IVF D2B, T2B and LD2B: To Cycle or Not to Cycle?

David Sable
2 min readJun 9


Flying to the superb Midwest Reproductive Symposium international a few days ago, we separated the patient IVF cycle purchasing decision into three components, and addressed the first, dollars to baby (D2B.) Now, flying home, let’s talk about the other two.

2) time to baby

T2B = ((time to secure financing or “save up”) + (time to get an appointment) + (time from first visit to start cycle) + (length of cycle) + (duration of the pregnancy)) / (probability of having a baby per cycle)

The big real world variable here is the time to secure financing or “save up” and the outlier point of “forever” is the most important part of the model.

3) life disruption to baby

LD2B is a bit more analog, with components ranging from costs of travel to a distant clinic, amount of travel and absence from work for the repeated monitoring sessions (blood tests and ultrasound), the inconvenience and literal pains in the ass (and elsewhere) from the repeated injections, and the back and forth communications between patient and nursing/care coordinator for periodic and ultimately daily stimulation instructions, plus the two procedure days for locate retrieval and embryo transfer.

Here the addressable variables are de-clustering clinical sites, addressing costs by dropping price, providing or facilitating financing and moving as much of the cycle as possible out closer to or into the patients’ homes.

Of course each of these alternatives are clinic controlled and clinic executed. A novel concept would be a deconstruction of the cycle into four components: 1) workup 2) stimulation/retrieval/vitrification 3) storage and 4) thaw/fertilization/development/assessment/transfer/embryo cryopreservation (and subsequent storage).

This alt version of IVF would permit the patient to control the staging of the cycle. This do-it-yourself IVF cycle concept, where the patient arranges her own workup, undergoes stimulation and retrieval at a local affiliate of a distant laboratory or at a non-affiliated facility, arranges storage at a central bio-repository (or at home?) before arranging transfer of eggs to an embryology lab for the final phase and transfer.

The monitoring can be addressed by highly precise urine endocrine testing with results shared via the cloud and remote ultrasound monitoring using a patient controlled trans-vaginal probe (the probe obtaining the inmate much like banking software uses a smart phone to transmit a check to the bank) AND by decreasing the amount of redundant, non-impactful monitoring that we ask patients to endure in an average cycle.

Next: what does the million baby a month IVF ecosystem look like?



David Sable

bio fund manager, Columbia prof, ex-reproductive endocrinologist, roadie for @PriyaMayadas. I post first drafts.