Fertile Ground

​Between 2004 and 2018, demand for in vitro fertilization increased almost 140%. Over the same period, for-profit IVF chain clinics’ market share grew from 5% to 20%, with chains performing over 40% of treatment cycles nationwide.

Policymakers worry chains will chase profit at the expense of patient outcomes. But clinics acquired by a chain actually serve more patients and increase IVF treatment cycles by 27%, according to a new study by Assistant Professor Ambar La Forgia.

La Forgia and her co-author examined two main outcomes: The number of IVF cycles each clinic performed and their live birth rates. IVF treatment cycles are comprised of five main stages with 100 distinct steps performed over four to six weeks, which require many subjective decisions to produce healthy babies.

After a fertility chain acquires a clinic, IVF cycles increase dramatically, and live birth rates increased by 13.6%. La Forgia also found that chains are producing more “singleton” births—the birth of one baby—than their independent clinic peers, suggesting better embryo selection.

They found outcomes improved for two reasons: availability of more resources and a heavier focus on sharing best practices. Chains tend to introduce new processes and procedures known to improve birth rates. In fact, the lowest-performing clinics see the largest improvements when chains take over, and clinics acquired by the highest-performing chains experience the greatest improvements.

Most notably, researchers found that affiliated IVF clinics, which pay chains for management support and financing but retain managerial independence, witness an increase in patient volume and number of IVF cycles—but not birth rates.

Chains also expand the market and increase access to IVF rather than stealing business from competitors.

As other healthcare—including dermatology, urgent care, and physical therapy—shifts toward a retail model, the researchers recommend that policymakers should increase transparency about chains’ quality of care and price, which could increase competition.

“Very little research speaks to the ways in which chains are good or bad for patients,” La Forgia says. “We ought to start paying attention to what kinds of markets might lend themselves well to this business model.”