Fertility
How chain IVF clinics improve infertility treatment
In the U.S., demand for in vitro fertilisation (IVF) increased almost 140 per cent between 2004 and 2018, with chains now performing over 40 per cent of IVF treatment cycles nationwide.
The new study by La Forgia provides a more optimistic view in the case of fertility clinics, suggesting chain ownership has improved results. The researchers found that clinics acquired by a chain serve more patients, increasing IVF treatment cycles by 27 per cent, and they increase live birth rates by nearly 14 per cent.
“Chain organizations are very common in hotels and restaurants,” says Ambar La Forgia, an assistant professor at the Haas School of Business, UC Berkeley. “But when it comes to healthcare, because it hasn’t traditionally been delivered in this way, it seems to be making a lot of people uneasy.”
Policymakers are particularly concerned that chains will chase profit at the expense of patient outcomes.
The study has been published in Management Science and co-authored by Julia Bodner of Copenhagen Business School.
Significant improvement with chain clinics
IVF treatment cycles comprise five main stages that require over 100 distinct steps performed over four to six weeks. Along the way, many subjective decisions must be made.
The goal, of course, is to produce healthy babies, and the last step—when a physician transfers an embryo, or embryos, into a patient’s uterus—is particularly important. Transferring more than one embryo increases the success rate, which is measured by the number of live births divided by number of transfers, but it also increases the chance of multiple births, like twins, which is riskier for both the mother and the newborns.
To compare the performance of chain and independent clinics, La Forgia and Bodner collated a novel set of clinic and patient data that drew from the Centers for Disease Control, and the National Center for Health Statistics.
They also manually checked the ownership of every fertility clinic in the U.S. From this effort, they were able to look at two main outcomes between the years 2004 and 2018: How many IVF cycles does each clinic perform? And what is the success rate, measured by live births per transfer?
The researchers found that after a fertility chain acquires a clinic, IVF cycles increase dramatically and live birth rates increase by 13.6 per cent.
“This means that these chain clinics are doing more cycles of IVF and converting more of those cycles into live births,” La Forgia says. “They are actually improving the quality of care in a meaningful way.”
Chain clinics are not doing this by simply transferring a lot more embryos, either. La Forgia and Bodner find that they are actually producing more “singleton” births—that is, the birth of one baby—than their independent clinic peers, which implicitly suggests a better embryo selection process.
A product of more resources and knowledge
But what if these results are driven by a more stringent patient screening process, or by chains being more selective about the markets in which they operate?
La Forgia and Bodner investigated these possibilities and found no supporting evidence. There is no appreciable change in the patient population after a chain takes over an independent clinic. In fact, the largest improvement in live births is among patients who are 38 years old and older—the population that typically has the lowest success rates. Nor are their significant differences in the broader demographics of neighborhoods in which chain clinics operate, the researchers found.
Instead, it appears that chains improve outcomes through two mechanisms: the availability of more resources and a heavier focus on sharing best practices. The researchers make this case through several analyses. For instance, chains tend to introduce new processes and procedures known to improve birth rates. In fact, the lowest-performing clinics see the largest improvements when taken over by a chain, and clinics acquired by the highest-performing chains experience the greatest improvements.
Most notably, the researchers found that affiliated IVF clinics, which pay chains for select management support and financing options but retain managerial independence, witness an increase in patient volume and number of IVF cycles, but unlike fully acquired clinics, they don’t demonstrate an improvement in birth rates.
“Basically, in affiliated clinics the number of live births is going up as an absolute value, but they’re not getting better at achieving live births,” La Forgia says. “Our hypothesis is that a chain is willing to share its resources widely, but it may not want to share specific knowledge with an organisation it doesn’t own, so we’ll only see this knowledge transfer in acquired clinics.”
The authors demonstrated a final benefit of chains, which is that they increase access to IVF by expanding the market—performing more IVF cycles—rather than stealing business from competitors.
Supporting a better healthcare market
Some of the findings may be explained by the fact that compared with many other parts of the healthcare system, fertility clinics share some characteristics with retail stores and chain restaurants. It’s a relatively more competitive market and patients typically pay up front and out-of-pocket for care.
Clinics are also legally required to send their data to the government. Other sectors like dialysis and nursing care are more opaque and dependent on insurance, so chains may have fewer incentives to improve quality of care. But the researchers point out that plenty of health care is shifting toward a retail model, including dermatology providers, urgent care clinics, and physical therapists.
The authors offer three recommendations to help these markets support the kind of competition that ultimately improves patient outcomes.
- Policymakers should increase transparency about quality of care. In the fertility sector, clinics are legally required to send their data to the government, which publishes them as an online report card, so patients can shop around.
- Price transparency is necessary to increase competition among providers. In most healthcare settings, patients do not know how much they will pay, often until months after treatment. Since patients typically pay up front for fertility treatments, clinic chains may compete more on prices to attract new patients.
- Finally, regulators should make sure patients have sufficient choice. In the dialysis market, for instance, two companies own 60% of clinics. Such concentration of power may negatively affect both prices and quality. As chains expand, regulators should make sure this growth doesn’t hinder patient choice.
“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.”
Article produced in association with London Pregnancy Clinic and Jeen Health
For the majority of couples planning a pregnancy, genetic testing is not something they think about until a problem arises.
Pre-conception genetic carrier screening challenges this approach by identifying risk before pregnancy begins.
As panel sizes have grown and at-home testing options have become widely available, carrier screening is transitioning from a niche clinical referral into a mainstream component of reproductive planning.
What Carrier Screening Tests For
Being a carrier of a genetic condition means carrying one copy of a variant in a gene associated with that condition, without being affected by it.
In most cases, carriers are entirely unaware of their status.
The clinical significance of carrier status emerges when both members of a couple carry a variant in the same gene: in this scenario, each pregnancy carries a one in four chance of resulting in a child who inherits two copies of the variant and is affected by the condition.
The conditions most frequently included in expanded carrier screening panels include cystic fibrosis, spinal muscular atrophy (SMA), fragile X syndrome, sickle cell disease, and a range of metabolic and enzyme deficiency disorders.
The Beacon 787 carrier test, offered by Jeen Health, screens for 787 conditions from a single sample, making it one of the most comprehensive panels currently available to UK families.
Who Is Most Likely to Benefit
Any couple planning a pregnancy can consider carrier screening. It is particularly relevant for:
- Couples with a family history of a known inherited condition
- Those from populations with higher carrier frequencies for specific conditions, including Ashkenazi Jewish, South Asian and African communities
- Couples pursuing fertility treatment, where genetic information informs treatment planning
- Those who wish to have the most complete picture of their reproductive health before conception
Importantly, being a carrier of a condition does not mean a child will be affected. It means there is a defined statistical risk that can be quantified, discussed and planned for with appropriate clinical support.
How the Test Is Performed
Carrier screening is typically carried out on a blood or saliva sample.
For at-home options such as the testing offered by Jeen Health, a cheek swab collection kit is dispatched to the patient, the sample is returned by post, and results are delivered digitally within a defined turnaround period.
In-clinic carrier testing may use a blood draw and provides the advantage of immediate access to a clinical consultation at the point of result delivery.
London Pregnancy Clinic offers genetics counselling through its partnership with Jeen Health, allowing couples to receive and contextualise carrier test results with expert support.
Genetic counselling before and after testing is recommended by Genomics England as a standard component of any genomic testing pathway.
What Happens If Both Partners Are Carriers
If both partners are identified as carriers for the same autosomal recessive condition, they are typically offered further counselling to discuss their options.
These may include proceeding naturally with an awareness of the risk, using prenatal diagnosis (CVS or amniocentesis) during pregnancy to test the fetus, or pursuing preimplantation genetic testing (PGT) in the context of IVF, which allows unaffected embryos to be selected before transfer.
The purpose of identifying carrier status before pregnancy is to give couples time to consider these options without the added pressure of an ongoing pregnancy.
Knowledge of carrier status does not remove reproductive choices; it expands the information available when making them.
The Role of Pre-Conception Services
Carrier screening sits within a broader category of pre-conception care that includes fertility assessments, general health optimisation and, where relevant, management of existing conditions before pregnancy begins.
London Pregnancy Clinic offers pre-conception services encompassing fertility investigations, genetics counselling and carrier testing as part of an integrated 0th trimester approach, allowing couples to address genetic and clinical risk factors before their pregnancy starts rather than after.
Disclaimer: This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment.
Clinical guidance referenced reflects published NHS, NICE and RCOG standards as at March 2026. Individual circumstances vary; readers are advised to consult a qualified healthcare professional before acting on any information in this article.
This piece was produced in association with London Pregnancy Clinic and Jeen Health, which provided background clinical information for editorial purposes.
Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.
A London-based fertility clinic has been shortlisted for a startup award.
Plan Your Baby was shortlisted as a London finalist for Innovative Startup of the Year at the UK StartUp Awards.
Plan Your Baby is a new generation fertility and pregnancy telehealth clinic that provides fertility treatment and and-to-end pregnancy clinical monitoring and psychological support.
The company said on LinkedIn: “Being recognised in a city as competitive as London is meaningful for our team.
“The award is judged by industry experts and reflects the growing need for fertility care that is structured, transparent, and centred around the patient.
“Many people come to us looking for clarity in what can often feel like a complex process.
“Our focus has been to make each step easier to understand and easier to access.”
Plan Your Baby founder Marija Skujina was inspired to launch the company after working at the highest level in private fertility clinics and realising the impact that the traditional approach to fertility treatment was having on clients.
She told Femtech World in a 2023 interview: ““Fertility support is not just a medical procedure, it’s physical, mental, and emotional too.
“That’s why I launched Plan Your Baby: to help parents conceive in a fully supported and holistic manner.”
The UK StartUp Awards aim to ‘recognise the achievements of amazing individuals who have had a great idea, spotted the opportunity and taken the risks to launch a new product or service.’
If selected as the regional winner, Plan Your Baby will go on to the national final at Ideas Fest this September.
Previous winners include Magic AI, makers of a wall-mounted AI fitness mirror that acts as a personal trainer, and EnsiliTech, a medtech startup developing innovative health technology solutions at the intersection of engineering and healthcare.
Future Fertility, a Toronto-based health technology company specialising in AI-powered fertility insights, has entered the Japanese market through a new commercial partnership with Kato Ladies Clinic — a globally recognised leader in IVF research and advancing clinical fertility care.
The collaboration marks Future Fertility’s first partnership in Japan and reflects growing global demand for technologies that bring greater objectivity and personalisation to fertility care.
Kato Ladies Clinic will integrate the company’s AI-powered oocyte (egg) quality assessment tools into its clinical workflows, with the aim of supporting more informed treatment planning and patient counselling across IVF and egg freezing cycles.
“At Kato Ladies Clinic, we are committed to advancing fertility care through innovation while maintaining a strong focus on individualised, patient-centred treatment,” said Keiichi Kato, chief executive officer.
“Partnering with Future Fertility enables us to integrate objective, data-driven insights into our clinical approach and better support our patients in making informed decisions.”
Future Fertility’s platform analyses images of oocytes using artificial intelligence trained and validated on a dataset of more than 650,000 unique oocyte images.
The technology is already in use at more than 300 clinics across more than 35 countries, helping clinicians better understand the developmental potential of individual eggs and provide patients with more personalised insight earlier in their treatment journey.
From Research Collaboration to Clinical Adoption
The partnership between Future Fertility and Kato Ladies Clinic began as a scientific research collaboration in 2024, marking the first use of AI-powered oocyte quality assessment in Japan.
The collaboration not only validated the technology in a new patient population and across diverse clinical protocols — including minimal stimulation cycles —but also resulted in a peer-reviewed publication in Reproductive BioMedicine Online (RBMO) and a poster abstract presentation at ESHRE 2025.
The joint research explored how AI-derived oocyte quality scores relate to early embryonic development and overall treatment outcomes. In a retrospective study conducted at Kato Ladies Clinic, researchers analysed nearly 2,800 mature oocytes across more than 1,300 ICSI cycles, linking image-based assessments of egg quality to key developmental milestones.
The study demonstrated that lower AI scores were associated with reduced fertilization rates, delays, and abnormalities in early embryo development, increased developmental errors, and lower-quality blastocyst formation.
Notably, the researchers also found that cumulative oocyte scores were a stronger predictor of live birth outcomes than the number of eggs retrieved — underscoring the importance of assessing egg quality alongside quantity.
“Our collaboration with Future Fertility has demonstrated how artificial intelligence can uncover meaningful biological differences between oocytes that were previously difficult to quantify,” said Kenji Ezoe, senior scientist.
“Bringing this technology into routine clinical use is an important step toward translating research into improved patient outcomes.”
Future Fertility’s VP of clinical embryology & scientific operations, Jullin Fjeldstad, noted that the findings provide important clinical validation.
“Our joint research with Kato Ladies Clinic has shown how AI-based oocyte assessment can be directly linked to numerous embryo development outcomes, from fertilization through early developmental milestones and blastocyst formation,” she said.
“We are excited to see this work translated into clinical practice.”
Growing Demand for Fertility Care in Japan
The partnership comes at a time when demand for fertility treatment in Japan continues to rise.
The country performs over 450,000 fertility treatment cycles annually, making it one of the largest markets globally. Delayed childbearing and evolving societal trends have also contributed to increasing interest in egg freezing.
As patients seek more clarity and personalization in their care, tools that provide earlier insight into reproductive potential are gaining traction.
“Entering the Japanese market with a partner like Kato Ladies Clinic is a significant step forward for our global commercial strategy,” said Rafael Gonzalez, Future Fertility’s VP of global sales & strategy.
“It reflects the growing demand for technologies that support more transparent, data-driven fertility care across diverse healthcare systems.”
Expanding a Global Footprint
Founded in 1993, Kato Ladies Clinic is known for its pioneering work in natural and minimal stimulation IVF and has long been a leader in clinical innovation in Japan.
For Future Fertility, the partnership represents both a geographic expansion and a continuation of its broader mission to bring AI-driven insights into routine fertility care.
“We are proud to partner with Kato Ladies Clinic, a globally respected leader in IVF and a pioneer in reproductive medicine in Japan,” said Future Fertility’s CEO, Christy Prada.
“This partnership represents an important milestone as we expand into Asia and continue our mission to bring objective, personalised insights into fertility care worldwide.”
Future Fertility develops AI-powered tools designed to generate personalised insights across the fertility journey.
Its flagship oocyte assessment technologies analyse egg images to provide objective, individualised measures of egg quality, supporting treatment planning, patient counselling, and clinical decision-making in egg freezing and IVF, while also enabling more data-driven approaches to donor egg distribution and quality assurance.
As fertility care continues to evolve, collaborations like this one are helping shape a new standard — one that emphasises earlier insight, greater transparency, and more personalised decision-making for patients navigating increasingly complex reproductive journeys.
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