Over half of US IVF now runs through private equity. Your independence is the asset, if you use it.

The calls started a few years ago. A platform wants to “explore a partnership.” Then a second one calls. Your partners ask what the practice is worth, and you don’t have a number you’d defend.

If you own an independent IVF clinic with its own lab and a few reproductive endocrinologists, you are now in the minority. The question isn’t whether platforms want practices like yours. It’s whether you take the first offer or make buyers compete. Make them compete, and start preparing a year early.

The platforms have already bought most of your competitors

A JAMA research letter (Ke et al., December 2025) estimates that clinics affiliated with private equity performed 54.0% of US IVF cycles in 2023, up from 13.3% in 2013. In 14 states and Washington, D.C., including Nevada, Colorado and Utah, they were estimated to handle 63% to 100% of cycles. The 2023 figure uses 2022 volumes, and “affiliated” includes venture capital and partnership structures, but the direction is clear.

IVI RMA alone has done five US deals since August 2023, three of them in the last 12 months. The same buyers keep coming back, and each deal makes the next one easier to justify.

What platforms buy is your lab and your physicians

IVI RMA entered New York City in 2025 through the only IVF lab on Staten Island. CCRM’s 2022 entry into New Jersey and New York came with 11 reproductive endocrinologists. The unit of value is an accredited lab with physicians who will stay.

If you are founder, medical director and lab director at once, you are both the asset and the risk. Buyers price that risk through structure: longer employment terms, and more of the payment deferred or tied to performance.

The headline number is one term among several

What decides whether a deal was good is usually the split between cash at closing and equity rolled into the platform, employment and non-compete terms, earn-outs, and how non-selling partners are treated. When IVI RMA partnered with Island Reproductive Services in 2025, the two founding physicians kept an equity stake and stayed on to treat patients.

Rolled equity gives you a second payout when the platform sells, but it sits behind the platform’s debt. After KKR bought into IVI RMA, the banks financing the deal sold about $869 million of its loans to private credit funds at a loss. Your equity is only as good as the platform’s balance sheet.

One offer is a price. Several offers are a market.

KKR’s 80% stake in IVI RMA, reported at about €3 billion and closed in January 2023, isn’t a comparable for a single-lab practice. The lesson is how it was won: in an auction against at least six other bidders, including Amulet Capital (owner of US Fertility), Nordic Capital, Bain and CVC. The price was more than three times the €1 billion IPO valuation IVI RMA had targeted in 2018.

The same logic applies at smaller scale. Where most cycles already run through platforms, the remaining independent labs are the last entry points for newcomers and a defensive buy for incumbents. That scarcity only becomes price if more than one buyer is at the table.

This isn’t an argument for selling. Supporters credit platforms with higher clinic productivity, while the JAMA authors note that effects on quality, cost and access remain unknown. Staying independent is a legitimate choice. But if you sell, sell into a process you control.

What to do in the 12 months before a deal

1. Months 12 to 9: decide who is selling. Agree in writing which partners want to sell, stay or neither, and what matters beyond price. Reread your operating agreement and physician contracts for surprises.
2. Months 9 to 6: reduce key-person risk. Add a second qualified lab director, make sure other physicians hold their own patient relationships, and secure your senior embryologists. Clean up lab records, reported outcomes and cryostorage consents.
3. Months 6 to 3: get to buyer standard. Commission a quality-of-earnings review with owner pay normalised to market, and assemble cycle volumes by type and payer mix. Check which leases and contracts need consent on a change of control, and how your state’s rules on practice ownership will shape the deal.
4. Months 3 to 0: control the process. Know which platforms need a foothold in your market. Talk to more than one buyer, and don’t sign exclusivity until the terms beyond price are on paper.

Waiting for a better offer is not a strategy. Deciding the terms of the conversation before it starts is.

Current to September 2026. Market data: Ke et al., JAMA, 30 December 2025 (2023 figures are estimates; “affiliation” includes venture capital). Deals: company announcements, counsel press releases and deal databases. IVI RMA valuation, bidders and loan sale: press-reported (Inside Reproductive Health, January 2023). Nothing here comments on any transaction in progress.