How I built a $275 million biotech company from nothing

What I founded Envision, I just did not look like the typical biotech or healthcare founder. I'm a brown woman. I'm a woman of color, and I didn't have any one of the many higher degrees that they like, you know, MBA, PhD, MD. So there I am with my little, you know, bachelor's degree, trying to go out and start a company. I sometimes just felt like I wasn't good enough. But even though there were so many opportunities to quit, I never gave up. An unexpected health care motivated a young Bay Area entrepreneur to start our own company, a company that I started and eventually sold to Boston Scientific for 275 million dollars. My name is Serbi Serna, and this is my back story.

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Oh, okay, here's a picture of me on the basketball team. I mentioned I wasn't 100% nerd, though close to it. Here's a picture of my mom and I in Mexico together. Little did we know that soon after this trip is when the ovarian cyst would hit. You know, so I'm in high school enjoying high school things, and I'm writing a paper in my bedroom when all of a sudden, I feel such a sharp pain in my side that I can barely make it to my mom and say, "My side hurts" before blacking out. That first night that I was in the hospital, they almost made me undergo surgery for appendicitis, but luckily the surgeon last minute realized that wasn't the issue. So it took them about a week to do the ultrasound and determine that I was suffering from repeat complex ovarian cysts.

What they couldn't tell me was whether or not those cysts were cancerous. An ultrasound only tells you that a mass exists; it doesn't tell you whether or not that mass is cancerous. And the blood test they have is no better than a coin toss when it comes to its accuracy. You can't biopsy the cyst because if it is cancerous, you risk spreading cancer cells all over the body. If you do decide to operate, you often have to remove the entire ovary. So the decision that my family was facing was, do we potentially do this very invasive surgery, which would have an impact on not just my fertility but anything that involves ovarian function, or do we wait and see if I have one of the most lethal cancers impacting women?

We thought about it quite a bit and we thought about the statistical probability of it being cancer, and then we did decide to wait. So we figured out how to control my pain a little bit, and I went back to school. You know, high school is tough, and young kids are tough without having to explain that there's something wrong with your ovaries. But in one way that I feel especially blessed was that I just had amazing teachers who really helped me through this tough time.

So eventually, after months of waiting, you could say we were one of the lucky families, and the cysts turned out not to be cancerous. But at that point, I had seen just how antiquated everything to do with women's health was. So I wrote in my personal statement as a senior in high school that I one day wanted to start a company in women's health so that other families did not have to go through what we did. From all of that, eventually was born Envision Medical.

So I worked as an engineer first at a large company called Abbott Vascular and then for another smaller device startup. I think at that moment, things were going well. I was actually enjoying my job. I was engaged to my best friend, now husband. But there was just something in me that did not feel satisfied. There was this energy that I couldn't contain. So even though my original plan was to get a little bit more experience in the industry, I jumped feet first into starting a company at 24.

After going through what I did in high school with the health scare, I decided that I wanted to be part of the effort to find an early detection mechanism for ovarian cancer. Here's some early prototypes of the device, and you can see the type of metal we used here and how flexible it is. So I thought it was a really good problem to work on. But that's the downfall of a lot of founders, right? They think that an idea is great to work on; they don't talk to their customer and, of course, the company dies.

I sort of intuitively felt like I needed to talk to some gynecologists to better sort of validate the concept I was thinking about making. So I was sitting there scratching my head, "What gynecologist do I know?" when I realized that I didn't know one—my own. So I called her office, pretended to have a stomach ache, and asked to see her as soon as possible. In the middle of a pelvic exam, I said, "Hey, I have this new catheter concept I wanted to talk to you about." Dr. Cook was quite taken back and startled but did kindly suggest that she would meet me in a café in Saratoga to talk about it more later.

After she did that, she liked the concept. She introduced me to another physician out at UC Davis and one at Stanford. So it really blossomed from there. Look, right when you graduate from college or even a few years out, no one's expecting you to have a huge Rolodex. Instead, focus on the personal network that you've already built and just ask for introductions to people who are in the industry that you're trying to do something in. If you try hard enough and you do it for long enough, you will get to the right people to talk to.

So after I had talked to Dr. Cook and she introduced me to all these other physicians, I sort of sketched out a concept I thought might work. But in order to test it, I really needed a little bit of seed funding. Once I decided to fundraise, it was really, really tough. I was rejected at least 50 times by investors, and it's very hard to know—was it hard for me to fundraise because I was a brown woman without a higher degree, or I just didn't have any progress yet at all?

So one thing that maybe I should not have been quite as surprised by, but I was, was the investors' reaction to women's health in general, saying things like, "Oh, women's health isn't a big enough market." I guess 50% of the population isn't big enough for you, huh buddy? And then also calling women's health things like "bikini medicine." I mean, things that just blew my mind. Finally, two women believed enough of the concept, and they had each told me if you find one other person to invest, that they would come in.

It's hard to be a founder, no matter who you are, but I would be lying—I wouldn't be honest with you if I said, "Oh, it's equally challenging for a woman." No, of course, you're going to encounter all sorts of bias. But what I can tell you is that these days I sincerely believe that there are enough people who believe in your potential that you can just ignore the folks who are being, you know, biased for whatever reason. Ignore them, don’t let it impact your confidence, and find the right people to work with, the right people to hire, and the right people to fund your company. They're out there.

So we raised our seed round, and we're off to the races. I was so lucky to attract a world-class team. At that point, we went on to raise about 20 million more in venture capital, and we took the device through the prototype stage into several clinical studies, and then FDA clearance—becoming the first and only device cleared to collect cells from the fallopian tube, which you can then evaluate for malignant features.

I hope that one day, if there is a woman who has a complex cyst, this device will give her answers about whether or not she has cancerous cysts, so that she can get the type of treatment she needs as quickly as possible, but also avoid unnecessary intervention if it, in fact, isn't cancerous. At that point in time, my goal was always to build this company to get the product to patients as quickly as possible, so I really truly had no interest in an acquisition.

But several companies, including Boston Scientific, read about the clinical data that we were gathering and wanted to have a conversation. It was a normal day. I was working; I was on my laptop when I heard a chime of an email go off. I opened it up, and there it was: It was an offer from Boston Scientific to buy the company for 275 million dollars. I cannot describe just the pure disbelief that I felt in that moment. Can you imagine just being rejected over and over again, struggling to raise any amount of money to push this life-saving device forward, and then all of a sudden having that much validation from a company that knows the industry so well?

Eventually, you know, we decided that we were going to take the offer from Boston Scientific. What it all comes down to, years of work, years of dedication, is a piece of paper and a pen. I remember having, you know, my mom to one side of me, my husband at the other, and I was holding my son on his first birthday when I leaned over and put my signature on that piece of paper to sell the company—crazy! It still gives me goosebumps, and it's been like six years.

I felt like at that moment, the future of the product was secure and that we were going to leave a meaningful mark on women's health. Right after I sold, I was introduced to Jared Friedman at YC, and we had this great conversation. He was talking about how they wanted to have their very first YC Healthcare and Bio partner. He invited me to speak at an event in front of maybe 60 to 100 founders. It was the first time that I had relayed my story, and the energy in the room was electrifying.

Talking to the founders after and realizing that everything I went through—all of the struggle, all the failures, all the mistakes that I made—could actually be put in a productive place that I could help other people, it was just an opportunity that I couldn't say no to. It's all about thinking about what your strengths are, what the story looks like, and what your network looks like. I am hoping that people apply to YC who are working on a real need.

As long as you really know your stuff, I am not going to look at whether or not you have an MD or PhD and make my decision exclusively on that. I want to know that there's a big problem that needs solving, and you are the founder to do it because no one believes in the solution as much as you do. Everything that's happened in my life has led me to this moment of being a group partner at YC.

The amount of joy I feel when I help founders work through their most difficult problems so that they can get their incredible technologies to market faster, so we can have better, safer, cleaner agriculture food to eat, or better medicines for cancer patients, or early detection of cancers—I cannot imagine anything more rewarding than that.

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Foreign.