Meet Dr Max Meissner, CEO and co-founder of CytoSwim. CytoSwim is a spin-out from the University of Warwick developing innovative sperm conditioning tools for in vitro fertilisation and aims to play a pioneering role in the future of assisted reproductive technology.

Max Meissner presented to raise further EIS investments at the Oxford Technology pitch day on September 2nd. The pitch recording is available here.

Thank you for joining us, Max. Could you shortly tell us the story behind CytoSwim?

CytoSwim is quite a strange company because we spun out from a physics lab, despite now working in Medtech. The reason for this is that our research was all about microswimmers and how small cells swim on tiny scales. In brief, this is really interesting because the physics is completely different from a larger swimmer at those length scales. And we were looking at microswimmers from a variety of sources: sperm cells, green algae, even bacteria. And throughout this research, one of the things that were discovered is that you can build these channels that have walls that guide sperms to a location. The next thing that we were looking at researching is what happens when you have a very high concentration of cells. Sperm cells in particular start behaving almost like they are a swarm. They move in these groupings of cells which are quite spectacular considering there is no intelligence or driving factor, it’s a purely physical phenomenon that leads sperm cells to swim in this sort of swarm pattern like you see a shoal of fish or flocks of birds doing. But one of the problems with doing this sort of research is that frozen sperm is mostly dead, and if you have dead cells in your systems, you don’t get these phenomena. At that point, we decided to look back at some of the research we had done previously and rebuild that research into a way that would select out healthy cells from dead ones so we could get these high concentrations of fast swimmers. That was quite successful, but then we took a step back and said, “Wait a second, we’ve just done something that can select healthy cells from a population of dead ones. Why are we just taking pretty pictures of this with a microscope instead of thinking about the wider context?”. And that is when we started looking into what this can do for Assisted Reproductive Technology. We started looking at working with bovine, semen producers, and working with people like Allan Pacey in Sheffield to find ways to expand this technology. And at that time we started looking into commercialising it, which we did through the ICURe scheme from Innovate UK. Everything was pointing in the direction that commercialisation could work. So we spun out the company in February 2019, then obtained funding about 6 months later, and we properly started CytoSwim in October 2019. And that’s where we are now.

What is the nitty gritty of the problem you are addressing and how does your technology solve it?

In terms of how it works, sperm cells have this interesting phenomenon when they encounter a wall: they swim along the wall. Our device has a microstructure that is shaped in such a way that when sperm encounters this wall, cells are steered in the direction we want them to go. You can imagine it almost like applying a bias to the motion of the sperm cells. Sperm cells would happily swim around in disorder, but our device corrects this disordered motion so it is harder for cells to swim away from where we want them to go. And what this means is that the good cells, the cells that can swim longer and faster, eventually make it to the middle of the device, where we can collect them, while the inefficient cells are left behind, swimming in circles or staying in place.

As to the problem, the statistics are that 1/6 couples can expect to have some form of infertility and, of that, something like 40% of it is directly linked to male infertility, which is a staggering number. And yet, due to various societal taboos people do not like talking about male infertility. This means that there is a problem, but it is completely underserved. For the longest time, IVF and other fertility matters were basically seen as just a women’s issue, and that men were just perfect sperm donors. Only recently, society has changed its viewpoint on that, and the actual IVF field is also changing. We are now seeing more and more awareness of how difficult male factor infertility makes IVF, while also factors like age or health affect sperm quality. What this means is that the assisted reproduction field is at a point where there is a range of treatments aimed at correcting female infertility, but very little to do the same for male infertility. Our technology offers a single-use medical device that can essentially correct sperm immotility and most types of male infertility. Sperm that goes through our device is better in pretty much every conceivable metric that is used to measure sperm quality and goes some way to addressing these issues of lower sperm quality.

How does this make you stand apart from the solutions available?

There are a few solutions but they are very limited. One of the techniques that are used in clinics is swim-up, which is a rudimentary system where sperm is just placed in a liquid and left to sediment, and the better cells will swim to the top. This is not a very fast or powerful method. The other one is density gradient centrifugation. This is quite powerful but involves significant forces on the sperm cells, which has been more and more implicated in actually damaging the cells themselves. So it is a bit of a devil’s bargain for the embryology clinics: you can do the less damaging, but less effective swim-up technique, or you can use density gradient which is quite good in getting you the healthy cells, but it also damages them. So are they healthy cells at the end? You select for motility and normality, but you don’t actually check the DNA damage. What our technique does is that it allows the best of both of these. It’s as easy and gentle as the swim-up, while being even more effective than density gradient.

So far, your solution has been commercially tested for cattle. What does the transition to humans entail?

It is quite an important transition. The veterinary market is a very good testbed for these technologies because cattle IVF is broadly similar to human IVF. The big barrier is, of course, medical device regulation. While veterinary providers mainly care about good success rates and results, they don’t need to have a certified medical approval stamp. So, to get this product into the human market we need to get it approved, and with a CE mark in Europe and FDA approval in the US.

Besides being a growing market, IVF is increasingly going to shape our lives. What does the future of assisted reproductive technology look like?

The first point is that we are going to need more and more of it. Societal trends are pushing people away from having children early. And, more clearly than anything else, it is the age that is affecting fertility. That is true for women, and now evidence shows that is also true for men. Far from the societal wisdom that men can have kids all the time, men have a biological clock and the sperm quality and count drop significantly over time. However, it’s going to be harder and harder to have a child early, from the perspective of affordability, stability, career, and financial security. Unless something significant changes in the way modern society is built, more and more couples are going to need IVF. In terms of the fertility treatments themselves, at the moment they are a bit like a hammer. The most powerful techniques are used for pretty much every IVF, but there is very little fine-grain for specific patients’ requirements. This is where the future of IVF is: as we increasingly gain awareness on the different families of infertilities, more and more tools like ours are becoming available, and IVF clinics will then be able to have bespoke treatments for their patients’ own needs, rather than one size fits all solutions.

What role does CytoSwim want to play in this process?

CytoSwim wants to make everyone’s life easier. Because our technology doesn’t require a time machine to go back and change your lifestyle habits. If you have good cells in your sample, our technology is going to find them. And I think that’s really important because age is a sword of Damocles hovering over fertility. So, it’s fine to tell people that they should’ve started to live healthily two years ago if they want to conceive because it is definitely true. But if you are at the point where you are actually struggling to conceive, where you are already getting fertility treatments, you really don’t have the luxury of time. You need to have the best chance of success now. By selecting out these incredibly good sperm cells with low degrees of DNA damaging and high motility, we can give the very best chance to succeed.

What’s on the cards for CytoSwim for the rest of 2021 and 2022? Can we take a sneak peek at what is coming?

We are currently fundraising, and this is quite exciting. With this fundraise, we’ll have the resources to finish some of our medical approval and start getting the product out. We’re hoping to launch the product before the end of 2022, and that is tremendously exciting. We are carrying out some studies with clinics in various locations and hopefully will get our product to the hands of skilled embryologists as early as we can. But it’s quite a big structural change for the company, as we are going from just a prototyping and R&D company to one actually manufacturing a product. A fascinating and slightly terrifying transition.