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Clinics are feeling the pressure.
And one year after the PGT class action lawsuits, the ripple effects are still unfolding.
We’re back with another Fertility Field Overview, and this one looks at what’s happening across patient finance, IVF benefits and third-party reproduction, genetics and diagnostics, and the evolving self-pay landscape.
We discuss:
Whether IVF benefits managers are helping clinics (or squeezing them)
Which lending institutions and loan programs are positioned to rise to the top
Why some say the third-party IVF experience is getting worse
What’s changed in genetics and diagnostics since the PGT lawsuits
How clinics are reducing workload through at-home testing solutions
How fertility compares to the broader self-pay healthcare market
Get an even deeper inside look at the current state of fertility networks from our recent Intel Articles:
You Can Stop Being Left Out Now, Y’Know
Next Big Exposure Before ESHRE!
If your organization belongs to this category but wasn’t included in this category overview podcast episode, then your competitors are dominating the attention of your customers: REIs, fertility network executives, embryologists, and others.
These same competitors will get more coverage in a report or podcast episode, about your category
To start the year
Before PCRS
Before ESHRE
Before ASRM
Why let them get all the attention?
If you don’t want to miss out before ESHRE, you have to join the IVF Heroes Universe as a sponsor now, before the next deadline.
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-
Griffin Jones (00:09)
We're back at it with overviews. What's happening in four different categories in the fertility world with patient finance and IVF benefits, Third Party IVF, Genetics, Diagnostics. Progeny stock might be up, but fertility clinics are getting squeezed, are they adapting?What's happening in the rest of the self-pay world? How does the fertility field compare other segments of healthcare with regard to finance care?cWhich lending institutions and loan programs will rise to the top. Why is third party IVF experience been getting worse according to some, even though it's supposed to be getting better? Like the damn internet. And then I have a guest join me and add some color commentary on the state of fertility diagnostics and genetics. It's been a year since the PGT action lawsuits. What's been the result of that? And then, how are clinics reducing workload with at-home testing. Like Fellow. And our special guest shares what she thinks is really driving that. Enjoy.
Griffin Jones (01:58)
Look who's here. Dr. Shefali Shastri is here. Thanks for coming to help me provide some commentary on the state of category chef.
Dr. Shefali Shastri (02:07)
Hi Griff, it's great to see you, it's great to be here.
Griffin Jones (02:10)
Let's start with fertility diagnostics. The central theme of that state of report was that people are burnt out AF. That means nurses, providers, embryologists, they've got a ton of administrative burden on their plate. Care teams want at home testing to relieve them of some of that burden and managed care payers seem to be driving a lot of that. Let's start with people being burned out. When I'm at a conference, I like to ask people,
I say, raise your hand if you feel completely underwater. And I'll ask that in rooms of doctors, nurses, embryologists, execs, business managers. How many people do you think have their hands down? Shef, virtually nobody, right? Everybody feels completely underwater. The report talks a little bit about nurses facing physical, emotional, mental exhaustion. ⁓
Dr. Shefali Shastri (02:54)
Their hands down? Yeah, no one.
Griffin Jones (03:07)
Michael Baker had shared some of the things that embryologists are going through. They're hard pressed for time already. They have a bunch of busy work on their plate. What are you seeing with regard to the different directions that people are being pulled in?
Dr. Shefali Shastri (03:22)
I mean, honestly, what I think is the way we practice fertility medicine today, it's not your mother's IVF. You know, what they did in the early 2000s was very different. And so, I mean, basic things, even just in terms of medications and the amount of medications and, you know, day three embryo transfers versus day five embryo transfers versus PGT, not doing PGT, counseling patients each step of the way and all these nuances, it's very different.
practicing in 2025, 2026 than it was 20 years ago. A, all this technology was not available. And B, I don't think the patient awareness was there. Currently, everything is out there on the internet, on Reddit, on Google, reviews. And so how, as a practice, whether it's at the level of the nurses, the patient services people, the physicians, the embryologists,
How do you keep up with that constant information ⁓ seeking? And so I think that's what makes it so difficult, the complexity of the medicine, along with all of that's sort of the need and the desire to know ASAP. People are expected to be available immediately. It's like texting. We thought we were helping our practice by putting together these, developing these great portals. And I really do think that they're helpful, ultimately.
But it's not a text message. It's not, I portal message you, you should message me back within a minute. But often that's how these tools are used. So I hear you, that's we're seeing.
Griffin Jones (04:49)
And there
are those tools that I want to zoom in on in other categories of AI and people that think that they can help solve that issue. This report talks a little bit about how at home testing might be helpful. Do you think that at home testing actually is helpful? Or do you think it will add administrative tasks somewhere else? Does it kind of depend? this report
talked a lot about what fellow is doing. And it seems like a lot of clinics like fellow. But does that home testing actually reduce burden on care teams? Or does it just kind of rob Peter to pay Paul?
Dr. Shefali Shastri (05:30)
No, I think it can. I think if utilized properly, it can. It's a great tool. let's talk about, you know, an example is an at-home semen analysis kit that is FDA approved, that is very accurate. So it's a really good test that's being marketed directly to consumer. But they've also partnered with so many clinics, so clinics can utilize that as part of their sort of toolkit. If it's used properly, I think it's great. It's one less thing that has to be scheduled.
by the clinic. If it's used properly, if a partner submits a semen analysis before they ever come in for the initial visit, that's something the doc can review at their initial visit. It's an opportunity to go over all the things that have been done already. So I do think it can be very beneficial. I also think it depends on what support is going along with it. So if Fellow has counselors that can counsel you on your results, I think that's great.
I think that if used independently without any counseling, I think it's a whole different ballgame. So to me, I definitely think some of these at-home diagnostics can be very helpful in terms of the workflow, if used in the proper manner.
Griffin Jones (06:44)
It seems like the managed care payers are driving a lot of this. The report talked about how Maven is engaged with Velo and seems like Progeny is and so that's they like to see that. Why do you think that is?
Dr. Shefali Shastri (07:00)
Very honestly, I think it's patient driven. I don't think it's clinic driven per se, but I think there's a great way to utilize it for clinics. I think it's patient driven. I think that's what patients want. I want to be able to automate semen analysis. I want to get it done and see what it is. I don't want to have to see a doctor before I do this. I don't have to go in for an hour consult. I think it's easy. I think it's access.
Griffin Jones (07:22)
So it's a little bit more bottom up. And do you think that then the payers are saying to the clinics like, hey, we're engaging with these folks, we're going to cover it because it's our employees that are saying that they want this?
Dr. Shefali Shastri (07:38)
Well, I think, I mean, I think there's a couple of central themes, right? That, you know, definitely insurance companies and payers, definitely clinics are focused on, you know, one, improving access, two, improving costs. You know, we want to take a very complicated process and break it down a little bit. And so meet patients where they're at. Not every patient is ready to come in for a full consult visit.
talk about this, talk about that. Some people just want the information, you know? And so, I mean, that's not everyone, but there's some people like that. So you're meeting patients where they're at, if you cover semen, at home semen analysis kits. And there's also a stigma around all of this, even though I think it's much different today than it was 10 years ago, there's still a stigma around it. You know, we still see so many patients whose partners don't want to come in for the semen analysis. I mean, the way I think about it, that's all they gotta do.
Griffin Jones (08:30)
Yeah, it sucks.
Dr. Shefali Shastri (08:31)
that's all you've got to do though. Your partner is going to be going through so much more, you know? And so if it makes it easier for compliance, for access, we'll mail you a kit, you mail it back. I mean, it doesn't get much easier than that, I think. ⁓ So to me, the way I see it, and I may be wrong, but I think it's a lot more patient-driven. And I think it's also more efficient in terms of cost and just the workflow.
Griffin Jones (08:56)
Interesting. Let's talk genetics. The central theme of the state of genetics report was about how it's been the year after the lawsuits. So we had those big lawsuits at the end of 2024 and those were about PGT, but I think there's a lot of related implications to carrier screening and we'll talk a little bit about that, but about how PGT labs have been quiet since then.
Some new players might be stepping up and then on the carrier screening side to your point it was a lot about how patient expectations and Dr. Reddit and Dr. Chat GPT and instant gratification plus the myriad of genetic test results that could be super scary. All of that together can be a sort of patient experience nightmare and can be draining on providers and staff.
Dr. Shefali Shastri (09:44)
totally.
Griffin Jones (09:49)
With the with regard to the lawsuits, did was this something that docs talked much about when it happened at the end of 2024? Was your reaction just like we're, you know, we've got our heads down, we're just looking at the evidence in front of us? Or did it cause you to pay attention to things or have conversations in certain frames that maybe you weren't before?
Dr. Shefali Shastri (10:09)
So that's a great question. So I feel like in our practice at RMA, not to mention specific labs, we worked with a lab that was not indicated or implied in this large class action lawsuit. And I think this lawsuit was more around the claims that people thought were being made regarding PGT results. So that was the central theme around this. the genetics, the PGT lab that we used,
wasn't part of because they don't make those claims. They haven't made those claims. So that's like the overall from a safety standpoint and a litigation standpoint, we felt very safe, you know. But the truth is, I think that pre-implantation genetic testing can be very misunderstood because the results are not so straightforward. We like to take something that's super complex and kind of like break it down, normal or abnormal. It's not that simple. And some of the basic nuances about PGT, which I could go on and on about,
we're looking at five to seven cells. How indicative is that of an entire human being or of an embryo to start with? So there's a lot of nuances there that are very difficult to counsel a patient on. And so I think that PGT, the way it was originally being done, even seven to 10 years ago to what we're doing today is very different. And I think we've learned a lot of lessons along the way. And I think one of the big keys is you can't make all these claims.
What PGT is doing is screening the embryos to give you an opportunity to transfer back the embryo that gives you your best chance at having a healthy baby. That's the claim that you can make. There can be false positives. There can be false negatives. I think it really depends on the lab and the actual molecular technology that they're utilizing and the mathematic modeling that they're using. So you need more than a PhD in genetics to actually
develop a test like this. And then to be able to understand a test like this, it's dumbed down. So, you know, those are my thoughts about PGT. And I feel like in the, you know, with the physicians, with our docs, I mean, I think this has grown into us from, you know, 10 years ago, each generation of new molecular technology that's introduced to be utilized on the PGTA platform, you know, has been discussed, you know? And so I don't think it was anything like a
anything new, we understand the limitations. Does everyone understand the limitations? I'm not sure. Do patients understand all the limitations? I think it's really important to counsel them. And so I think that's really what a lot of this is around.
Griffin Jones (12:38)
It's hard for me to know which PGT labs have adapted since then or are adapting during that time, because I just feel like a lot of them got quiet. And to me, it's like, well, are you really investing in the science? you, were you just peddling something that was being overused? And I'm sure some of them weren't, but it's hard for me to decipher who's who, because I think once that class action happened,
a lot of them just crawled into a cave. But I do know that some people are doing some things. And I remember when I was interviewing you and Kate Devine, Dr. Devine from Shady Grove, that she was saying that she was at Ashree and she was excited about something from Juniper. And I probably need to ask her more about that. have you checked them out? Do know what they're up to?
Dr. Shefali Shastri (13:32)
So what I'll say is I think there's a lot of work being done in genetics. I say that that's such a general thing to say. Genetics is continuously our understanding and our abilities are continuously expanding. There's a lot of technology that's available, but I'm not sure it's ready for the mainframe yet. I'm not sure that it's ready to be utilized clinically. I think there's a value.
in a lot of, in some of the information that's available, but I think it's really important how you use it. And so, to me, Juniper is probably not ready for real time just yet. Do I have faith and do I think it's amazing what they're doing? Absolutely.
Griffin Jones (14:12)
When you say
as things progress in that way, are there certain areas where there's sufficient evidence for maybe some cases and then you get more evidence for a wider breadth of cases?
Dr. Shefali Shastri (14:26)
what I mean is, you know, when you think about whole genome sequencing, I think the technology is amazing. That being said, do you really want to report on everything that you find when you do whole genome sequencing? No, you don't because there's so much background noise. That being said, if you can model specific pieces of information like genes associated with embryo viability.
And if you could do that and you can validate that and then roll it out, I think that's tremendously powerful. But I can't say, think whole genome sequencing is the way that we're going to be going and just get these extensive reports. What do you do with that information?
Griffin Jones (15:07)
I think that even though the class action was about PGT labs, that there still are kind of implications that carry over into carrier screening. The stories that when I was interviewing yourself and Dr. Devine and Dr. Keegan, there's things that are happening where there's a lot going on with panels and sometimes these panels are exceeding 700 genes and then maybe
one lab calls something a positive or another lab calls something a negative, how do providers deal with that?
Dr. Shefali Shastri (15:44)
And these are some of those nuances. To be very honest, I think these genetic carrier panels, these expanded carrier panels are amazing. Because 20 years ago, when we didn't have the technology to report on these expanded gene panels, we couldn't look at 200 or 300 or 400 or 500 or 700 genes. There were a lot of unknowns. And the way you found out that you were a carrier was when you had a baby that was deeply affected or passed.
So when you look at progress, it's amazing what's been done with technology. That being said, nothing is perfect. Nothing is without risk or without, there's always a small level of error in everything. And so the way I look at it, mean, think that it's, ⁓ and the way I counsel my patients, I'll tell them, currently this is what we think. Like currently it looks like.
Let me give you an example. This is an interesting that's come up recently. In the past, I've had patients, past five years ago, seven years ago, who were undergoing these genetic carrier panels. And if they were found to be a carrier of a single mutation, and there's a gene for non-syndromic hearing loss, and if they were found to have a mutation and their partner also had a mutation, you would say, wow, you have a high likelihood or a 25 % chance that one of your children will be affected by hearing loss.
What do we know now? And this wasn't known back then. They weren't able to clearly elucidate this, but today they can. Well, if you have X, Y, and Z mutations on this gene versus A and B mutations on these genes, A and B mutations, even if you have an affected baby, that's mild. It's going to be a very mild case. But if you have X and Y, that's going to be a severe case. So we have a much clearer picture, a much clearer understanding of that today. That knowledge and that
technology was not known or available seven years ago. So you counsel patients to what you currently know. And so that's a nuance that everyone has to
Griffin Jones (17:44)
Are these examples of what people use gene screen for? Because the report also talks about Dr. Jamie Griffo of NYU had a similar point of view as you about the sort of I don't think he didn't say Dr. Reddit or Dr. Chad GPT. He saying, look, they expect us to be perfect. He's referring to you've got these really deep panels, you've got increasingly complex
Dr. Shefali Shastri (17:50)
Yeah, this is.
Griffin Jones (18:09)
PGT decisions and carrier screening decisions. so, I remember the report also just talks about you and Deb Keegan at CCRM and Kate Divine at Shady Grove and Aramay of New York is also using gene screen. It seems like everybody is. Is that what people are using them for?
Dr. Shefali Shastri (18:27)
So,
I mean, think, yeah, I mean, I think it's, so one, we're physicians. And I have to be very honest with you. I think the docs that you've mentioned, I think are very interested and very knowledgeable in genetics. Not everyone is, but I think all of our labs do extensive amount of PGTA, PGTM, PGTSR. So I think being a physician in one of these practices, you have to be well-versed. That being said,
I'm not a genetic counselor, I'm not a geneticist, I don't have the bandwidth to be on top of every nuance that's identified in the last six months, nine months, 12 months, a year, two years, you know. So it's interesting. And if you remember, we definitely work with GeneScreen to counsel our patients on their carrier panels. We also have in-house genetic counselors. mean, at RMA, we think the number one key here is the counseling that goes along with the test.
every test will have some limitation. The most important thing is for the patient to understand what that limitation is and what do these results mean to us? What does this result mean to us today and how do we make an informed decision on that? And so, A, I think that if you offer your patients genetic carrier panels or PGT, which if you don't in today's day and age, then I question your standard of care. So I almost feel like, I don't know how you're in this field and you don't, but.
So if you do, I really feel like you have to have, you have to partner with a genetic counselor who is able to extensively counsel all your patients on the nuances, on the general tests and the nuances of these tests and of the results. And I don't, it's not because I think I'm a poor counselor or that I don't understand the information per se. I use our genetic counselors as a resource. I will ask them, hey, what do you think about this? I haven't seen this before, you know?
⁓ And should I be worried about this? So, I mean, physicians use our counselors as resources, but two, I haven't been trained in genetic counseling. That's not my niche. That's not my specialty. I'm the type of person, I really believe I'm really good at what I do. And I spend so much time honing that. But there's other people that are really good at genetic counseling. There's other people that are constantly staying on top of these new findings. That's who I'm gonna refer my patient to.
Griffin Jones (20:42)
it's carrier screening, whether it's PGT, whether it's other diagnostics, what do you want to see change? What are you excited about or any hot takes?
Dr. Shefali Shastri (20:53)
I mean, what do I want to see? I mean, I have to be honest with you, 2026 is really all around access. I want to make sure that patients are able to, the number of people that need care or diagnostics to identify the root cause are able to get that care. So to me, that's why going back a second, some of these at-home tests, I think are really changing the way that we practice and will change the way that people interface, patients interface with the fertility, with fertility medicine.
In terms of genetics, I think genetics is ever-changing, moving forward ever-changing, and we will continue to hone in. So we talked about whole genome sequencing. I don't think, I mean, we've been able to, you know, sequence the whole genome for some time. It's, the question always is, what are we doing with this information, and how are we using this information, and how are we presenting this information? So I think more and more, there's, you know, labs out there that are looking specifically at epigenetics.
You know, there are labs that are like it with mouse sperm, you know, epigenetics, that's path fertility. There's, you know, companies like Tuniper, labs like Tuniper that are looking at specific genes to identify variability of embryos. You know, ⁓ will there be a specific panel looking at RPL, recurrent pregnancy loss? I, to me, those are the things that are coming down the pipeline. So if you're a patient that has implantation failure, I'm hoping that there's something there from the genetics, you know, within the embryo.
that can help us identify or get, you the way I think about it, that magnifying glass just gets deeper and deeper, you know? So to me, that's what I think is gonna, you know, really be up and coming in the next five years. I think we do, we practice IVF very well today, but it's far from a hundred percent. And so it's that sort of smaller gap of patience that we are not successful, you know, immediately or early on.
And a lot of these patients, after cycle, after cycle, after cycle, at some point something will stick, and we won't even know why it worked. That's the sort of cohort that I think will really be helped by some of these ⁓ further advancements.
Griffin Jones (22:55)
You're the best, Chef. Thank you so much for coming on and helping us think about how to think of these two segments in our state of reports.
Dr. Shefali Shastri (23:04)
for having me.
Griffin Jones (23:04)
Patient experience is worse than it's ever been in 18 years. It's only getting worse.
I'll never forget that, that's what Eloise Drane told me last year.
She's been a surrogacy agency owner for almost 20 years.
and her view is...
Patient experience is supposed to be getting better.
But it's not.
going the wrong direction.
This is like the damn internet.
Has anybody else ticked off how cluttered the internet has become?
It's like worse than it was in 2010.
One of the reasons this is identified in the state of third party IVF services.
Report.
is that you're going to tank patient experience every time you're making patients be their own case managers.
It's not just third party IVF. It's everything.
But at least with third party IVF, there's not an excuse anymore.
Because you got to do the psychological evaluations, right? For donors, for surrogates.
Do they do them for intended parents too? I should know that.
And then so they're having to coordinate with the bank or the agency and the clinic and the counselor.
vast majority of clinics don't have counselors on staff, they're referring to somebody.
Call us back when you're ready. Are your teams calling them?
Like babysit the patient through this process. This voicemail and phone tag.
You wanna do more third party IVF? You ain't gonna do it.
if patients are having to deal with that.
There's just way too many cracks in that system, way too much drop off. And then even when you are successful, it ain't good for your patient experience.
patients aren't happy that they had to deal with all that.
lot of clinics have been using Mine360 for that. Mine360.
started by people.
that have run fertility practices.
Julius Varzoni being at the top of that.
A lot of people know Julius because he's so plugged in to the practice manager community.
So he and Mine360 know what they're dealing with.
And so mine 360 takes this whole process.
They centralized the criteria for IPs, donors.
GC's
and you give patients clear expectations about next step.
They do virtual fertility focused assessments, PhD, psychologists, trained specifically in third party.
Boom boom boom.
Let somebody else deal with that case management.
And it sounds like several dozen fertility centers, maybe even more, maybe it's even more than that at that point.
I'm mine 360 for that.
And the bank side is still the same damn problem.
Intended parents are still having a heck of a time finding the right donor. And not that many banks.
have sufficient selection.
because you gotta have the right screening. ⁓
And so in order to be able to have the rigorous screening.
and have.
enough donors you need some scale.
It's hard for a lot of egg banks to be able to manage that some do
And it helps when you got people investing in that infrastructure. My Egg Bank. Probably being one of those.
They were started at, what is it, RAB in Atlanta? RBA?
RBA, they become a national egg network. have multiple production centers. And then they're able to get donors.
from multiple ethnicities.
And so think that's why they keep growing.
because Clinics third party programs don't wanna spend time on donor sourcing. They got enough to do. need people that can deliver.
Griffin Jones (26:43)
There is probably a place.
with this type of patient experience and counseling.
ends and the egg bank begins. And I think that's an area that lead in.
because they integrate fertility counseling before, during, after donor conception. one of their differentiators.
they view emotional support.
as part of the whole process rather than just a step in the process.
They've also got a global geographic coverage.
and their mental health resources are in-house.
some of these egg banks are going to emerge victorious.
many of them are gonna go away.
Shared Beginnings might be one.
that you hear a lot more about this year.
Griffin Jones (27:21)
Then you've got gametes and embryos across the country for a lot of different reasons.
You're only going to have more.
Don't really want to send that with FedEx. you're starting to see some specialization cryo transport.
Cryoport being one of those.
I think they did deal with Inception with My Egg Bank with some others.
is because clinics and banks want somebody that this is what they do. They've got continuous monitoring, they got integrated tracking.
and your cryo security doesn't just happen at the egg bank or the sperm bank.
It's gotta happen to and from the clinics too.
So expect donor demand to rise.
Expect patient expectations around coordination, transparency, increasing meaning I want to know exactly
where my donor eggs are right now. I want to know what they're like in transit.
Where did they just come from? those kind of demands from patients to rise.
and expect more third party programs.
to use Mine360 and if there's any other services like that out there.
Because networks and private practices and academic centers too, they all want to grow the third party programs. You can't do if people are dropping out and having a lousy experience.
I don't know. 360 is not a publicly traded company. Maybe call Julia, see if you can buy some stock.
Griffin Jones (28:36)
What's going on with IVF benefit management in the United States? Nobody's really sure it seems.
You had the Trump administration indicate that fertility benefits can be offered outside traditional group health Kind of like dental and vision.
and not trigger the full set of ACA requirements.
So in theory, that'll allow employers to add fertility benefits.
without having to redesign their whole primary health plans.
but it doesn't mandate IVF coverage.
doesn't change how fertility care's price to reimburse.
It might lower some regulatory barriers.
And maybe that gets a little bit more employer coverage.
But much remains to be seen.
Meanwhile, it's still the case that fertility centers often absorb the consequences of partial coverage.
The State of IVF Benefits and Patient Finance Report.
stated that employer benefit managers often reimburse fertility clinics at a fraction of build rates, some cases around 50%.
Inside Reproductive Health checked in with David Stern, now CEO of Kind Body.
Who's really developed an expertise in this area?
both in his new role and when he was CEO at Boston IVF.
Probably should have invited David. On to this episode with me to provide some extra commentary.
Sorry David, I'll remember next time.
But Stern told Inside Reproductive Health in December, much has changed as far as reimbursement with insurance companies goes.
Cash pay patients often subsidize the low rates reimbursed by insurance companies and carve-outs. they probably hit the limit of what they're able to pay.
But even though it's not happening at the federal level yet, we do know that payer covered IVF is increasing in its market not just because of employer demand.
California mandate.
finally go into effect.
Some states have proven.
that you can have a viable business with a very large share of managed care.
David thinks that practices are going to have to adapt.
some of those adaptations are gonna be using REIs at the top of their license and using
not just like a life and Cycle Clarity, but those were two that David had mentioned.
He also thinks bots might be able to do some of the manual process, like verification of benefits.
I think practices can expect this trend to continue.
their margins continue to get cut.
might get lower reimbursement rates, they're going to find ways to scale. what the market wants. had their highest stock price of the at the end of the year.
their president, Michael Stummer.
step down at the very end of the year.
According to TradingView
They're not going to name a successor to him.
And I have no idea what that means for you.
But you're always going to have a cohort of self-pay, right?
even in countries.
that usually have universal healthcare they have covered IVF the UK.
there are still a lot of self-pay cases.
But like Stern says...
people have kind of reached the limit of what they can pay. centers have to find a way to...
help them find ways to pay for treatment.
So I'm expecting more activity.
from some of these lenders.
this year.
I think it'll probably come down to a two-horse race.
I wonder if that race won't be between CapEx and PatientFi
They both have active CEOs.
Todd Watts is the CEO of PatientFi.
I see him making more appearances in the fertility world, to bring some best practices.
from other medical sectors into the fertility space.
to help with patient experience and revenue cycle management.
Alex Shire is the CEO of CapExMD.
Very fertility focused.
seems plugged into the space.
So I wonder if the category doesn't become a two-horse race between those two. don't know if Lending Club is still in the fertility space.
I could be wrong, but it seemed like fertility was a small part of what they did.
So maybe they're focusing on.
other areas.
Then again, I think Dr. Adamson's company.
uses Lending Club.
Maybe they use others too.
I'm not sure what they're up to.
But I'm a big Dr. Adamson fan.
So I think as long as he's in the game, you can never count his firm out.
PatientFi also seems to be growing pretty rapidly. They're on that Deloitte list, fast 500.
came in at like 54th.
And I think speed is part of their value proposition.
Get patience on immediately.
And we know that speed is critical for conversion.
More broadly, I think these companies look at other sectors, like even dental.
And the percent of care that's financed in IVF
is dwarfed by the percent that it's financed in other sectors of healthcare.
Yes.
There's the strive to get more coverage.
And you have people Serena Chen.
Resolve.
doggedly fighting for that You have people
like Dr. Arredondo.
from Positive IVF.
who says, yes, that's great, let's do that too. that's not the same thing making IVF more affordable.
We have to drive down the cost of IVF.
Hopefully both of those things happen.
but it still could be the case.
that patient care is underfinanced in the fertility space.
You don't want people to have to pay that much IVF, but to the extent that they do...
if they're paying that for dental care.
I think most people.
would prioritize their family building above that.
So it seems like a bit of a lack of patient education.
And I think that's really hurting centers conversion rates.
So I wonder if people like CapEx.
Don't try to zoom in on that this year.
I have to admit though.
We have not really mapped delineation between lending institution.
and save loan Like sometimes there's some overlap.
And then sometimes there's some competition.
And that might cause me to reassess this whole Or at least part of Like future family.
I know they added $400 million in financing capacity.
And with that kind of cash it's almost like an insurance framework. got actuarial aerial modeling.
And then you can do cycle guarantees.
And so maybe they're a bigger player than I even realize right now.
I know they just got a new CEO.
Claire Tompkins was their CEO. She transitioned to board chair. Alden Romney is going to be their new CEO.
He's a veteran of the fertility space.
I remember thinking that he had good ideas when he was running Pacific Fertility Center. think he left be a CEO of the sector somewhere now he's back in the field.
So they might be somebody that I pay attention to more this year.
Speaking of actuarial modeling.
I want to learn more about what Sunfish does and how they do it.
because I keep seeing them being adopted by different networks and different practices. And the patient feedback I read about.
is they reduce the opacity behind IVF
formed a partnership with Loom Fertility.
Mark Leandris, Josh Hurwitz over there. Like those guys.
that they do flat fee IVF bundles, partial refund protections.
and they simplify that process.
Their CEO is Angela Rastegar. One day I think Inside Reproductive Health will do a piece about the cool kids in the fertility space.
And so this is going be one of those cool kids.
She's one of these rising stars.
It's almost like...
They come from the consumer tech space.
but they embed themselves in the fertility space and they're just as much from this field as they are from those other ones.
She was on Dr. Shaheen's podcast.
which is probably a huge part of their growth.
Some of the people that have really gotten this off the ground.
In the multi cycle packages, the refund guarantees.
is bundle. think bundling with medications is also huge.
Patients hate not knowing what treatment is gonna cost because they're such a variable with medications. I think that's a huge thing that Bundle did.
But I'll tell you the main reason that I pay attention to bundle.
I think TJ a lot of autonomy to that team.
and they seemed to really care.
Sherry Sheryl Campbell, Terry Van Steen.
Courtney Barrett.
They've each been there for years.
And these aren't people that are checking boxes.
They really, really care about bundle. They really care about the patients that they engage with. And to me, that's so huge.
because financial counseling is one of the biggest drop off points in the patient journey.
You can have the best financial products.
But if you do not have people that really, really
You're not going to engage the patients.
Those people love what they do.
And fertility centers need people like that.
to stop losing so many darn patients at that point in the journey.
Who knows what will happen on the federal side?
Probably a little, not a in the next year.
Expect.
the lending institutions to dial it up 2026.
because this field is underfinanced.
and then expect the California consolidation networks.
in employer demand increasingly put the squeeze.
on your margins figure out ways to adapt.
Dr. Shefali Shastri
LinkedIn
