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How chain IVF clinics improve infertility treatment

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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 because IVF is largely paid out-of-pocket, some patients widen their search beyond domestic clinics — comparing fertility clinics abroad, where a single cycle can cost a fraction of the US price.

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.”

Entrepreneur

UK femtech investment surges 194% in a decade, research finds

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UK femtech investment has risen by more than 194 per cent over the past decade, with deal activity and funding both increasing, new research has found.

The number of deals increased from 18 in 2015 to 53 in 2025, while total funding rose from £9.4m to more than £100m over the same period.

Despite the growth, deal volume and value remain relatively low compared with other parts of the health and care market. Healthcare recorded 69 deals in 2015 and 171 in 2025.

More companies have raised funding over the past decade, while investment values have also increased. Average deal size more than doubled from £527,000 in 2015 to £1.9m in 2025.

Some of the largest funding rounds last year included SheMed at more than £37m, Gaia at £12m, emm at £6.8m and Hertility at £5.9m, with the majority of investors based in the UK.

The research found femtech remains largely early-stage, with seed investments accounting for most deals.

However, venture capital involvement has increased over the past decade, which the research said showed the market was becoming more mature. The number of VC deals rose by 600 per cent.

Vicky Protano, corporate partner at Mills & Reeve, which conducted the research, said: “Over the last decade, the UK femtech ecosystem has expanded, both in terms of deal activity and funding levels. This positive upward trend demonstrates growing investor confidence in femtech and increasing institutional interest in the sector.

“Whilst companies in femtech have relied heavily on angel investors and angel networks to fund their growth ambitions, dynamics are shifting, with more venture capital and PE investors appearing in funding rounds. However, this is just the beginning and there is still more to do. While the sector has experienced strong growth, more work needs to be done to create the right funding environment that is balanced and evenly spread across the UK.”

The research found most deals had taken place in London. While the capital has strengthened its position as the UK’s main hub for femtech start-ups, regional clusters are gradually emerging elsewhere.

Protano said: “Whilst London clearly remains a dominant location for women’s health businesses and investment – both in terms of deal activity and total funding – there is a gradual move to regional expansion outside of the capital, with the South West, South East and the East of England showing increased investment activity in the femtech sector. What the data also highlights is a growing North/South divide, with areas such as the North East, North West, and Yorkshire & Humber significantly underrepresented in the national figures.

“As a national firm, we are also witnessing that similar divide. More investments are being made into women’s health businesses based in the South – and more businesses are, often as a result, locating themselves there, rather than in the North. This is representative of the investment landscape as a whole. However, growth in the femtech sector is being supported by growing regional innovation hubs, the increasing influence of university spin-outs, as well as improved support for start-ups at a regional level.”

She added: “Looking at the positives, we have advised and are continuing to advise on some significant investments in the sector. This further evidences the growing nature of femtech, with sector specific investors also coming to the market.”

Examples include Northern Gritstone’s investment in IVF technology business IVF Micro and Phoenix Private Equity’s investment in London Gynaecology, a provider of private gynaecology clinics.

Other deals include an EKA Ventures-led investment in tech-enabled postnatal care company Hesta Health and Amulet Capital’s acquisition of TFP Fertility.

September marks 10 years since the term “femtech” was coined by Ida Tin, co-founder and chief executive of Clue, one of the first period-tracking apps for women, and founder of think tank Femtech Assembly.

The global market grew to US$9.12bn in 2025 and is projected to reach US$41.4bn by 2034.

Despite that growth, women’s health is still not treated as a priority and significant gender inequalities remain globally in research, trials, diagnosis and treatment, continuing to disadvantage women.

Tin said: “I want men with money and power to get femtech on their radar. The business opportunity is there. The societal economic argument is there.”

Charlotte Lewis, commercial health lawyer at Mills & Reeve who specialises in healthtech and women’s health, said: “For far too long, ongoing disparities in women’s healthcare across the UK have adversely impacted women’s health outcomes, often resulting in prolonged diagnosis and treatment – some of which are well publicised, including the time it takes to diagnose women’s health issues such as endometriosis and rising maternal mortality rates.

“However, we are seeing the landscape beginning to shift in a more positive direction. Our experience is that this is helped by more open discussion and conversations which highlight the issues.

“The data around the sector is valuable and growing and demonstrates the progress that is being made from an investment point of view, creating a better environment where digital innovation can thrive, with a renewed focus on prevention through market-leading consumer-driven products.

“The UK has a real opportunity to transform women’s healthcare into a model of fairness, accessibility, and excellence, and femtech businesses have a crucial part to play in achieving this transformation. As a firm, Mills & Reeve is passionate and dedicated to continuing to influence and support this transformation.”

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Fertility

No clear evidence common embryo transfer techniques improve IVF success, review finds

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Common IVF preparation techniques used before embryo transfer have no proven effect on pregnancy rates, according to a review.

Researchers said evidence for the widely used practices remains uncertain because available studies are limited and generally of low quality.

Embryo transfer is the final and most vulnerable stage of IVF, when an embryo is placed into the womb. Only around one in three transfers results in pregnancy.

Practice varies between clinics, with some routinely using preparation techniques such as adjusting bladder fullness while others do not consider them necessary.

Dr Ryosuke Akino, practising obstetrician-gynaecologist from Kato Ladies Clinic, said: “To an extent, this is a case of tradition driving practice rather than the evidence.

“Current practices in this area often reflect local protocols, clinician preference, and historical convention rather than strong, high-quality evidence.”

The Cochrane review analysed 11 studies involving 2,524 women undergoing embryo transfer.

Researchers looked at three preparation techniques used by fertility clinics: having women arrive with a full bladder to straighten the angle between the uterus and cervix, removing cervical mucus and using a technique called afterloading.

Afterloading is a technique used to guide the embryo through the cervix.

The review found no reliable evidence that any of the three approaches improved pregnancy rates compared with standard care.

Researchers rated the evidence as low or very low certainty because the trials were small and had methodological weaknesses. They found no grounds to recommend any of the techniques over standard care.

There was also limited information about possible side effects.

The review team, which included methodologists and practising obstetrician-gynaecologists, said full bladder preparation and cervical mucus removal were generally considered safe, with no clear evidence of harm or major complications.

Dr James Brown, obstetrician-gynaecologist from Women’s Health and Research Institute Australia, said: “While these techniques are generally considered safe, it’s still important to test their effectiveness.”

Akino and Brown added: “A full bladder can be uncomfortable, although it may ease catheter insertion in certain uterine positions and reduce procedural difficulty.

“Mucus removal is usually quick, but if done roughly and causes bleeding, it may affect the woman’s experience.

“Overall, the risks are minor and relate mostly to discomfort and procedural factors rather than clinical harm.”

The authors said embryo transfer has changed relatively little despite major advances elsewhere in IVF.

Research has instead focused more heavily on embryo quality and genetic factors, which have a greater bearing on treatment success than transfer technique.

Embryo transfer also depends heavily on the person carrying out the procedure and can be difficult to standardise, making large, rigorous clinical trials harder to design.

Researchers said women may also be reluctant to risk valuable embryos by taking part in randomised studies comparing different transfer techniques.

Dr Noyuri Yamaji from Showa Medical University in Japan said: “Sixteen years of research still haven’t answered a basic IVF technique question.

“This is a critical step in the IVF process and these small changes and techniques have the possibility to make a massive difference, but we won’t know more until more robust, better-quality trials are conducted.”

All the studies assessed were carried out in high-income countries, meaning the findings may not necessarily apply to other healthcare settings and populations.

The authors said further research could be particularly valuable in resource-limited settings, where these procedures are inexpensive and simple to change and basic procedural standardisation could matter more than advanced technical modifications.

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Hormonal health

Menstrual data is missing a critical layer: The mind

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By Aleena Ashraf, neuroscientist, published author and part of Véa’s Clinical Advisory Board

Menstrual data is missing a critical layer: the mind.

The menstrual cycle won’t be fully understood until we track the mind alongside the body.

We measure the body exceptionally well.

Just three period-tracking apps, Clue, Flo and Period Tracker, have been downloaded over 200 million times combined.

Dates, symptoms, mood and fertility windows are all diligently monitored.

Still, logging when a period starts doesn’t document what it’s like to live inside a cycle.

A recent survey reported 61.9 per cent of participants used period-tracking apps for more than two years, yet only surface-level data could be observed.

Mental clarity, motivation, resilience, mental load, none of this gets recorded.

Which is why the data can’t answer one of the most common questions women ask themselves: why does the same task feel manageable one week and impossible the next?

Get this right and the payoff is significant: more precise, predictive and personalised care.

Neuroscience and the menstrual cycle

The menstrual cycle isn’t only a reproductive process.

It’s a neurobiological rhythm that the brain actively regulates.

Ignoring that means overlooking the system driving much of what gets logged as “mood”.

After menstruation, rising estradiol lifts serotonin and dopamine, sharpening mood, motivation and mental efficiency.

This is the phase where pushing hard toward a goal tends to feel the easiest.

Later, progesterone takes over and increases GABA, the brain’s calming neurotransmitter.

The body shifts toward rest and recovery: slower pace, more introspection and less drive for risk.

The brain isn’t weaker in one phase and stronger in another. It’s continuously realigning to match hormonal change.

This isn’t a drop in capability but a shift in cognitive mode.

Hormonal changes aren’t disruptive – they’re informative.

The subjective experience of every woman living through them is exactly where current data systems fall short.

The lived experience is missing

What it actually feels like to think and function differently across the month remains almost entirely undocumented.

Women keep pushing through their cycle to meet constant demands at work and at home.

The cost doesn’t show up immediately but builds quietly, then surfaces as burnout, anxiety or withdrawal.

The turning point is rarely dramatic. It lives in small, recurring thoughts:

“Why does this feel harder today?”

“Why can’t I think straight?”

“Why is everything triggering me?”

During the luteal phase, irritability is usually treated as a symptom to control or tolerate.

There is lower tolerance for social demands, heightened sensitivity to routine tasks and occasional emotional outbursts.

But tracked over time against the cycle’s stages, it stops looking random.

It becomes a measurable signal of cognitive and emotional load.

The same is true for the urge to withdraw.

Read in isolation, it looks like disengagement, a dip in performance or a personal shortcoming.

Read longitudinally, it frequently lines up with the phase where the brain is shifting toward introspection and recovery.

Rather than seeing it as avoidance, it’s regulation.

Picture a professional in a high-pressure role.

In one phase of her cycle she is sharp, decisive and efficient.

In another, she is re-reading the same email, struggling to focus and disproportionately overwhelmed by routine tasks.

Without context, that looks like inconsistency.

With context, it’s a pattern that can be understood, anticipated and supported.

Journaling reveals the missing layer

Journaling is already a proven way to surface this deep layer.

It’s well established for improving mental health and stress regulation.

A 2022 systematic review reported a 9 per cent decrease in anxiety levels through writing.

But its potential goes further than that.

Journal entries build a longitudinal record of how someone’s inner state and hormone-linked rhythms evolve across the cycle, across roles, across time.

The problem is journaling can be hard to sustain without structure.

It’s also tricky to know what to write, as it’s self-directed.

Insights end up buried in raw writing, disconnected from the neurological pattern actually driving it.

Véa is a digital platform that guides women to document their lived experience over time, surface recurring trends and put words to what they’re going through.

It develops freeform writing into systematic self-reflection through a framework supported by neuroscience.

This captures snapshots of how women are thinking and feeling across different phases of the cycle.

Guided support peels back layers of cognition and emotion, surfacing what current menstrual data misses.

No single narrative gets imposed on every user.

Instead, the method leaves room for genuinely different perspectives of productivity to emerge.

Performed well, this turns journaling into a system of signals, not a pile of disconnected entries.

Done responsibly, privately and anonymously, this kind of data could help understand more about female health.

It isn’t diagnostic and it isn’t here to label anyone. But it can feed clinical understanding and future research alike.

What changes if we take this seriously

Treat the menstrual cycle as a neurological framework rather than a purely reproductive one, and the entire model of care begins to change.

It’s possible to identify strain earlier.

Work can be paced differently.

For clinicians, it means treatment plans that account for cyclical variation in symptoms and inner state.

For researchers, it gives a richer dataset that moves past static and linear measurements toward dynamic patterns.

For employers, it’s a chance to build more personalised ways of working around shifting cognitive load.

For families, it’s a reason to recognise and redistribute the invisible load carried by female homemakers.

This also fits within the broader shift toward preventative healthcare.

Catch the early signs and intervention can happen before burnout or more serious conditions take hold.

The menstrual cycle may be one of the richest data systems we have, if we are willing to read it correctly.

Learn more about Véa at veajournal.com

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