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How to Develop a Business Plan for a Fertility Clinic: A Step-by-Step Guide

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Welcome to our blog post on How To Write a Business Plan for a Fertility Clinic in 9 Steps: Checklist. Fertility clinics play a vital role in helping individuals and couples achieve their dream of starting a family. According to the latest statistics, the fertility clinic industry in the US has experienced significant growth in recent years, with a market value estimated at $3.5 billion [1][1] [Statista - Fertility Clinic Market Size in the U.S.](https://www.statista.com/statistics/975416/fertility-clinic-market-size-in-the-us/)

Conduct Market Research

Before starting a fertility clinic, it is crucial to gather important market information to determine the feasibility and potential success of your business. Conducting thorough market research will help you understand the demand for fertility services in your target area, identify your target demographic, and analyze the competition.

To begin, study the local population demographics to determine the size and characteristics of your potential patient base. Consider factors such as age, income levels, education, and marital status, as these can influence the demand for fertility services.

Additionally, examine the existing fertility clinics in your area to understand their services, pricing, reputation, and patient volume. This will provide insights into the level of competition you might face and help you identify any gaps or opportunities in the market.

Tips for conducting market research:

• Utilize online resources, industry reports, and statistics to gather comprehensive data about the fertility industry and trends.
• Interview potential patients and seek feedback from healthcare professionals to understand their experiences and needs.
• Visit industry conferences, trade shows, and seminars to network with experts and gain further insights.
• Consider hiring a market research firm to conduct a detailed analysis of the local market.

By conducting thorough market research, you can ensure that your fertility clinic aligns with the needs of your target demographic and stands out from the competition. Gathering key information will also help you make informed decisions throughout the business planning process.

Identify Target Demographic

Identifying the target demographic is a crucial step in developing a successful business plan for a fertility clinic. Understanding the specific group of individuals who are most likely to seek fertility services will allow you to tailor your clinic's offerings and marketing efforts to meet their needs.

When determining your target demographic, consider factors such as age, income level, and geographic location. It may be beneficial to conduct market research and gather data on the demographics of individuals who have previously sought fertility treatments in your area. This information can help you identify trends and better understand the needs and preferences of your potential patients.

Tips for identifying your target demographic:

• Consider collaborating with local research institutions or organizations to gain access to data on fertility treatment-seeking patterns.
• Survey your existing patient base to gather information about their demographic profile and motivations for seeking fertility services.
• Segment your target demographic based on factors such as age, gender, marital status, and medical history to develop tailored marketing strategies.
• Consider hiring a professional market research firm to conduct a comprehensive analysis of your target demographic and provide insights that can guide your business decisions.

By identifying your target demographic, you can ensure that your fertility clinic's services and marketing efforts are directed towards the individuals who are most likely to benefit from and be interested in your offerings. This targeted approach can increase the effectiveness of your business plan and ultimately contribute to the success of your fertility clinic.

Analyze Competition

When starting a fertility clinic, it's crucial to analyze the competition in your local area. Understanding the strengths and weaknesses of your competitors can help you position your fertility clinic in a way that sets you apart and attracts prospective patients.

Start by identifying other fertility clinics or reproductive health centers in your area. Research their services, reputation, and patient satisfaction rates. This information can be gathered through online reviews, testimonials, and speaking with healthcare professionals in the field.

Important: Pay close attention to the specific services and treatments offered by your competitors. This will help you identify any gaps or opportunities in the market that your clinic could fulfill.

Tips for Analyzing Competition:

• Visit competitor websites to understand their branding, messaging, and pricing structure.
• Consider conducting secret shopper visits to experience their customer service and patient care firsthand.
• Take note of their marketing and advertising strategies, including social media presence and content marketing efforts.
• Attend industry conferences or events to network with professionals in the field and gather insights from industry leaders.
• Stay up to date with industry trends and advancements to ensure your clinic remains competitive.

By thoroughly analyzing your competition, you can identify ways to differentiate your fertility clinic and provide services that meet the needs of your target demographic. This knowledge will also guide your marketing and advertising strategy, allowing you to effectively communicate your unique value proposition to potential patients.

Define Services And Treatments Offered

Defining the services and treatments offered by your fertility clinic is a crucial step in creating a comprehensive business plan. It allows you to clearly articulate the range of services you will provide and helps potential patients understand what to expect when they visit your clinic.

Start by outlining the core fertility treatments that your clinic will offer. This may include assisted reproductive technologies such as in vitro fertilization (IVF), intrauterine insemination (IUI), or fertility medications. Clearly define the process and cost associated with each treatment to ensure transparency and clarity for your patients.

In addition to the core treatments, consider offering additional services that can enhance the patient experience or cater to specific needs. These may include genetic testing to identify potential hereditary conditions, egg or sperm freezing for future use, or donor insemination for individuals or couples requiring donor gametes.

When defining the services and treatments, it is important to consider the specializations or areas of expertise that your clinic will focus on. This could be related to specific fertility issues or conditions, such as endometriosis or male infertility. By highlighting these specializations, you can attract patients who are seeking expertise in those areas.

• Stay updated with the latest advancements in the field of fertility treatments and consider incorporating them into your services.
• Consult with medical professionals and fertility specialists to ensure that your range of services aligns with best practices and industry standards.
• Consider incorporating holistic or alternative therapies, such as acupuncture or nutrition counseling, to complement your core treatments and attract a wider range of patients.
• Ensure that your services are clearly communicated on your clinic's website, brochures, and other marketing materials to help educate potential patients and guide their decision-making process.

By clearly defining the services and treatments offered by your fertility clinic, you can differentiate your clinic from competitors and attract potential patients who are seeking the specific treatments and expertise you provide. This will ensure that you are able to meet the needs of your target demographic effectively and position your clinic as a trusted and reliable provider in the field of fertility services.

Formulate A Business Model

Formulating a business model is crucial for the success of your fertility clinic. It involves determining how your clinic will generate revenue, deliver services, and differentiate itself from competitors. Here are some important steps to consider:

• Define your pricing strategy: Determine how you will charge for services, whether it's a fee-for-service model, bundled packages, or a subscription-based model. Consider factors such as market demand, profitability, and pricing transparency.
• Identify your target market: Understand the demographics and needs of your target demographic, including factors such as age, income level, and geographic location. This will help you tailor your services and marketing efforts accordingly.
• Consider additional revenue streams: Explore opportunities to expand your clinic's offerings beyond basic fertility treatments. This could include services such as genetic testing, egg freezing, or partnering with complementary businesses such as surrogacy agencies or sperm banks.
• Establish relationships with insurance companies: Although not a widespread practice, partnering with insurance companies to offer coverage for certain treatments can be beneficial for both the clinic and the patients. Investigate potential partnerships and negotiate favorable reimbursement rates.
• Develop a referral network: Building relationships with healthcare providers, gynecologists, and other professionals in the reproductive health field can help generate referrals and enhance your clinic's reputation.

Tips for Formulating a Business Model:

• Conduct thorough market research to understand the demand, competition, and current trends in the fertility industry.
• Stay up-to-date with advancements in reproductive technologies and incorporate them into your business model if appropriate.
• Consider offering innovative financing options, such as payment plans or medical credit cards, to make your services more accessible to a wider range of patients.
• Regularly assess and adjust your business model to adapt to changes in the industry and meet the evolving needs of your target market.

By formulating a solid business model, you will be able to position your fertility clinic for long-term success and provide the best possible care to your patients.

Establish A Budget

When starting a fertility clinic, it is crucial to establish a comprehensive budget to ensure proper financial planning and management. This will help you determine the feasibility of your business idea and set a roadmap for its financial success.

Here are some important steps to consider when establishing a budget for your fertility clinic:

• 1. Determine startup costs: Include all the expenses related to setting up your clinic, such as lease or purchase of property, renovation and construction costs, purchasing medical equipment, licensing fees, and initial marketing expenses.
• 2. Calculate recurring expenses: Identify the ongoing costs necessary to run your fertility clinic, including monthly rent, utilities, payroll for staff members, medical supplies, administrative expenses, and marketing and advertising costs.
• 3. Consider revenue projections: Estimate the potential revenue your clinic can generate based on market research, competitive analysis, and anticipated patient flow. Take into account the fees for various fertility treatments and services offered.
• 4. Create a cash flow forecast: Develop a detailed projection of your cash inflows and outflows over a designated period, typically one to three years. This will help you understand how your clinic's finances will evolve and identify potential financial challenges.
• 5. Plan for contingencies: Set aside some funds for unexpected expenses or emergencies, such as equipment repairs, regulatory changes, or unforeseen events that may impact your clinic's operations.
• Seek professional advice: Consult with an accountant or financial advisor who specializes in healthcare businesses to help you develop a realistic and accurate budget.
• Research financing options: Explore different funding sources, such as loans, grants, or partnerships, to secure the necessary capital for your fertility clinic.
• Regularly review and update: Monitor your clinic's financial performance regularly and adjust your budget as needed to ensure profitability and sustainability.

Secure Necessary Funding Or Financing

Once you have defined your services and treatments offered, it's crucial to secure the necessary funding or financing to start and sustain your fertility clinic. Here are some steps to help you in this process:

• Assess your financial needs: Determine the amount of capital required to cover start-up costs, operational expenses, and potential cash flow gaps. Consider factors such as facility rent, equipment purchase or leasing, staff salaries, marketing expenses, and ongoing medical supplies.
• Explore funding options: Research different avenues for funding, such as traditional bank loans, private investors, venture capital firms, or crowdfunding platforms. Compare interest rates and repayment terms to select the most advantageous option for your clinic.
• Prepare a comprehensive business plan: Demonstrate the profitability and sustainability of your fertility clinic in your business plan. Include financial projections, market analysis, competitor analysis, and a detailed breakdown of expenses and revenue streams.
• Seek out grants or government programs: Investigate if there are any grants or government initiatives available specifically for funding fertility clinics. Research local, state, or federal programs that might assist in providing the necessary leverage for your venture.
• Consider partnerships or collaborations: Explore the possibility of partnering with other healthcare providers or fertility clinics to share resources and financial burdens. This can help reduce costs and increase access to funding .
• Provide realistic financial projections backed by thorough research and industry trends to increase your chances of securing funding.
• Be prepared to justify the potential return on investment for lenders or investors.
• Ensure you have a solid credit history and a good personal or business credit score to enhance your credibility with financial institutions.
• Consider collaborating with a financial advisor or consultant experienced in the healthcare industry to guide you through the funding process.

By securing the necessary funding or financing, you can confidently move forward with establishing and running your fertility clinic. Remember to thoroughly assess your financial needs, explore various funding options, and present a compelling business plan to attract potential investors or lenders.

Obtain Necessary Licenses And Permits

Once you have formulated your business plan for your fertility clinic, it's crucial to ensure you have all the necessary licenses and permits to operate legally. The specific licenses and permits required may vary depending on your location, so it's important to research and comply with local regulations and guidelines.

Here are some important steps to follow when obtaining the necessary licenses and permits for your fertility clinic:

• Research local requirements: Start by researching the specific licenses and permits required to operate a fertility clinic in your area. This may include healthcare facility licenses, medical laboratory permits, and business licenses. Make sure to familiarize yourself with the regulations and guidelines set by your local authorities.
• Contact relevant authorities: Reach out to the appropriate government agencies or departments responsible for issuing licenses and permits for healthcare facilities. They will provide you with detailed information on the application process, required documentation, and any fees involved.
• Complete application forms: Fill out the necessary application forms accurately and thoroughly. Be prepared to provide detailed information about your clinic, including its legal structure, ownership, physical location, and the services you plan to offer.
• Submit supporting documents: Along with your application forms, you will likely need to submit supporting documents such as a copy of your business plan, proof of professional qualifications, and any necessary certifications. Ensure that all your supporting documents are up to date and in compliance with the requirements specified by the licensing authority.
• Comply with health and safety regulations: Fertility clinics often deal with sensitive procedures and patients' health, so complying with health and safety regulations is crucial. Make sure your clinic meets the necessary standards in terms of cleanliness, infection control measures, and equipment maintenance. Some licensing authorities may conduct inspections to ensure your facility meets these requirements.

Tips for Obtaining Licenses and Permits for Your Fertility Clinic:

• Start the licensing and permitting process well in advance, as it can take time to gather all the necessary documents and receive approvals.
• Seek legal advice if you're unsure about any aspect of the licensing and permitting process. A lawyer specializing in healthcare regulations can guide you through the legal requirements.
• Keep records of all your communications, applications, and submissions during the licensing process. This will help ensure transparency and facilitate any future audits or inspections.
• Stay updated on any changes or updates to licensing and permitting regulations in your area. Compliance with evolving regulations is vital to ensure the continuous operation of your fertility clinic.

By obtaining the necessary licenses and permits for your fertility clinic, you demonstrate your commitment to providing high-quality and compliant services to your patients. It also helps build trust with your target demographic and ensures the smooth functioning of your clinic within the legal framework.

Develop A Marketing And Advertising Strategy

Developing a strong marketing and advertising strategy is crucial for the success of your fertility clinic. It will help you reach your target demographic, raise awareness about your services, and differentiate yourself from competitors. Here are some important steps to consider:

• Identify your target audience: Begin by understanding who your ideal patients are. Consider factors such as age, gender, income level, and geographic location. This will guide your marketing efforts and help you tailor your messages accordingly.
• Create a compelling brand identity: Your clinic's brand should reflect professionalism, trustworthiness, and empathy. Develop a well-designed logo, website, and marketing materials that convey these qualities. A consistent and visually appealing brand identity will help build recognition and credibility.
• Utilize digital marketing: In today's digital age, having an online presence is crucial. Invest in search engine optimization (SEO) to improve your clinic's visibility on search engines. Develop a user-friendly website with informative content and ensure it is mobile-responsive. Utilize social media platforms to engage with your audience and share educational content.
• Build relationships with referring doctors: Establish partnerships with OB-GYNs, urologists, and other healthcare professionals who frequently refer patients to fertility clinics. Maintain regular communication, provide educational materials, and offer networking opportunities to develop a mutually beneficial relationship.
• Organize informational events: Host seminars or webinars to educate the public about fertility issues and the services your clinic provides. Invite experts in the field and encourage attendees to ask questions. This will position your clinic as a trusted authority and generate leads.
• Offer exceptional patient experiences: Word-of-mouth recommendations are powerful in the healthcare industry. Strive to provide exceptional patient care and satisfaction. Encourage patients to share their positive experiences through testimonials or online reviews.
• Consider partnering with local businesses or organizations that align with your clinic's values, such as wellness centers or women's health groups.
• Utilize targeted online advertising campaigns to reach your specific demographic.
• Track the effectiveness of your marketing efforts through analytics and adjust your strategy accordingly.

By developing a comprehensive marketing and advertising strategy, you can effectively promote your fertility clinic, attract the right patients, and ultimately grow your business.

Developing a business plan for a fertility clinic is a crucial step in starting a successful clinic. By conducting thorough market research, identifying the target demographic, analyzing competition, and defining services and treatments offered, clinics can position themselves for success in a competitive industry. Formulating a solid business model, establishing a budget, securing necessary funding, obtaining licenses and permits, and developing a marketing and advertising strategy are all essential steps to ensure the clinic's long-term success. With the increasing demand for fertility services, clinics can also consider expanding their offerings and partnering with insurance companies to provide coverage for certain treatments. Overall, a well-thought-out business plan can help pave the way for a thriving fertility clinic.

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• Resources for Entrepreneurs > Becoming an Entrepreneur > How to Start a Small Business

Starting a Fertility Clinics Business

How to Start a Small Business

Opening a fertility clinic is a rewarding experience as long as you separate yourself from the competition. We offer a few secrets on the essential elements for business success.

Thinking about opening a fertility clinic? We tell you what you need to know to get started.

Tips for Creating a Great Fertility Clinic Business Plan

If it includes hard numbers, a fertility clinic business plan can become the catalyst for an executable business strategy.

But from an outsider's perspective, your business plan is also a reality check. Third-party stakeholders want to make sure that the most important parts of your plan are based on real world information, including your business plan's market analysis section.

Early in the process, it's worth your time to learn how to write the market analysis section of a business plan . It includes the identification of your target market and in many cases, the inclusion of supporting research to back up your claims and sales forecasts.

Consider Competitors

Well in advance of opening a fertility clinic in your town, it's worthwhile to find out how strong the competition is. We've provided the link below to help you get a list of local competitors near you. Complete the form by entering your city, state and zip code to get a list of fertility clinics that are close by.

• Find Local Fertility Clinic Competitors

Is the local market large enough to support another fertility clinic? If not, you had better be sure that you are doing things much better than the competition.

Talk to People Who Are Already in the Business

After you've evaluated your local competitors, it's a smart move to have a conversation with someone who is in the business. It's very unlikely that the local competition will talk to you. It'd be crazy for them to teach you the business.

However, a fellow entrepreneur who has started a fertility clinic outside of your community will be much more likely to talk with you, given that you don't compete with them in their area. In fact, they are often very willing to share startup advice with you. Our estimate is that you may have to contact many business owners to find one who is willing to share his wisdom with you.

What's the best way to find a fertility clinic entrepreneur who is willing to talk to you but doesn't live nearby?

Here's one way to do it. Just use our link below, find somebody and call them.

• Find Your Fertility Clinic Mentor

Getting Started in Fertility Clinic Ownership

Would-be fertility clinic business owners can either launch a new business or acquire an existing operation.

Startup fertility clinics can be attractive because they allow the entrepreneur to have more control and greater influence. But financially, startups present significant challenges because lenders are typically hesitant to fund startup fertility clinics.

On the other hand, a fertility clinic purchase is more attractive to lenders and investors. On the whole, buying a business minimizes uncertainty as well as many of the objections lenders use to disqualify startup entrepreneurs from financing.

Is Franchising the Right Option?

As an entrepreneur, your chances doing well with your venture are much better when you choose to franchise rather than going it alone.

Before you consider starting a fertility clinic, you may want to determine whether franchise opportunities in your space might simplify your entering the business.

The link below gives you access to our franchise directory so you can see if there's a franchise opportunity for you. You might even find something that points you in a completely different direction.

• Franchising Lists

Related Articles on Starting a Company

These additional resources regarding starting a business may be of interest to you.

Recurring Revenue Business Models

Starting a Business

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IVF Marketing Guide – 10 Growth Strategies

• December 8, 2023

Fertility and IVF clinics that are willing to invest in marketing are poised for growth. Potential patients are primed to interact with your practice through digital channels and more willing than ever to research and find a physician online. 

Do you have a fertility clinic marketing plan to acquire new patients ?

If not, keep reading to find a complete guide on the strategies we use to grow new patients for IVF practices.

Case Study: How RUNNER grew Fertility Partnership IVF cycles to their highest month ever!

Ready to Get More Patients?

Complete guide to ivf marketing strategies.

This guide will explore 10 IVF marketing strategies. Some of these strategies are essential to growth. But in contrast, the others are explicitly designed for those looking for a system to achieve above-average growth .

1. Invest in Your IVF Clinic Brand

Relative to other practice specialties, building a solid brand and reputation for your fertility practice, doctors, physicians, and staff is key. Your logo, photography, site design, and messaging all have an opportunity to build your brand promise and create credibility, authority, and trust as an IVF provider.

Some essential tips include the following:

• Use natural photography, rather than stock, wherever possible
• Create empathy in your copy
• Make your patient the hero, not your physicians. These patient stories will build your brand as an IVF provider.
• Make information about your physicians accessible, and talk about their motivations, not just their experience

More like this: The Power Of Empathy In Medical Marketing in 2022

2. Maximize Google Ads Spend for Your IVF Clinic

Google Search Ads  are still the most targeted way to drive new patients for your fertility practice. It targets ONLY those actively looking for fertility or IVF treatment, and you pay only when they click on your ads. Patients are highly active in researching IVF and fertility treatments, so the search volume for these terms is very high.

Case Study:   How RUNNER grew Dallas IVF’s new patients by 30% using paid advertising

Key tips for IVF and fertility marketing with Google Ads include:

• Buy search keywords specifically for the IVF treatments you’re looking to drive. For example, you want to include the range of keywords related to your treatments – IVF, IUI, ICSI, egg freezing, etc. Get specific, as patients heavily research fertility, and they will often search for particular treatments they’ve discovered.
• Send all Google search ads to landing pages targeted towards those keywords. You need specific pages created for each treatment or condition. This ensures you’ll receive the highest landing page relevancy score in Google.
• Make sure those pages include social proof in the form of patient testimonials. Showcasing the fertility journey of your patients can motivate site visitors to become leads.
• Spend enough budget to maximize your impression share for those keywords. We wrote a blog post to help you understand how to determine a budget for your practice marketing, and more recently, we wrote a detailed blog with a template that shows how to measure the potential ROI of investing in IVF marketing strategies.
• Your conversion tracking must be set up correctly, or your ads won’t optimize properly. You have to be able to understand what’s really driving not only new patient leads, but IVF cycles.

Check out how we helped Dallas IVF get 41% more qualified traffic with NO CHANGE in ad spend.

3. Expand Your IVF Marketing Strategies to Social Media

Social media is more critical for fertility clinics and IVF providers than other medical specialties. This is because there is more patient sharing around positive IVF outcomes.

A foundational strategy would include a solid organic and paid social media ad efforts. This includes regular posts and engagement on your Facebook and Instagram profiles and paid advertising on Facebook and Instagram .

However, fertility practices looking for opportunities to grow should explore the following:

• Increasing paid advertising spend on Facebook and Instagram
• Engagement with IVF or Fertility Facebook Groups
• Creating a practice or physician Youtube channel
• Exploration of organic and paid strategies on new channels like Tik Tok
• Example: Broadcast live on social media channels to engage with potential patients through live Q&A

More like this: Think Your Content Doesn’t Need Paid Social Promotion? Think Again.

4. Showcase More Patient IVF Success Stories

Patient testimonials are a key for any IVF or fertility practice to show potential patients what life could look like. Yet many practices don’t do a great job showcasing these testimonials or bringing them to life. Here are a few considerations to better showcase your fertility practice testimonials.

• Bring patient testimonials to life with video .
• Create a higher volume of testimonials and update them more often.
• Create testimonials targeted towards different patients and services: example, egg freezing, sperm freezing, IUI, IVF, LGBT, etc.
• Showcase testimonials on your homepage.
• Distribute testimonials to other channels – Facebook, Google My Business, etc.

Need help putting your testimonials to work for your fertility practice? We’ve got you covered .

More like this: Online Reputation Management for Doctors Your 2022 Guide

5. Optimize Your Site for Core Web Vitals

One must-have strategy for every fertility clinic website is optimizing your site towards the Google Page Experience Update that happened in 2021. This was a major algorithm update that focused on the user experience of websites using Google’s “Core Web Vitals” signals.

Core Web Vitals includes 3 primary dimensions:

• Largest Contentful Paint (LCP) – how long it takes the most significant element of your page to load.
• First Input Delay (FID) – how long does it take for a user to be able to scroll and click.
• Cumulative Layout Shift (CLS) – how stable is the page layout when loading.

Fertility clinic websites are often at risk because they generally have lots of photography and big images. Therefore, you must closely understand the above three Core Web Virtals dimensions and optimize your site specifically to address any challenges.

This is why we built our Practice Right Websites – to provide websites for fertility clinics that are better at converting site visitors to new patient leads, and are optimized to perform well against these 3 Core Web Vitals dimensions.

More like this: SEO for Fertility Clinics

6. Track Beyond Leads to Measure OVs & IVF Cycles

Most IVF clinics don’t have tracking figured out to understand how marketing is impacting patients and revenue. That’s because most fertility practices aren’t using a CRM that tracks potential new patient leads from first touch through scheduling an appointment and completing a cycle.

For our IVF clients, we have them use Front Office Helper , RUNNER’s HIPAA-compliant CRM system. With this system, we’re able to tell what marketing channels new patient leads come from, and if they become OVs or eventually, IVF cycles. This tracking is essential both to understand which marketing efforts are driving ROI, but also to provide a valuable feedback loop into optimizing your marketing efforts.

7. Find Ways to Compete With Online IVF Alternatives

We’ve also seen new competition for fertility practices with the telehealth opportunity . Several new fertility clinics have been competing for your patients in recent years. No longer are you competing against just other local IVF clinics; you’re also competing against many other online brands for diagnostic testing and other fertility services.

This trend has been accelerating and will continue to grow.

• Are you protecting searches for your brand name with paid search advertising ? Because competitors will buy your name.
• Are you investing in paid ads to grow brand awareness?
• Are you clearly differentiating your fertility practice from these new competitors?
• Are there opportunities to innovate your service model to future-proof your business?

8. Partner With Influencers

Your patients are your most important influencers, but influencer marketing is a growing social media advertising opportunity that many medical practices are not taking advantage of yet.

Fertility clinics have an opportunity to partner with influencers to educate potential patients or showcase experiences with treatment and distribute this content through social channels.

Influencers provide an authentic voice and outside perspective that will help build trust with many potential patients. In addition, using these videos or assets in your ads can result in higher performance.

9. Explore New IVF Patient Lead Generation Pathways

A phone number and a contact us page aren’t enough. You’re missing out on new patient leads that you can drive through a variety of other means, including things like:

• Schedule a Callback
• Website Chat
• Online Booking

Check out how we helped Dallas IVF get 25% more website conversions .

10. Move Fertility Clinic Marketing Events Online

It’s common for IVF and fertility practices to use educational seminars to educate potential patients about fertility treatments. However, if you haven’t been conducting these educational events online, you’re missing out on a unique opportunity to drive leads. It’s easier than ever to run a virtual event online, and patients are more willing to participate.

Participation in online events has grown significantly in the last few years, and most of your potential patients will be familiar with attending and engaging in them. We’ve found that the leads you get through these online events are far more likely to convert into patients.

Growing patients and revenue for your fertility clinic is easier when you’re working with an IVF marketing agency who has experience building IVF clinics and driving services like egg freezing and IVF cycles.

Request a consultation with a RUNNER IVF marketing expert and create your clinic growth plan.

More like this: 45 Ways to Attract New Patients to Your Practice 

John Keehler

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The Fertility Clinic Business Plan and Business Development toolkit features 18 different documents that you can use for capital raising or general business planning purposes. Our product line also features comprehensive information regarding to how to start a Fertility Clinic business. All business planning packages come with easy-to-use instructions so that you can reduce the time needed to create a professional business plan and presentation.

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• Meets SBA Requirements

Fertility clinics have become some of the most lucrative types of healthcare businesses within the United States. This is primarily due to the fact that these clinics receive a significant portion of their revenues directly from patients as well as a offsetting amount from private insurance companies. For high-end insurance plans, some or all costs relating to fertility issues are covered. However, many insurance businesses still do not provide a significant reimbursement for fertility services – and as such, the onus of paying for these fertility clinic services falls on the patient. It should be noted that given that many people are waiting until their early 30s to mid 30s to have children – the prevalence of fertility issues has increased. As such, the demand for in vitro fertilization as well as related services has exploded over the past 15 years. This trend is expected to continue in perpetuity as people are waiting longer before they have families.

As this is a healthcare business, many banks and lenders are more than happy to provide almost all of the capital necessary to launch a new fertility clinic. In the majority of states, these clinics must be owned and operated by a qualified physician that can render fertility services to the general public. If an individual is looking to start one of these businesses using bank capital then they are going to need a business plan. The fertility clinic business plan should feature a three-year profit and loss statement, cash flow analysis, balance sheet, breakeven analysis, and business ratios page. These figures should fall in line with industry standards. Beyond the financial model, a fully developed marketing analysis needs to be included in the documentation as well. This includes an examination of population base, population density, median household income, median family income, percentage of people that have private insurance, and the number of people that are waiting until there 30s before they have children. The last metric is extremely important to note as this will be one of the major determining factors as to whether or not this specific fertility clinic is going to be economically viable.

As it relates to fertility clinic marketing plan, this needs to be developed in conjunction with an advertising agency or marketing firm. There are usually a number of statistics that fertility clinics publish to the general public, and as such these need to be properly developed to showcase this to potential people that are looking to start families. A presence on the Internet is imperative given that people are going to want to know the backgrounds of any physician rendering the services before they commit to becoming patients of the clinic. This website should be listed on long all major search engines. Additional information that should be featured on the web platform include preliminary pricing information, insurance is accepted, hours of operation, and how to get an appointment with the business. Beyond an online and print marketing campaign, it is important that a fertility clinic developed ongoing relationships with area gynecologists, general practitioners, and endocrinologists that will refer women that have fertility issues to the company. Additionally, many fertility clinics also maintain ongoing referral relationships with urologists given that male infertility issues can also cause issues.

A fertility clinic SWOT analysis is also needed when raising capital. This document showcases the strengths, weaknesses, opportunities, and threats that are commonly faced. As it relates to strengths, the barriers to entry for new fertility clinic are extremely high given the fact that it must be a physician that owns and operates his business. The gross margins generated from services range anywhere from 85% to 95% depending on the procedures being offered. For weaknesses, the liabilities associated with a fertility clinic practice are somewhat hot. As such, there are expenses relating to maintaining an expansive malpractice insurance policy. Also, the general operating expenses of these businesses is also very high given that a number of nurses and allied health professionals must be hired to work in conjunction with the physician. As it relates to opportunities, these businesses will frequently hire associate endocrinologists and gynecologists that can work with the owner in expanding the billings of the business. For threats, there’s really no major threat that would impact the way that a fertility clinic does business. As many of these businesses receive their fees directly from patients, they are far less susceptible to changes in public health care policy.

A fertility clinic can be an extremely lucrative type of healthcare business. The average income generated by someone who owns and operates one of these businesses ranges anywhere from $300,000 per year to $600,000 per year depending on their location and types of payment accepted. The demand for service is expected to grow even more over the next two decades.

Fertility Clinic Business Plan (text of the plan – sample images only)

The purchased plan’s figures are specific for a fertility clinic.

1.0 Executive Summary

The purpose of this business plan is to raise $150,000 for the development of a fertility clinic while showcasing the expected financials and operations over the next three years. The Fertility Clinic, Inc. (“the Company”) is a New York based corporation that will provide fertility clinic services and related medical care to customers in its targeted market. The Company was founded in by Dr. John Doe.

1.1 The Services

Dr. Doe will render in vitro fertilization and related procedures within the greater targeted community. These services include examination, blood work, fertility consultations, sperm storage, embryo storage and related services.

The Company will also recognize revenues from the sale of fertility medical appliances prescribed by Dr. Doe. Most revenues will be collected directly from patients as fertility is typically considered to be an elective medical procedure.

The third section of the business plan will further describe the services offered by the Fertility Clinic.

1.2 Financing

Dr. Doe is seeking to raise $150,000 from as a bank loan. The interest rate and loan agreement are to be further discussed during negotiation. This business plan assumes that the business will receive a 10 year loan with a 9% fixed interest rate. The financing will be used for the following:

• Development of the Company’s Fertility Clinic location.
• Financing for the first six months of operation.
• Capital to purchase medical equipment.

Dr. Doe will contribute $25,000 to the venture.

1.3 Mission Statement

Dr. Doe’s mission is to become the recognized leader in its targeted market for fertility services.

1.4 Management Team

The Company was founded by Dr. John Doe. Dr. Doe has more than 10 years of experience as a practicing physician. Through his expertise, he will be able to bring the operations of the business to profitability within its first year of operations.

1.5 Sales Forecasts

Dr. Doe expects a strong rate of growth at the start of operations. Below are the expected financials over the next three years.

1.6 Expansion Plan

The Founder expects that the business will aggressively expand during the first three years of operation. Dr. Doe intends to implement marketing campaigns that will effectively target individuals and families that need free medical care within the target market.

2.0 Company and Financing Summary

2.1 Registered Name and Corporate Structure

Fertility Clinic, Inc. The Company is registered as a corporation in the State of New York.

2.2 Required Funds

At this time, the Fertility Clinic requires $150,000 of debt funds. Below is a breakdown of how these funds will be used:

2.3 Investor Equity

Dr. Doe is not seeking an investment from a third party at this time.

2.4 Management Equity

John Doe owns 100% of the Fertility Clinic, Inc.

2.5 Exit Strategy

If the business is very successful, Dr. Doe may seek to sell the practice to a third party for a significant earnings multiple. Most likely, the Company will hire a qualified business broker to sell the business on behalf of the Fertility Clinic. Based on historical numbers, the business could fetch a sales premium of up to 2 to 3 times earnings.

3.0 Medical Services

The primary source of revenue for the business will be the fertility based medical services provided by Dr. Doe. The Company will offer many of the services that are common within this specialty including in vitro fertilizations, consultations, examinations, and related procedures.

In the future, Dr. Doe will seek to hire additional physicians that will expand the Fertility Clinic organically through increased patient flow. These associate physicians may eventually acquire the practice from Dr. Doe upon his retirement or relocation.

4.0 Strategic and Market Analysis

4.1 Economic Outlook

This section of the analysis will detail the economic climate, the medical industry, the customer profile, and the competition that the business will face as it progresses through its business operations.

Currently, the economic market condition in the United States is moderate. Unemployment rates have declined while asset prices have risen substantially. However, the Fertility Clinic operates with great economic stability as people will continue to want to have children despite deleterious changes in the general economy.

4.2 Industry Analysis

Within the United States there are approximately 200,000 medical practices (excluding mental health practices) that comprise of one or more doctors that act in a private practice capacity. Each year, these practices generate more than $190 billion dollars of revenue and employ more than 1.8 million people (including the doctors). The growth of this industry has remained in lockstep with the growth of the general population. Approximately 5% of these doctors retire each year. Approximately 16,000 doctors enter private practice each year.

4.3 Customer Profile

The Fertility Clinic average client will be a  middle class man or woman living in the Company’s target market. Common traits among clients will include:

• Annual household income exceeding $75,000 per year.
• Lives or works no more than 15 miles from the Company’s location.
• Will spend $5,000 to $25,000 on fertilization services.

4.4 Competition

This is one of the sections we discuss in the purchased document.

5.0 Marketing Plan

The Fertility Clinic intends to maintain an extensive marketing campaign that will ensure maximum visibility for the business in its targeted market. Below is an overview of the marketing strategies and objectives of the Fertility Clinic.

5.1 Marketing Strategies

Dr. Doe intends on using a number of marketing strategies that will allow the Fertility Clinic to easily target men, women, and families within the target market. These strategies include traditional print advertisements and ads placed on search engines on the Internet. Below is a description of how the business intends to market its services to the general public.

The Fertility Clinic will also use an internet based strategy. This is very important as many people seeking local services, such as doctors, now the Internet to conduct their preliminary searches. Dr. Doe will register the Fertility Clinic with online portals so that potential customers can easily reach the business. The Company will also develop its own online website.

The Company will maintain a sizable amount of print and traditional advertising methods within local markets to promote the medical services that the Company is selling.

6.0 Organizational Plan and Personnel Summary

7.0 Financial Plan

7.1 Underlying Assumptions

The Company has based its proforma financial statements on the following:

• The Fertility Clinic will have an annual revenue growth rate of 16% per year.
• The Owner will acquire $150,000 of debt funds to develop the business.
• The loan will have a 10 year term with a 9% interest rate.

7.2 Sensitivity Analysis

In the event of an economic downturn, the Company will not see a major decline in revenues. Medical services are in demand regardless of the general economic climate as they are an essential service for health.

7.3 Source of Funds

7.4 Profit and Loss Statement

7.5 Cash Flow Analysis

7.6 Balance Sheet

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The changing world of IVF: the pros and cons of new business models offering assisted reproductive technologies

• Published: 20 January 2022
• Volume 39 , pages 305–313, ( 2022 )

Cite this article

• Pasquale Patrizio   ORCID: orcid.org/0000-0003-4796-7078 1 ,
• David F. Albertini 2 , 3 ,
• Norbert Gleicher 3 , 4 , 5 , 6 &
• Arthur Caplan 7  

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A Correction to this article was published on 27 January 2022

This article has been updated

This analysis contrasts traditional not-for-profit academic with new corporate practices of reproductive medicine and offers an assessment of risks to quality of patient care with investors entering the for-profit reproductive medicine market. Large corporate enterprises may have a global impact on access to care while at the same time is putting at risk the training of the next generation of reproductive medicine specialists.

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• Medical Ethics

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Introduction

The treatment of infertility has become big business around the world. A medical specialty that began as an academic, innovative, research activity has now evolved into an industrial and commercial service that has expanded well beyond the treatment of infertility. Treatment options originally aimed at infertile couples are now aggressively marketed to broader population of young fertile individuals. This marketing includes many promises, such as preserving future fertility with oocyte freezing, or having healthy children after relying on various forms of genetic preconception testing, including pre-implantation genetic testing for aneuploidy (PGT-A). A long list of “medical” interventions, referred to as “add-ons” have been introduced over the past decade [ 1 , 2 ]. Surprisingly, many such interventions have, however, yet to be clinically validated to improve pregnancy chances in the context of current in vitro fertilization (IVF) treatments [ 2 , 3 , 4 ]. As a result, practice revenues have been enhanced while patient costs have escalated, further limiting access to care especially in states with no or limited insurance coverage for infertility and IVF services.

How did we get here and where is the field going? Why are increasing amounts of private investment dollars flowing into the IVF world? What will their impact be on the viability of academic reproductive medicine including basic and translational research? Is a rapid increase in treatment demands, as witnessed over recent years for fertile individuals, an ethical practice of reproductive medicine?

The first models for delivering IVF

Louise Brown, the first baby born after in vitro fertilization (IVF), celebrated her 40th birthday on July 25, 2018 [ 5 ]. Her birth at the Oldham General Hospital in Manchester (England) made headlines around the world while raising religious, ethical, and legal questions. Her mother, Lesley Brown, had suffered many years of infertility due to blocked fallopian tubes. In November 1977, she agreed to undergo the then experimental procedure of IVF and conceived Louise with the aid of Drs. Patrick Steptoe and Robert Edwards. During a natural cycle, an egg was harvested, fertilized in vitro in a petri dish, and, two days later, a single embryo was transferred into her uterus and resulted in the birth nine months later of Louise Brown. For the development of IVF, Dr. Edwards received the Nobel prize for Physiology and Medicine in 2010. Since then, millions of individuals battling infertility have enjoyed the opportunity of having children through IVF. Today, under the broader umbrella of assisted reproductive technologies (ARTs), IVF is considered mainstream treatment for infertility with over 8 million children born worldwide, and over 2.5 million cycles are being performed every year, resulting in over 500,000 deliveries [ 6 ].

The origins of IVF were rooted in the considerable prior research experience using animal models, but grave concerns remained that the technique might produce abnormal offspring. Some objected that the future offspring could not consent to the potential risks. Others noted that there were many children needing adoption making IVF unnecessary. Yet others worried that “manufacturing” human life outside the female body would break the natural bond between procreation and family. Research to advance IVF, involving creation as well as potential loss of embryos, was seen by many as inherently immoral. Because IVF was so ethically controversial, many governments decided to withhold public support and much-needed funding for research. Clinical IVF practice, therefore, quickly moved into private settings where new therapies were often introduced without proper validation. Within a few years, in the absence of insurance coverage (in the USA, to this day, insurance coverage for infertility treatments is still inconsistent), IVF largely became a fee-for-service paid by patients directly.

By now, IVF and the whole practice of ARTs have become thriving commercial businesses. In the process, the early fee for service model for infertility treatments has evolved toward highly integrated multicenter corporate businesses, driven by profits and not academic pursuits. Interestingly, and as reflection of these market changes, out of 34 REI fellows trained by one of the authors between 1996 and 2021, only 9 (26%) are currently employed in academic practices. The active “industrialization and commoditization of IVF,” defined as transition of IVF from a physician- to an investor-controlled business environment, could ultimately prove to be detrimental for patients and their quality of care [ 7 , 8 ]. Between 2010 and 2017, the value of private equity deals involving the acquisition of healthcare–related companies (most involving physician practices and hospitals) increased 187% reaching $42.6 billion, while the number of healthcare deals increased by 48% [ 9 ].

In this paper, we examine the pros and cons of these developments and reflect on (i) the risks to the quality of patient’s care by investors (non-physicians), understandably interested in good returns on their investments, entering the reproductive medicine market; (ii) the threat that investor-driven corporate medicine poses for the academic base of infertility programs including the training of future generations of reproductive medicine and endocrinology specialists; and (iii) the global impact of corporate reproductive enterprises on access to care.

Background economic data: the US market and the international landscape

As of 2017, 498 clinics in the USA offered infertility services. The overwhelming majority (369, 74%) report outcome data both to the Society for Assisted Reproductive Technology (SART) and Center for Disease Control & Prevention (CDC), while 79 (16%) only report to the CDC. A few (50, 10%) do not report at all and, therefore, are non-compliant with federal law (in 1992, the Fertility Clinic Success Rate and Certification Act mandated data reporting) [ https://www.sart.org/globalassets/__sart/infographics/number-of-clinics.png ] [ 10 ].

According to the CDC’s 2006–2010 National Survey of Family Growth, 12% of American women of reproductive age (about 7 million women), or husbands/partners, had sought fertility treatment in their lifetimes. The fertility industry is growing. It proved resilient even during the Great Recession [ 11 ] and more recently during the COVID pandemic . Currently, the majority of IVF clinics are private, either owned by an individual or group of physicians or owned by private equity groups and often co-managed by physicians that have sold their practices to the investors (equity groups). Only a small minority of data-reporting clinics (< 15%) are currently within academic centers [ 12 ].

According to an international survey of the health economics of IVF, the global need for ART is estimated to be at least 1,500 cycles/million population per year [ 13 ]. The average cost of an IVF cycle in U.S. is $12,000 [ 14 ]. In addition, patients must pay for medications, adding approximately $3,000–$4,000 per cycle to the IVF costs. Very often, one treatment cycle is not successful, leading to the need for additional cycles. Each successive cycle accrues cumulative costs that can quickly run into tens of thousands of dollars and the success rate, even after three cycles, is still not 100%. Egg donation and gestational surrogacy costs are even more expensive, averaging between $22,000 and 30,000 for an egg donation cycle and between $80,000 and $100,000 for gestational surrogacy [ 15 ].

Insurance coverage in the USA remains spotty. Seventeen states—Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia— have passed laws that mandate insurance to either cover (15 states) or offer some coverage (California and Texas) for infertility diagnoses and treatments. In some of these states however, the treatment of infertility stops before offering IVF and the burden of out-of-pocket payments for infertility treatment remains. According to research by Marketdata Enterprises, about 75% of potential clients are not using infertility services because of costs [ 16 ]. The same research found that “women who use infertility services are more likely to be Caucasian, college educated, older than 30 and have higher incomes” [ 16 ]. Some corporations (Google, Facebook, Apple) have started to offer fertility services as special recruitment incentives to retain “high-powered” female employees . A new, highly specialized insurance industry has also evolved, offering corporations tightly managed infertility services outside the usual health insurance packages that corporations purchase for their employees.

Fertility centers usually offer most, if not all, of their services and procedures including many laboratory tests on site. They can also sell company-branded products and supplements to patients; they can offer new services as soon as they become available and refer to in-house specialists rather than referring outside the company framework (e.g., andrologists, urologists, genetic counselors, social workers, acupuncturists, massage therapists), all of which serve as additional revenue streams for the corporation. Moreover, many so-called add-ons to IVF, often introduced into routine IVF practice, are offered to patients as adjuncts to standard ART treatments [ 1 , 2 , 3 , 4 ] despite a lack of proper validation. Some of these include pre-implantation genetic testing for aneuploidy screening (PGT-A), time-lapse embryo imaging, endometrial scratching; assisted hatching, freeze-only cycles, the “embryo glue,” and the endometrial receptivity assays. From a socio-economic standpoint, the IVF market is growing thanks also to an increase in the age of first-time mothers and to an increase in women having difficulty in finding partners [ 17 ].

So how did investors and private equity investment firms become interested in the IVF market? The main obvious answer is that IVF has become a thriving business with considerable growth potential. In 1992, according to the Biomedical Business International newsletter, infertility care in US was a $2 billion per year business; today, it is about 8-billion-a year business in gross revenues. According to Technavio’s latest report, globally the fertility services market was expected to have exceeded US$ 20 billion by 2021, growing at a compound annual growth rate (CAGR) of almost 9% [ 18 ]. Globally, the industry is estimated to be worth $25 billion and is predicted to grow to $41 billion by 2026 [ 19 ]. A detailed predictive analysis of the international markets [ 18 ] shows the following:

Europe Middle East and Africa: EMEA countries will boost growth and the fertility services were expected to have reached USD 8.9 billion by 2021, with a compounded annual growth rate of over 8%. In this market region, the UK, France, Germany, Italy, and Spain are the major contributors though birth rates are declining, and currently, most of the countries in the region have fertility rates of less than 1.5 children per woman. Many governments and non-governmental organizations are trying to educate the population in the region about fertility and associated treatment options through commercial and professional media. In 2012, the number of ART procedures conducted in Europe amounted to twice that in the USA. Countries such as Belgium, Israel, and the Czech Republic are fertility tourism hotspots due to favorable reimbursement scenarios and the availability of advanced medical techniques. The government of Israel subsidizes IVF costs until a family unit has three children. The country, therefore, has the highest utilization rate for IVF services in the world.

Central and South Americas: The fertility services market in the Americas were expected to have generated revenue of US$ 6.6 billion by 2021, growing at a compounded rate of over 8%. Due to the expense of ART procedures in this region, many people cannot afford fertility treatments. Availability of egg donors is limited, and gestational surrogacy is commercially not available. Unavailability and expense of services drive many people to seek medical treatments in other countries [ 20 ]. Latin America has a high fertility rate. However, still by many considered morally and religiously unacceptable, fertility treatments are not as popular as in other regions of the world. In addition, as governments and insurance companies in the region do not offer coverage for these services, only wealthy people can afford fertility treatments or medical tourism.

Asia Pacific regions: The fertility services market in these areas were expected to have exceeded US$ 5.3 billion by 2021, growing at a compounded rate of over 9% per year. Because this market includes China, after removing of the one-child-policy, it is expected to grow at a rapid pace. Many countries in the region are improving their healthcare infrastructure and adopting sophisticated technologies, while also employing increasingly skilled medical professionals to keep up with their Western counterparts. Many Asian countries such as Thailand, Hong Kong, and India are major hotspots for fertility tourism. These countries offer services at much lower cost in comparison to developed countries. Regulations pertaining to infertility treatments are also less stringent in these countries. Australia’s fertility industry, alone, is projected to generate revenues of A$630 million by 2022.

The rise of the IVF Industry

Provision of infertility and especially IVF treatments are increasingly viewed as an industry. Facilitated by the accelerating development of the ART’s, strategic cooperative ventures between private and, recently, even some academic institutions with investors are becoming more frequent. Investors (private equity, venture capital, and other financing sources) and several already existing physician groups striving for further national expansion have been racing towards establishment of large national chains of fertility clinics [ 21 ]. The same economic forces driving consolidation in other medical specialties (dermatology, dentistry, orthopedics, radiology) and in other industries (airline, internet and media) are now shaping the future of the infertility field [ 7 , 9 , 21 , 22 ].

In the following section, we present the currently leading efforts in consolidating the IVF field of some US companies, understanding that the pace of change in the ART field continues to be a moving target with respect to recent exit/entry transitions. They in principle follow three types of business models (see Table 1 ): (a) progressive practice growth and expansions owned by physicians (type I model); (b) private investment firms entering the IVF market through acquisition of existing IVF practices and merging them into networks (type II model) with physicians remaining employed and becoming shareholders after their “cash out”; and (c) establishment of new independent IVF clinics, fully financed by investors hiring reproductive endocrinologists to run them profitably under a variety of incentive programs (type III model).

Initially a type I model, it since turned into a type II model, comprising of clinics mostly in the Northeast (Massachusetts, Maine, Vermont, New Hampshire, and Rhode Island but also in upstate NY, Arizona and Alabama). In 2019, Boston IVF was acquired by the NMC Eugin group and became a type II business model, with senior physicians of Boston IVF becoming shareholders in the NMC Eugin US corporation. Eugin group was a company founded by a wealthy Indian billionaire residing in Dubai, who had been consolidating infertility clinics across Europe before entering the US market. Since its inauguration in Barcelona in 1999, the group has treated thousands of patients worldwide. By 2019, Eugin reached about 36,000 treatment cycles, placing them as a European leader within the sector, with a team comprising over 1,000 specialists. In 2020, the NMC Eugin group was sold for €430 million to a German company, Fresenius Helios, one of the largest in-hospital and ambulatory services operators in Europe with properties in Germany, Spain, and Latin America. At the time of the sale, the Eugin group’s network comprised 31 IVF clinics and 34 additional sites across 9 countries in 3 continents (Fresenius.com, accessed December 30, 2020).

The Colorado Center for Reproductive Medicine (CCRM), founded in 1987, has gone from a type I to type II and III business model. Originally owned by a physician founder (type I model), after receiving private investment funds (type II), it further expanded into 10 new markets around the US (type III model). The CCRM received investments from TA (a private equity firm) and opened new IVF clinics in Atlanta, New York, Boston, San Francisco, Dallas, Houston, Minneapolis, Orange County (CA), Northern Virginia, and Maryland and also opened a clinic in Toronto, Canada. In June 2021, the Unified Women’s Healthcare, a practice management platform in women’s healthcare backed by Atlas Partners, with funds managed by the Private Equity Group of Ares Management Corporation and Oak HC/FT, announced that it had entered into an agreement to partner with CCRM. As part of the transaction, the CCRM founder was to remain Medical Director. In addition, TA Associates, which were the strategic investor in CCRM since 2015, sold its stake in the company [ 23 ].

Huntington Reproductive Centers (HRC) (type I and II models)

Huntington Reproductive Centers opened the first practice in 1988 and now has nine offices throughout the California Southland (Encino, Fullerton, Laguna Hills, Newport Beach, Oceanside, Pasadena, Rancho Cucamonga, Westlake Village, and West Los Angeles). In 2018, a Chinese investment company, Jinxin Fertility, acquired HRC. The new round of financing was led by Warburg Pincus and CNCB (Hong Kong) Investment Limited [ 24 ]. The press release of the acquisition [Oct. 10, 2018 /PRNewswire/Hong Kong] read “With a potential market size of more than RMB100 billion (about 11.5 billion US$), assisted reproduction has become one of the fastest growing markets among the healthcare industry in China.” This promising prospect has attracted a flood of capital. Among interested parties, the Sichuan Jinxin Fertility Company Limited (Jinxin Fertility), which recently announced the completion of a major financing round. In 2016, the National Health and Family Planning Commission of the government reported that “China's licensed assisted reproductive institutions had completed 700,000 assisted reproductive operations annually, while the number of infertile patients was over 40 million, indicating the severe inadequacy of supply.”

Chinese investors have many legitimate business reasons to be interested in American fertility clinics. In the years before COVID-19 pandemic, large numbers of wealthy Chinese flocked to American clinics, which are seen as among the best in the world. With the acquisition of the US-based HRC Fertility, which has had 30 years of history in the USA, Jinxin Fertility expanded their international market.

IntegraMed Fertility (type II model)

IntegraMed Fertility was a division of IntegraMed America, one of the largest networks of providers offering fertility services with 39 centers in 153 locations across 39 States. It also included Shady Grove Fertility centers (type I and II models). IntegraMed America was a privately held company of the Sagard capital group, and it was the first so-called physician management company in the IVF arena, starting management of IVF clinics in 1990. As one of the largest and most sophisticated chains of infertility clinics in the USA, Shady Grove Fertility Centers were IntegraMed’s largest client until the company filed for bankruptcy in early May 2020 after most US IVF clinics had shut down for several months. Many IVF clinics under management by IntegraMed found themselves in difficult circumstances when their management company shut down [ 19 , 25 ].

Shady Grove

The Shady Grove (type I and II models) enterprise is now one of the largest chains of fertility clinics in the country, present in 8 states, acquiring or opening de novo a number of clinics in District of Columbia, Georgia, Pennsylvania, Virginia, Florida, New York, Colorado, and Connecticut. They also have a presence in Santiago, Chile. The plans to open center in China in 2020 had to be put on hold. Shady Grove first attracted attention when one of its founders in 1992 started promoting a then highly controversial Shared Risk Program, which offered refunds to selected, good prognosis, patients who paid upfront double the IVF treatment price, but then get refunded their money if all the treatments allowed were unsuccessful. As a model, this program became the forerunner to multiple cycle packages, nowadays a marketing tool at many IVF clinics. After the departure of IntegraMed, Shady Grove has remained in a close relationship with a smaller chain of fertility centers in Chicago, IL, The Fertility Centers of Illinois (FCI), which also used to be managed by IntegraMed.

Ovation Fertility (type I and II models)

Ovation Fertility was created with money from a group of physicians from four REI/IVF practices. The group then hired a CEO and a CFO and raised money from MTS Health Investors, later renamed WindRose, an NY private equity firm, to further expand. The Ovation Fertility chain expanded their initial 4 clinics (from Southern California, Nevada, Tennessee, and Texas) to additional ones in Louisiana, Ohio, Indiana, and Washington DC. Recently, they entered in a partnership with the Penn Fertility Center at the University of Pennsylvania, IVF centers at the University of Alabama, and the University of Kansas to run their IVF/Andrology laboratories. Ovation Fertility differs in their operations from other players in the field in that both physicians and embryologists share in the ownership of the company, and, in principle, it only acquires and operates IVF and andrology laboratories. Selling physicians maintain 100% ownership of their clinical practices and 49% of their IVF laboratories. This structure facilitates alignment of incentives and ownership to the founders of the IVF practices. In addition, Ovation Fertility, like Inception (see below), has opened up a series of ancillary service chains as free-standing companies including ovation genetics, the Center for Surrogate Parenting, and ovation donor services (for both fresh and frozen donor egg services).

Prelude and Inception (type II model)

Supported by US$200 million from Lee Equity Partners, the serial entrepreneur M. Varsavsky established Prelude [ 26 ]. He first purchased the Reproductive Biology Associates of Atlanta, a large fertility clinic with an egg banking business, then bought Pacific Fertility Centers on the West coast and, recently, 22 clinics of the Vivere group as well as the prestigious IVF program of New York University Langone Medical Center, expanding Prelude’s reach across 23 States. More recently, Prelude merged with Inception, another investor-financed network of fertility brands including Pathways Fertility, My Egg bank, Inspire Rx, Inova, Haven Cryo, a centralized cryo storage company for the Prelude network, and also a multi-cycle fertility service bundling service company called Bundl. In the 2016 Forbes article [ 26 ], Varsavsky predicted a future fertility world where young women and men would cryopreserve gametes at peak fertility, thaw them when ready to parent, produce embryos in the laboratory, have them tested through preimplantation genetic testing for aneuploidy, and establish pregnancies through the transfer of only “normal” embryos. He predicted that companies like his Prelude, therefore, would have clients for many decades.

Reproductive Medicine Associates (RMA) (type I and II models)

RMA was founded by physicians in NJ and franchised the RMA brand mostly along the Northeastern corridor (New York, Connecticut, Pennsylvania) as well Florida and Texas. In Feb 2017, by becoming a minority partner, RMA sold out in a merger with the Instituto Valenciano Infertilidad (IVI) creating a global brand mostly on both sides of the Atlantic, the IVI-RMA [ 27 ]. IVI was founded in Valencia, Spain, in 1990 and owns many clinics in various regions of Spain and many other countries including Portugal, Turkey, Italy, Panama, Chile, Brazil, Argentina, and India. In addition, they own subsidiaries in genetic testing, IVF lab consulting, research and development, and stem cell banking. In 2016, IVI owned and operated 60 clinic locations in 11 countries and treated over 60,000 patients. In a translated press release, IVI reported that they own 70% of the new company, while RMA of New Jersey owns 30%. The company apparently has 2,400 employees, including 200 physicians and 300 research scientists across 70 clinics in 13 countries [ 27 ]. The 5-year plan of IVI-RMA global is to expand in the USA by opening additional sites.

Whether this plan can be executed remains to be seen since the founder of RMA, who after the merger of both companies served as CEO of the enterprise, has left the company.

Vios Fertility Institute (type I and II models)

Vios was founded by a physician formerly part of the previously mentioned Chicago-based chain of IVF clinics, Fertility Center of Illinois (FCI). This company has branched out to acquire existing IVF clinics and to open new ones in Chicago and St. Louis by now having a presence in 6 states.

Potential impact of mergers and acquisitions: a look at the cons and pros

Potential negative impacts (cons).

The mergers and acquisitions of clinical practices will undoubtedly create competitive market advantages and pose new financial challenges to smaller, independent private practices and to not-for-profit academic centers. If they are unable to survive, practices may be forced to close or swallowed up, fostering a rise in regional monopolies, resulting in higher prices for services thereby decreasing both access to and the diversity of medical care available to patients. A good example for such a development has been Australia and New Zealand, where three mega network companies control two-thirds of the region’s IVF cycles [ 28 ]. Both of these countries have done pioneering work in the early days of IVF and have, for a number of years, maintained academic excellence in research. Yet, live births have been declining in strong correlation with increasing monopolization of IVF and with, in parallel, declining patient satisfaction, while costs have been increasing [ 22 , 28 ].

Low offerings of affordable treatment options. Large chains are expected to respond to investors, understandably, seeking returns on their investments. Profits, and not patients, emerge as a principal priority, often pushing aside in importance cycle outcomes and patient satisfaction. Industrialization inevitably leads to commoditization, incentivizing physicians to spend less time with patients, encouraging higher cost and more treatments, even when less expensive and less invasive options are also acceptable.

Employee health and job security in networks vs. independent clinics could become suboptimal. Young physicians, embryologists, nurses, etc., may have less bargaining power with corporations as they may be seen as commodity other than assets. Ownership and sense of community has disappeared from many corporate-owned fertility centers, having been replaced by profit/metrics-driven evaluation. Long-term career growth of employees is often viewed as low priority in these corporate entities.

In reproductive medicine, it is difficult to export success rates across multiple facilities (franchisee) since patients are diverse and team behaviors and practices vary widely. One, therefore, can foresee that, in attempts to streamlines services, large provider networks will select out better prognosis and avoid poorer prognosis patients, unless they can be directed towards third party egg donation cycles, which represent the most profitable IVF treatment in fertility centers, but will jeopardize comprehensive patient care.

Commercial interests may blur diagnostic needs and accuracy by offering non-validated tests called “adds on” which are unproven and costly. Some examples include the “embryo glue”; fertilome analysis; time-lapse imaging; routine freezing of all embryos and not doing fresh transfers; assisted hatching; and PGT/A for all [ 1 , 2 , 3 ]. US clinics, for example, offer PGT-A more frequently than the UK [ 29 ], and Australian IVF centers face a class action suit as a result of PGT-A [ 30 ]. Interestingly, already in 2017, based on CDC data, 6% of private clinics (22/375) used PGT in more than 30% of the IVF cycles, while only 0.5% (2/47) of academic centers did so [ 31 ].

Investors are also driven to enlarge markets. An example is the intense marketing campaign towards very young women about freezing eggs for elective reasons (Kindbody strategy), despite the fact that a number of studies have now demonstrated the low utilization rate and thus the unnecessary expenses that these young women incur to cryopreserve eggs and maintain them in storage [ 32 , 33 , 34 ].

Concentrating the care of the infertile in the hands of business entities provides different market leverages (buying disposables in bulk, medications in bulk), creating competitive advantages for these multi groups over non-merged, stand-alone clinics and academic programs.

Better suited to offer certain price discounts (IVF packages), payment plans, and offering free marketing to practices of referring physicians. Partial acquisition of referring physician practices will pose increased competition to the academic programs and to stand-alone clinics.

Fewer academic training programs—academic centers cannot compete, and if they do not adapt to these new business models, they will likely be on the brink of extinction. Who will train the next generation of reproductive endocrinologist and infertility practitioners? The establishment of a proper REI fellowship still requires an academic institution to request the fellowship as regulated by the American College for Graduate Medical Education (ACGME). At present, except for few of these private enterprises that are connected with academic institutions, the majority do not have fellows rotating through their private clinics.

The breadth and width of women’s health related to reproductive endocrinology, metabolic and hormonal disorders, would be marginalized.

Potential for rapid commercial expansion of services not yet scientifically and ethically validated (germline editing for disease repair, disease prevention, cosmetic genetics).

More direct to consumer (DTC) marketing.

Lobbying to keep insurance from covering infertility services so that it remains a treatment for rich and the middle class or lobbying insurance to cover infertility services with preferential contracts since they will “own” the majority of patients, putting academic centers out of business.

Potential to move patients or reproductive materials across national borders.

Making it harder for individual patients to sue deep pocket owners.

Elimination of inner city and rural service locations following the money to the right zip codes and neighborhoods and nations.

Merger of infertility services with other big health care corporations—investors selling to even bigger firms (e.g., Eugin sold the practice to Fresenius Health a mega health German company).

Potential positive impacts (PROS)

The inflow of investor capital has unquestionably accelerated the commercial development of IVF practice, especially facilitating an unprecedented expansion in numbers of IVF clinics, and thereby improving access to care.

Expanded marketing efforts provide more information to the public and, in the process, are likely to help in destigmatizing infertility.

At least theoretically (but still to be seen in practice), increased availability of services should lead to lower prices for treatment. These chains will have better leverage on buying products (bulk shopping), disposables, renting spaces, and overall lower overhead compared to academic centers. These costs reduction opportunities could be passed on to patients or payers.

In principle, these mega capital-strong industries could have more political power to lend their voice to support causes demanding insurance coverage for infertility services and convince legislators to enact bills.

Theoretically, larger provider organizations also have better opportunities to conduct investigations to improve care. If they engage in research, it should be easier to carry out large randomized controlled clinical trials. Hypothesis testing with specimen archiving and appropriate data mining efforts should facilitate development of new products, protocols, and/or devices, faster than that of traditional small academic centers, while by-passing restrictions imposed by federal agencies. However, such an expectation awaits confirmation in practice because whether investors have enough long-term interests to direct capital towards research and development (R&D) is not certain.

Suggested responses

The American Board of Obstetrics and Gynecology (ABOG), the American Society of Reproductive Medicine (ASRM) with the help of the Society of Reproductive Endocrinology and Infertility (SREI), and the American College for Graduate Medical Education (ACGME) must cooperate for the future of REI training and credentialing.

Private enterprises and academic centers could form hybrid alliances to support REI training programs. Within such a hybrid framework, REI fellows would benefit from the opportunity to gain access to diverse models of leadership, business models, and large volumes of clinical care while still being assured time for academic scholarship and research projects.

ASRM ought to set marketing and advertising standards to control creation of demand for marginal services. Patient groups need to build websites with reliable, independent information about fertility treatment options, and costs.

Conclusions

In sum, the offering of infertility services is rapidly evolving into large commercial entities threatening patient care and the future of teaching and research in reproductive medicine. Private enterprises with increasingly aggressive sales techniques are fueling growth in this for-profit medical field; however, market values may not be the appropriate basis for creating families. More public fertility clinics and more insurance mandated coverage for fertility services might change the landscape. Such efforts might give women access to evidence-based treatments without running up huge bills and be less likely to be driven by the need to pay dividends to shareholders or return profits on private equity firms. Concurrently, academic centers need to be fully aware of these rapidly changing market dynamics and prepare plans for survival and for continuing teaching and training new generations of reproductive endocrinologist and infertility specialists.

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Patrizio, P., Albertini, D.F., Gleicher, N. et al. The changing world of IVF: the pros and cons of new business models offering assisted reproductive technologies. J Assist Reprod Genet 39 , 305–313 (2022). https://doi.org/10.1007/s10815-022-02399-y

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Business models and provider satisfaction in in vitro fertilization centers in the USA

J. e. mclaughlin.

1 Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA

J. F. Knudtson

R. s. schenken, n. s. ketchum.

2 Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA

J. A. Gelfond

T. a. chang, r. d. robinson.

The number of in vitro fertilization (IVF) cycles is increasing and the majority of patients undergoing IVF pay out of pocket. Reproductive endocrinology and infertility practitioners employ different business models to help create financial pathways for patients needing IVF but details regarding the different types of business models being used and physician satisfaction with those models have not been described previously.

A cross-sectional survey was sent to members of the Society of Reproductive Endocrinology and Infertility. The survey included 30 questions designed to assess demographics, practice patterns, and business models utilized.

A total of 222/736 (30%) physicians responded to the survey. The majority of physicians offer a-la-carte (67%), bundled services (69%), grants (57%), and cost/risk-sharing (50%). The majority answered that the single ideal business model is bundled services (53%). There was no significant association between financial package offered and region of practice or state-mandated insurance. The largest barrier to care reported was cost with or without state-mandated coverage (94% and 99%, respectively). The majority of practices are satisfied with their business model (75%). Higher physician satisfaction was associated with private practice [69% vs 27%; OR (95%CI) = 3.8 (1.7, 8.6)], male gender [59% vs 30%; OR = 2.4 (1.1, 5.4)], and offering bundled services [83% vs 59%; OR = 2.8 (1.2, 6.7)].

Conclusions

Physicians utilize a variety of business models and most are satisfied with their current model. Cost is the major barrier to care in states with and without mandated coverage.

Introduction

The cost of treatment has been identified as the greatest barrier to access to infertility care in the USA. The number of in vitro fertilization (IVF) cycles is increasing and the majority of patients undergoing IVF pay out of pocket [ 1 ]. The average cost for a single IVF cycle including medications, oocyte retrieval, and the first embryo transfer is $18,227 (range: $6920–$27,685) [ 2 ]. The high cost has led to disparities in health care and access.

As of 2015, 15 states have enacted legislative mandates with wide variation in policies that cover fertility services to varying degrees [ 3 ]. Tricare and the military health system also provide some services for their insured. However, for the majority of patients that are “self-pay” or receive partial coverage, there are different business models for cost appropriation.

Reproductive endocrinology and infertility (REI) practitioners work in a variety of settings and employ different business models to help create financial opportunities for patients needing IVF [ 4 ]. Details regarding the different types of business models being used have not been described previously. Little is known about actual utilization of shared costs, a-la-carte versus bundled services, use of insurance programs, grants or special discounts offered to different patient groups, and physician satisfaction with the differing models. Ethics of some of these business models has been addressed by the American Society for Reproductive Medicine (ASRM) [ 5 ].

Here, we analyzed the utilization of different business models and their relationship to demographics, practice patterns, physician satisfaction, and barriers to care.

Materials and methods

This study was reviewed by the Institutional Review Board at the University of Texas Health Science Center at San Antonio (UTHSCSA), determined to be exempt, and approved. A national online survey was sent via email to 736 board certified REIs with membership in the Society for Reproductive Endocrinology and Infertility (SREI). Study data were collected and managed using research electronic data capture (REDCap) tools hosted at UTHSCSA. REDCap is a secure, web-based application designed to support data capture for research studies [ 6 ]. The survey included 30 questions designed to assess demographics, practice patterns, and business models utilized. A-la-carte services was defined as fee-for-service where providers are paid for each service performed and services are unbundled and paid for separately. Bundled services was defined as offering several services as one combined package at a fixed price. Cost/risk-sharing included any type of financial risk-sharing program and included financial risk-sharing and refund programs. Grants were defined as non-repayable funds that were distributed or gifted from an organization outside of the practice. The survey was initially sent in May 2017 and closed to enrollment in August 2017. One reminder was emailed. Incentives included a $50 gift card to the first 100 respondents and a random drawing for three computer tablets.

Descriptive statistics were expressed as means ± standard deviation and median (IQR) for continuous variables. Counts with percentages were reported for categorical variables. Differences between those satisfied with current business model and those not satisfied, and those who offered each type of financial package versus those who did not, were assessed using Fisher’s exact test for categorical data and Mann–Whitney test for continuous data. Potential predictors of physician satisfaction were assessed using logistic regression. A p value of < 0.05 was considered statistically significant, testing was two-sided, and SAS Version 9.4 (SAS Institute, Cary, NC) was used.

Demographics

A total of 222 respondents participated in the survey for a response rate of 30%. The majority of respondents were Caucasian (75%) with an average age of 49. Forty-one percent had 20+ years of practice and 59% were in private practice. Respondent’s practice distribution was spread throughout the USA in the South (34%), Northeast (25%), Midwest (21%), and West (20%). The average number of fresh IVF cycles per practice reported to the Society for Assisted Reproductive Technology (SART) in 2015 was 463 and frozen embryo transfers (FET) were 274. Fifty-six percent of respondents were SART practice directors (Table ​ (Table1 1 ).

Demographics among 222 survey participants

Type of practice

The types of practices included the following: 12% of respondents in solo in practice, 79% in group practice, 7% in a multiple-site, single-state conglomerate, and 2% in a multiple site, multiple state conglomerate (Table ​ (Table1). 1 ). If they worked in a group or conglomerate, there were on average 4.7 providers at their primary location. The majority practiced with 1–4 registered nurses (RNs) (42%) and 1–4 medical assistants (MAs) (64%). The largest reported advantage of joining a multi-center conglomerate was business infrastructure (79%) and the largest disadvantage was lack of physician autonomy (87%) (Table ​ (Table2 2 ).

The advantages ( n  = 160) and disadvantages ( n  = 162) of joining a multi-center conglomerate

Financial packages

There are many different types of packages offered to patients throughout the USA. Respondents offer a-la-carte services (67%), bundled services (70%), grants (57%), and cost/risk-sharing (50%). Most believe that the single ideal business model is bundled services (53%; Fig.  1 ).

Current financial packages offered and single ideal business model: most respondents utilize bundled services and a-la-carte services and believe bundled services to be a single ideal business model

Bundled services

For those that offer bundled services, the majority include ultrasound exams, laboratory fees, oocyte retrieval, embryo transfer, intracytoplasmic sperm injection, assisted hatching, and anesthesia. Most clinics do not bundle medications nor pre-implantation genetic testing (PGT) (Table ​ (Table3). 3 ). Inclusion of frozen embryo transfer in the bundled package was not ascertained. In programs that bundle cycles, 74% bundled single IVF cycles and 26% bundled multiple IVF cycles.

Among the 131 who report their practice offers bundled services, what is included?

The most common grant offered was Livestrong (84%). Additional grants offered include Resolve (24%), Pay it Forward (14%), and Other (41%).

Cost/risk-sharing

Cost/risk-sharing was offered by 19% in solo practice and 53% in group practices ( p  < 0.004). In programs offering a refund, 58% offered a refund to less than 5% of patients, whereas only 6% offered a refund to more than 25% of their patients.

Associations with financial packages

Respondents that offer bundled services performed more fresh IVF cycles and FETs per clinic (mean = 515 and 315, respectively, p  = 0.001) compared to clinics that did not bundle (mean = 361 and 185, respectively, p  = 0.002). Similarly, larger-volume fresh and frozen cycles were performed in practices that offered cost/risk-sharing ( p  = 0.007 and p  < 0.001 for fresh IVF cycles and FET, respectively). Furthermore, offering grants was associated with large clinics as evidenced by a greater number of providers, greater number of RN, and higher number or fresh and frozen cycles performed per clinic (data not shown). There was no significant association between region of practice and financial package offered.

State-mandated IVF coverage

The majority of respondents (81%) practice in states without state-mandated IVF coverage. Most respondents (54%) have less than 25% of patients with insurance that covers IVF. Only 7% of respondents have greater than 75% of their patients with insurance that covers IVF. More fresh IVF cycles are being performed in states with mandated IVF coverage (mean = 839) compared to those without mandated coverage (mean = 381; p  = 0.004). Also, more FET are performed in states with mandated IVF coverage (mean = 491) compared to those without mandated coverage (mean = 226; p  = 0.01). There was no statistically significant association between state-mandated coverage and financial package offered.

Barriers to care

In states without state-mandated IVF coverage, cost is the largest barrier to care (99%). In states with state-mandated coverage, the largest barrier is still uncovered costs (94%). To a lesser extent, respondents practicing in states both with and without state-mandated insurance acknowledge other barriers including accommodation (i.e., patient too busy with other commitments), availability (i.e., difficulty getting an appointment), and accessibility (too far/long to get to the clinic) (Table ​ (Table4 4 ).

Barriers to care with and without state-mandated IVF coverage ( n  = 171)

Physician satisfaction

The majority of respondents are satisfied with their business model (75%). Male respondents and respondents in private practice are more likely to be satisfied with their current business model (85% of males vs 62% of females; p  = 0.001). Eighty-eight percent of private practice respondents were satisfied compared to 55% of academic practice respondents ( p  < 0.001). Those satisfied with their current business model perform a higher number of FET/year (mean = 318), compared to those not satisfied (mean = 153; p  = 0.04). The number of fresh IVF cycles was increased for those who reported being satisfied, but the difference was not significant when compared to those that were not satisfied. More satisfied respondents are offering bundled services compared to those that are not satisfied (83% vs 59%; p  = 0.003). Similarly, more satisfied respondents offer grants compared to those that are not satisfied (35% vs 16%; p  = 0.02). There was no association with satisfaction and state-mandated coverage (18% vs 21%; p  = 0.66). Overall, physician satisfaction was associated with private practice [OR (95%CI)] = [3.8 (1.7, 8.6)], male gender [OR (95%CI)] = [2.4 (1.1, 5.4)], and offering bundled services [OR (95%CI)] = [2.8 (1.2, 6.7)].

If not satisfied, why not?

Respondents that are not satisfied with their practice commented on common themes including too much administrative work, bureaucracy, academics, institutional decisions that are not in line with practices’ best interest, not enough support staff, high cost, lack of insurance for patients, poor reimbursement, high overhead, and not enough financial package options for patients.

While success rates with IVF have increased over the years, so too has the cost, especially in cycles with adjuvant procedures [ 2 , 7 ]. IVF centers are utilizing a variety of models to help mitigate the cost to serve both the needs of the patient and the physicians. Those business practice models include a-la-carte pricing (fee-for-service), bundled services (fixed cost), cost/risk-sharing (financial risk-sharing/refund program), and use of insurance and grants. We found state-mandated insurance mitigates, but does not eliminate cost as the major barrier to care.

Numerous financial packages are offered regardless of mandated coverage [ 3 ]. In 2011, Jain reported that 37 states without mandated coverage provided services primarily on a fee-for-service basis [ 8 ]. Our results demonstrate that the majority of respondents are offering bundled services, with the second most common being a-la-carte pricing. The majority believe bundled services to be the single ideal business model. Most that offer bundled services include an expansive package with a minority including medications and PGT. The higher volume clinics are offering bundled services, cost/risk-sharing, and grants.

The high cost and uncertainty in IVF have given rise to cost/risk-sharing programs, including financial risk-sharing or refund programs. Levy et al. compared the results of women treated through a risk-sharing program with those utilizing fee-for-service. They found that if a patient has a live birth after one cycle, the price would be greater for fee-for-service, after two cycles the prices would be equivalent and after three cycles, the couple would save money using a risk-sharing program. They also noted high patient satisfaction with the risk-sharing program [ 9 ]. Stassart et al. also reported their initial experience with an uncomplicated risk-sharing program in women less than 35 years of age. The program included the cost of medications and provided a full refund if no live birth occurred. In 2006, their risk-sharing program cost $25,000, representing essentially the same revenue if all the services had been provided as fee-for-service and double that amount charged to a patient for a single fresh IVF cycle [ 10 ]. A recent news article highlighted a cost-sharing program where three women split 21 eggs from a single donor and discussed that such business models are changing the American family in “new and unpredictable ways” [ 11 ].

ASRM reviewed the ethics of “risk-sharing” in a committee opinion statement. They concluded that it is an option that maybe ethically offered to patients when criteria for enrollment and success is clearly stated; there is full disclosure of advantages, disadvantages, and alternatives; and the program operates within the ASRM practice guidelines [ 5 ]. We found that 50% of respondents are employing the cost/risk-sharing programs in their practice, but only 17% believe this to be the ideal business model. Physicians in solo practice are less likely to offer cost/risk-sharing. There is little published literature about the percentage of patients receiving a refund from this model. One company’s case series reported that 20% of the patients received a refund when they did not conceive [ 12 ]. Our study shows that the majority (58%) give a refund to less than 5% of their patients. Future studies are needed to assess clinic requirements for eligibility into their cost/risk-sharing program and its effect on increasing access to care for patients.

The association between state-mandated coverage and practice patterns including a tendency for lower number of embryos transferred and a lower multiple birth rate has been well documented [ 8 ]. Our study confirms that a greater number of IVF cycles and FETs are being performed in states with mandated IVF coverage and is consistent with prior reports that state-mandated coverage has been shown to increase approximately threefold the utilization of infertility services [ 13 ]. However, we did not find any association between different financial packages offered in states with versus without mandated IVF coverage. There are differences in IVF practices in states with versus without mandated insurance coverage, but no differences in the business models utilized.

In our study, 74% reported being satisfied with their current practices business model. When asked about the reason if they were not satisfied, answers included common themes involving institutional bureaucracy, cost, not enough support staff, and academics. Barnhart et al. found a high degree of professional satisfaction and morale in the field with the most satisfying part of the job being patient interactions and the least satisfying part of the job being the work schedule [ 4 ]. We report that being satisfied with the practices’ business model was associated with male gender, private practice, and offering bundled services. It is logical that those physicians offering bundled services are more satisfied as they can focus on providing the best care for the patient with less concern on the exact cost to that patient for individual interventions. Gender differences in facets of career satisfaction have been evaluated previously [ 14 , 15 ]. One study reported high overall career satisfaction for men and women, but when compared to men, women were less satisfied with career-advancement opportunities, recognition, and salary [ 14 ]. The significance of our findings is unclear, but women and those practicing in academic practice are less satisfied with their current business model. Although respondents were specifically asked about physician satisfaction with their business model, we do recognize that factors not associated with payment types could have affected this such as satisfaction with other components of their job.

Limitations

The limitations of this study arise from this being an anonymous survey. Multiple physicians from one practice could have potentially responded to the survey. If so, the reflection of business models across the country could be skewed. However, physicians from the same clinic may have diverse perspectives on the business. In an attempt to keep to the survey anonymous, clinic information was not obtained. Also, respondents were asked what services they offered, and not whether the patient actually utilized that service. Potentially, this could have yielded different responses. The response rate is 30% which is relatively low, but similar to another published SREI survey [ 4 ]. As discussed by Barnhart et al., response rates for workforce surveys are often low because physicians are busy or there is a fear of sharing personal information [ 4 ]. We also chose to limit the number of questions to 30 to balance response rates and information acquired as greater than 25–30 questions can discourage respondents [ 16 ].

Another limitation is the definition of “state-mandated coverage,” which varies by state in terms of eligibility, amount of money allocated, and mandate to “offer” versus “cover.” For example, California excludes IVF but covers gamete intrafallopian tube transfer, Arkansas limits IVF coverage to a lifetime maximum of $15,000 if all other criteria or meet, and Illinois and Maryland allow businesses with 25 or 50 or fewer employees, respectively, to be exempt from providing IVF coverage [ 17 ]. More studies are needed to delineate details on state-mandated coverage, different business models to address uncovered costs, and financial viability. The strengths of this study included utilization of a well-respected national group of physicians, good statistical design, and the novel information yielded.

Building a family with IVF is a financial challenge. Physicians believe that cost is the major barrier to care in states with and without mandated coverage. Physicians utilize a variety of business models and most are satisfied with their current model. Larger-volume clinics utilize bundled services, cost/risk-sharing, and grants. Higher physician satisfaction was associated with private practice, male gender, and offering bundled services.

Acknowledgements

The project was also supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2 TR001118 (JFK). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

The project described was supported by the 2016 Vivere Scientific Advisory Board Research Grant (JEM).

Compliance with ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Conflicts of interest

The authors declare that they have no conflict of interest.

The material contained in the manuscript has not been published, has not been submitted , or is not being submitted elsewhere for publication. All authors are in agreement to submission of this manuscript.

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The IVF Process from Start to Finish: Creating a Reliable IVF Calendar & IVF Timeline

Planning for an infertility treatment like in vitro fertilization (IVF) is a significant step toward realizing your dream of becoming a parent—and it takes time, energy, and considerate planning. An IVF cycle calendar is one tool that can help. 

Whether you’re considering IVF as an option, have just started your IVF journey, or are well into the process, creating an IVF calendar can help you know what to expect of your treatment so that you can better plan for and manage your treatment—and ultimately achieve a successful pregnancy.

How do you determine an IVF calendar? 

Like many infertility treatments, IVF often involves a complex of hormone therapies, medications, and coordinating fertility treatments. With so many moving parts and diverging timelines, creating an IVF timeline calendar isn’t quite as simple as mapping out the IVF cycle itself. 

The IVF process from start to finish depends on your specific goals and infertility diagnoses. Some intended parents, for example, might be using an egg donor , sperm donor, or gestational carrier to build their family with IVF. This involves coordinating with a surrogacy agency, egg donor program, or sperm bank; choosing your donor or surrogate, and legally securing the third party. 

The timeline for this process varies widely, ranging anywhere from two weeks to secure a sperm donor to several months to secure a gestational carrier —depending on factors like your family’s personal third-party requirements, the availability of donors or gestational carriers, and whether you’re working with an external or in-house donor program .

Another preliminary process is pre-genetic carrier screening . Some parents choose to test their carrier status for genetic health conditions, either informing their donor selection or their selection of a healthy embryo later in the process. Depending on your IVF centre, it typically takes 1–2 weeks to receive these test results. 

When it comes to the IVF cycle itself, there is still plenty of timeline variability from one family to the next—depending on personal health factors, third-party factors, and whether your treatment involves a fresh or frozen embryo transfer . 

Your fertility specialist will help you create a more precise timeline, but to begin creating an IVF calendar or to get a general sense, you can work from the time ranges involved in a typical IVF cycle, which begins in coordination with your menstrual cycle.

What does a realistic IVF calendar look like?

A full round of IVF spans one menstrual cycle (1 month) for a fresh embryo transfer and at least two menstrual cycles (2 months) for a fresh cycle followed by a  frozen embryo transfer cycle. 

Frozen embryo transfer (FET) is the more common option for several reasons, including lower cost, reduced strain on the parent’s body, the option for preimplantation testing of embryos (PGT) , and the potential for multiple embryos which can be cryopreserved .

After retrieving and freezing embryos, intended parents can choose to wait any amount of time before beginning the FET cycle, but for the sake of presenting one continuous IVF calendar and timeline range, we’ll walk through the stages of the IVF cycle assuming no additional waiting times.

Assuming Day 1 is the first day of your menstrual cycle, here’s what a typical IVF calendar will include:

Ovarian Stimulation : The IVF cycle starts with a 9–15 day period of ovarian stimulation, using hormone injections called gonadotropins or follicle stimulating hormones, to produce multiple follicles and allow as many eggs as possible to mature for retrieval from the ovaries. Sometimes birth control pills or estrace are prescribed for you to take prior to starting the follicle stimulating hormones.

Monitoring : Throughout the ovarian stimulation phase, regular monitoring through ultrasounds and blood tests is conducted to track follicle growth and hormone levels and to inform any adjustments to medication dosages or changes in your IVF calendar.

Trigger Injection : Once a sufficient number of follicles have reached maturity, a different gonadotropin injection is administered to induce final egg maturation. 

Egg Retrieval : The egg retrieval procedure is performed as an outpatient procedure under sedation or anesthesia. A needle is used to extract the mature eggs from the ovaries. 

Sperm Collection and Fertilization : Sperm is either collected on the same day as the egg retrieval or cryopreserved earlier for later use. Once the eggs are retrieved and the sperm collected, both are transferred to an embryology lab where they are fertilized and closely monitored by embryologists. 

Beginning of Embryo Culturing : Once fertilized, the embryos are cultured in the lab for 5–7 days, until they reach the blastocyst stage, at which point embryologists evaluate the embryos’ quality to determine which can be used. At this point, viable embryos can either be transferred back into the uterus directly or frozen for FET and/or PGT.

Day 20–27 (Optional – FET only)

Preimplantation Genetic Testing (PGT) : Often informed by a genetic risk found during the earlier carrier screening, PGT allows parents to test the carrier status and chromosomal health of each embryo . The embryos are biopsied and sent into a lab for testing, which typically takes 1–2 weeks.

Beginning of Uterine Preparation : In the case of an FET, the parent or gestational carrier undergoes 3–4 weeks of hormone treatments to enhance the uterine receptivity and support the early stages of pregnancy. This involves 2–3 weeks of estrogen treatments, followed by progesterone. 

The embryo transfer is commonly done on the 6th day of progesterone. For a fresh embryo transfer, progesterone treatment is typically started within 24 hours of the egg retrieval and continues throughout the first trimester.

Embryo Transfer : On the 6th day of progesterone treatment, the fresh or thawed embryo is transferred to the uterus.

Pregnancy Test : Approximately 10–14 days after the embryo transfer, a blood test is performed to determine if pregnancy has been achieved.

How long do you have to wait after a failed round of IVF?

Experiencing a failed round of IVF—whether at the egg retrieval or embryo transfer stage—can be very discouraging and emotionally painful. Fortunately, there are often several treatment adjustments and therapeutic additions that can be made to increase odds of success in the next round. Before beginning the next IVF cycle attempt, it’s important to wait at least one menstrual cycle. 

This waiting period, which typically amounts to about 4 weeks, allows the body to recover from the hormonal stimulation and any procedures associated with the previous cycle, ensuring a more stable and receptive uterine environment for the next attempt.

Like most aspects of your IVF calendar, it’s important to note that the specific waiting time may be different for each person, and your fertility specialist may recommend more based on your medical history and the reasons for the previous IVF failure.

Creating an IVF Calendar with ICRM

No matter where you find yourself on your fertility journey, the Idaho Center for Reproductive Medicine is here to provide support, guidance, and tailored treatment for your unique family. 

During an IVF treatment with ICRM, our dedicated coordinators work closely with you to create and maintain an IVF calendar, schedule appointments, and navigate the intricacies of your treatment to help you achieve a successful pregnancy. 

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Attention New Patients

Beginning September 1, 2024 we will require a card placed on file to secure all New Patient Appointments.

Changes to our cancelation policy, effective September 1, 2024: If you do not show up for your appointment or cancel your appointment 48 hours before your actual appointment time, a $100.00 charge will appear on your card statement.

Attention Patients

We’d like to inform you about an important change in our payment processing procedures at ICRM. As part of our ongoing efforts to streamline operations and ensure the sustainability of our business, we have partnered with Freedom Payments to introduce new processing solutions.



To effectively manage rising costs without increasing prices across our services, we will be implementing a 3% processing fee on all credit card transactions, effective July 1,2024.



Our decision to partner with Freedom Payments was driven by their commitment to supporting our community and veterans. Freedom Payments generously donates 10% of the fees we pay to them to the Idaho Backcountry Veterans organization. We believe that by choosing a processing provider that benefits our community and veterans, we have struck an optimal compromise that aligns with our values.



At ICRM, we remain committed to providing you with exceptional patient care. We understand that changes like these can sometimes be inconvenient, and we sincerely appreciate your understanding and continued support. We firmly believe that this partnership will enable us to maintain the quality and value you have come to expect from us.



Should you have any questions or concerns regarding this change, please do not hesitate to reach out to our patient services team at 208-342-5900. We are here to assist you and provide any clarification you may require.



Once again, we want to express our gratitude for your support. Your support is vital to our success, and we look forward to serving you for many years to come.

Sincerely, Administration at Idaho Center for Reproductive Medicine

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As an academic affiliate of the UConn School of Medicine, we are experts in the latest technologies and treatments in family building and infertility. This allows us to offer many advanced techniques to help patients achieve successful pregnancies. We promise to deliver the very highest standard of care in a supportive and caring environment. 

As one of the leading fertility programs in the country, we focus on what you want most: family.

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Fertility Center

Infertility services: in vitro fertilization (ivf).

In vitro fertilization (IVF) is a procedure designed to improve fertility in patients who have not been successful with  ovulation induction  or  intrauterine insemination , or who are not candidates for those more conservative treatments. Eggs are surgically removed from the ovaries and fertilized with sperm in a laboratory environment. The fertilized egg, i.e. embryo, is then transferred into the uterus.

Who are good candidates for IVF?

• People who have absent or blocked fallopian tubes
• People who have  endometriosis  and haven’t been able to achieve pregnancy after medical or surgical treatment
• People who have ovulatory dysfunction who haven’t been able to achieve pregnancy after regular ovulation induction
• People experiencing  unexplained infertility
• People whose partner has a very low sperm count
• People interested in  preimplantation genetic testing (PGT)  for chromosomal or genetic reasons

At the Johns Hopkins Fertility Center, we pride ourselves on our dedication to helping you achieve your family building goals. We have a particular interest in helping people who have had extensive challenges, possibly deemed "poor responders" and/or people with baseline elevation of the follicle-stimulating hormone. We will exhaust all of our efforts to assist our patients with having their own biological child.

What is the IVF process?

Follicular development . In order to stimulate follicles in the ovaries to produce healthy, mature eggs, a patient receives injectable hormones administered at home for an average of 11 days. (The Fertility Center provides orientation classes to help couples become comfortable with this process.) Intensive follow-up every one to three days by blood test and ultrasound are important for appropriate medical treatment. The eggs develop inside fluid-filled cysts called follicles. Once the follicles reach maturity, the patient receives a different hormone to complete the maturation of the eggs. This is also administered at home by injection.

Egg retrieval . Egg retrieval can be performed on an outpatient basis, while the patient is under light sedation. Using ultrasound guidance, the follicles (containing the egg) are aspirated through the vagina to identify mature eggs.

Sperm preparation and egg fertilization . After the eggs are collected and classified, fertilization takes place using partner or donor sperm. Fertilization is carried out by conventional IVF (sperm and egg are combined in the lab using a special culture medium), providing that semen parameters are normal.

Embryo transfer . Once embryo development is confirmed, we will proceed with the embryo transfer. Embryo transfer is a process to place embryos into the uterine cavity by using a fine catheter that is passed through the cervix. The embryo transfer procedure is guided by a trans-abdominal ultrasound five days after the egg retrieval, at the blastocyst stage. Any remaining embryos can be cryopreserved (frozen) in the lab for future use, if desired. The Johns Hopkins Fertility Center adheres to the American Society for Reproductive Medicine Guidelines on the number of embryos to transfer.

Pregnancy testing . The first pregnancy test is usually performed approximately 10 days after embryo transfer by blood testing. Pregnancy hormone levels are monitored by blood testing every few days in the early stages of pregnancy, followed by ultrasounds once the pregnancy is further developed. At some point before 10 weeks of gestation, you will be discharged to the care of your obstetrician for the remainder of the pregnancy.

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Intro to IVF

IVF is a scary term for many, largely because it can seem so technical and mysterious. Let’s help demystify the process with a simple guide to IVF: what it is, how it works, and what it means for you.

IVF Process Overview: The Big Picture

While it can seem complex, the IVF process can be broken down into a few main parts:

Pre-IVF Requirements

Complete required tests to ensure patient safety, suitability, and legal compliance for treatment

Stimulate the Ovaries & Retrieve Eggs

Use medication to gently stimulate the ovaries to produce eggs, monitor progress, then retrieve the mature eggs

Fertilize Eggs, Culture and Test Embryos

Fertilize the retrieved eggs, then help the new embryos develop before testing their quality and freezing them for transfer

Prep the Uterus and Transfer Embryo

Readying the uterus to receive the embryo, then transferring the ideal embryo to achieve pregnancy

IVF Sample Timeline

Get a sense for how the IVF process works, the days you’ll need to be in-office, and timing of procedures with our illustrative guide to the IVF process

Note: Timelines are illustrative; your cycle(s) will be personalized to meet your needs.

Want to see if you’re a fit for PRP?

Click here to schedule time with a provider to learn more about PRP and the treatment packages we offer that include it.

Want to learn more?

We want our patients to feel as informed and prepared as possible at each step of their journey. Click below to learn about the patient process at Life IVF Center.

Don’t just take our word for it.

What patients are saying

Dr. Yelian and the staff at Life IVF were very professional and we’re just as dedicated as I was to becoming pregnant, they take the work that they do very seriously and you can see that everyone there loves what they do. I had a successful transfer my first time and got twins.

A.T. IVF Patient California, USA

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Life IVF Center Accessibility Statement

Accessibility Statement

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• September 9, 2024

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We firmly believe that the internet should be available and accessible to anyone, and are committed to providing a website that is accessible to the widest possible audience, regardless of circumstance and ability.

To fulfill this, we aim to adhere as strictly as possible to the World Wide Web Consortium’s (W3C) Web Content Accessibility Guidelines 2.1 (WCAG 2.1) at the AA level. These guidelines explain how to make web content accessible to people with a wide array of disabilities. Complying with those guidelines helps us ensure that the website is accessible to all people: blind people, people with motor impairments, visual impairment, cognitive disabilities, and more.

This website utilizes various technologies that are meant to make it as accessible as possible at all times. We utilize an accessibility interface that allows persons with specific disabilities to adjust the website’s UI (user interface) and design it to their personal needs.

Additionally, the website utilizes an AI-based application that runs in the background and optimizes its accessibility level constantly. This application remediates the website’s HTML, adapts Its functionality and behavior for screen-readers used by the blind users, and for keyboard functions used by individuals with motor impairments.

If you’ve found a malfunction or have ideas for improvement, we’ll be happy to hear from you. You can reach out to the website’s operators by using the following email

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Our website implements the ARIA attributes (Accessible Rich Internet Applications) technique, alongside various different behavioral changes, to ensure blind users visiting with screen-readers are able to read, comprehend, and enjoy the website’s functions. As soon as a user with a screen-reader enters your site, they immediately receive a prompt to enter the Screen-Reader Profile so they can browse and operate your site effectively. Here’s how our website covers some of the most important screen-reader requirements, alongside console screenshots of code examples:

Screen-reader optimization: we run a background process that learns the website’s components from top to bottom, to ensure ongoing compliance even when updating the website. In this process, we provide screen-readers with meaningful data using the ARIA set of attributes. For example, we provide accurate form labels; descriptions for actionable icons (social media icons, search icons, cart icons, etc.); validation guidance for form inputs; element roles such as buttons, menus, modal dialogues (popups), and others. Additionally, the background process scans all of the website’s images and provides an accurate and meaningful image-object-recognition-based description as an ALT (alternate text) tag for images that are not described. It will also extract texts that are embedded within the image, using an OCR (optical character recognition) technology. To turn on screen-reader adjustments at any time, users need only to press the Alt+1 keyboard combination. Screen-reader users also get automatic announcements to turn the Screen-reader mode on as soon as they enter the website.

These adjustments are compatible with all popular screen readers, including JAWS and NVDA.

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Users can also use shortcuts such as “M” (menus), “H” (headings), “F” (forms), “B” (buttons), and “G” (graphics) to jump to specific elements.

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• Epilepsy Safe Mode: this profile enables people with epilepsy to use the website safely by eliminating the risk of seizures that result from flashing or blinking animations and risky color combinations.
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• Keyboard Navigation Profile (Motor-Impaired): this profile enables motor-impaired persons to operate the website using the keyboard Tab, Shift+Tab, and the Enter keys. Users can also use shortcuts such as “M” (menus), “H” (headings), “F” (forms), “B” (buttons), and “G” (graphics) to jump to specific elements.

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We aim to support the widest array of browsers and assistive technologies as possible, so our users can choose the best fitting tools for them, with as few limitations as possible. Therefore, we have worked very hard to be able to support all major systems that comprise over 95% of the user market share including Google Chrome, Mozilla Firefox, Apple Safari, Opera and Microsoft Edge, JAWS and NVDA (screen readers), both for Windows and for MAC users.

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Despite our very best efforts to allow anybody to adjust the website to their needs, there may still be pages or sections that are not fully accessible, are in the process of becoming accessible, or are lacking an adequate technological solution to make them accessible. Still, we are continually improving our accessibility, adding, updating and improving its options and features, and developing and adopting new technologies. All this is meant to reach the optimal level of accessibility, following technological advancements. For any assistance, please reach out to

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We had various medical treatments without any success in our country, so we decided our only option left was to have IVF with an egg donor. To be able to choose the donor by ourselves, based on pictures, in a big European database was very important for us. The staff, receptionists, translators, medical professors were first-class. The clinic helped us to organize all that we required for the travel, which took the stress away and supported us for the time we spent there. The clinic was clean, well-organized, and modern. In conclusion, we had an enjoyable stay in St Petersburg, a warm welcome from the staff of the clinic, and the most important, the success with the pregnancy. So we highly recommend this clinic!

I'm writing this review with the most precious gift in my arms, my much longed for baby girl, who was born in March of this year, thanks to the wonderful treatment and care that I received from the team at NGC. For the first time during my years of treatments I felt that I was really being listened to and my concerns being addressed. No stone was left unturned! I found the clinic to be impressive and immaculate and so much more modern and advanced than previous clinics I had been treated at in the UK. I fell pregnant that first cycle and was over the moon. I will forever be so very grateful for the care and support received at NGC and I simply can't recommend them enough!

When we wanted a sibling for our daughter we turned to NGC in St.-Petersburg. Alex from NGC was very helpful in providing us with information, egg donors, pricing and logistics. He set us up with Dr Valentina Denisova who gave us an hour of her time and explained and advised us on the medical possibilities, requirements and procedures of the NGC via video conference. We welcomed our healthy, hungry, noisy son on our 1st try with NGC and recommend them highly. We are very impressed with and are extremely thankful to the NGC doctors, staff and coordinators, their new facilities, the customer care and coordination and of course our all success!

I couldn't recommend Next Generation Clinic more! The facilities are state-of-the-art and every member of staff has been polite and professional. The communication (in perfect English, as we unfortunately don't speak Russian) has always been prompt and reliable, thanks to fantastic Alex who has been helpful all along. Dr Valentina Denisova and the embryology team have done an excellent job. I got pregnant following the first embryo transfer, we are grateful!

Firstly I would like to thank Alex and Dr Valentina for the level of care and compassion shown to me throughout our IVF journey. The communication and response time was second to none. Replies within the hour! Dr Valentina was very reassuring when I become anxious or I had any sort of worries/concerns, she always put me at ease answering any questions I may of had. The clinic facilities are very state-of-the-art. Clean, modern just as you see in the pictures on their website. I am currently pregnant with my first frozen transfer. I will be eternally grateful to the team at Next Generation Clinic.

We are so thankful for everything. This is our 1st IVF, and we are glad it was successful. God bless you all!

We had directly a good feeling when talking to the international manager of NGC who was very helpful, reliable and fast to answer any question we would have. I gave birth in spring 2022 to a healthy baby. This pregnancy and birth happened thanks to NGC, and we are really grateful to them. We would certainly recommend NGC.

We travelled from Ireland to have our IVF treatment in 2022, and I am pleased to say that it was a fantastic experience. The team at NGC clinic provided exceptional care and attention. The doctors and staff were all incredibly knowledgeable and supportive throughout the entire process. I felt comfortable and informed at all times. The facilities and equipment at NGC clinic are top-notch, and I felt confident that I was in good hands. Most importantly, the IVF treatment was successful, and I am now expecting a healthy baby. I can't thank the team at NGC clinic enough for their expertise and care.

Best clinic ever, dreams come true here. If you want to achieve the result at your first attempt, this is where you should go. The doctors were absolutely amazing, Ksenia and Alexander were simply the best. Everyone is always willing to help and answer all your questions. The staff controls everything to make your journey smooth and productive. I do highly recommend NGC. This is a place where miracles happen. Thanks to the whole team that helped me. I’m forever thankful.

"All in all, an exceptional experience." After we had experiences with fertility clinics in three different countries in Europe (two of them in the EU), we chose Next Generation Clinic (NGC) in St. Petersburg, Russia. Our choice was initially based on the fact that they offer a large database of donors. Donors are often already genetically screened, and the process of getting the biological material is significantly easier than in other places.

We were really satisfied with the treatment, and support. The response time is very short and communication is easy, professional and to the point. Whenever we travelled to St. Petersburg, the clinic organized our transportation to and from the airport at their expense and helped us with the best money exchange place. The clinic offered great care and a personalized treatment plan that was well-rooted in the care of the patient in the first place. We are planning to go for a second child since we are currently pregnant with a girl and we are hoping for a boy as well.

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What will happen to the Bay Area’s millions of…

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What will happen to the bay area’s millions of square feet of closed mall space, san leandro’s bayfair center is the latest example of how former shopping centers are being reimagined.

Developers plan to replace the mall with the Speedway at Bayfair, a 400,000-square-foot redevelopment project  at the former shopping epicenter at East 14th Street and Hesperian Boulevard that will offer research and development space for Bay Area tech companies .

It’s the latest example of how the Bay Area’s huge commercial spaces, once packed with chain stores and food courts when malls ruled the shopping landscape, are being reimagined in the post-Amazon age.

“It’s been great because the project has a ton of good infrastructure,” said Steve Kapp, Speedway’s project manager and B3 Investors’ executive managing director. “When I say that, I mean it has very heavy amounts of power there and tons of air conditioning. Those two things are key for cooling in R&D spaces.”

The Bayfair Mall opened in 1957; built for $25 million, it boasted more than 80 stores at its peak and was able to accommodate 15,000 cars in its parking lot, according to an Aug. 8, 1957 San Francisco Examiner article on the store’s opening. The mall once featured leading American department stores like Macy’s, Target and Kohl’s.

But Bayfair has watched those stores close over the past decade—as did other once-popular Bay Area shopping centers, including the Hilltop Mall in Richmond and the Vallco Shopping Mall in Cupertino, which have closed as online retail grew to dominate the retail marketplace, making trips to department stores in malls obsolete .

In July 2022, the Bayfair Mall’s owner, Madison Marquette, along with affiliate Newmark, sold the 42-acre property for $57 million to B3 Investors with plans to redevelop the aging shopping center.

The mall’s interior officially closed in early 2023, but the loss of Macy’s in April 2024 – a store that had been a tenant since the mall opened in 1957 – marked a turning point as developers focused on creating a new iteration of the property.

“Looking at as closing down a mall is not the right way to look at that property,” said Nancy Wallace, a UC Berkeley professor of real estate and sustainability.

Wallace has turned Bayfair into a literal textbook example of what is happening to former malls—she uses the Speedway redevelopment project as a model for her students to learn about adaptive reuse, turning empty storefronts into homes, labs and startups.

Wallace said dead malls across the Bay Area and beyond are finding new life as redevelopment projects that seek to address a new set of community needs such as housing, transit-oriented development and office space for emerging industries.

“This is a huge effort to build a great deal of housing, including workforce housing. The core lab is part of the economic motivation for all of this,” Wallace said. “The fact that they have already redeveloped the Macy’s site with paying tenants and turned those empty comic book stores into high functioning tech space filled with Stanford and Berkeley PhDs is amazing.”

In the South Bay, the city of Cupertino agreed in July with the owners of the Vallco Mall property to permit the construction of 2,700 housing units , with about a third set aside for affordable housing. And Prologis, a San Francisco-based real estate company that owns Hilltop Mall in Richmond, hopes to create a data center, a transportation hub and hundreds of housing units in collaboration with the city’s specific plan to redevelop the 145-acre area around the mall.

The opening of Speedway at Bayfair will also work in coordination with San Leandro’s Bay Fair Transit Oriented Development plan. The city of San Leandro aims to leverage 150-acres surrounding the Bayfair BART station to foster a mixed-use community, create public spaces and enable a “range of development scenarios,” according to Bayfair planning documents .

As stores left the Bayfair Mall, the city of San Leandro gained more leverage to create flexible zoning for mixed-use development that utilizes pre-existing transit lines, said San Leandro Assistant Community Development Director Avalon Schultz.

“We saw a chance to rezone and provide property to evolve away from strict mall uses,” Schultz said. “The Bayfair plan, in coordination with Alameda County, was really looking at how to build on this prime location next to BART and turn it into a mixed-use transit village.”

BART has already taken notice of the progress at Bayfair. A 2024 update to BART’s transit development plan showed the Bay Fair station was re-evaluated from a mid-term project to a short-term project, citing the Bay Fair station’s high rankings in development streamlining, market readiness for offices and development capacity.

Phase I of the Speedway at Bayfair is already complete, with numerous Bay Area biotech and green energy companies moving into 140,000 square feet of renovated office space, Kapp said. Charge Robotics, a green tech company specializing in automating solar installation, has moved into the former mall where residents used to purchase corndogs and bedazzled shirts.

“With Macy’s going out, that is part of the second phase, and that’s another 250,000 square feet available starting in 2025,” Kapp said. “I think it’s going to become a nice mixed-use project for innovative projects for companies that are seeking affordable space with lots of power.”

Developers have already reinvented one shopping mall in San Leandro called Gate 510, a 300,000-square-foot biotech campus on 1900 Davis St. While the projects have some similarities, Kapp said Speedway at Bayfair has more retail amenities that make the redevelopment project a true campus for the surrounding community.

“When B3 bought the mall in 2022, they had already proved they could be really creative with redeveloping properties in San Leandro because of their Gate510 site,” Schultz said. “It was exciting to see how they wanted to invest in the interior of the mall to create Speedway. This building has been changing and evolving over time. It’s never been one thing.”

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