September 26, 2025 • 41 mins
Kindbody implements quotas requiring doctors to perform more lucrative procedures, internal company documents show. In Episode 4 of IVF Disrupted: The Kindbody Story, patients report being pushed toward expensive IVF cycles and questionable add-ons.
Bloomberg’s Jackie Davalos investigates how financial pressure drove medical decisions at the struggling fertility chain—including one woman's painful and seemingly unnecessary procedure that would leave her questioning everything.
Read more: IVF Disrupted: The Kindbody Story
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Episode Transcript
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Speaker 1 (00:02):
Bloomberg Audio Studios, podcasts, radio news.
Speaker 2 (00:09):
The global fertility market is worth an estimated forty six
billion dollars and is expected to more than triple in
the next decade. In the US, a company called kind
Body was once one of the fastest growing players in
the field IVF disrupted. The kind Body Story examines the
consequences of that rapid growth and what happens when startup
(00:32):
culture collides with the delicate science of creating life. Today
on the show, We're Bringing You Episode four. If you
missed episodes one through three, go back and listen. They
dropped in the Big Take Feed last week. And one
more note. The series features conversations about pregnancy complications and loss.
Please take care while listening.
Speaker 1 (00:54):
The day Elizabeth decided to start trying for a baby,
she was thirty eight years old. She and her husband
had been happy as they were traveling, building their careers
in Chicago, enjoying their freedom. But something was shifting. Her
mom was sick, the years were passing. There was the
sense that maybe they'd regret not trying.
Speaker 3 (01:17):
It just kind of felt like, you know, that opportunity
to have kids, the window could be closing. I had
kind of naively really thought that it was going to
work quickly for us, and then it didn't. And after
trying for months, we were talking to our obi and
then she was saying, you know, at your age, you
don't have to try it.
Speaker 1 (01:37):
I've spoken with dozens of women like Elizabeth during my
investigation of kind Body, and there's this moment that comes
up again and again, this pivot point where they decide
to seek help with fertility. It's vulnerable, intimate, and it
often comes with the clock ticking somewhere in the background.
Elizabeth and her husband had tried naturally for seven months
(01:58):
before her doctor recommend and did she look into fertility treatment.
So Elizabeth started looking into specialists covered by her insurance.
Kind Body was one of her options.
Speaker 3 (02:09):
I saw it and was like women doctors and the
way they made it seem like it was just so
easy to do and seamless. Right away, I just was like, oh, yeah,
this is the easiest choice I've had to make.
Speaker 1 (02:20):
She and her husband got an appointment right away at
a kind Body clinic in Chicago.
Speaker 3 (02:25):
I had heard from friends that it can take a
long time to get into clinics sometimes, and so I
was excited and pleasantly surprised that we were able to
get in right away. I see it as a red
flag now, However, at the time I was very excited
to be able to just jump right in.
Speaker 1 (02:40):
Elizabeth had several friends who had gone through fertility treatments before,
so she knew a little bit about her options. Because
IVF is expensive and invasive, Elizabeth wanted to start.
Speaker 3 (02:50):
Slow, and so I was interested to hear about other
things like AYUI are using clomate and different things like that.
Speaker 1 (03:00):
IUI stands for intrauterine insemination. It's when sperm is injected
directly into the uterus. Clomid is a medication that stimulates ovulation.
Unlike IVF, these treatments don't require an egg retrieval and
so patients don't need as much medication. In IVF, patients
often take multiple medications to stimulate the ovaries to produce eggs,
(03:23):
and there's also painkillers required for an embryo transfer. Doing IUI,
we're taking clomid can be a much cheaper option. Elizabeth
liked the doctor she met with that kind body. She
felt she was knowledgeable and personable, but something didn't feel
right about the way the doctor laid out the treatment options.
Speaker 3 (03:42):
They didn't mention anything about clomate or other drugs like that.
They had like a slide maybe briefly talked about an IUI,
but then really just the whole most of the hour
long kind of presentation was about IVF, So we just said, yeah,
you know, we're just a little nervous about doing IVF
to hear about the other steps. I can't remember her
exact verbiage, but something along the lines of, you know,
(04:05):
given my age and the fact that we've been trying
now for a while, she kind of presumed that I'd
want to jump right in and do IVF. My initial
reaction was that it seemed like they were pushing IVF.
Speaker 1 (04:20):
IVF is the most expensive procedure that kind Body offers,
and the number of patients who go through IVF has
a huge impact on kind Body's bottom line. What Elizabeth
didn't know at the time was that kind Body was
quickly running out of money. Behind closed doors, executives were
freaking out and facing tough questions from investors, including private
(04:42):
equity backers. I heard from people in these meetings that
investors were worried that the company wasn't hitting its targets
and would need more money. In an effort to boost profits,
kind Body came up with the plan, one that pushed
patients into more aggressive treatments, treatments that left some women
asking was this really necessary? From Bloomberg and iHeart podcasts,
(05:08):
this is IVF disrupted the kind Body story. I'm Jackie Devalos,
So how did we get here to a point where
kind Body, which had been a femtech darling for venture
(05:30):
capital and private equity investors, was now scrambling for money.
I want to take you to an important meeting in
the summer of twenty twenty three, when kind Body directors
gathered for their quarterly meeting at a luxury hotel in
the Hampdens. I saw them minutes and talked to people
who were there, and they said there was a feeling
(05:51):
of desperation at this meeting. The company had been talking
to investment bankers to explore an initial public offering IPO,
a move that could potentially transform the founder's equity stakes
into enormous wealth. But first they needed better numbers, more revenue,
less spending, or maybe both, and at that moment the
(06:13):
situation didn't look good. Kind Body had merged with Bio's
Fertility Institute over a year earlier, doubling their clinic count overnight.
They had a new CFO, had raised millions of dollars
from big investors, including JP Morgan, and despite multiple rounds
of layoffs, they were still burning through cash. Internal documents
(06:36):
I saw painted a rough picture. The company had spent
nearly sixty million dollars in twenty twenty three through September
and was losing an average of roughly seven million dollars
each month. According to the documents, of the startup's thirty
three clinics, only six were profitable. So kind Body executives
laid out their plan to try to improve the company's finances.
(07:00):
It would set specific quotas for their physicians in an
effort to hit revenue targets. One of the metrics that
kind Body tracked was the number of retrievals they performed.
It's a key step in IVF. Retrievals are when doctors
attempt to extract eggs from the ovaries. The procedure involves
blood tests, ultrasounds, and hormone injections, and it's one of
(07:23):
the most lucrative procedures. Kind Body offers retrievals make up
about half of the revenue collected from one round of IVF.
In a presentation outlining its turnaround plan to investors, kind
Body ranked all of its doctors only by the average
number of monthly egg retrievals they were performing. Those who
(07:43):
fell beneath the benchmark average of twenty three were labeled
as falling below expectations. If it was going to turn
a profit and go public, the doctors at kind Body
would need to raise the number of monthly egg retrievals
they performed. Some doctors would have to double their retrieval.
I was told many physicians didn't feel comfortable with the
(08:04):
new targets, and over the next three months, four doctors resigned.
Angie Beltzos, who was kind Body's chief physician when it
introduced the quotas, didn't respond to a request for commet
for the series. This push to do more IVF cycles
was invisible to Elizabeth when she had her first consultation
(08:24):
at kind body Chicago clinic, but for the people treating her,
the pressure was on to start. Elizabeth and her husband
tried clomid and then an IUI, and when those treatments
didn't work, they decided to finally try IVF in Chicago.
Kind Body's prices started at fourteen thousand, five hundred dollars
(08:45):
per cycle, and that prize doesn't include genetic testing or
embryo transfers. Although she had some insurance coverage, Elizabeth was
still on the hook for about six thousand dollars in
out of pocket costs when she finally decided to pull
the trigger. Elizabeth says she had trouble getting a hold
of the people who were supposed to guide her through
the process. During IVF. Timing is everything missing. Even a
(09:09):
single dose of medication can derail an entire cycle, wasting
thousands of dollars and pushing treatment back by months.
Speaker 3 (09:17):
It's all very very strict in that regard, at least
that's how they described it to me.
Speaker 1 (09:23):
Once Elizabeth's insurance authorized her IVF medications, she called kind
Body to make sure the clinic had put in the
order to the pharmacy. Knowing Memorial Day was approaching, Elizabeth
tried calling a few days before to avoid delays. No answer.
On the Friday before the holiday weekend, she started to panic.
She called their national helpline. No one could help. Her husband,
(09:47):
desperate left work early to drive to the clinic and
bang on the door.
Speaker 3 (09:52):
So the fact that I wasn't getting these answers or responses,
I mean, my anxiety levels were through the roof. It
felt like the strain, gaslighting or something or I was
just like confused.
Speaker 1 (10:06):
But behind the scenes at kind Body, there was a
financial reason Elizabeth might not have been able to connect
with her providers by phone. Documents I saw laid out
kind Body's policy to quote bill all visits to do this.
Employees I talked to said they were instructed to encourage
patients to come into the clinic in person or hold
(10:28):
virtual video visits. The goal was to bring down the
number of phone calls that they couldn't bill. In theory,
this policy makes sense. Many patients told me they liked
seeing their doctors in person, but in practice, they said
it made the IVF process more stressful. It was really
difficult to get an appointment with doctors after an initial consultation,
(10:51):
and because of kind Body staffing problems, they would be
seen by an ever changing set of nurses or patient coordinators. Instead,
one on one time time with the doctor was rare
for Elizabeth. The costs continued to pile up on top
of the six thousand dollars she was spending for the procedure.
Elizabeth says kind Body was trying to sell her add
(11:13):
on services. There was genetic testing, which cost over four
thousand dollars per embryo, and other treatments that she'd never
heard of.
Speaker 3 (11:23):
My good friend who went, you know, through another clinic.
She kept kind of mentioning like because I was like,
so did you pay for the extra however, couple hundred
bucks for embryo glue. She was like, embryo glue, Like
I never heard of embryo glue, And I was like, oh,
like we just paid for under bucks this round, you know,
for embryo glue and all of these like add ons
(11:44):
that was like thousands of dollars per retrieval these add ons.
Speaker 1 (11:49):
The idea of embryo glue is to help an embryo
implant on the wall of the uterus. A doctor at
kind Body told Elizabeth that she should also consider a
medication that would encourage the embryo to implant.
Speaker 3 (12:02):
So was this We had to go in a few
days before the transfer date and do this like nupigin wash,
which was a couple hundred bucks or seven hundred bucks
out of pocket. And again I'm just telling my friend
and she is just like shaking her head, like I
don't like, what is this?
Speaker 1 (12:19):
Experts I spoke to see. The science behind embryo glue
and nupagin wash is shaky at best. It's not definitively
proven to improve chances of getting pregnant. But in that moment,
Elizabeth went through with it despite her doubts.
Speaker 3 (12:35):
But again didn't want to question the doctor. If she
said this is going to improve our chances, then you know,
let's go for it. We've got the one embryo. Let's
like do whatever it takes. It just it's like a
situation where you're going in making these calls for this
round of IVF and you're already you know how invasive
it's going to be, and you know how hard it's
going to be on your body, and you know how
(12:56):
much money insurance is paying for it, and that you're
then going to be paying for it. So you're not
going to cut corners. If your doctor says I recommend this,
it's going to increase your chances by five percent or
whatever it may be, Like, that's not the time to
be like, no, I'm going to save this four hundred
bucks or whatever is so you just you know, you
have to trust the person of authority there. You have
(13:17):
to trust the doctors making those recommendations.
Speaker 1 (13:20):
By the fall of twenty twenty four, two IVF cycles
had left Elizabeth emotionally and financially drained. In total, she
spent more than twelve thousand dollars on the IVF treatment
and add ons. Her disappointment and frustration were compounded by
the fact, she said she was also getting bills in
the mail for things kind body had assured her recovered
(13:42):
by insurance. I spoke to nearly fifty patients, and nearly
all of them had what they called surprise costs during
the treatment and after. Eventually, Elizabeth and her husband ended
up moving to another fertility practice after switching their insurance.
Speaker 3 (14:00):
It's literally night and day the difference.
Speaker 1 (14:03):
Elizabeth said, her new doctor doesn't try to upsell her. Instead,
she told her she could skip genetic testing of her
embryos altogether.
Speaker 3 (14:11):
I was like, I remember my jaw was dropped because
I was so I don't know, indoctrinated into it, being
like you are over thirty six, you wild genetic test.
But genetic testing is a huge out of pocket cost.
It took me a while to wrap my head around
because again I just thought there was no way if
not through genetic testing. But the way she described it
(14:32):
to us was that that is not something we like
need doing.
Speaker 1 (14:37):
She says it makes her look back on her time
at kind Body differently. Even though she genuinely liked the
doctor she had there, she has doubts.
Speaker 3 (14:48):
At kind Body, and my heart of hearts, I do
not want to think that the doctor that we worked
with for months there is just trying to get us
to do more IVF rounds. Just don't want to think that.
But when you just could all the pieces and how
they're all kind of adding up, it's just really hard
not to come to that conclusion in my mind.
Speaker 1 (15:06):
We'll be right back. I spoke with dozens of current
and former employees who worked at kind Body around the
time Elizabeth was having her treatment, and they told me
there was this intense pressure to sell services that made
many clinical staff, including doctors, deeply uncomfortable.
Speaker 4 (15:28):
At your white coat ceremony, which is the first thing
you participate in before you start mid school, you take
that oath, and that oath is first, do no harm.
Speaker 1 (15:39):
This is Lauren again. She's a former Kind Body medical
staffer who asked not to be identified, so we've given
her a pseudonym and are having a voice actor. Read
what she told me. Lauren said that from the beginning
at Kind Body, doctors had metrics that were closely tracked
to measure their performance. One of these metrics was the
(15:59):
number of cycles they so that could.
Speaker 4 (16:01):
Be an egg free cycle or embryo creation, and then
the actual transfer of the embryo to hopefully create the pregnancy.
Speaker 1 (16:10):
There were also other procedures that counted toward a doctor's metrics.
Some of these were part of the IVF process, but
not always. For example, mock cycles. A mock cycle is
like a trial run. It simulates an embryo transfer. The
goal is to see how the body reacts and allow
the doctor to work out the kinks before the actual procedure.
(16:32):
Doctors tell me they can be helpful for patients who
have had trouble getting embryos to implant, but they aren't
necessary for everyone. Lauren told me that Kind Body doctors
often recommended mock cycles, which can add hundreds of dollars
to the bill.
Speaker 4 (16:47):
Well, there was one in particular, that would have patients
do mock cycles or multiple mock cycles, or different types
of procedures, because essentially that would increase her number in
regards to her cycles, which then essentially increased her revenue.
Speaker 1 (17:08):
Lauren told me that another closely watched metric was a
doctor's conversion rate. This measured how often a patient who
came in looking to learn about fertility services was then
turned into a pain customer. And to Lauren, measuring that
rate sometimes created the wrong kind of incentive.
Speaker 4 (17:26):
So you know, if I had in a month, say
twenty patients who are twenty two years old, and they're
coming to me freaking out, saying, oh my god, do
I have to do egg freezing this month because otherwise
I'm never gonna have kids. And I do my job,
and I go through the information and tell them and
educate them about biology and about what this means and
(17:47):
about their own statistics at that age and so on
and so forth, and then they decide to not do
egg freezing. That's account against me. Whereas some providers I
would use scared tactics to essentially make these patients want
to go through cycles and get revenue. I was never
(18:07):
ever going to do that. I'm not a salesperson when
it comes to medical care.
Speaker 1 (18:13):
Doctors were incentivized to do more cycles. Former employees told me.
Kind Body gave year end bonuses to doctors with high
rates of converting consultation into IVF. Former executives, doctors, and
other employees stressed that steering patients toward more lucrative services
(18:34):
was a direct result of Kind Body's funding structure. To them,
the decisions made to appease private equity and ventor capital
backers had an effect on clinical care. This isn't just
kind Body, though, experts told me. It happens to some
degree among a lot of fertility clinics that are backed
by big outside investors like private equity. The advantage of
(18:58):
private equity investment is at lets IVF clinics expand their
footprints and treat more people, which increases access. What's the
effect of private equity on IVF. Well, there's a twenty
eighteen study done by Alex Borsa, a researcher from Columbia University.
(19:18):
His study found that IVF clinics with any sort of
big institutional investor like private equity do more IVF procedures
than others. He looked at all the clinics in the US,
just fifteen percent had a private equity affiliation. It's a
relatively small slice, but those clinics did almost a third
(19:39):
of all IVF cycles in the country. Like a lot
of parts of medicine, private equity has entered the fertility
field in a big way in the last ten years.
One reason they've been particularly drawn to the space is
because it's less regulated than any other fields. I spoke
(20:01):
about the way this investment has impacted the industry with
Travis McCoy, a doctor at Piedmont Reproductive Endochronology Group, which
operates six clinics in South Carolina and neighboring states.
Speaker 5 (20:13):
I came out of fellowship and training in twenty ten.
There may have been some private equity groups, but none
that I had ever heard of, And so your choices
were really to take an academic role at a university
or go into private practice.
Speaker 1 (20:28):
These days, doctor McCoy says he frequently gets offers from
private equity firms eager to acquire the practice.
Speaker 5 (20:36):
I bet we at least get one at least once
every two weeks, and sometimes it's companies you've heard from
mostly it's companies you haven't.
Speaker 6 (20:43):
There's big dollars that are dangled, and.
Speaker 1 (20:46):
That's doctor Edward Tarnawa. He also works at Piedmont Reproductive
with doctor McCoy. Both doctors said they've resisted selling to
private equity because they're afraid of what strings become attached.
Doctor McCoy said that by staying independent, Piedmont can control
how it's staff's clinics in a way that wouldn't be
possible if a private equity firm was scrutinizing expenses.
Speaker 5 (21:09):
Is payroll a huge expense for our practice? Absolutely? Payroll's
the biggest expense, and so could we make it tighter
and more profitable. Yes, So you would start consolidating jobs,
which means you start to increase the workload on each
of our staff members. Well, everybody knows it doesn't take
(21:31):
a genius to know that leads to burnout. The patients
see when I don't have as many nurses and people
answering the phone and taking care of their portal messages.
They see that and they get frustrated with that. The
embryology labs, those are a little higher paid staff, and
so hey, if I can pare them down, then you know,
(21:52):
I'm cutting profits, I'm cutting out salaries. But then you
start to get into the safety issues. I would rather
have a payroll that's a little fat and plumped up
and you know, a little tougher to me. But we
know we're doing the right things for our patients by
doing that.
Speaker 1 (22:09):
Doctor Tarnaas said that inviting private equity into a practice
has profound implications for patient care.
Speaker 6 (22:16):
If there's somebody sitting behind a desk that you've never met,
that's looking at, you know, a spreadsheet and wondering why
the revenue dips, they're going to ask for other ways
to get that revenue. Hey, speed this person up to
treatment that they might not be quite ready for. Push IVF.
I never want to push IVF. I mean our field
is about options, and that is a that is a
(22:39):
two way discussion between us and the patients in terms
of pros and cons and experience and how they value efficiency,
What have they done before, what is their tolerance for disappointment?
Cost insurance? Those things all matter. And that's a complex
equation and it's not IVF for all, which I know
some sinners would would like it to be. There's some
(22:59):
fertility centers out there that offer nothing but ideaf and
that's mind boggling to me because there's there's other options,
and that's just trimming it down to a service that
they're trying to sell. And I don't like that.
Speaker 5 (23:14):
And I think most of us recognize that our patients
are at an extremely fragile place and we know that
they will do anything. They are very vulnerable, and unfortunately
that makes them that vulnerable population to that could be exploited.
Speaker 1 (23:30):
It wasn't just their clinic. I called over a dozen
veteran fertility doctors around the country, from big corporate chains
to mom and pop size clinics to ones that belonged
to academic institutions. Many had various performance targets, but nothing
quite like the retrieval quotas doctors at Kindbody told me about.
(23:50):
There's one thing that makes kind Bodies stand apart from
all these other fertility businesses with private equity investment. When
private equity got involved with these other practices is their
clinics were already built. Here's doctor McCoy.
Speaker 5 (24:04):
Because the ultimate goal for a private equity group is
to buy your practice, make sure it's profitable, make it
pretty for a certain number of years, so I can
sell it to somebody else at a higher rate.
Speaker 1 (24:17):
But when Gina Barchesy was wooing investors, there was nothing built,
just a vision. A few other fertility companies have tried
building from the ground up like this, but kind Body
was the fastest growing by far. Building fertility clinics is complicated,
(24:38):
but the company's plan was to roll them out like
they were a chain of coffee shops.
Speaker 4 (24:43):
When they started this company, you know, one of the
things they said was they wanted to be the Starbucks
of fertility.
Speaker 1 (24:52):
This is Lauren again.
Speaker 4 (24:54):
They wanted a clinic on every corner. Medical care is
not like that. Physicians are finite.
Speaker 1 (25:02):
In other words, a specialized medical practice isn't scalable, or
at least not in the same way that a retail
chain might be. But the pressure on kind Body intensified
with each funding round. Lauren remembers a sobering moment in
twenty twenty three, after kind Body raised one hundred million dollars.
Speaker 4 (25:23):
There was just this huge in the company, kind of like,
oh my gosh, we have one hundred million, so amazing,
We're doing so great. I mean, it was in every meeting,
it was in everything, And then the CFO at the time.
He was very honest and he basically yeah. Right at
the meeting to the everyone basically said that you know,
(25:43):
I know this sounds like a lot of money, but
this is not we're rolling in the money. He literally said, like,
this is a debt we have to pay back, so
we have to be judicious about what we're doing.
Speaker 1 (25:58):
After the break, the pressure to sell a kind Body
wasn't just limited to IVF.
Speaker 7 (26:04):
So I was like, I just went through two weeks
of medications and traveled here and spent thousands of dollars
for this procedure, and you're telling me I didn't need
to do it.
Speaker 1 (26:15):
We'll be right back. Before Lacey Michelson came to Kind
Body in twenty twenty three, her attempts at becoming a
mother had already been really traumatic. Nearly every step of
IVF had been a struggle for Lacey. She has endometriosis,
(26:36):
which causes painful inflammation and can make conception difficult. She
was also extremely sensitive to fertility medications and had severe reactions,
debilitating headaches, stomach cramps, and sweats, and one complication from
an early pregnancy caused her fallopian tube to rupture. She
almost died.
Speaker 7 (26:56):
You know, I had friends and family members, people really
close to me ask me like, why.
Speaker 8 (27:01):
What can you just stop? Please stop?
Speaker 7 (27:04):
And my desire for this ended the relationship I had
with what I would you know, describe as the love
of my life because I just this was so important
to me.
Speaker 8 (27:15):
I couldn't put anything else before it.
Speaker 1 (27:19):
But even after nearly dying, Lacey wasn't ready to give up.
Speaker 7 (27:24):
It's just, for as long as I can remember, since
I was a little girl, it's all I ever wanted.
Speaker 8 (27:29):
I never cared about getting married.
Speaker 7 (27:32):
I never gave a bit about that. All I ever
wanted was to be a mom. It just kind of
took on a life of its own at at some
point it was just something that I just had to
keep fighting for.
Speaker 1 (27:44):
When I met Lacey in twenty twenty four, she was
in her early forties and had been trying for a
baby for nearly four years. Unlike many women with husbands
are a partner by their side, Lacey was going at
it alone. She'd gone to clinics in LA and Texas
and spent tens of thousands of dollars. She briefly went
to a kind Body clinic in Austin, which she really liked,
(28:07):
but when she moved to Virginia, she had trouble finding
a clinic she trusted.
Speaker 7 (28:11):
I think there's three or four that I tried, and
I just wasn't getting proper care, wasn't getting return phone calls.
Speaker 1 (28:19):
In the spring of twenty twenty three, Lacey found Kind
Bodies DC clinic.
Speaker 7 (28:24):
I did a consult with one of the doctors there,
who I loved. She was just so great, so personal,
so like compassionate, and I was really comfortable with her.
Speaker 8 (28:35):
When I met her in person.
Speaker 7 (28:37):
She just gave me a giant hockey, you know, and
she acknowledged so many times, like everything that I had
been through. So I felt relieved to be working with
somebody that understood my journey and was really rooting for me.
Speaker 8 (28:53):
You know.
Speaker 7 (28:55):
I thought that everything, all the other crap that I
had been through was behind me, and that I was
on the right path now and working with the right
doctor and the right clinic.
Speaker 1 (29:06):
Lacey had six eggs shipped from her previous clinic in
LA to Kind Body, and those resulted in two viable embryos.
That summer, she had one transferred, but it didn't result
in a pregnancy.
Speaker 8 (29:17):
I was down to one embryo left. At this point.
Speaker 7 (29:21):
It was clear that I was not a really good
candidate for IVF because of my reactions to the medication.
I had kind of been thinking like this next frozen
embryo transfer that I do was essentially my last shot
at biological motherhood. At this point, I wanted to do
an unmedicated transfer. My body is exhausted, and I've just
(29:43):
had so many horrendous side effects from all these hormones.
I was just going to do a natural frozen embryo transfer,
or as natural as they'll do it.
Speaker 1 (29:52):
Basically, there was one more hurdle Lacey needed to clear.
Speaker 8 (29:57):
First.
Speaker 1 (29:58):
Lacey's doctor said, just did she do what's called an
endometrial receptivity analysis.
Speaker 7 (30:04):
An ER test basically takes a biopsy from your uterus
to see if there's any active infection.
Speaker 1 (30:13):
The test is supposed to show if the uterus is
in good shape to have an embryo im plantation. Experts
told me the test isn't that common. It also requires
a lot of preparation. She'd need to take two weeks
of medications. It wasn't ideal, but Lacey wanted to have
the best chance for her last embryo to stick. A
couple of days before she went in for the procedure,
(30:34):
kid Body called to collect payment about fifteen hundred dollars.
Speaker 7 (30:39):
Leading up to the procedure, I is getting a lot
of like different communications from the clinic.
Speaker 1 (30:47):
Some nurses were calling her ER test a mock transfer,
which is a totally different procedure. In a mock transfer,
the doctor is just looking to see if everything looks good.
Unlike an EER test, no tissue biopsy is done.
Speaker 8 (31:02):
I thought maybe they're essentially the same thing.
Speaker 4 (31:05):
You know.
Speaker 7 (31:06):
I got pre op instructions from the my nursing team, and.
Speaker 8 (31:12):
They were very specific.
Speaker 7 (31:13):
They should show up with a full bladder, drink thirty
two ounces of water, don't empty your bladder.
Speaker 1 (31:19):
Lacey wanted this to go well. She'd call the clinic
to double check instructions. Sometimes at answer and give conflicting information,
but most of the time no one replied. Lacy didn't
think too much of it at the time and stuck
with what she had been instructed to do. At the outset.
They're professionals, she thought, you know what they're doing.
Speaker 7 (31:39):
So the morning I went in for my transfer, one
of the first things they asked me to do was
give you your own sample and empty my bladder.
Speaker 8 (31:46):
So I was obviously really confused by this.
Speaker 7 (31:49):
I was like, okay, but I'm here for an ear
I test and I have to have a full bladder.
And the nurse was like, no, your bladder has to
be empty, and I was like, are you sure?
Speaker 8 (31:58):
Can you check with my doctor with my nursing team.
Speaker 1 (32:02):
Lacey was sitting on the exam table in her gown
waiting for an answer when someone came in to collect payment.
Speaker 7 (32:09):
And I was like, I already paid, and she said, well,
how much did you pay?
Speaker 8 (32:13):
And shouldn't you have this information? And I had to like.
Speaker 7 (32:16):
Pull it up on my phone and I told her
how much I paid and she was like, oh, okay,
and she seemed really confused, and she like left the
room and then came back and was like, okay, so
you might get like another bill from the lab because
the lab bills separately.
Speaker 8 (32:30):
And I'm like, okay, fine.
Speaker 7 (32:32):
She's like I think it'll be like seven hundred dollars
or something, and I'm like, okay, you guys probably could
have told me that before, but okay, yeah, I'll pay it.
Speaker 1 (32:42):
A nurse came back with an update Lacey would need
an empty bladder. After all, she did as she was instructed.
When the exam finally started, it was clear something was wrong.
Speaker 7 (32:56):
I had drinks so much of water at this point
that I still had a full block when I went
in for the procedure, which ended up being a problem.
She was not able to access the part of my
uterus she needed to biopsy because my bladder was in
the way. And this procedure is generally, as it was
explained to me, it's supposed to be uncomfortable. It's not
(33:18):
pleasant by any means, but it's very quick five or
fifteen minutes. I was in there for over an hour.
I was crying in agonizing pain. I think it was
four people and they're helping to do this very simple biopsy.
The ultrasoundtech was like holding me. It was awful because
she just couldn't get this biopsy that she needed. So
(33:39):
it was really pretty traumatic. And in the end I
was like, okay, you need to stop, like, hopefully you
have the biopsy you need, but I can't, Like this
needs to end now.
Speaker 1 (33:50):
When it was finally over, Lacey got dressed. Then her
doctor casually said something that stunned her, and.
Speaker 7 (33:59):
At some point point she mentions to me that if
I'm doing an unmedicated for as an embryo transfer, the
results of an ER test are irrelevant. So I was like,
you mean I didn't need to just do what I
just did. I just went through two weeks of medications
and traveled here and spent thousands of dollars for this procedure,
(34:23):
and you're telling me I didn't need to do it.
Speaker 1 (34:25):
Lacy's doctor explained that the test wasn't necessary, but that
useful information could still be gleaned from the biopsy. It
wasn't all for nothing, the doctor said, in an effort
to calm her down.
Speaker 7 (34:37):
I didn't really push the matter beyond that at that point.
I just wanted to get the hell out of there.
It wasn't until I was driving home with my friend
who had come with me for the procedure, that I
was telling her what the doctor said, and she was like, wait,
what all this happened when you left the waiting room,
And as I was talking.
Speaker 8 (34:57):
It through with her, I was like, yeah, yeah, yeah,
that just happened.
Speaker 7 (35:02):
It's just like kind of flabbergasted by the entire thing.
By the time I got home. I was extremely upset
that night.
Speaker 1 (35:12):
She sent a long email to Kind Body.
Speaker 7 (35:14):
I heard back from them within a day or two
and they apologized. And the woman that I spoke with,
she was nice and she understood my position, and she
said that she was going to see about refunding me
the cost of the procedure, and she was gonna get
back to me like within a few days. And I
(35:36):
didn't hear from her, so I kept following up. She
eventually came back and said, sorry, we can't do that.
Speaker 1 (35:44):
The unnecessary procedure had serious consequences beyond the financial cost
and physical pain.
Speaker 7 (35:51):
The hormones that I had to take in preparation for
this biopsy exacerbated my enemy triosis. I got a really
big cyst on my life ovary, and I had three
months of horrible pain from taking these hormones to do
this biopsy that I didn't need to do. And there
was just no accountability anywhere.
Speaker 1 (36:12):
Lacey decided to leave kind Body and transfer her embryo
to another clinic, and she says when she let Kindbody
know about her decision, they did offer her something.
Speaker 7 (36:23):
I will say they gave me one hundred and fifty
dollars off of that for my troubles with kind Body,
which was.
Speaker 8 (36:31):
Which is just in gold.
Speaker 1 (36:34):
Kind Body told me that the course of treatment and
medication was consistent with the standard clinical practice to suppress endometriosis.
Thinking back, Lacey said she felt pressured from the beginning
to do the procedure and that she could never get
a straight answer about what it would cost.
Speaker 7 (36:50):
I just can't see any other reason than just to
make extra money, you know, at my expense. I already
have an opinion that this particular part of healthcare fertility
is they're taking advantage of women that are quite frankly desperate.
(37:11):
That's why they're able to charge as much as they charge.
Speaker 1 (37:14):
But the costs weren't just financial.
Speaker 7 (37:18):
Everything that you have to do when you're going through
fertility treatments, every test, every exam, every phone call, every appointment,
every loss, like every single thing is hard, is really hard,
you know, And the further along you go with it,
the harder it gets. There's some train of thought on
(37:39):
their end, on somebody's end, where it's like essentially harmless
to do this biopsy. They can get some information from it,
you know, whether or not they need that information is
questionable the financial aspect of it aside, it is not harmless.
It was not harmless to me, And after this whole
(38:00):
ordeal with kind Body, I wanted to be done.
Speaker 8 (38:02):
I wanted to give up.
Speaker 7 (38:03):
I couldn't do it anymore, like physically, mentally, emotionally. I
was like, I just need to actually get to a
place mentally where I'm okay not being a wall.
Speaker 1 (38:17):
After nearly giving up, Lacey decided to try one last
transfer with her remaining umbrew at a different clinic in
New York. Recently, Lacey sent me a voice memo with
an update.
Speaker 7 (38:30):
So, yeah, I'm not totally sure how to start this.
I had my son on September nineteenth vac section, and
he is absolute pure joy. His middle name is Miles,
and one of his nicknames is Smiles Miles because he's
really just the happiest little dude. I often get stopped
(38:52):
by strangers that remark about how absolutely perfect he is.
When I think back on my journey to get him here,
which I do quite frequently, I still can't believe that
I went through all of that and came out the
other end with this perfect little human. Periodically someone will
say like, how lucky I am, and I always correct
(39:16):
them that luck had nothing to do with it. I
did this my blood, sweat, tears, heartbreaks, life.
Speaker 8 (39:22):
Savings, you name it.
Speaker 7 (39:24):
Anything and everything I had, I poured into this and
I made him despite all the obstacles and the horrendous experiences.
And I'm hopeful that my story and the stories from
other women can help begin a greater process of reform
(39:45):
in this field.
Speaker 1 (39:50):
Coming up on IVF Disrupted The Kind Body Story.
Speaker 9 (39:55):
I just remember she wouldn't make eye contact with me,
and the assistan was like doing a lot of the
talking too.
Speaker 7 (40:03):
You can't have an employee of yours beer carrier because
that is coercion, because she will feel she can't say no.
Speaker 3 (40:10):
When it comes to who has the opportunity to work
with a surrogate. It's very clear that it is of
the discretion of the treating physician.
Speaker 9 (40:17):
I was on mail duty, so I read this in
the office and my jaw hit the floor because I
was like, what do you actually mean we're doing this?
Speaker 1 (40:32):
IVF Disrupted The Kind Body Story is reported and hosted
by me Jackie Devalos. The series is produced by Sean
Wen and Jilda Decarly, editing by Caitlin Kenney, Jeff Grocott,
and Joshua Brustein. Blake Maples is our sound engineer and composer.
Voice acting in this episode was provided by Dana Johnston,
(40:55):
fact checking by Anica Robbins. Bloomberg Senior Executive Editor for
Technology is Tom Giles. Our head of podcasting is Sage Bauman.
You can reach us at podcasts at Bloomberg dot net.
IVF Disrupted is a production of Bloomberg and iHeart Podcasts.
Bloomberg Audio Studios, podcasts, radio news.
Speaker 2 (00:09):
The global fertility market is worth an estimated forty six
billion dollars and is expected to more than triple in
the next decade. In the US, a company called kind
Body was once one of the fastest growing players in
the field IVF disrupted. The kind Body Story examines the
consequences of that rapid growth and what happens when startup
(00:32):
culture collides with the delicate science of creating life. Today
on the show, We're Bringing You Episode four. If you
missed episodes one through three, go back and listen. They
dropped in the Big Take Feed last week. And one
more note. The series features conversations about pregnancy complications and loss.
Please take care while listening.
Speaker 1 (00:54):
The day Elizabeth decided to start trying for a baby,
she was thirty eight years old. She and her husband
had been happy as they were traveling, building their careers
in Chicago, enjoying their freedom. But something was shifting. Her
mom was sick, the years were passing. There was the
sense that maybe they'd regret not trying.
Speaker 3 (01:17):
It just kind of felt like, you know, that opportunity
to have kids, the window could be closing. I had
kind of naively really thought that it was going to
work quickly for us, and then it didn't. And after
trying for months, we were talking to our obi and
then she was saying, you know, at your age, you
don't have to try it.
Speaker 1 (01:37):
I've spoken with dozens of women like Elizabeth during my
investigation of kind Body, and there's this moment that comes
up again and again, this pivot point where they decide
to seek help with fertility. It's vulnerable, intimate, and it
often comes with the clock ticking somewhere in the background.
Elizabeth and her husband had tried naturally for seven months
(01:58):
before her doctor recommend and did she look into fertility treatment.
So Elizabeth started looking into specialists covered by her insurance.
Kind Body was one of her options.
Speaker 3 (02:09):
I saw it and was like women doctors and the
way they made it seem like it was just so
easy to do and seamless. Right away, I just was like, oh, yeah,
this is the easiest choice I've had to make.
Speaker 1 (02:20):
She and her husband got an appointment right away at
a kind Body clinic in Chicago.
Speaker 3 (02:25):
I had heard from friends that it can take a
long time to get into clinics sometimes, and so I
was excited and pleasantly surprised that we were able to
get in right away. I see it as a red
flag now, However, at the time I was very excited
to be able to just jump right in.
Speaker 1 (02:40):
Elizabeth had several friends who had gone through fertility treatments before,
so she knew a little bit about her options. Because
IVF is expensive and invasive, Elizabeth wanted to start.
Speaker 3 (02:50):
Slow, and so I was interested to hear about other
things like AYUI are using clomate and different things like that.
Speaker 1 (03:00):
IUI stands for intrauterine insemination. It's when sperm is injected
directly into the uterus. Clomid is a medication that stimulates ovulation.
Unlike IVF, these treatments don't require an egg retrieval and
so patients don't need as much medication. In IVF, patients
often take multiple medications to stimulate the ovaries to produce eggs,
(03:23):
and there's also painkillers required for an embryo transfer. Doing IUI,
we're taking clomid can be a much cheaper option. Elizabeth
liked the doctor she met with that kind body. She
felt she was knowledgeable and personable, but something didn't feel
right about the way the doctor laid out the treatment options.
Speaker 3 (03:42):
They didn't mention anything about clomate or other drugs like that.
They had like a slide maybe briefly talked about an IUI,
but then really just the whole most of the hour
long kind of presentation was about IVF, So we just said, yeah,
you know, we're just a little nervous about doing IVF
to hear about the other steps. I can't remember her
exact verbiage, but something along the lines of, you know,
(04:05):
given my age and the fact that we've been trying
now for a while, she kind of presumed that I'd
want to jump right in and do IVF. My initial
reaction was that it seemed like they were pushing IVF.
Speaker 1 (04:20):
IVF is the most expensive procedure that kind Body offers,
and the number of patients who go through IVF has
a huge impact on kind Body's bottom line. What Elizabeth
didn't know at the time was that kind Body was
quickly running out of money. Behind closed doors, executives were
freaking out and facing tough questions from investors, including private
(04:42):
equity backers. I heard from people in these meetings that
investors were worried that the company wasn't hitting its targets
and would need more money. In an effort to boost profits,
kind Body came up with the plan, one that pushed
patients into more aggressive treatments, treatments that left some women
asking was this really necessary? From Bloomberg and iHeart podcasts,
(05:08):
this is IVF disrupted the kind Body story. I'm Jackie Devalos,
So how did we get here to a point where
kind Body, which had been a femtech darling for venture
(05:30):
capital and private equity investors, was now scrambling for money.
I want to take you to an important meeting in
the summer of twenty twenty three, when kind Body directors
gathered for their quarterly meeting at a luxury hotel in
the Hampdens. I saw them minutes and talked to people
who were there, and they said there was a feeling
(05:51):
of desperation at this meeting. The company had been talking
to investment bankers to explore an initial public offering IPO,
a move that could potentially transform the founder's equity stakes
into enormous wealth. But first they needed better numbers, more revenue,
less spending, or maybe both, and at that moment the
(06:13):
situation didn't look good. Kind Body had merged with Bio's
Fertility Institute over a year earlier, doubling their clinic count overnight.
They had a new CFO, had raised millions of dollars
from big investors, including JP Morgan, and despite multiple rounds
of layoffs, they were still burning through cash. Internal documents
(06:36):
I saw painted a rough picture. The company had spent
nearly sixty million dollars in twenty twenty three through September
and was losing an average of roughly seven million dollars
each month. According to the documents, of the startup's thirty
three clinics, only six were profitable. So kind Body executives
laid out their plan to try to improve the company's finances.
(07:00):
It would set specific quotas for their physicians in an
effort to hit revenue targets. One of the metrics that
kind Body tracked was the number of retrievals they performed.
It's a key step in IVF. Retrievals are when doctors
attempt to extract eggs from the ovaries. The procedure involves
blood tests, ultrasounds, and hormone injections, and it's one of
(07:23):
the most lucrative procedures. Kind Body offers retrievals make up
about half of the revenue collected from one round of IVF.
In a presentation outlining its turnaround plan to investors, kind
Body ranked all of its doctors only by the average
number of monthly egg retrievals they were performing. Those who
(07:43):
fell beneath the benchmark average of twenty three were labeled
as falling below expectations. If it was going to turn
a profit and go public, the doctors at kind Body
would need to raise the number of monthly egg retrievals
they performed. Some doctors would have to double their retrieval.
I was told many physicians didn't feel comfortable with the
(08:04):
new targets, and over the next three months, four doctors resigned.
Angie Beltzos, who was kind Body's chief physician when it
introduced the quotas, didn't respond to a request for commet
for the series. This push to do more IVF cycles
was invisible to Elizabeth when she had her first consultation
(08:24):
at kind body Chicago clinic, but for the people treating her,
the pressure was on to start. Elizabeth and her husband
tried clomid and then an IUI, and when those treatments
didn't work, they decided to finally try IVF in Chicago.
Kind Body's prices started at fourteen thousand, five hundred dollars
(08:45):
per cycle, and that prize doesn't include genetic testing or
embryo transfers. Although she had some insurance coverage, Elizabeth was
still on the hook for about six thousand dollars in
out of pocket costs when she finally decided to pull
the trigger. Elizabeth says she had trouble getting a hold
of the people who were supposed to guide her through
the process. During IVF. Timing is everything missing. Even a
(09:09):
single dose of medication can derail an entire cycle, wasting
thousands of dollars and pushing treatment back by months.
Speaker 3 (09:17):
It's all very very strict in that regard, at least
that's how they described it to me.
Speaker 1 (09:23):
Once Elizabeth's insurance authorized her IVF medications, she called kind
Body to make sure the clinic had put in the
order to the pharmacy. Knowing Memorial Day was approaching, Elizabeth
tried calling a few days before to avoid delays. No answer.
On the Friday before the holiday weekend, she started to panic.
She called their national helpline. No one could help. Her husband,
(09:47):
desperate left work early to drive to the clinic and
bang on the door.
Speaker 3 (09:52):
So the fact that I wasn't getting these answers or responses,
I mean, my anxiety levels were through the roof. It
felt like the strain, gaslighting or something or I was
just like confused.
Speaker 1 (10:06):
But behind the scenes at kind Body, there was a
financial reason Elizabeth might not have been able to connect
with her providers by phone. Documents I saw laid out
kind Body's policy to quote bill all visits to do this.
Employees I talked to said they were instructed to encourage
patients to come into the clinic in person or hold
(10:28):
virtual video visits. The goal was to bring down the
number of phone calls that they couldn't bill. In theory,
this policy makes sense. Many patients told me they liked
seeing their doctors in person, but in practice, they said
it made the IVF process more stressful. It was really
difficult to get an appointment with doctors after an initial consultation,
(10:51):
and because of kind Body staffing problems, they would be
seen by an ever changing set of nurses or patient coordinators. Instead,
one on one time time with the doctor was rare
for Elizabeth. The costs continued to pile up on top
of the six thousand dollars she was spending for the procedure.
Elizabeth says kind Body was trying to sell her add
(11:13):
on services. There was genetic testing, which cost over four
thousand dollars per embryo, and other treatments that she'd never
heard of.
Speaker 3 (11:23):
My good friend who went, you know, through another clinic.
She kept kind of mentioning like because I was like,
so did you pay for the extra however, couple hundred
bucks for embryo glue. She was like, embryo glue, Like
I never heard of embryo glue, And I was like, oh,
like we just paid for under bucks this round, you know,
for embryo glue and all of these like add ons
(11:44):
that was like thousands of dollars per retrieval these add ons.
Speaker 1 (11:49):
The idea of embryo glue is to help an embryo
implant on the wall of the uterus. A doctor at
kind Body told Elizabeth that she should also consider a
medication that would encourage the embryo to implant.
Speaker 3 (12:02):
So was this We had to go in a few
days before the transfer date and do this like nupigin wash,
which was a couple hundred bucks or seven hundred bucks
out of pocket. And again I'm just telling my friend
and she is just like shaking her head, like I
don't like, what is this?
Speaker 1 (12:19):
Experts I spoke to see. The science behind embryo glue
and nupagin wash is shaky at best. It's not definitively
proven to improve chances of getting pregnant. But in that moment,
Elizabeth went through with it despite her doubts.
Speaker 3 (12:35):
But again didn't want to question the doctor. If she
said this is going to improve our chances, then you know,
let's go for it. We've got the one embryo. Let's
like do whatever it takes. It just it's like a
situation where you're going in making these calls for this
round of IVF and you're already you know how invasive
it's going to be, and you know how hard it's
going to be on your body, and you know how
(12:56):
much money insurance is paying for it, and that you're
then going to be paying for it. So you're not
going to cut corners. If your doctor says I recommend this,
it's going to increase your chances by five percent or
whatever it may be, Like, that's not the time to
be like, no, I'm going to save this four hundred
bucks or whatever is so you just you know, you
have to trust the person of authority there. You have
(13:17):
to trust the doctors making those recommendations.
Speaker 1 (13:20):
By the fall of twenty twenty four, two IVF cycles
had left Elizabeth emotionally and financially drained. In total, she
spent more than twelve thousand dollars on the IVF treatment
and add ons. Her disappointment and frustration were compounded by
the fact, she said she was also getting bills in
the mail for things kind body had assured her recovered
(13:42):
by insurance. I spoke to nearly fifty patients, and nearly
all of them had what they called surprise costs during
the treatment and after. Eventually, Elizabeth and her husband ended
up moving to another fertility practice after switching their insurance.
Speaker 3 (14:00):
It's literally night and day the difference.
Speaker 1 (14:03):
Elizabeth said, her new doctor doesn't try to upsell her. Instead,
she told her she could skip genetic testing of her
embryos altogether.
Speaker 3 (14:11):
I was like, I remember my jaw was dropped because
I was so I don't know, indoctrinated into it, being
like you are over thirty six, you wild genetic test.
But genetic testing is a huge out of pocket cost.
It took me a while to wrap my head around
because again I just thought there was no way if
not through genetic testing. But the way she described it
(14:32):
to us was that that is not something we like
need doing.
Speaker 1 (14:37):
She says it makes her look back on her time
at kind Body differently. Even though she genuinely liked the
doctor she had there, she has doubts.
Speaker 3 (14:48):
At kind Body, and my heart of hearts, I do
not want to think that the doctor that we worked
with for months there is just trying to get us
to do more IVF rounds. Just don't want to think that.
But when you just could all the pieces and how
they're all kind of adding up, it's just really hard
not to come to that conclusion in my mind.
Speaker 1 (15:06):
We'll be right back. I spoke with dozens of current
and former employees who worked at kind Body around the
time Elizabeth was having her treatment, and they told me
there was this intense pressure to sell services that made
many clinical staff, including doctors, deeply uncomfortable.
Speaker 4 (15:28):
At your white coat ceremony, which is the first thing
you participate in before you start mid school, you take
that oath, and that oath is first, do no harm.
Speaker 1 (15:39):
This is Lauren again. She's a former Kind Body medical
staffer who asked not to be identified, so we've given
her a pseudonym and are having a voice actor. Read
what she told me. Lauren said that from the beginning
at Kind Body, doctors had metrics that were closely tracked
to measure their performance. One of these metrics was the
(15:59):
number of cycles they so that could.
Speaker 4 (16:01):
Be an egg free cycle or embryo creation, and then
the actual transfer of the embryo to hopefully create the pregnancy.
Speaker 1 (16:10):
There were also other procedures that counted toward a doctor's metrics.
Some of these were part of the IVF process, but
not always. For example, mock cycles. A mock cycle is
like a trial run. It simulates an embryo transfer. The
goal is to see how the body reacts and allow
the doctor to work out the kinks before the actual procedure.
(16:32):
Doctors tell me they can be helpful for patients who
have had trouble getting embryos to implant, but they aren't
necessary for everyone. Lauren told me that Kind Body doctors
often recommended mock cycles, which can add hundreds of dollars
to the bill.
Speaker 4 (16:47):
Well, there was one in particular, that would have patients
do mock cycles or multiple mock cycles, or different types
of procedures, because essentially that would increase her number in
regards to her cycles, which then essentially increased her revenue.
Speaker 1 (17:08):
Lauren told me that another closely watched metric was a
doctor's conversion rate. This measured how often a patient who
came in looking to learn about fertility services was then
turned into a pain customer. And to Lauren, measuring that
rate sometimes created the wrong kind of incentive.
Speaker 4 (17:26):
So you know, if I had in a month, say
twenty patients who are twenty two years old, and they're
coming to me freaking out, saying, oh my god, do
I have to do egg freezing this month because otherwise
I'm never gonna have kids. And I do my job,
and I go through the information and tell them and
educate them about biology and about what this means and
(17:47):
about their own statistics at that age and so on
and so forth, and then they decide to not do
egg freezing. That's account against me. Whereas some providers I
would use scared tactics to essentially make these patients want
to go through cycles and get revenue. I was never
(18:07):
ever going to do that. I'm not a salesperson when
it comes to medical care.
Speaker 1 (18:13):
Doctors were incentivized to do more cycles. Former employees told me.
Kind Body gave year end bonuses to doctors with high
rates of converting consultation into IVF. Former executives, doctors, and
other employees stressed that steering patients toward more lucrative services
(18:34):
was a direct result of Kind Body's funding structure. To them,
the decisions made to appease private equity and ventor capital
backers had an effect on clinical care. This isn't just
kind Body, though, experts told me. It happens to some
degree among a lot of fertility clinics that are backed
by big outside investors like private equity. The advantage of
(18:58):
private equity investment is at lets IVF clinics expand their
footprints and treat more people, which increases access. What's the
effect of private equity on IVF. Well, there's a twenty
eighteen study done by Alex Borsa, a researcher from Columbia University.
(19:18):
His study found that IVF clinics with any sort of
big institutional investor like private equity do more IVF procedures
than others. He looked at all the clinics in the US,
just fifteen percent had a private equity affiliation. It's a
relatively small slice, but those clinics did almost a third
(19:39):
of all IVF cycles in the country. Like a lot
of parts of medicine, private equity has entered the fertility
field in a big way in the last ten years.
One reason they've been particularly drawn to the space is
because it's less regulated than any other fields. I spoke
(20:01):
about the way this investment has impacted the industry with
Travis McCoy, a doctor at Piedmont Reproductive Endochronology Group, which
operates six clinics in South Carolina and neighboring states.
Speaker 5 (20:13):
I came out of fellowship and training in twenty ten.
There may have been some private equity groups, but none
that I had ever heard of, And so your choices
were really to take an academic role at a university
or go into private practice.
Speaker 1 (20:28):
These days, doctor McCoy says he frequently gets offers from
private equity firms eager to acquire the practice.
Speaker 5 (20:36):
I bet we at least get one at least once
every two weeks, and sometimes it's companies you've heard from
mostly it's companies you haven't.
Speaker 6 (20:43):
There's big dollars that are dangled, and.
Speaker 1 (20:46):
That's doctor Edward Tarnawa. He also works at Piedmont Reproductive
with doctor McCoy. Both doctors said they've resisted selling to
private equity because they're afraid of what strings become attached.
Doctor McCoy said that by staying independent, Piedmont can control
how it's staff's clinics in a way that wouldn't be
possible if a private equity firm was scrutinizing expenses.
Speaker 5 (21:09):
Is payroll a huge expense for our practice? Absolutely? Payroll's
the biggest expense, and so could we make it tighter
and more profitable. Yes, So you would start consolidating jobs,
which means you start to increase the workload on each
of our staff members. Well, everybody knows it doesn't take
(21:31):
a genius to know that leads to burnout. The patients
see when I don't have as many nurses and people
answering the phone and taking care of their portal messages.
They see that and they get frustrated with that. The
embryology labs, those are a little higher paid staff, and
so hey, if I can pare them down, then you know,
(21:52):
I'm cutting profits, I'm cutting out salaries. But then you
start to get into the safety issues. I would rather
have a payroll that's a little fat and plumped up
and you know, a little tougher to me. But we
know we're doing the right things for our patients by
doing that.
Speaker 1 (22:09):
Doctor Tarnaas said that inviting private equity into a practice
has profound implications for patient care.
Speaker 6 (22:16):
If there's somebody sitting behind a desk that you've never met,
that's looking at, you know, a spreadsheet and wondering why
the revenue dips, they're going to ask for other ways
to get that revenue. Hey, speed this person up to
treatment that they might not be quite ready for. Push IVF.
I never want to push IVF. I mean our field
is about options, and that is a that is a
(22:39):
two way discussion between us and the patients in terms
of pros and cons and experience and how they value efficiency,
What have they done before, what is their tolerance for disappointment?
Cost insurance? Those things all matter. And that's a complex
equation and it's not IVF for all, which I know
some sinners would would like it to be. There's some
(22:59):
fertility centers out there that offer nothing but ideaf and
that's mind boggling to me because there's there's other options,
and that's just trimming it down to a service that
they're trying to sell. And I don't like that.
Speaker 5 (23:14):
And I think most of us recognize that our patients
are at an extremely fragile place and we know that
they will do anything. They are very vulnerable, and unfortunately
that makes them that vulnerable population to that could be exploited.
Speaker 1 (23:30):
It wasn't just their clinic. I called over a dozen
veteran fertility doctors around the country, from big corporate chains
to mom and pop size clinics to ones that belonged
to academic institutions. Many had various performance targets, but nothing
quite like the retrieval quotas doctors at Kindbody told me about.
(23:50):
There's one thing that makes kind Bodies stand apart from
all these other fertility businesses with private equity investment. When
private equity got involved with these other practices is their
clinics were already built. Here's doctor McCoy.
Speaker 5 (24:04):
Because the ultimate goal for a private equity group is
to buy your practice, make sure it's profitable, make it
pretty for a certain number of years, so I can
sell it to somebody else at a higher rate.
Speaker 1 (24:17):
But when Gina Barchesy was wooing investors, there was nothing built,
just a vision. A few other fertility companies have tried
building from the ground up like this, but kind Body
was the fastest growing by far. Building fertility clinics is complicated,
(24:38):
but the company's plan was to roll them out like
they were a chain of coffee shops.
Speaker 4 (24:43):
When they started this company, you know, one of the
things they said was they wanted to be the Starbucks
of fertility.
Speaker 1 (24:52):
This is Lauren again.
Speaker 4 (24:54):
They wanted a clinic on every corner. Medical care is
not like that. Physicians are finite.
Speaker 1 (25:02):
In other words, a specialized medical practice isn't scalable, or
at least not in the same way that a retail
chain might be. But the pressure on kind Body intensified
with each funding round. Lauren remembers a sobering moment in
twenty twenty three, after kind Body raised one hundred million dollars.
Speaker 4 (25:23):
There was just this huge in the company, kind of like,
oh my gosh, we have one hundred million, so amazing,
We're doing so great. I mean, it was in every meeting,
it was in everything, And then the CFO at the time.
He was very honest and he basically yeah. Right at
the meeting to the everyone basically said that you know,
(25:43):
I know this sounds like a lot of money, but
this is not we're rolling in the money. He literally said, like,
this is a debt we have to pay back, so
we have to be judicious about what we're doing.
Speaker 1 (25:58):
After the break, the pressure to sell a kind Body
wasn't just limited to IVF.
Speaker 7 (26:04):
So I was like, I just went through two weeks
of medications and traveled here and spent thousands of dollars
for this procedure, and you're telling me I didn't need
to do it.
Speaker 1 (26:15):
We'll be right back. Before Lacey Michelson came to Kind
Body in twenty twenty three, her attempts at becoming a
mother had already been really traumatic. Nearly every step of
IVF had been a struggle for Lacey. She has endometriosis,
(26:36):
which causes painful inflammation and can make conception difficult. She
was also extremely sensitive to fertility medications and had severe reactions,
debilitating headaches, stomach cramps, and sweats, and one complication from
an early pregnancy caused her fallopian tube to rupture. She
almost died.
Speaker 7 (26:56):
You know, I had friends and family members, people really
close to me ask me like, why.
Speaker 8 (27:01):
What can you just stop? Please stop?
Speaker 7 (27:04):
And my desire for this ended the relationship I had
with what I would you know, describe as the love
of my life because I just this was so important
to me.
Speaker 8 (27:15):
I couldn't put anything else before it.
Speaker 1 (27:19):
But even after nearly dying, Lacey wasn't ready to give up.
Speaker 7 (27:24):
It's just, for as long as I can remember, since
I was a little girl, it's all I ever wanted.
Speaker 8 (27:29):
I never cared about getting married.
Speaker 7 (27:32):
I never gave a bit about that. All I ever
wanted was to be a mom. It just kind of
took on a life of its own at at some
point it was just something that I just had to
keep fighting for.
Speaker 1 (27:44):
When I met Lacey in twenty twenty four, she was
in her early forties and had been trying for a
baby for nearly four years. Unlike many women with husbands
are a partner by their side, Lacey was going at
it alone. She'd gone to clinics in LA and Texas
and spent tens of thousands of dollars. She briefly went
to a kind Body clinic in Austin, which she really liked,
(28:07):
but when she moved to Virginia, she had trouble finding
a clinic she trusted.
Speaker 7 (28:11):
I think there's three or four that I tried, and
I just wasn't getting proper care, wasn't getting return phone calls.
Speaker 1 (28:19):
In the spring of twenty twenty three, Lacey found Kind
Bodies DC clinic.
Speaker 7 (28:24):
I did a consult with one of the doctors there,
who I loved. She was just so great, so personal,
so like compassionate, and I was really comfortable with her.
Speaker 8 (28:35):
When I met her in person.
Speaker 7 (28:37):
She just gave me a giant hockey, you know, and
she acknowledged so many times, like everything that I had
been through. So I felt relieved to be working with
somebody that understood my journey and was really rooting for me.
Speaker 8 (28:53):
You know.
Speaker 7 (28:55):
I thought that everything, all the other crap that I
had been through was behind me, and that I was
on the right path now and working with the right
doctor and the right clinic.
Speaker 1 (29:06):
Lacey had six eggs shipped from her previous clinic in
LA to Kind Body, and those resulted in two viable embryos.
That summer, she had one transferred, but it didn't result
in a pregnancy.
Speaker 8 (29:17):
I was down to one embryo left. At this point.
Speaker 7 (29:21):
It was clear that I was not a really good
candidate for IVF because of my reactions to the medication.
I had kind of been thinking like this next frozen
embryo transfer that I do was essentially my last shot
at biological motherhood. At this point, I wanted to do
an unmedicated transfer. My body is exhausted, and I've just
(29:43):
had so many horrendous side effects from all these hormones.
I was just going to do a natural frozen embryo transfer,
or as natural as they'll do it.
Speaker 1 (29:52):
Basically, there was one more hurdle Lacey needed to clear.
Speaker 8 (29:57):
First.
Speaker 1 (29:58):
Lacey's doctor said, just did she do what's called an
endometrial receptivity analysis.
Speaker 7 (30:04):
An ER test basically takes a biopsy from your uterus
to see if there's any active infection.
Speaker 1 (30:13):
The test is supposed to show if the uterus is
in good shape to have an embryo im plantation. Experts
told me the test isn't that common. It also requires
a lot of preparation. She'd need to take two weeks
of medications. It wasn't ideal, but Lacey wanted to have
the best chance for her last embryo to stick. A
couple of days before she went in for the procedure,
(30:34):
kid Body called to collect payment about fifteen hundred dollars.
Speaker 7 (30:39):
Leading up to the procedure, I is getting a lot
of like different communications from the clinic.
Speaker 1 (30:47):
Some nurses were calling her ER test a mock transfer,
which is a totally different procedure. In a mock transfer,
the doctor is just looking to see if everything looks good.
Unlike an EER test, no tissue biopsy is done.
Speaker 8 (31:02):
I thought maybe they're essentially the same thing.
Speaker 4 (31:05):
You know.
Speaker 7 (31:06):
I got pre op instructions from the my nursing team, and.
Speaker 8 (31:12):
They were very specific.
Speaker 7 (31:13):
They should show up with a full bladder, drink thirty
two ounces of water, don't empty your bladder.
Speaker 1 (31:19):
Lacey wanted this to go well. She'd call the clinic
to double check instructions. Sometimes at answer and give conflicting information,
but most of the time no one replied. Lacy didn't
think too much of it at the time and stuck
with what she had been instructed to do. At the outset.
They're professionals, she thought, you know what they're doing.
Speaker 7 (31:39):
So the morning I went in for my transfer, one
of the first things they asked me to do was
give you your own sample and empty my bladder.
Speaker 8 (31:46):
So I was obviously really confused by this.
Speaker 7 (31:49):
I was like, okay, but I'm here for an ear
I test and I have to have a full bladder.
And the nurse was like, no, your bladder has to
be empty, and I was like, are you sure?
Speaker 8 (31:58):
Can you check with my doctor with my nursing team.
Speaker 1 (32:02):
Lacey was sitting on the exam table in her gown
waiting for an answer when someone came in to collect payment.
Speaker 7 (32:09):
And I was like, I already paid, and she said, well,
how much did you pay?
Speaker 8 (32:13):
And shouldn't you have this information? And I had to like.
Speaker 7 (32:16):
Pull it up on my phone and I told her
how much I paid and she was like, oh, okay,
and she seemed really confused, and she like left the
room and then came back and was like, okay, so
you might get like another bill from the lab because
the lab bills separately.
Speaker 8 (32:30):
And I'm like, okay, fine.
Speaker 7 (32:32):
She's like I think it'll be like seven hundred dollars
or something, and I'm like, okay, you guys probably could
have told me that before, but okay, yeah, I'll pay it.
Speaker 1 (32:42):
A nurse came back with an update Lacey would need
an empty bladder. After all, she did as she was instructed.
When the exam finally started, it was clear something was wrong.
Speaker 7 (32:56):
I had drinks so much of water at this point
that I still had a full block when I went
in for the procedure, which ended up being a problem.
She was not able to access the part of my
uterus she needed to biopsy because my bladder was in
the way. And this procedure is generally, as it was
explained to me, it's supposed to be uncomfortable. It's not
(33:18):
pleasant by any means, but it's very quick five or
fifteen minutes. I was in there for over an hour.
I was crying in agonizing pain. I think it was
four people and they're helping to do this very simple biopsy.
The ultrasoundtech was like holding me. It was awful because
she just couldn't get this biopsy that she needed. So
(33:39):
it was really pretty traumatic. And in the end I
was like, okay, you need to stop, like, hopefully you
have the biopsy you need, but I can't, Like this
needs to end now.
Speaker 1 (33:50):
When it was finally over, Lacey got dressed. Then her
doctor casually said something that stunned her, and.
Speaker 7 (33:59):
At some point point she mentions to me that if
I'm doing an unmedicated for as an embryo transfer, the
results of an ER test are irrelevant. So I was like,
you mean I didn't need to just do what I
just did. I just went through two weeks of medications
and traveled here and spent thousands of dollars for this procedure,
(34:23):
and you're telling me I didn't need to do it.
Speaker 1 (34:25):
Lacy's doctor explained that the test wasn't necessary, but that
useful information could still be gleaned from the biopsy. It
wasn't all for nothing, the doctor said, in an effort
to calm her down.
Speaker 7 (34:37):
I didn't really push the matter beyond that at that point.
I just wanted to get the hell out of there.
It wasn't until I was driving home with my friend
who had come with me for the procedure, that I
was telling her what the doctor said, and she was like, wait,
what all this happened when you left the waiting room,
And as I was talking.
Speaker 8 (34:57):
It through with her, I was like, yeah, yeah, yeah,
that just happened.
Speaker 7 (35:02):
It's just like kind of flabbergasted by the entire thing.
By the time I got home. I was extremely upset
that night.
Speaker 1 (35:12):
She sent a long email to Kind Body.
Speaker 7 (35:14):
I heard back from them within a day or two
and they apologized. And the woman that I spoke with,
she was nice and she understood my position, and she
said that she was going to see about refunding me
the cost of the procedure, and she was gonna get
back to me like within a few days. And I
(35:36):
didn't hear from her, so I kept following up. She
eventually came back and said, sorry, we can't do that.
Speaker 1 (35:44):
The unnecessary procedure had serious consequences beyond the financial cost
and physical pain.
Speaker 7 (35:51):
The hormones that I had to take in preparation for
this biopsy exacerbated my enemy triosis. I got a really
big cyst on my life ovary, and I had three
months of horrible pain from taking these hormones to do
this biopsy that I didn't need to do. And there
was just no accountability anywhere.
Speaker 1 (36:12):
Lacey decided to leave kind Body and transfer her embryo
to another clinic, and she says when she let Kindbody
know about her decision, they did offer her something.
Speaker 7 (36:23):
I will say they gave me one hundred and fifty
dollars off of that for my troubles with kind Body,
which was.
Speaker 8 (36:31):
Which is just in gold.
Speaker 1 (36:34):
Kind Body told me that the course of treatment and
medication was consistent with the standard clinical practice to suppress endometriosis.
Thinking back, Lacey said she felt pressured from the beginning
to do the procedure and that she could never get
a straight answer about what it would cost.
Speaker 7 (36:50):
I just can't see any other reason than just to
make extra money, you know, at my expense. I already
have an opinion that this particular part of healthcare fertility
is they're taking advantage of women that are quite frankly desperate.
(37:11):
That's why they're able to charge as much as they charge.
Speaker 1 (37:14):
But the costs weren't just financial.
Speaker 7 (37:18):
Everything that you have to do when you're going through
fertility treatments, every test, every exam, every phone call, every appointment,
every loss, like every single thing is hard, is really hard,
you know, And the further along you go with it,
the harder it gets. There's some train of thought on
(37:39):
their end, on somebody's end, where it's like essentially harmless
to do this biopsy. They can get some information from it,
you know, whether or not they need that information is
questionable the financial aspect of it aside, it is not harmless.
It was not harmless to me, And after this whole
(38:00):
ordeal with kind Body, I wanted to be done.
Speaker 8 (38:02):
I wanted to give up.
Speaker 7 (38:03):
I couldn't do it anymore, like physically, mentally, emotionally. I
was like, I just need to actually get to a
place mentally where I'm okay not being a wall.
Speaker 1 (38:17):
After nearly giving up, Lacey decided to try one last
transfer with her remaining umbrew at a different clinic in
New York. Recently, Lacey sent me a voice memo with
an update.
Speaker 7 (38:30):
So, yeah, I'm not totally sure how to start this.
I had my son on September nineteenth vac section, and
he is absolute pure joy. His middle name is Miles,
and one of his nicknames is Smiles Miles because he's
really just the happiest little dude. I often get stopped
(38:52):
by strangers that remark about how absolutely perfect he is.
When I think back on my journey to get him here,
which I do quite frequently, I still can't believe that
I went through all of that and came out the
other end with this perfect little human. Periodically someone will
say like, how lucky I am, and I always correct
(39:16):
them that luck had nothing to do with it. I
did this my blood, sweat, tears, heartbreaks, life.
Speaker 8 (39:22):
Savings, you name it.
Speaker 7 (39:24):
Anything and everything I had, I poured into this and
I made him despite all the obstacles and the horrendous experiences.
And I'm hopeful that my story and the stories from
other women can help begin a greater process of reform
(39:45):
in this field.
Speaker 1 (39:50):
Coming up on IVF Disrupted The Kind Body Story.
Speaker 9 (39:55):
I just remember she wouldn't make eye contact with me,
and the assistan was like doing a lot of the
talking too.
Speaker 7 (40:03):
You can't have an employee of yours beer carrier because
that is coercion, because she will feel she can't say no.
Speaker 3 (40:10):
When it comes to who has the opportunity to work
with a surrogate. It's very clear that it is of
the discretion of the treating physician.
Speaker 9 (40:17):
I was on mail duty, so I read this in
the office and my jaw hit the floor because I
was like, what do you actually mean we're doing this?
Speaker 1 (40:32):
IVF Disrupted The Kind Body Story is reported and hosted
by me Jackie Devalos. The series is produced by Sean
Wen and Jilda Decarly, editing by Caitlin Kenney, Jeff Grocott,
and Joshua Brustein. Blake Maples is our sound engineer and composer.
Voice acting in this episode was provided by Dana Johnston,
(40:55):
fact checking by Anica Robbins. Bloomberg Senior Executive Editor for
Technology is Tom Giles. Our head of podcasting is Sage Bauman.
You can reach us at podcasts at Bloomberg dot net.
IVF Disrupted is a production of Bloomberg and iHeart Podcasts.
Hosts And Creators
Sarah Holder
Saleha Mohsin
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