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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 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.”
The Scottish government has launched a national review into whether NHS IVF access should be extended to single women.
The review will also consider whether wider access should be offered to couples who have children from previous relationships.
Health secretary Angela Constance said: “Access to NHS IVF treatment should be fair, timely and reflect the way people’s lives and families look today.”
Most single women are not currently eligible for NHS IVF treatment in Scotland.
Campaigners have welcomed the review.
Katie Rollings of Fertility Action said: “It’s an essential and long-awaited decision that will impact a huge number of people who are struggling to grow their families.
She said there is “no evidence” that having two parents rather than one determines whether a child will thrive.
She added: “What matters is whether a child is loved, safe, supported and has stable, positive relationships around them.”
Figures from the Human Fertilisation and Embryology Authority show Scotland is the only UK nation where NHS-funded IVF cycles outnumber privately funded cycles.
In 2024, more than 6,000 cycles of fertility treatment were carried out among more than 4,000 patients in Scotland. Both figures were slightly lower than the record highs recorded in 2022.
The past 20 years have also seen a rise in the number of same-sex female couples and single women receiving fertility treatment.
In 2024, 625 IVF cycles were carried out for women in same-sex couples in Scotland, with more than one third funded by the NHS.
There were 330 cycles involving single women, of which 50 were NHS-funded.
In England, single women can access IVF through the NHS, although eligibility varies according to the local health trust’s policy.
Current Scottish rules state that couples are eligible if they have been living in a stable relationship for two years and neither partner has been sterilised.
Couples where one partner already has a child can be eligible, but those where both partners have children from previous relationships are not.
Eligibility rules also require a body mass index above 18.5 and below 30, and state that couples must not smoke, drink alcohol or take drugs during treatment. The mother must be under 42.
The Scottish government said the review would also examine consistency of access to fertility preservation, including during cancer treatment, as well as reducing waiting times for donor eggs and sperm.
Same-sex female couples already have access to NHS IVF, but they can face long waits for donor eggs or sperm, as can heterosexual couples who require donor treatment.
The National Fertility Group will lead the review and make “costed, demand-modelled recommendations”, which are due to be published by early summer 2027.
The group will include fertility experts from Scotland’s four NHS-assisted conception units in Glasgow, Edinburgh, Aberdeen and Dundee.
Prof Sarah Martins Da Silva, an NHS consultant and chair of fertility medicine at Dundee University, said there were questions to be answered in a resource-stretched NHS.
“As a fertility specialist I’m never going to be disappointed if the criteria is widened,” she said.
“But with single people, as an NHS clinician looking at the competing demands we have, I’d ask the question about whether being single is a health condition that needs to be funded.”
Da Silva said NHS waiting lists were full of couples who require donated eggs or sperm because of medical conditions including cancer and could face longer waits.
“It’s slightly a disservice to them,” she said.
“There would need to be a real investment and resource without making everybody wait an extraordinary long time.
“With the current financial environment we work in, if you’re talking about new money, where would that come from?”
She said she would welcome changes that encouraged more people to donate eggs or sperm and questioned whether arguments about children needing two parents were necessarily relevant to the debate.
“On the one hand bringing up a child is quite an expensive process, and if you don’t have that support, it can be very difficult.
“But on the other hand, many people start off as a couple and divorce.”
Da Silva also welcomed plans for the review to consider eligibility for couples who already have children, describing the move as “fantastic”.
The FDA has granted accelerated approval to AstraZeneca drug Etcamah for certain adults with advanced breast cancer carrying an ESR1 mutation.
Etcamah, also known as camizestrant, was approved in combination with a CDK4/6 inhibitor, either abemaciclib, palbociclib or ribociclib.
The treatment is for adults with hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer when an estrogen receptor-1 (ESR1) mutation is detected during aromatase inhibitor and CDK4/6 inhibitor therapy using an FDA-authorised test.
ESR1 mutations are acquired resistance mutations that tumours may develop during treatment with aromatase inhibitors, a type of endocrine therapy commonly used as a front-line treatment for locally advanced or metastatic breast cancer.
Fewer than 5 per cent of patients have the mutation when HR-positive metastatic breast cancer is diagnosed, according to the FDA. After disease progression on an aromatase inhibitor, nearly 40 per cent have the mutation.
Acting FDA commissioner Kyle Diamantas said: “Women living with metastatic breast cancer face an uphill battle as their tumors continuously evolve to escape treatment.
“We owe them every weapon in our arsenal.
“Today’s approval delivers a win to these patients by granting them a targeted therapy designed specifically to overcome resistance, giving them more time before their disease progresses.”
The accelerated approval programme allows earlier approval of drugs that treat serious conditions and fill an unmet medical need based on surrogate or intermediate endpoints.
For Etcamah, approval was based on how long patients lived without their disease worsening, measured from when the resistance mutation was first detected in their blood.
The FDA said it has not yet been confirmed whether intervening when the mutation is detected, rather than waiting until disease progression is confirmed, results in a clinically meaningful benefit. Confirmatory studies are therefore required to verify and describe clinical benefit.
Angelo de Claro, director of the FDA’s Oncology Center of Excellence, said: “I commend both the FDA and the sponsor for their commitment to advancing cancer care and securing this accelerated approval.
“This marks the first FDA approval of a cancer therapy guided by the detection of a resistance mutation in circulating tumor DNA (ctDNA) before imaging tests show that the disease is progressing.
“But additional evidence is needed to confirm clinical benefit.”
Circulating tumour DNA, or ctDNA, consists of small pieces of tumour DNA released into the blood and can allow earlier molecular detection of resistance mutations.
The FDA also authorised the Guardant360 CDx assay as a companion diagnostic to identify patients with breast cancer who have ESR1 mutations for treatment with camizestrant.
Efficacy was assessed in a clinical trial comparing a switch to Etcamah plus a CDK4/6 inhibitor with continued treatment using an aromatase inhibitor plus a CDK4/6 inhibitor.
Estimated median progression-free survival was 16 months in the Etcamah group, compared with 9.2 months in the aromatase inhibitor group.
Etcamah’s prescribing information includes a boxed warning about the risk of irregular heart rhythm when taken with certain other medicines. It also includes warnings about an abnormally slow heart rate and potential harm to an unborn baby.
The FDA convened its Oncologic Drugs Advisory Committee for the application on 30 April 2026.
Entrepreneur
Last chance to save on Women’s Health Week and Women’s Sport Summit: Early Bird pricing ends 11 September
Early bird pricing for W Group’s two flagship October summits – Women’s Health Week Europe 2026 and Women’s Sport Summit Europe 2026 – closes on 11 September.
Both events take place at Emirates Stadium, London, bringing together founders, investors, corporates, and industry leaders shaping the future of women’s health and sport.
Women’s Health Week Europe 2026
7-8 October | Emirates Stadium, London
This year’s edition will be Women’s Health Week Europe biggest one yet: with 700+ attendees, 80+ speakers, and 20+ sponsors, it will also feature two stages – a Global Stage covering market trends and policy, and a Scale Stage focused on company-level growth and commercialisation. WHW takes place across two days of content, business matchmaking, and dealmaking.
Agenda highlights include:
- Where Capital Flows: Funding Trends in Women’s Health – with Merete Clausen (EIF), Ekaterina Gianelli (Calm/Storm), Henriette Hessen (Verdane), Jemma Day (British Business Bank), Ravit Warsha Dor (Telus Global Ventures), Tim Davis (LSEG)
- Six Feet Under-funded: Surviving the Valley of Death in Women’s Health – with Patric Stenberg (Gesynta Pharma), Valentina Milanova (Daye), Amber Vodegel (28x)
- The Women’s Health Label – Gift or Curse? · Live Debate – with Juan Camilo Arjona Ferreira (organon), Marissa Fayer (DeepLook Medical), Christian Lautner (Heal Capital), Annie Theriault (CBIV), Ida Tin (Clue)
- Passport to Scale: Taking Your Women’s Health Business Global – with Vanessa Carpenter (Femtech Across Borders), Annie Theriault (CBIV), Victorine Lançon (Daya Ventures), Dr Mridula Pore (Peppy)
Early bird pricing (ends 11 September):
| Ticket type | Early bird | Standard |
| Startups, Scaleups, Investors, Non-Profits, Government | £599 + VAT | £699 + VAT |
| Corporates, Payors & Providers | £1,799 + VAT | £1,999 + VAT |
| Service Providers & Consultants | £3,299 + VAT | £3,499 + VAT |
Register for Women’s Health Week Europe | See the full agenda for WHW
Women’s Sport Summit Europe 2026
6 October | Emirates Stadium, London
The first-ever Women’s Sport Summit expands W Group’s expertise in connecting key decision-makers to the sports industry.
WSS brings together rights holders, brands, investors, athletes, and media to accelerate commercial growth across the sector.
Agenda highlights include:
- From capital to crowd: the women’s sport cycle at scale – with Omar Shaikh (Arsenal FC), Nicole McWilliams (Google), Kerstin Lutz (Mercury13), Jo Currie (BBC Sport)
- Women’s sport through the investor lens: what gets funded – and why – Hugo Sever (APEX Capital)
- Rethinking ROI: what are we measuring that doesn’t actually matter? – Fi Watherston (Metro Bank), Silvia Keiser (Billie Jean King Cup), Gabriel Akin-Odujobi (Crux Football), Tammy Parlour (WST)
- Beyond the 90 minutes: matchday as a commercial product, not just a fixture – Maggie Murphy (Aston Villa Women FC), Sam Feasey (Diageo/Guinness), Molly Miller (OneFootball), Megan Feringa (The Athletic/The New York Times)
Early bird pricing (ends 11 September):
| Ticket type | Early bird | Standard |
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| Service Providers & Consultants | £1,799 + VAT | £1,999 + VAT |
Register for Women’s Sport Summit Europe | See the full agenda for WSS
Attending both events?
For group tickets or to attend both summits this October, contact Callum, W Group’s Client Success Lead, at [email protected].
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