Source: The Guardian
A growing number of women, often working and unmarried, are ready to pay to postpone motherhood and that’s music to the ears of investors in fertility clinics.
About two dozen women ate cheese and canapés in a swanky Midtown Manhattan building in early December. It could have been mistaken for a networking event if it weren’t for the women’s singular focus – egg freezing.
Formally called “oocyte cryopreservation”, egg freezing has boomed over the last decade. Since 2009, there has been an 11-fold increase in the number of women who choose to “bank” their eggs. During that time, the American Society of Reproductive Medicine officially removed its “experimental” designation.
“It’s a conversation more women need to talk about, just like miscarriages and periods,” said Florence Ng, a 35-year-old real estate broker in New York City who froze her eggs this year. “These are really important and relevant today.”
Now, Wall Street is taking notice of the fertility industry. Analysts see it as one “ripe for a merger and acquisition cycle”, according to one group.
Extend Fertility, one of the organizers of this event, is one example of the new breed of fertility clinic. The business is in part backed by private equity and Dr Joshua Klein, Extend Fertility’s youthful chief medical officer, owns the medical practice. What it is selling is a promise: that capitalism and technology can buy women time.
“I’m confident we’re the busiest egg freezing clinic in the US,” said Klein. “I definitely think this is something that will grow exponentially.” He added he “could easily see 50,000 women per year”, freezing eggs. So can Wall Street.
“The US Fertility Clinic market has come of age and is ripe for a merger and acquisition cycle,” wrote Capstone Partners, an investment banking firm, in early 2017.
“The wave is already beginning,” the firm wrote, ticking off a raft of private equity and venture capital firms that recently purchased clinics: TA Associates, MTS Health Partners, Lee Equity Partners, TPG Biotech, Kleiner Perkins Caufield & Byers. Extend Fertility is partially owned by a hedge fund called North Peak Capital LLC.
“The trend for couples to marry later in life and to delay starting a family in pursuit of professional careers and financial security is also boosting demand for fertility services and accelerating industry growth,” wrote Capstone.
The majority of the women at the event reflected trends Wall Street investors find attractive: 30-ish, working and unmarried. Many were also clients of the venture capital-backed Three Day Rule. The company uses professional matchmakers who pitch themselves as a “personal trainer”, but “for your love life”.
Riffing off the matchmakers, Klein described his clinic’s services as, “a personal trainer for your eggs”, before he explaining how age ravages a woman’s reproductive capacity.
Two dynamics affect a woman’s fertility, and both are transformed with age. They are the quantity and quality of her egg supply.
Unlike men, who make new sperm throughout life, women are born with all of their eggs. When a woman is young, in her 20s, the vast majority of those eggs will be normal, with the 23 chromosomes needed to pair with sperm and make a fetus.
But as women age into their 30s, those dynamics shift. Gradually, she will have fewer eggs as well as a higher proportion of abnormal eggs, with 22 or 24 chromosomes. By the time a woman is in her mid-40s, most fertility doctors believe she will have to seek donor eggs to get pregnant. Egg freezing, once reserved for cancer patients, is increasingly sold as the solution to this problem.
“I’ve been in the field for 30 years, and for 20 years we had no good way to preserve an unmarried woman’s fertility, so egg freezing has been a tremendous advance,” said Dr Kevin Doody, a Texas-based fertility doctor and president of the Society for Assisted Reproductive Technology.
More than 99% of the nation’s fertility clinics now offer the procedure. “It’s been amazing,” Doody said. However, some fertility experts remain concerned that “some women might view it as a guarantee”, he said. “It’s not a commodity, we’re not selling hamburgers here.”
Women are encouraged to freeze their eggs as young as possible – in their 20s preferably – to ensure the largest number are viable.
“Freeze your eggs!” said one Extend Fertility ad on Instagram. “Take control of your biological future – freeze your eggs and freeze time”. Extend pitches testimonials from women who have already frozen their eggs as “masters of time”.
But with an accompanying cost of about $11,000, that creates a paradox. Most women in their 20s cannot afford such an expensive elective procedure. Women in their mid-30s, more able to bear the cost, are likely to have fewer viable eggs. And this group of women, 35 and older, represent the vast majority of fertility clinics’ egg freezing customers. Of the 6,200 who froze eggs in 2016, 4,500 were older than 35, and 2,500 were older than 38.
The American Society of Reproductive Medicine seemed to anticipate this paradox. “Technologies such as oocyte cryopreservation may allow women to have children later in life,” said ASRM in its 2012 guidelines. “In particular, there is concern regarding the success rate of women in late reproductive years, who may be the most interested in this application,” ASRM wrote.
Further, egg freezing does not address the chance a woman chooses an infertile partner (the CDC estimates 9.4% of American men are).
“That 38-to-40-year-old woman is going to not have even a one-in-four chance of a live birth, it’s going to be even less than that,” Doody said. “I’m not going to say it’s unreasonable, but these women certainly won’t have the same likelihood of success” as a younger patient.
Even though there is no guarantee of a successful pregnancy, many patients, such as Ng, see egg freezing as an “insurance policy”.
“I was working a lot. My hours are long. It’s very stressful and I just didn’t really have time to date at all,” said Ng. “I knew I had wanted the option to have kids one day … Egg freezing allows you to buy more time and focus on your career.”
Women like Ng, who have the resources and gumption to go through a life-altering week of hormone shots and blood tests, can effectively function as their own egg donors in the future. At Extend alone, more than 700 women froze their eggs this year.
The still relatively young industry has seen few of the fruits of its labor. Because the procedure was experimental until 2012, the number of babies actually born from frozen eggs is small.
“The wave of frozen egg babies is yet to come,” Klein said. He said Extend Fertility had “limited experience in our lab thawing eggs”, because the business only opened in 2016.
As of 2015 in the United Kingdom, only 20 babies had been born from frozen eggs, among 2,000 human children worldwide. In 2009, researchers such as Dr Nicole Noyes of New York University estimated about 900 babies were born from self-frozen or “autologous” eggs.
“Once I realized egg freezing was something that was real, meaning something women could take advantage of, I think I wrote 17 papers in three years,” Noyes said, “because I so believe in egg freezing.”
The American industry was worth $1.9bn in 2016 alone, and now private equity is beginning to scoop up many of those largely independent clinics.
Lee Equity Partners helped launch a $200m chain of clinics called Prelude Fertility. Prelude bought 22 clinics and the majority of a San Francisco clinic, according to Stat News. MTS Health Investors, another New York firm, created the Ovation Fertility chain and scooped up clinics in Louisiana.
“Now the [hedge funds] are coming in, so their objective is to make as much money as possible,” said Noyes.
“I’m not saying they’re unethical, I’m just saying it’s their objective.”