Oct 25th 2021

What's Next for the Fertility Market?

The U.S. fertility market is estimated to be an $8 billion industry (including in vitro fertilization (IVF), genetic testing, reproductive tissue storage, and donor services), according to a Harris Williams Industry Update. IVF services alone are estimated at $3 billion and are projected to grow at a 10% rate through 2024.

If anyone has their pulse on this growing fertility market, it's Dr. David Sable. The reproductive endocrinologist, who founded an IVF clinic and worked with fertility patients for many years, is now a life sciences portfolio manager active in investing venture capital in reproductive companies. Here are some of the trends in fertility he's seeing—and what they portend for the future of the fertility market and individuals ready to embark on a fertility journey.

Economic trends impacting the fertility market

Dr. Sable has good news for employees: When it comes to fertility support, “there's a greater penetration of employer coverage."

The numbers bear out his observation. According to a recent study, among “jumbo" employers (those with more than 20,000 employees), coverage for IVF has risen from 36% in 2015 to 42% in 2020. Meanwhile, egg freezing increased from 5% in 2015 to 19% in 2020.

In addition, fewer companies offer no fertility coverage at all—that is, no IVF, IUIs, drugs, or even a fertility consultation. In 2015, 40% of the largest companies offered no coverage. In 2020, the number dropped to 23%.

The growth in coverage for IVF and other services supporting people on the fertility journey is driven by a desire to be known as a family-friendly employer, a greater emphasis on inclusivity, and the need to compete for top talent, the study found.

Typically, at $20,000 per IVF cycle, cost has been the biggest barrier for people to get fertility treatment, so increased employer fertility coverage will likely increase demand for fertility support. “There's a big new population of people who can afford it," Dr. Sable says.

He estimates increased coverage will result in a few hundred thousand more people per year who elect IVF. One likely impact on the fertility market is that companies offering fertility coverage to employers will be able to "exert their buying pressure," Dr. Sable says. He likens it to buying out airplane seats on a plane. As the number of patients these companies represent increases, so will their ability to negotiate better prices.

A second major trend in the market is the consolidation of clinics. “Smaller clinics without resources are closing or merging with others," Dr. Sable says. In addition, established clinic brands are expanding to markets in other geographies, which will benefit patients, he believes.

“I would much prefer a less populated area have a [major] clinic, because they traditionally have had better results," Dr. Sable says. Their higher success rate in part may be because they can tap into the experience of the dozen of clinics they work with around the country, he notes.

Fertility preservation

Beyond fertility support for those on the fertility journey today, one of the next frontiers for reproductive medicine, according to Dr. Sable, is oncofertility. This field of medicine is concerned with minimizing the negative effects of cancer treatment (such as chemotherapy or radiation) on the reproductive system. Oncofertility also aims to assist individuals with reproductive impairments resulting from cancer.

“Anyone with cancer who isn't past the reproductive age or hasn't completed their family should be counseled on fertility preservation," argues Dr. Sable, noting that if you count gynecological, testicular, and other cancers, there are at least 50,000 new cases every year for people age 0-29. “That's a pretty big population per year," he says.

While many OB/GYNs counsel their patients on fertility preservation—freezing eggs and sperm—before cancer treatment, it's not always a reflexive part of general cancer treatment. Right now, it's at the discretion of the doctor treating the disease, who may be fully focused on a patient's survival. “They may not be attuned to the need to preserve fertility," Dr. Sable says.

Beyond fertility support

There may also be a market for using infertility treatment to prevent diseases, Dr. Sable predicts. “Since the 1990s, we've been doing preimplantation genetic testing (PGT)," he says, referring to the testing embryos undergo before transfer. "There's enormous potential."

Many clinics use PGT to search for chromosomally normal embryos, but it can also be used to test for known genetic mutations for diseases like cystic fibrosis, Huntington's, and Fragile X syndrome. People who have the disease or gene for such mutations could test embryos, but “it's almost never done," Dr. Sable says. “There's no reflex for medical referrals to diagnose such genetic conditions."

While millions of dollars are poured into genetic treatment of diseases, some could be prevented with a $25,000 IVF cycle. “It's a potentially large growth area," Dr. Sable says, for which "you'd need to set up a patient supply chain." The first step would be to identify patients who are at-risk and then referring them to fertility doctors.

Technology improving the field

Artificial intelligence and other technological advances are likely to ensure that fertility treatments will get better, more efficient, and therefore less expensive for patients, Dr. Sable predicts. “We're going to see increased levels of data collection," he says.

Instead of a group of doctors sitting around a table and discussing a patient's case, all the information may be fed into a program that could assess the best treatment based on thousands of data points. “There's no reason we can't have computer-analyzed data protocols, and send the outliers to the doctors," Dr. Sable says.

He also thinks there will be more automation of fertility treatment, perhaps fertilization with “no human intervention whatsoever," such as sperm and eggs inserted into a box. Right now, for example, there is time-lapse photography to analyze embryo growth in real time, but in the future, “algorithms will choose embryos better."

The future of fertility

One of the reasons fertility is such a good investment, according to the Harris Williams Industry Update, is that it is "one of few healthcare service sectors in which clinical outcomes data are measured and reported, providing potential benefit to best-in-class providers." In addition, it is "highly recession-resistant" because of "parents' desire to build families and the ticking of the biological clock."

Dr. Sable says that at the beginning of COVID-19, IVF doctors were worried that the lockdown and concern for patients' health would devastate the market. Now, he says, those concerns are "a distant memory."

In fact, the surge of patients returning after the initial pandemic lockdown has taught clinics that other OB/GYNs can pick up the slack and do some routine procedures. Along with the aforementioned increase in technology, consolidation of clinics, and the entrance of new patients (either due to employer coverage, oncofertility, or the need for PGT to weed out genetic mutations), this development will likely contribute to significant increases in the number of IVF treatments in the future.