And and they need to be able to do it because they that's what's important to them. What's important to them is being able to give the decision to their patient right there. And so that was an assumption that you had that that you had. Oh crap. Like we have to figure out a way to provide exactly right.
And I think your example of The the phlebotomy is like, Oh, why is it so important that they draw blood first or second? Well, because the, the, you know, the phlebotomy room is right next door. That's a really good example because there are so many good solutions that are having a hard time being adopted in our field and to say, Oh, Well, they, they can't just change.
It's like, well, it is kind of like they're there. You really have to understand it because there are reasons why they do things. And even if there are better ways of doing things, it's, it's hard to change. And it's not just because they're comfortable necessarily. It's because they, there are, there is an institutional momentum to do certain things in the structure and changing those structures is a lot different than just Changing one thing in a, in an order of operations on paper.
[00:33:45] Dr. John Schnorr: And to their credit, they've been doing it for 30 years. So to me, to ask them to do something different than they've been doing for 30 years to save them a couple of minutes on an ultrasound, but then hire a nurse to call people back in the afternoon that they're not used to, that's an instant fail, right?
I mean, that was going to go nowhere fast. So. our platform, our technology needed to accommodate for that. And, you know, never in my dreams would I think that I can really ask our team to get processing down from five minutes to 30 seconds, but they have been able to do that. And I think that's part through computing getting faster and platforms getting better.
And we've done more annotations and other things that have allowed this technology to get better. And to me, that's just one amazing example of going back to my journal, what's changed over the last year or two years, but also. A way to look forward at the future and think, well, if we can do that in one year, where are we going to be in the next two years with how the platform changes and how things improve?
[00:34:40] Griffin Jones: Do you feel like, because that you're bootstrapping, you are able to do this at a pace that allows you to actually figure it out? Like that's one of the, I would add that to the reasons where people might want to bootstrap is I like being able to go at. My pace that and I know there are certain things, certain like business fundamentals that I really want to master.
That wouldn't make sense to an investor. They would just figure it out, move on to the next thing where I'm trying to master it at a cellular level, like really trying to master how you delegate to outcome and manage senior leaders over other leaders. And I think that a lot of Venture capitalists would say too late.
You should have got an MBA for that. Hire an MBA to figure it out and just move on. Whereas like, I, it's like, I really, really want to, like, I really want to fix this, how, how much of bootstrapping. Has allowed you to go at this pace to figure out these challenges.
[00:35:41] Dr. John Schnorr: I think a lot. I think a lot because we can make our own decisions.
We no longer need to go to our investor and say, Hey, we're thinking about doing this or investing in this or doing that. We can literally sit together as a team on a on Friday at 2 p. m. and identify a problem. prioritize that problem to the top and be starting on it Monday morning and done with it by Wednesday or Thursday of the same week.
We can just instantly pivot. Uh, and one way we're doing this. Another example of what we're doing is I'd had a doctor not too long ago who lives three and a half hours away from coastal fertility and she used to live in Charleston. She moved three and a half hours away. She said, John, I would love to refer patients to you.
Um, but you're three and a half hours away. I can't. figure that out. I can't make that work. And I said, I have the magic. Why don't we go ahead and install cycle clarity at your center? Your ultrasonographer can do the ultrasound. That image will instantly show up in our platform. I can see the image from top to bottom.
I can see every follicle and I can make decisions with every follicle while the patient is still three and a half hours away. And that formed what we call cycle clarity connections, the ability to connect patients at a distance to the fertility practice with technology that occurs instantly with the same accuracy as if the ultrasound was done in your own clinic.
And so we actually thought of that idea on a Friday and by three days later, the following Monday, We're halfway down the road in getting that developed. We already had the core technology. We just needed to add a couple of pieces to it. And so that is a new product line for us that was really thought about just over the weekend.
Does it commit capital to do that? Yes. We'll have some capital commitments to do that. Did I have to go to any investors to get approval and to meet on it and talk with the board? No, we just did it because it seemed like it fit the market. It was a need. We're probably now 3 to 4 months into that cycle clarity connections, and it's been a revolution for care of patients at coastal fertility.
There are a distance. And we're going to soon roll that out nationally and even internationally to help patients at a distance go to their center of choice, whether it's a lower cost center or a higher pregnancy rate center or a more compassionate center, then go wherever they want now.
[00:37:58] Griffin Jones: Where have you had a board of investors?
They might've said, well, John, we think that's kind of a distraction. Forget about that for now. Whereas you're able to, you're able to make that decision as a, as a bootstrapper.
[00:38:08] Dr. John Schnorr: Instead of them saying, Hey, we committed X number of dollars to you. You've used them up, you know, move on. We're not doing that or.
We don't have the time for that. You can see it as the end user, the physician, that this is really something that needs to happen. We had most of the technology here. Now let's just prioritize that above everything else we're doing and get that role in and then circle back on the other things we've been working on in a month or two, and I love the ability to do that.
And it really empowers the team that you're working with. to feel like they're a committed part of the process that's influential on the outcome to really make things better at the end. So not only do they have equity in the business, but they have significant say and sway in the business. And that's important to me.
[00:38:52] Griffin Jones: So this is the long drawn out battle to prove concept that I think is missing from a lot of companies that raise money really fast that they they get the money and then they're trying to prove the concept. And I think I think if you can, it is worth it. To spend that long, arduous battle, figuring out the concept and then you go get the money.
And I think the examples that you've given are are really good one. We both know Julius Varzoni, I think. And I think you've checked out his new venture, Mind360. I'm not just saying that because he's advertised on the program before. I'm saying it because I've, I've gotten to watch him on the entrepreneurial side.
And I think They're doing it the right way off of making sure that they've got something that's really valuable and we can take this off of your plate for the mental health professionals. We can integrate. We can do it a lot faster and we can ensure the quality. And I think That's a concept where, as you know, if he had investors at that time, I'm not saying it's wrong to ever get investors, but if he had them in that time, they may have said, no, move on from that, move on to the next thing without ever really mastering what, what they're doing.
[00:40:10] Dr. John Schnorr: We're one of Julius's customers. We love Mind360. They've done a great job.
[00:40:14] Griffin Jones: I think there's another group, Cicero Diagnostics. I don't know them that well, and I don't, so I don't want to speak on them, but I, there is something that I could tell. is true for them that I don't think would be true if they were a VC back group, which is they, their testing is for a very, it's for a very particular niche where they, they think the scientific evidence really bears out that for this niche, this is truly valuable.
And I think that if they had more. Like investor money behind them, they would be pressured to try to expand what that niches and say, Oh, you should use the test for this. And you should use the test for that. Even if the scientific evidence doesn't bear it out. And so I think there's in addition to the proving the concept on me on the marketplace side that it allows you to find the niche that is actually Okay.
Going to benefit from from that solution, as opposed to having to expand it to be some kind of unicorn. Do you see that when you see other do you see like when you see some of the new solutions coming out? It's like, well, yeah, this would be useful for like this particular use case, but not for everything that they're trying to sell it for.
Do you ever see that?
[00:41:26] Dr. John Schnorr: Yeah, I think my team hears that a lot. I think they hear my input on other products that are coming to market and what I feel might be hitting it solidly and what might be missing it by a mile and a half. And so, you know, and maybe that's just one person's viewpoint, you know, maybe I'm just one reproductive endocrinologist, but, you know, I've talked to enough doctors and seen enough clinics function that you kind of know when something solves a problem or when it's a.
Uh, near miss or far miss. And so you do see some of that.
[00:41:54] Griffin Jones: Talk to me about your team struggles. So you mentioned, you mentioned your team a couple of times and, and how you've, how you've built that. Well, struggles, wins, lessons, the lessons you learned along the way. How did you structure your team? Would you have done anything differently in hindsight?
Would you have done more of things in, in, in hindsight? Talk to us about your team.
[00:42:12] Dr. John Schnorr: Yeah, well, the team started with a close friend, a former next door neighbor who had a lot of expertise in software as a service and and kind of doing the engineering of that. And he quickly became our CTO to kind of pull all this together.
You know, with his help, we got a very senior engineer. Who's actually doing a lot of our engineering and we've been lucky to have him around. And so, you know, my thought is, is that I always wanted everybody to be fairly paid. Uh, so we wanted salary to be at market rates. I wasn't trying to low ball anybody on salary.
We tried to do salary adjustments along the way as the market demanded salary adjustments, but importantly wanted equity. I wanted people to be incentivized and the outcome of this. And so we use equity for this. And I think that's really helped us out a lot. I think we've been very fortunate with Paul.
Who's our CTO and Jack, a senior engineer. We have a data scientist named Seth who helps us with all of our data analysis. Who's been amazing. Caroline is our lead integration specialist who's been amazing. And then Chad, our chief operating officer. So I think we've gotten really lucky with who we've hired and they came from extensive interviews and making sure we were aligned over time.
And if things kind of got out of alignment, we're pretty candid and open about how we want things to change and why we want them to change and people got on board. Fortunately, we haven't really had any turnover and I think there are our greatest strengths by far. We meet monthly with big reviews. We meet weekly twice a week to go over minutia.
And I think everybody knows kind of what's going on at a macro level and what the problems are and how we're solving them. So I think keeping the team small, keeping it tight, keeping a team who's willing to. work outside their field. Like it's a common thing where we're going to want to do videos and, you know, who on the team knows how to do video editing?
None of us, right? None of us were really good at it. Okay. Well, who wants to learn it and master it moving forward? So we didn't go out and hire expensive video people. We did it ourselves internally. There's software that allows you to do that. And Cut and edit clip and probably all the things you know better than I will ever know, Griffin.
But, you know, we had team members who just volunteered to go out and pursue that and to learn that. And I think that really helped them out. We have engineers who, you know, have really learned how to do training with AI that they never knew how to do before, and it's broadened their horizon and helped them out a lot in their knowledge base, and they enjoy being a critical part of our successful platform.
[00:44:48] Griffin Jones: I think you got a little bit of lucky too. And I'm not, I'm not saying a lot of it. I think you did. And I'm not, and I'm not saying that you didn't do the right things with, with giving equity and the right things with, with how you figured out market rate and salary. But you know, I've gotten to know Chad and Caroline pretty well, you know, the last year or so.
And they're, they're There's not it's not so easy to find young people that can be put into roles like that that are it's like you're getting the people on their way up and you know, they're not always that easy to find. And when you can, they don't always necessarily want to work for a small company or or if they do want to work for a startup, they want to work.
They want to work for the one that's getting headlines for raising Yeah. 10 million in, in tech crunch and all that sort of thing. And so, so I think you, you've done well with that. And what I've noticed about each of them is that they're, I think they're both kind of old souls. And I think that might have to like, you have to be forward thinking to work in any kind of startup that by definition you have to, but I think for bootstrap, you have to have a little bit of an old soul.
Do you think that's the case?
[00:45:53] Dr. John Schnorr: Sure. I agree. And that the people who are okay, not spending a billion dollars on little things here and there, and to be resourceful and to be proud that they've been resourceful, you know, to really take pride in the fact they did this for a thousand dollars instead of 10, 000, you know, those are things that I think really matter.
And so they. They've been great to do it and I think they enjoy it. A lot of them have worked in large corporations before and I think they run from that. I mean, I think all those endless meetings they had in these large corporations where no decisions were made after a four hour meeting. I mean, literally we'll have a 35 minute meeting and make pivotal decisions and then move forward and start implementing those the next day.
And that's just really rewarding and something I love about a small business in the startup.
[00:46:36] Griffin Jones: Yeah, I think that that industriousness that you're talking about is necessary and bootstrap and, and I worry about that being kind of like pushed out of the culture a little bit that if we, if we lose too much of that, being proud that I did something for a thousand dollars that we could have spent 30 grand on willing to just kind of eat crow for, uh, for a longer period of time than you would like, not forever.
I don't want anybody to eat crow forever, but, yeah. But to be able to endure for a little while, if we don't do that, if we, if we only, if, if, if all of the fringe benefits become table stakes, like we, we, we all got to have the company car. We all have to have the ping pong table in the giant office. We all have to have, you know, Amy Schumer come to our, our annual retreat.
Then, well, then you're only going to have a small. handful of very financially embedded companies that can even afford that. And you look at who actually, who is doing a lot of bootstrapping in this country right now. It's the immigrants think about immigrants that come to this country that have no money to sell fund and they work 90 hours a week and they grind and they grind and they grind and they reinvest that in their business.
And all of a sudden this, this immigrant that came here with nothing 10 years later owns. 13 Baskin Robbins and 12, 12 Dunkin Donuts. I think, I think it's missing. And from a big part of the culture, I think you've found a couple of people and that's amazing. How did you decide to do, do you have a thought before I move on to my equity question?
[00:48:13] Dr. John Schnorr: Yeah. Let me give you a classic example. Caroline, our lead integration specialist said, I would love when I go to a center. I would love to have a phantom with me to train them. So I don't have to have a patient to train them. A phantom is, you know, a device that represents what a patient would look like with an ultrasound.
So you put your ultrasound probe in and do the scan. And I said, that is a great idea, Caroline. I said, you think that's important? She goes, I think it's critical. I said, OK, well, let's buy a phantom. Well, you can't find an ovarian phantom for less than 15, 000. Literally 15, 000. So Chad, who's got a degree in biomagical engineering, who's our chief operating officer, he goes.
You know what? I think I can help you make a phantom. So we bought ballistics gel, which you would use to shoot a gun into to stop a bullet, right? It's real dense gel, which phantoms are made from. He melts it down in his oven. He takes condoms and puts water in condoms and wraps it up. Melts it into the gel, puts it into a jar, and creates a phantom that looks identical to an ovary.
And that cost us 75 and it's perfect, and it's small enough to fly around with it gets through TSA without any problems whatsoever. And wherever we go, we got a phantom. So we have probably 7 or 8 different phantoms. Now they have all been named. They all have different architectural and feature characteristics of it.
Our favorite phantom is CC moon, a CC for cycle clarity. And so it's just fun and it's team building. It's inspiring. And it's just one of many things we've done to innovate, to become who we are.
[00:49:48] Griffin Jones: That, that is amazing. And, and it's only like the fourth coolest Chad Clark story I've ever heard. Yeah. You guys.
Right. He's got a bunch. So I've, I've been interested in giving team members equity and thinking about that. I don't feel like I really understand the structure that I would use to do that. We, at one point tried to launch profit sharing and, and I still want to redo that, but. It was, it was more involved in, in terms of, of how you're able to do that.
And, and I realized that the team, it was not immediately obvious to them, like the incentives for doing so. And so I realized like, okay, I need some more training on this. How did you do that? How did you, how did you give equity to folks?
[00:50:31] Dr. John Schnorr: Yeah, so, so by far this is probably my weakest area is corporate governance and all that kind of stuff.
But we do of course have a corporate attorney. We've done it mostly through stock warrants, which basically mean we promise to give you stock if you sign this when you want to do it. So they don't have ownership right this second, but they have Uh, you know, a guarantee that they'll get it once they sign it, which gives them tax benefits that they don't own it.
Now we don't, um, share profits with them cause we're not profitable. Hopefully one day we will be profitable and we actually do it in a way that I think people need to be part of the corporation to exercise that warrant. So, you know, if you got a stock warrant, you can exercise it whenever you want and we'll give you X number of shares.
for nominal dollar, like 10 or something, basically give you it, but you need to be working at the company at the time. Meaning, you know, if you choose to be an employee now and to work now and to work for stock warrants, but then you decide you're going to chase another dream in three years and not be part of us at the end of it.
then the stock needs to come back into the corporation so it can be redeployed to other employees who are now working with the company at the time. So we've chosen to use stock warrants. I'm sure there are many different ways of doing that, but it seemed like a tax advantage way for the employee to use it.
It seems like a non dilutional way that if we diluted shares over time, but you have a warrant. You wouldn't be diluted out. So that protects them in that way. And they get to exercise that at the end of the journey. If there were to be a transaction, if they wanted to,
[00:52:03] Griffin Jones: That is a good lesson for those considering giving equity to their team members.
Was there, are there any hard lessons that you've learned about? With your team, giving them things that are outside their scope. Like, you know, you've got your COO helping with, it's not the mannequin. What is it avatar? What's it called?
[00:52:22] Dr. John Schnorr: It's called a phantom phantom, or, you know, you've got people doing video editing.
[00:52:27] Griffin Jones: So I, a mistake that I made in an earlier generation of my business, John was that I gave too much to certain people at certain times. And I, I, I, it made it. Difficult for me to hold them accountable to an outcome because I had stacked other outcomes that were outside of their seat on their plate, and then I couldn't just walk away from that outcome because they weren't accountable for that one outcome because they were distracted with other things that I had assigned to them.
And so in this generation of the business. I've been hiring from the bottom of the accountability chart going up and I will get more independent contractors and part timers and I'll have them in smaller seats, but I've got different people in smaller seats and then I can walk away because I can divide it down to an outcome for which they can be responsible.
And so instead of like hiring a full timer that maybe I'm giving them like four or five, you know, main core outcomes, it's like you hire part timer two outcomes or something like that. Sometimes only one. And and then, you know, as is. Is the company grows? I've been adding more full time people to manage those folks once they have a team of those folks.
I seem to like it better that way because of the mistake that I made. Have you ever? Have you? Have you run into that challenge at all where it's like when you have a small core team that you're loading too much up on them?
[00:53:42] Dr. John Schnorr: Yeah, I do think that, you know, we need to be understanding people's demands and their bandwidth and those types of things.
I think we've been lucky to get consultants who will train us and teach us so that they can learn from the expert that allows, for example, Caroline and Chad to become expert themselves because they're learning from the experts and to practice that discipline internally. So they become our guides and kind of mentors these consultants.
And I think that's worked out very well for us.
[00:54:09] Griffin Jones: It's a good idea. What other tips would you have for people that are that are trying to solve this chicken and the egg when it comes to bootstrapping. So I have come to understand entrepreneurship is the art of solving the chicken and egg problem. I said in passing to David Sable one time in a conversation where I said, Well, yeah, but how do you do that?
That's chicken and the egg. And he just looked at me and said, Griffin, the entrepreneur's job is to solve The chicken and the egg. And then I thought, Oh yeah, that's all it is. That is exactly what the entrepreneur's job, what comes for it? Well, we can't, we can't make the product if we don't have the money.
We can't make the money. We don't have the product. We can't hire the people if we have et cetera, et cetera. It's, it's about trying to, to, to balance that. And I. The ideal of having capital investment come in is that we can circumvent some of that chicken and the egg because they just give us a chicken.
I don't think it actually works out for that for the conversation that we've talked about that many times, but what tips would you give to people trying to bootstrap to overcome this chicken and the egg paradox?
[00:55:11] Dr. John Schnorr: Yeah, I would say that importantly, I think you need to really be a master of that domain and know what the market is you're trying to hit and understand the details of that market.
I had an advantage there. I think that you should set a financial limit on what you need to have happen before you put in your next a hundred, $200,000. Like, you know, I need proof of concept and I need this to do X, Y, and z. And if we don't get to that, I'm going to rethink whether or not I'm going to put in the next 200, 000 again using examples.
And so, I think always stepping back, seeing where you are, figuring out what that financial commitment is, what our progress has been. Again, I'm big on journaling. I think being able to look back and see where you've been. Forget where you've been and how big of problems you had three or four years ago compared to the problems you have now.
I get tremendous reassurance out of seeing that and then really listening to the team around you. And then, you know, I'm a physician who has my own opinion, but do other physicians have the same opinion? I do meeting with people like Michael Levy and other experts in the field and making sure I'm not too far off base, incredibly reassuring.
So I would say. Really get to know your market, get a product out to market in a beta form, look to see what's hitting, what's missing. Don't be afraid to go back to the drawing board, make quick decisions along the way to readdress the market as we have with, for example, ultrasound processing timing so people can make decisions in front of the patient.
[00:56:46] Griffin Jones: Yeah, I might go a little bit beyond that of you saying getting to know the market, which is what you did, which is work in the market. And I think that it's part of, you know, I, uh, it took me a while to build fertility bridge to, The goal that I had for it probably took like seven years in something I wanted to do three, the version of inside reproductive health that I'm building is going faster because I had that experience with fertility bridge.
I would, I would recommend that people work in the field that they go work for someone. I think that there's a lot of contemporary advice that says, You're not a true entrepreneur if you ever work for somebody else. I think B. S. Like maybe if you're Mark, if you're Mark Zuckerberg, sure. Like go and go and go and do the thing.
But for most people, especially if you're going to end up being a small business owner, a 10, 15, 20 million business, which by the way, is being a one percenter, you know, it's being. It's still a really, really good life, then you can learn a lot by going to work for somebody and maybe go work in one vertical and then another.
So if you wanted to work in the R. E. I. Space and the tech space, go work for R. E. I. Company for three years, then go work for a tech company for three years and In meanwhile, network with everybody you possibly can because you're going to need those early customers fast and you're going to need to hire people that can deliver really fast and not have to figure, figure that stuff out later.
Is there anything about that you've learned about pre selling or, or selling, you know, On one hand, you don't want to sell so early that you can't deliver something. Um, on the other hand, if you waited for the perfect solution, like the absolute theoretical perfect solution, you would never actually get it because you need to sell in order to figure out what it is.
So have you learned some lessons around rules for pre selling?
[00:58:44] Dr. John Schnorr: We've learned a lot of lessons and I think the sales cycle is longer than I would think and again my own Personality is I'll look at something I'll decide if I want or not and move on and implement it move on and act quickly But now all organizations can do that.
So you might be bringing a software solution that improves clinical efficiency And in some organizations, there's going to be one or two people who are going to make that decision. You're going to move on to the next week and everything's going to be fine. There are other organizations. You need to get through three or four committees to make sure it gets approved along the way to make sure that it is okay.
And security is okay. And then some centers want to measure every follicle for three months to make sure it's accurate. And others are going to say, well, you know, if the FDA approved it, then I'm good with it too. Let's move on. And so I think everybody's different and you need to understand. A, what the center's challenge is.
Why are we here? What are you trying to address? B, talk about what our technology can do and figure out how we can implement it the best. And I think you need a physician champion. And I think for us, you need an administrative champion too, who's going to try to encourage people to invest time into it.
Technologies like ours, you start by losing you time. You, you lose time to learn this technology and implement it. By two months in, you might break even, you really don't start seeing the benefits until four to five months down the road and you got to prepare the client for that journey.
[01:00:08] Griffin Jones: John, this has been a blast.
I've had a great time going through this with you because I think your company is doing it right. I think you're doing it right as a bootstrapper. I'd like to see a few more companies do it. Other companies like the ones we talked about, I think are. doing it well. And of course, there's more, but I, I think it's a solution that is not for everyone or a pathway that isn't for everyone, but should probably be considered by more than it is now.
And so how would you like to conclude, you know, maybe you will raise money someday if the time is right, but you haven't up to this point. So how would you like to conclude with how you think about bootstrapping in this space?
[01:00:46] Dr. John Schnorr: I would just like to conclude and say that I think entrepreneurship is for the brave.
That it, you know, you got to have bold ideas. You got to have convictions. You got to be willing to put resources behind it. Sometimes less, sometimes more depending on how you end up funding yourself. But I think that entrepreneurship creates great ideas that make the world a better place. And I'd like to encourage people to pursue their dreams, to think about.
what problems are that they can help solve and help solve those. And the more of that you could do with your own funds, the more equity you'll have at the end for having a big investor kind of help get you to that, you know, international, you know, deployment or wherever you're headed next.
[01:01:26] Griffin Jones: Dr. John Schnorr, it has been a pleasure.
I look forward to having you back on for a third time. Thanks so much for coming back on the Inside Reproductive Health podcast.
[01:01:36] Dr. John Schnorr: Thank you so much, Griffin.
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