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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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.

CNY Fertility triples IVF cycles since 2017 with no investor funding

Independently owned fertility center reports more than 7,300 IVF cycles in 2022

BY: RON SHINKMAN

Robert Kiltz, M.D., is a Los Angeles native who mostly studied and trained within California. Buffeted by the civil unrest and major earthquake that struck the city in the first half of the 1990s, he decided to move his family to the Finger Lakes region of New York. combined, the population of the region’s biggest cities, Rochester and Syracuse, have less than one-tenth the population of L.A. However, the region was still welcoming enough newborns to support Kiltz’s obstetrics practice.

Back in the mid-1990s, Kiltz received about $2,000 for a delivery. “When I started (offering) IVF, that sounded like a reasonable price,” he said. “I don’t have to deliver a baby at two in the morning and it’s a lot less work.”

Since CNY Fertility’s founding in 1997, Kiltz’s original single-site practice has steadily grown. It now operates nine clinics in upstate New York, Georgia, Pennsylvania, Colorado and Florida. That includes clinics that opened in Colorado Springs last year and Sarasota, Fla. this year. Companywide, CNY Fertility employs nearly 500 workers. That includes 15 physicians and osteopaths and 33 practitioners in total. Eight of the doctors are board certified in reproductive endocrinology and fertility (REI), with a ninth currently obtaining their certification, according to Kiltz.

CNY Fertility’s IVF cycle numbers have grown rapidly in recent years. It performed more than 7,300 cycles last year, triple the 2,429 performed in 2017. Just a decade ago in 2013, it performed fewer than 1,800.

Kiltz is the sole owner of CNY Fertility, and he has financed its expansion primarily through loans, he said. The company has accepted no venture capital or private equity investments.

Despite possessing the singular ambition to steadily grow CNY Fertility over the years into a national player, Kiltz said he didn’t do it to become rich.

“I went into medicine to help people and to make a reasonable living doing it. But I never did it for the money,” he said.

Low Price Points, Direct-to-patient Marketing

One of the keys to CNY’s growth has been its low price point, which it has maintained over the decades and is prominently advertised on the homepage of its website. That $2,000 IVF cycle in 1997 is now $4,275, or $4,720 including remote monitoring. Add a frozen transfer, remote monitoring, and a one-year embryo storage and the cost is just over $10,000. By comparison, the National Conference of State Legislatures estimates that the average IVF cycle costs between $12,000 and $17,000, not including medication. CNY Fertility also promotes travel programs where patients can undergo bloodwork and cycle monitoring by a local doctor before traveling to one of its clinics for a procedure. 

Kiltz said that prices are kept low through aggressive negotiations with all its suppliers, including medications. About 60% of CNY Fertility’s patients pay cash, with the rest paying through insurance, in line with recent data about payer mix in the reproductive medicine space.

Aside from aggressive pricing, CNY Fertility is also quite active on social media. Kiltz’s nephew, William Kiltz, directs its marketing and business development full-time.

CNY Fertility’s TikTok page, for example, has 55,000 followers. A few individual fertility doctors have similar or higher numbers, but the handful of fertility clinics using TikTok do not come close to that, based on searches on the TikTok application. CNY Fertility’s feed includes dozens of videos on subjects ranging from the egg retrieval process, TSH levels and employee and patient testimonials. Most are produced and edited and often include multiple camera angles and graphical overlays.

Kiltz, sporting a short black t-shirt, jeans and a thick silver chain, narrated one video on immunologic issues and IVF that has drawn thousands of views.

CNY has also trademarked various slogans for marketing purposes, including “Making Priceless Affordable.” Another slogan, “Miracles by CNY” was used to brand clinic merchandise, including a baby bag that made the “Today Show’s” list of top baby bags in 2021. 

Meanwhile, Kiltz is focused on continuing to grow CNY Fertility. He plans to add about 50 employees over the next year, including three to five new physicians and practitioners for the New York, Colorado and Florida sites. Plans are also on the drawing board to expand into Orlando, Fla., Texas and Kiltz’s old stomping grounds of Southern California. And Kiltz suggested his expansion strategy may soon no longer be a solo venture.

“If we’re going to open up three to five new centers in the next couple of years, then we’re certainly up to other joint partners to help CNY Fertility grow,” 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

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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.

Compared: Progyny, Kindbody, Carrot, and Maven as fertility benefit coverage increases 33% in two years

BY: RON SHINKMAN

According to a recently released survey by the International Foundation of Employee Benefit Plans, 40% of U.S. employers offered some form of fertility coverage last year. That’s up dramatically from 2020, when only 30% offered fertility benefits – a 33% jump in just two years. More employers now offer fertility benefits than financial assistance or paid leave for an adoption.

“We’ve been seeing family-friendly benefits like fertility coverage continue to grow as part of the larger trend of expanding work-life integration policies to be more inclusive of all employees,” said IFEBP Vice President of Content Julie Stich.  “Fertility benefits hold a high value by talent no matter their gender identity or relationship status. Providing these benefits helps nurture overall happiness and well-being.”

However, coverage can differ dramatically between employers. For example, among companies that offer fertility benefits, less than 35% cover egg harvesting or freezing services, and less than 45% cover fertility services that are not related to in vitro fertilization (IVF). There are numerous other variations along those lines.

Larger employers – those with more than a few hundred workers – often self-fund their employee medical costs and use a third-party administrator to handle claims (typically a subsidiary of a large health insurer). They may also outsource their benefits to major fertility platforms such as Progyny, Carrot or others in what are known as benefit “carveouts.” In those cases, the fertility firms usually act as a one-stop shop, offering benefits in line with the limits of coverage set by the employer, managing claims and collecting payments. Here is a breakdown of the four largest platforms:

Kindbody
Founded: 2018
Headquarters: New York City
Valuation: $1.8 billion
Locations: 27 Clinics in 21 cities in 15 states and the District of Columbia, Including New York City, Los Angeles, Atlanta and Houston
Senior Management: Gina Bartasi, Founder and Chairwoman; Angeline Beltsos, M.D., CEO, clinical operations; Annbeth Eschbach, CEO, corporate operations; Greg Poulos, President; Taryn Branca, Chief Revenue Officer
Major Employer Clients: Walmart, Lyft, Activision

Walmart, the nation’s largest company with more than 2.3 million employees, entered into a fertility benefits carveout with Kindbody last September.

“Our partnership with Walmart signals that fertility benefits have joined medical, dental, and vision as standard workplace benefits for leading employers,” said Bartasi when the deal was announced.

The pact with Walmart is an indication of how all-in-one fertility companies have grown in just a few years. Kindbody was founded only five years ago. That it was able to raise more than $281 million, according to Crunchbase, helped turbocharge its growth.

Although Kindbody does not post specifics regarding its benefits packages for employers, a recent webinar conducted by its senior management indicated that companies should curate a benefit that takes into account projected utilization by employees, medical and drug costs per cycle, and sources of direct and indirect savings.

Progyny
Founded: 2008
Headquarters: New York City
Enterprise Value: $2.7 billion
Coverage: It networks with 650 clinics and 950 physicians and clinicians
Leadership: David Schlanger, Executive Chairman; Peter Anevski, CEO; Michael Sturmer, President; Mark Livingston, Chief Financial Officer; Jennifer Bealer, General Counsel
Major Employer Clients: Detroit Pistons (NBA Team and its employees); Children’s Hospital Association

Progyny is the elder statesman of the group with its founding in 2008. Its 2022 revenue of nearly $787 million was 57% higher than 2021’s. It works with 370 corporate clients nationwide representing some 5.4 million employees, although the company has been mostly tight-lipped about its clientele. Unlike the other companies, it does not post the names and logos of its major corporate clients on its website. And the employer pacts it has announced – with an NBA team and a healthcare trade association – likely only cover a few hundred employees apiece.

Progyny and Maven were the only companies to respond to a request seeking comment for this article prior to publication. According to Progyny spokesperson Alexis Ford, the company assigns each patient an advocate “to better understand their Progyny benefit, their deductible, co-insurance, etc., since this is dependent on each employer’s health plan. The patient care advocate also provides unlimited education and is the patient’s go-to resource during the entire journey.”

Ford provided a single detail regarding Progyny’s carveouts: 90% of employers working with the company also offer their workers ProgynyRX, which includes medication coverage, next-day deliveries and access to support from pharmacists and other medication clinicians.

According to Holly Hutchison, co-owner of Reproductive Health Center in Tucson, Ariz, a carveout firm such as Progyny offers a “smart cycle.” That is specifically an egg retrieval and transfer along with anesthesia, laboratory and monitoring services. “Employers choose how many cycles they want to include in coverage, from one to five cycles,” she said.

According to Progyny’s website, an IVF procedure where one embryo is implanted and rest are tested and/or frozen represents three-quarters of a cycle. An intrauterine insemination represents one-quarter of a cycle. Egg freezing is half a cycle. A reciprocal IVF procedure involving a same-sex couple is 1.25 cycles, while a surrogacy IVF is 1.5 cycles.

Carrot Fertility
Founded: 2016
Headquarters: Menlo, Park, Calif.
Valuation: $500 million (estimated)
Locations: NA
Leadership: Tammy Sun, Founder and CEO; Ashima Ahmad, M.D., Co-Founder and Chief Medical Officer; Tim Kelly, Chief Commercial Officer; Brooke Quinn, Chief Customer Officer
Major Employer Clients: Zoom; Clif Bar; Lucid Motors (luxury electric automaker)

Carrot Fertility has raised more than $114 million since its founding, according to Crunchbase. Its $500 million valuation is an estimate made by Inside Reproductive Health based on available revenue data and multipliers for the healthcare industry.

Carrot Fertility did not respond to a request seeking comment about their company’s differentiation in the fertility space.

Maven Clinic
Headquarters: New York City
Founded: 2014
Valuation: $1.35 billion
Locations: NA
Leadership: Katherine Ryder, Founder and CEO; Kalliope White, Chief of Staff
Major Employer Clients: Snap, Bumble, Sanofi, Booz Allen Hamilton

A Maven spokesperson said the company offers “typical” carveouts, but did not provide specifics. 

Maven has raised more than $292 million since its founding, according to Crunchbase.

Carveouts Provide More Guidance Than Traditional Insurance Companies

Despite the dramatic increase in fertility benefits from employers, there are still no standardized guidelines mandated by nationwide governmental bodies such as the U.S. Department of Health and Human Services. As a result, fertility benefits and carveout structures vary from company to company.

“The coverage will vary depending on the employer and which fertility benefit management group they choose,” said Hutchison. State mandates on fertility benefits also play a role, she added. Hutchison estimated that about 45% of its patients currently have some form of insurance coverage. “They all have co-payments and deductibles and out of pocket amounts that apply prior to the coverage kicking in,” she added.

David Stern, the chief executive officer of Boston IVF – which operates 18 fertility clinics in six states – observed that most employees receive minimal guidance regarding their fertility benefits.

“You might have fertility coverage and IVF coverage, but the employee is told by their insurer ‘you’ve got to figure out yourself,’” he said. That puts enrollees at risk of using up their benefits on unneeded testing and procedures before they even start IVF, Stern added.

By contrast, carveouts can provide direction to health plan enrollees. According to Stern, one of the most important parts of a carveout is that fertility platform companies can provide care managers “who will talk to you about what the process is and what it looks like.” Boston IVF is a network provider for several major fertility benefits companies , including Progyny, Maven, Carrot and Stork Club Fertility, according to Stern.
 

Controlling Unexpected Costs

Stern noted that many platforms also emphasize “centers of excellence” models where they only refer patients to clinics with the highest standards and outcomes. This not only helps with success rates, but can also protect the employer, which may rely on rigorous standards to avoid multiple births. A triplet birth, even if all are healthy, can cost a self-insured company more than seven times the cost of a single birth, Stern said. As a result, he observed that many carveout arrangements specify only one embryo transfer at a time may be attempted for an IVF or similar procedure. Currently, about 95% of Boston IVF’s procedures are comprised of only a single transfer, according to Stern.

Whether employers offer carveouts or not, most coverage Stern sees from companies is minimal.

“You can go to a doctor and you can be seen by a specialist, but they don’t pay for medication or treatment,” 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

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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.

Number of REI Fellowship programs since ACGME’s takeover from ABOG

BY: LISA MUNGER

If REI fellowships and physicians with this expertise are limited, there are several consequences, some of which can be seen in evaluating patient care today. Without enough fellowship programs, qualified REI specialists may be unable to care for patients with infertility and other reproductive health issues. Without enough fellowship programs, there may be reduced research on infertility and other reproductive health issues, limiting progress in the field, according to the NIH.

Escalating Need

Rachel Weinerman, M.D. and REI specialist, credited as a nationally-recognized educator in the field, said REI fellowships and specialists are needed now more than ever. REI services demand has experienced a precipitous uptick in recent years, even as the number of fellowships haven’t increased properly to meet the demand. 

Increased coverage for IVF among employer-sponsored insurance and more states requiring coverage accounts for part of the equation. 

The International Foundation of Employee Benefit Plans has tracked fertility benefits over the past since 2016. According to their most recent survey in 2022, 40% of overall U.S. employers  currently offer fertility benefits (an increase from 30% in 2020).

• 28% cover fertility medications (8% covered in 2016, 14% in 2018, 24% in 2020)

• 30% cover in vitro fertilization (IVF) treatments (13% in 2016, 17% in 2018, 24% in 2020)

• 16% cover genetic testing to determine infertility issues (11% in 2018, 12% in 2020)

• 17% cover non-IVF fertility treatments (6% in 2016, 11% in 2018, 11% in 2020)

“People are accessing IVF services for fertility and fertility preservation, " Weinerman said. “There is a much wider population of people accessing services, including members of the LGBTQ community, who are increasingly seeking IVF services.”

REI Fellowships

There are 49 accredited fellowship programs, as of the Accreditation Council for Graduate Medical Education most recent data from the full 2021-2022 academic year. The National Resident Matching Program’s (NRMP)’s April 2023 The Match report says that there were 41 REI Fellowship programs in 2022. ReportingWhen ACGME assumed accreditation responsibilities for the first year in 2016 from the American Board of Obstetrics and Gynecology; 41 REI fellowships existed.

The University of Miami/Jackson Health System Program and the University of Washington Program received ACGME approval in September 2022, making them the latest programs to receive approval. 

The University of Miami/Jackson Health System Program and the University of Washington Program received ACGME accreditation in September 2022, making them the latest programs to get the nod. 

ACGME cannot estimate new programs coming in the pipeline. 

“It depends on receiving and approving new program applications,” said Susan Holub, director of communications at ACGME. 

The National Resident Matching Program matched 49 out of 49 open fellowship positions in 2022.There were 78 individual applicants for REI fellowship program positions for the 2021-2022 academic year in the most recent available data.

Creating an REI Fellowship: Obstacles

Potential programs must meet the ACGME requirements for the REI specialty and the Common Program Requirements to be accredited. 

The organization is solely responsible for accrediting new programs, said Susan Holub, vice president of communications for ACGME. 

Obstacles are inherent in beginning an REI program, as doing so requires significant resources, expertise and infrastructure. 

Securing funding to developing and sustaining a fellowship program can be difficult, Weinerman said. 

Besides the dollars required to pay staff, upstart also needs to include the resources for educational resources and materials, equipment and technology, according to the American Society for Reproductive Medicine. 

Programs must undergo accreditation by ACGME, which is sometimes a time-consuming and complex process. Further, new programs require many resources, including access to clinical facilities (reproductive surgery spaces, labs for testing and access to assisted reproductive technologies like IVF and IUI. 

Since ACGME took over accreditation from the American Board of Obstetrics and Gynecology in 2016, guidelines for establishing a new fellowship are more stringent and often more complex, which often translates into cost in actual dollars and time. 

“There are very specific guidelines and an intense application process. There's the review, so establishing a new program can take up to a year,” she said.

A Field, Underserved

While training obstetricians and gynecologists in a private setting can provide valuable experience in diagnosing and managing REI issues, it’s not necessarily a sufficient substitute for an REI fellowship, said Ruth Lathi, M.D., program director of the REI Fellowship at Stanford Health Care. 

“This requires access to complex patients and advanced specialists, which are rarely encountered in private clinics,” she said. “While many providers do not care for all aspects of reproductive life, this knowledge is used in managing complex patients with infertility.” 

Nonetheless, she said REI fellowships are needed to further the industry. 

“Without sufficient REI fellowships, there may not be a sufficient pipeline of providers and research to serve the future men, women and people who require reproductive care.”

Weinerman concurred. 

“We have a lot more use of advanced practice providers like NPs, PAs and general OBGYNs to fill those roles because of demands, she said. “There are a lot of practices that have very long waitlist practices because it’s hard to hire REIs … That may change overall the field provides patient care.”

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.

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.

Fight for Families: RESOLVE’s 2023 Initiatives in a post Roe world

This News Digest Is Donated Sponsored Content From RESOLVE

BY: MELANIE KALMAR

When the Supreme Court overturned Roe v. Wade last year, one organization renewed its focus on access to care for patients battling infertility.

Since 1974, RESOLVE: The National Infertility Association  has provided education, advocacy and emotional support to people nationwide who are trying to build families. The 501c3 is funded by individuals, corporations, fertility clinics, and individual professionals/experts in the field. 

A majority of the work RESOLVE does involves ensuring patients have access to emotional support and all family building options, no matter their zip code. This work includes, —support groups, federal and state advocacy, a program to encourage employers to include IVF coverage in benefits packages, public awareness campaigns and patient education, explained Barbara Collura, CEO of RESOLVE.

In FY 2022, RESOLVE helped 1.4 million people gain new or improved family building benefits through its access to care initiatives. According to Collura, the non-profit’s three big initiatives for 2023 include: protecting access to IVF services, opening access to it in California, Minnesota, Oregon and Washington State (four states that don’t have IVF insurance mandates) and increasing emotional support by returning to in-person support groups. RESOLVE offers peer-led support groups in 30 states and Washington, D.C. (42 in-person; 78 virtual; and 31 professionally led).

Protecting access

In response to the Supreme Court overturning Roe v. Wade, a move that could restrict access to IVF and people’s rights over their embryos, RESOLVE launched a new campaign: Fight for Families. Its goal is to amplify the non-profit’s existing state advocacy work and protect access to care.  

“What’s different now is the stakes are so much higher,” Collura said. “We felt we needed a louder voice and brought in PR support.” RESOLVE recently hired New York-based Fenton Communications to work with IVF patients on how to succinctly tell their stories to the media, to change minds and influence public policy.

Increasing access

Sharing stories of people who face barriers to building their family is so important in RESOLVE’s work, especially the Fight For Families campaign and when it comes to increasing access to IVF insurance through state laws,, Collura said. RESOLVE sees even more of an opportunity to increase access to care in California, Minnesota, Oregon and Washington State because after Roe v. Wade was overturned, legislators from those four states announced reproductive rights of women are protected in their regions, yet  those states don’t have an insurance mandate for IVF to back it up, Collura explained. She went on to say that this state advocacy work largely happens because of a strong coalition of other non-profits and corporate partners that work together. 

She said a robust insurance mandate would include coverage of at least two cycles of IVF, medication, unlimited frozen embryo transfers and fertility preservations (insurance coverage to preserve sperm, egg or embryo of patients experiencing Iatrogenic Infertility; infertility caused by medical interventions like chemotherapy, surgery or other medications someone facing Cancer treatments may undergo).

It’s critically important for people in those states to know what’s going on and speak with legislators,” Collura explained. “RESOLVE can show up and advocate but if constituents, the people that vote these lawmakers into office, don’t show up it doesn’t move our issues forward. “If legislators are hearing from their constituents about how important it is, it changes their mind and gets them to support our issues.”

She said RESOLVE has put coalitions to work made up of doctors, patient advocates, attorneys, grassroots influencers and bill sponsors and hired a team of paid lobbyists to help advance legislation they introduced in those state capitols.

Mental health matters

The third initiative is restarting and reinvigorating in-person support groups across the country that were virtual during the pandemic. “We believe your mental health and ability to take care of yourself enhances and directly correlates to your ability to stay in medical treatment,” Collura said. “Connecting with others, finding a sense of community and taking care of yourself is vitally important to everyone as they go through this journey.”

Introducing federal legislation

With the overturning of Roe v. Wade, access to IVF was not federally protected. RESOLVE is hopeful that the Right to Build Families act that was introduced at the end of last year will be reintroduced this year. It aims to reintroduce to Congress the Right to Build Families Act that was introduced at the end of last year. “It would create a new law at the federal level that says people have a right to access IVF, medical professionals have a right to offer that service and people have a right over their embryos,” Collura said. “We’d love to see it in federal law, then states wouldn’t need to pass their own laws restricting access.”

On April 25, RESOLVE and the American Society for Reproductive Medicine (ASRM) will host a federal advocacy day, an opportunity for people to join RESOLVE and ASRM to advocate on a federal level. Participation is free.

“We provide training and an opportunity to tell you what to say, what the issues are, why these issues are important,” Collure explained. “We help people develop their own story and make it very bite size and succinct so that it will hit on the really important points members of congress need to hear.”

Meetings between participants, senators and state representatives are virtual and last 15 to 20 minutes. Most conversations actually take place with legislators’ staff who relay the messages.

“So many members of congress don’t know about all these issues,” Collura said. “This is our chance to tell them what’s important to us.”

This News Digest Story is donated featured sponsor content, where the Advertiser has editorial control. They do not reflect the views 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.

Silicon Valley Bank’s Ties to The Fertility Sector

BY: RON SHINKMAN

Silicon Valley Bank (SVB) played a role in providing financing to companies in the fertility business. However, the impact of its recent failure on the sector appears to be minimal for now.

The Santa Clara, Calif.-based SVB failed on March 10, after its heavy investments in U.S. bonds were sunk by rising interest rates and inflation, eventually triggering a liquidity crisis and then a run on deposits. Its holdings are currently being managed by the Federal Deposit Insurance Corp. 

FDIC has promised to make all depositors whole. And all lines of credit have been transferred to a stopgap facility called the Silicon Valley Bridge Bank, the FDIC said.  

The bank, which was founded in 1983, had extensive involvement with the biotech industry, which is at the core of providing in vitro fertilization and other fertility services. SVB was involved in more than 250 investments with biotech and healthcare firms, according to data from Crunchbase.

“Silicon Valley Bank was generally focused on the tech space. For the most part, the folks in (the fertility space) are not quite like that,” said Robert Goodman, vice president of healthcare at MidCap Advisors, a New York City-based investment banking firm focusing on companies with annual revenue up to $250 million. However, Goodman noted that SVB was involved with some of the companies offering an all-in-one platform of fertility services.

SVB’s biggest investment in a fertility firm, that Inside Reproductive Health found, occurred in August 2021, when it was part of a consortium providing $75 million in Series C funding to Carrot Fertility, the Menlo Park, Calif. firm that provides services to health plans, self-funded employers and other entities, including major firms such as Slack and Peloton. Executives from Carrot did not respond to requests seeking comment about their financial future.

The bank also played a role in financing Progyny, a New York-based firm that like Carrot also offers fertility benefits to employer groups and other entities. It had a line of credit with SVB that was at least $15 million, according to a February 2022 report by the Australian financial information service News Bites. A Progyny spokesperson declined to comment.

SVB also played a role in securing financing for Oma Fertility. Last June, SVB provided the firm $8.5 million in credit. The announcement of the financing coincided with the startup’s unveiling of Oma Sperm InSight, a service guide with artificial intelligence that assists embryologists in identifying “the most promising sperm cell to pair with an egg in IVF,” the company said at the time. Oma was founded in 2020.

Along with the debt facility, Oma has raised an additional $29 million in series A funding. Oma executives declined to comment about its relationship with SVB and how it might impact the sector.

For now, the demise of SVB appears to have left a minimal footprint on the fertility sector. Goodman noted that the platform companies such as Carrot and Progyny are “pretty strong” financially and were not overly reliant on lines of credit or other bank services to keep their operations going. 

Goodman also believes that SVB’s failure had virtually no impact on smaller practices offering financing services to patients. He added that patient finance is typically the realm of bigger financial institutions, such as Barclays Bank and Wells Fargo Bank, as well as credit card firms such as Visa.

“I’d be very surprised” if such financial services took a hit, Goodman said.

Executives from Oma Fertility declined to comment on the security of the company’s financial future.

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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All external links active as of 3/23/23.

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.

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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All external links active as of 3/16/23.

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.

Natera revenue over $800 million, net loss almost $600 million for 2022

BY: NATASHA SPENCER

On 28th February 2023, the US clinical genetic testing company released its full-year financial results for 2022, which include information on milestones achieved in 2022 and early 2023 and its financial statements. 

Net loss increase

Natera’s net loss increased to over half a billion dollars, reaching $547.8 million for the full year in 2022, compared to a net loss of $471.7 million in 2021 and 229.7 million in 2020. On the newly-released earnings call, a spokesperson for Natera told Inside Reproductive Health: “The company reiterated its goal of hitting a cash flow breakeven quarter in 2024.”

Despite these losses, Natera reported cash reserves, cash equivalents, short-term investments and restricted cash totaling approximately $898.4 million at the end of 2022, compared to $914.5 million at the end of 2021. 

As of 31st December 2022, the company had a total outstanding debt balance of $362 million. The amount comprises $80.4 million including accrued interest from its credit line with investment bank, UBS, along with a gross outstanding balance of $287.5 million under its seven-year convertible senior notes, which it received in April 2020. 

Total revenue projections

In 2023, Natera’s total revenue guidance is between $980 million- $1 billion. If Natera reaches this projected revenue, it is expected to reduce cash burn—the rate a company loses money—by approximately $150 million in 2023. 

“Our guidance for 2023 reflects our expectations for robust top-line growth as we reduce operating expenses and continue to position the company for ongoing success,” said Natera’s CEO, Steve Chapman. The company’s increased operating expenses were primarily due to growing its headcount, it reports, to support new product offerings.

Natera’s total operating expenses increased by 16.7% in 2022 year-on-year, amid its changing product portfolio, increased labor, and overhead costs. In 2023, Natera will focus on lowering these total operating expenses to achieve its projected targets.

The company anticipates its 2023 gross margin to be approximately 41% to 44% of revenues. Natera’s selling, general and administrative costs are estimated to reach approximately $510-$540 million in 2023; research and development (R&D) costs are projected at $325-$345 million, and net cash consumption is expected to be between $300-$325 million.

Revenue is up, gross profit margin is down

Speaking to Inside Reproductive Health, Natera provided information on the company’s revenue breakdown. Natera generated total revenues over the last three years of $820.2 million in 2022, $625.5 million in 2021, and $391.0 million in 2020.

The company’s gross profit equaled $364.0 million in 2022, $307.1 million in 2021, and $187.4 million in 2020, representing a gross margin of 44.4%, 49.1%, and 48%, respectively. While Natera’s gross revenue and gross profit are up, the company’s gross margin has dropped by 4.7% year-on-year.  

In 2022, medical device provider for women’s healthcare, Cooper Surgical, also saw a drop in its gross margin, decreasing from 67% in the fiscal year 2021 to 65% in 2022. The company stated that this was driven mainly by currency. 

It was also a similar story at science and technology company Merck, which saw its gross margin decline from 72.0% in 2021 to 70.6% in 2022. Merck said this decrease is primarily due to higher amortization of intangible assets, along with increased sales of the oral antiviral medicine Lagevrio and revenue from third-party manufacturing arrangements, both of which have lower gross margins.

Natera cited its changing product mix, increased labor, and overhead costs as the primary reasons behind its lower margins in 2022. Volume growth and customer support drove these, as well as one-time revenue of £28.6 million recognized from its Qiagen arrangement in 2021. Natera saw a year-over-year volume improvement of 31.6% in 2022, the company’s spokesperson shares.

No fertility services breakdown

When asked, Natera was unable to detail how much of the revenue and net income comes from fertility-related services. “We don’t break out revenues or other financials by product,” Natera’s spokesperson confirmed. 

Currently, the company’s fertility-related product portfolio includes Spectrum, a preimplantation genetic test, Anora, a miscarriage test, and Horizon, a carrier screening test. 

New board member 

Natera announced that Ruth E. Williams-Brinkley is joining its board of directors, growing its total board members to ten, effective in the position from 2nd March 2023.

As the current president of Kaiser Permanente Health Plan of the Mid-Atlantic States (KPMAS), a position Williams-Brinkley will continue to hold, the healthcare executive oversees the company’s care delivery and health plan operations.

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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All external links active as of 3/9/23.

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.

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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All external links active as of 3/2/23.

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.

Profit Down for 11 of 12 Publicly Traded Fertility Companies

This News Digest Brought to You by
BUNDL

BY: RACHEL LELAND

At least 12 publicly traded companies have multi-million dollar divisions, or their entire corporate focus, in the reproductive health space. 

The companies have different fiscal years. Some ended their 2022 fiscal year last summer. Most will not until the end of March 2023. In their most recent quarterly or annual reports, only one company, Jinxin Fertility Group which owns HRC Fertility, reported a gain in net profit. Inside Reproductive Health indicates the reporting periods below.

Jinxin Fertility Group
According to Jinxin Fertility Group’s half-year earnings report, the company experienced a 27.8% increase in gross profit, jumping from ¥363.2 million in June 2021 to ¥464.3 million the same month in 2022. In the same period, the company’s total revenue climbed from ¥859.3 million to ¥1.1 billion, a jump of 32.5%. The Group’s net profit bumped from ¥162.6 million to ¥187.6 million, a 15.4% climb. Jinxin Fertility Group is listed on The Stock Exchange of Hong Kong Limited. 

Femasys
Femasys’ third-quarter report shows that the company’s gross sales jumped 24.7% from $105,403 to $131,451 from Q320, largely due to the increase in U.S. FemVue sales. The report flagged the company’s YoY revenue up 28.89% from $269,580 to $347,460. Their income statement reports an $8.5 million net loss for the first three fiscal quarters of 2022. Femasys is listed on the NASDAQ.

Cryoport 
According to Cryoport’s third-quarter report, revenue from the company’s reproductive medicine  increased to $7.6 million, a gain of 15% or $1.0 million compared to the same period in 2021. The report noted that the increase was driven by strong demand for the company’s CryoStork solutions as well as new international fertility clinic partnerships. YoY net loss attributable to common stockholders was $33.9 million, or $0.69 per share, for the nine-month period ending in September 2022. Cryoport is listed on the NASDAQ.

Hamilton Thorne 
According to Hamilton Thorne’s third-quarter report, YoY gross profit increased a total of 11.8% from $18.2 to $20.4 million. Year over year sales increased 14% to $41.8 million. Hamilton Thorne’s net income dropped 41.8% from $1.6 million to $930,000. Hamilton Thorne is publicly traded on the Toronto Venture Exchange.

Monash IVF
Monash IVF’s group revenue grew 4.7% from AU$183.6 million to AU$192.3 million. 26,22236,200 Their net profit for fiscal year 2022, which ended June 30 of the same year, decreased from 2021’s AU$36.2 million to $26.2 million, a drop of 27.6%. Monash IVF is publicly traded on the Australian Securities Exchange. 

Natera
According to Natera’s third-quarter report, gross profit for the third quarter in 2022 and 2021 were $94.1 million and $76.7 million, respectively, representing a gross margin of 44.7% and 48.5%, respectively. The company’s total revenue climbed from $452.4 million in 2021 to $602.9 million, a 33.2% increase. Natera reported a net loss for the third quarter of 2022 of $121.5 million, or ($1.25) per diluted share, compared to a net loss of $151.3 million, or ($1.63) per diluted share, for the same period in 2021.

EMD Serono
Merck KGaA is publicly traded on the Frankfurt Stock Exchange and the Xetra Stock Exchange.In the United States and Canada, Merck operates as EMD Serono in the healthcare business. According to Merck’s third quarter report, fertility sales grew 6.2% from €1.003 billion to €1.066 billion. The company’s healthcare specific income loss was substantial, dropping to € –133 million from € 129 million in 2021.

Organon
According to Organon’s third quarter report, the company’s gross profit in 2022 of $991 million was close to last year’s gross profit of $986 million. Total net revenues were $1,537 million for the third quarter of 2022, a decrease of 4% as-reported and an increase of 3% excluding the impact of foreign currency, compared with the third quarter of 2021. Net income from continuing operations for the third quarter of 2022 was $227 million, or $0.89 per diluted share, compared with $323 million, or $1.27 per diluted share, in the third quarter of 2021. According to the report, Follistim AQ (follitropin beta injection), increased 2% ex-FX in the third quarter of 2022, and ganirelix acetate injection increased 52% ex-FX. Organon is publicly traded on the New York Stock Exchange. 

INVO Bioscience 
According to INVO Bioscience’s third-quarter earnings report, revenue decreased by more than 87% following the termination of the company’s license with Ferring Pharmaceuticals on January 31, 2022. Gross profit for the YoY third quarter also dropped by 36% from $198,456 to $126,205. In the third quarter, INVO had a net loss of $2.5 million. INVO Bioscience is listed on the NASDAQ.

Cooper Surgical
In its fourth quarterly report, CooperSurgical, a subsidiary of CooperCompanies, saw revenue up 35% to $277.1 million. YoY gross profit for the entire CooperCompanies climbed from $1.95 billion to $2.14 billion, 9.4%. All in all, CooperCompanies’ net income fell by 86.9% from $2.94 billion to $385 million. Cooper Companies is traded on the New York Stock Exchange. 

Myovant Sciences
In its third-quarter earnings report, Myovant Sciences showed its cumulative total revenue for 2022 reached $321.5 million surpassing the previous year’s total of $173.4 million by 85%. Net loss for the Q3 2022 was $57.6 million compared to $63.4 million for the same period a year ago. Myovant Sciences is traded on the New York Stock Exchange. 

Progyny
In its third-quarter report, Progyny, reported a 53% year-over-year growth increase to $572.5 million from $373 million. The company’s gross profit was $122.8 million, an increase of 41% from the $87 million reported in 2021. Finally, net income was $26.9 million, a decrease of 46.8% from last year’s $50.6 million. Progyny is listed on the NASDAQ.

Pete Anevski, Chief Executive Officer at Progyny attributes the biggest driver of demand for fertility benefits to need and increased interest among millennials, the largest demographic in today’s workforce.

“Traditional insurance plans attempt to control the cost of care by restricting utilization with dollar maximums, step therapies, prior authorizations, and treatment exclusions. Their approach results in low live-birth rates and high-cost, high-risk pregnancies and multiple births, which negatively impact employers and their members,” Anevski 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

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IVF Center loses >$300,000 from 20 lost patients

This formula calculates the economic value of a fertility center’s patient retention by using your SART data and IVF prices. Email Courtney from BUNDL to get your fertility center’s  patient retention valuation calculated for free.

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All external links active as of 2/23/23.

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.

Program Prevents IVF Patient Drop Out. 100% Retention Through Shared Risk

This News Digest Brought to You by
BUNDL

BY: MELANIE KALMAR

After an initial IVF cycle fails, money and emotions can become a complicated mix for patients without insurance or those who exhausted their benefits.

Disappointed, they might switch to another clinic, especially in markets saturated with competition. But starting over is a mistake. Each cycle gives doctors clinical information that informs how they approach the next one, in order to have a chance at success. By eliminating that step, patients risk wasting time and resources.

Still, it happens. They may even take a break from IVF or use the money for something else and potentially miss out on becoming parents. According to the National Library of Medicine financial burden is the top reason 62.5% of couples drop out of IVF treatment. 

BUNDL, an innovative shared risk program, removes financial concerns from the process. Patients pay for two or three IVF cycles upfront at a discount—a full suite of services—and never see another bill again. Most importantly, doctors can automatically move to the next cycle and do what they need to do to help couples start families.

“Statistically, one IVF cycle isn’t enough for patients faced with an infertility diagnosis,” explained Cheryl Campbell, director of operations at BUNDL. “We’re not a lender or financial institution. But we’re helping on the financial piece.”

The program provides the patient with a good experience while giving the practice a chance to retain that patient who might otherwise drop-off. “BUNDL is driving 100% retention,” Campbell said. “Patients want to take off that pressure upfront.”

If a patient has services remaining after a loss, they will pick up right where they left off, Campbell explained. If they don’t and the program ends unsuccessfully, they can reup and try again.

“The risk for BUNDL is you may use more services than we collected for; the risk for the patient is they may leave services on the table,” Campbell explained. “But those funds go back into the program, to help it grow.”

BUNDL is an extension of a participating clinic’s financial counseling center. Doctors refer patients based on their medical histories and/or finances. “We try to mirror what our practices offer, so patients understand they’re getting the same services just at a discounted rate,” Campbell said. Once they pay the enrollment fee, BUNDL takes care of the billing and goes back and forth with the clinic on their behalf.

BUNDL can accept payments from patients until they meet the enrollment fee required to start treatment, direct them to grants or, when applicable, offer tips on how to improve their credit score.

The team at BUNDL understands the client experience because half of them are fertility patients.

“The best conversations we have with patients are ‘I’m pregnant or here’s a picture of my newborn that I had through BUNDL,’” Campbell said. “If you take home a baby that is our measure of success. It’s important that our patients understand we want them to take home a baby.”

Already creating a buzz online, BUNDL directs patients to clinics nationwide that offer the program.

This News Digest Story is paid featured sponsor content, where the Advertiser has editorial control. They do not reflect the views of Inside Reproductive Health.

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IVF Center loses >$300,000 from 20 lost patients

This formula calculates the economic value of a fertility center’s patient retention by using your SART data and IVF prices. Email Courtney from BUNDL to get your fertility center’s  patient retention valuation calculated for free.

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All external links active as of 2/16/23.

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.

$189 Million. Five Fertility Companies Raised the Most Venture Capital in 2022, say two VCs

This News Digest Brought to You by
BUNDL

BY:  ERIN FLYNN JAY

According to two venture capitalists in the women’s health space, the top five venture capital raises of 2022 for Assisted Reproductive Technology (ART) companies were:

1. Maven Clinic – Series E at $90M

2. Oma Fertility--Series A at $29M

3. AiVF – Series A at $25M

4. Gameto – Seed at $23M

5. Alife – Series A at $22M

The analysis was offered by two different venture capitalists who do not work together and who both wished not to be named. The raises do not include other businesses that look at provide prenatal or post-natal care, menopause, or contraception.

Who was behind these venture capital fund raises and what are they using the money for?

In November 2022, Maven Clinic, the largest virtual clinic in women's and family health, announced it raised a $90 million Series E funding round. According to a Maven Clinic press release, this was led by General Catalyst, with participation from CVS Health Ventures, La Famiglia, and Intermountain Ventures, as well as existing investors Sequoia, Oak HC/FT, Icon Ventures, Dragoneer Investment Group, and Lux Capital. 

This brought Maven's total funding to $300 million.

Maven is using this new funding to continue to invest in personalization across its platform in both commercial and Medicaid populations. 

Oma Fertility raised $29M through Seed and Series A rounds led by JAZZ Venture Partners, Root Ventures, Mithril Capital, Global Asset Capital, and Free Solo Ventures in addition to a $8.5M debt facility led by Silicon Valley Bank according to their June 2022 press release. Oma Fertility also purchases fertility clinics and is building De Novo IVF centers. They are associated with Oma Sperm Insight and Oma Robotics.

In June 2022, AiVF®, developer of the first fully operational AI-based IVF software platform, announced in a company press release that it raised $25 million in a Series A round led by Insight Partners, a New York-based venture capital and private equity firm with participation from Adam Neumann’s Family Office, 166 2nd.

AiVF is using the funding to fuel adoption of the company’s AI platform, EMA™ in the United States and Europe, expand its work force and develop additional solutions to drive a new generation of digital fertility care.

AiVF did not respond to requests for comment on their expanded capacity to serve the US and European markets. 

In January 2022, Gameto, a biotechnology start-up solving the problem of accelerated ovarian aging to change the trajectory of women's health and equality, announced it raised a $20 million in Series A funding led by Future Ventures, with participation from Bold Capital Partners, Lux Capital, Plum Alley, TA Ventures, Overwater Ventures, Robert Nelsen and Anne Wojcicki. 

Gameto also raised $3 million in Seed funding in March 2020 from a range of notable investors including Jack Abraham, SALT Fund, FJ Labs, Dan Rose and Brian Armstrong, according to a company press release.

The Series A funding was led by venture-capital firm Future Ventures. Founded by Steve Jurvetson and Maryanna Saenko, Future Ventures focuses on early-stage disruptive technologies.

Gameto is building a platform for ovarian therapeutics to initially address menopause and improve assisted fertility with three sequenced programs:

1. Fertilo. Treats oocytes outside of the body, increasing maturation rates and oocyte quality to improve IVF and egg freezing outcomes.

2. Deovo. To initiate drug discovery and a computational platform for ovarian aging.

3. Ameno. A cell-based therapeutic to disassociate the unwanted effects of menopause that occur with the loss of fertility.

In March 2022, Alife Health, the fertility technology company building artificial intelligence tools to advance in-vitro fertilization (IVF), announced it raised $22 million in Series A financing co-led by existing Seed lead Deena Shakir at Lux Capital, and new investors Rebecca Kaden at Union Square Ventures and Anarghya Vardhana at Maveron, both of whom joined Alife's Board of Directors.

With its new funding, Alife brought its first two products to market and continues conducting clinical studies for a third product. Alife's first medical product, Stim Assist, was released in October 2022. It is used during the ovarian stimulation process. 

Alife also released its first patient product late last year. Upon conducting extensive interviews with past IVF patients, Alife identified the need to streamline and organize the IVF process. With Alife's mobile app, patients gain a comprehensive platform that includes educational resources and easy-to-use organizational tools for medication reminders, appointments, lab results, and more.

"Looking into 2023, there is still a large amount of capital that funds must deploy in the near future, but I expect that they will be very selective on who they fund" remarks Dr. Eduardo Hariton, a practicing REI physician who is the Managing Director of US Fertility's Innovation Fund. "Companies who have not been able to achieve product-market fit or meet previous milestones may struggle to raise further capital. Ultimately, this may lead to some consolidation of companies in our space." 
 

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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IVF Patient Drop Out Rises, Patients Seek Fertility Clinic

The number of patients who do not continue after a failed IVF cycle is on the rise at some IVF centers.

To counter the decrease in IVF revenue, fertility centers are turning to partners who have IVF-ready, financially qualified patients, but who don’t yet have a fertility clinic.

Courtney from BUNDL has a list of treatment-ready patients in each city. There is no fee but the offer is for the US and Canada only.

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All external links active as of 2/9/23.

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.

Fertility Division Closures Raise Questions about Future of Genetics Companies

This News Digest Brought to You by
BUNDL

BY:  ALEXANDRA FROST

Major genetics companies downsized their fertility divisions in 2022 and 2023, causing speculation on the future of fertility testing. Genomic testing company Sema4, which recently changed names to GeneDx, another genetics company it acquired last year, administered a round of layoffs after 2022 quarter 2 results were announced. 

Again on November 14, 2022, they announced additional restructuring, cutting their reproductive health testing lab, approximately an additional 500 employees. CEO, Katherine Stueland, said in a call with investors, that the reproductive health testing business is “unsustainable,” pointing to capital market constraints in the macroeconomic climate. GeneDx didn’t respond to requests for comment on these layoffs. 

Similarly, in July 2022, genetic testing company Invitae announced layoffs of more than 1,000 employees, according to a U.S. Securities and Exchange Commission report. In addition, Invitae’s January 9, 2023 financial results from 2022 reflect a fourth-quarter decline “ due to the exited businesses and geographies,” compared to the previous year.  The Mercury News reported that Natera announced plans to lay off 58 people in November 2022.

In Invitae’s July 2022 business realignment strategy, they describe focusing on higher margin testing opportunities as part of a plan to realize $326 million in cost savings in 2023. Invitae responded with “no comment” for more information on these layoffs and changes.

The shift away from tests such as carrier screenings, noninvasive prenatal testing, among others, have fertility industry leaders examining what these strategy changes mean for the future of genetic testing.  “In terms of the genetics lab space right now, I would sum it up as the chickens are coming home to roost,” says Carrie Haverty, a genetic counselor who spent around 15 years working in reproductive health space seeing patients, and then moved into women's health product leadership roles at Counsyl, Myriad Women's Health, and now Mirvie

“This is happening now, versus the last five to seven years, because money is not as readily available to smooth over the gaps,”. Haverty points to a combination of “unfortunate business models — data isn’t valuable if you don’t have an actual plan to monetize it,” and macroeconomic cycles, in which she says investors are demanding some reasonable path to positive margins. In her December article “Genetic Testing Labs: Winter is Coming,” she expresses concern that if reproductive health was a major part of Sema4’s testing volume and revenue, where will growth come from? 

Christina Ren, board-certified genetic counselor turned life science investor, says “ [Sema4] cut reproductive health services to focus on pediatric and rare disease tests instead. Not all tests cost and are reimbursed the same, leading to discrepancies between different genomic specialties.” 

Former Sema4 Regional Sales Leader in the Women’s Health division, Brie McKeller, MPA, says she started to be alarmed about the company’s direction after hearing the mid-August shareholders call, and was abruptly notified of layoffs on November 14, 2022. She says Sema4 “has done a huge disservice to employees, but also to the IVF industry as a whole.” 

“More and more we saw other companies were going under that were doing women’s reproductive health testing. We came to find out, as a whole, the insurance industry was no longer allowing for these large payouts,” she says, noting that genetics companies didn’t have input with large payors. “That preempted the downfall of so many of these companies. They didn’t foresee insurance payors would no longer be paying these larger amounts, and would be consolidating which places they’re using.”

At the Sema4 shareholder call, McKeller says she was shocked to hear that the company was dealing with a $30 million revenue reversal. “It turns out, in an attempt to get in network with Blue Cross Blue Shield, Sema4 was at the helm of an internal audit by BCBS, only to find out that Sema4 overcharged them by $30 million between 2019 and February 2022.” McKeller says it felt like CEO Katherine Stueland “breezed over” the development which foreshadowed the eventual cuts. 

Haverty adds that reproductive health is typically poorly reimbursed, especially compared to oncology. Haverty says testing in the reproductive endocrinology/infertility space is often paid by wealthier patients. “Insurers do not place a high value on reproductive health outcomes, particularly when the issue would either result in [the loss of the baby or pregnancy]  at no cost to the [insurer].  [If the issue] results in a serious condition later,it’s unlikely [the insurance company] will still have that patient under their care given the average turnover is less than 2 years,” she says. “Why pay for something that won't deliver an ROI for [the insurance company], but rather for some other payor — and often a government payor?”

As stakeholders watch the future of genetics testing unfold, some, like Ren are still optimistic. “It's not about altruism; it's about good businesses that can make a positive impact. In a time dominated by short-termism, there's more value than ever in building for the long term. Cancer doesn’t care about inflation and rising interest rates. Infertility doesn’t care when earnings season is. There are real problems to be solved regardless of the macro environment.”

Dr. Mili Thakur, Triple board certified in obstetrics and gynecology, reproductive endocrinology/infertility and medical genetics, adds that clinicians' reliance on genetic testing companies for their genetic counseling needs is “not sustainable.”

“The drivers for for-profit commercial companies are financial, while the driver for clinicians is good patient care,” she says. “The field of reproductive genetics will keep on expanding. If we strengthen our clinical genetic practice and highlight its importance, genetic testing companies and stakeholders will have to acknowledge that this field of genetics is essential, enabling adequate support for this specialty.”

When asked to remark on the future of genetic testing companies in the reproductive medicine space, Progenesis did not respond to a request for comment and Natera declined to 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

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New Patient Visits Drop, IVF Centers Seek Strategy

Different fertility centers across the United States have started to see new patient volumes decrease.

To counter the decrease in new patient revenue, fertility centers are turning to partners who have IVF-ready, financially qualified patients, but who don’t yet have a fertility clinic.

Courtney from BUNDL has a list of treatment-ready patients in each city. There is no fee but the offer is for the US and Canada only. 

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All external links active as of 2/2/23.

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.

$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

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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.

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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

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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.

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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

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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

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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.

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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.

Investigation: Progyny Aim of 'Wall Street Suing Machine' After Anonymous Firm Alleges Deceptive Accounting in Competitor-Informed Short Report

This News Digest Brought to You by
BUNDL

BY ERIN FLYNN JAY
 
Rosen Law Firm, The Schall Law Firm, and two other national shareholder rights litigation firms, each announced an investigation of potential securities claims on behalf of shareholders of Progyny, Inc., the largest fertility employer benefit company (NASDAQ: PGNY). 
 
The litigators cite a competitor-informed report by unknown authors that alleges that Progyny “is deceiving the investor community via its financial reporting practices”.
 
On December 7, 2022, Jehoshaphat Research published a short report addressing Progyny, entitled “A Love Child of Accounting Games & Credit Risk. The Jehoshaphat Report alleges that Progyny “is deceiving the investor community via its financial reporting practices” and that Progyny “is actually unprofitable but masks this problem with accounting games.” Among other items, the report alleges that Progyny recently stopped accruing allowances for customer cancellations.
 
According to the report, an employee of KindBody, a competitor of Progyny, talked to the Jehosaphat Research Group. We asked KindBody to comment on who that was and what their relationship with Jehosaphat is. Gina Bartasi, Chair, replied in an email: “We do not know who spoke with Jehosaphat. We won't be weighing in on this report.”

Six investment banks, including KeyBanc Capital and JP Morgan Securities provide analysis on Progyny. None of them have issued short reports on the company.

Rosen Law, Schall Law, and the two other law firms are investigating claims on behalf of investors of Progyny, Inc. (NASDAQ: PGNY) for violations of securities laws. The Rosen Law Firm is preparing a class action seeking recovery of investor losses. Rosen has ranked in the top four of securities class action firms nationwide each year since 2013 by ISS Securities Class Action Services. This ranking is based on the volume of settlements.  
David Sable, a former practicing fertility specialist who now manages a life sciences fund, said “occasionally these types of lawsuits are substantive and unearth malfeasance. Often, they are reverse-pump and dump schemes that cause brief movements in the stock if the firm (already having sold the stock short) can cover the short sale and make a profit.
“There is a well-oiled suing machine on Wall Street that responds to sudden stock drops by filing class action suits — they race to the courthouse to be first to file. The outcomes rarely benefit the shareholders; company boards sometimes pay a ‘settlement’ to make the nuisance suits go away,” he added. 
When reached by phone, Laurence Rosen of Rosen Law Firm said he does not comment on litigation. 

Jehoshaphat Research is operating anonymously, according to their website. 

Neither Progyny nor Jehoshaphat Research responded to requests for comment. 

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

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IVF Ready Patients in Your Area

Most patients come to BUNDL because they don’t have insurance, or their insurance doesn’t adequately cover IVF or other fertility treatments. See how BUNDL reduces financial risk for patients at no fee to the practice.

They may even have patients in your area who are financially eligible but have not yet found a fertility provider. Contact BUNDL to see if they have IVF-ready patients in your area. 

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All external links active as of 12/14/22.

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BREAKING EXCLUSIVE: CEO Pardew's Last Day At CCRM Friday

CCRM's is Second Fertility Network Chief to Step Down in as Many Months

BY RON SHINKMAN, special to Inside Reproductive Health

The chief executive officer and president of one of the nation’s largest fertility clinics is stepping down, Inside Reproductive Health has learned. It’s the second exit of a head of a large reproductive health  provider in recent weeks.

Jon Pardew’s last day with the Lone Tree, Colo.-based CCRM Fertility is scheduled for this Friday, Oct. 21, a source inside the company said. He has been working remotely for an unspecified period of time.

While an exact reason has not been discerned for Pardew’s departure, a source familiar with the situation said it was health-related but not life-threatening. Pardew and a CCRM spokesperson did not respond to emails and phone calls seeking comment.

The 51-year-old Pardew has led CCRM and its affiliate companies since October 2013. At the time, it operated single clinics in Colorado and Houston and was then known as the Colorado Center for Reproductive Medicine.

CCRM Fertility has grown dramatically during Pardew’s tenure. It now operates 22 clinics in nine states, as well as two additional clinics in Canada. Its most recent acquisition occurred over the summer, when it acquired The Institute for Reproductive Medicine & Science (IRMS) , which has offices in both New York and New Jersey.

Revenue data for the privately-held CCRM Fertility, purchased by Unified Women's Healthcare from TA Associates in 2021, is not available, although GrowJo and ZoomInfo estimate it is between $75 million and $80 million per year.

Industry observers praised Pardew’s leadership.

“Jon was an incredibly thoughtful leader who approached his work as a service. He led the organization with incredible integrity and strength through the pandemic (and always),” said Carol Lynn Curchoe, a former IVF lab supervisor with CCRM Fertility, in an email. “I admire his authenticity greatly.”

Richard Groberg, a Las Vegas-based finance and private equity executive who has worked extensively in the reproductive health space, said in an email that Pardew was “dedicated and
fair.”

Prior to his tenure at CCRM, Pardew served as a managing director at St. Charles Capital, a Denver-based boutique venture capital firm, a plant manager for General Mills and as a U.S. Army officer.

No succession plans have been announced at CCRM Fertility, and Pardew is still listed as the CEO and president on the company’s website as well as his LinkedIn profile. A source said that a recruitment firm has been retained by CCRM Fertility to find Pardew’s successor.

Both Curchoe and Groberg said it would be tough finding a replacement of Pardew’s caliber, but that the company should still fare well.

Along with Pardew’s departure, Mark Segal announced in late September he was stepping down as CEO of US Fertility, which operates 69 locations nationwide. Richard Jennings, current CEO of Generate Life Sciences, will replace him. Jennings has already been named to the US Fertility board.

Segal’s last day is Dec. 31. He will become chairman of the US Fertility board of directors upon leaving the CEO post, which he has held since the company formed in 2020. He had been the CEO of Shady Grove Fertility since 1997.  “Mark has been a powerful force in shaping US Fertility and the reproductive industry,” said Jay Rose, a managing director at Amulet Capital and a US Fertility board member.

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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