Remove the Friction, Unlock the Market: Shopify’s Lesson and a Fertility Care Revolution
Shopify’s Early Pitch: A Market “Too Small”
In Shopify’s early days, founder Tobi Lütke struggled to convince venture capitalists that his fledgling e-commerce platform could ever be big. When he pitched Shopify to Sand Hill Road investors around 2008, they balked at the opportunity. At the time, there were only about 40,000–50,000 online stores in existence. Even if Shopify captured half that market, the VCs argued, it still wouldn’t amount to a venture-scale business (Weinberg, 2023).
Years later, after Shopify had grown exponentially (the company would later be valued at nearly $100 billion), one of those VC partners ran into Lütke again and asked: “What did we miss?” The implication: how did a company serving such a “tiny” market become a multibillion-dollar giant? Lütke’s answer was illuminating. They weren’t wrong about the market size – they were wrong about the market’s potential. The small market was a symptom, not a fixed reality. “You were actually correct,” Lütke told the investor, “but what you didn’t realize was that Shopify was the solution to the very problem you identified. The reason there was only 40,000 online stores was because it was hard, expensive, and everyone who tried ran into all these brick walls of complexity, which Shopify, one after another, smoothed over and made simple to do” (Weinberg, 2023).
Friction: The Hidden Force Expanding Markets
Lütke believes this misunderstanding is common. Many observers, even savvy free-market thinkers, overlook the enormous effect of friction in limiting markets. “What a lot of free-market thinkers don’t understand is that between the demand and eventual supply lies friction,” he said. “I actually think that friction is probably the most potent force for shaping the planet that people just generally do not acknowledge” (Weinberg, 2023).
In Shopify’s case, there was plenty of latent demand (many aspiring merchants like Lütke himself) and eventual supply (a world full of online shops). But the gap between them was full of hurdles: setting up an online store was technically complex, time-consuming, and expensive. That friction strangled the market, keeping the number of online businesses artificially low.
Shopify’s insight was to attack that friction directly. Every obstacle removed, every tool that made building an online store easier, unleashed more of the pent-up demand. As Lütke put it: “Shopify has proven out that every time we make the process simpler, there’s more consumption” (Weinberg, 2023). The result? A market that exploded from tens of thousands of online stores to over a million merchants on Shopify’s platform.
Fertility Care’s “Small” Market Problem
That same principle applies in an entirely different arena: fertility healthcare.
Today, fertility care is still seen as the domain of specialists. In the U.S., there are only about 1,351 board-certified reproductive endocrinologists to serve a growing population of people needing IVF and other fertility care (CDC, 2023). At first glance, one might think the “market” is limited. But the demand tells a different story. According to the World Health Organization, 1 in 6 people globally experience infertility at some point (WHO, 2023).
And crucially, patients don’t begin their fertility journeys in specialist clinics. Most start with generalist clinicians. Studies show that 84% of women seeking fertility care first approach OB-GYNs, PCPs, or NPs (Feinberg et al., 2021). But many of these providers don’t feel equipped to support them. Fertility medicine is rarely included in medical training, and most students receive fewer than five hours of education on it (Patel et al., 2018).
This capability gap, workflow gap, and confidence gap among generalist providers is the friction that limits the market, not a lack of demand. Patients are ready. Many providers are willing. But the infrastructure to support their participation doesn’t exist.
Removing Friction in Fertility Care
What is needed is an enablement engine for the front lines of care. The thesis is simple: friction is the biggest suppressor of market size in fertility, and enablement is the unlock.
We can solve this through:
Curriculum: A modular CE-accredited micro-course library, and a comprehensive Fertility Curriculum tailored for generalists.
Support: Tools that guide providers through testing, diagnosis, treatment, and when to refer, all without needing to “hand off” patients prematurely to REIs.
Workflow Integration: Patient coordination software that tracks evaluations, helps close care gaps, and ensures treatment readiness without burdening generalist workflows.
When generalist providers are enabled, not sidelined, patients access care earlier, more often, and with better outcomes. In fact, one study found that when infertility evaluations began with OB-GYNs, patients had the same live birth rates and were less likely to need IVF compared to those who started with specialists (McClamrock et al., 2012).
From Niche to Movement: Enabling the Long Tail
Remove friction. Unlock participation. Let volume do the rest.
This is how niche solutions become mass movements. Shopify did it for e-commerce and it CAN be done for fertility.
References
Centers for Disease Control and Prevention. (2023). Assisted Reproductive Technology (ART) reports. https://www.cdc.gov/art/reports/index.html
Feinberg, E. C., Grobman, W. A., Mogul, M., & Yeh, J. (2021). Primary care providers’ role in fertility care: Knowledge, practices, and barriers. Fertility and Sterility, 115(2), 400–407. https://doi.org/10.1016/j.fertnstert.2020.08.013
McClamrock, H. D., Jones, H. W., & Adashi, E. Y. (2012). Infertility evaluation and treatment among women in the United States. Fertility and Sterility, 98(1), 30–38. https://doi.org/10.1016/j.fertnstert.2012.04.043
Patel, A., Sharma, P., Kumar, P., & Binu, V. S. (2018). Knowledge, attitude, and practice related to infertility among medical undergraduates: A cross-sectional study. International Journal of Reproductive BioMedicine, 16(10), 647–652.
Weinberg, D. (2023, November 20). Shopify founder Tobi Lütke on market size and friction. [LinkedIn post]. https://www.linkedin.com/pulse/tobi-lutke-what-most-vcs-missed-about-shopify-dan-weinberg/
World Health Organization. (2023). Infertility. https://www.who.int/news-room/fact-sheets/detail/infertility
