How Private Equity is Reshaping Fertility Clinic Ownership

Fertility challenges affect one in six people globally, driving increasing demand for assisted reproductive technology and transforming this once-niche industry from physician-led to a global, multi-billion-dollar private equity-backed sector.

In 2018, private equity firms were affiliated with 14.7% of fertility practices listed in the Centers for Disease Control reports. Yet, these clinics performed nearly 30% of all U.S. IVF cycles. These consolidations have accelerated with large transactions like KKR’s €3 billion acquisition of IVI-RMA and BPEA EQT’s $656 million investment in India’s IVF, signaling that fertility care has become a global investment focus.

The same question arises in all of healthcare: Does private equity-backed care deliver services that benefit the patient? Fertility care operates more like a retail marketplace than a traditional healthcare system. While patients can compare clinic success using CDC data, out-of-pocket costs can exceed $50,000 for multiple IVF cycles.

Research indicates that after a chain or private equity firm acquires a fertility clinic, both the number of IVF cycles and live birth rates increase. On the surface, these numbers suggest that private equity’s involvement is a boon for patients seeking to start families. However, the issue is far more intricate, involving access, cost, and the quality of care.

Understanding Chains vs. Private Equity

It's important to distinguish between chain ownership and private equity backing, though the two often overlap. A fertility chain is a network of clinics under common ownership and management, which may be privately held by physicians, publicly traded, or backed by private equity firms. Private equity refers specifically to investment firms that acquire companies with the intention of improving profitability and typically exit within 3–7 years through public offering or another sale.

Why Private Equity Sees Opportunity

Unlike most healthcare sectors, fertility care isn’t dominated by insurance reimbursement and government programs. Fertility care is typically a cash-pay system with transparent success metrics. The U.S. fertility market was estimated to be worth $7.9 billion, and its value is projected to double by 2028. Globally, the market was valued at $34.7 billion in 2023 and is expected to nearly double by 2033.

The IVF market analysis shows several factors that make fertility clinics an attractive investment for private equity firms.

• Procedures are high-margin and often repeated; patients typically undergo multiple IVF cycles before success.
• The CDC requires all clinics performing IVF to report their success rates publicly, creating a transparent marketplace where success rates are readily available.
• The market remains highly fragmented, with hundreds of independent clinics.

Private equity firms argue their involvement enables critical improvements: capital for equipment upgrades, economies of scale for resource sharing, and expansion into underserved markets. Large chains can invest in emerging technologies—such as AI-enhanced embryo selection and preimplantation genetic testing (PGT-A)—that smaller independent clinics struggle to afford.

Improved Outcomes Under Chain Ownership

After a fertility chain acquires a clinic, IVF cycles increase by 27.2%, and live birth rates increase by 13.6%. Live birth rates are the ultimate measure of IVF success. This improvement represents a statistically meaningful gain for patients, reassuring them about the quality of care they can expect under chain ownership.

Chain-owned clinics achieve what industry executives call the “IVF Gold Standard”, a term that refers to the ideal balance of reducing higher-risk multiple births while increasing singleton births. Better embryo selection processes drive this achievement. Chain clinics use PGT-A to screen embryos for chromosomal abnormalities before transferring, rather than simply transferring multiple embryos. The most significant improvements in live births occur among patients aged 38 and older—the population that typically faces the lowest success rates.

Chains facilitate the sharing of best practices through research consortia, case reviews, and standardized protocols developed from aggregate data across multiple clinics. Chains also provide financial resources for state-of-the-art equipment, marketing, and administrative tasks, allowing physicians to focus on providing care.

Commercialization and Eroding Trust

Even these improved outcomes can’t outrun the pressure that physicians and patients face. Physicians working in a chain or private equity-backed clinic report a higher workload due to constant changes in marketing materials. That change in messaging creates “a high risk for misunderstanding”, a situation where constant changes in marketing can lead to misinterpretation or miscommunication possibilities, potentially affecting patient care.

Patients at private equity-affiliated clinics are 10.6% more likely to use preimplantation genetic testing (PGT-A) than those at independent clinics, which raises a concern: are patients being pressured into expensive procedures? While PGT-A can be valuable, recent lawsuits allege that some clinics exaggerate the benefits and reliability, pressuring patients to discard potentially viable embryos.

Clinics market 'success guarantee' programs that promise a level of success in fertility treatments, often bundled with financing options, potentially pushing patients toward unrealistic expectations and debt.

Geographic and Socioeconomic Disparities

Private equity-affiliated clinics tend to locate in areas with higher median household incomes, at $83,610 compared to $72,161 for non-affiliated practices. Chains argue they expand access by performing more cycles and serving more patients. Still, this geographic concentration raises questions about whether consolidation truly democratizes fertility care or just optimizes for returns.

The financial structure of fertility treatment, where most patients pay out-of-pocket, creates conditions that bad actors may exploit. Patients may go into debt financing treatment, and the emergence of specialized third-party fertility lenders raises ethical concerns. As consolidation continues, fewer independent clinics remain, reducing competition and constraining patient options.

Balancing Innovation with Patient Protection

The transformation of fertility care into a private equity-backed industry has two truths: chain ownership improves outcomes, with IVF cycles increasing by 27.2% and live birth rates rising by 13.6%. While these statistics represent aggregate data, this translates to thousands of families who might not have succeeded at smaller, less-resourced clinics.

Yet these gains come with significant costs. The commercialization of care, aggressive marketing, and questionable add-ons suggest that not all patients benefit equally from these practices. At the same time, some physicians report that commercial pressures damage patient trust, lead to a high turnover rate, and patients generally feel like revenue targets rather than individuals on a journey to parenthood.

The fertility industry has benefited from private equity’s capital and expertise. The question is whether these improvements can be sustained without sacrificing the trust, transparency, and patient-centered approaches that families need. The answer will determine whether consolidation ultimately serves patients or prioritizes investor returns over clinical integrity.

Moving forward, protecting patients while preserving these clinical gains requires the collaboration of multiple stakeholders.

For Policymakers: Mandate disclosure of ownership structures and financial relationships; establish oversight mechanisms for add-on procedures with limited evidence.

For Healthcare Providers: Develop and enforce professional standards that prioritize clinical evidence over commercial incentives; resist pressure to recommend unproven interventions.

For Investors: Recognize that long-term value creation in fertility care depends on maintaining patient trust and clinical integrity, not just short-term cycle volume.

For Patients: Compare not only success rates but also ownership structures, treatment philosophies, and pricing transparency when selecting providers.