The rise of private equity firms investing in health care facilities across the United States has been exploding in the last decade.
Because of that rapid growth, researchers have been digging into what this could mean for health care and patients in the long term.
In recent years, private equity firms have become more active in the fertility space, where many patients seek care for reproductive issues and pursue in vitro fertilization, or IVF, which costs thousands of dollars, and usually isn't covered by insurance.
James Dupree, M.D., M.P.H., and his colleagues wanted to explore what these changes could mean for patients with infertility. Dupree is a professor of urology and obstetrics and gynecology at the University of Michigan Medical School, who directs U-M Health's Male Fertility Preservation Program and studies fertility care.
In their new paper published in JAMA, the team shows that since 2013, expansive growth has been seen in affiliations between fertility clinics and private equity firms .
They also find that over half of IVF cycles in the country in 2023 were done at clinics affiliated with private equity firms.
More about the paper
A federal law requires every fertility clinic to report data about their IVF cycles to the federal Centers for Disease Control and Prevention.
The team used those reports from 2013 to 2022 to examine every IVF clinic in the country, which includes private practices and hospital-based clinics.
They used other databases and online searches to identify which clinics were affiliated with private equity firms.
What they found was pretty dramatic growth. In 2013, only 4% of fertility clinics were affiliated with private equity firms. But since then, the number has exploded.
"As of 2023, we estimate that 32% of IVF clinics were affiliated with private equity firms," explained Dupree. "And these clinics affiliated with these private equity firms are performing over half of the IVF cycles in the country."
So what does that mean?
"There's a lot we don't know yet. It might be good for patients; it costs a lot of money to modernize IVF laboratory equipment and perform outreach to patients and private equity firms can provide capital to hopefully improve quality and patient care."
He also explains that in other health care settings outside fertility care, there's data to suggest quality could decline while costs increase.
"We don't know yet in the fertility world whether this is a net gain for patients or net loss," he said.
Dupree emphasizes how private equity-supported fertility care will be a crucial business model to continue examining, especially with the government's recent interest in making IVF care more accessible to Americans with infertility.
He said, "Given how prevalent the business model is, we need to do more research and understand the benefits and risks — like the quality of care, cost of care, access to care — are they better or are they worse?"
As a top researcher in the area, Dupree and his team will continue his work looking into fertility care across the United States, including how IVF is covered by insurance companies, to help hopefully inform future health policies and help patients in the long run.
The study's first author, Jesper Ke, M.D., MBA, is a resident physician at the Yale School of Medicine, and graduated from the U-M Medical School and Ross School of Business in 2025. Other authors are U-M medical student Joshua Chen, U-M statistician Elena Chun, M.S., and U-M urology professor Vahakn Shahinian, M.D.
Dupree and Shaninian are members of the U-M Institute for Healthcare Policy and Innovation , which sponsored the research through a grant from its Policy Sprints program.
Paper cited: "Trends in Private Equity Affiliations with Fertility Clinics in the US," JAMA, doi:10.1001/jama.2025.24516
Written by Johanna Younghans Baker
