U.K.-based startup Hertility provides at-home hormone tests to help women assess their risk of fertility decline and make informed decisions about whether to consider treatment like IVF or egg-freezing. It wants to advertise its services on TikTok, which women use at higher rates than men. But it can’t.
That’s because Hertility ads that mention its diagnostic tests have been blocked by the platform. TikTok spokesperson Ben Rathe says it’s because the company prohibits advertising about fertility treatments and IVF care—something not stated publicly or explicitly in TikTok’s healthcare advertising policy—but Hertility doesn’t offer those. TikTok also offered a number of other reasons for the blocks: that Hertility offers medical appointments through its website (something not necessarily mentioned in its ads), or that an ad featured pharmaceutical content (when the company doesn’t sell prescription drugs).
When Hertility has managed to get an ad on TikTok, it’s been forced to water down its promotional language to the point that it’s no longer even clear what the company does. The company spent two years trying to find a way to market itself on the platform. But in the end, it’s just giving up.
“We are literally hitting our heads against a brick wall,” said Dr. Helen O’Neill, a Hertility cofounder and molecular geneticist who’s spent more than a decade researching infertility and embryonic development.
“We’re not trying to sell anyone egg-freezing or IVF; we’re trying to actually help them get on an IVF journey if they need to sooner,” O’Neill said. But the platform “blocks people from even just getting answers, even though [people] sell all sorts of untoward things on TikTok.”
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Previously, Hertility’s ads had also been blocked by Meta. The Instagram and Facebook parent’s policies allow ads that promote sexual health, wellness and reproductive products and services—including IVF—as long as the users targeted are over 18, and the focus is on health and medical efficacy rather than sexual pleasure or enhancement, according to Meta spokesperson Daniel Roberts.
“What this leads to more broadly is also that it negates normalizing conversations around sexual and reproductive health.”Caroline Hoffman, chief business officer at Nurx
“I’m sad to say that it has something to do with the fact that anything involving women’s health becomes territorial,” O’Neill added. “We see it now with IVF and egg-freezing—that even the smallest bit of insight into women’s health will soon become under attack.”
Hertility isn’t the only fertility company that has struggled to advertise on social media: Startups across the space have seen their ads about in-vitro fertilization and egg-freezing blocked or restricted across TikTok, Google and Meta, according to leaders of multiple reproductive health companies.
On the one hand, these giant platforms have valid reasons for their strict advertising rules, often stemming from the need to meet complex legal requirements of regulations in healthcare and medicine, as well as user safety and privacy laws that vary between countries and states. On the other, some companies and brands in the space see these decisions as censorship of a topic deemed by many to be controversial, in a post-Roe v. Wade era when fertility care has become politicized in the race for the White House, Congress and state governments.
Social media platforms have long struggled to strike the right balance with content moderation: Its rules are ever-changing and often opaque, with imperfect detection and decisions. And the lines between what is or isn’t an ad have been blurred by influencer marketing, which is another (and arguably, more powerful) form of advertising that is not always disclosed, nor policed the same way as classic paid ads.
Different platforms have different rules about whether they allow political ads, but across the board, users and companies alike have raised concerns that politicized topics like women’s reproductive health are increasingly getting the ax. This has previously affected posts about abortion and ads about female sexual health, which may be disproportionately suppressed or removed compared with similar ads geared towards men. In 2022, the nonprofit Center for Intimacy Justice published a report highlighting this disparity across Facebook and Instagram, which allowed ads from men’s health companies promoting products for their sexual endurance, erectile dysfunction and premature ejaculation while blocking ads about menopause, endometriosis and bladder control experienced by women. Hertility and other “femtech” startups banded together to lobby against the issue. And last year, Democrats in Congress asked the Federal Trade Commission to investigate.
Reproductive health companies “engage in a lot of work-arounds [to avoid getting their ads rejected] but by and large, other than obvious known knowns… you often have to guess what wasn’t right,” said Caroline Hoffman, chief business officer at Nurx, a telemedicine platform for women’s health aimed at expanding access to birth control, emergency contraceptives and reproductive care. She said Nurx spends millions per year advertising on TikTok and that they’ve had problems not only with paid ads, but also with organic posts. They see their organic content suppressed less on Meta platforms, and when their ads are rejected there, Meta offers more explanation than TikTok as to why, she said.
“What this leads to more broadly is also that it negates normalizing conversations around sexual and reproductive health,” she added. “It decreases the accessibility for credible and educational content. We want to play a much more active role in informing and sharing facts, and we think that this is our responsibility as a company to educate our patients. But it’s more and more difficult.”
“Trying to conceive: Not a political issue, unless you are not in a traditional relationship. But egg freezing: Very controversial.”An anonymous fertility startup founder
IVF and egg-freezing now appear to be the newest frontier for the problem. At the same time as startups in the space say they’re seeing their ads rejected or restricted, brands are using the same platforms to hawk dubious fertility products to enormous audiences. On TikTok Shop, for example, it’s easy to find unproven pills, powders, teas and gummies claiming to improve the quality of women’s eggs, circulation of their ovaries, functioning of the uterus and balance of their hormones, in apparent violation of company policies. (TikTok Shop prohibits the sale of “unlicensed medicines, herbal or homeopathic products, and those making health claims.”)
Meanwhile, influencers being compensated by fertility clinics are broadcasting their IVF and egg-freezing journeys to followers as a promotional tool—without always disclosing the financial relationship. (This, too, is not allowed on TikTok.) “That seems so ironic that a clinic can directly pay someone to get a procedure” as an advertisement, and “we want to enable people to just get answers, and we’re banned,” O’Neill, the Hertility founder, said.
The cofounder of an egg-freezing company said that TikTok regularly rejecting their ads is polarizing fertility issues that should be straightforward. They were told their ads violated TikTok’s policy on “medical devices,” though their company does not sell medical devices.
“Trying to conceive: Not a political issue, unless you are not in a traditional relationship. But egg freezing: Very controversial, because it means that you are someone who’s potentially looking to put off having a baby so you can pursue a career, education or other parts of your life,” said the cofounder, who requested anonymity because the company is actively lobbying to be able to advertise on the platform. They said they never expected egg-freezing to be controversial. And given the size of the audience for the TikTok hashtag #eggfreezingjourney — at one point 30 million viewers, they said — “Why wouldn’t they want our money as an advertiser to reach that audience?”
TikTok spokesperson Ben Rathe said ads for egg-freezing are allowed in the U.S., as long as they are targeted at individuals over 18 and comply with other rules set out in the company’s policies. But the egg-freezing startup said it met those age requirements.
These obstacles extend beyond traditional social media to search giants like Google.
Google has limited the advertising possible for AIVF, a startup using artificial intelligence to improve and digitize the end-to-end IVF process for patients, fertility clinics and embryology labs across the United States, Europe and Latin America, said AIVF’s vice president of marketing Eyal Katz.
IVF and egg-freezing fall under a Google advertising category called “birth control,” even though they are not a form of birth control. Google spokesperson Nate Funkhouser told Forbes advertising on these topics is restricted only in some parts of the world, banned in China, Hong Kong, Iran, Lebanon, Palestinian Territory, Saudi Arabia, Ukraine and the United Arab Emirates, among other places. But AIVF’s Katz said their prospective U.S. market is affected, too.
“We are targeting countries not included as part of the policy… and still having issues with the policy rejecting our ads,” Katz said. “I was told by a Google representative that it would be wise to remove any mention of birth control or IVF from our landing pages and/or ads. However, unclear as to why I would need to do that in countries where the policy is not supposed to be enforced.”
Funkhouser, the Google spokesperson, said over email that “we have long allowed ads for fertility treatments and services in most countries,” but “to ensure advertisers don’t target people based on sensitive health information, we do implement certain protections.” As part of its personalized advertising policies, Google prevents those advertising fertility services—which it considers a sensitive category—from using certain ad customization tools. The goal, he noted, is to avoid targeting that could negatively impact user experience. But there are no restrictions on specific fertility-related words (except for users under 18), he said.
“It’s not that [Google] prohibits us from advertising to people in search of an IVF treatment, it just limits the ways that we can do it, into a way that makes it not very effective,” Katz told Forbes.
“Technology makes IVF something that is more accessible to a wider audience,” he added. “And with these platforms limiting it, they’re limiting the access that IVF treatment would have, especially for those types of audiences that need it.”
This story has been updated to clarify Meta’s ad policies.
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