This is a great framing of a combine and conquer approach for aligning our forces and continuing the push for democratization of IVF. Thanks, David Sable!
Life sciences, buy side. Ex ob/gyn and IVF doc. On Fridays I teach Entrepreneurship in Biotechnology at Columbia.
How do you convince the small group of reproductive endocrinologists (RE’s), the fertility docs who are the primary gatekeepers to IVF in the United States, to lower prices and see more patients? How do you motivate someone already working long hours providing an ever-improving service and making a very good living to work longer hours for less pay? The short answer is you don’t. Instead, you make it easier for someone to fill the void left by millions of extremely motivated patients to gain access to treatment. The industry incumbents, not only doctors but also their scientist, embryologist and nursing colleagues, all play an indispensable role in the evolution of the industry; that evolution, however, can start and proceed without them for a long time, and open up the marketplace to varying degrees with only their incremental participation. Indeed, the process of democratizing IVF is well underway, with three other important groups building a foundation for a much larger, inclusive industry. But before discussing how the complementary forces of patient advocacy, rational insurance expansion, and entrepreneurship are already working effectively to transform the industry, let’s dispel another of the myths of IVF: that RE’s are our opponents in making IVF more accessible and inclusive. More accessible IVF means more IVF, but it also means better IVF, and no one wants to build a practice by doing hundreds of low-quality cycles and charging for each one. The largest, fastest-growing, and most successful IVF programs are those that have the highest percentages of successful cycles. This performance translates into low dollars per baby and time-to-baby calculations (I know that sounds crass, and boils the transcendence of parenthood down to the dry language of industrial quality control, but so be it), the two metrics that best align with patient priorities. Industry leaders have earned their leadership positions by working on the “better” part of the more, better, cheaper formula for IVF democratization. Healthy birth rates for each embryo transferred continue to climb and now approach seventy percent in top programs. Each year there are more healthy babies and fewer multiple pregnancies, meaning more term pregnancies, less pre-eclampsia, lower rates of gestational diabetes, and maternal morbidity and mortality. Severe ovarian hyperstimulation syndrome (OHSS), a once common and serious complication of fertility drugs, is now preventable with modifications to the IVF procedure itself. RE’s, embryologists, nurses, and other patient-facing professionals are our allies in democratizing IVF; however, with their traditional focus on outcome improvement, patient experience, and quality control, it is unrealistic to expect them... continued:
