Written evidence submitted by Dr Helen O’Neill, Dr Natalie Getreu, Zoya Ali, Dr Esther Wainwright & Lauren Crawford, Hertility Health Ltd. [RHW0052]

Introduction

Hertility Health welcomes the opportunity to contribute to this inquiry. As a UK-based leader in women’s health, we specialise in developing and deploying clinically validated digital diagnostics and reproductive health screening. Our algorithm-driven platform delivers effective triage, personalised testing, and clinical care, combining secure data handling and digital and physical services to provide earlier insights and shorten the long journey from symptom to diagnosis. Crucially, we have built a proven solution that directly addresses the diagnostic delays, lack of support, and poor patient outcomes outlined in this call for evidence.

With their combined expertise, Hertility’s founders are well placed to address the systemic issues highlighted in this inquiry. Dr Helen O’Neill, Associate Professor of Reproductive and Molecular Genetics at the Institute for Women’s Health, UCL, has led research at the intersection of reproductive genetics, fertility care and women’s health policy for over a decade, giving her a unique perspective on how evidence can translate into earlier interventions and improved outcomes. Dr Natalie Getreu, a reproductive biologist and fertility preservation specialist, has worked across both clinical and research settings, with a focus on safeguarding reproductive potential and improving access to timely care. Their backgrounds equip them to bridge the gap between scientific discovery, clinical delivery and policy change, ensuring that the lived experiences reflected in Hertility’s dataset are translated into actionable recommendations for government. Hertility has built one of the largest reproductive health datasets of over 650,000 participants, including more than 98,000 young women and girls. Our evidence provides a unique lens into menstrual literacy, symptom burden, healthcare experiences and inequalities of women in the UK.

Our dataset tells a story that too many already know: young women are entering adulthood without the knowledge, tools or support to manage their reproductive health. Their pain is dismissed, their symptoms normalised, and their conditions diagnosed years too late. But our evidence also shows what is possible. When education, diagnostics and digital tools are combined, they can be empowered to recognise red flags, seek timely care and make informed choices about their futures. This evidence strongly positions reproductive health, and Hertility's mission, to align with the ambitions of the forthcoming 10-Year Health Plan, particularly concerning prevention, early intervention, digital innovation, and patient empowerment.

This submission draws primarily on Hertility’s dataset to address the Committee’s terms of reference. We provide insights in four priority areas:

1. Provision of Effective Education and Quality Information

Despite reforms to Relationships and Sex Education (RSE), menstrual health education in England remains inconsistent (Department for Education, 2024; Department for Education, 2025). Delivery of menstrual health content by teachers is often reported with limited confidence beyond the basics of biology (Curry et al., 2022). Content frequently focuses on reproduction and contraception, rather than wellbeing, red-flag symptoms, or the impact of conditions such as endometriosis. The result is that many girls leave school without the basic literacy needed to recognise what constitutes a normal menstrual cycle, when symptoms are concerning, or how to seek appropriate help.

Hertility’s dataset makes these gaps visible. Among more than 98,000 under-25s in our cohort:

●        One in three (32.6%) did not know  how long their cycle was.

●        Even among those who described their cycles as “regular,” one in five (20.5%) still did not know their cycle length.

●        Nearly 1,000 confused the term “cycle length” with “period length”.

●        For those with irregular cycles, uncertainty was even greater: almost half (48%) could not state a cycle length at all, and a further 28.5% reported cycle lengths within the normal 21–35 day range, showing that many are unsure what “irregular” actually means.

When we turn to fertility knowledge, the picture is just as concerning. Among 16,037 women under 25 who told us they were trying to conceive, 56.2% did not know when their fertile window was. Without this knowledge, young women struggle to plan pregnancies, but more importantly, they miss early warning signs of conditions that disrupt ovulation.

The consequences are profound. Without understanding what is normal and healthy, girls and young women are less likely to recognise abnormalities such as irregular cycles, heavy bleeding or severe pain and leaves them less confident in seeking care when something is wrong (Taylor & Greig, 2024). They delay seeking care, conditions go unrecognised, and years are lost before diagnosis. Hertility’s data shows that many women report unmanaged symptoms throughout adolescence and only access care in adulthood, by which time treatment options may be fewer.

This lack of knowledge also fuels stigma. Girls who are not taught to speak openly about their menstrual health are more likely to miss school due to unmanaged symptoms, less likely to advocate for themselves with healthcare professionals, and more likely to internalise pain as “normal.” In this way, silence becomes a form of harm (Scott et al., 2020; Brown et al., 2024; Wiggleton-Little, 2024; Wall et al., 2025; Sawyer et al., 2025)..

A clear example is polycystic ovary syndrome (PCOS).  PCOS is one of the most common hormonal and metabolic conditions, affecting an estimated 1 in 10 in the UK (NHS, 2022). Despite its prevalence and impact, it still takes an average of two years and more than three clinical consultations for most women to receive a diagnosis (Gibson-Helm et al., 2017).

Hertility’s research shows that limited awareness plays a central role: young women do not recognise symptoms characteristic of PCOS need investigation, and therefore delay seeking help (Ali et al., 2022). More than 70% in our 2022 study reported symptoms indicative of PCOS, yet three-quarters of participants delayed seeking medical help for up to two years, most commonly because they did not realise their symptoms required medical attention, followed by dismissal by healthcare professionals. Even after seeking help, satisfaction with traditional healthcare was low. Over half of participants said they were dissatisfied with the information provided to manage their condition. While mental health concerns were among the most frequently reported symptoms, very few recalled these being addressed in consultations. More than 90% turned to the internet for answers, with many relying on unregulated sources such as TikTok or Instagram.

This is what happens when education fails. Without clear teaching on what needs medical review, young women normalise debilitating symptoms and delay care-seeking.It also underlines the risks of young women turning to unregulated sources when official health systems do not provide accessible, trustworthy information. The result is longer diagnostic journeys, a lack of trust in medical professionals, inadequate management and poorer health outcomes.

2. Addressing Racial Bias and Discriminatory Assumptions

Knowledge gaps are widespread across all communities. Hertility’s data show that 32.6% of under-25s overall did not know their cycle length. This uncertainty was consistent across ethnic groups: 28.4% among Asian respondents, 28.8% among Black respondents, 31.6% among those of mixed ethnicity and 33.1% among White respondents (Figure 1). These figures confirm that menstrual literacy is a systemic issue, not confined to any one community.

Figure 1. Hertility respondents who did not know the length of their menstrual cycle, split by ethnicity.

However, inequities do not end there - they accumulate and create downstream harms. Hertility’s Inequality Report shows that Black women approach reproductive health interventions later in life than White women, on average by 1.5 to 3.6 years, and are more likely to have been trying to conceive for more than five years (14.4% compared with 8.9%) (Hertility, 2023). By the time many reach services, opportunities for timely intervention or fertility preservation have narrowed, suggesting that the burden of inequality falls disproportionately on women of colour.

These disparities demand structural solutions. Ethnicity should be systematically recorded across reproductive health pathways to enable accountability. Community-led initiatives must be integrated into national strategies to ensure education is relevant and accessible. And cultural competence training must be embedded as a core requirement in healthcare, so that discriminatory assumptions no longer shape clinical practice. New diagnostic tools and digital innovations must be designed and implemented in ways that actively reduce inequalities rather than reinforce them. For example, AI systems trained on incomplete or biased datasets risk encoding and amplifying the very disparities they are meant to address (Hasanzadeh et al., 2025). Without deliberate action, the benefits of innovation risk being disproportionately felt by those already best served by the system.

3. Work to Develop and Roll Out New Diagnostic Tools

If the problem begins with poor education, it is compounded by diagnostic delay. Hertility’s data highlight a striking mismatch between the symptoms young women report and the clarity they receive from the healthcare system. Among under-25s, the burden of symptoms is high (Table 1). Yet almost 35% of respondents told us they suspected something was wrong but had not received answers through traditional care.

When asked about their objectives in using Hertility, almost half (45.9%) said they wanted answers about their fertility, one in three (32.4%) wanted more information about their hormones, 12.6% sought help with symptoms, and 9% said their primary goal was to obtain a diagnosis. Among those concerned about endometriosis, 15.5% were primarily pursuing a diagnosis, while for PCOS it was 10.9%.

Table 1. Top 12 symptoms described in Hertility’s under-25 cohort

Of the 4,751 women under 25 who received a suggested diagnosis following Hertility testing, the most common finding was PCOS (40.5%). Symptoms indicative of endometriosis were flagged in 19.3%, while low ovarian reserve was identified in 3.7% cases. Although small, this group is clinically critical, early fertility preservation discussions could change their future options. Under current NHS pathways, these women would likely have been missed, as ovarian reserve is rarely assessed until difficulties conceiving emerge.

These findings demonstrate the prevalence of reproductive health conditions in young women and the missed opportunities created by diagnostic delays. Current NHS models, reliant on repeated GP visits before referral, leave many waiting years for answers. Endometriosis diagnosis still takes eight to nine years on average (Endometriosis UK, 2024). Around 70% of women with PCOS remain undiagnosed (WHO, 2025), and many only receive clarity when they start trying to conceive. The consequences are profound: pain and health concerns are dismissed, quality of life is undermined, and treatment options are restricted at a later stage.

Hertility has developed a clinically validated, end-to-end diagnostic and care model that shortens the journey from years to days. At the core is our proprietary Online Health Assessment (OHA), which captures over 1,200 variables spanning medical history, symptoms, lifestyle and reproductive goals. This data is analysed using machine-learning models aligned with international diagnostic criteria (RCOG, ASRM, ACOG, ESHRE, NICE), generating differential diagnoses and next-best-action recommendations for clinician review.

Users are then guided into tailored hormone testing, including up to 10 biomarkers such as ovarian reserve (AMH, FSH, LH, oestradiol), thyroid function, cycling hormones and androgens. Samples are collected using Hertility’s validated at-home capillary blood kit that can be done at home and posted directly to our laboratories, removing barriers such as in-person phlebotomy, repeated GP visits or prolonged waits. Our validation study, published in a high-impact journal, confirms that capillary testing achieves the highest standards of accuracy and regulatory compliance (Vasavan et al., 2023).

This pathway continues with specialist consultations and follow-on care. Each user receives a personalised report reviewed by our doctors, with clear recommendations for next steps. Where conditions such as PCOS, endometriosis or thyroid dysfunction are suspected, users are guided into appropriate referrals like ultrasound scans, repeat blood testing,  fertility clinic referrals etc. Hertility also provides continuity of care through gynaecology, endocrinology, nutrition and mental health services, ensuring that women are supported beyond their test results.

To date, Hertility has collected over 650,000 OHA responses and 71,000 hormone test results, creating HertilitAI, one of the most comprehensive reproductive health datasets worldwide. Internal evaluations show that our OHA-led pathway outperforms clinician-only baselines in identifying likely conditions and directing appropriate testing, achieving 98–99% diagnostic accuracy. Crucially, HertilitAI complements rather than replaces clinicians, reducing subjectivity, improving consistency and preventing women from being left in limbo while waiting for referral.

Our model demonstrates what is already possible. With national support, validated diagnostics and AI-driven triage could be embedded into NHS referral systems, e-consult platforms and the forthcoming NHS HealthStore. This would allow earlier answers, reduce demand on overstretched services and prevent thousands of women from enduring years of pain and uncertainty.

This evidence highlights two important truths. First, the gap young women face is not only in diagnosis but also in reassurance, education and the ability to understand their bodies and fertility. Second, current pathways fail to meet these needs. By neglecting menstrual literacy, symptom recognition and early fertility conversations, the NHS is pushing women towards private providers like Hertility. Our model demonstrates what is possible, but these benefits should not be confined to those who can pay, these innovations must be integrated into NHS pathways to ensure equitable access and prevent the widening of health inequalities.

This model demonstrates that innovation is an existing, practical solution. With national support, validated diagnostics could be scaled to provide earlier answers for thousands of young women, addressing one of the most significant barriers in reproductive healthcare today: the delay between symptom onset and meaningful diagnosis.

4. Potential Impact of the 10-Year Health Plan for England

The forthcoming 10-Year Health Plan represents a pivotal opportunity to embed reproductive health within national priorities. Its ambitions around prevention, early intervention, digital innovation and patient empowerment align closely with Hertility’s mission and evidence.

Hertility’s data show that too many young women enter adulthood without the knowledge or tools to manage their reproductive health. This is precisely where the Plan’s emphasis on digital transformation could deliver meaningful change. For example, transforming the NHS App into a platform for access and care planning could provide a trusted channel for menstrual and reproductive health education. Embedding clear, evidence-based literacy resources into the NHS App would give young women the confidence to identify abnormal patterns early and seek timely help.

The Plan’s proposed creation of a “HealthStore” of approved digital tools is equally important. Hertility’s clinically validated digital assessments and at-home hormone testing already demonstrate how innovation can shorten diagnostic timelines and connect women to care sooner. Including reproductive health tools within such a HealthStore would allow these benefits to be scaled equitably, ensuring that early detection of conditions like PCOS, endometriosis or low ovarian reserve is not limited to those who can afford private testing.

To succeed, however, the Health Plan must place women’s health at its core. Without explicit commitments to reduce diagnostic delays, improve menstrual literacy and address systemic inequalities, reproductive health risks being overlooked once again. But with clear targets, integration of validated digital tools, and strong oversight, the 10-Year Health Plan could mark a turning point in how girls and young women experience reproductive healthcare in England.

Hertility is uniquely placed to support this ambition. Our model combines one of the UK’s largest reproductive health datasets with clinically validated diagnostics and personalised digital education. We have already shown that young women can be identified at risk of 18 of the most common gynaecological pathologies within days, rather than years, and provided with tailored advice about when and how to seek care. Integrating this model into NHS pathways would provide earlier answers, reduce diagnostic delays, and empower women with trusted information from the start.

Conclusion

Hertility’s evidence makes clear that too many young women in England are being let down by a system that fails to equip them with the knowledge, recognition, and care they need to manage their reproductive health. Too many enter adulthood unsure of what a healthy cycle looks like, unable to identify red-flag symptoms, and left waiting years for a diagnosis when something is wrong. For women of colour, these barriers are compounded by bias and inequity, resulting in even later engagement with services and poorer outcomes.

Hertility’s data show both the urgency of the problem and the potential for solutions. We have built one of the largest reproductive health datasets in the UK and developed clinically validated, at-home diagnostics that can identify risk factors for 18 of the most common reproductive health related conditions such as PCOS and endometriosis long before they are typically recognised in NHS pathways. When paired with personalised digital education, these tools not only provide earlier answers but also improve confidence, literacy and trust.

The demand for answers is already there. Young women come to Hertility not because they want to bypass the NHS, but because they cannot find clarity within it. With the right policy framework, those answers could be made available to every girl and woman, not just those who can afford private care.

Hertility stands ready to share our data, insights and expertise to help achieve this. Together, we have the chance to transform reproductive healthcare so that no young woman is left waiting years in pain or uncertainty, and every generation grows up with the confidence and support to take control of their reproductive health.

October 2025

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