Five IVF Mega-Network Dinosaur Prevention Strategies

David Sable
4 min readAug 1


Another big clinic merger today. IVF consolidation continues!

Which means it’s time to think about… dinosaur prevention.

Ten years from now, some of today’s leading IVF networks could dominate a multi-billion. dollar industry. Others will be long gone.

A few suggestions for network self preservation:

1) Watch the pricing cycle.

IVF will follow the same playbook that every other tech-based industry follows, from choosing where to live on the industry demand curve (usually at the top left, limiting supply to maximize profitability) to having less and less discretion over pricing. Line item pricing evolves into all-inclusive cycle pricing (eventually even “add-on” pricing disappears), which eventually evolves into charging for outcomes rather than cycles.

No one wants to buy an IVF cycle, and no one wants to pay for a negative cycle. The ability to transfer the risk of a bad outcome from the patient to the clinic will be an enormous competitive advantage.

And a great form of dinosaur insurance.

2) Adopt the patients’ OKR’s.

OKR: objectives and key results. These have been my North Star in valuing IVF start-ups, and I borrowed them from my patients, all of whom based decisions on three criteria:

Dollars to baby

Time to baby

Life disruption to baby

There are a lot of seductive technologies in development for IVF, and the nature of the procedure — ie the long distance and countless confounders between an intervention of cycle modification and the pregnancy result that it is intended to improve —makes it difficult to isolate the effect and precisely define the value of each.

Again, this is tech playbook stuff; in the case of IVF it means layering more and more disciplined engineering on top of a foundation of great science. Measure everything, use sharp pencils and by-the-book statistics, and use mechanism-agnostic artificial intelligence carefully. Don’t prematurely embrace small sample artifact for true cause and effect.

3) Be your own FDA.

We’re fortunate as hell that the FDA regulates IVF procedures and practices a lot less stringently than it regulates biotechnology and pharma. Demonstrating — proving — both safety and efficacy is time consuming and expensive and slows innovation.

But —

It also keeps worthless treatments away from patients and lends a discipline to the design and funding of innovation that we in the IVF industry should self-impose. Pointless, invalidate steps anywhere in the network’s patient care paradigm are competitive disadvantages.

Give your network a Bell Labs of fertility ethos. Avoid parachute experiment justifications. Worthless procedures are an unjustifiable expense, regardless of the dollar cost or who is writing the check.

4) Expect the cavalry.

By which I mean organized buying.

IVF’s days as one of the last bastions of retail medicine are numbered. The IVF buy side is consolidating too, which means more effective state mandates, more leveraged negotiation by employer-based coverage administrators, and more aggressive medical advisory boards. And that’s before the government policies aimed at improving access to IVF due to fears of population decline go into effect.

And… that assumes that the other side of the US healthcare Mega-duopoly stays on the sidelines. Hospital systems pretty much abandoned IVF in the 1990’s and early 2000’s, but as they continue to consolidate, and as IVF becomes scaleable and its data more actuarial they will be rediscover IVF. (Many are doing the background work already.)

5) Be your own competition.

“Every patient deserves all of the benefits of the best patient experience that exists today. No one should have to settle for less.”

How often have I heard that argument? It comes from a good place, but what about the the millions of people who have *no* access to IVF, for whom a different delivery model, maybe cheaper or closer or less of of a time commitment may be the only viable path to having a baby?

As technology isolates and optimizes the components of an IVF cycle, perhaps disassembling the work up, stimulation, monitoring, retrieval, storage, thaw, fertilization, development and transfer into different sites with different oversight, more and more patients will find combinations of care delivery that can work for them, (like the journey from travel agents to self-booking.)

You can make an argument that the most experienced, longest-tenured IVF programs should hav a lasting competitive advantage in an expanding, scaled IVF ecosystem. But what if a slimmed-down, patient-directed alt-IVF experience does a better dollars per baby / time to baby / life disruption job than the lumbering incumbents?

Wouldn’t it be preferable to be on top of the technology, vet the alt-delivery models and establish as important a presence in the coming parallel IVF industry as you have in the consolidating industry of today?


Watch the pricing cycle. Adopt the patient’s OKR’s. Be your own FDA. Expect the cavalry. And be your own competition.

Make babies (a million a month!), not dinosaurs.



David Sable

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