The IVF Landscape
Reflections from 20 years inside the belly of the beast…
Sitting here in San Antonio, TX inside the exhibit hall at the annual American Society for Reproductive Medicine (ASRM) meeting, I can’t help but reflect on my time as an operator within the IVF landscape. It’s amazing to me how much things have changed. For providers, clinics, payers, and employers alike. Not to mention the most important person in the room, the consumer. Whether domestic or international, the landscape for IVF has changed so much and I’m here to tell you about it!
Let’s start with the private equity money that has flowed into our tidy little end of referral spectrum sector. Did you know that KKR poured in $3 billion dollars (that’s right you heard me…) – $3bn into the purchase and acquisition of IVI RMA less than 3 years ago? Making it the single largest acquisition inside the space in its history?! With market multiples for practices nearly reaching 20x!…(Back in my day, it was 5-7x..if the physician owners were lucky..) Exponentially increasing the volume and activity amongst a flood of relatively new management service organizations (MSO’s) inside the fertility landscape. A non-exhaustive list of players including Ivy Fertility, US Fertility, Pinnacle, Inception, CCRM, Kindbody, Prelude Network, & of course IVI RMA the largest international player based in Madrid Spain. BTW, just compare that to the fact that the entire fertility market spend in 2024 was $9.9bn. By 2034, that market is suggested to be close to $20bn. We will talk about factors that lead to this growth later.
Back in the day (early 90’s), it was just IntegraMed! (nasdaq listed INMD)…the only public microcap stock and traded company in the Fertility Space. Our famous tag line inside the Purchase, NY offices was, when we started coming to ASRM we had to meet with physician owners behind fake plants in the exhibit hall to discuss partial liquidity plays!! Look at the MSO space now!!! Let me tell you guys, there isn’t anybody hiding from MSO’s now…..W.O.W. Add to this a bevy of payer networks such as Progyny and Carrot on the employer benefit management companies specifically created for IVF and you’ve got yourself a brand new ecosphere for young OB/GYN’s and REI’s to have to navigate as they start out in creating their own private practices.
Perhaps in the early 2000’s that religious fervor of private practice independence has waxed and waned over time as these once proud Fertility Physicians neared retirement?? Finding ways to create generational wealth for themselves and for their families (who can blame them?!) over-powered their once proud defiance in the winds of private equity and venture capital pressure. But, I think about young RE’s coming out of residency today and its akin to the dentists joining the fray amidst the bevy of dental service organizations out in the dental sector today, making it nearly impossible to post up a shingle on your own and call yourself a viable business. The likes of alphabet soup dental service organizations looks a lot like the IVF landscape now. Who’s the best? How do you even monitor and gauge quality? Beyond word of mouth, how do even tell the difference?
And then throw in the mix of the pharmaceutical providers. Serono, Ferring, Organon and the bevy of new online pharmacies dedicated to women’s healthcare. (Great opportunities reside here btw, especially with advent of agentic AI, there is a ‘close the loop’ situation here but that’s for another time). You think about our IVF space today, pressures of multiples on the newly acquired clinics causing havoc w staffing models. Everyone and their mother claiming a better more engaged and efficient operating model by leveraging OB’s and training up OB’s to basically do everything that a higher priced, higher trained REI would do. Opening up capacity for the RE to perform a larger % of egg retrievals. MSO’s like Pinnacle and Kindbody pushing RE’s to their upper limits of productivity while disturbing the old established staffing models making existing physician teams very nervous about quality and outcomes. No doubt an interesting time to play in this sand box.
Ultimately, as the IVF sectors continues to mature, consolidation will be the name of the game. US Fertility one of the largest MSO’s in the space is up for sale. Rumor has it IVI RMA and the boys at KKR will announce their acquisition of US Fertility within the coming days?! Is this the worst kept secret in town??…You have disruptive technology like Conceivable Life Sciences out of Mexico City promising to automate the Embryology Lab, with lines going into UCSF for testing and validation, how many years before these lines are distributed throughout the US? Trends like introducing women’s longevity within IVF practices and technology stacks promising to bring AI tools to allow for better tracking, and training, & engaging the IVF patient throughout their journey are all what’s coming next…! Exciting times to be sure. Stay tuned!