Entrepreneurship In Reproductive Medicine 1: Industry Overview

The Columbia Business School Alumni Association packed a midtown conference room last week to discuss The Business of Reproductive Medicine. I had the privilege of moderating a panel that included RMA of NY founder and reproductive endocrinologist Alan Copperman, Prelude Fertility CEO Susan Herzberg, Union Square Ventures’ Rebecca Kaden, Anne Morriss, CEO of Genepeeks and reproductive endocrinologist Mylene Yao, CEO of Univfy.

We have all sat through (and on) tedious industry panels where the participants look at each other after every question, each hoping someone else will think of something novel to say and speak up. This panel was the opposite, thanks to the knowledgeable and candid speakers, and some really insightful questions from the audience. I highlight the key points below.

Reproductive Medicine Industry snapshot:

There are 75 million women in the United States between the ages of 15 and 50, and 6 million pregnancies per year total, resulting in 4 million live births.

The US has 34,000 ob/gyn’s, approximately 1,000 of which are subspecialty trained in reproductive endocrinology (called RE’s), with 34 newly trained RE fellows graduating per year.

There are between 450-500 IVF programs in the UNited States, performing slightly more than 200,000 IVF cycles per year, producing 65,000 babies, or approximately 1½% of US births.

The use of IVF in the US lags other developed economies. In Australia, for example, IVF accounts for 4% of births per year. Use of the procedure correlates with out of pocket costs to the patient in each country.


Treating infertility, with a prevalence of 7 million people, is a 4-5 billion dollar business in the United States. For comparison, (obviously very different types of medical conditions), the prevalence of cancer in the United States is approximately 15 million, and spending on oncology is over 85 billion dollars.

Trends in the industry include the consolidation of IVF programs into large mega-clinics, often funded by private equity, the emergence of elective egg freezing for proactive management of age-related infertility, and the expansion of the use of IVF for the prevention of genetic disease, mirroring an expansion of pre-conceptual genetic screening as part of family planning. IVF is still largely self pay. Insurance coverage is mandated in a number of states, although the nature of the mandates differs greatly from one state to another. A number of large companies are creating their own plans and providing coverage to their employees, particularly companies with high costs of employee recruitment and retention.

The Problem Of Access

We’re nowhere near the ideal of a 100% live birth rate per cycle, but the consolidation of care into large programs, usually (but not always) accompanied by adoption of tested standards and constantly improving processes, means that those undergoing IVF now receive very good care from well-staffed programs with well-run laboratories.

Unfortunately, the industry only accommodates a small fraction of the population in need. A relatively fixed number of practitioners and facilities provides incentives to improve the quality of service but not to expand or to migrate to another point on the industry demand curve. Not all of the 7 million women with infertility need IVF, but utilization in other countries strongly suggests that hundreds of thousands of patients have limited access to, or simply cannot afford, care.

In the short term this may get worse. Expansion of elective egg freezing for preservation of future fertility, for example, unaccompanied by an increase in IVF laboratory capacity, further limits access to IVF for women and couples with infertility now. And while the panelists disagreed about how rapidly elective egg freezing is being adopted in the US, there was consensus that it is growing quickly (growth rates between 12% and 35% were cited in specific locations.)

Where do we find the solution to limited access to IVF? From the industry itself? From the insurance industry or employers? Policy makers? Coming: the case for entrepreneurship and market forces in the evolution of reproductive medicine.

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