News
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.”
News
Can biotech help close the fertility gap? Inside the race to improve egg quality
With delayed parenthood now the norm, a new wave of biotech innovators is targeting the root cause of rising infertility rates. Oxford-based startup Uploid tells Femtech World how addressing egg ageing could reduce the “age penalty” that currently defines fertility outcomes.
Infertility now affects an estimated one in six people worldwide, with the World Health Organization determining it to be a “major public health issue.”
Across the OECD, the average age of first-time mothers has risen consistently over the past decades, driven by economic pressures, career progression, delayed partnership, and the availability of contraception. But human biology has not kept pace with this societal shift.
Egg quality declines sharply with age, beginning as early as the mid-thirties. It is this decline, not the body’s ability to carry a pregnancy, that remains the most significant factor behind falling conception rates.
IVF attempts to work around this challenge, yet even with technological advances, success rates remain modest. For women aged 18-34, birth rates per embryo transfer were around 35 per cent in 2022, dropping to five per cent by the age of 43-43.
“Fertility outcomes fall, not because the body is unable to sustain a pregnancy, but because egg quality declines with age,” Dr Alexandre Webster, co-founder and chief scientific officer at Oxford-based biotech firm, U-Ploid, tells Femtech World.
“Most existing fertility treatments are limited in how directly they can address this biological constraint. While IVF has advanced significantly in helping clinicians identify embryos with the best chance of success, there are currently very few options to intervene earlier and improve the quality of the eggs themselves.”
Current fertility treatments tend to focus on hormonal stimulation to produce more eggs, improving embryo selection, or improving implantation rates through uterine optimisation.
But none of these approaches address the root cause of age-related infertility, which is the egg’s declining ability to divide its chromosomes correctly.
This unmet need has set the stage for a new generation of reproductive biotech innovators, focusing on novel therapeutics, cellular engineering, AI-driven diagnostics, and biomarkers that could change how infertility is understood and treated.
A new frontier in fertility treatment
Among these innovators, U-Ploid is pioneering a new therapeutic category with Lyvanta™, a first-of-its-kind drug aimed at improving egg quality by addressing the biological mechanisms of maternal ageing.
Central to its approach is meiotic aneuploidy, which occurs when chromosomes fail to separate correctly as an egg matures. This increases dramatically with age, Webster explains, and is the leading cause of failed IVF cycles, miscarriage, and natural infertility. Studies have shown that over 50–80 per cent of embryos from women in their early 40s exhibit chromosomal abnormalities.
Lyvanta™ is designed to reduce the risk of these errors at the egg stage, before fertilisation occurs. It is injected into the egg before IVF, where it acts to stabilise chromosome segregation during meiosis.
“What makes this approach distinct is that, today, there are no approved or clinically available therapies that directly address meiotic aneuploidy or improve egg quality at its biological source,” Webster says.
“Lyvanta™ therefore represents a genuinely new therapeutic category. It does not act on embryos, does not alter DNA, and does not involve genetic modification. Instead, it supports a natural biological process that becomes increasingly error-prone with age.”
Evidence-gathering and regulatory engagement
The programme is grounded in over a decade of global academic research in chromosome biology and maternal ageing, and Uploid has carried out mechanistic studies, preclinical validation in aged animal models, and tightly regulated human egg studies in collaboration with IVF clinics.
However, the drug is still in the early stages of development, and the company is taking a cautious, evidence-driven approach.
Over the next one to two years, the research team will focus on building the scientific evidence needed to demonstrate clinical safety and efficacy. Meanwhile, regulatory engagement is ongoing, and timelines will depend on the outcomes of these studies.
“As with any new therapeutic, progress toward the clinic requires careful, stepwise evidence generation and regulatory review,” Webster says.
“Our focus at this stage is on ensuring that any future progress happens within established scientific, ethical, and regulatory frameworks. We engage with regulators, clinicians, and patient stakeholders to understand expectations around safety, evidence, transparency, and consent, and to ensure that the questions being asked of a new reproductive therapeutic are addressed rigorously and appropriately.”

He adds: “Lyvanta™ will only move forward if it meets the required standards set by regulators and ethics bodies, and only following thorough evaluation.”
If successful, the impact could be considerable. Improved egg quality may mean fewer IVF cycles, more viable embryos, and overall better outcomes for patients.
“If a therapy like Lyvanta™ can safely improve egg quality, it could lead to more viable embryos per IVF cycle, fewer cycles needed to achieve pregnancy, and better outcomes for people whose chances of success currently decline sharply with age,” Webster says.
“While much work remains, this is the long-term impact we are working toward.”
Global access and affordability
Globally, infertility affects people at similar rates regardless of income, but access to advanced treatments is often dependent on financial barriers.
IVF remains expensive worldwide. In the UK and US, a complete IVF cycle typically costs several thousand to tens of thousands of pounds, often requiring multiple attempts.
“One of the reasons fertility treatment is so costly and emotionally taxing is that patients often require multiple IVF cycles to achieve a successful outcome,” says Webster.
“Indeed, some 70 per cent of couples that start an IVF journey will end it with no baby, having run out of money and patience before a successful outcome.
By making each IVF cycle more efficient, it could reduce some of these costs and make treatment more accessible to more people.
“By improving egg quality upstream, Lyvanta™ has the potential to increase efficiency per cycle, which could reduce the overall burden, financial, physical, and emotional, on patients and healthcare systems,” Webster says.
The therapy is also being designed to integrate into existing IVF workflows, without requiring new infrastructure or highly specialised equipment.
He adds: “By focusing on improving biological efficiency rather than adding complexity, we believe this approach has the potential to support broader access over time, including in low- and middle-income countries where need is high but resources are limited.”
The new wave of fertility innovation
U-Ploid is part of a new wave of fertility biotech innovators. Companies such as Oxolife, developing a first-in-class oral drug to improve implantation; Gameto, engineering ovarian support cells to optimise IVF and egg freezing; and Genie Fertility, uncovering molecular biomarkers to personalise reproductive care, are all reshaping the field.
While progress in the fertility space has been incremental for decades, breakthroughs in chromosome biology, cell engineering, and molecular therapeutics are changing what might be possible.
This new generation of therapeutic innovation could improve outcomes and expand options for millions navigating delayed parenthood, and allow fertility science to catch up with the realities of modern life.
“Our aim is to reduce the biological ‘age penalty’ that currently defines fertility outcomes, so that success is less tightly coupled to chronological age,” Webster adds.
“If successful, this could allow more people to build families on timelines that reflect modern social and economic realities.”
Wellness
The science behind the scar: What’s really in our period products
By Ruby Raut, founder and CEO, WUKA
Over the past year, headlines about “toxic period products” have been hard to ignore. Stories about PFAS, heavy metals, and hormone disruptors in pads, tampons, and underwear have sparked global concern, and for good reason. But behind the fear, there’s a scientific story worth understanding.
At the recent House of Lords event, “Have We Reached the Tipping Point for Toxic Period Products?”, researchers and policymakers came together to separate fact from panic. The truth is more nuanced: yes, chemicals and metals are present in some menstrual products, but understanding how much, where they come from, and what that means for our health is key to driving change that’s informed, not sensational.
What Scientists Have Found So Far
Dr Kathrin Schilling, an environmental health scientist at Columbia University, shared new research that tested 16 metals in menstrual products, including arsenic, cadmium, lead, and antimony, all known toxic substances linked to long-term health effects such as cardiovascular disease, kidney problems, and hormonal disruption.
The findings were striking:
- Non-organic products showed higher levels of lead and cadmium than organic ones.
- Some reusable and single-use products exceeded 30,000 nanograms per gram (ng/g) of antimony, a toxic metal commonly used in plastics manufacturing.
- Lead levels varied dramatically, some products contained 100× more than others.
To put this in perspective, even very small doses of lead can cause harm. The World Health Organization confirms there is no safe level of lead exposure. Chronic, low-level contact can gradually affect the nervous system and fertility. The same applies to arsenic, where countries have tightened drinking water limits from 10 µg/L to as low as 1 µg/L after learning that long-term exposure causes disease.
So while the numbers in menstrual products might sound tiny, what matters most is frequency and route of exposure. Menstrual products are used regularly and in contact with one of the body’s most absorbent tissues — the vaginal wall — where absorption is estimated to be 10–80× higher than through skin. Over decades of use, even low concentrations can add up.
Understanding PFAS — The “Forever Chemicals”
Alongside metals, PFAS (per- and polyfluoroalkyl substances) have become another major concern. These synthetic compounds are used for absorbency and stain resistance — but they don’t break down easily, earning the name “forever chemicals.”
They accumulate in soil, water, and the human body, and have been linked to reproductive issues, thyroid disease, and immune dysfunction. California recently became the first state to ban PFAS in menstrual products, while New York is pushing for broader restrictions that include heavy metals and hormone disruptors.
These international shifts signal a clear message: the world is moving towards stricter, transparency-first regulation — something the UK could soon follow.
Why It Matters for Our Bodies
It’s important to remember that our world is already filled with background exposure, from air pollution, processed food, and household plastics. We all live in a chemically complex environment. The key isn’t to fear every product but to understand which exposures matter most and how to minimise them.
Menstrual products are unique because of their intimate and repeated contact with the body. Even trace chemicals can bypass the body’s natural detox systems when absorbed vaginally. This doesn’t mean every product is dangerous, but it underscores why regular, independent testing and clear ingredient disclosure are essential.
Internal vs. External Exposure: Why It Makes a Difference
One of the least understood parts of this debate is the difference between internal and external products. A pad or period underwear sits on the skin; it can only transfer chemicals through surface contact. But products like tampons or menstrual cups are inserted directly into the vagina, an environment that absorbs substances 10–80 times more efficiently than normal skin.
That’s because the vaginal wall is highly vascular, full of small blood vessels, and it bypasses the liver, the organ that usually filters and detoxifies harmful substances. So when a chemical is absorbed vaginally, it goes straight into the bloodstream.
Yet, most testing and regulation still treat all menstrual products as if exposure happens through skin contact. There’s very little research separating the risk profiles of internal (tampons, cups, discs) versus external (pads, underwear) products. That’s why scientists like Dr Schilling emphasised the need for new safety standards that actually reflect how the body interacts with these materials, not just how a fabric performs in a laboratory test.
How Responsible Brands Are Responding
Some brands are already ahead of regulation.
At WUKA, we take this responsibility seriously. We are one of the very few period underwear brands with no PFAS detected in our products. Every batch is tested rigorously, both at source (in China) and again in the UK by Eurofins laboratories, an independent global testing agency.
We also screen for toxic chemicals, metals, and harmful finishes, ensuring that what touches your body is as safe as it is sustainable. As a founder, I always remind our team: I use our products myself. If I wouldn’t wear it, I wouldn’t make it for anyone else.
Our philosophy is simple, transparency builds trust. Consumers shouldn’t need a chemistry degree to choose a safe period product.
The Path Ahead
The science is clear: menstrual product safety deserves the same rigour as drinking water, cosmetics, or food. But we can also take heart, awareness is growing, data is expanding, and governments are beginning to act.
As policymakers push for international standards (through bodies like the ISO TC338 on menstrual products), and as responsible brands lead by example, the future of menstrual care looks safer, smarter, and far more transparent than the past.
This isn’t just about fear of toxins, it’s about empowering everyone who menstruates with knowledge and choice. Because understanding the science is the first step toward changing it.
Find out more about WUKA at wuka.co.uk
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