Mergers & Acquisitions

Details: Hamilton Thorne and IVF/ART assets of Cook Medical to merge after Astorg acquisition

WOLF, ASTORG SAY TEAMS WILL REMAIN IN PLACE

The content and themes expressed within the article are that of the news. The advertiser does not have editorial control over the content of this article, and Inside Reproductive Health maintains full editorial independence. The views and opinions expressed in this article do not represent the views of the Advertiser or of Inside Reproductive Health.

BY RON SHINKMAN

Luxembourg private equity firm Astorg has beefed up its reproductive medicine portfolio with pending acquisitions of equipment supplier Hamilton Thorne and the IVF/ART business of Cook Medical.

Massachusetts-based Hamilton Thorne Ltd. – parent company of subsidiary Hamilton Thorne, Inc. – announced last week that Astorg is acquiring the company outright for $228 million, or $1.63 per share in U.S. dollars. That’s roughly a 54% premium over its recent trading price on the Toronto Stock Exchange. The deal is expected to close by late 2024.

Hamilton Thorne Executive Chairman David Wolf said in an email that all of the company’s employees will remain onboard after the transaction closes, including himself. And while the company is U.S.-based, it trades on a Toronto exchange because “the Canadian markets represented a desirable alternative for a company of our size and scale,” Wolf noted.


“When two high profile tank failures occurred in 2018, I sat there in disbelief along with so many of my colleagues.”

Next article, continue reading ↓


Stock Performance

The company reported 2023 net income of $1.1 million on revenue of $67.2 million. However, that included a $1.7 million gain based on foreign currency fluctuations. Otherwise, the company reported an operating loss of $607,000 last year. In 2022, it lost $2.1 million on revenue of $58.2 million, although that included a nearly $4.1 million loss tied to currency fluctuations. Its 2022 operating profit was $1.9 million.

For the first quarter of 2024, Hamilton Thorne reported a loss of $2.1 million on revenue of $19.4 million. That included an operating loss of more than $936,000. In the first quarter of 2023 it reported net income of more than $896,000 on revenue of $16.7 million. That included operating income of $77,405.

Exit

Brian Leonard, chief executive officer and president of IVF on Demand, a Pennsylvania-based supplier for reproductive medical practices, observed that Hamilton Thorne was in a tight spot that made it look for a buyer, prompted in part by some acquisitions that did not spur hoped-for growth. Among the acquisitions Hamilton Thorne has made in recent years include Belgian consumables manufacturer Gynetics last October, as well as equipment manufacturer Planer Ltd. in 2019.

“Hamilton Thorne likely could have continued down the path they were on with the hopes of improving margins and (pre-tax earnings) but the headwinds they faced forced this less-than-ideal exit,” Leonard said in an email, in reference to the company’s recent losses.

Merger

At virtually the same time the Hamilton Thorne acquisition was underway, Astorg also announced that it had signed a letter of intent to acquire the IVF and other assisted reproductive technology business of Bloomington, Ind.-based Cook Medical

Financial terms of that transaction were not disclosed. The company said that all 93 employees who work in Cook’s ART division would immediately receive job offers from Astorg. After the transactions closed, Astorg said the Cook assets and Hamilton Thorne would be merged. Although the deal also includes Cook’s manufacturing facility in Pennsylvania, the spun off venture will continue to manufacture products for Cook for three years after the transaction closes. After that, the factory’s 209 employees will join the merged companies.

“I believe Astorg took advantage of two companies actively looking for an exit while also seeing a handful of synergies,” Leonard said. He added that Cook’s ART division mostly focused on consumables, while Hamilton Thorne is focused more on capital equipment.

Hamilton Thorne Ltd. has eight brands and sells about five dozen products to fertility medical practices, including computer assisted sperm analysis platforms, laser-guided imaging of oocytes and spindles, and numerous consumables in support of both sperm analysis and imaging. Brijinder Minhas, vice president of the healthcare division for MidCap Advisors, LLC, said the company developed one of the first automated and computerized platforms for semen analysis.

Cook’s ART line includes a benchtop incubator as well as products to assist in cervical ripening. Minhas observed that its best-known products are embryo transfer catheters, pumps and aspiration needles.

Cook Medical Senior Vice President D.J. Sirota said in a statement that “Astorg has exciting plans to build an IVF/ART manufacturing hub at our facility in Vandergrift…creating a core location for manufacturing operations for Cook ART products.”

The entire Cook enterprise reported revenue of about $2.3 billion in 2022, but as a private company it does not break out exact figures, or for its various divisions. It had struck a deal in 2023 to sell its ART business to the CooperCompanies for $875 million. However, CooperCompanies backed out of the deal last August, according to the Federal Trade Commission.

The acquisitions will be folded into Astorg’s portfolio of biotech firms, including hg medical, Demetra, Nemera, Echosens and Sebia, among others.

Leonard noted that Astorg’s portfolio could certainly leverage its resources to develop new technologies.

“Alternatively, they could keep business as usual while merging resources and cutting costs to improve the collective financial health,” he said. “That is the more likely outcome as with most private equity firm transactions.”

Wolf told Inside Reproductive Health that he will be able to provide more details on the transaction after Hamilton Thorne’s proxy materials are mailed in some weeks’ time.

The content and themes expressed within the article are that of the news. The advertiser does not have editorial control over the content of this article, and Inside Reproductive Health maintains full editorial independence. The views and opinions expressed in this article do not represent the views of the Advertiser or of Inside Reproductive Health.


GIVE ME A TIME MACHINE, THIS IS HOW I’LL STOP THE TWO CATASTROPHIC 2018 TANK FAILURES FROM EVER HAPPENING!

By Dr. William Baird, HCLD

Cryotank failures are devastating – it’s everyone’s worst nightmare in the field of IVF. When two high profile tank failures occurred in 2018, I sat there in disbelief along with so many of my colleagues.

Thousands of people lost their last chance at starting or expanding their families in those tanks – people with advanced ages, cancer patients, military personnel, and embryos of siblings that can no longer be conceived. Clinics were slapped with millions of dollars in lawsuits that are taking years to resolve because of the complexity that comes with human and manufacturing errors.  

There were a few things that caused these tank failures, but ultimately it comes down to action and responsibility. Attempts were made to prevent these failures, but they either weren’t completed or done correctly. In one of the cases, the staff was able to flip a switch. The alarms were bothering them so much they turned them off on a Friday, then forgot to turn them back on. They dumped buckets of liquid nitrogen (LN) into the tanks that were empty by Monday. Vapor tanks are very unforgiving and more complicated than people think – they can be good one minute and bad the next. I don’t think this is always taken into consideration as labs move to these large tanks.

Technology and humans can both fail – that’s why these failures happened, and it’s important to note that both of these failures occurred in large vapor tanks. A failure is always catastrophic for the patients affected, but these large vapor tanks are holding thousands of samples. If you lose a typical dewar, you’re going to lose 100 or more individual patient samples. It’s still a failure and it’s horrific, but you’re not making 2500+ phone calls to patients to let them know that you’ve lost their irreplaceable samples. I am of the strong belief that you do not, literally, put all your eggs in one basket.

CAP has specific regulations in place to prevent catastrophes, but labs need to be more responsible for how fragile and important these specimens they’re storing are.

How would I have prevented these tank failures? Three things:

1 - Smaller tanks

2 - A greater sense of staff responsibility

3 - A state of the art, fool-proof, tank monitoring system

Our team at Boreas was already working on our initial product, a weight-based monitoring system called the CryoScout™, when these two tank failures occurred. The failures were the catalyst to finish what we started and create a monitoring system that was more accurate and reliable than anything else on the market, with an alarm system that couldn’t be manipulated.

Weight is far more accurate when it comes to measuring LN inside a cryotank than temperature is, but we needed to do more than that. We needed to build a system that couldn’t be turned off due to alarm fatigue, and gives you the ability to be proactive vs. reactive when monitoring your tanks. That’s why we started Boreas Monitoring and built the Cryoscout™.  We provide relevant data points about your tank health that gives you the time to take corrective action.

As it stands today, most IVF labs are still at too high of a risk of repeating the 2018 tank failure catastrophes. Your lab staff, the courts, and most importantly, your patients expect a better system. We can help your lab create an implementation plan to protect your cryotanks, patients, and irreplaceable samples from catastrophes like the 2018 tank failures. Just grab a time with us to book your demo using the link below and we’ll set up a meeting to help.

 
 

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External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

 
 

$20M. Arredondo, Pozitivf's plans for affordable IVF expansion in Texas

THREE NEW CLINICS PLANNED IN 3-4 YEARS

The content and themes expressed within the article are that of the news. The advertiser does not have editorial control over the content of this article, and Inside Reproductive Health maintains full editorial independence. The views and opinions expressed in this article do not represent the views of the Advertiser or of Inside Reproductive Health.

 

BY MALLIKA MITRA

In an effort to make IVF more accessible, fertility clinic network Pozitivf says it will use $20 million it recently secured in funding led by MonCap to develop three new sites, build a training academy and improve its current systems.

Pozitivf, founded in late 2022, currently has one clinic and IVF lab in an 8,000-square space in San Antonio, Texas in addition to a satellite office in Brownsville, Texas. In 2023, they conducted roughly 350 IVF cycles, but the new funding will give them the ability to expand, according to Dr. Francisco Arredondo, Pozitivf's co-founder & CEO. The goal is to open three new clinics during the next three to four years within the “Texas Triangle,” a region made up of the state’s major cities —  San Antonio, Austin, Dallas-Fort Worth and Houston — that is home to nearly 70% of Texas’ population.

The company is also using the funds to address a major problem facing the fertility industry: a shortage of human capital. The team at Pozitivf created the andrology, embryology and nursing training program, IVF Academy USA, and has trained approximately four embryologists and andrologists every three to four months since June 2022 as well as three OBGYNs. Next year, it plans to train around 10 nurses, 10 nurse practitioners and 10 physician assistants. With the new funding, Pozitivf is building the physical academy in the 7,000-square feet below the clinic.


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“The idea is not to replace REIs with these other providers but to increase the capacity to make IVF more accessible geographically and financially,” Arredondo said.

Pozitivf is currently researching how to reduce variability and assessing what services do not add value. They say some add on tests haven’t been proven to be effective and some expensive filtering systems have not been proven by randomized controlled trials. The aim is to eliminate wasted inventory and inefficiency in their supply chain, Arredonodo said.

Focusing on long-term growth

Arredondo has expressed doubts about private equity’s role in medicine in the past. He said many firms are “obsessed with growth,” acquisitions and eliminating costs. That approach doesn’t work with the fertility industry, which is in its very early stages and only servicing around 20% of the women in the country who need IVF, he said. The cost of IVF continues to rise because a few companies dominate the market and there is a human capital shortage, so consolidation by private equity is not reducing costs, Arredondo added.

But MonCap is a venture capital firm whose investment strategy focuses on scalability, Arredondo said.

“One of the alignments that we had with MonCap was that we would not replicate things until we feel very confident that the processes have been documented… instead of replicating things that are not at an optimum place,” Arredondo said.

The $20 million funding round came amid a challenging time for raising capital, with venture funding falling in 2023 to its lowest level since 2017, according to research from market intelligence platform CB Insights. Moncap is also a primary investor of EngagedMD, which provides an admin software platform for caregivers in the fertility space.

Moncap’s managing partner, Jonathan Sockol, declined to comment on the firm’s investment strategy in the fertility sector at this time.

The content and themes expressed within the article are that of the news. The advertiser does not have editorial control over the content of this article, and Inside Reproductive Health maintains full editorial independence. The views and opinions expressed in this article do not represent the views of the Advertiser or of Inside Reproductive Health.


All external links active as of 6/13/2024

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

 
 

Northstar Fertility Expands Its Portfolio with Strategic Acquisitions

Include Surrogate Support and ‘Ethical’ Egg Donation

The content and themes expressed within the article are that of the news. The advertiser does not have editorial control over the content of this article, and Inside Reproductive Health maintains full editorial independence. The views and opinions expressed in this article do not represent the views of the Advertiser or of Inside Reproductive Health.

This News Digest Brought to You by
MyEggBank

 
 

BY: LISA MUNGER

In a move that expands its reach in the fertility sector, Boston-based Northstar Fertility has announced its latest acquisitions, Surrogacy.com and Everie in calendar 2023, in November and October, respectively. 

In addition to Everie and Surrogacy.com, Northstar's companies include Circle Surrogacy, Growing Generations and Reproductive Possibilities surrogacy agencies. Northstar companies also offer services related to fertility, like insurance coordination, financing and escrow management, according to the parent company, the CortecGroup. Key partners formed Northstar in 2019.

The price tags paired with the acquisitions have not been made publicly available as of this writing. Representatives of Northstar, Surrogacy.com and Everie declined to speak to Inside Reproductive Health for this article.  

These additions to Northstar's already portfolio signal a new era in the fertility space, catering to a growing and increasingly diverse fertility business portfolio, outside of fertility clinic consolidation.

Surrogacy.com, a new platform dedicated to the needs of surrogates, represents a shift in the approach to surrogacy. Niki Renslow, Surrogate Success Manager for Surrogacy.com, said in a prepared statement. 

Renslow said the web community promises to provide candid answers from people with experience in surrogacy, including support networks, education and help in determining if surrogacy itself is an appropriate avenue for consideration. 

A month before the Surrogacy.com acquisition, Northstar acquired Everie, a frozen egg donation company, launching “Mutual Match,” a system designed to foster transparency with donors and recipients. 

Aisha Lewis, president of Everie and a bioethicist, said in a prepared statement that she hopes the new relationship will foster growth and evolve with the field.

"The traditional egg bank system has previously lacked overt consent from donors on who the recipient parents are for their genetic lineage," said Steuart Botchford, CEO of Northstar Fertility in the same statement.

Everie said in the statement that their Medical Director is Dr. Mark P. Trolice, principal of Fertility Care: The IVF Center in Central Florida.

The content and themes expressed within the article are that of the news. The advertiser does not have editorial control over the content of this article, and Inside Reproductive Health maintains full editorial independence. The views and opinions expressed in this article do not represent the views of the Advertiser or of Inside Reproductive Health.


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External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

What’s In the Fertility Pharma Pipeline

Three Companies and What They’re Working On

This News Digest brought to you by
BUNDL

 
 

BY: Lisa Munger

The biotech sector has experienced a surge in venture capital (VC) funding in recent years, providing a boost to fertility-related research and development, according to a report by analysts at McKinsey & Company.

In 2016, VC companies invested in 2,200 biotech start-ups worldwide, growing to 3,100 by 2021. These investments have contributed to developing next-gen biopharmas and biotechs actively working on fertility innovations.

PIPELINE HIGHLIGHTS

Granata Bio

Founder Evan Sussman said he started Granata Bio five years ago because he saw an unmet need in the field. Before that, he spent 10 years at EMD Serono. He said there was more bandwidth for drug development in the U.S. and hoped Granata would help fill the gap. 

Now, the company is focused on a pipeline intended to minimize market monopolies and bring new therapeutics to market. 

“We hope to bring clomiphene citrate back to the market by the end of the year,” Sussman said. “That product is symbolic of what's going on in women's health generally. There's a paucity of available drugs. Clomiphene is a 50-year-old class of drugs, but there's only one commercialized product, and the price has gone up significantly in the last year or two years because there's no competition.”

Also in Granata’s pipeline development: subcutaneous progesterone, menotropins for injection and a commercially-available ganirelix acetate injection.

Oral Allosteric Agonists Show Promise in Preclinical Studies

High-complexity methods like controlled ovarian stimulation - in vitro fertilization (IVF) or low-complexity methods like ovulation induction - intrauterine insemination (IUI) for treatment. In preclinical studies, researchers discovered that two oral follicle-stimulating hormone receptor allosteric agonist compounds, TOP5668 and TOP5300, have pharmacology, drug metabolism, pharmacokinetics and safety profiles suitable for clinical use.

While more testing is necessary before clinical use, these results provide avenues for infertility treatment. If clinical trials prove successful, these oral follicle-stimulating hormone receptor allosteric agonists could offer a more convenient and efficient single-agent treatment for infertility patients than existing therapeutic approaches.

Celmatix

Celmatix announced a development in their pipeline - an oral follicle-stimulating hormone (FSH) candidate. This treatment can potentially shift fertility care and allow individuals more options other than traditional injections associated with IVF. 

Celmatix's oral FSH candidate aims to unlock a more convenient and accessible fertility treatment option for patients. 

“Our goal is to eliminate the need for injections during ovarian stimulation ahead of egg freezing and IVF procedures,” said Dr. Piraye Yurttas Beim, founder and CEO of Celmatix. “We also want to reduce the need for women to undergo IVF procedures in the first place by both providing a more effective strategy for restoring ovulatory function in women with ovarian conditions like polycystic ovary syndrome (PCOS) and addressing the significant burden that male infertility places on couples by also advancing our program to help men increase their sperm count and viability.”

While Celmatix's oral FSH candidate shows some promise, Sussman said, he said any oral application is likely 10 years from the market. Further research, clinical trials and regulatory approvals are necessary to validate its safety and efficacy. 

While an oral therapeutic may appeal to some and enhance tolerability, Sussman said it’s Celmatix’s “moonshot,” but other companies are focused elsewhere. Specifically, he pointed to targeting poor ovarian response and diminished ovarian reserve patients- as one of the industry’s moonshots. 

Oviva Therapeutics 

A biotech startup called Oviva Therapeutics has emerged to develop drugs to prolong fertility and delay menopause. This approach could affect women's reproductive health and overall well-being. Sussman pointed to Oviva’s work as “one to watch.”

Led by Dr. Patricia K. Donahoe, director of Pediatric Surgical Research Laboratories at Massachusetts General Hospital, Oviva Therapeutics is focused on harnessing the potential of a little-studied hormone to achieve these revolutionary goals. Dr. Donahoe said that the hormone, or drugs that mimic its effects, could slow down or even halt the natural loss of eggs that women experience every month. This ability to preserve eggs could extend a woman's fertility and potentially delay the onset of menopause.

Oviva Therapeutics plans to test its AMH-based therapies in the clinic, starting with using AMH to aid women struggling to conceive through IVF. This initial step will serve as a platform for broader indications and applications.

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser


How to Finally Streamline Medication Costs for Your Patients
 

Medication costs are a huge stressor for patients working through IVF and IUI treatments.


They can be costly, and the variability of when they’re needed means an even more difficult process. But it doesn’t have to be this way, and that’s why BUNDL has streamlined the process with their new BUNDL with Medications℠ program.


BUNDL with Medications℠ is a multi-cycle offering that includes all the patient’s medications, for one up-front cost.


Contact BUNDL today to learn about their exclusive virtual pharmacy program partnership, and how this can optimize treatments for your practice and patients.


 
 

This News Digest Is Paid Sponsored Content From
BUNDL


 
 

All external links active as of 8/31/23.

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

IVIRMA Global Recruits Former Head of Airline Iberia as New CEO

Javier Sánchez-Prieto began his new position in mid-July

This News Digest brought to you by
BUNDL

 
 

BY: RON SHINKMAN

IVIRMA Global, one of the largest multinational chains of fertility clinics, has named former Iberia Chairman and Chief Executive Officer Javier Sánchez-Prieto as the company’s new CEO.

Sánchez-Prieto started the position on July 17, according to company spokesperson Michael Samuelson. He has taken over a company with 74 clinics in nine countries, including 20 in the United States and 30 in Spain, where IVIRMA is headquartered. He had been the CEO of Iberia – Spain’s flagship airline – since September 2020.

Sánchez-Prieto replaces Antonio Pellicer, M.D., who launched IVIRMA’s predecessor with the opening of its first fertility clinic in Spain in 1990. Samuelson said that Pellicer has been named IVIRMA’s executive chairman.

“It was clear during the recruitment process his skills and experience would complement Dr. Pellicer’s medical leadership,” Samuelson said of Sánchez-Prieto, who did not have any experience in the healthcare business prior to taking the position at IVIRMA.

Sánchez-Prieto began as chief financial officer for Iberia’s regional subsidiary before becoming the parent company’s CFO a decade ago. Before Iberia, Sánchez-Prieto spent nearly a decade as an executive with Spanish construction giant Uralita Group, according to his LinkedIn profile

Sánchez-Prieto was unavailable for an interview, but Samuelson said that he became interested in the job after the giant investment fund KKR acquired IVIRMA for just over $3 billion earlier this year, likely with the intent to expand aggressively in the coming years.

“For IVIRMA to achieve the next phase of transformative growth, it was essential to recruit a business leader with Mr. Sanchez-Prieto’s track record and experience,” Samuelson said.

Iberia announced back in May that Sánchez-Prieto would be leaving after 12 years with the company, but did not say where he was going, other than to a career outside of aviation.

According to Sánchez-Prieto’s LinkedIn feed, he spent the first week on the job undergoing the onboarding process at IVIRMA Global’s headquarters in Valencia, Spain, and then spent several days at RMA New Jersey’s clinic in Basking Ridge, N.J.

“More to come in the next weeks,” Sánchez-Prieto posted.

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser


How to Finally Streamline Medication Costs for Your Patients
 

Medication costs are a huge stressor for patients working through IVF and IUI treatments.


They can be costly, and the variability of when they’re needed means an even more difficult process. But it doesn’t have to be this way, and that’s why BUNDL has streamlined the process with their new BUNDL with Medications℠ program.


BUNDL with Medications℠ is a multi-cycle offering that includes all the patient’s medications, for one up-front cost.


Contact BUNDL today to learn about their exclusive virtual pharmacy program partnership, and how this can optimize treatments for your practice and patients.


 
 

This News Digest Is Paid Sponsored Content From
BUNDL


 
 

All external links active as of 8/24/23.

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

BPEA EQT Acquires Majority Stake in Indira IVF for $656.6 Million, ‘Sets a New Benchmark’

In One of the Largest M&As in the IVF Space, Indira Now Valued at an Estimated $1.1 Billion.

This News Digest brought to you by
BUNDL

 
 

BY: Lisa Munger

Hong Kong-based investment firm BPEA EQT, formerly known as Baring Private Equity Asia, is set to acquire a 60% stake in Indira IVF, an Indian fertility services provider, for $656.6 million, according to a report on July 28 by multiple outlets.  

The Deal

The deal places a valuation of $1.1 billion on Indira IVF, according to a reporter by Mint Media. Indira operates a network of 116 clinics across India.

Indira IVF CEO Kshitiz Murdia, M.D. told Inside Reproductive Health the company employs 250 full-time Gynecologists. Indira has 2,700 employees and 150 Embryologists, Gitika Sharan, a company representative told Inside Reproductive Health.  The company does 33,000 IVF cycles on average each year. 

Given Indira’s wide scope of influence in India and beyond, analysts note the import and historical landmark of the deal. 

“It’s a big milestone event for the Indian health industry, especially for the business because it’s the second most valuable IVF transaction across the globe,” Vinesh Gadhia, an IVF industry expert on the Indian market told Inside Reproductive Health. 

In another billion dollar M&A in the space, The New York-based buyout firm KKR & Co. Inc., completed the acquisition of Spanish-based  IVIRMA Global SL in January for approximately $3.8 billion according to Market Screener

Further, in February 2022, fertility startup Kindbody completed its acquisition of Vios Fertility Institute, along with its network of clinics. This move has allowed Kindbody to achieve a valuation of $1.15 billion, another high-figure M&A of late.  

Sweden's EQT, the parent company of BPEA EQT, released a statement confirming the acquisition, specifying that the stake would be purchased from private equity firm TA Associates and Indira IVF's founders. While the statement indicated that the founders would retain a minority stake in the company and continue to lead it, it did not disclose the exact size of the stake or the deal's total value.

Indira was the last IVF related company in TA Associates’  possession according to its publicized portfolio. TA Associates sold its stake in CCRM Fertility in 2021, according to a report by Business Wire

Beyond TA’s divestiture, BPEA representatives said they plan to expand in Asia in their statement on the subject. 

“BPEA EQT will invest in Indira IVF’s R&D capabilities and technology while further broadening its footprint across India and exploring expansion into neighboring markets, making fertility services and reproductive health more accessible to couples,” the statement read. 

BPEA EQT representatives declined a request for comment. 

Growth Beyond India

Murdia said the deal will help the company to expand its influence in the rapidly growing market. 

“Indira IVF has a solid foundation built in the last four to five years on compliance, governance, systems and processes that has truly institutionalized the whole medical and non-medical operations we do,” he said.

“With many years of experience training people and being successful in many geographies in India the company feels very comfortable to take on international expansions and acquisitions to grow beyond the Indian subcontinent especially in Asia Pacific and BPEA has had the experience of owning businesses in Asia Pacific which would really fuel the growth of Indira IVF in Asia Pacific,” he said. 

Testing Business Viability with Increased Regulation

For analysts like Gadhia, the deal portends positive outcomes for both parties. 

The investment firm's strategic move into India's healthcare industry will likely position Indira IVF for further growth and expansion under the new ownership, Gadhia said. It shows the hand of the Assisted Reproduction Assistance (ART) Act in motion, he added.

The ART Act, passed in 2021 by the Rajya Sabha, was aimed at overseeing and governing ART clinics and ART banks in India. Its primary focus was to ensure proper supervision, regulation, licensing and promotion of ethical practices in the rapidly evolving field of assisted reproduction. 

For Gadhia, the deal with BPEA is a litmus test to determine how the ART Act operates in the “real world.”

“It’s significant because the deal may stand as a new benchmark," he said. It proves as testimony that the Indian IVF business is set to take off and is on a major growth trajectory. It also reveals that the ART regulation act hasn’t significantly increased global investors’ confidence in the Indian IVF space.”

The deal remains subject to regulatory approvals and finalization processes, according to multiple outlets. 

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser


How to Finally Streamline Medication Costs for Your Patients
 

Medication costs are a huge stressor for patients working through IVF and IUI treatments.


They can be costly, and the variability of when they’re needed means an even more difficult process. But it doesn’t have to be this way, and that’s why BUNDL has streamlined the process with their new BUNDL with Medications℠ program.


BUNDL with Medications℠ is a multi-cycle offering that includes all the patient’s medications, for one up-front cost.


Contact BUNDL today to learn about their exclusive virtual pharmacy program partnership, and how this can optimize treatments for your practice and patients.


 
 

This News Digest Is Paid Sponsored Content From
BUNDL


 
 

All external links active as of 8/17/23.

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US Fertility Acquires RMA of New York, Largest Fertility Center in New York City

Now Totals Almost 200 REIs, >100 locations, >30 IVF labs

This News Digest BROUGHT TO YOU BY
THE FDA CONSULTANTS, LLC

 
 

BY: STAFF

US Fertility will expand its presence in the second largest city in North America, with the acquisition of Reproductive Medicine Associates of New York (RMA-NY)  it said in a press release this morning.

The acquisition brings US Fertility to “nearly 200 Reproductive Endocrinologists and five fellowship programs for Reproductive Endocrinology and Infertility. With the addition of RMA NY, US Fertility will now provide advanced fertility care through [105] clinic locations and 32 IVF laboratories” the press release stated.

According to the CDC’s latest finalized reports from 2020, RMA-NY performed more IVF cycles than any other clinic in the nation’s largest city, with roughly 7.200 cycles between its Manhattan and Long Island labs. RMA-NY opened an IVF lab in Mt. Kisco, NY in 2021.RMA-NY has seven partner physicians, eleven associate REIs, and four IVF labs, according to its website.

US Fertility currently has an IVF lab in Manhattan with an office in Brooklyn, Shady Grove Fertility New York. SGF New York opened in 2019 and performed 527 IVF cycles in its first full year in 2020, according to CDC data. Five REIs now practice there according to their website. No announcement has been made about whether the SGF New York and RMA-NY brands will remain distinct.

This is US Fertility’s second acquisition of the year, after its purchase of Ovation Fertility from Morgan Stanley in April.

The financial terms of the deal were not disclosed.

US Fertility CEO Richard Jennings and RMA of New York did not respond in time for comment.

 

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser

Correction:
It was originally stated that North America's largest city is New York. It's actually second largest after Mexico City.


FDA on “Monster Hunt” for IVF Labs in Violation

One west coast fertility center reports being inspected by the FDA eight times in the last year. 

Because the FDA halted inspections due to the pandemic in 2020 and 2021, they are now going after fertility centers at greater frequency than ever before.

The FDA Consultants protect fertility centers by doing a “Mock FDA inspection” but they have a waitlist, and priority will go to clinics in their second year post-inspection and/or already have a warning letter.

 
 

 
 

This News Digest Brought to You by
FDA Consultants


 
 

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External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

Monash IVF moves to complete the acquisition of PIVET Medical Centre for AUD 9.4 million

Implements digital front door, stock steady

This News Digest Is BROUGHT TO YOU BY
THE FDA CONSULTANTS, LLC

 
 
 

BY: LISA MUNGER

Monash IVF has been one of the largest IVF providers in Australia for more than 40 years. 

Monash offers various services, including IVF, donor programs and fertility preservation. Recently, its stock has been featured in international media

Stock Steady, Speculation Raises Profile

Recent stock reports suggest that Monash is a strong investment opportunity with the potential for significant growth in the coming years. The company went public in June 2014 with CEO Michael Knapp

The company's shares could be worth as much as AU $1.81 compared to their current trading price of AU $1.16, according to analysts with Simply Wall Street.

The report used a discounted cash flow model to estimate the company's intrinsic value by forecasting future cash flows and discounting them to their present value. The model assumes that Monash will experience two stages of growth, with a higher growth rate in the initial period and a stable growth rate in the second stage.

The report estimates that Monash IVF Group's free cash flow will increase from AU $5.45 million in 2023 to AU $42.2 million in 2032, with a growth rate of between 2.32 and 5.27%. The present value of these cash flows, discounted at a rate of 6.7%, is estimated to be AU $233 million.

The report also noted that the analyst price target for Monash IVF Group is AU $1.32, which is 27% less than the estimated fair value of AU $1.81.

Monash’s stock hit its highest point ever in July 2016 at $2.54 USD. By contrast, on May 2, 2023, the stock hit its highest point in the last year, starting the opening bell at $1.60 USD, according to Rask Media. 

New Technology Implemented

In 2020, Monash became the first clinic in Australia to offer a new genetic screening technique called karyomapping, which can identify genetic disorders in embryos before they are implanted. By using this technique, Monash aims to reduce the risk of genetic disorders in children born through IVF.

The company has implemented a digital front door, which is a digital interface that optimizes the collection and sharing of critical information with patients throughout their treatment, thus increasing accessibility. 

The portal offers patients various services and information, including the ability to schedule appointments, access medical records, receive personalized treatment plans and access educational resources about fertility treatments. 

The digital front door is a centralized platform that enhances patient engagement, facilitates communication and ensures that individuals are well-informed throughout their fertility journey. 

Monash partnered with Personify Care to set up digital patient pathways, allowing patients to access their treatment plans, communicate with their care team, and receive reminders and education materials through a mobile app

PIVET

Monash acquired PIVET Medical Centre (PIVET), a leading fertility provider headquartered in Pert, in May 2022. The initial upfront cost of the acquisition was set at $9.4 million USD.

PIVET played a role in Western Australia's first successful IVF birth in 1982. Over the years, PIVET has expanded its operations and extended its services to Cairns in 2009. PIVET has assisted in the birth of more than 8,000 babies through its comprehensive range of treatments, according to Business News Australia.

The acquisition, which is due to be completed during the third quarter of FY23, is expected to be funded through Monash IVF's operating cash flows and/or available debt facilities of $105 million.

Currently generating annual revenues of approximately $8 million, PIVET may be entitled to additional earnouts depending on its performance over a one-to-two-year period following the deal's completion, according to the report. The deal was supposed to have been completed by projected to conclude by the end of September 2022, as of the latest update in February 2023.

Neither Monash IVF nor Michael Knapp responded to Inside Fertility Health’s requests for comment for this story. 

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser


These 5 Deficiencies Lead to FDA Nightmare


HCLD IVF lab director comes together with reproductive health attorney  to make checklist of what she wishes she had known about what the FDA is looking for in the IVF lab. 

Download their free FDA checklist for the five most common IVF lab deficiencies before the FDA audits you.


 
 

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External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

Fresenius Reportedly Looking to Unload Eugin Group. Includes Boston IVF, TRIO

Sale would include the parent company according to Spanish news media and industry sources

This News Digest Is BROUGHT TO YOU BY
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BY: RON SHINKMAN

European healthcare conglomerate Fresenius Helios is looking to sell its major fertility holding, the Eugin Group, according to a European media outlet and industry sources.

Fresenius, which is based in Germany, acquired Eugin in late 2020 for about $520 million.

“Eugin and Fresenius Helios are an excellent fit. Eugin is highly profitable and holds excellent positions in attractive country markets,” then Fresenius CEO Stephan Sturm said at the time.

Founded in 1994, the Barcelona-based Eugin is a massive global provider of fertility services. It operates 69 clinics in 11 countries on three continents and performs 45,000 cycles a year. Its footprint includes Spain, Italy, Latvia, Sweden, Colombia and Brazil. It is also a major player in the U.S. and Canada, where Eugin owns Boston IVF, Ohio Reproductive Medicine and TRIO. That latter is one of the largest fertility providers in Canada.

A potential sale of Eugin was first reported by the Spanish publication PlantaDoce. The news outlet reported that Fresenius is under pressure to divest by Elliott Investment Management, which obtained a significant stake in the conglomerate last fall and is apparently unhappy with its financial performance in recent months. Fresenius’ stock price is down about 6% from a year ago, although it has risen about 25% since Elliott bought shares in the company.

Strurm departed as CEO just before Elliott bought its stake in Fresenius. His replacement, Michael Sen, spoke of the company needing a “reset” just weeks after taking over.

“We have embarked on a top-to-bottom review of every business activity, looking at the entire corporate portfolio,” Sen said at the time. 

Fresenius is also reportedly shopping its hospitals in Colombia and Peru, according to the Colombian news outlet El Pais. The holdings are part of Fresenius’ Quirónsalud Group affiliate, which also owns hospitals in Spain.

Fresenius declined to comment about a sale of Eugin. “Please understand that as a matter of principle we do not comment on market speculation or rumors,” said company spokesperson Steffen Rinas in an email. That was the exact response Rinas gave to El Pais about the potential Quirónsalud sale.

However, along with the coverage in the Spanish media, two sources have confirmed with Inside Reproductive Health that they’ve been told that Eugin is on the market. 

“I’ve heard they’re for sale, but I don't know who is the likely buyer,” said Richard Groberg, who regularly advises businesses in the fertility sector on mergers and acquisitions.

Walt Conrad, vice president of marketing for Pinnacle Fertility, an IVF platform that has been active in dealmaking as of late, observed in an email earlier this month that he did hear of Eugin being on the market, but that he was not aware of Pinnacle pursuing a deal “at this time.”

Who might actually bid on Eugin is a major question among industry observers. Its size and geographical breadth may be hard for a potential acquirer to swallow whole.

“Eugin is a large network of IVF centers in diverse markets around the world, and finding an existing player in the space that can offer advantages to all of their markets may be very hard to do,” said Robert Goodman, vice president in charge of healthcare for New York City-based MidCap Advisors. “There are several fertility platforms that may have the ability to absorb them, but it will be a significant undertaking.”

Goodman, who was not aware Eugin was for sale, speculated about a list of potential buyers. They include Carefertility, which operates 23 clinics in England and Ireland; Inception Fertility, which includes The Prelude Network, which operates more than 80 clinics in the U.S.; and US Fertility, which acquired Ovation Fertility last month.

Goodman noted that all those companies have either solid financial backing or have recently expanded into new markets.

“The backers and senior management teams of these platforms…could be interested if the opportunity is made attractive enough,” he said.

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser


These 5 Deficiencies Lead to FDA Nightmare


HCLD IVF lab director comes together with reproductive health attorney  to make checklist of what she wishes she had known about what the FDA is looking for in the IVF lab. 

Download their free FDA checklist for the five most common IVF lab deficiencies before the FDA audits you.


 
 

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External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

Fertility Clinic M&A Halved In First Four Months of 2023, Compared to 2022. May be Accelerating Again

Buying Prices of REI Practices Down In Multiples of EBITDA, According to Sector Advisors

 

BY: RON SHINKMAN

M&A activity in the fertility sector was sluggish during the first quarter of 2023 compared to the same period last year, although momentum toward bigger deals is building in the second quarter.

According to Irving Levin & Associates, a Connecticut-based firm that closely tracks M&A in the healthcare space, there have been eight transactions involving fertility practices or platforms so far in 2023. That compares to 16 through the first four months of 2022 and 40 for all of last year, according to Irving Levin Managing Editor Ben Swett. 

The slowdown in healthcare M&A – specifically the acquisition of physician practices, which include fertility clinics – began in the second half of 2022, according to a report by Bain & Co.

Among the factors behind the slowdown: Borrowing costs have quintupled since the start of 2021. The Federal Funds Rate – the benchmark for setting interest on loans – rose from below 1% at the start of 2021 to 4.83% as of the end of April. .

Richard Groberg, the managing member of RSG Advisors in Las Vegas, noted that buyers were wary toward the end of last year into the beginning of 2023.

Buyers for fertility practices and related businesses “were nervous,” Groberg said. “They were nervous about interest rates. They were nervous about inflation, and they were nervous about whether (those factors) would affect demand for fertility treatment.”

However, some of those concerns appear to have dissipated according to Groberg, who noted that his current pipeline is “very busy.”

The year 2022 was record-breaking for deals involving physician practices, which includes fertility clinics. According to Irving Levin, there were 608 such transactions last year, up from 457 in 2021, a 33% increase. In related healthcare services – which includes fertility storage businesses – there were 574 deals last year, compared to 477 in 2021. 

Among the deals that were publicly announced: 

  • Ivy Fertility acquired Fertility Associates of Memphis (announced February 14)

  • INVO Bioscience acquired the Wisconsin Fertility Institute (announced March 20)

  • Maven Clinic also acquired the digital health company Naytal, but that was with the intent of building business in the United Kingdom, not the U.S. (announced March 21)

Meanwhile, there are stronger tailwinds toward dealmaking at the start of the second quarter. Among the deals announced or closed in recent weeks include: 

  • The planned acquisition of Morgan Stanley-owned Ovation Fertility by US Fertility (announced on April 3); 

  • CCRM Fertility’s acquisition of the New Hope Center for Reproductive Medicine (announced April 18); 

  • Ivy Fertility’s acquisition of Virginia Fertility and IVF (announced April 17).

Executives at several major fertility companies: First Fertility, Pinnacle Fertility, Inception Fertility and The Fertility Partners, either declined comment on current acquisitions and trends, or did not respond to a request seeking comment.

While M&A activity appears to be perking up, both Groberg and Hayden Rosenthal, an associate with Intrepid Investment Bankers in Los Angeles, say that the multiples of earnings before interest, taxes, depreciation and amortization (EBITDA) to determine purchase prices have gone down.

“In the first or second quarter of last year, (fertility practice multiples) were at 12 or 13. Now it’s 10, or maybe 11,” Groberg said.

According to Rosenthal, multiples continue to be fairly strong, but they are off from their late 2021 highs. He said they are currently running in the high single digits for one or two physician practices, and the low to mid-teens for larger operations.

Swett noted that there are few multiples publicly available on transactions. Irving Levin was only able to obtain clear numbers on INVO’s purchase of Wisconsin Fertility Institute. The three-physician practice reported 2022 revenue of $5.5 million, and EBITDA of $1.9 million, according to Irving Levin. The $10 million sale price was based on an EBITDA multiple of 5.2. The payments will be made in equal payments over four years, with the first payment in cash. The sellers have the option of taking future payments in INVO stock, according to Irving Levin data.

“Times are a little tougher, and people are a little more hesitant, particularly investors or private equity-backed platforms,” Rosenthal said. “Some of them are still doing acquisitions for sure, but some people have been a bit more conservative and are taking a ‘wait and see’ approach.”

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health.

 
 

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U.S. Fertility to Acquire Ovation Fertility

 

BY: RON SHINKMAN

U.S. Fertility, which bills itself as the nation’s largest physician practice management platform in the fertility space, is acquiring Ovation Fertility, the companies announced on Tuesday.

The Los Angeles-based U.S. Fertility works closely with 14 major medical practices in 11 states, along with an additional practice in Chile. It provides healthcare IT and business information services, facilities and operations management and fertility treatment financing programs, among others.

The Nashville, Tenn.-based Ovation operates a network of 21 laboratories in 11 states that perform fertility-related services, including IVF, genetic testing and egg and embryo storage. A significant number of its laboratories are concentrated in the Southeast and Midwest.

Both companies are relatively youthful and have close ties to venture capital firms. U.S. Fertility was founded less than three years ago when Amulet Capital and Shady Grove Fertility joined forces to create a platform-specific company.

Ovation was founded in 2015. It is owned by Morgan Stanley Capital Partners with an additional investment from WindRose Health Investors.

Although a joint statement issued by the two companies described the transaction as a merger, Morgan Stanley Capital Partners described the deal as a sale of Ovation to U.S. Fertility. It noted that Harris Williams acted as financial advisor to Ovation, while DLA Piper advised Morgan Stanley Capital Partners on legal issues.

Terms of the deal were not disclosed. Executives with both companies did not immediately respond to requests seeking comment.

“By creating one of the leading fertility networks in the U.S., we can utilize shared best practices to enhance the patient experience, provide outstanding care, and deliver improved research and innovation to the fertility industry. Collectively, the company will provide a platform for growth and expansion into new geographies and additional life sciences verticals,” said U.S. Fertility CEO Richard Jennings in a statement.

The companies said they expect the deal to close sometime during this quarter, subject to regulatory approval.

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser

 
 

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External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

KindBody raises $100M debt investment from Perceptive Advisors

 

BY: ERIKA RILEY

KindBody recently announced a $100 million debt investment from the life sciences division of investing firm, Perceptive Advisors, which puts its total debt-equity at $290 million. With a valuation of $1.8 billion following its last equity round (Series C), the company is poised to go public – something that founder Gina Bartasi says they plan to do in 2023 according to Fierce Health Care.

“Our focus is on profitable growth and achieving both EBITDA positive and cash flow positive this year. We believe both are essential for a successful IPO,” said Bartasi in an email to Inside Reproductive Health.

KindBody is a multi-channel fertility clinic network that also provides fertility benefits for employers. Bartasi shared that about half of KindBody’s revenue comes from employers and about 30% comes from its managed care service line. The remaining 20% of revenue comes from direct access of services.

This new raise also pushes KindBody’s total funding well over competitors in the fertility benefits space, such as Carrot, with a total $114.2M in funding, according to Crunchbase. Progyny raised a total $115.5M before their initial public offering, according to Crunchbase, and their market capitalization is now $3.06 billion according to Google Finance. 

Its 2022 acquisition of Vios Fertility Institute, which operated clinics in Illinois, Michigan, Missouri, Oregon, Washington, and Wisconsin, doubled KindBody’s number of brick-and-mortar clinics to a grand total of 31. With this new $100M investment, the company plans to open 10 more clinics in underserved areas, KindBody shared in a press release

“We’re prioritizing opening clinics in ‘fertility deserts,’ or underserved markets that are often outside major metropolitan areas or lack significant competition, that have a high need and long wait times to see fertility doctors,” Bartasi said.

In 2023, KindBody plans to open clinics in Seattle, Brooklyn, Philadelphia, and Miami, said Bartasi, who previously founded fertility benefits company Progyny. 

Vios was one of three companies KindBody acquired in 2022. In June, it acquired genetics testing company Phosphorus Labs and combined it with its KindLabs division. Then, in August, KindBody acquired the Chicago-based surrogacy agency Alternative Reproductive Resources, combining it with its KindEOS division.

These acquisitions position KindBody to be an end-to-end solution for fertility services. The company already offers fertility benefits to employers in addition to clinical care both in-person and virtually. Now, the company can offer genetic testing and surrogacy as well. 

An investor-executive in the fertility space, who did not wish to be named, said in an interview that companies are currently having trouble profiting off of genetics testing due to its oversaturation in the market.

“There's overcapacity in the number of sequencers out there. And that means that drives down the price of what you can charge for those tests. So it's most likely a loss-making genetics company that they are carrying there,” the investor-executive said.

While surrogacy can be a bit more profitable, it is also subject to legal and ethical changes that can happen overnight, the source said. 

According to Bartasi, KindBody is also using the $100M loan to “sharpen our operations and make strategic acquisitions to increase access to care.” The company is looking to acquire both “virtual and fertility” companies that can help to expand KindBody’s access, Bartsai said.

Last year, KindBody also added 42 new employer clients, including Walmart, bringing its grand total to 112. 

On the clinical side, KindBody employs 34 reproductive endocrinologists and 52 embryologists. The company’s spa-like practices aim to appeal to millennial and Gen Z patient-consumers who don’t want their healthcare to appear sterile; the waiting rooms are called “lobbies”.
“There are not many interesting assets [in reproductive medicine] with strong branding,” the investor-executive said. “And KindBody has done branding fantastically in the market.”

Perceptive Advisors has invested in KindBody previously during its Series C funding round. The New York-based firm specializes in life science and biotech companies. KindBody is currently the only fertility company located on its website’s list of investments.

Corrections and Amplifications:

Correction: 3/9/23 News Digest Article titled Natera revenue over $800 million, net loss almost $600 million for 2022 by Natasha Spencer. Natera's 2022 net loss was actually $547.8 million, which means that rounding up to "almost $600 million" is inaccurate.

 
 

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After End of Ferring License Deal, INVO Bioscience Moves to Acquire Fertility Practices

 

BY: RON SHINKMAN

In a bid to gain traction with its intravaginal device for IVF patients, INVO Bioscience has modified its business strategy to focus on acquiring freestanding fertility practices.

For the first nine months of 2022, INVO reported a loss of $8.1 million on revenue of $544,000. By contrast, the company lost $6.8 million on revenue of $1.1 million during the first nine months of 2021.

INVO has had to refocus its business strategy after a distribution deal with Ferring Pharmaceuticals ended in late 2021. Ferring had issues convincing physicians at busy practices to bring its products on board, INVO Chief Executive Officer, Steve Shum, said in an interview with Inside Reproductive Health.

“For a medical practice operator that is generally running at 100% of capacity or close to it, the idea of bringing in a completely new treatment methodology leads to the question ‘why? Why do it if nothing is broken?’” Shum said.

Nevertheless, soon after the Ferring pact began in 2019, it immediately became one of INVO’s leading sources of revenue. In the last year of the agreement, $3.6 million of INVO’s $4.1 million in revenue came from Ferring’s licensing fees. 

By comparison, INVO reported revenue of just $544,054 for the first nine months of 2022. Nearly $395,000 of that revenue came from INVO’s branded clinics in Georgia, Alabama and Monterrey, Mexico, which are operated in joint venture with existing fertility practices. Less than $150,000 was derived from direct product sales. 

“We see quite a few smaller practices that have one to two or maybe three physician operators, and we think that's the right sort of size practice for us to entertain potential acquisitions,” Shum said. 

The Sarasota, Fla.-based INVO is close to completing its first acquisition, which involves what Shum described as a “great practice” in an area of the U.S. he declined to disclose. 

“It’s been around for quite a while, it does good business and it’s nicely profitable,” Shum said. “It has a good reputation in the area, which is important. So, we’re excited about it.” He later added that he hoped to announce specifics of the acquisition when the company releases 2022 year-end earnings, likely sometime next month.

Shum discussed the new strategy during the company’s third-quarter earnings call in November, and suggested there may be as many 100 clinics nationwide with annual revenue of $1.5 million to $6 million that could be purchase targets.

John Heerdink, managing partner of Vista Partners, a San Francisco-based investment management firm, noted during the earnings call that “If you tucked in one, two or three of these (practices), you would reach breakeven (or) profitability very quickly.”

A Ferring spokesperson did not respond to a request seeking comment on the agreement’s end. Shum said that the company looked for similar distribution deals with other firms, but that there has not been any success as of yet.

Shum noted that the cash-pay policies of many fertility practices and the INVO product may be at odds. According to INVO, the average cycle with its product runs $5,000 to $8,000, versus $12,000 to $15,000 for a traditional round of IVF, although both have similar chances for success. Although the lower cost may be attractive to clients, selling it to clinicians who rely almost exclusively on cash-paying patients bred a fear they may “cannibalize” their own revenue streams, Shum said.

By acquiring its own practices, INVO is able to provide its products to patients directly. Shum noted INVO would also provide administrative and other forms of support to the practices it intends to acquire. It plans to keep the practicing physicians and other staff in place.

INVO has plans to open as many as 20 joint venture clinics in the U.S., with plans to open new sites in Tampa and Kansas City soon. It is also offering its products in Malaysia and Spain, with plans pending to enter the Chinese and Indonesian markets.

Shum did not immediately respond to a follow up request to describe how the acquisition strategy will be funded. Shum noted that the company has identified and executed a letter of intent for specific funding to close the acquisition, but has not released any other details.

INVO has raised $1.025 million since late 2022 for general business purposes, according to recent filings with the Securities and Exchange Commission. That came from the issuance of $500,000 in debentures, $275,000 in unsecured convertible notes and even $250,000 chipped in by Shum and Andrea Goran, the company’s chief financial officer, along with the latter’s colleagues. 

Regardless, the practice acquisitions will be a linchpin of INVO’s business moving forward. “We’re definitely going to work to try to find additional acquisitions this year and beyond, so it will become an ongoing part of our strategy,” Shum said. “But I would say right now we have a very intense focus on completing this first (transaction).”

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser

 
 

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External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

$3.25B. World’s Largest Ever Fertility Clinic Acquisition Approved After Almost One Year

This News Digest Brought to You by
CYCLE CLARITY

 
 
 

BY: RON SHINKMAN

Private equity giant KKR & Co. has, after 11 months of waiting for approval, closed its purchase of an 80% stake in IVIRMA Global, the Spanish-based chain of IVF clinics that is among the largest in the world.

The acquisition of IVIRMA by KKR is the world’s largest ever among fertility clinics, according to deal flow monitoring by Dresner Partners, a middle-market investment bank not involved in this deal, said Mitchell Stern, managing director.

The Spanish newspaper Cinco Dias reported that IVIRMA had originally planned an initial public offering, at a valuation of just over €1 billion in 2018, before disagreements among shareholders ultimately led to an offer from KKR for more than three times that amount.

KKR first announced the deal to acquire the majority stake in IVIRMA for an estimated 3 billion Euros ($3.25 billion) in March 2022. However, the Spanish trade regulator CNMC (Comisión Nacional De Los Mercados Y La Competencia) only approved the deal on Dec. 21 and did not announce it until Jan. 18, suggesting KKR and CNMC were in protracted negotiations to reach an agreement.

Specifically, the CNMC voiced concerns about the overlap of IVIRMA’s operations with IVF provider GeneraLife, which KKR acquired last year. GeneraLife operates 16 sites in Spain, and dozens more in Italy, Sweden, the Czech Republic and other European countries.

IVI is one of the older fertility chains in Europe, having been founded in 1990 and offering services such as ICSI as early as the mid-1990s. Spain’s IVI merged with U.S. contemporary, RMA of New Jersey in 2017, creating IVIRMA Global, and caught the attention of large investors.

KKR agreed to two specific conditions imposed by CNMC to close the acquisition: Divest its current clinic holdings in the provinces of Seville, Murcia and Zaragoza. GeneraLife operates five sites in those regions under the Ginemed brand. 

KKR also agreed not to raise prices among the clinics it will operate in Madrid, as well as not engage in any agreements to provide fertility services in conjunction with its primary competitor in Spain’s largest city. That provision is in effect for three years. The competitor was not named by the CNMC, but the GeneraLife-owned Ginefiv has the highest number of Google reviews in the area. 

Lastly, KKR agreed to modify arrangements for distributing exclusive solutions it owns that are used to freeze eggs and embryos.

“The offered commitments are sufficient to remedy the risks generated by the transaction in the markets for the provision of reproductive medicine services,” CNMC said in a statement.

KKR topped at least six other firms, including Cinven and Amulet Capital, Nordic Cap. Bain Capital, Carlyle and CVC Capital Partners, in their bid to purchase IVIRMA. Amulet Capital owns US Fertility, Nordic Capital owns CARE Fertility, CVC owns FutureLife, and Bain is an investor in sperm testing co., Legacy. Carlyle acquired equity in pharmaceutical company, Thermamex in August 2022.

KKR went ahead with the deal despite the choices of Morgan Stanley, Credit Suisse AG, Bank of America and Deutsche Bank AG last summer to dump their loan obligations,. In April 2022, Bloomberg reported the four banks had battled private creditors to finance the deal. Less than six months later, Bloomberg reported that those same four banks sold their approximately $869 million in obligations to private credit firms at a loss.

KKR declined to comment to Inside Reproductive Health about their post acquisition plans. There is no mention of the deal closing on the KKR website, and no indication of management or boardroom changes on the IVIRMA website.

Currently, IVI operates a total of 75 sites in nine countries, including clinics and laboratories. That includes 33 in Spain, 20 in the United States and 13 in the United Kingdom, according to the company’s website.

“They are interested in expanding in the United States,” said Stern. Currently, the bulk of IVIRMA’s U.S. clinics are in New Jersey and California. It operates two sites each in Pennsylvania and single locations in Florida, Texas and Washington State.

Aside from Spain and the United Kingdom, IVIRMA operates just six clinics in Europe--in Portugal, Italy and Denmark, according to their website. It is unclear if KKR plans to further expand IVIRMA clinics into areas where it has GeneraLife properties.

A recent interview given to Bloomberg by Philipp Freise, a KKR partner and its co-head of European private equity, suggested that the company will be particularly aggressive in Europe, in reproductive services. “As a macro point, Europe has never been more attractive in our view,” he said. “Now’s the time.”

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser


Fertility Provider and Staff Benchmarks Surprise Many
 
Last week, more than twenty fertility providers, executives, and employees downloaded averages for 

  • Ultrasounds per IVF cycle

  • Time required for each Ultrasound

  • Ultrasonographer Time

  • Ultrasonographer Salary with Benefits

  • Nursing Time per IVF Scan

  • Nursing Salary with Benefits

  • MA Salary with Benefits

  • MD Revenue Working Top of License/hr

Link below will not be available in Inside Reproductive Health next week. See how your fertility center compares while still available now.


 
 

All external links active as of 1/26/23.

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

At least 25 Fertility Clinics Sold in 2022. Who They Were and Who Bought Them

This News Digest Brought to You by
CYCLE CLARITY

 
 
 

BY MICHAEL BARBELLA

Merger and acquisition activity continued to consolidate fertility clinics in 2022 as companies providing reproductive assistance brokered deals that expanded their buyers’ geographic footprints and market share. Transaction totals have increased in recent years from more buyers. 

“For fertility practice transactions, 2022 was a tale of two kinds”, explains Richard Groberg, a financial executive who advises business sellers and buyers in the fertility field.  “Early 2022 saw significant interest from buyers at high multiples [of EBITDA]”.  

Groberg went on to say that many practices’ IVF and patient volumes declined in later 2022 after peaking from what he sees as a post-Covid boom in 2021. “As a result, acquirers have become much more prudent/risk averse in terms of valuations, earn outs, claw back provisions, etc.”

Damian Dalla-Longa, a partner at New York City-based Albaron Partners, a lower middle-market investment firm focused on the healthcare sector, says he is very optimistic about his group’s investment position in the fertility industry. “In the U.S. and globally, patient demand for fertility services outstrips the supply of physicians and IVF facilities. This will continue to drive strong growth in the industry for years to come.” 

Such demand, along with a better awareness of IVF (in-vitro fertilization) and related services, rising infertility rates, and the advancing age of first-time parents, is expected to boost the global market’s value 37.5 percent (reaching $36.25 billion) by 2028, according to Zion Market Research data.

That growth has spawned a bounty of M&A activity over the last seven years. At least 25 deals transpired in 2022, as PE firms, digital health providers, and reproductive assistance/fertility companies jockeyed for market share. Some of the transactions included:

North America
 

Kindbody’s purchase of Vios Fertility Institute (February), Phosphorus Labs (June), and Alternative Reproductive Resources (August). The Vios deal doubled Kindbody’s U.S. footprint at the time to 26 clinics and propelled the company to unicorn status at a $1.15 billion valuation. The Phosphorus Labs and Alternative Reproductive Resources additions, meanwhile, gave Kindbody in-house genetic testing and surrogacy capabilities, respectively.
 

The Fertility Partners’ Canadian and U.S. expansion via partnerships with Ottawa Fertility Centre (Ontario), Grace Fertility Centre (Vancouver), Illume Fertility (Norwalk, Conn.), and Kitchener Area Reproductive Medicine Associates (Ontario). The latter affiliation expanded The Fertility Partners’ presence to 13 IVF centers across 36 locations in Canada and the United States, including seven in Ontario.  

Pinnacle Fertility’s eight-clinic spending spree. Joining the Pinnacle corporate family were ORM Fertility (four practice loations in Oregon and Washington), Advanced Fertility Care (two practice locations in the metro Phoenix area), California Fertility Partners (Los Angeles), Institute for Human Reproduction (Chicago), Dominion Fertility (greater Washington, D.C. area), Seattle Reproductive Medicine, Center for Reproductive Care (Chicago), and IVF1 (Naperville, Ill.). “Our two most recent additions, Seattle Reproductive Medicine (SRM) and IVF1, have expanded our geographical blueprint,” said Chief Operating Officer Beth Zoneraich. “With SRM, we vastly expanded our presence in the Pacific Northwest and the West Coast overall.”

CCRM’s pickup of The Institute for Reproductive Medicine & Science, a fertility treatment center with eight offices in New York and New Jersey, and RADfertility, a fertility center with offices in Newark, Wilmington, and Dover, Del. CCRM is backed by TA Associates and Unified Women’s Healthcare. 

Innovation Fertility, headed by CEO, Dwight Ryan, is the result of Albaron Partners affiliates’ acquisition of SpringCreek Fertility in Ohio. Charlotte, N.C.-based wealth advisory firm New Republic Partners made a strategic investment in Innovation Fertility, which is owned by Albaron Partners. “When we look at opportunities in general, we look to invest in underserved markets with positive growth potential,” said Dalla-Longa.

Ivy Fertility was backed by InTandem Capital Partners to purchase Utah Fertility Center, Nevada Center for Reproductive Medicine, and Nevada Fertility Center. 

Prelude Network, owned by Inception Fertility, made its second fertility clinic purchase in Canada with Alberta’s Regional Fertility Program. Inception Fertility’s financier, Lee Equity Partners, is in the process of seeking a buyer for the company, according to reports from Axios.

Ovation Fertility, which typically purchases the IVF lab rather than the clinic, announced its deals with the Fertility Center in Grand Rapids in May Northeastern Reproductive Medicine in August. WindRose sold its stake in Ovation to Morgan Stanley Capital Partners in 2019.

Oma Fertility’s acquisition of Syosset, N.Y.-headquartered New York Reproductive Wellness. Oma Fertility is a division of San Jose, Calif.-based Oma Robotics, which boasts Jazz Venture Partners, Mithril, and Root Ventures as investors.

Boston IVF’s purchase of Delaware Institute for Reproductive Medicine, a fertility treatment provider in Delaware and the Mid-Atlantic region. Boston IVF is owned by the Eugin Group which is owned by publicly traded, Fresenius Helios.

Global Premiere Fertility’s pickup of Laguna Hills, Calif.-based Reproductive Health & Wellness Center. Led by CEO Kolin Ozonian, Global Premiere closed an $11 million Series C funding round last June from Triangle Capital Corporation. 

CARE Fertility, owned and financed by Nordic Capital, made their first entry into the United States when they purchased Reproductive Endocrinology Associates of Charlotte (REACH) at the end of 2022.

International

IVIRMA sold to KKR for €3 billion instead of listing an initial public offering.

Monash IVF Group Limited’s $9.4 million purchase of PIVET Medical Centre, a southwest Australian fertility services provider; and $3.9 million deal for ART Associates Queensland #2 Pty. Ltd. in Brisbane, Queensland.

FutureLife was backed by CVC Capital Partners and Hartenberg Holding in its acquisition of Institut Marques, one of Spain’s largest fertility clinics. Headquartered in Barcelona, Institut Marques operates three clinics in Spain and two in Italy. 

Not announced in 2022
 

Fertility Specialists Network, supported by LongueVue Capital, acquired Boca Fertility on January 12, 2023.

The last announced acquisition from Sverica Capital’s First Fertility was Fertility Institute of New Orleans in December, 2021

No announcements on 2022 acquisitions were found from US Fertility, whose principal investor is Amulet Capital, in 2022.

Groberg says that fertility networks, also known as Management Service Organizations (MSO) may begin to merge or invest more in starting De Novo (new location or start-up) fertility practices this year. 

With regard to acquisitions of fertility centers in 2023, Groberg anticipates another tale of two kinds.

“I expect that acquirers will continue with more prudent valuations and terms.  Also, there seem to be fewer multi-physician practices available, which likely will reduce overall activity but might increase the multiples for the strong, multi-physician practices that are interested in selling”.

 

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser


Corrections and Additions, January 27, 2023:

Correction: US Fertility's acquisition of Center of Reproductive Medicine in the Houston area was announced in January 2022.

Addition: Inception Fertility reported to Inside Reproductive Health that Prelude's acquisition of Main Line Fertility in the Philadelphia area took place in 2022.


Fertility Provider and Staff Utilization Rate Benchmarks Revealed
 

One fertility company releases their averages for 

  • Ultrasounds per IVF cycle

  • Time required for each Ultrasound

  • Ultrasonographer Time

  • Ultrasonographer Salary with Benefits

  • Nursing Time per IVF Scan

  • Nursing Salary with Benefits

  • MA Salary with Benefits

  • MD Revenue Working Top of License/hr

See how your fertility center compares


 
 

All external links active as of 1/19/23.

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

British Invasion: UK's Largest Fertility Group Makes First US Acquisition

This News Digest Brought to You by
CYCLE CLARITY

 
 
 

BY RACHEL LELAND

CARE Fertility, the United Kingdom's largest fertility group, has announced its first-ever entry into the United States fertility market by acquiring REACH, a former Integramed fertility clinic in Charlotte, North Carolina with four REI physicians and four advanced practice providers (APP).

The acquisition, along with one other, are CARE's first outside of the U.K. and Ireland. In tandem with announcing the REACH acquisition, CARE announced it was buying IVF-Life Spain. 

The financier behind CARE is Nordic Capital, which bought CARE from Silverfleet Capital in January 2022, to support the fertility group’s expansion into international markets. CARE Fertility generated €74 million in revenue in 2021. Nordic Capital reports €31 billion in assets under management from 47 investments in its current portfolio. According to Crunch Base, the international investment firm is based in Copenhagen.

Robert Goodman, Vice President at MidCap Advisors, an investment banking firm which handles mergers and acquisitions, and is familiar with REACH, said that he couldn’t speak to the dollar figure of the deal because MidCap was not involved in this sale. Goodman estimates the range of the deal was “probably a low double digit multiple of EBITDA.” 

According to Patrick McPhillips, Executive Director at REACH, the North Carolina clinic ultimately decided to liaise with the buyer directly, rather than work with an investment banking firm.

As the largest provider group of IVF in the U.K., CARE does about 10,000 fresh treatment cycles every year and a similar number of frozen embryo procedures, according to Alison Campbell, Chief Scientific Officer at CARE. REACH currently does just under 600 retrievals per year according to McPhillips.

Campbell called their acquisition timely, because of a shortage of embryologists in the U.S., which is largely due, in their view, to a lack of adequate embryology training programs. CARE launched a master's program in clinical embryology in partnership with Liverpool John Moores University in 2022.

“We use half a billion images of thousands and thousands of embryos to train the machine learning to automatically annotate these timelapse videos,” Campbell said. “So that in itself is saving twenty-three weeks of embryology time across the group. A real efficiency gain there.” 

McPhillips, says one of the most significant benefits of the partnership for REACH will be having access to CARE’s extensive network of data. While the two clinics are in the beginning stages of the integration, REACH will soon have access to CARE’s IT systems and Power BI, the cloud-based analytics service that CARE uses to visualize and analyze data from its over twenty clinics in the U.K. 

According to Campbell, CARE and REACH are already talking about introducing CAREmaps, CARE’s trademarked time-lapse imaging technique, which helps clinicians select embryos that have the highest potential without needing genetic testing. 

CARE was co-founded in 1997 by Dr. Simon Fishel, who was a part of the team that created the world's first IVF baby in 1978. REACH was founded in 1988 by Dr. Richard L Wing.

Campbell says that CARE is looking at partnering with even more clinics in the Southeast and the broader U.S. 

REACH says they will maintain their name and not take on the CARE name in the United States.

“CARE isn’t going to rebrand us or make us one of many,” McPhillips said. 

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser


IVF Center Performing 1,500 cycles loses $2.38 million


Artificial Intelligence company calculates the expense and time presets of ultrasounds per IVF cycle and per OI cycle. The time and revenue audit of clinical inefficiencies during monitoring ultrasounds reveals that the average IVF center, doing 1,500 IVF cycles per year, loses $9,168.25 per day.


 
 

All external links active as of 1/12/23.

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.