Four Reasons the Tech Revolution Has Disrupted Fertility, and Why Practice Owners are Frustrated

By Griffin Jones

CHANGING TECHNOLOGY

Part 4 of a four part series on the main business challenges facing fertility centers because of the shift from "small clinic" to "entrepreneurial endeavor"

For some IVF centers, the change has already done them in. For others, it is the level playing field needed to thrive against massively funded competitors. No phenomenon presents a greater threat, nor a greater opportunity to today’s fertility centers than the technological revolution through which our society is living.

So far, we've deeply explored the four major implications of the following axiom: today's fertility practice is no longer a small, independent healthcare clinic, but an entrepreneurial venture. We talked about business structure, strategy and vision, and accelerated competition. These three tenets pale in comparison to our society’s rapidly changing technological and social behavior.

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While all four of these elements have caused the tectonic shift from small healthcare office to entrepreneurial venture, none are more significant than this one, the drastic change of technology and society.

In this article, we mostly refer to consumer technology. Leave alone advances in medicine and laboratory technology, though their convergence may ultimately be indistinguishable. Rather than individually analyze various silos of the tech sector— such as social media, e-commerce, augmented reality, and artificial intelligence—we will examine how our relationships with our patients are changing, and more rapidly than we may realize, as a result of the speed of the changes happening in tech and society. These are just four implications of how advances in technology have changed our society, our patients, and consequently, our practices.

  1. Information exchange has accelerated at an uneven pace, which has led to

  2. Problems meeting needs and expectations which has contributed to the need to form

  3. Connected communities of patients who have both equalized and imbalanced

  4. Competitive advantages and disadvantages between large and small fertility practice groups.

And it’s only the beginning.

1). INformation EXCHAnge: Patients need more than providers can give

Travel back with me to the mid 1990’s. While today’s REI Fellows ran home from grade school to watch the latest episode of Saved By the Bell, the second generation of fertility sub-specialists left the universities to open their own fertility practices or start REI divisions at the hospitals. We’re referring to those who came after the pioneer generation of Howard Jones and Patrick Steptoe. Really, this class of baby-boomer REIs is the first generation of the fertility care provider whom we know today.

Now let’s imagine a couple from the same time period. They’ve been unable to conceive after two years of trying. How would they have found information on their

  • Diagnosis
    They could go to the bookstore. There was likely a book or two that offered good introductory information on infertility and/or how to get pregnant. But how is one supposed to keep a best selling thriller like The Fastest Way to Get Pregnant Naturally by Christopher D. Williams, MD on the shelves for long? Maybe there was a seminar in their area. But how would they have found out about it?

  • Support How would someone struggling with infertility have found professional or peer support? Could they just ask around town? RESOLVE was around, but it's not as though one could look them up in the yellow pages.

  • Treatment How did patients find their fertility provider? Would we have to hope that their OB/GYN or primary provider knew enough about emerging fertility care to direct them to the new sub-specialists in their area?

Think about the most powerful man in the world at that time, U.S. President, Bill Clinton. One of the most powerful supercomputers to which he had access was the Intel Paragon XP/140. Today, every one of your patients walks around with a supercomputer more powerful than that in their pocket. Because of that, our patients have access to more information than each of the world leaders from that time period as well. Information asymmetry is over, and it didn’t take long for these supercomputers to conquer our social habits.

The adoption of smart phones more than doubled from mid 2011 to late 2017 from 35% to 77%. 92% of adults ages 18-49 own a smartphone. You went to work one day and most of your patients did not have all of the world’s information at their fingertips. You came back to the same office six years later, and they did. The exchange of information has changed, but patients have outpaced their practices in their means to deliver and receive information, and that poses a problem in meeting patient expectations.

2). unable to meet patient expectation: not speaking the same language

“Not to use social media platforms is to be culturally incompetent. As a physician, we are supposed to give medical advice in a language the patient understands. Not doing so is considered to be medically inappropriate and can lead to adverse outcomes. If large segments of the population get the majority of their information digitally, isn’t it incumbent upon healthcare providers to provide information in an accessible, understandable way?”-Dr. Serena H. Chen, MD, REI

On a webinar that I conducted in August 2018, the most common challenge reported by fertility practice owners and managers was increasingly high patient expectations. Because patients have adopted the new methods of information exchange much more quickly, communication needs are frequently not met. This imbalance can negatively impact a fertility center’s relationship with its patients.

Patients are reaching out to practices through Facebook Messenger and Instagram at a quickly increasing rate. Patients spend most of their communication time on these channels, yet some practices don’t even have a contact form on their website. For younger patients, this is the equivalent of not having a telephone. On an average day, almost 40% of millenials interact with their smartphone more than anything or anyone else, including their significant other, according to 2016 research from Bank of America.

Practices are reporting challenges with meeting patient expectations, partly because technology has raised expectations of response time to a standard that staff cannot meet. Even if the expectations are unfair or unrealistic, fertility clinics are unable to reset those expectations if they are unable to effectively exchange information in balance.

  • Phone Calls
    Today's patients reluctantly call you to schedule an appointment. Tomorrow's patients simply won’t. Every year, the idea of making a phone call to schedule a new patient appointment is all the more foreign. When they are consumers, patients are accustomed to instant transactions, as with transportation, hotels, entertainment, and food. A survey from the United Kingdom found that more than 25% of smartphone owners never use their phone to make a call, up from only 4% 3 years prior.

  • Text Messaging
    Pew also states that Americans made over 12 phone calls a day in 2011. In 2015, however, a report by Informate shows that Americans make or answer only 6 phone calls a day, while sending and receiving 32 texts and spending 14 minutes on Chat. By the time institutes like Pew can even report their conclusions, the changes have already accelerated. 

  • Chatbots
    69% of consumers prefer interaction with chatbots for quick answers. Our prospective and current patients want (and expect) answers faster than we can respond to them. Think of the twenty most frequently asked questions that your front office staff has to answer over and over. They may even be answered as FAQs on your website. People expect these answers immediately, and the technology exists to meet that speed. See the example chabot flow below that can be used for your Facebook Messenger or website chat.

 The future of chatbots for fertility centers

The future of chatbots for fertility centers

The data suggest that clinics are unable to set and reset expectations with patients because the information exchange is imbalanced in such way that is insufficient to the patient. If patients and centers are not communicating in the same media, they are not speaking the same language. Consider this data point from the same Bank of America study: “the majority (67 percent) of Americans feel the appropriate response time to a text is under an hour, with 43 percent citing under 10 minutes and 10 percent thinking it should be instantly”. Contrast this with how long it takes your already work-loaded staff to respond to patients who are anxiously awaiting their test results. So they turn to each other.

3). COnnected communities of patients…and a chance to lead them

With the information exchange so out of balance, how are patients meant to process their information overload? Technologist Alex Kouts argues that reasoning by proxy, is the reliance on other people or organizations to offload one’s cognitive load, for forming a conclusion on complex subjects. Many patients rely on the experiences and opinions of their peers to help them process the very complex information they receive about infertility.

Part of the reason behind a massive social behavior change in our patient population is that people are now starting to talk about infertility. In the past, how could patients have connected with others to talk about their experience with infertility? Today, many people still struggle with infertility in silence, but hundreds of thousands of people worldwide are changing that.

#TTC stands for “trying to conceive” on social media. As of July 2018, the infertility hashtag had been used over 580,000 times and the #ttcsisters hashtag has been used almost 330,300 times on Instagram. There are thousands of infertility support groups and pages on Facebook, hundreds of infertility blogs, and dozens of podcasts about fertility. 

The cat is out of the bag. Good!

If we want to encourage people who are struggling with infertility to pursue medical advice, then we want them to talk. People are now talking publicly about a very pressing problem which you are more qualified to address than virtually anyone in their area. By becoming the voice for people with infertility in your area, and the forum for which they can connect with information and support, we create a natural and honest referral system. To the extent that you can encourage this system by truly providing values to prospective patients, you will never want for new patients.

Smaller fertility practices have access to a word-of-mouth referral network that was never previously available to them. In Part 3 of this blog series, we discussed the major advantages that large, private equity backed practice groups have over independent fertility centers. Thankfully, large practice groups aren't so much better equipped to adapt to these changing habits as we are.

4). COMPETitive advantages and disadvantages: rigged game or level playing field?

Many patients don’t see a fertility specialist when they need to because they are scared and they have no idea what seeing a fertility doctor will be like. They don’t know who to trust, but they do trust their friends and relatives. In years past, most people would not have known that their cousin, co-worker, or college roommate struggled through many of the same problems which they currently face, much less that they saw a fertility specialist, whom, and how happy they were with him or her. Now, hundreds of people in a person's social network can see when they post a picture of their beautiful family to their fertility center's social media channels, and publicly thank their fertility doctor and care team.

Larger practice groups often spend more money on social media advertising, yes, that is true. Because of that they are taking patients from practices who are not active on social media. But those practices that constantly create content and engage their community are acquiring new patients by word-of-mouth faster than ever. In fact, some practices don't need to spend any money at all on social media advertising, because there organic reach is so high. If dozens to hundreds of patients refer your practice in a given month and help persuade strangers who are looking for social proof, you will never want for new patients again.

Large corporations can outspend your marketing budget. They will and they are. They can create referral programs for large OB/GYN groups. They can leverage better deals with insurance companies. But there is a kink in their armor: they have to keep up with patients' attention as much as you do. People struggling with infertility want to give you their attention. Many times, they think about nothing other than their problem and you have at least part of the solution. If you make the effort to build trust with them and help them where they spend the most attention, you can reach them in such a way that large competitors cannot.

 The tech revolution and reproductive health

The tech revolution and reproductive health

ONLY the beginning

We are only at the very beginning of this technological revolution, which is greater than that of Johann Guttenberg and the printing press. Marketing for fertility clinics is only one facet of how consumer technology has changed reproductive health. Companies and products are invented every day that can change our field forever. Consider these breakthroughs and their potential ramifications in our field.

 Think of AI in the IVF lab

Think of AI in the IVF lab

Artificial Intelligence

Error rates for image labeling have fallen from 28.5% to below 2.5% since 2010. On this specific test, AI is now more accurate than human performance. Imagine artificial intelligence being used to

  • Score embyro quality

  • Predict success of recommended prognosis

  • Real time diagnosis

virtual reality impact on Assisted Reproductive Technology

Virtual and Augmented Reality

Statista estimates that there are 171 million active users of augmented reality in 2018. A 2016 poll of consumers in the United States by ClickZ found that more than a third (37%) have now used either their own or someone else’s VR headset. In the not distant future, VR and AR may be used to

  • Provide initial consults

  • Tour the practice and IVF lab

  • Take CME lectures and courses

How will block chain affect Assisted Reproductive Technology?

Blockchain

Blockchain technology scopes far beyond the function of currency. Blockchain is the digitized, decentralized, public ledger of transactions of virtually any kind. The number of Blockchain wallets has been growing since the creation of the Bitcoin virtual currency in 2009, reaching over 25 million Blockchain wallet users at the end of June 2018. Accenture estimates that 30% of operating costs could be eliminated using Blockchain. Blockchain development is still in its very early life, but it could be used in reproductive health to

  • Replace electronic medical records

  • Finance treatment

  • Integrate systems such as billing, records, results, and treatment protocol

change is here

Whether we like it or not, the REI practice of 2019 can no longer be designed as a small medical clinic. Whether its motives are profit driven or in service to the betterment of humanity, or anywhere along that spectrum, it is an entrepreneurial venture. We’ve examined how the world has changed dynamically in the last two decades and will change even more in the next two. To succeed, fertility centers need to be structured as an entity that is led by a visionary, with a strategy and vision that account for powerful competitors and the ability to adapt as quickly to social and technological changes as quickly as our patients do.

The variables for which we need to account are infinite if we try to keep pace with our society’s technological revolution as a whole. If we manage to keep pace with our patients, however, we have access to a breadth of opportunity the likes of which the world has never seen.


 

 

Flipping the Script is On Us

By Justine Froelker

Whenever I get included in anything infertility and loss awareness wise there are three parts of my brain that fire:

  1. Ego – Duh, my story needs to be a part of this.

  2. Shame – Who do you think you are? You shouldn’t even be included, no one wants to hear or is ready for your story and message.

  3. Gratitude – Thank you so much for including me and remembering my scary story is more common than people think or want to admit.

My name is Justine Froelker, and I am the infertility advocate whose story scares the bejeezus out of most in our community.

A recap:

We tried IVF due to my history of back surgeries and body casts in high school.

We lost three babies.

The money was gone.

Our hearts were broken.

We stopped treatments before we got the babies.

We are not choosing adoption.

We are accepting a childless not by choice, or as I like to call it, a childfull, life.

I am a forever grieving mother who chooses to do the work to see the gifts in everything.

I am happy and sad…you can watch my TEDx talk on that.

I am happier than I ever was before failed IVF because I choose every day to honor my three, and myself, in the work of happy. I realized the infertility journey had left me a shell of who I once was without the ability to ever go back to her, or even the desire to go back to her. I have fought for, created, and received this incredible life, a life that didn’t turn out how I hoped, dreamed or planned.

Infertility is not who I am. A woman without her children here on earth is not who I am.

These are part of my story. At the end of the day, we will all have our traumas, losses, and tragedies, none of us get out of this life unscathed, sure as hell not the infertility and loss journey. The day we speak more of these truths, and speak the shame that is inherent in this community is the day we free ourselves and flip the script for our loved ones and society to better understand us.

If we want more compassion and empathy from our lawmakers, doctors, and loved ones when it comes to the infertility and loss journey, we must better ask for what we want and need. Asking for what we want and need means we must speak our stories with authentic vulnerability and rewrite our shame.

As a Certified Daring Way™ Facilitator (trained by Dr. Brené Brown), I teach, talk, and model shame resilience and vulnerable living and loving every single day. Shame defined by Brené is the deeply painful feeling of being flawed and therefore unworthy of love and belonging. I don’t know about you, but my body not being able to do what I thought, and what society thinks, it is supposed to be able to do in getting pregnant and birthing a baby easily made me feel not enough and unworthy.

This isn’t fair.

I deserve this.

Am I being punished?

Is anyone else struggling with this?

Why is this happening to me?

When we own this shame, speak our truth, and ask for what we want and need, we are more likely to get the empathy and compassion we so desperately need and deserve from the people in our lives. For someone to sit with us in our pain, and simply say, “This freaking sucks. I am here,” rather than, “Why don’t you just adopt or just relax…” requires us to get vulnerable first. Healing only takes place in connection, and connection requires vulnerability.

Flipping the script is on us.

Is this scary work?

Yes.

Is it worth it?

Absolutely.

We have a taste of this within our own community if we can stay out of comparison, which is a whole other blog post… When you let your loved ones into your truth, give them the words, ask for what you want and need, you are way more likely to get it. Now, they will mess up and sometimes they won’t have it to give because we are all flawed human beings.

But you asked.

You owned your truth.

You honored your story.

Which means it can’t own you anymore.

Hi, I am Justine Froelker.

I mother more mothers than I can count, and my three in heaven.

I am a mother.

Full of grit and grace, Justine Froelker uses her fiery passion, the occasional curse word, and her witty humor to share her vulnerability and truth to light up the world. Justine is an advocate for speaking about shame and learning to thrive when life doesn't turn out how you hoped, dreamed, or even planned that it would. Justine is a Licensed Professional Counselor and a Certified Daring Way™ Facilitator with over 18 years of experience (based on the research of Dr. Brené Brown). She is the author of her best-selling books, Ever Upward and The Mother of Second Chances.  Justine currently lives in Saint Louis with her husband, Chad, and their three dogs. She enjoys her childfull life by spending time with friends and family, practicing creative self-care, laughing (many times at herself) and building butterfly gardens on her acre of land, which has made her an accidental butterfly farmer.

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6 Things Infertility Taught Me

By Brianna Steele

6 Things Infertility Taught Me

There is no question, my journey to parenthood was the hardest thing I’ve ever dealt with.  My entire life I dreamed of becoming a mother and the thought of this dream not happening was heartbreaking. I wouldn’t wish infertility on anyone but I do believe that infertility taught me six things that changed my life for the better.

Patience

I’ve always been a Type A, go-getter.  I was working in my dream job by age 21, I had my Master’s degree by age 22, I married my high school sweetheart at 23… I really thought I could plan for everything that I wanted in life but this journey taught me not everything is in my control and I needed to be patient.  The never-ending waiting for your next doctor’s appointment, waiting for your medicine to arrive, or waiting for the next cycle was extremely hard and it seemed like the light at the end of the tunnel was far, far away. What gave me patience and hope was the many options that were available: IUI’s, IVF, surrogacy, and adoption. There were so many options and I knew one of these options would help me become a mom. Every day I kept telling myself that I was one day closer to becoming a mom and that kept me going.

Strength

There were times that I didn’t want to face the outside world and didn’t want to get on social media because I knew I’d probably see a baby announcement.  Though I was always happy for others, I was also incredibly sad for myself. That being said, through the sadness and fear, I kept reminding myself that I was made to be a mother and I needed to be strong and fight like one. Sometimes you have to go through really hard struggles to realize how strong you are.Empathy

In this world, we are so quick to judge.  Infertility taught me that you don’t always know what someone is going through.  Everyone is going through some tough battle that you might not have any idea about.  I wish everyone would look deeper into a person before they make any assumptions. Wouldn’t this world be more beautiful if we all did this?

Gratefulness

One of the best pieces of advice I can give someone who is struggling with infertility is to treat yourself when something doesn’t go the way you wanted it to.  Whenever a treatment failed for us, we booked a trip to cheer us up because traveling makes our hearts happy. Due to a lot of failed treatments we were able to travel to several different countries. I’m thankful for these trips because it opened my eyes (and my husbands) to so many different cultures, provided me so much joy during this hard time, and most importantly, it taught me to be grateful for what I do have.  I know trips aren’t always feasible but do something that makes you happy and brings you joy after a failed treatment, whether that be a pedicure, a trip, spend the day with a loved one, or even just a night out. You deserve it and it’s always nice to be reminded to be grateful for what you do have.

The TTC Community and TTC Sisterhood is a Real Thing

The TTC Community on Instagram was so supportive and non-judgmental during my journey. We’d pray for each other, cry for each other, and were always there during the good times and the bad.  They also “understood” what you were going through. This community made me feel not alone. There are a lot of good people in this world, you just have to find them. If you’re going through infertility, please find us on Instagram (my username is MyTwinMomAdventures). We are a VERY welcoming group and would love to have you.

It Made Me a Better Mother

This will sound very cliché, but I truly believe this struggle made me a better parent. I’m sure I would’ve been a good mom even if I hadn’t struggled with infertility but infertility made me realize what miracles my children are.  It made me a more understanding, patient, and grateful mother. I thank God, every single day that I get to be their mom. I will never take being a mom for granted.

When going through infertility, you can easily get caught up in how horrible, unfair, and sad everything is. Or you can take what’s happening and learn from it. I was often consumed in anger and sadness but I did learn these important lessons and I truly believe that I am a better person because of the journey I went through.

BRIANNA IS A MOM TO BOY/GIRL TWINS, CAMDEN AND ELLA! SHE AND HER HUSBAND STRUGGLED WITH INFERTILITY FOR YEARS. AFTER THREE ROUNDS OF IVF (IN VITRO FERTILIZATION), THEY WERE BLESSED WITH THEIR MIRACLE TWINS. WHEN SHE’S NOT WITH HER FAMILY, SHE’S PURSUING ONE OF HER PASSIONS: TRAVELING (40 COUNTRIES AND COUNTING!), WORKING OUT, ORGANIZING, DECORATING, COOKING, BLOGGING, OR WATCHING REALITY TV!

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The Natural Route

By Caroline Harries

My husband, Colby, and I received our infertility diagnosis 6 years ago, in April of 2012. As most couples who have been diagnosed with infertility would understand and agree, we were completely caught off guard. You get married and you have kids, right? Well for 1 in 8 couples this is not the case and we happen to fall into that statistic. This diagnosis came quickly and although we were so thankful to find out what we were up against sooner, rather than later, it was still devastating. What we thought was just routine tests before we started our family, turned out to be much different as we were diagnosed with both female and male fertility.

What we found out in those first few months of trying to start our family was that I had lots of irregular hormones and a tumor on my pituitary gland and Colby was diagnosed with azoospermia, which is the fancy word for no sperm. Despite the diagnosis given, our journey has been different from many in that we have decided not to pursue medical intervention, but take a more natural route. Even though doctors told us the only chance we have to get pregnant is by in vitro fertilization, we are still on the path for believing for a supernatural miracle. We have received a lot of push back for this decision, but are thankful for the peace and freedom along the way. We have used our time of waiting to focus on our marriage and enjoy the things we love to do, like travel all over the world, spend time with our nieces and nephews and compete in triathlons and 5K's. Even though infertility brings many apart, for us and our journey, it has brought us closer together. We decided from the beginning that it was no ones fault; not my husbands and not mine, but that we are in this together. We are very open with each other about our journey and we agree that there is no one to blame. We truly view our wait as a learning experience and we are grateful for everything we have learned along the way.

In addition to the blessings that have come from our wait in our marriage, there have been so many other blessings as well. A year into our diagnosis I started a support group for women desiring to be mothers called Moms in the Making. It's been such an honor to serve and celebrate others as we wait for our own miracle. I'm so thankful to connect with women from all over the world through the online community, in-person support groups, an annual conference and a virtual group.

I want to encourage you that no matter what route you choose, whether it's to pursue medical intervention or to choose a more natural route, make sure to keep your marriage a priority. Advocate for you and your husband and do what is best for the two of you, not what is best for the doctors or those around you. I also encourage you to share your story or find an online or local support group. Whatever your story looks like or how long you have been waiting, know that there is every reason to have hope! Know that you are not alone! Know that there are other couples all over the world who understand the struggle and who are willing to join you in cheering you along in the pain.

Caroline Harries has a heart for those who are waiting on breakthrough from the Lord. Her unwavering faith is evident as she believes for her own miracle of children. She delights in encouraging women through her internationally followed blog and book, In Due Time, as well as her ministry to those desiring to become mothers, Moms in the Making. Caroline loves traveling the world with her husband and stays active by competing in triathlons. She holds a degree in finance and marketing from Baylor University in Texas, where she and her husband live. {Let's Connect} Facebook • Instagram • Bloglovin • Pinterest •Google + • Twitter

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Caroline Harries has a heart for those who are waiting on breakthrough from the Lord. Her unwavering faith is evident as she believes for her own miracle of children. She delights in encouraging women through her internationally followed blog and book, In Due Time, as well as her ministry to those desiring to become mothers, Moms in the Making. Caroline loves traveling the world with her husband and stays active by competing in triathlons. She holds a degree in finance and marketing from Baylor University in Texas, where she and her husband live. {Let's Connect} Facebook • Instagram • Bloglovin • Pinterest •Google + • Twitter

The Battle for the IVF Market: 5 Wall Street backed companies vs. private practice

By Griffin Jones

In Venture Capital fertilization

Part 3 of a four part series on the main business challenges facing fertility centers because of the shift from "small clinic" to "entrepreneurial endeavor"

Multi-million dollar private equity firms offer fertility practices an ultimatum: sell part of their practice, or have their market-share siphoned away.

Major firms spend hundreds of millions of dollars nationwide because they are in a race to consolidate as much of the fragmented IVF market as they can. This is only to speak of companies who own and operate networks of fertility clinics. In parallel, in 2017, PitchBook tallied more than $178 million invested into startups developing fertility products. In our series about fertility practices’ tectonic shift from small clinic to entrepreneurial venture, we’ve detailed the challenges that independent fertility practices face that their big new competitors don’t. So who are these new titans, and what are they up to?

 Merger and acquisition pattern of fertility centers

Merger and acquisition pattern of fertility centers

Important disclaimer: Neither I, nor Fertility Bridge have a direct commercial relationship with these companies at time of writing, though we certainly may in the future. We work or have worked with clinics in some of their networks. This profile is not a revelation of insider knowledge. Rather, it is a curated synopsis of public information. My observations and opinions are exactly those, based on information that has been publicly released by these companies or covered in the press.

compete with or join them. just don't pretend they don't exist

deciding to sell fertility practice

I have good friends that work for these companies or have affiliated their practices with them. Some might be very happy with their corporate partners and some might not be. It could be an excellent decision for your practice to sell equity to one of these firms or engage in a different level of strategic partnership with them. For some practice owners, a relationship with one of these firms is the answer to a lot of headaches. The stress of operations is shared with someone else, so providers can focus on practicing medicine.

Other practice principals feel they would lose control over the way they treat patients. They have their own vision for their culture and operations. If you’ve been struggling with this decision, I suggest reading part 2 of our series on vision and strategy, to see where you stand. This might be a long conversation, or several, with your business partner, spouse, clergyman, or bartender. You have to make the decision that’s right for you, your family, and your practice. There’s no right or wrong answer in a vacuum. Whether you decide to fight ‘em or join ‘em, however, we just can’t pretend these major new players don’t exist.

Second important disclaimer: It can be very fashionable to say these companies are more interested in their quarterly profits than the best interest of the patient. There may be cases when business pressures affect personal care. But I would be just as quick to point out that these companies might better serve patients in certain areas because they are better suited to face the challenges that we talked about throughtout this series. Their bankrolls may come from Wall Street, but the people that I know that work for these fertility networks are just as passionate about serving patients as those in private practice. Nevertheless, neither you, nor I, nor they get to pass final judgement on the quality of their output. The patient market decides.

The (Relatively) New Kids on the block

If we covered all newer companies in non-direct competition with fertility practices, this blog post would be longer than Don Quixote. In this article, we profile those networks who directly compete with other fertility centers. We also learn about the private equity firms behind them. Once again we ask ourselves, what is the plan?

Now let’s meet the people who want to buy you out or blow you over.

1). PRELUDE FERTILITY

 Fertility acquisition strategy

Fertility acquisition strategy

Prelude Fertility splashed into reproductive headlines in the fall of 2016 when Forbes magazine reported on The 200 Million Dollar Startup That Wants to Stop the Biological Clock. Where does a startup get $200 million and how have they acquired market-share so quickly? Meet the war chest and strategic acquisitions behind Prelude’s rapid market entry.

  • Lee Equity Partners. If Prelude’s coffers total $200 million, and Lee Equity’s buy-in was in line with their disclosed portfolio, then one might speculate that 25 to 50% of Prelude’s initial funding came from Lee Equity Partners. Massive capital from Lee Equity Partners has allowed Prelude to accelerate their acquisition of existing companies, and have they ever.
     
  • RBA. In October 2016, Prelude reported that it had acquired Reproductive Biology Associates (RBA) of Atlanta. RBA is the largest IVF practice group in the state of Georgia. Perhaps more importantly, RBA came with their sister company, My Egg Bank.
     
  • MyEggBank was created by RBA in 2010. According to their corporate timeline, their affiliate network grew from 22 clinics in 2012 to 109 in 2017. They report that over 4,400 babies have been born from MyEggBank donor eggs.
     
  • Vivere Health. Why buy one IVF lab at a time when you could acquire several at once? In a parallel running story, Prelude reported acquiring Vivere Health in October 2017. Vivere Health, LLC was founded in 2010 in partnership with Houston Fertility Institute. After an impressive acquisition journey of its own, Vivere Health had owned and operated IVF clinics and labs in
    • Austin
    • Dallas
    • Houston
    • New Orleans
    • Florida
    • Arizona
    • Kentucky

In April 2016, Vivere was listed in Fortune Magazine as one of the fastest growing female-owned companies in the United States.

Prelude says that their strategic goal is national scale. With a few more acquisitions of this pattern and magnitude, they will have achieved that end.

2). IVI RMA Global

If you’re less familiar with European originated IVI , Reproductive Medicine Associates (RMA) might ring a bell.

  • IVI was founded in Valencia, Spain in 1990. They own subsidiaries in genetic testing, IVF lab consulting, research and development, and stem sell banking, to name a few. In 2016, IVI owned and operated 60 clinic locations in 11 countries and treated over 60,000 patients.
     
  • Nova IVI. Major fertility networks aren’t relegated to the United States. They come from all over the globe and their expansion is international. In April 2012, IVI acquired Nova Pulse IVF and now owns and operates one of the largest fertility networks in India. Nova IVI reports over 19,000 IVF pregnancies in India alone.
     
  • RMA. According to their own PR announcement, RMA of New Jersey grew 70% in new patient volume from 2012 to 2017. I am unclear on RMA of New Jersey’s exact relationship with other RMA network clinics in the United States. Clinics under the RMA name operate in
    • New Jersey
    • New York
    • Pennsylvania
    • Florida
    • Connecticut
    • Michigan
    • Texas
    • Florida

In February 2017, IVI announced that their merger with RMA of New Jersey would make them the largest fertility network in the world. In a horridly translated press release, IVI reports that they own 70% of the new company while RMA of New Jersey owns 30%. They mention their combined 2,400 employees, including 200 physicians and 300 research scientists across 70 clinics in 13 countries.

3). INTEGRAMED

Integramed Fertility’s model is different from many fertility networks. Private equity is only one of three relationship models for Integramed. They also sell services for marketing and practice management that do not involve taking equity in the practice.

  • Integramed Fertility is a division of Integramed America and they report to be the largest fertility network in North America. With 2,200 employees and affiliate employees, the network is comprised of 39 centers at 153 locations across 32 states and the District of Columbia.
     
  • Attain Fertility. Integramed owns Attain Fertility, a patient-facing IVF finance program. They offer multi cycle programs, multi cycle programs with refunds, and bundling with additional services such as PGS and third party services. Subsequently, Attain functions as a lead generation company. Patients can search for Attain Fertility member clinics by doctor or by geographic area and Attain funnels those new patient leads to the clinic. Their business model is similar to that of ARC Fertility.
     
  • Sagard Holdings. Similar to how Prelude Fertility acquires practices through the funding of Lee Equity Partners, Integramed’s capital comes from Sagard Holdings. Integramed had been a publicly traded company, but Sagard reportedly took them off of the Stock Market in 2012 for just under $170 million.

4). OVATION FERTILITY

Ovation Fertility was founded in 2015 by physicians at Texas Fertility Center after a “major private equity investment to form a national network of assisted reproductive technology (ART) labratories”. At time of writing, Ovation Fertility owns and operates six IVF labs in five U.S. states.

  • California
  • Texas
  • Louisiana
  • Nevada
  • Tennessee

The private equity manager behind Ovation's capital is MTS Health Services.

 May meritocracy win all in the competition for best serving the patient population.

May meritocracy win all in the competition for best serving the patient population.

5). CCRM

The Colorado Center for Reproductive Medicine, CCRM as you fondly know them, enters new markets by acquisition like everyone else. Perhaps more than the other groups, however, CCRM enters new market areas through De Novo clinics. This means they help develop new labs and clinics in strong markets. In recent years, CCRM has opened or acquired IVF labs and practices in

  • Atlanta
  • Boston
  • Houston
  • Minneapolis
  • New York
  • Northern Virginia
  • Southern California
  • San Francisco Bay Area
  • Toronto

CCRM markets their lab advantages in every one of their markets. Since 2015, the private equity behind CCRM’s expansion comes at least partly from TA Associates in Boston. TA reports having raised over $18 billion in capital across their portfolio.

HONORABLE MENTION

In this article, we’ve only talked about your direct competitors. There are more companies from China and elsewhere that are buying fertility practices at high multiples that I don’t know very much about. There are large practice groups without private equity that acquire other clinics into their group. We didn’t even mention the new competitors that siphon market-share by offering new solutions or focusing on particular services. Here are just a few:

You don’t need to find Indiana and Arizona on a map to see that Boston IVF has interest in expanding beyond the northeast. Boston IVF is the “preferred provider of fertility services” for 15 different major health insurance plans. Boston IVF is the clinical affiliate of the Beth Israel Deaconess Medical Center and Harvard Medical School REI fellowship program. How would you like that advantage for recruiting new physicians? If there is a private equity firm associated with Boston IVF, I didn’t find it.

WHAT DOES IT all MEAN FOR YOU?

What’s a good ol' independently owned fertility practice group to do? Is there an opportunity for you to compete and thrive in this radically different world? You might look at regional banks or craft breweries. A century ago, every city in North America boasted their own local brewery, likely several. Beer became commoditized, and the corporations with the best distribution, market share, and financial leverage acquired or vanquished their competitors. By the 1990s, we were left with Anheuser-Busch, Miller, and Coors. South African Breweries  purchased Miller  and Molson-Coors (another merged mega conglomerate) in 2008 to become SABMiller-Coors, and finally merged with Anheuser-Busch/InBev (another merged mega conglomerate) in 2016 .

The past twenty years should have been a terrible period to start a brewery. Yet, quite to the contrary, independent breweries opened all over the country and took marketshare from the big players, now at 23% . Middle market companies like Sam Adams and Yuengling grew their own sales and grew by acquiring small breweries. The cycle continues. We see the same pattern among regional banks, and I believe we are seeing it in our field as well.

Small practices join together to become mid-size practices, and large companies acquire both small and mid-size groups. Then, physicians leave big practice groups and academic institutions to start the cycle anew. (I’ve got my eye on you, Vios Fertility). I don’t believe that all independent practices will be acquired or wiped out. The current and coming landscapes are just exceedingly difficult for unintentional REI entrepreneurs.

if you can't beat 'em, join 'em

when fertility centers join big practice groups

What will happen if you're unprepared for these competitors when the next economic recession starts? What will you do if 30-40% of the money in the marketplace goes away, seemingly over night? What would that do to your IVF volume? To your new patient visits?

Entrepreneurial competition isn't the only answer. It might make sense to sell equity in your practice or control of your lab. It could be the answer to a lot of your problems. One of the companies profiled in this article might be a great fit for your office. If we want to sell our practice, and want to go into the negotiation with “strong upside”, plenty of options, and not as a “distressed asset”, what is the plan?

if you can't join 'em, beat 'em

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On the other hand, the idea of giving up control and direction of your practice might eat you alive. Only you can make that decision. By taking market-share from big competitors now, as opposed to letting them take ours, we can prepare for an economic downturn in which we will not only survive, but thrive. If we are going to defend and grow market share against majorly funded competitors, what is the plan? 

We’ll conclude our series on IVF centers’ tectonic shift from small healthcare practice to entrepreneurial venture with perhaps their greatest challenge of all. Yet, it’s also their greatest opportunity and their chance to beat their giant new competitors where they lag.

In Part 4, we discuss the biggest change ever to occur in human communication and technology.

The one that dwarfs the revolution of the printing press.

The one we're living through right now.

What is the plan?

Flip the Script

By Chelsea Ritchie

This week marks an important week in the world of infertility as it is National Infertility Awareness Week (NIAW). It’s a week where people unite, help educate others about infertility and open up conversations to all that it all entails. I am so grateful for the infertility community and RESOLVE as we work to educate others on what it’s like to wear these shoes.

Let’s talk about the facts here. Infertility affects 1 in 8 couples. 1 in 8. That’s tragic. It’s a disease that doesn’t discriminate – it touches men and women. Black and white. Rich and poor. Young and old. You are all in once you get the diagnosis. Your heart becomes invested, your body becomes tormented and your faith is tested. You learn to deal with grief daily, wishing things were different, coping with the loss of dreams, and navigating your way through anger, jealousy, sadness and brokenness.

This year, RESOLVE has set the theme for NIAW by spreading the message to “Flip the Script”. There are so many ways to branch out on this topic, but today I want to touch on helping those around us flip the script on what they say once they hear about our infertility.

We’ve all been there. Aunt Marge asks “When are you and Jimmy going to have a baby?! You aren’t getting any younger!” You feel the sting and quickly reply with a tense grin “We are trying, it’s not always that easy.” “Of course it is!” she barks back, “Just lay with your legs up a little longer. Or go on vacation and relax! This family is fertile.”

I know you understand.

After you spend 10 minutes in the bathroom pulling yourself together and wiping dry the blood caused from the lip you had to bite to keep from screaming, you walk out and pretend like you aren’t hurting. I’ve been there, I know you have too.

Let’s flip the script. Let’s start EDUCATING people on what not to say when we share our hardships. Can you imagine if someone told you they had cancer, and you replied that they just need to relax a little, get drunk on vacation, and try drinking Robitussin? Let’s be honest, that would never happen. We need to do our part to continue to educate others, to help others show sympathy when they hear of our diagnosis’s, and teach them what to say and what not to say. I hope this list helps you in that direction today! Please, feel free to share this to get the conversations going!

What Not To Say: “Ohhh, you just need to relax.” Or “You’re trying too hard!” or “Don’t think too much about it”

What to Say Instead: “I am so sorry you are going through this.”

 What Not to Say:  “You should just adopt.” or the infamous “I know someone who tried for a long time and as soon as they adopted, they got pregnant.”

What to Say Instead: “I am so sorry, this must be so difficult. What can I do for you?”

 What Not to Say: “It’s okay, there must be a reason.”

What to Say Instead: “I am here for you whenever you want to talk.”

 What Not To Say:  “Well, you are sooooo young, you have time.”

What to Say Instead:  “I cannot imagine how hard it must be to want to start your family and be unable to. I am here for you and will be praying for you.”

What Not to Say: “Oh, I wish I had that problem! I just look at my husband and BOOM! We are pregnant.”

What to Say Instead: “It must be so hard to see so many pregnant women all the time. You are stronger than you will ever realize.”

What Not to Say: “The cost of all of these doctors’ appointments will be so worth it when you are holding your child.”

What to Say Instead: “All of those doctor’s appointment sand medications must add up. If you ever want me to bring over dinner and a movie and hang out at home, please let me know.”

 What Not to Say: “You want a child? Ha! Here, take mine!”

What to Say Instead: “I care and I am so sorry you are experiencing this kind of pain. Let me know if there’s anything I can do to make this burden easier.”

Bottom line – In order to flip the script, in order to stop creating more pain and start creating more empathy, we all have to be willing to be vulnerable and enter into someone else’s intimate sorrow. And we have to be willing to speak up when someone says something insensitive and hurtful, as hard as that is. It’s okay if not everyone identifies with the struggle, but sensitivity can go a long way.

Connect with Chelsea more, and follow her at her blog Trials Bring Joy, on Instagram at @chels819, and on Facebook at Trials Bring Joy.

Chelsea is a Midwestern girl who loves connecting with fellow women and bloggers about the topic of infertility, living authentically, and motherhood. She’s been married to Josh for almost 13 years and now celebrates life as a twin mom to Kirsten and Logan, born after nearly a decade of infertility. Chelsea loves a good cup of coffee, a cozy bookshop and mindless reality TV. She values engaging her faith and embracing difficult seasons with joy. She also co-authored the devotional In the Wait, which you can find on Amazon.

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I Didn't See THAT Coming! One Woman's Struggle with Infertility and How it Changed Her Life

By Lyneda Lincoln

How did I get here?! I have NO idea how I got here!

As a little girl dreaming about the life I aspired to have – a high powered career, a doting husband, two beautiful children – it never crossed my mind that I might not be able to have one of those things. From a young age I was told that if I wanted something, I just had to work hard enough, and it could be mine; something about the world being my oyster – you know the saying. So, that’s what I did. I worked hard. I was dedicated. I crushed high school. I sailed through college. I landed an amazing job with a Fortune 100 company right out of college at the ripe age of 22. And finally, that sexy guy that I had kept on my arm for the past four years - my best friend turned love of my life - finally asked me to marry him! I was getting everything I ever wanted. But, why shouldn’t I? I followed the recipe of life that had been handed to me – I worked hard and maintained focus. For that, I deserved everything I ever wanted. Crack that oyster open y’all! I want my pearl!!

My husband and I had decided before we got married that we wanted to spend the first two years of our marriage just enjoying each other and settling into adult life. After that, we’d start the next part of our journey together and have that first child we had been fantasizing about. It was the perfect plan. But, this was the first time I would find that life doesn’t always quite go as planned. A year after we got married, I was unwillingly saddled with this burdensome feeling that I wanted to be a mother sooner. As exciting as the prospect of being a mother was, I was a bit annoyed that my mind and my heart didn’t get the memo that I needed another year of blissful married life before I started thinking about children. I tried to push the feeling aside, but pregnant bellies popped up everywhere and babies had these cute, googly eyes that caused my heart to palpitate uncontrollably. The baby aisles suddenly had this alarming power to pull me towards them and then it happened… the mirror whispered to me to look down at my hand cupping my belly and picture that oyster pearl finally cradled within my grasp in the form of tiny hands and toes. I told my husband about how I was feeling. He was kind hesitant because he didn’t want the pressure of trying yet. But, he was willing to let me stop my birth control pills and with an, “if it happens it happens” attitude, he began toying with the idea of a surprise pregnancy that would whisk him into fatherhood. So, Christmas 2013 was an exciting time because we had it in our minds that within the next few months we would make the exciting announcement that Baby Lincoln was on the way!

Oh… but its 6 months later and we haven’t even seen a shadow of a line on any of those little pesky tests that we had stocked up on. What was going on?? Well, duh! I wasn’t following the recipe. I was expecting it to just happen without any hard work. No worries – challenge accepted!!! I began rigorous research – I found articles, books, Facebook support groups. I downloaded more apps for tracking my cycles to compare against the My Calendar app I had already been using. I started my Rainbow Lite Prenatal Vitamins. I purchased Wondfo OPKs. I booked a pre-conception check-up appointment for myself and my husband. By this time my husband also felt we should be more pro-active and start actively trying to conceive so we just knew that the pre-conception check-up would give us the ammo we needed to make this baby. Much to my surprise, because we were only 24 years old at the time and too young to be worried about fertility issues, the pre-conception visit consisted of a standard physical and a metaphorical pat on the head with a, “have fun!” on the way out the door.

Christmas 2014 had now come and gone. Still no baby. How could this be?? I clearly wasn’t working hard enough… I wasn’t praying hard enough. Time to add in monitoring my Basal Body Temperature and get down on those knees a bit more so my Heavenly Father could hear me better. But despite my hard work, my heart was still in shambles as with each month Aunt Flo showed up like clockwork. By early 2015 I was tired of waiting around. Friends and family had been telling me to stop stressing and just let it happen. Our doctors had told us it just takes time and that we are young so there was nothing to worry about. Yet, each month, someone else was making a pregnancy announcement or posting photos of their new baby and here I was with an empty womb. My oyster shell was closing… and fast. I was in despair. The emotional toll began to affect me physically as well in many ways. My husband didn’t know how to console me. Aside from dealing with what I presumed to be an undiagnosed fertility issue, I was also trying to cope with grief and loss of several family members. By June 2015 I had a more positive outlook on life and decided to go in for fertility testing. Once again, we were told that we were too young to be worried about fertility issue, but I was persistent.

After fertility testing with our local doctor, we were diagnosed with severe Male Factor Infertility and were hesitantly advised that we had a 1% chance of ever being able to conceive naturally. So, a referral was made to a local fertility clinic and urologist who would help us going forward. After a few months, my husband was prescribed Clomid to start his treatment, but before we could get the prescription filled, we found out that we were miraculously pregnant!! At 8 weeks, my OB had trouble believing we were pregnant and asked that she be able to check via ultrasound before my dad and my husband came back into the room to prevent any harsh surprises. But, sure enough our little pearl was there - strong and healthy.

I went on to have a perfect pregnancy filled with awe and a blissful unmedicated home water birth where we met our precious baby girl. However, I never lost sight of the fact that we were one of the few lucky ones. Most go on to do years of treatment and endure IVF before they ever get to meet their long-awaited miracle(s).

Being a spiritual person, I believe that everything happens for a reason and at the perfect time. But, I also can’t help but feel as though we may have had our miracle that much sooner had our medical professionals not been so blinded by our age. Infertility doesn’t just happen to those in their mid-30’s and 40’s. We were a stable, otherwise healthy married African American couple in our mid-20s who had an explainable fertility issue that could have been addressed early on during our pre-conception checkup and could have saved us a lot of heartache, time, and money.

Although our infertility journey was admittedly long and painful (longer than some, shorter than others), it did make me more appreciative of the privilege it is to be a mother. My husband and I spend every day extremely thankful for our daughter and we cherish every small moment with her. But, what I didn’t anticipate was that the feelings of infertility don’t just go away after you “beat it”. You look around at the other women who are still standing in the mirror cupping an empty womb. Their pain continues. You watch women complain about how easy it is for them to get pregnant with children they don’t want. You get angry. In my case, you change your life plans and decide that you don’t need two children – one is good enough – because you don’t want to experience the pain and longing all over again. So, then what DOES come after infertility?

In our case, I realized that our burden could be used as someone else’s blessing. I wasn’t ready to give up the fight against infertility just yet. From this, I made the decision that I was going to become a surrogate to help other couples complete their forever family. My husband was completely supportive, and we went through the laborious process of screening, testing, matching, fertility medications, and embryo transfer. It gave me the chance to understand all we could have gone through, so I could appreciate my blessing that much more. It also gave me the chance to meet a beautiful couple in their mid-40s who is now eagerly awaiting their fraternal boy/girl twins from our first successful FET in December 2017 after years of their own infertility struggle which included failed transfers, pregnancy loss, and financial sacrifice. This journey has presented its own set of challenges but is equally rewarding and fulfilling for me knowing that I did my part to help eliminate the fertility struggles of another couple.

I honestly can’t say how I go here – how I became this 28-year-old mama discussing and spreading awareness about infertility. But, I am so honored to be a part of this movement and to have been given a platform to tell my story. I hope as you’ve read through some of these stories this week, you gain a better understanding of the struggles about infertility and how it can affect just about anyone around you. I hope you choose to speak out and do your part to bring more awareness to this topic so that people don’t have to continue suffering alone… It really can happen to anyone.

Lyneda is a 28-year-old aspiring entrepreneur and mama of one. Several years ago, in the midst of her pain, she took to Instagram as a way to express her frustrations of eagerly awaiting a child and to find other women who might be experiencing the same thing. Since then, she has continued the unfiltered documentation her life on her Instagram profile @WeAreTheLincolns in the hope to spread awareness about infertility, motherhood, and surrogacy. In between Instagram blog posts, Lyneda enjoys reading, working her new endeavor as a home-based travel agent, and spending time with her family.

Our Story of Infertility

By Owen Davis

My name is Owen and I am so excited to share my story with you guys today. I am a part time orthopedic Physician Assistant and a full-time mommy. I still get butterflies when I call myself a mom… I will never get used to hearing that and I will never take it for granted. Unless you have personally struggled with infertility, you probably have no idea that this week is National Infertility Awareness Week. A week dedicated to bringing awareness to a topic that is under discussed and over prevalent. I'm sharing our story in hopes of removing the stigma surrounding infertility and to help at least one person feel less alone.

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Our infertility story began when we were just dating when a doctor delivered the heartbreaking news that it would be hard for us to get pregnant naturally in the future. At that point we knew we would one day get married and want babies so we decided to proceed with surgery, knowing that it may or may not help our chances. These are some scary decisions to make for your future when you are just dating. After surgery it was just a waiting game... we wouldn't know whether it was successful until we started trying to conceive. Fast forward about 4 years. We were married and it was (finally!) time to start trying to get pregnant.

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This is where God stepped in, as He always does. I was in PA school and I chose to do one of my elective clinical rotations in infertility medicine. Ever since our infertility journey began it had become so intriguing to me both medically and personally. I told the reproductive endocrinologist I worked with all about our story and asked his personal opinion. He told me that we should go back to our previous doctor for more testing since we had not successfully gotten pregnant yet. So back to the doctor we went where more tests were done which showed that 1) the surgery had not worked and 2) they were concerned my husband may have a benign brain tumor that could also be affecting fertility. An MRI was done which did, in fact, show that he has a benign brain tumor also affecting fertility. With all of these factors, they told us our only option was IVF.

We were referred to UNC Fertility where we met our absolutely amazing doctor for a consultation and more testing and he agreed that IVF was our only option. That was a really low point in my life. I was overwhelmed, ashamed, heartbroken, scared and lonely. I decided that I could either keep it a secret from everyone or I could bravely share our story with the world which is what we decided to do. I am not a sharer by nature so this was a huge leap of faith for me! But I knew that if I stepped out of my comfort zone I could bring awareness to infertility and break the stigma behind it. I prayed that I could help at least one woman not feel so alone by sharing our journey.

Now it was go time! From there we began shots in preparation for egg retrieval. Egg retrieval went amazing and we got 44 eggs, 28 of which became healthy, day 5 embryos! This was such amazing news and a huge relief. I then suffered from ovarian hyperstimulation syndrome (OHSS) so our fresh embryo transfer was canceled while my body recovered. Six weeks later I was feeling great and ready to proceed with a frozen embryo transfer! We started medications again and on June 24, 2016 we transferred one grade 4AA embryo. It was the most amazing experience watching it on the screen and I will never forget my doctor saying, "You should be cautiously optimistic!"

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Five days later I did what any Type-A person would and peed on a stick... there was no way I could wait 4 more days for my blood test. A faint line appeared immediately and I was in shock! The rest of my pregnancy flew by and at 37 weeks I delivered our perfect baby girl via urgent C-section after 50 hours of labor.

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Struggling with infertility was a huge blessing in disguise. While I would never wish it on my worst enemy, it taught me so much about myself and about life in general. The three things that infertility has taught me are:

1) Never ask someone when they are going to have kids. You don't know what they may be going through. They could be going through IVF, IUI, just had a miscarriage, been trying for years unsuccessfully, you name it. Everyone's story is different and 1 in 8 people are struggling to get pregnant. Words can hurt so badly when you are in the midst of infertility heartbreak. Think before asking someone such personal information.

2) Ask how she is doing. If someone you know has shared that they are going through infertility, always say something. I was so hurt by the things that people didn't say when we were struggling. Some of the people I am closest to never said a word to me about it. I know that they felt uncomfortable and at a loss for what to say, but I will never forget feeling so alone and forgotten by some of my closest friends. Even if you don't know what to say, a simple "I'm thinking about you and praying for you" goes such a long way.

3) Never take a single moment for granted. I am one of the lucky ones who got my miracle baby on this side of Heaven. Not everyone is that lucky and I will never take that for granted. Even the most boring, mundane days with her are the best days ever. At least once a day I think to myself, "I still remember the days I prayed for the things I have now". Infertility has made me so much more patient and grateful. Our battle with infertility wasn't easy but the fact that it resulted in our baby girl made it so worth it. I would take every injection, procedure, tears and heartache all over again to be her mommy.

Owen lives with her husband and their 14-month-old baby girl in eastern North Carolina. She is a beach bum at heart and loves a good cup of coffee and cold glass of prosecco. She began blogging in 2014 to document their lives as she navigated PA school, marriage, and traveling. She quickly realized that she would be doing the world a disservice if she wasn’t transparent about their struggles with infertility and their journey through IVF which led to their miracle baby. 

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Flip the Script - Tia Gendusa

By Tia Gendusa

Hello and welcome lovely readers! I am so, so happy you took a few minutes out of your busy day to connect with me here at Fertility Bridge! My name is Tia and I am a former IVF warrior that writes over at ForeverOrchard.

My path to motherhood closed in late 2017, after unsuccessfully going through four egg retrievals, three transfers, and suffering two miscarriages. We fought and failed for five years, and I spoke frankly about our lives and our decision moving forward in THISPOST

I wouldn’t wish infertility on my worst enemy, but I am here, standing and thriving, even though life is shaping up a bit differently than I had planned.

These days I speak to spread awareness about the ups and downs of infertility, not only in the thick of treatments an uncertainty, but for everything that comes afterward, whether you find success or not.

I hope by cultivating happiness through my Blog, YouTube Channel, and Instagram, we all learn to give ourselves more grace and practice positive thinking no matter what life throws at us.

One of the top issues about fertility treatments for our family included our finances and insurance coverage. Did you know that only 15 states currently offer some formof infertility coverage? I live in IL, one of the covered states, but even I work for a company that was exempt from this type of coverage, forcing me to branch out and buy my own individual insurance. I thank my lucky stars every day that we had the coverage we had. Even so, we spent roughly $30,000 out of pocket, and while that number may be shocking to see, it fell somewhere in the middle of the (very wide) spectrum of financial woes associated with these types of treatments.

This year, Resolve’s theme is Flip the Script, and it’s offering a chance for people like me to level the playing field when it comes to breaking down barriers with family-building.  This week in particular is NIAW, or National Infertility Awareness Week. It’s our week to band together and fight for the justice we deserve. We deserve better insurance coverage, more affordable treatment options, less discrimination, more empathy and more education for the masses.

Infertility doesn’t just affect the person or people trying to grow their family. All facets of their lives take a hit. Our friends and family may not know about our struggles, and if they do, they don’t know what to say when faced with such a heavy topic. Our careers are constantly taking a back seat to appointments and procedures. Financial woes hit heavy on our emotions and our wallets. To think that it takes the equivalent of the child’s college fund just to have a child in the first place, is daunting. A complete lack of infertility insurance coverage or state-to-state exemptions leave us scraping money together via loans or fundraisers for something that comes so easily to others.

There are MILLIONS of us. Don’t believe me? Start a conversation with your friends and I could bet good money (maybe enough for another round of IVF?) that you know at least one other person who has, or is, struggling to conceive and resorted to fertility treatments.

Our goal is simple. To fulfill our lives in the best way we know how. We want to nurture and raise little miracles of our own that will eventually be thriving adults. The love we have for these babies that don’t exist yet is paramount. And yet, so many of us are bashed for our way of thinking or forced to close this chapter of our lives because we simply cannot afford it.

I urge you to use your voice. I urge you to use your social media platforms. Write the letters. Send the emails. Speak up and help lift up this community. It’s time to Flip the Script.

Thank you for reading. Please feel free to email me with any questions or comments that are on your mind. Let’s do better together.

Tia is a Vlogger and Writer at Forever Orchard. She lives in the suburbs of Chicago with her husband and English Bulldog. She started her journey to parenthood in 2012 and quickly realized it wasn’t as easy as her Health teacher once told her. She and her husband are both autosomal recessive carriers of a genetic condition called MCAD, therefore, IVF was the only option to eliminate this disease from their future children. After four egg retrievals, three transfers, and suffering through two miscarriages, she closed the door to motherhood in late 2017. These days she speaks openly about her struggles with grief and cultivating happiness no matter what life has to offer.  

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A New Vision and Different Strategy for IVF Centers to Thrive Beyond 2018

By Griffin Jones

Part 2 of a four part series on the main business challenges facing fertility centers because of the shift from "small clinic" to "entrepreneurial endeavor"

We might criticize REI fellows for not wanting to take over existing IVF practices, but they are making the same decision that current practice owners have made for decades. They are deciding to be doctors and not CEOs. At the time, starting an independent practice didn’t mean launching a commercial enterprise. The difference is that new doctors know they can’t get away with that today.

 Organizational leadership is an issue at many fertility practices

Organizational leadership is an issue at many fertility practices

In Part 1 of our series on the contemporary fertility practice’s shift from “small, independent healthcare practice”, to “entrepreneurial venture”, we discussed the traditional model’s outdated business structure. Now, in Part 2, let’s talk about how the leadership atop that structure dramatically affects a fertility center’s ability to do business today, leave alone tomorrow. We’ll discuss eight critical elements of vision and strategy, and we’ll deeply explore those with which IVF centers tend to have the most trouble.

A new vision and different strategy needed for fertility centers

We mentioned that the Practice Director is in charge of an IVF clinic, where the CEO is tasked with the overall responsibility of creating, planning, implementing and integrating the strategic direction of an organization. But what happens when infertility clinics don’t have a clear vision in place? Here are some real life examples:

  • One partner wants to sell his share of the practice to a private equity firm but his partner wants to remain independent.
  • The practice principal wants to increase fertility preservation, bur the rest of her team knows very little about this initiative.
  • Practices jump from one marketing venture to the next, wasting time and money because they aren’t making their advertising work toward their vision.
  • Business development projects are started and abandoned because practices have few benchmarks in place and consequently don’t accurately measure if they’re moving toward their goal.

“Hope is not a strategy,”—Rick Page

Do any of these problems resonate with your practice? We’ve accepted that the head of our company, Principal, Founder, CEO, President, or whatever we choose to call it, has responsibilities that extend far beyond the role of physician and even that of Medical Director and Practice Director. Now visionaries can lead their practices in ways that allow us to super-serve their patients and grow. The leader of a company identifies, articulates, and plans its

  • Core Values
  • Core Focus
  • 10-year target
  • High Level marketing strategy
  • 3-year picture
  • 1-year plan
  • Quarterly Priorities
  • Issues

All of these tenets are essential, with the priority starting at the top of the list. Some we will link to external sources for further reading, because we need to spend more time with the most common principals with which fertility clinics struggle.

1). Core Values

I’ll wager that your values are far more compelling than those of the average business. After all, you’ve devoted a career to helping loving parents create life. But how do you articulate your values to your team, to patients, and to the public? We work in a field that is both being changed by society, and changing society…rapidly. How do we stay true to who we are and what we believe while being able to adapt? When core values are true and defined, leaders make hiring decisions that allow them to unload responsibilities and feel comfortable that their practice is in good hands.

2). Core Focus

Your Why and Your What. Purpose, passion, and cause combined with your niche. The more closely aligned employees are with Core Focus and Core Values, the more prepared they are to make decisions in the best interest of the practice, and the less practice owners need to micromanage.

3). 10 Year Target

Where one wants to be in ten years is the destination from which the rest of the roadmap is drawn. This is where fertility centers frequently fall off track. Do you want to open more offices or labs? Do you want to attract patients from overseas? Do you want to pilot a technological solution? You may notice that we can’t move to the next core tenet of Vision and Planning, the High Level Marketing Strategy, until we have solid long term goals.

 Original fertility marketing consultant, Yogi Berra, on strategic growth

Original fertility marketing consultant, Yogi Berra, on strategic growth

In the same week, I received two calls from two different fertility doctors who had the same question, “how much money should I spend on marketing?”

A million dollars. A couple thousand dollars. My answers to each of them were starkly different.

The first doctor was in his early sixties. He works for a larger practice group and does a little bit of marketing for himself. He’d like to perform seven or eight more egg retrievals per month. He plans to retire in the next two years.

The second physician just completed his REI board certification in the United States. He’s in his early thirties. He wants to move back to Latin America to start a large IVF center that draws patients from the United States, Canada, and Europe.

These are two vastly different long-term targets that dramatically impact who they will hire, how they will build from patient feedback, and how they will market. The 10 Year Target could be the most measurable differentiator between visionary entrepreneurs and independent physicians. Fertility practice groups without a defined long-term target are finding themselves directed by the demands of the day instead of concentrating their resources on becoming who they want to be. Entrepreneurial Operating System (EOS) founder, Gino Wickman, says that the 10 Year Target is not the time to be conservative. Dream big for the best version of yourself and your practice.

4). High Level Marketing Strategy

Do we know who we want to serve and what we mean to them? Is our 10 Year Target defined? Great. Our High Level Marketing Strategy involves doing whatever it takes to get there, within our core values and core focus. It details our

  • Goals (obtained from 10 Year Target, 3 Year Picture, and 1 Year Plan)
  • Benchmarks
  • Unique Marketing Position (obtained from Core Values and Core Focus)
  • Practice Brand
  • Content Strategy
  • Distribution Strategy (advertising)

Benchmarks

Many practices want to jump right into marketing without having reliable benchmarks or key performance indicators (KPI) to plan their strategy. Without them, money and effort may be wasted.  If you’ve ever spent money on advertising and aren’t sure of the results, revisit your KPIs. Do you have access to all or any of these Indispensable Indicators?

  • New Patient to IVF Conversion
  • Phone Call to New Patient Conversion
  • Online Contact Forms to New Patient
  •  Cost Per New Patient
  •  Patient Life Time Value
  • Cost Per Lead

We are data-driven marketers. Results must be measured as accurately as they can be. If you need help calculating your Indispensable Indicators, read Chapter 2 of The Ultimate Guide to Fertility Marketing.

Brand

If you feel like you can’t trust your employees or marketing partners with your message, you may need to document your practice's brand. At the Midwest Reproductive Symposium international (MRSi) in June 2018, I will be giving a branding workshop for fertility centers with branding expert, Mara Lucato. Here’s a glimpse of my thesis.

Brand is being known to the people we serve: how and why we help them with their problems. Logos, color schemes, and slogans, are relevant, or not, in so far as they help us achieve that end.

In our case, we have a community of people that desperately needs our help. In many cases, they don’t know who we are or how we can help them. Our brand and our high level marketing strategy involve providing them with as much value as we can, and then making it as easy as possible for them to do business with us. It includes

  • Connecting them with peer and professional support
  • Educating them
  • Encouraging them
  • Standing up for them

We are charged with making sure that everyone in our region knows that infertility is a common medical issue. That people struggling with infertility are human and their problem is human.
They need to know that we are the ones who will help them. That is a fertility center’s brand.

Content and Advertising Strategy

A fertility practice’s High Level Marketing Strategy activates its brand by delivering its message across the platforms on which patients spend their time and attention. The platforms, and consequently the methods, change. 15 years ago, creating an infertility support blog was a game-changer. 10 years ago, having a Facebook page was a tremendous way to reach new people. Three years ago, Instagram stories and Facebook Live didn’t exist. Today, they are among the best ways to connect with prospective patients. Four years from now, there will be new tactics, and some of our current marketing efforts will be less relevant. A High Level Marketing Strategy allows us to adapt our marketing efforts to the tactics that are relevant to the attention of the people we serve.

5). 3 Year Picture

The 3 year picture and the 1 Year Plan zoom in on the 10 year target. Where are we going to be in three years? What is our revenue? How many IVF cycles are we doing? How many physicians are on staff? In the same way that practices often lack a 10 year target, the three year picture serves the same importance, just getting closer to bridging Vision and Traction.

6). 1 Year Plan

Long term planning for fertility centers

Often fertility centers have annual volume goals, but are they committed before the start of the year? Are they realistic?

7). Quarterly Priorities

Again, fertility practices frequently fall off track here. Do we have three to seven quarterly priorities that must be accomplished this quarter? Are we accomplishing priorities that move our business toward its one year plan, its three year picture, and its ten year target? Or are we drowning in the issues of the day-to-day?

8). Issues

 Just another REI practice manager

Just another REI practice manager

The image of Sisyphus pushing the rock up the hill for all of eternity resonates with many practice managers. Fertility centers’ staffs frequently burn out because they are working on the same issues with no resolution. Care teams spend so much time working on issues that are urgent, they may have precious little time to focus on important, big picture issues. Take a look at the Eisenhower Decision Matrix. 

 The Eisenhower Decision Matrix applied to fertility clinics

The Eisenhower Decision Matrix applied to fertility clinics

As a fertility specialist, or a practice manager, you never have to deal with matters in Quadrant 1, do you? Yeah right. Fertility centers live in Quadrant 1. Employers that make their employees and managers work in quadrant 4 ought to go to jail, (joking…or am I?). Work of little importance and urgency robs human beings of their energy and happiness. Most of the responsibilities in Quadrant 4, by definition, can be eliminated. Let software do the rest.

Now we’re left with Quadrants 2 and 3. As the owner or manager of your practice, with your very limited time remaining from Quadrant 1, which do you prioritize between “urgent and non-important” and “important and not urgent”? It’s Quadrant 3, isn’t it? We often worry about issues that are not important but they have to be attended to right away. This isn’t to say that issues in Quadrant 3 don’t need to be addressed, but that’s exactly what we do, address them. By prioritizing issues in Quadrant 2, we solve them. Visionaries that focus their companies in Quadrant 2 make Quadrant 3 less relevant, and Quadrant 1 less overwhelming.

Paint the picture, chart the course

With a clear vision and strategy, fertility centers know exactly what their goals are and how to achieve them. Without them, practices frustrate their team members, exhaust resources, and find themselves losing market share to competitive IVF centers. Whether one wants to be the largest fertility preservation company in the world, or happily perform 150 egg retrievals per year and super-serve their patients, there’s no right or wrong answer. Their Core Values, Core Focus, and 10 year target inform their High Level Marketing Strategy, 3 Year Picture, 1 Year Plan, Quarterly Priorities, and resolution of Issues. When practices follow a strategy to a committed vision, they are prepared for the powerful competitors and challenges that pursue them. And just in the nick of time, because there are plenty. We’ll talk more about them in Part 3 of our series on the tectonic shift from medical clinic to entrepreneurial enterprise.

If you would like help building your practice’s High level Marketing Strategy, learn more about the Fertility Marketing Blueprint below.