✅ Reviewed by Samuel Sarmiento, MD, MPH, MBA
Antonella Sturniolo, MPH, CEO and President of Upsilon Healthcare Technologies joins Carrie Haney, MSPH, of Juniper Life Sciences in a Q&A session discussing current trends in the reproductive health landscape, the Upsilon IUD in development, artificial intelligence in healthcare, and more.
Carrie Haney: Tell us about yourself and your career journey.
Antonella Sturniolo: I grew up in New York City and I come from an international family background. My mother's side is Brazilian, and my father's side is Italian. I stayed in New York for the first 2 years of college. I was at Columbia [University].
I grew up in the medical space. My mother is a melanoma patient at Sloan Kettering [Institute]. Since I was 5, I was always taking care of her bandages, stitches, and wounds. I thought I would continue along that direct patient contact route. I started to realize that there were other ways [I could work in the health space], more from the public health perspective. So, I dropped the pre-med route.
I started hearing more and more about my grandfather [Dr. Samuel Soichet]. He was an OB/GYN from Brazil who opened his practice in New York City. He actually invented one of the first IUDs back in the sixties.[i] This was the same time that the copper T [IUD] that we still have on the market was invented. Some of his studies were actually in comparison with the copper T. Doctors and hospitals all over the world studied his IUD and used it.
I never met [my grandfather] because he passed away in 1982. A few years after he passed away, the IUD market collapsed. It was due to this IUD called the Dalkon Shield, which was invented by a doctor at [Johns] Hopkins.
Carrie Haney: That is ironic!
Antonella Sturniolo: Yeah! So, the Dalkon Shield had a very porous tail and was causing perforations. It looks like a spider. Some women were dying from it.
So, the doctor [who invented the Dalkon Shield] said, “If you're going to review mine, you should review all [IUDs]” to the FDA. So, the FDA created this new protocol for IUDs.[ii] And that's why we see this 20-year gap from the eighties to the early 2000s where IUDs aren't really used. Everyone was scared, and people weren't willing to take that risk again.
In the U.S., we have five IUDs on the market. Four of them are hormonal IUDs and the fifth one is the copper IUD.[iii] The FDA classifies the copper IUD as a drug—they're all drugs because of the way they regulate your body and the biological mechanism of action that these IUDs use. [My grandfather’s IUD] was purely a device. There's nothing active in it.
I started researching my grandfather and found his old IUDs in my grandmother's basement. I thought: “Why don't we have something like this on the market now?” Everything's hormone-based and our only easy [contraceptive] option without hormones would be a condom. We need something that is long-acting, reversible, and doesn't mess with your body. If this [device] was used before, we can make it better.
And then I went to Penn. I focused mostly on the politics and economics of the women's health space. I was fortunate enough to talk about [my grandfather’s IUD] as it was in the research phase. I gave talks about what it would mean to hypothetically have something like this on the market. People came up to me saying, “I'm on this medication. I can’t use a hormonal contraceptive. I have taken the pill. I've tried a million times; nothing is working for me. I get all these side effects. Please let me know when you're doing clinical studies, I would love to participate.” And so that was when the research turned into a reality.
I took all the research, and I turned Upsilon into what it is today. I have a really wonderful mechanical engineer who's on my team. We took the historical device and asked: “How do we make it better?” We came up with about twelve new designs with different materials, different shape variations, and same mechanism—no hormones, no copper. Then we patented the one that we thought would be most suitable. We're at the pre-clinical trial phase now. The FDA said that we would be classified as a device rather than a drug. So, that's great to have something potentially like that on the horizon for the contraceptive space.
And then after Penn, I took some time off. I was doing Upsilon work, moved back to New York. COVID hit and I worked at the UN. Then I went to Hopkins. I did my MPH with a concentration in women's and reproductive health, health policy, and health leadership and management. I got to host a few sessions on entrepreneurship in the health space, which was fun.
Then I lived in Mexico for a year. I was a director for an NGO in the reproductive health space. They provide reproductive health services to low- and middle-income countries around the world. It was really interesting to see their barriers, their perspectives on LARCs [long-acting reversible contraceptives], how religion tied into their perceptions of contraceptives, and how we could gain the trust of people.
And then I came back to the U.S. and I’m still running Upsilon. I'm also helping project manage at a public health startup that's based in California called Wellness Equity Alliance. They are helping bridge gaps in health services in the U.S. [related to] healthcare deserts and underserved populations.
Carrie Haney: Well, clearly, you have done a lot of work in the reproductive health space! All of the accolades and the pursuits that you have mentioned are really impressive, especially for being so young and so motivated.
I know that you mentioned earlier that there are a lot of people who are interested in taking non-hormonal contraception. So, for the current state of the reproductive health technologies and reproductive health space, what can you say about non-hormonal contraception and how does that play into your work at Upsilon right now?
Antonella Sturniolo: There aren't that many [options]. Just in the last couple of years, there are more app-based or thermometer-based non-hormonal options. There’s Natural Cycles, which is the thermometer [app] that that pairs up with your phone and, based on your temperature, can detect whether you're ovulating or not. I think they are working with Oura Ring, too. I think it's a very overlooked market. It's unfortunate that it's overlooked because I think there's a lot of opportunity and a lot of need [for non-hormonal contraception].
Carrie Haney: What are your thoughts on how non-hormonal contraception plays into aspects of reproductive autonomy and self-care?
Antonella Sturniolo: In general, the most common reason for discontinuation of hormonal contraceptives is because of the side effects. The copper IUD also creates the same sorts of side effects.[iv] In terms of autonomy, you want to know what you're putting into your body and be able to regulate it.
I had an instance where I was taking the pill for years and, during COVID, I spent a lot of time outside of New York City. I didn't have my birth control pills because I didn't get a refill. Immediately, it was like this hormonal roller coaster of side effects and feeling really horrible. What we have now, it makes people dependent on the hormones. It’s unfortunate that there's not another option. People may use what's on the market now, but it's more so because they don't have an option rather than actually wanting to use [their contraceptive method]. Something that's non hormonal…you can stop using it, and you don't have those side effects or withdrawal. So, it does make you feel a little bit more in control.
Carrie Haney: Yeah, I agree. I have also seen studies come out showing high discontinuation rates when people are not enjoying side effects, or they feel like they can't successfully manage them. It seems to me a lot of people are turning towards self-care and that's why they're more interested in non-hormonal contraceptive options or just not going on contraception at all.
Antonella Sturniolo: Right, and in Central America, a huge thing was invasiveness. People didn't want to take birth control because it felt invasive. There are plenty of religious reasons as well.
I'm a big proponent of starting reproductive health education at a younger age. But you know, not everyone has that opportunity. So, if they're stuck in that mindset of “This is invasive. I don't have control,” at least providing them with an option that can take away from those feelings is also really important.
Carrie Haney: I want to dive a little bit deeper into what you mentioned about reproductive health education and how you support it being taught at a younger age. In terms of reproductive health education, what would you include in it? Would it be different for different contexts?
Antonella Sturniolo: I'm super open to talking about sex and anything reproductive health. I spent a fair share of my time working in clinics and hospitals. So, I've seen a lot. To me, it's just the natural way that bodies work and the cycle of life happens. But I know not everyone is like that. I think it's up to the educator—who could also be the parents—to present [reproductive health] in a way that doesn’t scare the child or makes them uncomfortable.
I have an older sister. My sister is almost 10 years older than I am. So, for me, I felt more comfortable learning things from her and observing her experiences. I trust my sister. I was fortunate enough to have that.
But in terms of the classroom, the same things [are important]: comfort, trust, and not making it like you're doing something wrong if you're curious. I know that's really tricky to do in certain countries and certain states here in the U.S. I don't truly think there's going to be one uniform approach, but, at least at a basic level, providing accurate and truthful information about how the body works [is important]. Also, making sure that the students are aware of different genders and not just their own bodies, but other people's bodies, too, and how to respect them.
Carrie Haney: Yeah, so it could perhaps be more tailored to certain groups or certain ages. I'm also wondering if you think that reproductive health education, if improved, can also improve our reproductive health indicators as a country or even globally.
Antonella Sturniolo: Oh, definitely! I think it would help the economic burden of unintended pregnancies, which costs [the U.S.] billions of dollars each year and also the families that have these unintended pregnancies.
I think in terms of some of the barriers to having comprehensive, all-inclusive, reproductive health knowledge—at least in this country—maybe even tailor [reproductive health education] to more conservative states. For example, maybe frame it more from a family planning perspective, explaining that when the time comes and you want to create a family, or have a relationship with someone else that's very intimate, here's what you can do. Frame it to what is appropriate to each community.
And having the right person teaching the information is extremely important, similar to birth control. Our birth control options, historically, were invented by men, which is very odd to me. Try to shift that space a little bit and make it come from people who actually have the experiences and the knowledge.
Carrie Haney: I think a better understanding of reproductive health in its multiple aspects—whether it's family planning, maternal health, menstruation, or sex education—a better understanding of that could definitely benefit public policy and thus benefit all kinds of communities.
Antonella Sturniolo: Yeah, and also having the politicians be informed is something that we're lacking right now. I don't think there's enough [reproductive health] education—not just at the student level, but at the adult level too.
Carrie Haney: So, that’s all-encompassing—having better reproductive health education for everyone. That would definitely benefit us as a society.
Antonella Sturniolo: In general, yes.
Carrie Haney: I’m curious about the Upsilon IUD itself. You did mention that it's in development and that it’s different from currently available IUDs because it's non-hormonal and non-copper. Are there any impacts that you think this IUD could have on clinical care or treatment decisions?
Antonella Sturniolo: The Upsilon is a Y-shaped IUD. It actually fits the natural shape of the uterus, so insertion and removal are easier and less painful than the T-shaped IUD. For postpartum women, the go-to method is to insert an IUD after someone has a baby. First of all, the expulsion rate for postpartum women is high after you have a child, so usually you stick an IUD in, and it tends to come out pretty easily. With the Upsilon, because there's no active component to it, you can re-sterilize it and reinsert it. It's like a recycling method, but with the same device.
We also have it in different sizes, so it's accommodating to how many children you've had. There’s a smaller one for [those with] zero to one child and a large one for multiparous people. So [the Upsilon IUD could be] for postpartum, avoiding side effects, or if you're on certain medications and can't mix with hormones.
It can be left in longer, too. We're claiming that the [Upsilon IUD] should be able to be left in longer based off the results of the historical device. So, that can help with the economic burden of having to go to the doctor more than a few times over the span of, maybe, 10 years. Let's say you're in a healthcare desert, you have a few kids, and you're working more than one job. It’s a lot even to get yourself to go to a doctor. So, having something that prevents pregnancies and can be left in longer may be the goal because it reduces that burden.
Carrie Haney: It’s interesting that you mentioned the “recycling” aspect of the Upsilon IUD. I would assume that for the IUDs currently available, if you decided to get them removed [and] reinserted, it would have to be a new, sterilized device. So, that could have both an economic and environmental impact.
Antonella Sturniolo: Yeah, like the Diva Cup of IUDs! You can re-sterilize, reinsert, and reuse it for a longer time than other devices. And if you don't have insurance, some IUDs can go up to $1,300 a device. So, at least creating something that can be more accessible and affordable is very important.
Carrie Haney: Definitely. These are very interesting and very positive aspects that would certainly differentiate this product from other products that are available right now.
In terms of non-hormonal contraception in general, it sounds like you have personally witnessed some interest in non-hormonal contraceptive products from patients and consumers. But from a provider’s perspective, do you think they would be open to offering a non-hormonal, non-copper IUD?
Antonella Sturniolo: Oh, definitely. One of the biggest pain points that we've heard from physicians was a need for easier insertion and removal techniques. They have their patients coming back and having all of these adverse effects and bodily discomfort, frequent dysmenorrhea, so irregular bleeding…We've definitely heard this from physicians and OBs all over the U.S. and even some internationally as well.
It's just a matter of finding the right people that aren't scared to use it. Older doctors—not all of them, but some tend to fall back into, “Well we already have things that work, so let’s just keep going with what we know.” I don’t think that’s the best approach for being innovative and bringing new things to the market that people are actually asking for.
Carrie Haney: Exactly. Sometimes, a new product or a new indication could be really helpful for patients.
Alright, I'm going to switch gears a little bit and ask about what you think of the future of reproductive health. Juniper is very interested the roles of precision medicine and newer technologies, such as AI and machine learning, in different health spaces. So, in your view, is the proliferation of AI changing the reproductive health space? What effects that could that have on contraception, specifically?
Antonella Sturniolo: In terms of patient care, I don't think anything is really changing, at least right now in the most graspable future. But I do think AI provides a really unique space for people who can't make it to their doctors, or maybe don't quite know what's happening. Let's say, during the menstrual cycle, you have ovarian pain, and you don't have an outlet to talk to, or you can't make it to the doctor’s [office]. I think AI does provide that resource to be able to ask questions and see what might be going on. It could be a good tool for the health space in general.
Carrie Haney: Yeah, it seems like there are a lot of different ways we can use AI to improve the health system and patient experience with their health services and health care. But in terms of precision medicine and the role that AI plays, whether it's the reproductive health space or other health spaces…
Antonella Sturniolo: I don’t believe AI is there quite yet.
Carrie Haney: That's what I've heard. And I've seen that there are a lot of business endeavors to improve the ways AI can be used. But at this point in time, it doesn't seem like there's a lot of confidence in that quite yet. Do you think this is something that should be pursued further? Or do you think there are other uses for AI?
Antonella Sturniolo: I'm not opposed to it. I want to see where [the use of AI] takes the healthcare space. It's going to be a lot of trial and error…a lot of people being hesitant or mistrusting. But I think if done right, it has a lot of potential to change the whole industry, which is also kind of scary to think about.
Carrie Haney: It’s the fear of the unknown and being unable to anticipate the outcome. I feel like there's a lot of things that AI could do in this space, but I can't even conceptualize it in my head at this point.
Antonella Sturniolo: It's also that feeling of lack of autonomy and loss of control, right? In person-to-person contact, you see in real time what they're doing. And there's a sense of relational contact going on. Whereas, with AI, it's like you're talking to something that's not alive. There's something a little unnerving about that, at least for me.
Carrie Haney: So, with that idea, do you think that there's still an important role that person-to-person interaction has in healthcare and the provision of healthcare services?
Antonella Sturniolo: Oh, yeah, I think so. I don't think that's ever really going to go away. Coming out of surgery, I want to be able to talk to a person and ask: “Am I okay? You know what this feels like.” You want something that knows what you're experiencing and not just something that's relaying the information from someone or a system. With AI, I think it's more like a game of telephone. But I also think it's really powerful for [less-invasive] forms of healthcare. For the provision of information and for basic treatments, I think it could be a really useful tool.
Carrie Haney: I'd be very interested to see in what forms AI manifests in the reproductive health space. I'll be paying attention to that!
I think we have time for one more question. So, I would like to know: how do you anticipate this field changing in the future? I know we've mentioned patient and physician interest in non-hormonal contraceptive options. Also, it sounds like reproductive autonomy—having a lot of [contraceptive] options, in general—is a goal that people are trying to strive for.
Antonella Sturniolo: Well, I think the space is going to grow significantly. The FemTech space, and just the reproductive health space, in general, has been overlooked for so long that people are getting kind of antsy and aren't satisfied with what they have now. [There is] big unmet need in this space. So, I definitely see it expanding. There is more awareness of unmet need, and more and more communities being built up. People are gathering and creating meetings and online platforms to support with one another.
Carrie Haney: So, you anticipate it growing because all of these unmet needs are being expressed and people are starting to pay more attention to that. Do you think that will translate into more funding for reproductive health research as well?
Antonella Sturniolo: I hope so—we need it! The investor side, unfortunately, is also saturated by people who don't really understand the space. But I think people should eventually feel more comfortable with taking risks in this space. A lot of the ideas that are being pitched…they're not coming from nowhere. For example, with the Upsilon [IUD], it's something that was proven to work before, and something that would fill in the gaps for an unmet need. It's coming from real world experiences. And the same goes for some of the other technologies that are in the works. People just need to see that these are real issues and need take those risks.
Carrie Haney: So, there's a second part to this question. In addition to how you anticipate this field to change in the future—which we have just discussed—in what ways do you anticipate it to stay the same? Or what do you think is going well so far, and that we need to maintain?
Antonella Sturniolo: That’s a good question. I mean…should anything ever really just stay exactly the same? I don't think so. We’re going to keep discovering new things about how the body works. On the most basic level of, let's say, the menstrual cycle, right? People are now figuring out what exercises to do at the different stages of your cycle and what foods to eat.
Carrie Haney: I think I’ve been seeing that same thing!
Antonella Sturniolo: Yeah! And no one even thought of that ten years ago! Well, maybe people did, but they did not have a platform to share that information. So, I think things will be ever-changing and should be ever-changing. Like how the copper IUD came back to the contraceptive space. We had those fifty or sixty years ago and now it's better than it was. We can maintain the same technologies or approaches to things but updating it in real time to account for the twenty-first century. I don't think anything will ever just stay stagnant.
Carrie Haney: That's a very good answer! Well, it’s past time. But I want to reiterate that I really appreciate you taking the time and sharing your thoughts with me, sharing your journey, and about Upsilon in general. I am very excited for you and to see what you and Upsilon will do in the future! Thank you so much!
Antonella Sturniolo: Of course! Let me know if you need anything else from me.
Footnotes
[i] Dr. Soichet’s preliminary report of his Ypsilon IUD, a Y-shaped device made of stainless-steel wire and silicone rubber, appears in an issue of the American Journal of Obstetrics & Gynecology published in 1972.
[ii] Articles from Britannica online encyclopedia and the American Medical Association (AMA) Journal of Ethics provide further information on Dalkon Shield and the FDA’s adjustments to medical device regulations in response to the scandal.
[iii] For more information on IUDs currently available in the U.S., please refer to resources available through the Centers for Disease Control and Prevention (CDC) and KFF.
[iv] WebMD and other online health resources report that hormonal IUDs and the copper IUD tend to have slightly different side effects.
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