All-Woman Independent Practice Heartland Fertility Grows to Five Physicians [] New technology in egg banking on the horizon

DR. STEPHANIE GUSTIN SAYS SHE’S NOT SELLING, ENCOURAGES OTHER DOCS TO BUY PRACTICES

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



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BY ROSEMARY SCOTT

As more fertility clinics and chains are bought up by investment firms across the U.S., reproductive endocrinologists who choose to own their own practices are becoming more of a rarity.

Stephanie L.F. Gustin, M.D., is one of the few who chose to take the leap into independent ownership. She is now managing partner at The Heartland Center for Reproductive Medicine in Omaha and Lincoln, NE, and has grown her all-women physician team from one reproductive endocrinologist to a total of five in five years.

Gustin told Inside Reproductive Health that after she finished her fellowship program at Stanford University, she knew she wanted to work either in an academic setting or at a private practice. As a University of Nebraska School of Medicine-affiliate, Heartland was a mix of both, and she started working there shortly after her fellowship ended.

Heartland offers a partnership track to its doctors, which is how Gustin was eventually able to become a partner and partial owner in 2019 and purchase the practice entirely from the previous owner, Dr. Victoria Maclin, in 2021. She said that once a doctor has a patient load that is similar in quantity to the other partners, that doctor will also have an opportunity to purchase part of the practice.

Gustin said the biggest changes she made upon purchasing the practice were in an area she still prioritizes today–recruitment. Shortly after she became the owner of Heartland, she hired Barry R. Behr, Ph.D., who was formerly the IVF laboratory director at Stanford.

“He was one of my mentors [at Stanford] and someone that I have a profound respect for,” Gustin said. “And I felt really confident that our practice, in terms of our success rates, was going to evolve quickly with his help.”


“When it comes to egg banking, there are technologies and protocols that are on the horizon that you need to know about.”

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Gustin said that though she believed recruitment may be difficult given the clinic’s more rural location, she has now hired a total of four reproductive endocrinologists in five years. She said she built relationships with the new staff before offering the job through advocacy, collaboration and mutual connections, and after introducing her business model, they each decided to make the leap.

The staff, Gustin said, has made all the difference.

“We all work really hard, but it's easy to do that when we really love who we work with,” she said. ”I don't think many people have the kind of job that I have.”

Though all five of Heartland’s reproductive endocrinologists are early or mid-way into their careers, and the IVF market is only getting more lucrative, Gustin said they have no interest in selling the practice, as they value the autonomy of private ownership and the ability to prioritize patient care over profits.

“We really enjoy the autonomy of creating the culture and running the practice in a way that feels authentic to us,” she said.

Gustin said she thinks the business side of owning a private practice might deter some doctors, especially those without a background in business. Still, she emphasized the importance of being confident in one’s own skill set to learn along the way and hire experts to fill any knowledge gaps.

“I haven't heard a single person [who has bought a private practice] say that they regret it,” Gustin said. “It’s something that I wish more people coming out of training would seek out.”

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


THE NEW TECHNOLOGY IN EGG BANKING: IMPROVED PROTOCOLS, AUTOMATION, AND AI, OH MY!

BY: KATHRYN WOZNIAK, MS SENIOR EMBRYOLOGIST & LEAD CRYOBIOLOGIST AT ASIAN EGG BANK

No matter the area of life or business, the newest and most notable advancements are  often cause for excitement. When it comes to egg banking, there are technologies and protocols that are on the horizon that you need to know about. Here are three in particular that are worth your attention.

The overarching expectation is that technology moves fast and is constantly improving. While that’s certainly the case in some areas, the opposite can also be true. Over the past decade, there's been minimal progress made towards improving oocyte freezing techniques. At Asian Egg Bank, we are researching and reviewing the current processes of oocyte vitrification and warming, and this work is showing very promising results in the field with blastocyst embryos. While current methods have an over-90% survival rate, this new ultra-fast vitrification and rapid elution protocol gets outcomes much closer to fresh eggs, with survival rates close to 100%. It's still very new in terms of oocyte cryopreservation and the protocol will need to go into clinical trials to be implemented across the country, but we are very excited for the increased reliability of frozen oocytes so that they can be accessible to patients worldwide.

Like many industries, the field of ART is moving into an era of AI. This technology is going to be particularly relevant in the egg banking space because it will allow us to remove technologist bias and subjectivity from the egg selection process. It may also be able to provide additional information that is not visible with the human eye. AI uses images and markers, which will allow us to grade and group oocytes before the vitrification process, according to the likelihood that they'll produce the viable blastocysts. This is extremely valuable information for egg banks and for intended parents, so that they can make better decisions on their family planning.

While a little further out on the horizon, we could eventually see automated oocyte freezing. Oocyte vitrification can be a very tedious and lengthy process and automated vitrification could potentially alleviate the manual labor, and also help to standardize the outcomes by removing some of the operational error. And less manual labor could mean lower cost as well. We will have to wait and see on this one.

In addition to conducting our own research, Asian Egg Bank team members attend regular educational conferences and workshops to stay on top of new information. The fertility industry is so dynamic, and it’s growing every day. We need to have the most up-to-date techniques and technology in order to provide our patients with the best care.

Discover how Asian Egg Bank is leading the industry in new technology. Visit asianeggbank.com/for-professionals to learn more.


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

WOLF, ASTORG SAY TEAMS WILL REMAIN IN PLACE

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BY RON SHINKMAN

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

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

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


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

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Stock Performance

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

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

Exit

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

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

Merger

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

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

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

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

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

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

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

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

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

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

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

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


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

By Dr. William Baird, HCLD

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

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

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

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

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

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

1 - Smaller tanks

2 - A greater sense of staff responsibility

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

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

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

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

 
 

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

 
 

Expanding IVF Access: Initiatives to Make Fertility Treatments More Accessible

US CLINICS INNOVATE TO BREAK FINANCIAL, GEOGRAPHICAL, AND EDUCATIONAL BARRIERS

This News Digest Story is paid featured content. The advertiser has had editorial input and control over its creation. However, the views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by Inside Reproductive Health.

By Lisa Munger

As demand for fertility treatments surges and barriers persist, several leading fertility clinics and organizations in the U.S. are implementing innovative measures to make in-vitro fertilization (IVF) more accessible to a broader population. By working to address financial, geographical, and educational barriers, these organizations seek to ensure that more people can access the resources they need to expand their families.

CNY Fertility: Affordable and Accessible Care

William Kiltz, vice president of marketing and business development at CNY Fertility, said the company has emerged as a leader in making fertility treatments affordable and accessible.

Kiltz highlighted three primary mechanisms for expanding access: eliminating financial barriers, removing restrictive cutoffs based on age or health metrics and addressing geographical challenges.


ORGANON IS COMMITTED TO HELPING ASPIRING PARENTS ON THEIR FERTILITY JOURNEY

Organon is proud to collaborate with the fertility community in championing care equity around the world and is committed to:

  • Elevating fertility education and awareness

  • Expanding resources and access to care

  • Investing in innovative fertility solutions

Every journey to parenthood is unique, and Organon is here to empower aspiring parents every step of the way.

 
 

He said CNY Fertility's pricing stands out in the industry, with treatments costing one-third of the national average.

“Where standard IVF treatments typically cost around $20,000, CNY Fertility offers similar services for $6,764,” Kiltz said. “This affordability and flexible financing options allow more families to access fertility care. The average household income of CNY’s patients is around $80,000, significantly lower than the typical $180,000 for IVF patients nationwide.”

CNY Fertility has developed a patient-friendly travel program that leverages telehealth and local medical facilities to address geographical barriers.

"Patients can receive treatment remotely for most of the process, only needing to visit our clinics for two days," Kiltz said. "We believe that access to the care needed to grow one’s family is a fundamental human right."

Inception Fertility: Advocating for Improved Insurance Coverage

Under the leadership of CEO TJ Farnsworth, Inception Fertility is also at the forefront of expanding IVF access. Inception focuses on increasing insurance coverage and educating insurance companies about comprehensive fertility care.

"Our top priority is to remove capacity constraints and advocate for expanded coverage," Farnsworth said. "We are dedicated to adapting to changes in the insurance landscape and increasing the number of employers offering fertility care benefits."

Inception Fertility offers solutions for patients facing financial barriers. Through BUNDL Fertility, patients can bundle multiple cycles at a discount, reducing the overall cost and increasing success rates. Additionally, the Wyatt Fertility Foundation provides financial assistance and funds research in infertility.

"We are excited to award five $15,000 grants for IVF, demonstrating our commitment to the future of fertility care," Farnsworth said.

Kindbody: Training and Expanding Access

Kindbody is tackling the issue of limited access through innovative training programs. Angie Beltsos, M.D., chief executive physician, emphasized the importance of increasing the number of qualified fertility specialists.

"Kindbody was founded to create health equity and make family-building more affordable," Beltsos said. "Our new KindInstitute will train board-certified OB/GYNs in reproductive endocrinology and infertility, significantly increasing the number of professionals available to provide care.

This training program, set to graduate its first cohort in 2024, seeks to address the shortage of fertility specialists and improve access for underserved communities. By equipping OB/GYNs to perform fertility-related procedures, Beltsos hopes to increase the monthly cases treated by 50% or more. Additionally, Kindbody is expanding its online offerings to provide convenient, remote patient consultations.

Organon: Cost-Saving Programs for Medications

Organon, a company with a portfolio that has a long history in fertility medications, focuses on reducing patients' costs, said Mike Pohleven, U.S. Fertility Business Unit lead, regarding the effect of Organon’s partnership with ReUnite Rx on expanding access to fertility care

“Our two most popular and utilized programs are the ReUnite Discount Program, which offers point-of-sale discounts for cash-paying customers without insurance benefits, and ReUnite Assist, which provides additional savings for uninsured, income-eligible patients.”

Going forward, Pohleven said the company’s development “will be based on market dynamics and events, so we are always aiming to meet the needs of aspiring parents.. Organon’s mission-critical NorthStar is to be ‘Here for Her Health.’ We continually look for ways to address women's unmet needs.”

Through ReUnite Rx, Organon provides access to several cost-savings programs, benefiting 50,000 eligible patients since 2018, he said.

This News Digest Story is paid featured content. The advertiser has had editorial input and control over its creation. However, the views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by 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.

 
 

The Regulatory Gap: Why Embryology Labs Are Exempt from CLIA Oversight

A PROPOSAL WAS QUIETLY SHOT DOWN BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES BACK IN 1998.

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

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BY RON SHINKMAN

The 144 pages of the Clinical Laboratory Improvement Amendments, known in healthcare circles as CLIA, were codified in the late 1980s. They have been regulating virtually every facet of U.S. medical laboratories since 1990.

Yet embryology labs – the linchpin of reproductive medicine practices – are exempt from CLIA. That’s despite the fact CLIA governs the andrology and endocrinology labs that often operate alongside their embryology counterparts. How this came to be is a bit of a mystery; some industry observers say politics played a role

In 1998, it appeared CLIA was on the cusp of expanding its regime to include embryology labs. The Clinical Laboratory Improvement Advisory Committee, a group of medical and laboratory experts attached to the Centers for Disease Control and Prevention that advises the U.S. Department of Health and Human Services, voted 12-2 in September 1998 to have CLIA regulate embryology labs, according to the American Board of Biologists.

However, the recommendations of CLIAC are not binding; they require the approval of the HHS Secretary. Once approved, HHS would draft regulations that would undergo a public comment period before they were finalized.

But HHS – then led by Secretary Donna Shalala – never approved CLIAC’s recommendation, according to the AAB and others familiar with CLIAC’s history. Shalala, now interim president of the New School, a university in New York City, did not respond to a request seeking comment.

Thomas “Rusty” Pool, an embryologist and director of the assisted reproductive technology laboratory at the Fertility Center of San Antonio, testified as a technical expert in favor of putting embryology labs under CLIA during a May 1998 CLIAC meeting. He testified that diagnostic data was generated when performing procedures in the embryology lab, and that given it could be used to diagnose infertility and future medical therapies, it should be governed by CLIA.


“There are unique challenges in recruiting Asian egg donors in particular, ones that require a nuanced approach and deep cultural understanding.”

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Nevertheless, “there was a reticence to do that, largely from the physicians associated with fertility practices,” Pool told Inside Reproductive Health about adopting those regulations. Minutes from that meeting indicated representatives from both the American Society for Reproductive Medicine and the affiliated Society for Assisted Reproductive Technology testified against modifying CLIA to govern embryology labs.

A spokesperson from ASRM declined to comment.

Eva Schenkman, an embryology lab director and consultant based in Rocky Mount, N.C., said  the reasons ASRM and SART were against the CLIAC recommendations remain unclear to this day. “I don’t think it’s ever been fully transparent,” she said.

However, Schenkman believes the primary concern was economic: Under CLIA, all laboratory directors must either be a medical doctor, osteopath or hold a doctoral degree in certain fields and have a requisite amount of laboratory experience. Doctors running fertility practices didn’t want to spend the extra money recruiting and retaining employees whose educational background would command a premium, Schenkman said. And while ASRM and SART guidelines recommend that embryology labs hire such degreed professionals, the organizations recently proposed withdrawing that qualification, a trial balloon that was quickly dropped after it received pushback from Schenkman and other embryology lab directors.

In the absence of CLIA oversight, ASRM and SART have served as the de facto regulator for many embryology labs, Schenkman said. If such a lab wants a SART membership, it must be certified every two years by either the College of American Pathologists or the Joint Commission. The former is the primary trade group for physicians engaged in laboratory medicine, while the latter is the largest accrediting body for hospitals, clinics and other medical ventures in the U.S

Both CAP and the Joint Commission adhere to standards that are either CLIA-equivalent or go beyond those regulations, according to Sharon Ehrmeyer, a professor in the department of pathology and laboratory medicine at the University of Wisconsin and author of a well-regarded compliance manual for laboratory professionals.

“CAP is a very good accreditation” to have, Ehrmeyer said, adding that CLIA accreditation does not mean “bad apple” labs with quality issues have been completely eliminated. But there are also fertility practices not affiliated with SART or ASRM whose levels of quality remain a mystery.

“I'm sure that there are some very capable people running these laboratories that feel that they don’t need to be part of CAP or Joint Commission. And they still may be doing a good job,” Ehrmeyer said. “And then there is probably some other situations where people are perhaps trying to do things on the cheap and they’re not so concerned about quality.”

But even with an accreditation from CAP or the Joint Commission, some regulatory measures are missing from embryology labs. Schenkman noted that CLIA-accredited labs are required to report individual medical errors to the Centers for Medicare & Medicaid Services, which serves as the licensing agency to medical labs under CLIA. CMS does not gather such information from embryology labs, according to Schenkman. And errors can be significant, from the loss or accidental destruction of embryos to the accidental swapping of gametes or embryos. Labs have to report assisted reproductive technology success rates to the CDC, but not errors

According to Schenkman, although embryology labs submit incident reports to CAP, “they have no way of knowing if you’re committing egregious errors, and they don’t have the ability to stop you from doing business.” She noted that is different in other countries, such as the United Kingdom, whose regulatory body suspended the license of the Homerton Fertility Centre in northeast London after its embryology lab lost embryos in three separate incidents last year.

The lack of transparency on medical errors in the fertility sector recently prompted five U.S. Senators to ask the U.S. Department of Health and Human Services Office of the Inspector General  to “audit the safety standards at fertility clinics and the quality of data collected by the Centers for Disease Control and Prevention (CDC) with respect to assisted reproductive technology procedures to treat infertility.” The June 20 letter was signed by Sens. Roger Marshall of Kansas, Markwayne Mullin and Bill Lankford of Oklahoma, Bill Cassidy of Louisiana and Tommy Tuberville of Alabama. All are Republicans.

As a result, patients are walking into fertility practices in the U.S. that “may have a very low error rate, or may have had some major incidents,” Schenkman observed. “And I think patients have a right to know that – especially since most are paying out of their own pockets.”


EVERYONE WANTS ASIAN EGG DONORS, SO WHY IS IT SO HARD TO RECRUIT THEM?

BY: ALEX FRANKLIN, CMO OF ASIAN EGG BANK

Despite the increasing demand for Asian egg donors, the supply won’t be secured by a few extra “$$$ for eggs” ads on social media or billboards. There are unique challenges in recruiting Asian egg donors in particular, ones that require a nuanced approach and deep cultural understanding.

The decline in birth rates, particularly in Asian countries, is making global headlines. South Korea even plans to create a government agency to tackle the “national emergency.” How did it get to this? There are many factors, one being marriage. An NIH study found that in many East Asian contexts, marriage and childbirth are proximally linked with low fertility because of the social expectation that marriage is a precondition for childbearing. In addition, Asian American patients have decreased clinical pregnancy and live birth rates, even after receiving treatment (Purcell et al, 9).

Another reason might be social stigma and shame. They can be strong motivators, and talking about sexual and reproductive health is often taboo—not just for donors, but for prospective parents as well. Asian women may conceal any fertility issues and it can keep them from seeking treatment (Missmer et al, 3). If they do pursue treatment, certain types such as gamete donation, either sperm or egg, are typically frowned upon in both religious and cultural contexts (Cross-Sudworth, 47). When they do explore gamete donation, couples have a preference for Asian donors, as mixed ethnicity oocytes can raise even more ethical dilemmas (Culley et al, 48).

With those cultural taboos, a major factor of donor onboarding is education. We cover everything from the basics, like what exactly is egg donation and the difference between ”fresh” and frozen egg donation, to how their eggs can help members of their community. With our Donate Love campaign, Asian Egg Bank is reaching potential donors on college campuses by providing education on sexual health, and offering fertility testing, as well as free egg storage with donation.

Another block to donor recruitment is the ability to identify possible donors online. When Meta got negative press for turning over abortion seekers’ data to police in states where abortion is illegal, the company significantly reduced its ad platform’s ability to market and measure the efficacy of ads to people seeking any form of reproductive care, including egg donation. Ad targeting is now more broad, and requires more input from our multicultural donor team to craft messages that will resonate with the intended audience.

Since Asian Egg Bank only works with Asian egg donors, the donor team is multilingual; any donor can communicate in their own language, which goes a long way in making donors more comfortable with the process. The team also understands the cultural taboos and nuances, and can answer questions about them.

While Asian egg donor recruitment has its challenges, there are significant ways the Asian Egg Bank team can combat them, with cultural sensitivity, education, and community.

Discover how Asian Egg Bank is leading the path in Asian egg donorship. Visit asianeggbank.com/for-professionals to learn more.

 
 

All external links active as of 6/27/2024

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

 
 

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

THREE NEW CLINICS PLANNED IN 3-4 YEARS

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

 

BY MALLIKA MITRA

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

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

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


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

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

Focusing on long-term growth

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

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

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

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

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

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


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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.

 
 

Improvements in quality control, donor recruitment, in donor egg IVF

VIDEOING PROCEDURES, ADDING ‘SHARE AND FREEZE’ PROGRAM PARTS OF MEASURES

This News Digest Story is paid featured content. The advertiser has had editorial input and control over its creation. However, the views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by Inside Reproductive Health.

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BY: Natasha Spencer-Jolliffe

Evolving standards of egg-freezing care

Leading network of donor egg banks, MyEggBank, has introduced specific quality control measures to optimize egg freezing for fertility preservation. “Most of the quality control is based on the timing of the process,” Dr. Daniel Shapiro, Clinical Director of MyEggBank, says. “A lab director times everybody’s moves during the freeze process since it is done by hand and speed is essential,” adds Dr. Shapiro. MyEggBank also videos every procedure so they can monitor the entire process.

MyEggBank requires the inventory-producing centers to adhere to American Society for Reproductive Medicine (ASRM) criteria, Food and Drug Administration (FDA) guidance, genetic testing and counseling, and strict criteria for the states that require licensure. In addition, MyEggBank maintains strict policies and procedures when accepting donors for donor inventory.

Donors also have to do extensive screening before they are accepted. “The percentage of people who begin the process of enquiry and get to egg retrieval is very low,” Danielle Sheehan, President of the New England Fertility Society (NEFS), says. This increases potential productivity leaks and extensive time spent on administration. “Some egg banks have a model whereby they do all the recruiting, which is attractive to IVF center programs,” shares Sheehan.


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Maximizing donor recruitment

MyEggBank is raising the standard of freezing eggs to positively impact donor recruitment.

Network recruitment numbers are high, or referred to as top of the funnel, meaning, many applications are received,” shares Deb Mecerod, Director of Clinical Operations at MyEggBank.However, during the process of screening and testing donors, the number drastically reduces due to initial disqualification in the screening process, lack of donor commitment, or disqualification later in the process,” Mecerod added.

MyEggBank also strictly adheres to internal and external guidelines, which affects the number of donors accepted. “However, the quality of the donor candidates who pass all the milestones are quality donors who are presented to our intended parents,” Mecerod states.

Share and freeze solutions

As part of its unique egg donor value proposition, MyEggBank has a “share and freeze” program. The egg bank’s network has options at the local donor sites for its share program. For example, most donors recruited produce 24-26 mature egg (MII) oocytes. “Most donors with good outcomes will return for additional donation cycles,” says Mecerod.  

Typically, on the third donation cycle, the donor is offered eight eggs for egg preservation and storage at no cost to the donor. The donor is paid full compensation for the donation, and the remainder of the eggs are added to the general inventory for intended parent selection.  

The share and freeze program gives donors the benefit of fertility preservation for future use.  “Many of our donors are single working towards advanced degrees. Freezing their eggs allows them a unique opportunity to control the timing of their own family building,” says Mecerod. This dually provides a service to the intended parents and donors, Mecerod adds: “The fertility clinics providing the service look at this as a goodwill gesture, or as some would say ‘paying it forward’”.

Technology enabling ‘premium’ standardized care

MyEggBank provides a strategic service in training the egg producing centers, maintaining strict quality control, and updating standard operating procedures (SOPs) and policies and procedures.  

The criteria for accepting donors is rigorous, but results in quality eggs being retrieved,” says Mecerod. Additionally, the intended parent clinics are trained by MyEggBank's embryologists to warm eggs and embryos to achieve the best possible outcomes.

Recently, scientists proposed a simplified oocyte warming protocol with promising results that could potentially improve clinical pregnancy rates as well as its potential to significantly improve IVF success rates,” says Mecerod.

The research and collected data for the updated process are on the horizon. “Yet, it is currently too early to say if the simplified oocyte warming technique could be used in a clinical or laboratory setting,” Mecerod adds.
What is here, however, is the egg bank’s ability to collect “a profound amount of analytical data related to egg freezing and outcomes”, Mecerod says. This data is then utilized to troubleshoot when needed in their partner fertility clinics and production centers. “Ultimately, the data is used to provide ‘best in class’ outcomes,” Mecerod adds.

This News Digest Story is paid featured content. The advertiser has had editorial input and control over its creation. However, the views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by 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.

 
 

Progyny stock falls 15% day after earnings call, down 35.9% since February

Company says decision from Alabama Supreme Court dampened utilization of ART services.

 

BY RON SHINKMAN

Progyny’s leadership said the Alabama Supreme Court’s ruling that embryos created by IVF are human beings was largely responsible for its missing first quarter revenue estimates that led to a $1 billion drop in its market capitalization.

Stock in Progyny – a New York City-based firm that provides fertility benefits to employers – dropped about 15% the day after it announced earnings on May 9, from $32.50 a share to $27.53. It has since dipped to $26.67 a share as of the end of trading on May 28. The company’s shares are down nearly 36% from its 2024 high of $41.62 per share on Feb. 12.

Progyny reported net income of $16.9 million on revenue of $278.1 million for the first quarter ending March 31. That compares to net income of $17.7 million on revenue of $258.4 million for the first quarter of 2023.

Although Progyny’s net income was in line with estimates from Wall Street analysts, its revenue for the quarter was more than $11 million short of the consensus number of $289.3 million.

Progyny leadership tied the revenue dip to a decrease in utilization of services for the first quarter. About 0.46% of people offered fertility benefits through Progyny used its services. During the first quarter of 2023 the utilization rate was 0.48%. That means utilization dropped about 4.2% year-over-year.


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


“We began to see the ramp in member activity leveling off slightly in March, coinciding with the national conversations about women’s access to reproductive healthcare sparked by the Alabama Supreme Court ruling,” Progyny Chief Executive Officer Pete Anevski told stock analysts during the company’s earnings call.

Anevski added that “the modest dip in activity that we saw across the country was more pronounced in the states [which have] the most restrictive laws for women’s reproductive healthcare, suggesting that a relatively small number of members were proceeding with a greater degree of caution before commencing their fertility journey.” He noted that initial user levels during the second quarter of this year were also lower than the second quarter of 2023.

Nevertheless, Progyny says activity is up. Chief Financial Officer Mark Livingston said during the earnings call with analysts that the number of overall assisted reproductive technology cycles performed during the first quarter totaled 14,800, up 12% from the first quarter of 2023. And the number of insured individuals who have access to Progyny through their health insurance rose to 6.4 million during the quarter, compared to 5.3 million during the same period a year ago.

However, Livingston also cautioned that with its utilization rate essentially remaining unchanged going into April, Progyny projects second quarter 2024 revenue of between $300 million and $310 million. The forecast from Wall Street is on the higher end, at $307.2 million, suggesting another revenue miss for the second quarter was possible.

Livingston said full-year 2024 revenue is now forecast at between $1.23 billion and $1.27 billion. Wall Street forecasts $1.24 billion. The company’s 2023 revenue was just under $1.1 billion.

“Our range assumes that utilization in the second half of the year will be nearer to what we saw in 2022 at the low end and closer to what we saw in 2023 at the high end,” Livingston said.

Progyny has responded by buying back its own shares, including a plan to repurchase $100 million worth of stock announced on May 22.


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  • Avg days from consult to IUI

  • Avg new patients

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


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

 
 

Early Diagnosis, Better Outcomes: The Future of Fertility with Clinical Decision Support Software

LEVY Health reveals how 96% of women trying to conceive received diagnoses for previously undiagnosed conditions

This article has been authored by our advertiser, and is paid featured content. The advertiser had complete editorial control over its creation. The views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by Inside Reproductive Health.

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Shockingly, only 16% of women with infertility are properly diagnosed.

New data highlights the potential of clinical decision support software (CDSS) to revolutionize fertility diagnostics and treatment. CDSS can help providers identify conditions earlier and more efficiently, leading to an increase in treatment conversions and improved patient outcomes.

A recently published white paper by LEVY Health with first author Serena Chen, MD, FACOG reveals that including OB-GYNs in diagnostic fertility workups and early diagnostics is essential to improving access to fertility care. However, OB-GYNs also need support. 

"Many women facing challenges with conception have conditions that don't necessarily require in-vitro fertilization," says Chen, the first author of the white paper. "Without increased involvement from OB-GYNs and tools to aid in diagnosis and treatment, infertility rates will continue to climb."

In a study using LEVY Health’s software, 96% of women received diagnoses for previously undiagnosed conditions, including polycystic ovary syndrome, thyroid disorders, or premature ovarian insufficiency - conditions that oftentimes need many years to diagnose. The white paper shows that clinical decision support can empower OB-GYNs, thereby improving patient triage and making fertility clinics more efficient.

This article has been authored by our advertiser, and is paid featured content. The advertiser had complete editorial control over its creation. The views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by 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.

 
 

Aetna Will Pay LGBTQ+ Enrollees up to $2 Million to Settle IVF Lawsuit, Law Firm Gets $1.65M

The litigation accused the health insurer – which is owned by pharmacy chain CVS Health – of having separate IVF coverage policies for same-sex and heterosexual couples.

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

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BY RON SHINKMAN

A national insurer under criticism for its reproductive health benefits design has agreed to settle a lawsuit and change its policies regarding IVF and other reproductive health coverage for same-sex couples.

Aetna – which is owned by pharmacy chain giant CVS Health – will set aside $2 million to reimburse same sex couples who had previously been denied coverage under its prior policies.

The insurer was sued in September 2021 by playwright Emma Goidel, who obtained her Aetna coverage through Columbia University.

Goidel’s lawsuit, a class-action filed in federal court in New York City, argued that Aetna’s policy of requiring same-sex couples to undergo a dozen rounds of intrauterine insemination at their own expense before it would provide IVF coverage was discriminatory. By contrast, heterosexual couples only had to claim 12 consecutive months of trying to get pregnant before IVF coverage would kick in.

Under the terms of the settlement, Aetna has agreed to change its coverage policy. “Aetna will apply and administer its clinical policies such that individuals with a uterus in an eligible LGBTQ+ relationship at the time of seeking IVF are not required to undergo any greater number of IUI cycles to qualify for IVF than individuals with a uterus in a heterosexual relationship,” the settlement stated.


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Aetna has also agreed to reimburse same sex couples who had IVF coverage from the insurer but previously had to pay for IUI treatments out of their own pocket. Each enrollee would be eligible to a default payment of $2,300, although they may apply for additional compensation if they spent money on procedures exceeding that sum. 

“We celebrate this significant stride toward achieving justice for LGBTQ+ people who have faced obstacle after obstacle trying to access the health care services that they need to build their families,” said Alison Tanner, an attorney with the National Women’s Law Center, which represented Goidel in the litigation

Court records indicate 5,621 individuals belong in the various classes of plaintiffs, although only 850 are currently confirmed as qualifying for reimbursement, according to the settlement. The other individuals would have to prove they were in a same-sex relationship and denied fertility benefits in order to qualify. Any money left over from the $2 million fund will be donated to a charity of choice decided by the plaintiffs and Aetna.

The attorneys who represented Goidel and the other class members will receive $1.65 million in legal fees separate from the $2 million settlement fund. Aetna will also pay $130,000 to administer the settlement, which is comprised primarily of notifying class members that they may be due compensation.

“We are committed to providing quality care to all individuals regardless of their sexual orientation or gender identity and pleased to reach a resolution to this matter,” Aetna said in a statement provided to Inside Reproductive Health. A spokesperson for the health insurer declined to answer specific questions.

Meanwhile, Aetna was sued again in federal earlier this month, this time in Los Angeles. The plaintiff in that case, Amelia Rynkowska, claims Aetna has ambiguous language in its group employer coverage that appears to exclude coverage of many reproductive services completely.


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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.

 
 

Down 70%. The IVF Clinic Network that Just Made Their IPO on the US Stock Market

How the Operator of a Handful of Asian IVF Clinics Wound up on Nasdaq

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

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BY RON SHINKMAN

A small chain of IVF clinics in Asia has gone public, with its stock listed on the Nasdaq exchange.

NewGen IVF Group operates single clinics in Hong Kong, Thailand, Cambodia and Kyrgyzstan. Its stock began trading on April 4, according to a statement issued by the company.

NewGen IVF was founded a decade ago, according to a video posted in 2019 by Alfred Siu, founder of its parent company, First Fertility Group. Siu said in the video that the clinic in Cambodia was conducting about 700 IVF cycles per year.

How did a company as small as NewGen IVF go public? It relied on a fairly new path for making an initial public offering: A blank check company or special purpose acquisition company, also known as a SPAC.
A SPAC is essentially a shell company that raises money from outside investors and issues stock. It then acquires a privately-held company that becomes the face of the organization as it is listed on a stock market such as Nasdaq. The best known SPAC transaction took Donald Trump’s Truth Social platform public, which combined the Digital World Acquisition Corp. SPAC with Trump Media & Technology Group.


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However, Goodman also noted that the company was not sizable and its stock offering wasn’t much different from so-called “penny stocks” or “pink sheet” stocks – shares issued by companies so minuscule they often can’t meet the requirements for trading on traditional stock exchanges.

To date, the market expressed extreme skepticism to the NewGen IVF stock. It was initially priced at $10 per share but dropped to around $3 per share on its first regular trading day on Nasdaq. The stock was trading at $1.22 per share midday on April 16. It had fallen below $1 a share, but was bolstered in late April by the announcement of a pending reverse merger with a company called European Wellness Investment Holdings Limited. That briefly pushed the NewGen IVF price above $2 a share, but it has since dropped.

“This may be an easier way to get to the IPO market for some companies, but you still have to be deserving (to remain there),” Goodman said of NewGen IVF Group’s approach. “You still have to have the fundamentals of a good management team and a good strategy to make the business work.”

In this case, the Bangkok-based NewGen IVF Ltd. was acquired by A SPAC I Acquisition Corp., which is based in the British Virgin Islands, according to a filing with the Securities and Exchange Commission. The merged companies then renamed itself NewGen IVF Group. Its stock trades on Nasdaq’s Capital Market, a tier of the exchange for newer and smaller companies whose rules are more relaxed than the Nasdaq Global Select Market and the Nasdaq Global Market, which are venues for larger and more established companies.

“We believe our public listing will help us to accelerate our growth and execute on our long-term vision,” Siu said in a statement announcing the merger, although no further details were provided. A spokesperson for NewGen IVF Group in New York City did not respond to a request seeking comment.

SPACs are a relatively rare vehicle for taking a company public, and this appears to be the first instance of a reproductive medicine company to take that route, according to Robert Goodman, vice president of healthcare for MidCap Advisors, a New York firm that assists in transactions among mid-sized companies.

“I think (Siu) saw value in the SPAC concept,” Goodman said, adding that the NewGen IVF founder was educated in the U.S. and is likely familiar with such an esoteric transaction.

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


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

 
 

How These Fertility Centers Are Effectively Using APPs

NPs and PAs improve quality of care for patients, quality of life for physicians

This News Digest Story is paid featured content. The advertiser has had editorial input and control over its creation. However, the views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by Inside Reproductive Health.

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BY NATASHA SPENCER-JOLLIFFE

Advanced Practice Providers (APPs) can be effectively integrated into fertility clinic teams to enhance patient care. “APPs are often used as physician extenders in the fertility space,” Dr. Courtney Failor, Medical Director of Aspire Fertility, told Inside Reproductive Health. 

Formerly called physician extenders, APPs manage new patient consults and introduce patients to the breadth and depth of fertility. They also help perform diagnostic workups with ultrasounds and radiology and monitor patients for lower-acuity fertility treatments like ovulation induction and insemination.

A recent patient survey by Inception Fertility found that over 80% of people considering fertility services across the US stated they were willing to see an APP if it would mean they were seen sooner. 

“Fertility practices can integrate APPs in meaningful ways that support both patients and physicians, increase fertility center efficiency and productivity, and ultimately enhance patient care,” Dr. Jamie Grifo, Chief Executive Physician at Inception Fertility and the Program Director at NYU Langone Fertility Center told Inside Reproductive Health. 


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How These Fertility Centers Are Effectively Using APPs

NPs and PAs improve quality of care for patients, quality of life for physicians

This News Digest Story is paid featured content. The advertiser has had editorial input and control over its creation. However, the views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by Inside Reproductive Health.

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BY NATASHA SPENCER-JOLLIFFE

Advanced Practice Providers (APPs) can be effectively integrated into fertility clinic teams to enhance patient care. “APPs are often used as physician extenders in the fertility space,” Dr. Courtney Failor, Medical Director of Aspire Fertility, told Inside Reproductive Health. 

Formerly called physician extenders, APPs manage new patient consults and introduce patients to the breadth and depth of fertility. They also help perform diagnostic workups with ultrasounds and radiology and monitor patients for lower-acuity fertility treatments like ovulation induction and insemination.

A recent patient survey by Inception Fertility found that over 80% of people considering fertility services across the US stated they were willing to see an APP if it would mean they were seen sooner. 

“Fertility practices can integrate APPs in meaningful ways that support both patients and physicians, increase fertility center efficiency and productivity, and ultimately enhance patient care,” Dr. Jamie Grifo, Chief Executive Physician at Inception Fertility and the Program Director at NYU Langone Fertility Center told Inside Reproductive Health. 

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Innovative Environment: Work in facilities equipped with the most advanced reproductive technology, enhancing your ability to provide transformative care.

Expansive Network: Be part of the fastest-growing fertility network in North America, spanning over 90 locations, offering flexibility and security for your career growth.

Profound Impact: Contribute to a meaningful mission, having helped bring over 165,000 babies into the world, turning hopeful dreams into joyful realities.

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Take The Next Step

Improving the entire fertility journey

APPs have served as educators and ambassadors to patients during the fertility journey; fertility centers are now leveraging them to drive innovation. “Because many APPs have worked across various specialties, they bring a different perspective to ‘Fertility 101’ conversations, which can be especially helpful to someone who has never spoken to a reproductive specialist before,” says Dr. Grifo. 

Underutilized APPs can result in lengthy new patient consultation timelines or geographical limitations due to challenges opening freestanding fertility clinics. “Access to care is a barrier that patients across the country face,” says Dr. Failor. Clinics can use APPs as an extender to these locations and improve access for more patients. “APPs can be ideal bridges into the often-overwhelming world of assisted reproduction,” says Dr. Grifo. The team also sees them as skilled providers who augment physician capacity. 

APPs play a crucial role at satellite offices as leaders who can effectively expand a practice’s geographic footprint without the investment required to establish a new full-service clinic. Fertility clinics also use APPs to lead niche teams. “Many clinics have found specialty programs—such as third-party reproduction, including Donor Egg and Gestational Carrier services—to be game-changers for their practices and patients,” Dr. Grifo shares.  

Wellbeing success and staff retention

A 2022 APP wellness survey conducted at Stanford Health Care broadly indicated that APPs with higher levels of professional fulfilment and self-compassion were less likely to experience burnout and, ultimately, leave the organization.  

“Stanford’s initiatives closely align with the best practices identified at our own clinics,” says Dr. Grifo. Inception Fertility’s patient experience steering committee has found a highly effective way to maintain efficient, compassionate, and safe patient care is to care for its employees. It focuses on opportunities for professional development, role clarity, and the ability to practice at the “top of licensure”. 

Clinics implementing and optimizing APP models have reported significant improvements in key performance indicators. “Having an APP can reduce the number of patients that need to be screened for an initial evaluation and ensure that all diagnostic testing is done and up-to-date prior to meeting with a physician,” says Dr. Failor. 

At Aspire Austin, adding a nurse practitioner to their two-doctor practice has enabled them to see more patients and grow their revenue within the first year. Patients don’t have to wait three months to get in the door, but they have a treatment plan within six weeks of calling to set up an appointment.

APP-led consults, ultrasounds, IUI cycles, and third-party reproduction programs create space in REI schedules they can use with value. They may spend this extra time facilitating more IVF cycles, consulting with higher-risk patients, and following up with patients who have experienced an adverse outcome or multiple unsuccessful cycles. 

Expanding an invaluable part of patient care

“APPs are already an extremely important part of patient care throughout The Prelude Network,” says Dr. Grifo. Inception Fertility has tested four models for leveraging APPs across its expansive network of 90+ clinics in North America. Its next step will be to roll out all four across all our regions, where applicable, allowing additional growth opportunities for each APP in the network.

“Prelude continues to maximize patient care from both a patient-experience mindset and success-driven outcomes,” says Dr. Failor. “The networking of APPs across the country and specifically across our network of clinics will enhance our ability to share and implement best practices.”

This News Digest Story is paid featured content. The advertiser has had editorial input and control over its creation. However, the views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by Inside Reproductive Health.


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All external links active as of 5/9/2024

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

 
 

Lawsuits Against Ovation Prompted by Physician and Company ‘Whistleblower’

Physicians may later be named in suit, lawyer says

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

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BY RON SHINKMAN

A referring fertility physician and an employee are what led Ovation Fertility in part to face four separate lawsuits alleging it negligently killed embryos by exposing them to hydrogen peroxide.

According to one lawsuit, Terence Lee, M.D., an Ovation referring physician who is medical director of Fertility Care of Orange County, notified his patients that his recent patients suddenly had a zero IVF success rate. Lee and other physicians who work with Ovation pressed the company to conduct an investigation, according to the lawsuit. Although Lee is mentioned in the lawsuit, he is neither a plaintiff nor defendant in the case.

The lawsuits were filed in Orange County, Calif. Superior Court in late April. Seventeen different plaintiffs – most of whom are only referred to by their initials – accused Ovation’s laboratory in Newport Beach, Calif. of “killing” their embryos last January by exposing them to hydrogen peroxide during the thawing process and then failing to tell them about it.


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Also named in the lawsuits were FPG Services, LLC, FPG Labs LLC and Newport Beach IVF, LLC. Corporate records indicate they are all Ovation subsidiaries. The lawsuits state they all do business under the Ovation name.

Lee is one of 39 doctors listed as “partner physicians” on Ovation’s website.

An Ovation spokesperson did not respond to requests for comment on Ovation’s corporate structure.

According to Robert Marcereau, a Dana Point, Calif.-based attorney representing eight of the plaintiffs, Ovation’s physicians are either given an ownership interest in Ovation, or are paid financial incentives to make referrals to its laboratories.

No physicians are currently named as defendants in the lawsuits, but that may change, according to Marcereau.

“Were these doctors being forthright with their patients once they learned of what happened?” he asked. “Because a lot of these doctors were very slow to provide information to their patients and were not in my opinion forthcoming. That's something that's going to have to be explored.”

Marcereau said his firm was contacted by an Ovation employee at the Newport Beach lab. That employee made allegations of poor work being performed by embryologists, which was attributed in part to lax training provided by Ovation. Similar allegations were made in another of the four lawsuits.

Although Marcereau declined to name the whistleblower, the suit his firm filed mentioned an Ovation embryologist by name. It referred to her as an “unqualified and inexperienced employee” whose errors – along with others allegedly committed by Ovation staff – regularly killed embryos.

Ovation’s official statement on the incident appears to confirm at least a portion of Marcereau’s allegations. “This was an isolated incident related to an unintended laboratory technician error that impacted a very small number of patients,” Ovation said. “As soon as we recognized that pregnancy numbers were lower than our usually high success rates, we immediately initiated an investigation.”

However, Ovation did deny one of the primary accusations in the lawsuits: That embryos were implanted in patients even after the company was aware they were non-viable.

“We have been in close contact with these few impacted patients since the issue was discovered,” Ovation’s statement concluded. “We are grateful for the opportunity to help patients build a family and will continue to implement and enforce rigorous protocols to safeguard that process.”

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


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

 
 

Under-utilization of fertility benefits negatively impacts patients and practices

One fertility savings program proves a useful tool for patients and practices.

This News Digest Story is paid featured content. The advertiser has had editorial input and control over its creation. However, the views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by Inside Reproductive Health.

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BY NATASHA SPENCER-JOLLIFFE

Reproductive Medicine Associates of New York (RMANY) has had to counsel their fair share of patients who have exhausted their fertility benefits. 

“Patients may not be fully educated on the medical criteria of their fertility benefits, which plays a vital role,” said Romain Singramdoo, Finance Manager at RMANY.

In “cases where implantation needs to occur within a certain time frame, the patient was not fully educated, and did the implantation past the allowed time,” Singramdoo said. In this instance, the finance coordinator informed the patient that their Global Health Insurance (GHI) policy mandated her to have her frozen embryo transfer (FET) cycle within 60 days of the retrieval. “When the implantation happened past the allowed time, the implantation cycle counted as ‘another try’,” Singramdoo added. 

Patients may see a total dollar amount ‘covered’ and want to use the entirety of that coverage as soon as possible to afford fertility treatment without understanding their potential treatment path. “They may need more than one cycle to achieve their goal, based on their individual circumstance”, Amanda Travis, Director of Brand Marketing, US Fertility at EMD Serono, said. “Or that the medication part of the treatment costs may be extracted and paid out of pocket”.


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Often, patients meet with the appropriate staff member at the fertility clinic to ask the important questions: How much will this cost me, and how much will my insurance pay? Typically, at this point, patients have “a minimal understanding of how their ‘coverage’ can be best and most efficiently leveraged”, Travis shared. 

By the very nature of fertility treatment, patients experience a range of emotions, not to mention challenges, one of which is the affordability of expensive fertility treatment programs. “Couple these complexities with what a patient seeking infertility treatment may be feeling at the point in time when they’re exploring costs; they are overwhelmed and feeling ‘challenged’ from the start,” Travis said. 

The underutilization or misutilization of fertility benefits is devastating for patients, who have to pay the extra costs out of pocket. 

But forward-thinking fertility centers like RMANY have also found ways to help patients maximize their fertility benefits efficiently. Whether they “had a specific dollar amount of $25,000 to utilize for IVF”, or other stipulations and amounts, Singramdoo said. 

Benefit challenges impact fertility centers and patients

“Insurance and coverage are foundationally complex, regardless of how and where a patient is accessing it,” Amanda Travis, Director of Brand Marketing, US Fertility at EMD Serono, said. 

Confusion over how to optimize benefits can also impact patients’ fertility treatments and entitlements. “Patients may be paying more than they should be to achieve the outcome they are looking for,” Travis shared. “They may miss the chance to apply for a manufacturer or pharmacy savings program for their medications if they choose to entirely pay through their insurance coverage or plan,” Travis added.

Limited knowledge of fertility benefits can also impact the patient’s fertility center. “Frustration could lead to bad reviews for the finance team for not giving clarity, or patients may begin to lose trust in the practice,” said Singramdoo. Financial counselors and patient navigators face several hurdles when allocating benefit coverage. “Insurance reps tend to be very vague and inconsistent when explaining benefits, leaving the practice to relay information that may be incorrect,” Singramdoo detailed. 

How fertility centers can help their patients get the most from their benefits

Fertility clinics can help their patients properly navigate, optimize, and advise their patients. “Insurance coverage is a good starting point for the financial conversations, but prepare a process and questions to best educate and set the patient up for success,” said Libby Horne, Senior Vice President of US Fertility & Endocrinology at EMD Serono.

Bespoke fertility benefit packages are available to clinics. In today's fertility sector, it's recommended that clinics implement a process that builds in personalization and doesn’t treat all patients with ‘coverage’ the same.

Expanding supply chains to involve pharmacies in patients’ fertility treatment plans can optimize operations for facilities. “If the clinic doesn’t have the process or personnel to do this effectively with every patient, outsourcing to their pharmacy may be an effective idea,” Horne said. 

Three-way calls with patients, insurance providers, and fertility practices help clarify benefits. “Asking the patient to get their written certificate of coverage or provide us with a concierge number for their benefits can also assist in clarifying benefits,” Singramdoo noted.

EMD Serono’s savings program saves eligible fertility patients an average of $1,700

EMD Serono encourages all eligible patients to apply to see their potential savings and confer with their EMD Serono network pharmacy if they do not immediately qualify to see if there is potential for other savings.

The biopharmaceutical company hosts a Fertility LifeLines Resource Hub featuring program descriptions, patient materials, program logos, and patient-facing instructional videos for clinics to educate patients on Fertility LifeLines. 

Fertility LifeLines is a program for eligible patients who will be paying out-of-pocket for EMD Serono fertility medications. EMD Serono offers a Compassionate Care program to support certain eligible patients’ access to affordable fertility treatment. 

On average, eligible patients save over $1,700 on EMD Serono Fertility medication, but some may save more. The savings patients can expect to make are based on several factors, including financial need, number of dependents, and military status.

This News Digest Story is paid featured content. The advertiser has had editorial input and control over its creation. However, the views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by Inside Reproductive Health.


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All external links active as of 4/25/2024

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

 
 

Doors Shut: Nashville IVF Clinic Closes Without Notice to Patients

Staff walked out, and now patients want answers. 

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

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BY: ROSEMARY SCOTT

Patients of the Nashville Center for Reproductive Health were left with more questions than answers when the clinic suddenly closed during the first week of April with little explanation. 

An anonymous clinic staff member told Nashville’s Channel News 5 that on April 4, clinic staff staged a walkout after receiving letter over email from administration that stated their paychecks would be late. The letter cited “unforeseen financial circumstances” and told staff their checks would be paid “as quickly as possible” once the money is available.

Since then, patients have struggled to get in contact with clinic owner and director Dr. Jaime Vasquez, despite some patients having paid in advance for treatments. Other patients also have sensitive information like medical records, and in some cases, embryos, stored at the facility. 

Patients Left in Limbo 

It is unclear whether the facility will reopen. Some patients, like April Moore of Murfreesboro, TN, arrived at their appointments over the last week to find the doors locked with no staff inside to answer their calls. 

Moore told Inside Reproductive Health she stood outside the clinic on Thurs., April 11 with several other patients who were there either for appointments or to follow up on unreturned calls. 

The next day, Moore said her husband received a call from Vasquez informing him his wife’s procedure scheduled for later that day would be canceled. After being informed that the procedure had actually been scheduled for the day before, Vasquez hung up the phone, Moore said.

Moore said she will likely return to her previous provider, Kindbody, despite having to make the trip from Murfreesboro to Atlanta. 

“At 40, time is not in my favor, and this [has] wasted more time,” Moore said. “Now, I have to start back over from the beginning, because I don’t even have the test results I need to move forward again.” 

The Nashville Center for Reproductive health has made no mention of the office closure on its social media and has responded to negative reviews on its business pages with canned responses that don’t address any particular situation. The center has continued to post on its Facebook page as normal, and many patients have commented on the company’s most recent post for World Health Awareness Month on April 8 asking for answers.

This led to patients using the comment section to help one another by suggesting other doctors with openings and linking to Support for families of CRH, a Facebook group formed for those affected by the clinic’s closure to connect with one another. 

Rumors of Bankruptcy

Kristyn Rogers-Escudero of Clarkesville, TN started fertility treatments at the Center for Reproductive Health in February. She told Inside Reproductive Health that it took over a month of back-and-forth to schedule her next appointment, and clinic staff blamed the lack of availability on updates to the facility.  

On Monday, April 8, Rogers-Escudero received a text from the center canceling her appointment for the next day. After calling and emailing the facility with no response, she stopped by the center on Tuesday while she was in the area for work. Rogers-Escudero stated that she is familiar with property improvement in her line of work as a commercial property manager, and she did not see any signs of construction or improvements being made to the facility. 

The door was unlocked, but no staff answered Rogers-Escudero when she called and rang the desk bell for help. 

As Rogers-Escudero continued through the building, Vasquez came out of his office to speak with her. The day before, Channel News 5 reported news of the closure, including a patient who stated they heard the center’s receptionist say the clinic was bankrupt. Vasquez dismissed these claims to Rogers-Ecudero, calling them “rumors” and emphasizing that once staff returned, all would be well. 

“He said, ‘We are not broke. Everything is fine here…We just need to get people back in the office so they can answer the phone,” Rogers-Ecudero said.

When she asked Vasquez if she could have a copy of her medical records before she left to take to her new provider, he directed her to the secretary. When Rogers-Ecudero pointed out there were no other employees in the building, Vasquez told her he couldn’t provide the records and asked her to leave. 

No bankruptcy filings for The Center for Reproductive Health were found as of this writing. 

How did this happen? 

There are myriad reasons a fertility clinic could close its doors, Robert Goodman, VP Healthcare, MidCap Advisors, told Inside Reproductive Health. He stated reasons for closing could be financial, like poor financial management, an excess of debt or a slowdown post-COVID.

“Why would a practice close this abruptly?... I think it certainly can be poor management in terms of their finances. They could be over leveraged with too much debt…or maybe they overpriced themselves,” Goodman said. 

Goodman stated the abrupt nature of the closure is uncommon in the field, even due to financial reasons, and it could also be a result of embezzlement or theft by someone at the center. 

“Is this typical? The answer is no, no it isn’t…unless there's some big bombshell [that you haven’t uncovered yet].” 

Goodman stated that the closure could also be due to declining market share caused by competition in the area. 

According to the most recent CDC data, the clinic has at least one major competitor in the city. In 2021, the Nashville Center for Reproductive Health logged 187 total cycles, according to CDC data. Nashville Fertility Center, the only other Nashville clinic the CDC listed in 2021, logged 1375 total cycles, resulting in 374 total infants born. 

Regardless of the cause, the negative effects of the clinic’s closure have spread beyond the center’s walls and into the lives of patients. 

“I'm thankful that I wasn’t super far along in my fertility journey with [the Center for Reproductive Health], but I do feel very sad for the other couples that are having to deal with this…I just hope they get justice,” Rogers-Escudero said. 

The Center for Reproductive Health did not respond to Inside Reproductive Health’s request for comment.

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


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

Kindbody Shakes Up C-Suite with Six New Hires

Who they are, where they came from, and what’s next for the New-York based company

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

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BY: ROSEMARY SCOTT

New York-based end-to-end fertility network Kindbody has undergone shifts in its leadership and financial landscape over the last year. On March 19, the company announced the appointment of six new executives onto its leadership team in an effort to support what the company called its “next stage of growth.” 

In the same press release, the company also announced expansion plans that include opening clinics in four cities: Charlotte, NC, Miami, FL, Newport Beach, CA and San Diego, CA. 

Of the new appointments, three were hired for previously existing roles, while the other three will be the first to hold their respective titles. Here’s the details on each new player, including who they’re replacing and how they fit in Kindbody’s strategy. 

New People in Existing Roles

Scott Bruckner, Chief Financial Officer (CFO)

Bruckner was able to get a head start on his role compared to the other new hires, as he left his role as CFO of Fluid Truck, a technology-based sharing platform, to start at Kindbody in June 2023. The role of CFO has been vacant since Debbie Markowitz, former Kindbody CFO, left the role in November 2020 after a little under two years at the company. Markowitz is now CFO at Spring Health.

Haleigh Tebben, Chief Revenue Officer (CRO) 

Tebben most recently served as Chief Commercial Officer at Brightline after leaving her role as CRO at Collective Health. Tebben is replacing Taryn Branca, former Kindbody CRO, who left the company in February and is now Chief Commercial Officer at Airvet, an employee benefit service for pets.

Jason Barritt, Chief Scientific Officer (CSO)

The appointment of a new CSO may seem like déjà vu, as it comes only a few months after Kindbody announced Alison Bartolucci, Ph.D., HCLD, had been hired for the position. However, Kindbody Spokesperson Margaret Ryan told Inside Reproductive Health that Bartolucci accepted a promotion from her employer, First Fertility, instead of taking on the role at Kindbody. 

For his part, Barritt brings relevant experience to the role, as he served over 10 years as CDO and Lab Director at Southern California Reproductive Center in Beverly Hills, CA.

Dr. Angie Beltsos’s title had been CEO, Clinical, and is now Chief Executive Physician (CEP). Kindbody explained to Inside Reproductive Health how Dr. Beltsos’ role interfaces with other medical leadership roles in the company. She leads clinical strategy across Kindbody national fertility clinic network. Dr. Beltsos is responsible for establishing and implementing superior clinical standards and patient care at Kindbody clinics to yield exceptional outcomes and high, patient satisfaction levels. As CEP, Dr. Beltsos provides strategic leadership to the Chief Medical Officers to ensure the execution of consistent clinical care and safety. Kindbody’s four Chief Medical Officers cover the following:

Dr. Lynn Westphal, Chief Medical Officer, Lead CMO, Medicine + Research

Dr. Amber Cooper, CMO, Genomics + Lab Operations

Dr. Roohi Jeelani, Chief Growth Officer

Dr. Kristin Bendikson, CMO, Clinical Development”

Newly-Created Roles

Gina Bruzzichesi, Chief Operating Officer (COO)

Bruzzichesi has a background in human resources and previously served as COO at Aspen Dental Management. Prior to that role, she held positions at CLEAR, WeWork and Avis. In her early career, Bruzzichesi worked as an employment attorney. 

Tim Springer, Chief Compliance Officer (CCO)

Prior to his role at Kindbody, Springer oversaw healthcare ethics and compliance programs at One Medical. Before that role, he ran financial services global anti-fraud programs at MetLife and John Hancock.

Matt Slepian, Chief Accounting Officer (CAO)

Though Slepian’s role as Chief Accounting Officer (CAO) sounds similar to the CFO role filled by Bruckner, Ryan told Inside Reproductive Health that Slepian’s role is “focused specifically on managing the company’s accounting functions, including audits, compliance and accounts receivable and payable.” 

In contrast, Bruckner “oversees the company’s financial strategy and operations and plays a critical role in scaling the finance, accounting, and revenue cycle management teams to support the [c]ompany’s rapid growth,” Ryan stated. Slepian brings over 25 years of finance experience to Kindbody, and most recently served as CAO at Casa Systems. 

What Happens Next

These new appointments are the latest in a series of changes Kindbody has made to its leadership team. 

In September, Kindbody president Gregory Poulos stepped down from his role and now works as a strategic advisor for the company. No replacement for this position has been announced. Two months later, Bloomberg reported that Kindbody is paying a search firm $750,000 to replace CEO Annbeth Eschbach, citing sources familiar with the matter.

Kindbody Spokesperson Margaret Ryan confirmed Eschbach will be leaving the company in a statement to Inside Reproductive Health.

“Annbeth and the Board have been working together to develop a succession plan which ensures that Kindbody remains responsive to its employees, patients and all stakeholders.”

Kate Krejci, current Vice President of Operations at The Fertility Partners, left her role as GVP, Growth Operations at Kindbody in October after working at the company for about two years. Prior to her role at Kindbody, she was Vice President of Operations at Vios, which Kindbody acquired in 2022. 

Krejci told Inside Reproductive Health that when she left, Kindbody was still trying to clearly define the responsibilities of each team following the acquisition. Krejci said she’s hopeful the new additions to the leadership team will help make expectations and strategy for each team more clear.

“I think there needed to be more guidance and expertise making those decisions and driving that change,” Krejci said. “I'm hopeful that it's the right direction for the organization to really bring expertise at a high level to drive each of those departments independently.” 

Though Krejci left before many of the new hires started their roles, she did spend time working with Scott Bruckner, CFO, and called him a “really good fit” for the role. 

Kindbody told Inside Reproductive Health it hopes these new players will help the company reach its goals of continued growth. 

“The expansion of our leadership team ensures we have the right leadership and dedicated resources in place to continue our focus on excellent patient experience and delivering successful outcomes for every patient and employer we serve,” Kindbody stated.

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


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

UK Government Halts IVF at Clinic After Loss of Embryos

The Homerton Fertility Centre reported three incidents in seven months last year that led to the loss of embryos.

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

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BY RON SHINKMAN

A reproductive medicine practice in London had its license suspended by the United Kingdom’s top fertility regulator after three incidents in recent months where embryos were mishandled, authorities said.

The Homerton Fertility Centre had its license suspended by the United Kingdom’s Human Fertilisation & Embryology Authority on March 8. The suspension will remain in effect until at least May 8 while the clinic fixes issues cited by the regulator, according to a letter issued by the clinic’s parent organization, Homerton Healthcare.

“The HFEA License Committee made this decision because of the potential risk to patients, gametes and embryos if the clinic’s license is not suspended with immediate effect,” said HFEA Chief Executive Officer Peter Thompson in a statement.

The terms of the suspension did allow the clinic to continue to treat patients who were in the middle of IVF cycles, Homerton CEO Louise Ashley said in a letter to patients.

Homerton Healthcare is a regional healthcare provider affiliated with Britain’s National Health Service. It provides medical services in the Hackney and City of London neighborhoods in northeast London. Its fertility clinic has been licensed to operate since 1995.

According to Simon Lumsdon, who operates a consulting firm in the U.K. called Lighthouse Fertility, such suspensions of clinics are rare.

“It really doesn’t happen very often,” he said, adding that the U.K.’s regulation of fertility clinics is among the most robust in the world. “You have to have quite high standards just to be operating."

Shaun Rogers, a clinical scientist who has worked and consulted for numerous IVF laboratories in the United Kingdom, observed that fewer than five U.K. fertility clinics have had their licenses suspended or revoked in the 30 years he’s been in the business.

According to minutes of the March 7 HFEA License Committee meeting, the suspension was in the wake of three incidents at the clinic that took place last year that were reported to the regulator under NHS rules. The first incident occurred in May 2023 and involved not following the correct procedure for storing frozen embryos. The second incident, which took place in October, some frozen and stored embryos “displayed a lower rate of embryo thawing survival rate,” according to the minutes. The third incident, which took place in December, involved embryos missing from a cryogenic straw after the thawing process.

Additional details about the incidents were not available. The HFEA declined to comment beyond what is already in the public record, while a spokesperson for Homerton Healthcare did not respond to a request seeking comment. Ashley said in her letter to clinic patients that in each case other embryos were located and that the IVF cycles were completed

These incidents were not the first indication that Homerton Fertility’s operations were troubled. According to minutes from an HFEA License Committee meeting from May of last year, Homerton Fertility “has had a poor history of compliance in recent years and has been subject to considerable regulatory scrutiny.”  

An April 2021 inspection for the renewal of the clinic’s license turned up issues. That inspection “identified two critical areas of non-compliance relating to swab counts performed during surgical procedures and the reporting of adverse incidents and near misses.” A followup inspection in March 2022 indicated that some improvements had been made but that the HFEA was “made aware of several whistleblowing communications from various sources. The concerns raised included leadership, working conditions, the welfare of patients and staff, training, policies and procedures, decision-making, non-reporting of incidents, and information to be provided to patients.” The agency also noted that the center was short-staffed in comparison to the volume of procedures it performed.

Nevertheless, the HFEA License Committee agreed to renew Homerton’s license for three years with an interim inspection to take place one year after the approval was granted.

Lumsdon observed that these events along with the more recent mishaps is what led to the suspension.

“You have to almost repeatedly push and push and push to get to this point where your license is (suspended),” he said.

In response to the suspension, the clinic said in two separate letters to patients that all of its staffers now work in pairs; all of the licenses and competencies of the staff have been vetted and verified, and that the fertility clinic’s security had been improved.

Lumsdon believes the issues at Homerton partly reflect austere funding of the NHS over the past decade-and-a-half. Fifteen years ago, funding for Britain’s single-payer system routinely rose 5.5% per year. It’s been trending about half of that in recent years

Lumsdon did add that some NHS-operated fertility centers are able to overcome the wage disparity through their affiliations with prestigious teaching hospitals.

“Homerton didn’t really have that draw,” he said.

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


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ISO Certification Still Elludes Fertility Clinics, IVF Labs

Boston IVF may be only fertility center with ISO certification

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BY MALLIKA MITRA

There’s a certification and set of guidelines for maintaining and aligning standards that is common in many industries — but not in the fertility space. One fertility network that has had the International Organization for Standardization (ISO) certification since 2003, however, says it has been hugely beneficial to its organization and that other clinics could find it helpful as well. 

What is ISO? 

ISO is a non-governmental international organization made up of 170 national standard bodies that each represent ISO in their country. The organization — which was founded in 1947 and is headquartered in Geneva, Switzerland — brings together experts to develop standards that can be applied to various industries. ISO itself does not certify organizations; instead, external certification bodies use the ISO standards to certify organizations.

While ISO certifications are popular in many industries, the certification is rare in the fertility space, which has its own standard certification and accreditation.  

ISO is different from accreditation from the College of American Pathologist (CAP) or Joint Commission — standards that are common for fertility clinics in the U.S. — as it focuses more on individual processes and safety such as documents control protocols and processes, said Dr. Steven Katz, CEO of REI Protect. While CAP assesses an organization’s competency to meet specific standards of care, the ISO is more specific in terms of how the laboratory personnel handle tasks and processes. 

The only ISO certified fertility center that could be confirmed by Inside Reproductive Health

Boston IVF became ISO-certified in 2003, said Michael Alper, founding partner of Boston IVF. 

“When an organization gets larger, you have to make a special effort to keep things organized,” Alper said. “[ISO] really helps you get control over things, especially documents.” 

Years ago, Alper asked his staff to send him every document bearing the Boston IVF name. He received thousands, many of which were older and outdated consent forms and brochures. The clinic’s documents were not organized — but Alper says ISO has helped Boston IVF implement guidelines for document control. Alper said the standards also require internal audit.

Every role has a clear job description with detailed workflows, which has “made us a better organization and much more transparent,” Alper said. Protocols, such as the process for transferring frozen embryos, are documented. 

To the best of his knowledge, Boston IVF is the sole ISO-certified IVF clinic in the U.S. even as more hospitals become ISO certified, Alper said. Because ISO certification is carried out by various national and international certification bodies, they could not confirm this.


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Why ISO certification isn’t more common in IVF labs 

Because there is a large focus on outcome in the fertility industry — including how many eggs are fertilized and how many people get pregnant — there also needs to be a focus on safety measurements, equipment and documentation, said Dr C. Brent Barrett, chief lab director at Boston IVF. 

“One of the really critical things that ISO continues to do for us is align everyone,” Barrett said. Barret, who inspects IVF labs, said he’s found that labs can be very siloed: the nurses are often separated from the administration workers, who are separated from the physicians. Document control, standardized by ISO, has everyone on the same page, he said.

ISO has also required Boston IVF to put a strict protocol in place to deal with errors, Barret said. 

Katz said fertility clinics may not have a clear understanding of the difference between ISO standards and those of the common certifications and accreditations in the fertility space. 

“For IVF labs around the country, I think they’re having trouble delineating between the ISO certification and the CAP or Joint Commission accreditation,” Katz said. IVF labs may view the certification and accreditation as duplicates, and therefore not consider ISO certification, he added.

“In order for labs to spend time, energy, money, capital resources, to get ISO certified, they really have to understand what it is and how it’s differentiated from CAP or the Joint Commission accreditation,” Katz said. 

ISO’s impact on the desirability of IVF labs in the marketplace 

Boston IVF has changed hands three times since 2019. In late 2023, reproductive medicine group IVI RMA announced it was acquiring the North American operations of Eugin Group, including the Boston IVF fertility network. Before that, the network was owned by European private healthcare provider Fresenius Helios, which bought Eugin Group in 2020. Prior to that, NMC Health plc acquired a majority stake in Boston IVF in 2019.

Alper says that while buyers are not necessarily looking at Boston IVF’s ISO certification when determining its desirability, the culture that the standard has brought to the clinic — such as the  transparency of the clinic, the team-approach to results and the focus on customer satisfaction — has helped establish the clinic’s strong position in the industry.

“Our position in the industry is partly related to that philosophy,” he added.

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


 
 

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Invitae Sells $10M in Assets to Natera, But Can’t Shrink $1B Debt Before Ch. 11 Bankruptcy

The company will auction off the rest of its assets under court’s supervision.

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BY Rosemary Scott

On Feb. 13, genetic testing company Invitae Corporation announced it had filed for Chapter 11 bankruptcy protection in New Jersey. 

At the time of the filing, the company had assets worth $500 million to $1 billion and debts of $1 billion to $10 billion. Invitae stated in the filing it plans to auction its assets under the court’s supervision.

On Jan. 22, Invitae announced it had sold its reproductive health assets, which include carrier screening and non-invasive prenatal screening, to genetic testing company Natera for $10 million upfront and up to $42.5 million in milestone payments and litigation credits. Weeks later, on Feb. 5, the Wall Street Journal reported Invitae would likely file for bankruptcy soon, citing anonymous sources familiar with the matter. 

The same day the WSJ article was published, Invitae’s stock dropped over 75% to about $0.10 per share. 

From the time of its launch, Invitae’s stock remained steady for years, hitting a high of about $55 per share in December 2020. Ever since, the stock has been on the decline, trading for less than $1.00 a share since August 2023. This prompted a warning from the New York Stock Exchange in September that the company may soon be removed from the exchange. 

Invitae offered its line of genetic carrier screening tests in the following areas: oncology, women's health, pediatric & rare diseases, cardiology and neurology. According to Invitae’s Q3 2023 earnings report, the company served 4.4 million patients over the quarter, with oncology generating the most revenue ($62 million), followed by women’s health ($27 million). 

Was Invitae’s Business Model Too Good to be True?

Launched in 2018, Invitae stated the tests provide “affordable, accessible information on genetic changes that pose a risk for parents of having a child with an inherited genetic disorder.” 

David Sher, founder and CEO of global fertility agency Elite IVF, told Inside Reproductive Health that Invitae’s average test price was about $200, versus about $1000 per test from some competitors.

As a former customer of Invitae, Sher was disappointed to hear of Invitae’s bankruptcy filing. Sher said the company’s low price allowed genetic testing to be more accessible for his patients. Now that the company is no more, Sher believes the rise in cost could keep many of his patients from being able to afford the service. 

“Invitae changed the way the world looks at testing,” Sher said. “Testing became more standardized as a result of its accessibility, and I wonder what’s going to happen now.” 

The business model and price point drove millions in annual sales for Invitae–in its 2022 full year financial report, the company reported $516 million in revenue, a 12% increase from the year prior. Still, the revenue couldn’t keep up with the money Invitae was spending. Despite a restructuring effort put in place by a new CEO that included laying off over 1,000 employees in July 2022, it lost over $654.4 million between Q3 of 2022 and the year before due to its total expenses of $1.3 billion. 

Additionally, with more than $1 billion of debt, interest payments may have been too high to maintain, and a loan would likely share a similarly high interest rate, given the company’s income to debt ratio at the time of the filing.

“As a customer of theirs, I was astonished by their excellent offering and their service–it was amazing,” Sher said. “I thought it was almost too good to be true, and unfortunately, it seems like it was.”

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


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Thousands of IVF Payments Frozen After Change Healthcare Cyber Attack

Other clearinghouses, cash-pay patients, insulate reproductive medicine sector from severe financial crunch.

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

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BY RON SHINKMAN

A ransomware breach of one of the nation’s largest clearinghouses for health insurance claims has likely caused some consternation to reproductive medicine practices, an expert familiar with the situation says.

The breach of Change Healthcare – a subsidiary of UnitedHealth Group, the nation’s largest medical insurer – occurred in late February. Change reportedly paid a $22 million ransom in bitcoin to regain control of its data and networks, but the company said it will not be able to start processing healthcare claims against until at least March 18. Change handles about 15 billion healthcare transactions a year, according to the U.S. Department of Health and Human Services.

“The hack affected not only (our customers), but the entire healthcare industry,” said Nimesh Shah, chief executive officer of eIVF, which provides services to about 140 fertility practices, although not all of them use its billing service. The company relies on Change Healthcare to process and pay claims to its clients. Shah said about 30 to 40% of the claims its processes for clinics are billable to insurance companies, and the company typically handles “thousands” of such claims each day.

The issue has become so serious that last Sunday, Health and Human Services (HHS) issued a letter urging UnitedHealth to “take responsibility to ensure no provider is compromised by their cash flow challenges stemming from this cyberattack” and “ensure expedited delivery of funds to impacted providers.” 

How the breach is impacting individual reproductive medicine clinics and their networks remains unclear. Executives and spokespersons with some of the largest fertility clinics in the U.S. – including Boston IVF, Shady Grove, the Prelude Network, Progyny and the University of California at San Francisco Center for Reproductive Health – have either declined to comment or did not immediately respond to requests seeking comment.

Taylor Stein, co-CEO of EngagedMD, which provides support services to clinics but does not handle their claims, suggested that fertility centers’ finances may not be as crimped as other medical practices, because of the number of self-pay IVF patients.

“Unless they’re operating in states (with mandated insurance coverage for IVF), most clinics have a lot of cash coming in the door,” Stein said.

Workarounds through other clearing houses

Meanwhile, other clearinghouses have been offering workarounds to providers who contract with Change Healthcare. Availity, another claims clearinghouse, is offering to process claims for Change clients, Shah said.

“Once a clinic registers with Availity and creates a relationship, we’re automating that into our (electronic medical records) or billing solution, so that they can do things in an automated fashion as opposed to a manual process (for submitting claims),” Shah said. He added that about half of eIVF’s clients – fewer than 100 in total – have signed onto the program, which is known as Availity Lifeline.

According to Availity spokesperson Matt Schlossberg, the company has "provided free digital connectivity to more than 300,000 providers—and that number continues to grow,” Schlossberg said in an email, adding that about $5 billion worth of claims had been processed through the program as of early this week. He was unable to immediately provide a breakdown on the number of reproductive medicine providers participating in the program.

Remaining concerns

Although Shah observed that his company wants “to create choice whenever possible,” he would not say directly whether eIVF would seek another clearinghouse for its clients.

“When this happens, nobody is claiming victory,” he said. "If you’re Availity or (other clearinghouses), you are not excited by what just happened. Probably their number one reaction is ‘thank God that wasn’t us.’”

However, the likelihood of clearinghouses and other players in the healthcare industry dodging such breaches appears to be diminishing, said Stein, whose expertise is in cybersecurity.

“They’re going to keep on happening,” he said. “It’s the new normal.”

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


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Pause and Go: What Alabama’s Four SART-affiliated Fertility Centers Are Doing Now

The pause, the unpause, and remaining challenges 

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

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BY: RON SHINKMAN

The decision from the Alabama Supreme Court giving a just-fertilized ovum the same legal rights as children has upended the IVF business in that state, with at least three of its SART-affiliated fertility clinics pausing such procedures and patients taking their embryos elsewhere.

Alabama’s highest court reversed the prohibition on seeking wrongful death damages late last month, concluding that a human life begins at fertilization. It also concluded that it was up to the state Legislature to make any accommodations regarding that issue.

The decision puts many IVF clinics in a bind because the damages awarded in a wrongful death lawsuit can be much higher than for a breach-of-contract claim, as the latter only focuses on placing a dollar value on the services provided by the clinics and whether they made an earnest attempt to deliver IVF services as promised. Wrongful death litigation focuses more on emotional losses suffered by parents and other family members and could also include punitive damages – additional financial penalties for negligent or deliberate acts.

The state Supreme Court ruling could also lead to criminal prosecutions of clinics that destroyed embryos, although Alabama’s Attorney General promised that would not occur in connection with delivery of IVF services.

Alabama’s four SART-affiliated IVF centers, and what they’re doing

The decision immediately created ripple waves throughout Alabama’s reproductive medicine community, with most pausing procedures. Alabama Fertility Specialists, the University of Alabama at Birmingham health system and the Center for Reproductive Medicine  have all placed pauses on IVF procedures. They comprise three of the four providers in Alabama affiliated with the Society of Assisted Reproductive Technology. The fourth clinic, New Leaders in Fertility and Endocrinology, did not immediately respond to a query about the status of its IVF services.

“We are finishing out patients who are in stimulation and we are just trying to see what happens this week,” said Kathleen Miller, who is laboratory director for Alabama Fertility Specialists in Birmingham, specifically referring to a bill crafted by Alabama lawmakers that would exempt fertility clinics from liability under the Supreme Court ruling  The clinic previously announced that it is putting on hold any new IVF treatments or cycles.

The University of Alabama at Birmingham – which runs perhaps the biggest IVF program in the state, is also continuing to do some work. “Everything through egg retrieval remains in place,” the provider said in a statement. “Egg fertilization and embryo development is paused.”

A source indicated that the Alabama Center for Reproductive Medicine is continuing to perform IVF procedures, but that could not be independently confirmed. Practice founder Cecil Long, M.D. and practice administrator Emma Williams did not respond to phone and email queries.


 
 

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1. Domar, et al. Barriers and factors associated with significant delays to initial consultation and treatment for infertile patients and partners of infertile patients, RBMO, VOLUME 43, ISSUE 6, 2021


Impact on Non-Clinic Fertility Companies Doing Business in Alabama

Miller noted that the bill currently lacks a safe harbor for ancillary businesses, who she said are apparently balking at sending supplies and equipment to Alabama practices until that issue is addressed by lawmakers.

Meanwhile, there are signs that IVF patients in Alabama are taking steps to move their embryos out of the state. Louis Villalba, chief executive officer for New York City-based TMRW Life Sciences, noted that his company’s offer of one year of free storage to anyone wishing to remove their embryos from Alabama has received a strong response. Typically, the company receives about 50 phone calls a week about moving and storing embryos, Villalba said. That call volume has quadrupled since the offer was made. 

Moreover, moving requests are also coming from other nearby states, such as Texas. “It’s coming from all the Red states if you will, and from the Southeast in particular,” Villalba said.

Inception Fertility, which operates 48 clinics in nine states, also confirmed that IVF patients in Alabama have been moving embryos to its facilities in Tennessee and Georgia, according to an email from Chief Marketing Officer Lindsey Rabaut.

Remaining Challenges for IVF in Alabama

Igor Brusil, a former embryologist who now is an attorney in Texas, noted that while the high court’s decision will cause chaos in the short-term, there are feasible workarounds for IVF clinics in Alabama.

“There are things to be done to reduce the number of embryos that the clinic works with, which reduces the risk of any action” that might inadvertently damage them, said Brusil, who added that he is not involved in the Alabama case.

“Clinics can freeze unfertilized oocytes to reduce the number of oocytes that would be inseminated with sperm. This would result in fewer embryos created, thus reducing the number of embryos that potentially could be cryopreserved,” he added. “Alternatively, clinics may have to change stimulation protocols to decrease the number of oocytes collected.”

However, Brusil added that any changes to how the clinics approach the procedure will come at the expense of patients. “They will certainly suffer because whatever decision is made is not going to be the most effective IVF treatment possible,” he said.

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


Correction: 2/29/24 The Inside Reproductive Health article ASRM, SART, SRBT Withdraw Proposal to Eliminate Doctoral Requirement for Embryology Lab Directors, stated that ELDs are governed by the Clinical Laboratory Improvement Amendments of 1988, better known as CLIA. The CLIA regulations govern andrology and endocrinology laboratories within a fertility clinic.

Regulations suggested by the Centers for Disease Control and Prevention and endorsed by the American Board of Bioanalysis and the American Society for Reproductive Medicine and its affiliates require that an ELD have a medical or osteopathic degree or an earned doctorate degree from an accredited institution in a chemical, physical, or biological science as the major subject. Alternatively, individuals may serve as ELD directors without a medical or doctoral degree if they were certified prior to July 20, 1999.


 
 

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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.