Jinxin Fertility, 3rd Largest IVF Provider in China, Revenue and Stock Reports

Down in revenue, volume from 2021 to 2022, reported that Insiders bullish on stocks, growth

This News Digest brought to you by
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BY: RON SHINKMAN

With a population of 1.4 billion, China is one of the world’s biggest markets for IVF services. Jinxin Fertility Group Ltd., based in Chengdu in Eastern China, is among its biggest players.

The stock analysis site, Simply Wall St, reported in June that company insiders have secured a larger position of Jinxin, buying approximately HK$54m worth of shares – or about $6.9 million in U.S. dollars – in the 12 months prior to the article, but Inside Reproductive Health wasn’t able to independently verify Simply Wall Street’s figures with information from the Hong Kong Stock Exchange.

Background on Jinxin Fertility

Although Jinxin’s history of operating hospitals and clinics dates back to the early 1950s, Jinxin Fertility’s focus on reproductive medicine began in 2003. A group of physicians formed Jinjiang IVF Center in Chengdu that year; the practice joined Jinxin in 2010, according to a company stock prospectus issued in 2019.

Today, Jinxin Fertility Group operates eight clinics at hospitals it owns in China, along with another clinic it operates jointly, the Chengdu Jinjiang District Maternal and Child Health Hospital Reproductive Medicine Center.

Jinxin also has a footprint in the U.S. after it acquired HRC Management in December 2018. HRC operates a chain of nine clinics in Southern California stretching from Los Angeles to San Diego. It also has a relationship with USC Fertility Clinic in Los Angeles that includes a fellowship program to train more physicians in reproductive medicine, according to Jinxin’s most recent annual report.

The company made an initial public offering on the Hong Kong Stock Exchange in 2019. Its stock price debuted at around $1.24 U.S. It was recently trading at around 57 cents U.S. per share.

Executive Leadership

Jinxin Fertility CEO Sunny Dong was named CEO in April 2020 after serving as CFO and board member for an affiliate, Jinxin Medical Investment Co. Dong, who is in his mid-30s, previously served as a director with the China asset management arm of Dongxing Securities in Hong Kong, as well as accounting/business consulting giant PwC, according to his LinkedIn profile. He did not respond to written questions for comment, nor did another executive with the firm.

Volume, Revenue and Competition

Last year, Jinxin-owned clinics performed 26,125 IVF cycles, down from 27,354 in 2021, according to the company’s annual report. That is equivalent to some of the largest fertility chains in the U.S. However, the company was impacted  by COVID-19 in 2020, Jinxin performed just 22,879 cycles that year, down nearly 18% from the 27,854 cycles it performed in 2019.

Jinxin Fertility Group’s bottom line has since suffered. It reported adjusted net income of $38.4 million on revenue of $331.1 million last year. That compares to adjusted net income of $63.8 million on revenue of $257.5 million in 2021.

Overall, Jinxin said in the introduction to its 2022 annual report that it is the third-largest provider of IVF services in China (as of 2018), and that its number of annual cycles represent about 3.1% of the country’s total market share. Its biggest competitors, according to its 2019 stock prospectus, are the Reproduction Hospital Affiliated to Shandong University, Peking University Third Hospital, Shanghai Ninth People’s Hospital and the Reproductive and Genetic Hospital of Citic-Xiangya.

Expected Growth from Public Policy Changes

There is room for growth in China in the coming years. Despite it currently leading the world in population, the nation has seen its fertility rates plummet in recent years to 1.2 births per woman, down more than half from 1989. That has prompted the Beijing city  government last month to announce it would pay for 16 different types of assisted reproductive technology, including IVF, to increase the birth rate.

Jinxin said in its annual report that it “expects the penetration rate and market size for assisted reproductive services in China to significantly increase as the government implements supportive policies and supportive measures to encourage fertility.” The nation as of earlier this year had just 539 institutions performing IVF and only 27 sperm banks to serve a population more than four times larger than the United States, according to a Chinese government survey issued late last year.

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


How to Finally Streamline Medication Costs for Your Patients
 

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


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


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


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


 
 

This News Digest Is Paid Sponsored Content From
BUNDL


 
 

All external links active as of 9/14/23.

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.

What’s In the Fertility Pharma Pipeline

Three Companies and What They’re Working On

This News Digest brought to you by
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BY: Lisa Munger

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

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

PIPELINE HIGHLIGHTS

Granata Bio

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

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

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

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

Oral Allosteric Agonists Show Promise in Preclinical Studies

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

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

Celmatix

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

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

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

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

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

Oviva Therapeutics 

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

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

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

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


How to Finally Streamline Medication Costs for Your Patients
 

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


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


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


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


 
 

This News Digest Is Paid Sponsored Content From
BUNDL


 
 

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

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

IVIRMA Global Recruits Former Head of Airline Iberia as New CEO

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

This News Digest brought to you by
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BY: RON SHINKMAN

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

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

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

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

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

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

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

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

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

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

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


How to Finally Streamline Medication Costs for Your Patients
 

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


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


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


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


 
 

This News Digest Is Paid Sponsored Content From
BUNDL


 
 

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

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

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

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

This News Digest brought to you by
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BY: Lisa Munger

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

The Deal

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

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

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

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

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

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

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

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

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

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

BPEA EQT representatives declined a request for comment. 

Growth Beyond India

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

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

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

Testing Business Viability with Increased Regulation

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

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

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

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

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

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

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


How to Finally Streamline Medication Costs for Your Patients
 

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


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


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


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


 
 

This News Digest Is Paid Sponsored Content From
BUNDL


 
 

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

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.

Medications Finally Included with Price of IVF

Program Expands to Remove Variable from Patients and Clinics

This News Digest Is Paid Sponsored Content From
BUNDL

 
 

BY: ERIN FLYNN JAY

Historically, IVF medications have almost never been included with the price of an IVF cycle. That was, until very recently.

The popular fertility financing program BUNDL has launched BUNDL with Medications℠, a new partnership with InspireRx to finally include patient medications with the price of IVF.

Separate Medication Costs Negatively Impact Patients, Providers

When patients can’t plan for medication costs, they may not be able to start their cycle when they’d like…or they may not be able to start their cycle at all. They may need more of a certain drug or a different protocol and they can’t afford it. 

“It puts an extra stressor on patients--maybe they finally have an IVF plan and finally have their treatment scheduled. But then they have to figure out what's going to happen with the meds?,” said Cheryl Campbell, Director of Operations for BUNDL. “It continues to grind at them and halt their process. They’re left alone to research where they’re going to get the best and most inexpensive meds.”

When patients face financial strain because of medication costs, it puts their treatment in jeopardy and may end up canceling their IVF cycle, which negatively impacts the fertility center’s scheduling.

BUNDL with Medications℠ allows fertility clinics and patients to consolidate treatment and medication costs into one plan with the backing of a financial guarantee. 

Campbell said it's hard for fertility physicians to see patients struggle with medication costs.

“As an ex-fertility patient myself, time is of the essence, right? When a patient can’t move forward with their provider’s treatment plan because they are hindered by medication costs, that's very daunting for physicians. They want those patients to move forward.”

How to Reduce Stress of Medication Costs for Patients

BUNDL with Medications℠ is a multi-cycle program. “Patients’ financial barriers are being removed because we are discounting their treatment. We’re going from top to bottom for the patient; all they have to do is focus on their IVF cycle.” Campbell added.

“It works as a layer onto our existing discount program. When a patient buys a two-cycle program from us, for an extra X amount of dollars, they can choose to add the costs of their medications and we'll handle that back and forth with their clinic.”  

BUNDL with Medications℠ covers everything a patient might need. “If a patient needs more but we didn't realize it, they're going to get it,” said Campbell. “If they're a poor responder and they need more, we're going to give it to them. Our patients will get what they need when they need it. The only exception drug is omnitrope, an off-label drug; other than that, patients will be able to access what they need.”

Which Fertility Clinics Can Benefit

BUNDL with Medications℠ is open to any clinic who has partnered with BUNDL.

Karol E. Bonilla, Strategic Account Manager for InspireRx, said there are many patients who don't have any coverage for either treatment or medications. “It's not difficult to actually combine great providers and great pharmacies to provide brand name medications,” she said.

Patients go with the provider of their choice. “Through InspireRx, they have less medication pricing for their fertility drugs since they don't have any coverage,” she said. “You're going to get multiple cycles so there are savings on the treatment and then also savings on the medication. It's a win-win for our patients.”

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.


How to Finally Streamline Medication Costs for Your Patients

Medication costs are a huge stressor for patients working through IVF and IUI treatments. They can be costly, and the variability of when they’re needed means an even more difficult process. But it doesn’t have to be this way, and that’s why BUNDL has streamlined the process with their new BUNDL with Medications℠ program.

BUNDL with Medications℠ is a multi-cycle offering that includes all the patient’s medications, for one up-front cost. Contact BUNDL today to learn about their exclusive virtual pharmacy program, and how this can optimize treatments for your practice and patients.


 
 

This News Digest Is Paid Sponsored Content From
BUNDL


 
 

All external links active as of 8/10/23.

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.

Oma Robotics, also Known as Thread Robotics and Thread Fertility, the Parent Company of Oma Fertility is Reported to be Going Out of Business

BY: ROSEMARY SCOTT

“I was informed that Thread Robotics will be closed by the end of the month.” Oma Fertility Lab Director, Dr. Barry Behr, confirmed in a phone call with Inside Reproductive Health. 

“They are moving quickly to try to sell the clinics and labs”. Dr. Behr said he did not know which companies might buy the clinics nor did he say if the company was filing for bankruptcy. 

In an email to Inside Reproductive Health on July 21, Oma Fertility CEO, Gurjeet Singh said “I can confirm that we are not filing for bankruptcy. I’ve heard the rumor as well and it is unfortunate.”

Mr. Singh did not respond to other requests for comment about the future of the company.

Oma Fertility employees who announced their layoffs on LinkedIn said the layoffs began on Tuesday, August 1, but no official number of eliminated posts has been released by the company. One Oma Fertility employee, who wished to remain unidentified, said that office and corporate staff had been laid off.

Both the employee and Dr. Behr said that no official announcement about layoffs has been made to the employees.

Oma Fertility launched in 2022 with the raising of $37.5 million in debt and venture funding. On May 31, Oma Fertility opened a new clinic in Atlanta. Oma opened the doors of its Atlanta location in the same month as it opened new locations in St. Louis and New York City.

Singh, told Inside Reproductive Health that Oma had been practicing in the three cities since 2022. Singh said he rented a space in each city for about six to nine months while the permanent locations were being built. 

Dr. Behr said he did not believe layoffs were planned for lab and clinical personnel. “The parent company will pay my check until the end of the month. As far as I know the lab and clinic staff are going to keep working. They need them to be valuable to a potential buyer”.


Larkin out, Reymann in as Top Boss of First Fertility 

BY: STAFF

Inside Reproductive Health obtained an email sent by a First Fertility executive that said that CEO Derek Larkin stepped down as CEO to pursue another opportunity. 

The executive said that Larkin’s last day was Monday July 31 and that Cara Reymann will take over as CEO on September 6. Ms. Reymann was previously president of Fertilitas for one year and held Market President and other roles at Capital Digestive Care for 12 years, according to her LinkedIn profile. 

The email did not specify the role for which Larkin left. Inside Reproductive Health has not yet reached out to Larkin, Reymann, or First Fertility for comment.


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


 
 

All external links active as of 8/2/23.

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.

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

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

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

 
 

BY: STAFF

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

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

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

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

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

The financial terms of the deal were not disclosed.

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

 

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

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


FDA on “Monster Hunt” for IVF Labs in Violation

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

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

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

 
 

 
 

This News Digest Brought to You by
FDA Consultants


 
 

All external links active as of 8/1/23.

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.

Recharge Capital Launches $200M Investment Vehicle to Streamline Fertility Services, Women’s Health

Aims to Consolidate IVF Service Verticals by Continent, Starting with Southeast Asia

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

 
 

BY: RON SHINKMAN

In an attempt at consolidating a fragmented global market for reproductive medical services, Recharge Capital has launched a $200 million vehicle to invest in women’s health, including IVF.

New York and Singapore-based Recharge Capital announced last month that the new holding company – called the Women’s Healthcare Investment Vehicle – will “be strategically deployed to invest, roll up, and create an end-to-end ecosystem within the women's fertility value chain across Southeast Asia, Latin America, Europe, and the Middle East.”

Recharge, which has assets of about $6 billion, has placed funds in “thematic-focused” investments. Along with women’s healthcare, these include clean biotech, semiconductors and fintech, among others.

The vehicle has at least eight big investors attached. Among them are Thiel Capital, run by billionaire Peter Thiel; the Al Rashid Family, headed by Saudi billionaire Nasser Ibrahim Al-Rashid; and Shamrock Holdings, the investing company for the estate of Roy Disney and members of the Disney family.

Lorin Gu, the 30-year-old founding partner of Recharge Capital, said in an email that “we aim to transform the sector by creating full-scale integration of disruptive technologies, diagnostic solutions, and seamless patient experiences through digital platforms and local clinic chains.”

One of the biggest issues causing fragmentation of reproductive medical services, according to Gu: Different laws and regulations by country.

“For example, many couples start their experience in China for consultation, believing that China has the best medical quality, but only to realize that the country has many restrictions such as egg freezing requirements, genetic testings and sex selection, which are allowed in other markets like Thailand and Malaysia,” Gu said. 

Generation Prime Planned to Launch 15 Clinics

Partly as a result, Gu predicts that about 70% of its customers in Asia will be Chinese medical tourists seeking services in other countries. “We want to demonstrate how a streamlined service can bring much more efficiency and less opacity to the process as patients navigate across different jurisdictions,” he said. 

One of the first ventures invested in by the Women’s Healthcare Investment Vehicle is Generation Prime, which received seed backing. It has plans to open 15 clinics in Thailand, Malaysia and Singapore.

“For Chinese patients seeking services not currently available in their home country, Generation Prime provides hand-holding experience for patients, starting from virtual education and consultation to understand the customization needs of the IVF journey, and then travel and treatment arrangements for specific services in our clinics in Singapore, Malaysia, Thailand,” Gu said. He added that some clients may also elect to obtain some services in the U.S., such as surrogacy. 

Global Expansion of IVF

David Sable, M.D., a life sciences portfolio manager in New York City who also founded two separate reproductive technology firms, suggests entrepreneurs are beginning to see reproductive medicine in global as opposed to regional terms, and it’s clear there is a mismatch between demand and available services. Worldwide, he said there are about 3 million IVF cycles a year performed on between 1.5 million and 2 million people when repeat cycles are included. But based on his company’s research and making some assumptions about the market, Sable believes there is probably enough demand worldwide to perform 20 to 30 million cycles annually.

“If you really map out demand for it, it’s easily a half-trillion-dollar industry,” he said. “Right now, it’s disguised as a $20 billion-a-year niche industry. So, I’m not surprised that people who have a lot of money to invest are putting capital into it.”

Gu said that in addition to Asia, Latin America, Europe and the Middle East are also expected to see enormous demand for services in the coming years. As in Asia, it is expected that clients will engage in foreign travel in order to receive the services they specifically desire but may not be able to obtain in their home countries. “A primary focus will be placed on international fertility medical tourism,” he noted. 

“Novel” Structure for Accountability to Investors

The Women’s Healthcare Investment Vehicle also has what Recharge has described as a novel structure for investors, based on a “milestone-driven deployment schedule.” According to Gu, the milestones are connected to revenue numbers and earnings before interest, taxes, depreciation and amortization.

“Investors and managers have clear visibility into how capital is being deployed (as opposed to a blind pool with little visibility), as well as reduced risks for capital usage,” Gu 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


FDA on “Monster Hunt” for IVF Labs in Violation

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

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

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

 
 

 
 

This News Digest Brought to You by
FDA Consultants


 
 

All external links active as of 7/27/23.

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.

2020 Yale Fertility Fentanyl Incident: New York Times Releases Miniseries

Serial’s “The Retrievals” Podcast Tells Stories of 12 Women Who Underwent Sober Egg Retrievals

 

BY: ROSEMARY SCOTT

In November 2020, Susan Burton, a staff member of the weekly podcast “This American Life,” came across an article published by a local news outlet that detailed an incident at the Yale Fertility Clinic in which a nurse was caught stealing fentanyl intended for outpatient surgical procedures for her own personal use. This caused the women at the clinic to undergo egg retrieval procedures partially or completely sober. 

This was the start of what is now known as The Retrievals–a five-part podcast series produced by Burton for Serial Productions, which, as of 2020, is a unit of The New York Times. The first episode was released on June 29, with a new episode scheduled for every Thursday following for four weeks. 

At the Yale Fertility Center in November 2020, Donna Monticone was caught replacing fentanyl with saline and putting the vials back to be administered to patients, causing women to undergo egg retrieval procedures with little to no painkillers for a total of five months. Shortly after being confronted with the accusations, Monticone admitted that she had been doing this for about five months. 

Seven of those women, after being informed of Monticone’s actions through a letter in the mail, sued Yale University in November 2021, accusing the facility of failing to safeguard its supply of fentanyl. As of now, there are 68 plaintiffs involved in the lawsuit, and as many as 200 women could have undergone this reality over the five months in 2020 that Monticone admitted to tampering with the medication, The New York Times reported. 

In the series, Burton tells the stories of 12 of those women, in which they detail the physical pain they went through during the egg retrievals and the emotional pain they were caused when, according to them, no one at the center seemed to care. 

An audit by the U.S. Drug Enforcement Administration showed that in total, there were discrepancies in 665 units of controlled substances, including fentanyl, ketamine and midazolam. Monticone eventually pleaded guilty in federal court and admitted to tampering with the products in March 2021. She was sentenced to four weekends in prison, three months of home confinement and three years of supervised release.

In episode one of the podcast, Laura Czar tells the story of her egg retrieval at the clinic. Two months prior to the procedure, she said she had been diagnosed with breast cancer and underwent a double mastectomy. She scheduled the egg retrieval in the hopes that she could use them later if her cancer treatment affected her fertility. 

When the procedure began, she recalled saying to the doctors and nurses, “I feel everything.” A nurse responded, she said, and told her she had been given the maximum dose of painkillers. Her story mirrors what others told in the podcast–some were fully alert during the procedure, and others woke up in what they described as “excruciating pain” after. When they told their physicians of their pain, they all got the same response: they were given the maximum dose of painkillers, and could be given no more. 

Karen Peart, a spokesperson for Yale, told the Yale Daily News that Yale “deeply regrets the distress suffered by some of the patients.” 

“After Yale discovered the nurse’s misconduct, it removed her from the Center, alerted law enforcement agencies and notified patients who might have been affected,” Peart said. “The Center also reviewed its procedures and made changes to further oversight of pain control and controlled substances.”

When the news outlet asked what those changes entailed, Peart declined to comment. Researchers shall store schedules I-V controlled substances in a securely locked, substantially constructed cabinet.

In October 2022, Yale University agreed to pay $308,250 to settle the lawsuit and resolve the allegations that it violated civil provisions of the Controlled Substances Act. According to the U.S. Department of Justice, the act requires clinics and researchers to store schedule I-V controlled substances in a “securely locked, substantially constructed cabinet.”

The American Society for Reproductive Medicine frequently issues guidance for fertility clinics such as Yale’s on best practices for patient safety and positive outcomes. When asked to comment about any guidelines about how best to safeguard drugs and painkillers in a clinic that the organization might issue as a result of the public nature of the incident, Dr. Michael Thomas, president of ASRM, told Inside Reproductive Health he is not familiar with the incident and declined to comment further. 

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

 
 

All external links active as of 7/20/23.

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.

Washington Post Describes Unbridled Price Hikes For Cryostorage

Industry Experts Predict Steadier Market

 

BY: MEG ST-ESPRIT

There is recent speculation in the media that cryostorage prices are rising. A May 2023 article in The Washington Post noted a 40 percent increase in storage prices in a single year, though they did not cite a source for the statistic.

Inside Reproductive Health was unable to independently verify that statistic. Patients interviewed for the article reported feeling “stuck” or forced to make decisions about storing their genetic material while concerned that the price of cryostorage in the United States will rise.

Within the reproductive health industry, there are less clear-cut answers on pricing trends. 

Are cryostorage prices in the United States actually rising?

Hard data about how much prices have risen remains scarce, though patients report receiving notifications of increases to their monthly or yearly storage bills. 

Eric Widra, chief medical officer at Shady Grove Fertility, was interviewed by the Post. He declined to comment on national pricing trends at this time. Other cryostorage facilities do not expect to raise their prices anytime soon. 

Pete Anevski, CEO of Progyny, expects costs to remain stable for patients. “We can confidently say that costs for our members will not be going up – this includes overall costs and the costs directly associated with tissue freezing and storage” he said in an email.

He added that their pricing structure does not vary depending on the genetic material being stored.

Inside Reproductive Health did reach out to Luis Fernandez, partner at Red Barn Equity Partners, the investor-operator of ReproTech, for commentary on cryostorage pricing trends. Mr. Fernandez did state he would provide commentary but did not respond by publication deadline.

At TMRW Life Sciences, Chief Impact Officer Linsday Beck said that while most of their business is providing B2B storage to fertility clinics, they do have a small sector of their business that offers direct-to-consumer storage options. In both their DTC and B2B sectors, Beck said TMRW Life Sciences has not increased prices in the last year.

She said for the clinics they work directly with they have also not instituted any significant change in pricing structure at this time. “We have not increased our pricing due to inflation, but it's sort of a different beast.” she said in an interview. “We're not an apples-to-apples [comparison] with fertility clinics.” 

What are the barriers to reducing cryostorage costs? 

Dr. Widra cited several reasons via email that clinics may be paying more to store eggs and embryos — a cost that could be passed down to consumers.

The price of hardware such as tanks and monitoring devices as well as square footage to store them in is subject to inflation, like any consumer good. Supplies such as liquid nitrogen as well as electronic monitoring equipment to reduce the risk of tank failure are also expensive, he says. “Liability insurance costs have risen in the wake of the recent tank failures,” he adds.

A 2021 settlement in California awarded patients $15 million in damages after a major storage failure destroyed thousands of samples of genetic material. 

Beck said Many clinics, she said, use a manual system. “It's handwritten labels; it's manually filling in the tag. There is manual inventory. Information is written down either in a binder or an Excel spreadsheet.” This process, she said, is very human-labor intensive.”

As the demand for cryostorage increases, Beck said the best way to keep storage affordable to patients is to automate it. Not only does it reduce labor costs for clinics, it reduces that risk of failure Widra cited. “Robots reduce potential points of failure by 94%. So it's a far better system for a similar price,” she said.” 

Beck noted that cryostorage is not marked up as much as other medical procedures, but due to lack of insurance coverage the cost is largely covered by patients — including unexpected increases.

Despite industry efforts to keep costs low, any increases are passed along to consumers. “So for the patient it does feel expensive,” said Beck. “I think there's a really important perspective to consider.”

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

 
 

All external links active as of 7/13/23.

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.

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

Implements digital front door, stock steady

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

 
 
 

BY: LISA MUNGER

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

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

Stock Steady, Speculation Raises Profile

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

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

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

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

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

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

New Technology Implemented

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

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

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

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

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

PIVET

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

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

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

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

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

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


These 5 Deficiencies Lead to FDA Nightmare


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

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


 
 

All external links active as of 7/6/23.

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.

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

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

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

 
 
 

BY: RON SHINKMAN

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


These 5 Deficiencies Lead to FDA Nightmare


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

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


 
 

All external links active as of 6/29/23.

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.

FDA Issues Warning to Over 30 Fertility Centers In Last Five Years

What the FDA has been looking for in their audits

This News Digest Is Paid Sponsored Content From
THE FDA CONSULTANTS, LLC

 
 
 

BY: ERIN FLYNN JAY

Last year, the FDA issued a warning letter to a New York City fertility center after an FDA investigator documented significant deviations for human cells, tissues, and cellular and tissue-based products. In 2020, the FDA issued a warning letter to a California IVF fertility center after an FDA investigator found the same issue.

In 2019, the FDA ordered a San Juan, Puerto Rico clinic and its Medical Director to cease manufacturing immediately due to significant violations of FDA regulations. An FDA inspection revealed violations regarding donor eligibility determinations. According to the FDA, the clinic put patients at risk for exposure to communicable diseases, including HIV and Hepatitis.

How does the FDA audit fertility centers? According to Rijon Charne, Fertility Attorney with Sunray Fertility and Chief Legal Officer with The FDA Consultants, the FDA performs random inspections whenever they want. The inspector arrives without notice to inspect the clinic. “They go straight into your lab, they start pulling files, and they start looking at the specimens to see if any of them violate FDA regulations under the specific code.”

Sunday Crider, PhD, HCLD/ELD (ABB), Chief Scientific Officer with The FDA Consultants, said when the FDA finds an offense during a laboratory inspection, they generate a “Form 483”, which is an official documentation of deficiencies .. “The FDA will review areas of concern with the responsible person at the clinic in a debriefing session post-inspection.  The official Form 483 is then sent to the clinic within a few weeks. The laboratory will generally have 30 days to respond to the FDA on how they are going to address those deficiencies.”

Once a clinic registers with the FDA, they are subjected to routine, unannounced inspections at the Agency’s discretion. However, Crider said if serious issues are found on any laboratory inspection,, the FDA may come and inspect more frequently..  Inspection records are retained by the FDA for every registered facility.  Inspections are generally on a two year rotation and almost always unannounced.  FDA inspections are nerve-racking for clinics because of the repercussions if the FDA finds something. Charne spoke of issues of donor eligibility, one of the most common deficiencies the FDA discovers. There are specific labeling requirements for donors that might have HIV or a sexually transmitted infection (STI). Regarding donor oocytes, “those eggs have to be specifically labeled and they need to be put in a separate freezer so that there is no chance of possible cross-contamination with other eggs or other specimens that are being held in the lab.”

If the FDA finds there are egregious issues with donor screening, testing, labeling or storage  during an inspection, they issue a public warning and post it to the FDA website. The clinic then needs to address the issue with a written plan, to be approved by the FDA. Charne said the FDA will return and either pass the lab’s inspection or shut them down.

“The worst part of it all is that the warning to the clinic becomes public,” added Charne. “The notice is put out in an FDA Warning Letter and the clinic goes on the FDA warning list. Any patient (current or potential) of the IVF clinic can see the warning letter on the FDA website. As the fertility space is such a small community and reputation is everything, when people talk, it looks very bad for the clinic.”

FDA violations and warnings can be especially harmful during mergers or acquisitions, especially for private equity firms or Management Services Organizations (MSO) that may want to sell a fertility clinic in the future. An FDA violation could affect the price valuation of the entity and create pause for an insurance company to underwrite a policy for the clinic.

“An FDA violation or warning will raise questions and concerns,” said Charne. “That is why private equity companies and law firms assisting in fertility acquisitions bring on people like the FDA Consultants to do a neutral third party inspection before getting caught in are a unknown FDA violation. The worst issue that could occur is the FDA shutting you down.”

Crider said that while the FDA is only concerned about donor issues, a warning or violation from the FDA tarnishes the reputation of the entire clinic. “You don't want it made public that you do not have good patient care and are okay putting a patient at risk,” she said.

The FDA requires clinics to maintain donor records for at least 10 years.   This is to ensure traceability of donor records, such as communicable disease testing.  For instance, Crider stated, if the recipient of donor eggs or sperm contracted HIV at some point in their life after receiving the donor tissue, it would be important to have records on file to show that the source likely did not come from their anonymous donor, as they are thoroughly screened and tested as a part of becoming an eligible donor.     Proper documentation that the donor was thoroughly screened and tested would become critical should any patient care or legal issues arise. 

Bottom line: every IVF laboratory that processes, screens, stores, tests or distributes any type of donor tissue--be it egg, sperm, or embryo--must register with the FDA and follow the Federal Code 21 CFR Part 1271, guidelines they have set forth. If not, prepare for that FDA violation.

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.


These 5 Deficiencies Lead to FDA Nightmare


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

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


 
 

All external links active as of 6/22/23.

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.

Three New Fertility Network CEOs And What They Have Done In Their First Calendar Year

Francisco Lobbosco of Future Life, Beth Zoneraich of Pinnacle and Richard Jennings of US Fertility

 

BY: RON SHINKMAN


Since being named group CEO of FutureLife in April, Francisco Lobbosco has been visiting every clinic in the company’s network. There are 44 in all, including 16 in the Czech Republic, where FutureLife is based. Lobbosco says he is traveling two to three days a week to visit all the locations. They include company-owned sites in Slovakia, the United Kingdom, Ireland, Spain, Romania, the Netherlands and Italy, along with affiliated clinics in Finland and Estonia.

Lobbosco says in an email that the visits are part of a steep learning curve in his new job that has “allowed me to immerse myself in the unique dynamics of each clinic, gain firsthand insights into the challenges and opportunities they face, and develop a strong rapport with the dedicated teams.”

Lobbosco is one of three new CEOs named to major fertility companies in recent months. They also include Beth Zoneraich, named CEO of Florida-based Pinnacle Fertility in late March, and Richard Jennings, CEO of Maryland-based U.S. Fertility, in January.

All three companies are completely or mostly financed by venture capital firms. CVC Capital and Hartenberg Holding back FutureLife; Pinnacle is held by Webster Equity Partners and Amulet Capital backs US Fertility.

Francisco Lobbosco, FutureLife 

Of the three CEOs, Lobbosco had the most circuitous journey to the top job. An Argentinean by birth whose family relocated to Italy when he was an adolescent, Lobbosco was serving as chief operating officer for AniCura, a chain of veterinary hospitals and clinics, when he was contacted by a recruiter. Prior to AniCura, Lobbosco had been in senior positions with GrandVision and Vission Express, two European eyewear chains.

“The initial contact came as a surprise since I was content in my prior position,” Lobbosco says, but the top job resonated with him. He went through several rounds of interviews with the FutureLife board before being offered the position. He replaced Matěj Stejskal, who remains on the board of directors and is overseeing FutureLife’s mergers and acquisitions. Lobbosco relocated his family from the Netherlands to the Czech Republic for the new job.

He adds the experience in both the veterinary and vision worlds helped him with the transition.

“They provide a deep understanding of complex healthcare industries and regulatory compliance, which translate well into reproductive medicine,” he says.

Aside from visiting the various clinical sites, Lobbosco notes that the company is expanding. “We have been actively hiring more professionals to support our clinics and strengthen our team,” although he did not provide specific details on the new hires.

Beth Zoneraich, Pinnacle

Zoneraich joined Pinnacle as its chief operating officer in October 2021, after it acquired Advanced Fertility Care, the company she co-founded and served as CEO since 2005. She replaced Andrew Mintz, an executive whose primary expertise was in general medical group and hospital operations and was in the top job exactly a year. Mintz is now the CEO of a dental network.

Richard Groberg, who heads a consulting firm that works closely with companies in the fertility sector, says the changing of the guard at Pinnacle was sudden. He suggests that it likely took Zoneraich by surprise.

Zoneraich initially agreed to answer written questions, but had a change of heart after they were submitted. A spokesperson said Zoneraich was “finalizing a large partnership” and was unavailable.

Groberg says Zoneraich has been particularly aggressive regarding mergers and acquisitions since she became CEO.

“She’s made extraordinary progress in a very short period of time,” says Groberg, who represents several companies that have been in talks with Pinnacle. “I’ve had nothing but good experiences.” He adds that issues with absorbing some of Pinnacle’s acquisitions prior to Zoneraich’s elevation have also been resolved. 

Zoneraich recently worked out a deal with TMRW for Pinnacle’s frozen egg and embryo storage, according to a TMRW press release.

Richard Jennings

Jennings was eased into his new job. U.S. Fertility named him to its board of directors last September, and also announced that he would become CEO on Jan. 1. He replaced Mark Segal, who had guided U.S. Fertility’s largest practice group, Shady Grove Fertility, since the 1990s. Segal was promoted to chairman of the U.S. Fertility board. Jennings was previously CEO of Generate Life Sciences and a board member of Gallant Therapeutics. He also held the top job at California Cryobank Life Sciences and MediScan Diagnostics.

Groberg says the appointment of Jennings was due to its top leadership wanting to transition into less strenuous roles. 

Jennings and US Fertility have also been busy during his first five months at the reins. In March, the company agreed to acquire Ovation Fertility, a deal that was finalized late last month, creating a powerhouse with nearly 100 clinics and 28 laboratories. It also recently opened up its network of clinics to members of the Stork Club. And the company has also launched partnerships with two professional women soccer teams: Gotham FC and the Washington Spirit of the National Women’s Soccer League.

Jennings did not respond to a request for an interview. 

Different Jobs, Different Situations

Groberg notes that although three major players in the fertility field have changed out their leadership in just a span of four months this year, it is not an indication of greater turmoil in the sector as a whole.

“These are three jobs – and three very different situations,” he says.


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

Amplification

Amplification from Three New Fertility Network CEOs And What They Have Done In Their First Calendar Year on 6/15/2023,

Original sentence:

Richard Groberg, who heads a consulting firm that works closely with companies in the fertility sector, says the changing of the guard at Pinnacle was sudden. He suggests that it likely took Zoneraich by surprise.

Amplification: The quote that the sentence referred to was 

"When they first bought her practice, my understanding is that she was going to have a role, but there was no intention of her being CEO, nor did she intend to be CEO, but I don't know the inner details about what happened".

 
 

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SREI Weighs Options to Deal with Fellowship Scarcity in REI

Taking fellowship training from three years to two, corporate-academic partnerships considered primary options

 

BY: LISA MUNGER

There are 49 accredited fellowship programs, as of the Accreditation Council for Graduate Medical Education's most recent data from the 2021-2022 academic year. ACGME assumed accreditation responsibilities for the first year in 2016 from the American Board of Obstetrics and Gynecology; 41 REI fellowships existed. 

As first reported by Inside Reproductive Health, the University of Miami/Jackson Health System Program and the University of Washington Program received ACGME approval in fall 2022, making them the latest programs to receive approval. 

Academic Years and New Programs Accredited By ACGME

2021-2022 University of Rochester

2020-2021 None

2019-2020 SUNY Downstate Health Sciences

2018-2019 None

Before the 2018-2019 academic year, all previously ABOG-accredited programs had to apply for accreditation with ACGME. Thus, in 2016-2018 all existing were re-approved.

What’s more, 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.

The Pipeline for New Programs

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. 

Currently, 49 fellowship programs exist, with 175 fellows, according to ACGME. 

How to Increase REI Fellowships: Challenges

One hurdle in establishing new REI Fellowships is finding qualified faculty. REI is a specialized field; a limited number of qualified physicians can teach in fellowship programs. Another barrier is finding a suitable location for the program. REI programs require access to a large number of patients, as well as state-of-the-art facilities—all costly prospects.

Ruben Alvero, M.D., past president of SREI, professor of Obstetrics and Gynecology at Stanford Medical School and division director of Reproductive Endocrinology and Infertility at the Lucille Packard Children’s Hospital told Inside Reproductive Health there are several impediments to establishing programs and in adding fellows. 

“It's onerous to establish new programs or fellows,” he said. The biggest stumbling blocks that exist are securing financing and in terms of the paperwork and the actual application itself.” 

Alvero said the cost of adding fellows is highly variable, as is the prospect of beginning a new fellowship program. Costs vary based on the geographic area, cost of living, demographics, facilities in place, availability of private partnerships and faculty recruitment needs; thus, no amalgamate data exist as these factors are unique to each case. 

Securing Accreditation: The Process

The process of starting an REI fellowship program is complex and requires a significant investment of time and resources. The first step is to obtain accreditation from the ACGME. A five-step journey is outlined on their website

This process involves submitting a detailed application with information about the program's curriculum, faculty and facilities. Once accreditation is granted, the program can begin recruiting fellows.

Step 1—Locate and Read Program Requirements and FAQs

Step 2—Locate and Save Review Committee Staff Contact Information

Step 3—Gather Information Needed to Prepare the Application

  • Complete the specialty-specific application, which can be found on the Program Requirements and FAQs and Applications page of the REI specialty section of the ACGME website. 

  • Provide a block diagram for each year of education in the program

  • All Program Letters of Agreement for participating sites with required rotations

  • Policies and procedures for resident/fellow clinical and educational work hours, including policies on moonlighting

  • Policy for supervision of residents and fellows

  • Establish competency-based goals and objectives for one educational experience at each educational level.

  • Evaluation forms for residents/fellows, faculty, program assessors

  • Semi-annual, summative and final evaluation forms

  • Policy for resident/fellow and faculty member well-being 

Step 4—Initiate Application to ACGME’s Accreditation Data System

Step 5—Submit the Application

  • A Letter of Notification (LoN) will be sent through ADS after the Review Committee reviews the application. 

  • The LoN will detail the accreditation decision and any citations or areas for Improvement issued during the review.

  • It can take four to 12 months following the submission of an application to undergo a review and receive an accreditation decision from the Review Committee. 

Viable Options for Expanding Fellows

Alvero said one option under discussion is possibly shortening the fellowship term from three years to two. However, given the rigor the programs require, this may not be an appealing choice. 

Alvero’s colleague and current president of the American Society for Reproductive Medicine, Michael A. Thomas, MD, told Inside Reproductive Health that though ASRM will look to SREI for guidance, as an REI specialist himself, moving from three years to two may be untenable. 

“In a short amount of time, it’s not just learning how to get the eggs and put the embryos back, but also learned understanding the physiology, understanding and contributing to the research,” said Thomas, professor and department chair of Obstetrics and Gynecology at the University of Cincinnati College of Medicine. “From what we know from a clinical standpoint, it takes longer than six months to contribute the research necessary to advance the field.” 

Alvero said that a second option is to secure public/private investments to support academic programs financially. 

One example is private funding from Shady Grove Fertility with publicly-held Walter Reed National Military Medical Center, intended to benefit military families. 

“The program at Shady Grove has fellows from Walter Reed from the National with support through NIH [fellowship program] so that there's a collaboration there,” he said. 

Alvero said he expects more of these collaborations to develop. 

In the interim, Thomas said he hopes more fellows will mean REI specialty services will be available to a broader audience and, promisingly, with insurance coverage to increase access to more marginalized populations. 

“The problem is you can’t just expand a program; they must be good programs. You want to make sure that you have fellows that are being trained rigorously and make sure that those fellows have the opportunity to go wherever they want [rather than limited by geography near major population centers.].”

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

 
 

All external links active as of 6/8/23.

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.

FTC to Fine Easy Healthcare $100K For Data Breaches Connected to Premom App

Justice Dept., Connecticut, Oregon and D.C. Attorneys General Also Take Action

 

By: RON SHINKMAN

The U.S. Federal Trade Commission (FTC) on May 17 proposed fining the maker of the Premom smartphone app $100,000. It is also working with the U.S. Department of Justice to obtain curbs on how it manages the highly sensitive information provided by users. Attorneys specializing in healthcare and privacy law say other reproductive health companies may soon find themselves the target of similar actions.

Premom, which was created by the Chicago-area firm Easy Healthcare, helps users get pregnant by charting their ovulation cycles. Pregnant users can also use the app to chart their pregnancies. It has been downloaded more than 1 million times by Android users, and has been reviewed more than 19,000 times by iPhone and iPad users.

The FTC also said that data gathered by the Premom app was illegally shared with third parties, among them two Chinese companies. According to a complaint the Justice Department filed against Easy Healthcare in federal court in Illinois on May 17, the companies are Umeng, a mobile app analytics firm owned by the e-commerce firm Alibaba, and Jiguang, a mobile development and data analytics company that goes by the name Aurora Mobile Ltd.

Premom also disclosed sensitive medical data to both Google and a company called AppsFlyer, which engages in data analytics. The Justice Department complaint describes the data that was shared as “identifiable health information,” a term for medical data that can be used to identify a specific individual. Such data includes names, addresses and dates of birth, among others.

Easy Healthcare, the Illinois-based firm that operates Premom, also failed to notify consumers of such disclosures, an alleged violation of the federal Health Breach Notification Rule.

“Premom broke its promises and compromised consumers’ privacy,” said Samuel Levine, Director of the FTC’s Bureau of Consumer Protection, in a statement. “We will vigorously enforce the Health Breach Notification Rule to defend consumer's health data from exploitation.” 

In conjunction with the Justice Department, the FTC has also proposed that Easy Healthcare be barred from sharing users’ personal health data for advertising or marketing purposes, obtain their consent before sharing that data for any other purpose, and must also tell consumers how their personal data is being used. Although a federal judge is required to approve this order, a recent court filing states that Easy Healthcare is not contesting any of the proposed actions.

Michelle Merola, a partner with the New York-based law firm of Hodgson Russ and a former U.S. Assistant Attorney in Washington, D.C., called the FTC/Justice Department action a “shot over the bow to developers and vendors of health apps,” and that similar steps against other app makers will be forthcoming.

Cynthia Khoo, a senior associate at the Center on Privacy and Technology at the Georgetown University school of law, agreed that enforcement is being ratcheted up.

“The FTC has become overwhelmingly cognizant of the harms of not just privacy…but the social, psychological and economic harms of technology companies engaging in these types of privacy practices,” she said.

Andrea Frey, San Francisco-based senior counsel and co-chair of the digital health practice of the law firm Hooper Lundy Bookman, added that regulators have a target-rich environment for enforcement.

“My guess is that there are certainly a lot of companies (that are) intentionally or unintentionally, gathering information through tracking technologies that are potentially in violation of FTC or HIPAA rules,” she said.

Khoo said that last year’s decision by the U.S. Supreme Court to strike down Roe v. Wade has made the feds and some state attorneys general particularly sensitive to the legal risks posed by not protecting personal information regarding the ovulation and pregnancy cycles of individual women. That has been further compounded by the growth of healthcare apps in recent years and gaps in the Health Insurance Portability and Accountability Act (HIPAA) that do not completely cover businesses that work with consumers but not with healthcare providers.

Khoo noted that the federal health breach notification rule – which requires companies managing breaches of healthcare information impacting 500 or more individuals report the incident to the general public – has been on the books for 14 years. However, it has only been used twice to punish violators – both times in 2023.

“This suggests to me that they are willing to use it again going forward,” Khoo said. She added that was further reinforced by the FTC recently introducing new guidelines for how businesses collect and manage biometric data.

In addition to the federal fine, Premom’s parent company, Illinois-based Easy Healthcare, has also agreed to pay an additional $100,000 in fines to attorneys general in Connecticut, Oregon and the District of Columbia for state-level violations.

“District residents who used the Premom app were entitled to have their locations and devices kept confidential, but Easy Healthcare shared that private information with third parties without notice or consent, putting users at risk,” said D.C. Attorney General Brian Schwalb in a statement.

In a statement issued in mid-May, Easy Healthcare said “our agreement with the FTC is not an admission of any wrongdoing. Rather, it is a settlement to avoid the time and expense of litigation and enables us to put this matter behind us and focus on you, our users. Rest assured that we do not, and will not, ever sell any information about users’ health to third parties, nor do we share it for advertising purposes.” Easy Healthcare’s statement ended with a pitch for a new line of supplements for those trying to conceive and an upcoming line of prenatal vitamins; a segue Merola and Khoo said was extremely odd for a company responding to a federal regulatory action.

“Odds are that the FTC takes issue with Easy Healthcare’s response and that it is removed from the website before the settlement is finalized,” Merola said.

An Easy Healthcare spokesperson would only refer back to the posted statement when asked to comment about the specifics of the settlement and the product pitches.

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.

Chart Inc reserves >$300 million to settle suits from 2018 PFC Tank Failure, sues insurance provider, contractor

The Latest: More Than 550 Legal Actions from 2018 Pacific Fertility Tank Failure

 

By: RON SHINKMAN

March 4, 2018 was a day that shook U.S. reproductive medicine in a way few others have.

That Sunday, a seal in a cryogenic tank at the Pacific Fertility Center in San Francisco failed. That caused the liquid nitrogen inside to vaporize and the tank’s temperature to rise above the optimal temperature for storing eggs and embryos. Its contents – some 4,000 eggs and embryos belonging to approximately 600 clients – were soon ruined.

The first lawsuit over the failure was filed just nine days after the crack was discovered – and only two days after Pacific Fertility had informed its clients of the issue, court records show. That first suit was filed by a client known only as a female San Francisco resident who is referred to by the initials “S.M.” Virtually all of the subsequent suits were filed by plaintiffs who did not reveal their identities. Pacific and its parent Prelude Fertility were accused of negligence in that first suit for failing to monitor the liquid nitrogen tanks more closely.

That initial legal volley was a mere preview of a flood of litigation in both state and federal court, as well as in private arbitrations – more than 550 cases in total, according to court records. 

The legal battles have also embroiled collateral parties. Chart Industries, the Georgia-based manufacturer of the tank that cracked, was added to the initial lawsuits after they were filed. According to court records, the failed tank was manufactured by a Chart subsidiary company in 2012. Chart’s warranty guaranteed the tank would perform without issue for at least a decade. Altogether, that company is trying to resolve some 217 state and federal lawsuits in total, according to a report the company filed in January with the Securities and Exchange Commission. 

Chart also disclosed to the SEC that it is “in ongoing discussions in an effort to establish a settlement framework for the various lawsuits” and that it would be in place as early as the first quarter of 2023. Chart also said it has set aside $305.6 million to fund settlements, or about $1.4 million per case. However, records indicate that only one case in federal court has been settled. Chart did not respond to a query seeking comment.

Chart also filed suit against Navigators Specialty Insurance Co. in February 2019, claiming it refused to provide a high enough payout to cover some costs for its legal counsel. Chart dropped that suit last March and agreed not to refile it, also suggesting a settlement was reached. 

Law Firms Involved

Chart has been represented by Zenere Cowden and Stoddard of Santa Clara, Calif.; the Chicago law firm Swanson Martin & Bell; and until May 2020, Morgan Lewis & Bockius in Los Angeles. Pacific Fertility has been represented by San Francisco-based law firm Morrison & Foerster and another Northern California firm, Galloway, Lucchese, Everson & Picchi, court records show. 

More than four-dozen plaintiffs in the state lawsuits are represented by Lieff Cabraser Heimann & Bernstein in San Francisco. Another San Francisco firm, Walkup, Melodia, Kelly & Schoenberger, represents 33 state case plaintiffs. Five other firms represent between two and four plaintiffs apiece.

Among the federal cases, where multiple law firms are often representing a single client, the Gibbs Law Group of Oakland, Calif. is representing 39 plaintiffs, while Girard Sharp of San Francisco is representing 36. Lieff Cabraser is representing eight clients, while New Orleans-based Peiffer Wolf Carr Kane & Conway is representing seven. Two other firms are representing a handful of other plaintiffs. Pennsylvania-based Sauder Schelkopf is representing three plaintiffs, while the Clarkson Law Firm in Malibu is representing a single plaintiff jointly with Gibbs, Girard Sharp and Lieff Cabraser.

Cases Consolidated

The litigation surrounding the tank failure has been so large and complex “due to the sheer size and how many people were affected” by the incident, said Rob Marcereau, an attorney and founder of the Fertility Law Group, a firm in Irvine, Calif. that often represents fertility clients in malpractice suits. And while a large number of the 600 clients were California residents, many were not. That led to litigation in both state and federal court.

Eventually, the number of lawsuits became so voluminous – more than 60 filed in state court alone – that those were mostly consolidated into a single case. The state cases were settled in late 2021 for an undisclosed sum, court records show. Most of the nearly 150 federal suits have yet to be resolved.

Pacific Fertility Benefited From Contract Terms, >340 Cases Arbitrated

Pacific Fertility eventually scored legal victories. Most of its contracts with its clients contained an arbitration clause. In March 2019, it obtained a court ruling forcing most of the state lawsuits into arbitration. The process is intended to work much more swiftly – and less expensively – than a lawsuit. A retired judge usually hears the case, and their rulings are binding and almost always private. Court records indicate that Pacific Fertility has arbitrated more than 340 cases to date.

However, Chart – which did not have direct contracts with the affected clients – could not move its cases to arbitration. Along with the state lawsuits, there have been at least 140 cases filed in federal court against Chart, records show. 

To give breadth and scope to the federal litigation, a case involving just five Pacific Fertility clients contained more than 1,000 docket entries – individual motions and other documents pertinent to the case. Nevertheless, the lawsuit moved fairly quickly for a federal civil case, which can take five years or more to get to trial. In June 2021, a jury awarded the five clients $14.975 million. The jury also decided that Chart and its manufacturing defect was 90% responsible for the damages. Pacific Fertility was found 10% liable.

“This is an important and emotional ending for our clients who have been through so much pain and hardship since the 2018 tank failure,” said Amy Zeman, a partner with the Gibbs Law Group, after the verdict was delivered.

It didn’t end there, however. Chart and Pacific appealed the verdict. Nearly two years into the appellate process and just days before oral arguments were scheduled in front of the U.S. Ninth Circuit Court of Appeals, the plaintiffs agreed to settle the case last March for an undisclosed sum, the Washington Post reported. The Gibbs attorney who handles media inquiries on the case did not respond to a request seeking comment.

Chart Inc Files Suits of Its Own Against Associates

The episode also embroiled Chart in litigation with its insurers. It was sued in June 2022 by its primary liability insurer, Starr Indemnity & Liability. The carrier asked the court to declare that Chart’s claim for excess liability insurance payouts of up to $231.9 million should not be honored. Chart quickly countersued Starr, accusing it of engaging in a “classic insurance company preemptive strike” to try and get out of paying a claim.  Starr and Chart dismissed their lawsuits in March and April, respectively, suggesting a settlement was reached. 

And even as Chart is moving to settle all the lawsuits against it, it is also suing other parties it believes contributed to the tank failure.

Chart filed a lawsuit in federal court in Ohio against electronics manufacturer Extron, accusing it of supplying a faulty control panel that did not provide accurate pressure and temperature levels for the tank, which it claims contributed to its failure. It is seeking reimbursement from Extron for all liability payments it must make connected to the tank failure.

Whether Chart will prevail in that case remains to be seen. In the 2021 federal trial, the jury found that Chart was aware of potential defects in the tank’s electronics but took no steps to repair or recall them. 

An Extron executive did not respond to a request seeking comment.

Litigators Call For More Regulation

Despite all the ramifications from this single tank failure, the incident did not lead to tighter regulations for egg and embryo storage at either the state or federal levels, according to Marcereau.

“There should be basic, uniform requirements in place for cryogenic storage of embryos or eggs, but sadly there aren’t,” he said. “Until state or federal laws mandate it, many fertility clinics will continue to cut corners – even in the wake of this litigation.”

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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How Spring Fertility Became a Bi-Coastal IVF Player in Seven Years

It started with 13 employees in 2016. Now it has 300.

 

BYRON SHINKMAN

In just seven years, Spring Fertility grew from a partnership of two physicians to a bicoastal business with seven clinics and hundreds of employees.

The San Francisco-based Spring Fertility’s two co-founders –

Nam Tran, M.D. and Peter Klatsky, M.D. were its only doctors when the practice opened in 2016. Despite their geographical separation – Klatsky began working from Spring’s offices in midtown New York City in 2019 while Tran’s office remained in the Bay Area – they have been extremely successful in continuing to grow their practice. Spring Fertility started with 13 employees just seven years ago. It just hit the 300-employee mark, according to Vice President of Marketing Meghan Dwyer.

Tran and Klatsky met during their residencies at the University of California at San Francisco in the mid-aughts and became fast friends, often sharing hotel rooms at academic conferences.

“We both wanted to make a difference in the field. We thought that the best way to do that initially was being in academic medicine,” Klatsky recalls of that time. Tran was unavailable for an interview.

But sometime after Tran and Klatsky joined the faculties at UCSF and the Albert Einstein College of Medicine in New York City, respectively, they realized they were on the outside looking in.

“Once we were out of our fellowships and in academic roles, we noticed that the big changes in our field were coming from the private sector, and that’s where the best fertility centers were as well,” Klatsky says. “And when it came to patient experience and what we would want if we were patients, there were so many things we wanted to do differently. And at those larger academic medical centers, we didn’t have the flexibility to do that.

“We went through every step and thought about what was necessary and what would bother us if we were patients," Klatsky adds. "And we asked how can we achieve the same or better outcomes and minimize (patient) discomfort and annoyance.”

That included offering evening and weekend consultations with patients, extended hours for monitoring and other ways to streamline the care experience, according to Klatsky.

The pair have combined this focus on patient needs with innovation – Spring Fertility developed the first process to ensure that eggs and embryos weren’t exposed to air during the harvesting and fertilization cycles – with growth. Last year, Spring Fertility performed 4,500 egg retrievals, either for immediate use in IVF or to freeze for a future procedure. That’s up from 3,400 in 2021 and just 2,000 cycles in 2020. Spring Fertility opened up new labs and clinics in the East Bay and Silicon Valley in early 2021 that helps explain the increase, according to Dwyer.

Currently, Spring Fertility operates seven clinics, six in the Bay Area (including two in San Francisco) and one in New York City. It also operates labs at its sites in New York, its clinic in the Pacific Heights neighborhood of San Francisco, Oakland, and Sunnyvale, Calif. Tran travels to each clinic on a monthly basis in his role as Spring Fertility’s chief medical officer, according to Klatsky.

Spring Fertility currently has 13 physicians on staff, of which 10 are board certified in reproductive endocrinology and infertility. The other three doctors are in the process of obtaining their certifications, Dwyer says. Spring also has four nurse practitioners and 22 embryologists on staff.

A basic IVF package at Spring Fertility runs $15,900 at its New York clinic, and about $100 less at its California locations. A more advanced package of services that includes ICSI and embryo transfer costs $18,700 in New York and $19,600 in California. The American Society of Reproductive Medicine estimates that the average IVF cycle in the U.S. costs about $12,400, but it can run significantly higher in urban areas.

Newsweek recently ranked Spring Fertility 23rd of the 100 best reproductive medicine clinics in the U.S. It’s ranked higher on the list than a number of fertility clinics operated by academic medical centers, including the University of Pennsylvania and UCLA.

However, Spring Fertility’s future is likely to include working with medical academia. Klatsky says plans are in the works to open a clinic in a new “major metropolitan area” in 2024 that would include a “strong academic affiliation,” although he declined to disclose any other details.

Such a collaboration “will allow us to further promote both education and research, which are things we’ve really been touching on” at Spring Fertility, Klatsky says.

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

 
 

All external links active as of 5/18/23.

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.

20 Years After Toft Report, Most Fertility Centers Have Yet to Automate

90% OF Fertility Centers Still Doing Manual Witnessing, Exec Says

 

BYNATASHA SPENCER-JOLLIFFE

A boom in demand for fertility treatment means more embryologists are turning to management to invest and implement processes and systems to modernize fertility care through implementing automated technologies.

“As the UK regulator of fertility treatments, we expect clinics to have robust systems in place to ensure eggs, sperm, and embryos are safely stored for patients,” Rachel Cutting, Embryologist and Director of Compliance & Information at the Human Fertilisation & Embryology Authority (HFEA) told Inside Reproductive Health.  

Long-standing, antiquated, manual tools have traditionally been the process of choice, despite the risks associated with being prone to human error and inconsistencies that subsequently compromise the standard of care. 

However, some fertility managers and embryologists are changing their approaches to embrace automation and ensure they continue to deliver a standard of care to patients that provide cell transparency and safety. For example, managers want to automate the tracking and storage of frozen eggs and embryos.

Swapping antiquated for automated

Regarding IVF laboratories, the main problem with automation and artificial intelligence (AI) is “a lack of standardization”, Danilo Cimadomo, Science and Research Manager of GeneraLife IVF, told Inside Reproductive Health. 

While there is a “very good concordance and reliability”, among people working within the same IVF center, the same is not true across different centers. “When it comes to the procedures as well as to the assessments that we make, there is not very much concordance between embryologists,” says Cimadomo.

Global managers are exploring automation in response to the estimated over 300 million anticipated to be born from IVF by 2100. Automation enables them to continue to provide cell transparency and safety – while ensuring compliance. 

“Advances in technology have meant greater success for patients using cryopreserved eggs and embryos and therefore, more patients are storing them for treatment or to preserve their fertility,” Cutting shares.  

“Even now, around more than 90% of fertility centers around the world are still not using any form of electronic witnessing,” says Matt Pettit, Chief Scientific Officer at IMT International, responsible for developing and implementing Matcher, an electronic witnessing and quality management system. Many fertility centers still handwrite Petri dishes, test tubes, and items.

“It is still a problem within the industry, still a change that needs to take place,” says Pettit. Serious adverse events are still happening, he continues. There are still reported incidents, year after year, where incorrect sample handling means babies are born to the wrong parents or embryos have been discarded.

As a result, today, we are seeing “a paradigm shift towards the use of electronic systems”, Pettit notes, continuing, “we are seeing a big wave now where there has been a very rapid 
adoption of electronic systems”. “Covid has expedited that realization,” Pettit adds.

Despite the release of the Toft Report almost two decades ago, implementing new automation-led processes and systems to support the fertility sector has been slow to adopt. Yet, increasingly, managers are conducting audits to recognize risks in manual systems and seeking tech to reduce the risks of these existing systems. 

Managers are exploring tech with specific features to improve digital tracking, robotic automation, and 24/7 remote monitoring to take the burden off of manual staff procedures and overcome identified risks. They see the benefits of automating embryo tracking and storage to reduce errors and ensure their infrastructure is robust to meet patient demand. 

Advancing tech encourages acceptance and adoption

Electronic tech innovations are entering the reproductive health space and finding acceptance in the wider healthcare sphere, helping to foster trust and uptake among managers of fertility centers and donor banks. 

With a focus on automation, transparency, and standardization, the tech connects to the company’s software, which assigns a unique identifier for each specimen and captures real-time information. It aims to reduce most manual inputs that risk failure in the existing cryogenic process.  

“Systems such as electronic witnessing systems and other automated technologies are becoming more commonly used, and clinics will use these to ensure security and safety is optimized,” Cutting details. 

Electronic witnessing systems are currently “the easiest and most effective way” for fertility centers to embrace automation and AI, Cimadomo says, describing it as “one of the most impactful automation tools” he has seen implemented in his clinic.

Fertility centers and donor bank managers are implementing automated patient tracking information to reduce errors, like Matcher IVF electronic witnessing technology. Described as a double-checking system, IMT’s Matcher tech is a barcode-based electronic witnessing, labeling, scheduling, traceability, and data insights system.

Teaming up with academia to provide education on the potential of automation in IVF is a priority for fertility researchers, clinicians, and embryologists. The electronic witnessing system’s upgrade is in response to an increasing number of treatments that require labeling, identifying, selecting, and matching a specific embryo for a predetermined fate, such as biopsy, transfer, cryopreservation, or disposal.

In an MIT Technology Review, researchers found almost three-quarters of health professionals (72%) show significant interest in implementing AI in their work. Embracing the technology appears more likely as professionals perceive it to be an extension rather than an extinction of professional capacity in health care. Research has found that the number of AI publications in medicine and health has also grown, with 61.6% of the papers dated between 2008 and 2017.

Encouraging change through embracing convenience 

Sharing information between databases is a powerful tool. It enables centers to cross-reference data across different systems and use that to effectively help drive further efficiencies, mitigate error, and for root cause analysis. 

Describing this realization as “probably the tipping point”, Pettit continues, it means people will “very rapidly adopt these types of technologies because it is more about the collection of data and that knowledge is power than it is about the prospective error prevention”, says Pettit. 

“The real advantage of automation will be for smaller centers that do not get the same experience as centers that are managing large volumes in terms of procedures,” says Cimadomo. However, cost-effectiveness remains a barrier to implementation. “That perhaps is the reason why we still do not have any automatic tool in the IVF laboratory, you need an investment in terms of money that should be justified from the volumes you have,” Cimadomo adds.

The use of technology and its specific applications varies from lab to lab. Research labs, for example, may require automatic timing and sanitation, whereas a lab engaging in clinical activities may not need this data. Therefore, the technology and the strategies need to be framed for the country, the regulations applied, the population of patients, and the specific center’s needs. 

“There is not really any effective automatic tool in the lab, it is still very manual the activity that we do, but that doesn't mean that there's no research,” says Cimadomo.

Automation

However, researchers have found that the answer does not have to lie in automation. Scientists developed an embryo tracking system (ETS) with six control steps to see if it increased the safety, efficacy, and scalability of massively parallel sequencing-based preimplantation genetic testing (PGT). The researchers found that the ETS approach precluded error-prone manual checks and did not impact preimplantation embryos’ genomic landscape.

Yet, increasingly, the benefits of automation in assisted reproduction technology (ART) are being recognized. Researchers of the review, Paving the Way for the Future of Infertility Treatment, said in August 2022 that implementing novel technologies to automate ART “will soon become a reality”. 

On 13th May 2023, the Italian Society of Embryologists Reproduction (SIERR) is dedicating its 2023 event to understanding the role of AI in IVF, demonstrating the growing interest in the possibilities of automation in fertility. Understanding how AI applications in embryology and reproductive medicine work and defining the state of the art is the goal of the 2023 event.

“We thought it was about time to talk about AI because there are lots of companies commercializing tools and are approaching us in the laboratories, and there are people who do not know what AI is”, says Cimadomo, a member of the Italian Society of Embryologists at Production and Research.

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 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.