Fertility Clinics See Explosive Growth in Private Equity Money: Study

The U.S. has seen a massive expansion in private equity-linked fertility clinics since 2013, new research shows.

The peer-reviewed study published in the Journal of the American Medical Association in December 2025 found that more than half of IVF cycles in the U.S. in 2023 were done at clinics affiliated with private equity firms, or investment funds that raise capital to acquire and manage companies. 

Researchers examined the relationship between private equity firms and fertility clinics in the U.S. between 2013 and 2023. They found that in 2013, less than 4 percent of fertility clinics were affiliated with private equity firms, but in the decade that followed, private equity-linked clinics soared. By the end of 2023, 32 percent of the roughly 500 clinics that shared data with the U.S. Centers for Disease Control and Prevention in 2022 were affiliated with private equity firms. In 14 states and Washington, D.C., 50 percent of fertility clinics studied had ties to private equity by the end of 2023. 

This uptick in private equity involvement comes amid an increased focus on U.S. fertility rates.

Fertility rates have been on the decline in the U.S. since the early 2000s. In 2024, the U.S. reached its lowest-ever fertility rate, with about 1.6 kids per woman. And on the 2024 campaign trail, now-President Donald Trump said he would expand IVF (in vitro fertilization) access—a promise that remains unfulfilled. 

Research on private equity affiliations in other medical specialities has shown mixed impacts on quality of care, including poorer nurse staffing and the hiring of less experienced providers. Private equity has also been linked to increased costs for patients and insurance companies.

Rewire News Group spoke with one of the paper’s authors, University of Michigan infertility specialist Dr. James Dupree, about private equity’s growing role in U.S. reproductive care and the impact it could have on fertility patients. 

The following interview has been edited for length and clarity.

What was your most significant finding? 

What stood out to me most was that, at least using data from 2022 and 2023, it appears that now over half of the IVF cycles in the U.S. are done at clinics that are affiliated with private equity firms. We had a sense that private equity firms were affiliated with many clinics that perform IVF, but I do not think we knew exactly how many in the current state were affiliating, nor did we have a sense for the volume of IVF care that was being done at those clinics.

Your research mentions the potential for private equity involvement in fertility care to influence costs to patients and insurers, and quality of care. What would that look like?

We do not know in the fertility space about that balance between benefits and risks for patients. That research has not been done, to my knowledge. That’s very important research to be performed, but I haven’t seen any results speaking to that in the fertility space yet. 

Other researchers, looking in other parts of medicine … have found that cost of care might increase—either for the patient or for the insurer. There’s some limited research suggesting that there might be certain benefits to the patients—quality of care, outcomes of care. A somewhat larger body of research suggests either mixed or potentially harmful outcomes for patients associated with these types of affiliations. But again, it is important to emphasize that research has been done outside of fertility care in other parts of medicine. 

Incentives may change when ownership of the medical practice changes, and those incentives could encourage doctors and other folks in the clinic to maybe update or improve the way they practice for the betterment of patients. It is unlikely that any incentives are put in place that directly or [are] intended to harm patients. I think that’s very unlikely. But it’s possible that incentives could be put in place that might have unintended consequences, or unintended effects on patients.

What should patients already getting fertility care know, consider, or be worried about if a private equity firm acquires their clinic? 

I don’t think we’ve seen research yet that tells us that patients need to be worried about [private equity ownership] at their clinic. It’s important to acknowledge there could be benefits associated with private equity firms affiliating with fertility clinics as well. That’s certainly possible. 

It is, for example, expensive to run a laboratory that does IVF. There’s a lot of very expensive equipment, a lot of training, and a lot of quality improvement efforts that are necessary to run an IVF lab. You can imagine that … when [a private equity firm] comes in and affiliates with a clinic, it will invest capital, and that capital could be used to improve the laboratory equipment. It could be used to implement quality improvement structures or do additional training for the staff. 

So there absolutely could be benefits as well. I’m not ready to say that there’s anything that patients should worry about, because I just don’t think that that has been shown yet.. I think it needs to be studied. It’s important to look at, given what has been seen in other parts of medicine. But it’s too soon for me to say that there are worries there. 

If you could do further research on an aspect of this issue that you weren’t able to account for, what would it be and why?

I personally have a strong belief that patients should be able to access [fertility] care. I’d like to know, after a clinic affiliates with a private equity firm, does that improve their access, or in any way limit their access? That research hasn’t been done. You could imagine that with the capital that comes from a private equity firm, clinics may be able to open satellite clinics that are able to reach patients further away that were struggling to access their care before. Or maybe it allows them to hire additional health-care providers that are able to help see more patients. We don’t know. 

I’d love to look at costs for the patient, costs for the insurer. And especially given what has been found in other fields, look and see if costs increase, which has been found in several other parts of medicine. 

And the most important thing that I’d like to look at, if budget was no limitation, is outcomes for patients. Patients that are doing IVF care are hoping to have a baby—hoping to build their family—which is a really powerful and really important outcome that they are seeking. It’s really important to know: Do those outcomes improve? 

What should patients think about when deciding where to go for fertility care based on your research findings?

It’s important for them to look for clinics that are members of the Society for Assisted Reproductive Technology. A lot of those clinics are dedicated to quality improvement. I would encourage patients to look for clinics that have experience doing IVF. 

[And] this is more about the actual health-care providers than the clinic broadly, but that [patients] end up getting cared for with a provider that they feel like they mesh well with, and that they can establish trust with.

Going through IVF is really difficult. It’s difficult financially, emotionally, physically. It’s not necessarily an easy treatment for patients to receive. The connection between the patient and their health-care provider is really important. 

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