Employers and Clinic Buyouts Now Shape the Pregnancy Market

Private equity now performs most U.S. IVF cycles, and a new podcast on the business of pregnancy is asking who that market serves. The episode treats getting pregnant as a commercial problem, with clinics, labs, pharmacies, and benefits managers in the middle.

Patients already meet those firms as bills, wait lists, and HR forms. The overlooked brokers are the buyout groups that own the high-volume clinics and the employers who decide whether a cycle is a covered benefit or a cash purchase.

The Clinic Chains That Now Run Most IVF Cycles

Researchers writing in JAMA tracked CDC clinic lists against private-equity deal records through the end of 2023. In 2013, 17 of 464 reporting clinics, or 3.7%, were tied to a buyout firm, and they handled 13.3% of IVF cycles. By the end of 2023, 163 of the 507 clinics that had reported in 2022, or 32.1%, were private-equity affiliated, and those clinics were estimated to perform 54.0 percent of U.S. IVF cycles.

That is a majority of the work, not a majority of the storefronts. Independent practices still exist. The large chains absorbed the volume.

PE SHARE OF U.S. IVF

In 14 states plus Washington, D.C., at least half the CDC-reporting clinics were PE-tied by the end of 2023, and those clinics were estimated to run 63% to 100% of local cycles. Alaska and Hawaii had none.

The largest pure-play U.S. platform is US Fertility, built around Shady Grove Fertility after Amulet Capital Partners partnered with the group in 2020. On December 30, 2025, consumer buyout firm L Catterton took a 42.5% stake as co-lead. Physicians and management kept 15%. The financing included up to $1.7 billion of new cash and rollover equity. S&P Global projected 2026 revenue around $969 million. The network listed 121 clinics and labs in 20 states and more than 200 physicians.

Other platforms still on the board include Prelude, Pinnacle, Inception, Kindbody, and KKR-backed IVI RMA’s U.S. arm. Deal pace cooled after the 2021 to 2023 buying wave, as debt got more expensive and sponsors prepared exits rather than more add-ons. The clinics those deals already assembled still see most of the patients.

HR Departments Decide Who Can Afford a Baby

Coverage did not arrive as a national health benefit. It arrived as a recruiting tool at large firms.

Mercer’s survey of employer-sponsored health plans found that 47% of firms with 500 or more workers covered IVF in their largest medical plan in 2024, up from 22% in 2019. KFF’s 2024 Employer Health Benefits Survey, using a wider large-firm cutoff of 200 workers, put IVF coverage at 27%. The two figures describe different samples. Both show the same pattern: the benefit clustered at bigger companies.

WHO HOLDS THE BENEFIT

• Large-firm IVF: 47% of employers with 500 or more workers covered IVF in 2024, per Mercer, up from 22% in 2019.
• Wider large-firm cut: 27% of firms with 200 or more workers covered IVF, per KFF’s 2024 benefits survey.
• Progyny’s book: 555 fertility and family-building clients at year-end 2025, up from 473 a year earlier, with full-year revenue of $1,288.7 million.
• Named-employer list: INCIID’s rebuilt registry listed 311 U.S. companies by name as of May 27, 2026, searchable by IVF, egg freezing, surrogacy, adoption, and drugs.

Progyny, a benefits manager that sells “Smart Cycle” bundles to employers, reported fertility benefit services revenue of $830.9 million in 2025, up 14%. Chief executive Pete Anevski said client retention was near 100%, including all of its largest employers. Thirty percent of the client base expanded benefits for 2026. More than 2.7 million members were set to get new pregnancy, postpartum, and menopause services. That is an HR product line, not a clinic waiting room.

Workers at smaller firms, and people on Medicaid, sit outside that product. Federal law even exempts state Medicaid programs from having to cover fertility drugs, a carve-out that does not apply to most other outpatient medicines. Self-funded employer plans, which cover a large share of workers, are also exempt from state insurance mandates. A state that requires IVF in fully insured policies still cannot reach those plans.

What One IVF Cycle Costs

Mercer puts a single IVF cycle, including medication, egg retrieval, fertilization, freezing, testing, and embryo transfer, at $25,000 to $35,000. People who need IVF often require two cycles. Against that bill, Mercer’s median lifetime dollar limit among large employers that use a dollar cap is $20,000. Fifty-four percent of those large employers use a dollar limit. Twenty-three percent cap the number of cycles, with a median of three.

THE BILL VERSUS THE CAP

A $20,000 cap can run out before one complete cycle. Cycle-based designs avoid that mid-treatment cutoff, which is why benefits consultants push them. Dollar caps are easier for a finance team to budget.

KFF’s 2026 Women’s Health Survey, fielded March 11 to April 14, 2026 among 3,538 women ages 18 to 49 and published October 8, 2026, found that 15 percent of reproductive-age women said they or a partner had ever needed medical help to become pregnant or prevent a miscarriage. Eleven percent received care. Three percent needed it and did not get it. Cost was the main reason.

Among women who had needed care, 17% of those with higher incomes reported IVF, against 3% of women with low incomes. Advice (46%), testing (39%), and ovulation drugs (34%) were the common services. IVF was 13% of that need group, and IUI was 16%. Either service reached about 2% of all women 18 to 49. The expensive procedure is not the typical first stop. It is the stop many households cannot fund.

IVF Births Crossed 100,000 in 2024

Volume is not the access problem. SART’s 2024 national file, released March 24, 2026 by the American Society for Reproductive Medicine, recorded 449,772 IVF treatment cycles at 364 member clinics, 97,549 cycles with a live birth, and 100,158 babies born through IVF. It was the first U.S. year above 100,000 IVF births. Cycle volume was up 15% from 389,993 in 2022.

More than 100,000 babies born through IVF in a single year is a powerful reminder of how many families rely on reproductive medicine to build their families.

Dr. Jennifer Eaton, SART president, March 24, 2026

More than 97% of those births were singletons. Twins were about 2.6%. Triplets were 0.04%. About 79% of embryo transfer cycles used elective single embryo transfer, a practice shift that cut multiple-pregnancy risk over the past decade.

Success still falls hard with age. On SART’s 2024 national tables, live births per intended egg retrieval with a patient’s own eggs were 41.7% under 35, 29.6% at 35 to 37, 18.5% at 38 to 40, 8.8% at 41 to 42, and 2.8% over 42. CDC publishes the companion clinic-level ART success rates that patients are supposed to use when they compare shops. The file is public. The prices next to those rates usually are not.

Drug Discounts Leave the Clinic Bill Intact

Washington has spent a year selling cheaper drugs and easier HR paperwork, not a coverage mandate. There is still no federal requirement that insurers pay for fertility care. President Trump had campaigned on one.

THE FEDERAL FERTILITY CALENDAR

1. February 18, 2025: Signs Executive Order 14216, Expanding Access to In Vitro Fertilization, directing agencies to make IVF more available and less expensive.
2. October 16, 2025: Announces a deal for EMD Serono fertility drugs on TrumpRx and tells employers they can offer standalone fertility benefits, similar to dental or vision.
3. May 10, 2026: The Labor, HHS, and Treasury departments propose a new “limited excepted benefit” for fertility care, with a combined lifetime maximum of up to $120,000 per participant and beneficiaries, indexed for later plan years.

Officials said the Serono drugs could cost patients more than 70% less. Medications are a slice of the cycle, not the retrieval, lab, anesthesia, or transfer. A warehouse-club program advertised in March 2026 also pitched fertility-drug cuts as high as 80% for members. Those offers attack the pharmacy line. They leave the clinic invoice in place, and they do not require an employer to fund it.

.@POTUS: "We're here today to announce a historic victory for American women, mothers, and families. With the actions I will outline this afternoon, we'll dramatically slash the cost of IVF, and many of the most common fertility drugs… prices are going way down." pic.twitter.com/O8YOXNPLF7

— Rapid Response 47 (@RapidResponse47) October 16, 2025

The May 2026 proposal would let a company sell fertility coverage as an extra, like vision, if almost all of the benefit is for diagnosing or treating infertility or related conditions. It does not make anyone offer the extra. KFF’s October 2026 analysis of the administration’s steps so far found limited help for people who already lack coverage and cannot pay cash. Small and midsize employers, which the White House itself called sparse on fertility, still have to choose to buy the product.

Add-On Tests That Raise the Bill

Once a patient is inside a clinic, the catalog expands. Preimplantation genetic testing, extra scans, immune protocols, and embryo “upgrades” are sold beside the core cycle. Kathryn Blaze Baum, a Globe and Mail investigative reporter, spent more than 100 interviews on that catalog for her 2026 book In Fertility: The Story of a Miracle and the Big Business Behind It, after five egg retrievals, multiple transfers, two surrogates, and more than 100 transvaginal ultrasounds. Britain’s regulator rates many add-ons with a traffic-light system. The United States has no equivalent federal fertility authority.

On October 13, 2026, reproductive-medicine physician Yaron Goikhman summarized a Human Reproduction Update review of seven randomized trials of PGT-A, the chromosome screen often pitched as the upgrade that raises the chance of a baby. Live birth per woman was no better (odds ratio 1.16 on the first transfer; cumulative odds ratio 0.87). Per-transfer rates looked better because they count only the patients who still had an embryo to transfer. A Swedish cost model, he wrote, nearly doubled the IVF bill. “A tool for selected cases. Not a default add-on.”

That gap between a marketing line and a per-woman result is the commercial pressure the podcast framing keeps circling. Patients arrive in a hurry. Clinics operate like any other high-fixed-cost service line. An extra test that sounds like safety is easy to accept when the alternative is another $25,000 to $35,000 cycle.

Patients Still Shop Without a Price List

The episode’s own checklist is still the live one. How clearly do clinics state prices and likely outcomes? Which treatments will an insurer or an employer actually pay for? Can a patient compare providers with reliable information? How do businesses hold the most intimate medical data in the file?

THE COMPARISON PROBLEM

• Posted outcomes: CDC and SART publish success rates. They do not publish a standard cash price next to those rates.
• Posted benefits: INCIID’s 311-company registry is one of the few public lists that names employers. Survey percentages cannot tell a worker what their own plan caps.
• Posted drugs: TrumpRx and club-store discounts attack pharmacy list prices. They do not itemize retrieval, lab, or transfer fees.
• Posted ownership: A patient can sit in a PE-backed clinic without being told a buyout firm is on the cap table.

People paying cash already behave like shoppers even when the shops will not post a menu. One widely shared account of an IVF cycle at age 34 described an $18,000 bill, appointments a month out, a packed waiting room, and a six-hour round trip to a cheaper clinic. That is the market working in the only way it can when prices are opaque and local capacity is tight: drive farther, wait longer, and hope the next retrieval is the one that holds.

Carolynn Dubé, executive director of Fertility Matters Canada, put the same structure in one line after Baum’s reporting: “Fertility has become a privatized commodity for the wealthy.” The U.S. version of that commodity now has a corporate benefits wrapper for people at 555 Progyny clients and at other large firms, and a cash window for everyone else. The podcast is late to that split. HR and the clinic chains got there first.

The May 2026 excepted-benefit rule would raise the optional cap to $120,000. It still leaves the purchase decision with the employer. Until a plan is on the job, the cycle remains a household loan against an uncertain live-birth rate.

Disclaimer: This article is news reporting and analysis of fertility-industry data, employer benefits, and public policy. It is informational only and is not medical advice, insurance advice, or a recommendation to start, skip, or pay for any fertility treatment, add-on test, or benefits product. Readers considering IVF, IUI, genetic testing, or a workplace fertility plan should consult a board-certified reproductive endocrinologist and a licensed benefits or insurance professional who can review their own medical history and plan documents. Figures, coverage rules, and proposed regulations reflect the sources cited and can change with new clinic data, plan years, and final federal rules.