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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.”

Mental health

Yoga and omega-3 as effective as therapy for depression in pregnancy, research finds

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Yoga and omega-3 supplements may be as effective as talking therapies for pregnancy depression, a major review suggests.

Globally, nearly one in three pregnant women experience depression, but most receive no treatment.

When support is available, women are often directed towards talking therapies such as cognitive behavioural therapy, or CBT, and mindfulness.

CBT is a structured talking therapy that helps people identify and change patterns of thought and behaviour affecting their mental health.

The review examined 115 clinical trials involving more than 12,000 participants across 30 countries.

It found that yoga, massage, omega-3 supplements and bright light therapy were broadly as effective as talking therapies at reducing depression symptoms during pregnancy.

Bright light therapy involves controlled exposure to bright light and is sometimes used to treat mood conditions.

The findings point to the importance of social support and increased connection, as all these approaches offer some element of contact or guided support.

Led by King’s College London, the research brought together trial evidence across every type and format of treatment for antenatal depression under a common framework.

Antenatal depression is depression that occurs during pregnancy.

The study was conducted as part of HappyMums, a European consortium led by the University of Milan that aims to improve mental health support during pregnancy and after birth.

Carmine Pariante, professor of biological psychiatry, said: “This is the most comprehensive analysis of treatments for depression in pregnancy ever conducted, and the findings should prompt a rethink of how we support women during this critical period.

“The evidence is clear that there is no single best approach. What matters is that women have access to a range of options, and that clinicians feel equipped to offer them.”

The researchers said yoga and omega-3 supplements could be legitimate treatment options, rather than stopgaps, for women on waiting lists or those who struggle to access mental health support.

However, the studies differed considerably in design, sample size and how results were measured, so the findings should be interpreted with care.

The team said non-psychological approaches could help women cope with long waits for care without ruling out other treatments alongside them.

Digital and online interventions, including apps and telephone-based support, were also found to be as effective as face-to-face treatment.

Researchers said this could affect how antenatal depression is managed, particularly for women who cannot travel or face long waits for in-person care.

The team found no randomised controlled trials of pharmaceutical treatments for antenatal depression, despite antidepressants being widely prescribed for depression outside pregnancy.

A randomised controlled trial is a study in which participants are randomly assigned to different treatment groups, allowing researchers to compare outcomes more fairly.

Evidence for drug treatment during pregnancy therefore relies on indirect research rather than trials carried out during pregnancy, reflecting long-standing caution around testing medicines in pregnant populations.

NICE guidelines recommend antidepressants for moderate to severe depression in pregnancy, while evidence from outside formal pregnancy trials suggests they can be safe and effective.

However, the researchers said trials are still needed, particularly for women who cannot access or engage with other forms of support.

Riddhi Laijawala, trial manager and PhD student, said: “Depression in pregnancy is common, but it is not inevitable, and it is treatable. What this review shows is that the options available to women are broader than many people realise.

“A yoga class, music therapy, or an online programme may not sound like clinical treatment, but the evidence suggests they can make a real difference, and for many women they may be easier (and quicker) to access than a course of therapy.”

Depression during pregnancy affects an estimated 28.5 per cent of pregnant people worldwide, but only around one in five receives appropriate and timely treatment.

The team said closing this treatment gap should be a priority for health systems because the condition can affect both parent and child.

The HappyMums project is supported by the European Union’s Horizon Europe research and innovation programme.

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Hormonal health

Type 2 diabetes rising among young women, experts warn

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Type 2 diabetes is rising among women in their 20s in England, with experts warning of a worrying increase since the Covid pandemic.

The rise has largely occurred since the pandemic and is closely linked to increasing obesity levels, according to an analysis of NHS data from 2011 to 2024.

The condition is serious and can lead to severe complications, including heart attacks and strokes.

Diabetes UK said it tends to be more aggressive when it develops at a younger age, raising the risk of serious complications and shorter lives.

The charity said early diagnosis is vital for people at risk to help prevent long-term organ damage.

The condition can sometimes be put into remission through healthy eating and maintaining a healthy weight, without relying on glucose-lowering medicines.

Researchers said newer obesity treatments, including GLP-1 injections and pills, may also help alongside healthy eating advice.

About 90 per cent of the six million people living with diabetes in the UK have type 2 rather than type 1, or insulin-dependent, diabetes.

The risk increases with age, and older adults still account for the largest proportion of new diagnoses.

However, NHS England estimates suggest that 12,000 people under 30 are now living with the condition, with women making up more of the younger cases.

Common symptoms include feeling very tired, urinating more often than usual and feeling thirsty all the time.

Researchers at Imperial College London analysed NHS data from the English National Diabetes Audit to examine trends over time.

The figures showed that cases are falling slightly among older adults, who still account for the largest share of new diagnoses.

However, diagnoses are increasing rapidly among people under 40, with some of the sharpest rises among women aged 20 to 29.

Body mass index at diagnosis has also been rising more quickly among younger adults than in older age groups, pointing to obesity as a likely factor.

Body mass index, or BMI, is a measure of obesity based on a person’s height and weight.

Separate NHS data for England shows obesity rates have worsened since the pandemic, with nearly one in three people now affected.

The largest increases over time have been among younger adults.

Between 2019 and 2025, new obesity cases rose by 16 per cent among people aged 20 to 29 and by almost 20 per cent among those aged 30 to 39.

Rates fell among adults aged 60 to 79 over the same period.

Lead researcher Dr Shivani Misra said: “We think that the earlier onset of severe obesity in young people is increasing their type 2 diabetes risk in early life and pulling down their age at diagnosis.

“This is really worrying given the poor health outcomes from early-onset type 2 diabetes.”

Misra said much of the discussion about rising rates among younger people had focused on ethnic minority groups, which have traditionally been considered at higher risk.

However, the new data suggests the trend extends well beyond those communities.

She added: “We now see that incidence is also increasing in white populations too, showing that this public health challenge is broadening across the generations.”

Diabetes UK said better follow-up care is also needed for mums-to-be diagnosed with gestational diabetes during pregnancy because it raises the risk of developing type 2 diabetes after childbirth.

Some studies have suggested that the risk of developing the condition may also increase after being ill with Covid, although the evidence remains inconclusive.

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Wellness

AstraZeneca drug approved for breast cancer in EU

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AstraZeneca’s breast cancer drug Etcamah has been approved in the EU as part of a combination treatment for advanced disease.

The European Commission acted on a positive opinion from the Committee for Medicinal Products for Human Use, the Cambridge, England-based drug maker said.

The decision followed positive results from the Serena-6 phase III trial, which showed a 56 per cent reduction in the risk of disease progression in advanced oestrogen receptor-positive breast cancer.

A phase III trial is a large, late-stage study used to assess a treatment’s safety and effectiveness before wider regulatory approval.

Oestrogen receptor-positive breast cancer is a form of the disease that can grow in response to the hormone oestrogen.

Etcamah, whose generic name is camizestrant, was tested in combination with a cyclin-dependent kinase 4/6 inhibitor.

Known as CDK4/6 inhibitors, these medicines block proteins that help cancer cells grow and divide.

AstraZeneca said the Etcamah combination has also been approved in Japan, the UAE and Saudi Arabia based on the Serena-6 trial results.

The company said breast cancer remains the leading cause of cancer death among women in Europe, with more than 140,000 deaths and more than 540,000 patients diagnosed in 2024.

AstraZeneca shares were down 0.6 per cent at 12,628 pence in London on Thursday.

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