We have undeniably come a long way when it comes to health. Yet, there is still so much that hasn’t been explored about women’s health. There is a noticeable gap in how women can learn about the different chapters of their lives. Dr. Daisy Robinton, the Co-founder and CEO of Oviva Therapeutics, is elevating conversations around women’s health, helping them live longer, healthier lives. In this episode, she discusses hormones, ovaries, and our overall reproductive health and the current struggles in the space to tackle the unknowns and black boxes on them. Plus, Dr. Robinton shares the great things they are doing at Oviva to help women through ovarian physiology to live with longer vitality and better health.

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Ovarian Physiology: Helping Women Live Longer, Healthier Lives With Dr. Daisy Robinton

Elevating Conversations For Better Women’s Health

I loved our conversation with Dr. Daisy Robinton. I love language and these visual ideas. She described dealing with menopause as now it’s like Whac-A-Mole with each symptom. I’ll never forget that because it does feel sometimes and we hear this from you, from patients, from other clinicians that you’re dancing as fast as you can and you fix one thing then another thing becomes so disruptive.

What I took out of it the most is this is the most optimistic person in the space who is full of hope and dream when it comes to preventing poor aging of our ovaries and all of the health consequences that this may have. It’s fascinating to hear about her work and the sequential steps she intends to make.

I love when you are with a doctor or scientist and you do this mind meld of all the complex underbelly that I probably should have paid more attention to in high school and college. We’re excited to bring Daisy on.

 

BOV 67 | Women’s Health

 

We are so excited to have our guest, Dr. Daisy Robinton, who is the Cofounder and CEO of Oviva Therapeutics. Welcome.

Thank you. I’m happy to be here. Thanks for having me.

We’re so excited because you are a serious scientist. I spend much time with a molecular biologist. I don’t know that you do either, Alyssa. We had the opportunity to meet recently at a women’s health conference and your energy and this unique approach were intriguing. We wanted to have you on and learn more. Why don’t we start with a little bit about your background and how you got to be the cofounder of this company and how it builds on what you were a student of for so long?

For many people, it’s a personal story that led me to where I am now. I love science. I’ve always been a curious person. Family history of disease is what pushed me into science but it wasn’t until I was 31 that I launched my career in women’s health in particular. I had already completed a PhD in Human Biology and Translational Medicine at Harvard.

I had gotten out of a long-term relationship and was 31, thinking about my options. I’ve always wanted to have a family, so I decided to visit a reproductive endocrinologist who was married to a mentor of mine and get an understanding of what should I be thinking about. I’m a single 31-year-old woman. I have a career I’m pursuing. I want a family. How do I make smart choices? In that meeting, I was shocked to learn how ignorant I was about the inner workings of my own body in general, but also as a scientist with a PhD in Human Biology and a female person.

I was horrified. This sent me down a whole path of self-education around how our bodies work and what the different transitions throughout our lives are. We all hear about puberty when we’re in school and there’s some talk of fertility. That’s growing now but there’s no real structure to how women learn about the different chapters of their life as dictated by their hormonal health, ovarian health, and reproductive health.

It was serendipitous how I came to found this company, Oviva Therapeutics. It started with that conversation in the reproductive endocrinologist’s office. The next inflection point was a casual coffee I had with a man named James Peyer, who’s the CEO of our parent company, Cambrian. They run a longevity-focused company. I brought up the concept that no one ever talks about ovaries in the context of longevity despite the fact that they’re the fastest aging organ and their decline leads to negative health outcomes for women universally and all women undergo menopause if they live long enough.

It’s fascinating because we have this conversation all the time when you hear how difficult it is to raise money in this space. There’s always someone in the room, sometimes it’s me, who says, “Do you need a bigger market than 50% of the people on the planet for something that they experience that for some never ends?” Once you hit it, it’s a lifelong experience. I get it as a scientist and as a woman. I’m not a scientist and obviously, Alyssa is a physician.

I am still amazed at the state of education that we find where people would look at a map of the female anatomy and have no idea what’s what. It’s part of a big breakdown in education, which we talk about at some point. Going back to your point, I did not know that the ovary was the fastest-aging organ in the body. The doctor and the scientists are nodding.

 

BOV 67 | Women’s Health

 

Its function declines, in some cases, decades earlier than other tissues. If you look at a little chart on when organs decline, your cardiovascular system, your lungs, your liver, they all start going down at midlife. Usually, there’s a precipitous decline in your 80s or 90s. Once you approach menopause, the ovaries go off a cliff. There is a transition period. Probably your readers are familiar with the menopausal transition and the fact that there’s a series of years. Although, it’s usually retrospectively defined.

Once that happens, that whole organ is shut down. All of the systems that it talks to in the body, which are many also get dysregulated leading to increased risk for various diseases and disorders and the loss of vitality, which to me, is the important thing. It’s the ability for a woman to feel vibrant in her life and to continue doing the things she cares about and have the energy to devote to the things she cares about.

Vitality is the ability for a woman to feel vibrant in her life, continue doing the things she cares about, and have the energy to devote to the things she cares about. Click To Tweet

Not to mention fertility. You bring up such a good point. In my office, we often talk about the fact that your ovaries age with you. Your eggs age with you. You don’t generate new ones the way a man may new sperm every couple of days. That’s a very big deal to your point about what we’re educated about even during puberty. We never hear that.

Number two, the age where we start to talk about fertility or the decline in fertility or to get a head start, a jump start on your fertility if you’re interested in pursuing that is gone down. Forty was always that, “This is the age you’ve now reached,” then it was 35 and now it’s 32, where we start to have the conversation about, “Are you interested in freezing your eggs or freezing embryos?” Tell us about how is what your company doing translating to clinical frontline care if it does yet.

It’s a multistep process because what we hope to achieve in the long term is offering a suite of therapeutics that can help women manage the menopausal transition but address ovarian function. The goal is to extend ovarian function. That’s a hard thing to do. It’s a hard thing to build a clinical trial around. The approachable step towards that is starting with more short-term acute indications.

What we’re approaching now with the first program that we’re developing is women who are poor responders to IVF. They’ve probably gone through a couple of cycles and had a very small number of eggs or a few or zero eggs retrieved. The drug that we’re developing would essentially enhance the number of eggs that can be captured during an ovarian stimulation cycle.

That would be the first way that we enter the clinic to establish safety, efficacy, and ultimately, what we think the drug is doing is modulating ovarian reserve and the depletion of the ovarian reserve. Longer term, we’d want this to look more like a chronic preventative treatment that someone could opt into if it felt right for them. Similar to the way many women are currently on oral contraceptives, the daily pill to manage their contraception.

My absolute dream would be that we, Oviva, and a number of other companies have a variety of means that women can engage with different ways to manage. Not just the symptoms of menopause but the onset of menopause and all of the factors that influence the quality of life at that time. This is our first stab at it, so to speak. We’re feeling optimistic because the science is strong. There are decades of beautiful academic work by my cofounder David Pépin and his mentor, Pat Donahoe, who’s also a cofounder of Oviva. We’re just chugging away.

I’m assuming you’re working on prescription drugs. The question to me is like, “Why not use estrogen?” It’s not in vogue now. Although, it seems to be coming back into vogue. Is there any thought to replacing the function rather than something else?

We do need better options with estrogen and more attention to that. We all are somewhat familiar with the women’s health initiative and how that led to a lot of people not getting the care that they would benefit from. My argument would be that unfortunately, across women’s health and female physiology in general, there are so many black boxes and unknowns.

Unfortunately, across women's health and female physiology in general, there are so many black boxes and unknowns. Click To Tweet

Now, the best solution we have for women going through menopause is HRT with either estrogen or progesterone or a combination. There’s a myriad of other hormones that are in play to allow for our homeostasis and well-being. Most of which we don’t have very well-defined roles for throughout our physiology. Part of the rationale is instead of plugging in something that we know we lose, how do we keep things that we know work going?

I don’t know this to be true because there’s such a lack of knowledge in this area unfortunately because of so much attention being focused on male physiology, both in lab animals being tested, leading up to clinical development, and also, in male people who were the vast majority of participants in clinical trials up until 1993 when women were mandated to be included in clinical trials.

A lot of it is expanding our understanding of female physiology and what is going on that we don’t know. Even in the work that we’re doing, there are so many unanswered questions. It’s hard to move forward, which is what all of the women’s health is butting up against. There’s so much basic research that we don’t have on hand. Basic information about variability between women and their cycles and different phases of the cycle and how that changes across people and how it looks for different women to go through the menopausal transition.

There are some data on that. We know that people of different backgrounds experience menopause differently but there’s not a lot of granularity to that. I would love to see over time, as we continue to do this work and more funding comes into this space, that we start getting more granular at the population level so that a woman who’s my age can have some predictive measures as I approach what’s the average age of menopause 52, roughly.

Know to some degree, what is my experience likely to be? When might it happen? Is it going to be in 5 years’ time and 10 years’ time? Is there a way that I can learn that and start taking steps at the appropriate time and interventions that are appropriate based on the predictive measures for me? We see this in cancer biology now. You can do genetic tests. There’s some blood screening you can do. We’ve come a long way there and we’ll have that for women’s health. We’re at the very early stages of that.

It’s interesting when you say that in terms of the data and so much of what we’re collecting is being created, measured, researched, and designed by companies. We hear the downside that information going to be kept private but we now have billions of data points on women’s cycles. We have billions of data points on fertility.

When we talk about reproduction, one of the challenges and I’m sure you’ve heard this expression, is that investors used to focus on bikini medicine but it’s so much more what you described when you’re talking about ovarian function and the outcome is vitality. You can’t say it’s specific to a specific life stage. With that, I also have another question. Is the goal staying vital longer? Is the goal perhaps delaying the onset of menopause? Is the goal maybe making the onset less disruptive as it is for so many women? What is the holy grail here in terms of science?

Everyone will have their own opinion but my opinion and the position of Oviva is what you said prior to your question. How do we sustain vitality for women? There are a lot of different ways that we can get there. A part of it is allowing for there to be options so that women have agency to choose what’s right for them because I do not think this is going to be a one-pill suit also to speak.

Women are going to want different things for their bodies and their experience. It also gets into this strange semantic zone where when you think about menopause, again, that’s retroactively diagnosed right after you haven’t had cycles for twelve months. It’s not so much that’s problematic and many women look forward to that.

It’s the physiological dysregulation that’s paired with that’s problematic. It’s harder to address all the symptomology like Whac-A-Mole rather than either having healthy menopause. You still go into a state where you’re no longer having reproductive capacity. You’re no longer cycling or having menstruation but you also still have skin and hair that feel good to you. You can still have intimacy with your partner that’s not painful. You don’t have mood disorders, hot flashes, and the variety of symptoms that can be experienced by women for years during and after the menopausal transition.

In my view, it’s creating a set of options that is a choose-your-own-adventure for women that allows them to pursue what feels like it supports their vitality. That might be a later onset of menopause. It might be that it changes what that onset means. It changes what that transition is physiologically but you’re still in menopause formally by the medical diagnosis standards.

Here’s our hot flash. At birth, people with ovaries are born with approximately 1 million eggs and by the time puberty is reached, only about 300,000 eggs remain.

I know this isn’t scientific. You’re playing Whac-A-Mole with symptoms but I want to throw it ove to Alyssa. You see patients every day who are complaining of these symptoms. Do you feel a little bit like you’re playing Whac-A-Mole? Do you have to zero in on the most disruptive one? What Daisy’s talking about is a whole new approach but we’re not quite there yet. In terms of what you do now, do you sometimes feel like you’re doing Whac-A-Mole? You resolve one symptom and then the something else becomes very intrusive.

We’re putting out fires where we have to put them out literally and figuratively. At first, we’re treating regular bleeding if necessary, then we’re treating hot flashes and night sweats if necessary. Not everybody goes through these symptoms in a distressing way. The vaginal dryness and the intimacy issues come about a little bit later but certainly, we deal with that very regularly.

I am very much appreciating the things we don’t see on the outside. For example, all the information that has evolved about the earlier menopause, the higher chance of cardiovascular disease. This is not something we’re seeing. I hate to say it’s not as sexy to talk about as some of the other issues but prevention of heart disease is a big deal.

The only real preventative or interruptive types of behaviors that we can recommend regularly are lifestyle modification, dietary manipulation, exercise, stress reduction, getting enough sleep, and that type of thing. Could you imagine if this almost anti-aging phenomenon could come about in the form of a pill maybe? It’s pretty fascinating. On the other hand, do you ever feel like you’re overstepping your bounds or fooling with Mother Nature only because it’s quite profound when you think about it on that level?

It’s a good question and completely reasonable. Again, it’s partly why I tend to frame what we are doing as part of a suite of options because I don’t, by any means, think it’s appropriate for everybody or desired by everybody. When I think about that question as a longtime scientist, but also a Bay Area Californian semi-hippy person who doesn’t like taking Advil but I will when the right headache comes along.

I like to ask myself and the asker of the question, the type of thing of, “Was electricity part of Mother Nature or this sweater that’s probably part synthetic?” It’s cashmere but sometimes synthetic. There are so many unnatural things that we interact with every day. We tend to have that question come up a lot in the context of how we interface with healthcare. Certainly, I don’t want to suggest that putting a band-aid on is going to fix anything, which is partly why I don’t like focusing on symptomology.

More so think about, we know our ovaries are declining in function. We know that their function is integral to our health and well-being and that’s a basic fact. Some people choose a more homeopathic path but generally, if you have a disease like cancer, you’re not thinking, “It’s Mother Nature.” Where do we draw the line when we’re fiddling?

That decision belongs in the patient’s hands. I like being able to provide an option. In the evolution of the work that we’re doing, a big piece of it for me is also broadening the body of knowledge that we’re producing around women’s health. Maybe I’m too entrenched in the system but most drugs that are trying to be developed fail. There’s a significant likelihood that what we’re trying to do, at least this first attack we’re taking, will fail.

In my view, it’s almost not important because all the work we’re doing in the process is as important as making it through by producing more information, both in the animals and hopefully, humans soon. Also, elevating the conversation, being able to have conversations and discussions like this so that other people and women in particular can learn more about their health but also equip themselves with the right questions to ask themselves, their doctors, and their families and whomever they need to make informed decisions about how they’re living their lives.

I’m a major Advil proponent here in the neurotic State of New York. I’m going to come clean about that. How long do you think is realistic for something tangible to come to market on this front for real people?

For menopause prevention, if we’re going to call it that, I won’t get into the whole debate around how we build a clinical trial around this because that’s a whole other worm and it’s difficult. Anything that’s anti-aging or delaying something that’s natural like menopause is a difficult thing to appropriately design a clinical trial around. With that in mind and also having some understanding of some of the science and technology that’s at the forefront of this, I’d like to believe that within a 10 to 15-year timeframe, we’ll see at least 1 or 2 compounds in clinical trials, I would hope, if not an approval.

Certainly, what we’re doing in the clinical path we’re taking would be much sooner than that for the stepping stone disease indications that we’re going to be using to both impact patients but also, demonstrate proof of concept that what we’re doing is working the way we think it does. It will be a much harder task to demonstrate that we’re changing the fundamental nature of something that is already poorly defined at the population level. There’s a lot of work to be done, both from the development point but then also from the infrastructure around how our drugs are approved for anything.

You bring up a real thought first. Please correct me if I’m wrong, I was under the impression that most FDA-approved drugs treat a disease state or disease. With the thought that menopause is a natural phase of life, how is that managed? There may be no answer. It’s just something that struck me by what you said.

Current therapies tend to hinge on a symptom. For example, one of the things that we talk about, at least internally in the work that we’re doing is women who experience painful periods. There’s something going wrong that’s leading to the painful periods but the indication is the painful period itself. It’s like the outcome of the thing going wrong. I think about menopause similarly. Is menopause the indication or is it the dysregulated physiology on the other side? There’s no nomenclature for this currently in the infrastructure of all of this. Part of the work is how we put that forward to be an ICD code or being recognized as something that is treatable. We have some time to get there.

It sounds like Whac-A-Mole on a foggy night with sunglasses on. You’re waiting through all this complexity. When you said 10 to 15 years out, and for folks who are reading and don’t know that that is short to create an entirely new pharmaceutical or active chemical compound, we talk all the time about there’s a lot of challenging things about women’s health. Do you ever get frustrated? It’s such a big vision and you’re so focused on it and it’s still quite far away.

You talk very rationally about the potential for failure, which every entrepreneur faces but doesn’t ever focus on a going-forward basis. Are there moments where you feel like it’s too big a boulder, whether it’s systemically, economically, financially, or in terms of having the conversation? You are coming at the intersection of so many roadblocks and I’m wondering how you deal with the challenges because they come up all the time. I’m sure you had some now.

What I’m encouraged by is that now and for the last several months, I feel like I’ve seen, at least in the United States, a huge surge of energy around women’s health and a lot more voice and presence being given to women’s needs. We had Roe v. Wade overturn, which was gutting, shocking, and horrible. As you said, there are a lot of bad things happening in the space but there’s also a galvanization that’s occurred.

There are a lot of bad things happening in the space but there's also a galvanization that's occurred. Click To Tweet

My first answer is that I feel encouraged by that. My second piece to that is there’s so much to do. It is so daunting but in some ways, it’s nice because the goal is up here. It’s going to take forever to get there but there are so many little wins along the way because there’s so much that hasn’t been done. That is also completely infuriating but I’ve channeled that fury into the work. My fury is constantly raging but it plugs into tackling each of these things all the time and it works for me.

You are quite the glass-half-full type of gal. I love this. Do you have any other pipeline dreams that you’re thinking about for Oviva Health at this point? It sounds like you’ve got your plate pretty full.

Echoing some of what I said earlier, the ultimate goal of providing choice to women is where we’re headed but there’s so much that’s exciting on the path there for me. In part is the academic in me. Most of my history, my career is in academia and there are so many unanswered questions. A big piece of it is what cool studies can we do along the way.

 

BOV 67 | Women’s Health

 

Some of them will directly relate to business activities and some of them might be a bit tangential but there’s a lot of energy around it. I’m a very passionate advocate. I think we can get the funding we need to do those studies. To your point, Rachel, there’s a lot of this work happening in private companies in part because it’s been easier to get the funding there lately relative to academic work.

I’m very excited about that. The third piece is the story component and the conversation. I’m so thrilled to be able to be here, speaking with both of you and to be able to continue not talking about Oviva’s work but the nature of this field, how it’s changing, dreaming up together what could be possible for us, and putting the pieces together because it’s the motivation and community that’s allowing for this new future to be ushered in. I’m excited to be part of it and want to invite everyone in who wants to participate.

That’s a great place to end. One of the reasons we love doing this so much is because we meet people like you who are so passionate and are talking about things that most people can’t even envision. When I think of the people in women’s health as this growing army, I, for one, am thrilled that you’re part of the infantry who is trying to win this battle. We wish you continued success. We will be watching you and cheering you on for sure. It’s exciting work.

Thank you so much. It’s so great to be here. I appreciated this.

 

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About Dr. Daisy Robinton

BOV 67 | Women’s HealthDr. Daisy Robinton has spent her career driven by the notion that healthcare can and should do more to empower people, especially women, to be advocates for their own health. Given the historic gender disparities in biomedical research and healthcare, she launched Oviva Therapeutics with the vision to help women lead longer, healthier lives through the study of ovarian physiology. As an authority on aging, Dr. Robinton has appeared in numerous publications, given a widely watched Ted Talk, and has been recognized by Forbes as one of their 30 Under 30 for her scientific discoveries. Her writing has been published in periodicals such as Nature, Vanity Fair and NEO.LIFE. Dr. Robinton graduated from UCLA and completed her PhD in Human Biology and Translational Medicine at Harvard University. Her work as a molecular biologist, writer, public speaker, and lifestyle & fitness model, contribute to the unique lens with which she examines the intersection of science and culture.

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