Tight Labor Market, Physician Autonomy Pressure Every Corner of MSO Operations
State of Fertility Center Networks: 2026
The demand for REIs, embryologists, and clinical staff refuses to lessen, driving up salaries and renewing interest in independent practice formation by physicians seeking more autonomy. Some networks struggle to differentiate, while others use advantages of leadership credibility, technology adoption, safety, research, and workplace stability. Across the U.S., Canada, and Europe, policy shifts, AI integration, and patient-experience investments signal that the next era of fertility care will be defined as much by workforce dynamics as by capital.
“Everyone is Freaking Out”. Competition for Fertility Specialists Remains Fierce
“We’re in the process of signing with [different practices]. Everyone in our class is freaking out in Park City right now” one REI Fellow texted Inside Reproductive Health from the SREI Fellows’ Symposium in August.
The Fellows’ uncertainty about their career potential comes from the likelihood that the practice networks who are recruiting them will soon be owned by different private equity investors. As Inside Reproductive Health reported in its 2025 Year In Review, after nearly a decade of dealmaking, many of the funds that financed fertility-clinic roll-ups are nearing their maturity dates.
Those exits are no longer theoretical. US Fertility—backed by Amulet Capital Partners—is in the second round of its sale process, marketed around USD 175 million EBITDA with Morgan Stanley and Moelis advising. Sources told ION Analytics the asset could command a mid-teens multiple. Whatever number lands first will set the benchmark for every other network seeking a similar hand-off.
Behind the scenes, executives at Kindbody, Inception Fertility, Pinnacle, and others are widely expected to be preparing for exit once buyers are secured. En route, cost discipline and data-driven efficiency remain the tools for defending multiples in a market more interested in margins than in speculative growth. Still, clinics are already “at physical and human-capacity limits,” Dr. Eduardo Hariton of RSC of the Bay Area said.
The shortage affects both operations and valuation; buyers have to consider a network’s ability to recruit and retain physicians and other personnel. Some networks, like Inception’s Prelude and others, have invested heavily in being valuable to doctors and other employees.
They have to; the demand for specialists has only continued to increase over the last decade. A recent post of job descriptions, observed by retired fertility specialist, Dr. Ronald Feinberg, indicates that the starting salary of an REI in small markets alone might be $650,000/year plus bonuses. That average would be a quarter of a million dollars greater than the average identified in an informal survey gathered by Inside Reproductive Health in January 2020.
Renewed Attention on Physician Owned Practices
As networks’ bidding war for fertility specialists, embryologists, advanced practice providers, nurses, and other personnel intensifies, MSOs are also competing with a renewed attention on REIs opening and operating their own independent practices.
Three Boston IVF REIs left their organization to open their own practice, Tera Fertility, in September 2025. Regarding the prospect of not having control over his own practice, Tera co-founder, Dr. Pietro Bortoletto, told IRH. “A lot of us found it unappetizing and not how we wanted to practice medicine for the future.”
“If you are never privy to what your true potential is as a business owner, [younger physicians] actually have no idea what the numbers are and what the potential is,” Dr. Kyle Tobler, partner at the independently owned, Idaho Center for Reproductive Medicine, said on an episode of the IRH podcast. [Owning one’s own practice can be] better than having an actual employer, but you just don't know”.
“Having gone through the IntegraMed collapse, I can tell you that you can be very vulnerable in private equity,” Dr. Lauren Johnson of the independently owned, Carolina Conceptions, stated in a separate IRH interview. “You have to decide how much autonomy you want in your practice and who do you want at the table with you 10 years, 15 years down the road. At a small independent practice, I know who's going to be at the table with me…I know their values, I know what they want. You can't always say the same thing in private equity because someone else is going to be at the table with you in 10 years”.
Networks Use Physician and Executive Leadership as Differentiators
In response to the pressure to attract and retain personnel, some groups are leveraging their advantages in leadership and peer-recognition.
Not all networks are the same. While physicians at some networks may feel stifled, physicians at other networks feel empowered, like many of the REIs at Inception’s Prelude.
“The venn diagram of executive leadership and [clinical excellence] does not always overlap”. Dr. Jason Yeh said on an episode of the IRH podcast. Yeh noted that while physicians can make great leaders, sometimes physician leaders take autonomy away from the physicians under their purview. “Because we have corporate leadership, a lot of those clinical decisions are left in the hands of physicians. And that actually means that we have a lot of autonomy.”
Kindbody brought in David Stern, longtime executive and former CEO of Boston IVF, as CEO. The company’s SART Gold Certification and listing in the Digital Health New York Hall of Fame 2025 signaled clinical credibility to potential recruits deciding where to practice. Comments on IRH appearances of Dr. Jason Barritt, Kindbody’s Chief Scientific Officer, point to him as a stabilizing force for whom embryologists want to work.
At Prelude, ten clinics appeared in Newsweek’s America’s Best Fertility Clinics 2024 ranking, and forty physicians earned/are named Castle Connolly Top Doctor honors. Those distinctions matter in a market where physician loyalty can determine network stability. The network has been among the most attractive for graduating REI Fellows; six fertility specialists from the class of 2024 told IRH their reasons.
Even consumer-facing publicity now plays into elevating and supporting the workforce. Over the past year, CCRM Fertility was featured by viral social media influencers and legacy media outlets alike, including but not limited to KXAN, Healthline, POPSUGAR, and The Atlantic. The coverage supports its clinicians by communicating CCRM’s commitment to patient care and access across underrepresented patient populations.
AI Integration, $250M in Fertility Funding, CRMs Needed for Patient Experience
The recruitment market is so tight that buying a practice is sometimes as much for the purpose of acquiring its key physicians as much as its EBITDA.
Yet because there are so few viable acquisition options at the moment, forward thinking networks find differentiation through technology and patient experience—to remain attractive to young physicians and staff.
The embryologist shortage appears to be as great or greater than the scarcity of REIs. Some networks did little in 2026 to reduce the administrative burden that reduces their embryologists’ productivity. Innovation Fertility’s partnership with Alife Health, on the other hand, integrates artificial intelligence to help make more informed decisions about patient care. Using decades of experience and connections as the fertility field’s expert on launching new IVF labs, Innovation CEO, Dwight Ryan, has assembled a team of veteran leaders. “Our leadership team has always been driven to discover the most cutting-edge, science-backed technologies,” said Chief Science Officer Dr. Kathleen Miller.
In continental Europe, 87% of healthcare patients believed that their healthcare systems’ care stagnated or worsened in the last six years, according to a new survey by Roche. FutureLife Group appears to be investing in being the exception in Europe’s fertility space.. CEO Francisco Lobbosco has positioned FutureLife Group as a technology-enabled network emphasizing a unified patient journey built on connected systems. The company acquired Gynatal Clinics in Romania and introduced digital-record and CRM platforms across its European operations.
In Canada, Ontario’s CAD 250 million fertility-funding expansion and new 25 percent tax credit have expanded access—and with it, patient volume in a market already known for long wait lists and staff shortages. The Fertility Partners positioned themselves to get ahead of the changing policy by investing in the advancement, development, and retention of their personnel. TFPs Great Place to Work certification highlighted their workplace stability even as patient volumes soar.
Younger docs don’t want to give up research, demands for safety technology in lab grow louder
Many younger doctors continue to list the opportunity to participate in research as one of their must-haves in choosing a practice for whom to work. Piedmont Reproductive Endocrinology Group (PREG) participated in a study of an AI-driven IVF prediction model, which outperformed the national SART benchmark and allowed center-specific outcome forecasting. Seen as an example of stable, organic growth, PREG has grown their roster to nine REIs.
Calls to install electronic witnessing systems in IVF labs became much louder in 2025, starting with Dr. Steven Katz and Dr. Eva Schenkman on the IRH podcast. “We're really pushing all of our IVF labs to be working with electronic witnessing programs. And there's some really good ones out there. So I think all labs should be focused on that in 2025 if they haven't already brought one in” said Katz in an interview in February 2025. At Pinnacle Fertility, under the leadership of CEO, Beth Zoneriach, management built an in-house electronic witnessing platform that reduced sample-tracking errors and reportedly saved $1 million annually—a specific expression of how cost control, emphasis on safety, and ingenuity now intersect.
IVI RMA North America became the first and only reproductive medicine organization in the United States to receive a federally recognized Patient Safety Organization (PSO) designation, creating the Institute for Safety in Reproductive Medicine (ISRM). The PSO was approved by AHRQ and HHS and is designed to collect and analyze patient-safety events across more than 22 IVF laboratories in the network. Leadership described the move as a foundational step toward building a system-wide culture of transparency, continuous learning, and measurable safety improvement.
The pressures shaping today’s fertility networks balance ownership transitions, workforce scarcity, operational sophistication, and rising expectations from patients, clinicians, and staff. Networks that can demonstrate stability, credible leadership, and meaningful investment in technology and safety are positioning themselves to be valuable to both investors and employees . For physicians and staff, the choices made now—whether to join a consolidating group, stay where they are, or build something new--will shape a very different landscape for fertility center networks in the coming years.
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