Is Fertility Care Getting Better—or Just Bigger

[00:00:00] Speaker A: The fertility industry has seen massive growth over the last decade. What used to be a field dominated by small, independent clinics is now home to large networks, private equity investments, and increasingly complex business models. At the same time, the demand for fertility care is higher than ever. And so are the expectations around access, outcomes and patient support. Behind the scenes, a lot is shifting from how care is delivered to how clinics are marketed and managed. And the landscape is changing fast, and not always in ways that are visible from the outside. These changes are affecting not only patients, but also the professionals working in the space, the decisions being made at the top, and the future of family building as a whole. Welcome to Fertility Cafe. I'm your host, Eloise Drainage. When we talk about fertility care, most people think about clinics, but the reality is this industry is much bigger and more layered than that. From labs and agencies to tech platforms, consultants and investors, there are many players shaping the way care is delivered, priced and experienced. And all of that directly impacts patients, whether they realize it or not. The way clinics are running, how services are marketed, how networks are built, and how professionals are trained, it all filters down into what someone experiences when they walk through the door seeking help to grow their family. Today I'm joined by Griffin Jones. He's the founder of Inside Reproductive Health, a trade media company that covers the business side of the fertility field. He's also a member of ASRM and ARM and a strong supporter of Resolve, the National Infertility Association. [00:01:48] Speaker B: Cross. [00:01:48] Speaker A: Griffin has spent years talking to people at every level of this space, helping professionals understand the system they work in and how it continues to evolve. Let's get into it. Welcome to the Fertility Cafe, where we explore the beautiful complexity of modern family building. I'm your host, Eloise Drain, and this is a space for honest conversations about surrogacy, egg donation and the journey to parenthood. With expert insights and real stories, we're here to guide you through the met legal and emotional aspects of third party family building. We believe that love has no limits and neither should parenthood. All right, Griffin, thanks for joining me. I appreciate it. [00:02:37] Speaker B: My pleasure, Eloise. Nice to be in your house for a change. [00:02:40] Speaker C: Yes, yes, yes, yes. I was recently on yours, so had a lot of things to say. Now it's your turn. [00:02:46] Speaker B: I loved your hot takes. I hope that I can be as informative and entertaining. I got big shoes to fill, though, but I. But I'm going to try. I'm going to give it my best. Okay. [00:02:56] Speaker C: All right, good. Well, good, good. Obviously you work directly with a broad range of professionals. In the fertility industry, from clinics to networks to other industry leaders. [00:03:08] Speaker A: First, what first drew you into this space? [00:03:11] Speaker B: Normally, people come to the field from one of three areas. They either come in because they're coming in with either a scientific or a clinical background. They're a nurse, a doctor, an embryologist, a geneticist. Or second, they come in because they went through the ivf journey and they saw an area that they could improve, and so there's something from the patient side that's connecting them. Or three, they just come in with a wheelbarrow full of money because private equity or venture capital sent them, and they see the opportunity for money here. And none of those things was the case for me. I was just a generalist marketer from little old buffalo, New York. I always wanted to stay in western New York, where I'm from. There are no Fortune 500 companies in the city of Buffalo. I knew that if I was going to have a decent career and still live in Buffalo, I needed to have my clients come from elsewhere. This was before remote work is what it is today. Like, it wasn't, you know, 12 years ago. And so I decided, like, okay, I'm doing generalist marketing. Started working with one fertility clinic in my area, and at that time, I didn't know who I was, which category I was going to niche with, but had some success with that fertility clinic, and then said, hey, can you give me some other names? Because I think this might be the niche I want to niche down in. He gave me five names of different clinics across the country, called all of them. One of them gave me a shot that was in Hawaii. John Frattarelli in Hawaii. So with two clients, I could say, we serve fertility clinics from New York to Hawaii. And then I started calling the patient side. I went on resolve's website, and I emailed every peer support group leader for every support group there was, and about a dozen of them got back to me saying they'd get on the phone with me. And I talked to each of them for an hour, maybe more, over different phone calls. And then I was just kind of blown away by how nice they were to me. Here I am, this guy coming in, saying, I know jack about medicine. I know jack about, like, the problem that you're going through. I don't have any money, and I'm thinking about maybe starting a business in this category. Would you be willing to talk to me? And they were all like, yeah, we'll talk to you. And so I felt like I always had a leg to stand on and So I built a low seven figure client services firm for fertility clinics, doing marketing for clinics, their social, their video, their branding, their websites, their paid search. About six years ago started a weekly podcast called, that was called Inside Reproductive Health. Never meant to start a trade media company but that kept growing and growing and then people like David Sable and Joshua Abram and Ellen Murray kind of put a bug in my ear saying we would normally expect to see a trade media publication or industry media company in a field this size. And we don't think we'll. There is none and you've sort of started one so maybe you think about that. So in 2022 transitioned the business to be the trade media company. So now I'll do some consulting for clinics but, but we don't do like we don't do their marketing for them anymore. Now my business is making content for the IVF lab directors, the fertility doctors, the fertility clinic network executives, all of the people on the industry side and the people that sell to them are marketing partners. [00:06:24] Speaker C: You've evolved clearly in a lot of ways and obviously have seen a lot of changes. So can you give us a sense of how things have changed from where you started and obviously what you were doing to what you're seeing now and where you are now? [00:06:40] Speaker B: When I came in there was a lot less private equity. There was a lot less fertility clinic networks. There were very few. There was Integromat. So people might remember Integrmed. This was a company that they owned equity in some practices. For other practices they just provided management services like their hr, their payroll and some other contracting stuff. Under usually long term contracts, like 10 or 20 year contracts. Integromat had been a public company. Then they were bought off of the stock market and taken private again by private equity company. I think Cigard holdings was the name of that company. Integromat ended up going bankrupt in 2020, I want to say 2014. That was pretty much it. And then there was another budding company that had started called Vivera that ended up merging Slash being acquired by a couple of other companies and sort of, you know, segued into being part of what is now inception Slash Prelude. At the time you mostly had independently owned private practices and academic centers like in the university and hospital systems. So contrast that with today where like 30, somewhere between 30 and 40% of the clinics are private equity owned and they're probably responsible for. The latest figure I got was 62% of the IVF cycles in the country. And pretty much the same thing has happened in Canada. So that wasn't the case when I started off a couple years ago. And so then. And then on the industry side, the AI software, it didn't exist 10 or so years ago, and now it's really. It's had its battles the last three or four years. I think it's really starting to take traction now. [00:08:26] Speaker C: Clearly, you have your podcast Inside Reproductive Health, and you get to hear what's really going on across the industries. You just talked about AI and all of that, like, what are the professionals most concerned about with right now? Because obviously you and I spoke. I've been in this field for 24 years running in my agency, 17 and I, when we spoke, I told you in the last pre. Covid. Post Covid. Right. Post Covid. How drastic things have changed already. [00:08:53] Speaker B: I know one lady that owns a surrogacy agency that's really concerned with patient experience not getting any better. [00:09:00] Speaker A: Really? [00:09:00] Speaker B: Do you? Oh, wow. That's one thing that I've perked my ears up to. I joke a little bit about that, but you sort of got me thinking. What I'm referencing to people that don't understand that inside joke is Eloise was on my podcast and talking about, in your view, the patient experience has not gotten better from what you can tell in terms of response time, in terms of communication. And that sort of, like, perked my ears back up because the networks are all saying the patient experience is at the top of their list. And I think some of them are really trying to do things about it, and it's hard. So that sort of, like, made me pay attention to something else. It's like, oh, okay, they're working on it. And you kind of brought up to my attention of, like, are they like. Or if they are, they've got a really long way to go. And that's in line with what I'm seeing on online reviews. I thought about it. I'm like, you know what? Eloise might be right. I've seen a lot of reviews still saying that kind of stuff. And then I went through to some other fertility centers. They are very concerned about patient experience. We can go into why that might not be achieved in terms of the responsiveness and communication that patients want. Yet they're very concerned about their headcount, or I guess I should just say payroll as an overhead item because it's their biggest expenditure and it really constrained their margins. And they all have shortages with doctors and embryologists, but also all the way down to nurses and even people that answer the phones and front desk Folks, medical assistants everywhere across the clinic and lab, they're really focused on that too. Then they're also worried about what's happening on the payor side. So as more states require insurance companies to provide for ivf, who knows, maybe President Trump, this thing that he just says where IVF is going to be free, maybe he'll actually do something about it someday or somebody will. And if that happens, then you have a payor, not a single payor, but a limited number of payors that are able to leverage the negotiation in their favor because they control the volume of patients and that puts downward pressure the finances and pricing for clinics. So they're worried about how they're going to be able to be viable after all that. [00:11:12] Speaker C: Yeah, but the problem though is how is it shaping patient care? Because at the end of the day, what I have heard throughout, for many, many years is we're building these networks because we're going to consolidate, things are going to get better, expenses are going to get less for patients, they're going to pay less, they're going to get. [00:11:34] Speaker A: Better care, blah, blah, blah. [00:11:36] Speaker C: None of that is happening. [00:11:37] Speaker B: And why not? I can give a little bit of a hypothesis as to why not. So far, one of the hypothesis is you just paid a ton of money to acquire all of these individual clinics. So I don't know what the number is, but my guess would be that of all the clinics in these clinic networks, 80% of them are acquired as opposed to being open de novo. I don't know if that's a true number, but I'm pretty sure the vast majority of them are acquired. And these networks paid multiples on the net income of all of these different practices. It's called ebitda. And so you know, if, if X Clinic is making a million dollars a year in income and you pay a 5 multiple of their EBITDA, you're basically paying $5 million for that practice. And so in the 2020 to 2022 bubble, there was really high multiples being paid for practices. And part of the condition for those practices, those pract earning some of that money for which their practice was bought is staying on working for those networks for at least a couple years. People have heard the term golden handcuffs. That's what that is. You buy all of these different clinics. This one in Chicago, this one in la, this one in Seattle, this one in Miami, this one in Houston, this one in a couple of these small cities that don't have anything in common. For the most part, these networks were building that infrastructure that oversaw each of these clinics. So in, in many cases, the private equity firm would take a couple people from leadership from like one clinic, elevate them to CEO and like the ops and chief medical officer, and then try to have them over the oversee the whole thing. Then they've got to build like these physician advisory boards, build these operational systems. And there was a ton of resistance. Eloise. I've talked to so many people that I don't want to like, throw the networks under the bus because see a lot of good that they do. And I see some things that I'm not thrilled about and I'm not sure, like the net benefit yet. I also don't have a ton of sympathy for the doctors that sold to them. It's like, that's what the money was for. You are their punk now. You sold to them like that's what the money was for. So. But there was a lot of resistance of like, no, we, we're still going to do these things this way. And so, you know, this is all unrolled the last three, four, five years. What I'm starting to see now. And I'm thinking of one network in particular. I won't mention their name. And I know the top exec there has had some challenges and this individual has expressed, you know, there have been times where I have not been popular, but they have bitten the bullet, I think, and just said, this is the way it is now in there. And they've rolled out an operational system for all of their clinics or in the process of doing so, in the ones that they have, you can actually see their online ratings go up. You can see them have numbers. It's like, here's X thousand unanswered calls before we implemented this system. And now our unanswered calls are zero because of the automation and things that we put in. I think it took a long time because of the resistance. I think the people in the front have decided we're going to squash the resistance and they can cry about it if they want, but some are going to cry about it and some are going to get on board and, and be evangelists for this new way of doing things. And I, I don't know, but I speculate that other networks will look at that and be like, okay, that was the person that stood up and stuck their neck out first. Now we're willing to start pushing our people more. And maybe your audience isn't thrilled about hearing their doctors being given orders. I think that there are bad things and good things about that. [00:15:27] Speaker C: I mean, let's be real here. The majority of people that are making money when it comes to any medical care is the insurance, pharmaceutical, whatever. I definitely don't believe it's all of the doctors that are making money anymore. Things have drastically changed. And we all know that in the US Healthcare is a joke, and that's an understatement. So I don't want to say that that's the same for fertility care, and hopefully that will never be the case in this space. But that's the whole point of us having these conversations, is to ensure that we are bringing all of the issues up front so that the powers that be have the ability to start making improvements. You said this, you know, network is already making improvements and is tracking the actual improvements that are being done. It's not just hearsay. [00:16:17] Speaker B: Yeah, they are going to tell the doctors how to practice medicine somewhat. That's a conversation that I have with all the CEOs that come on because every single one of these business organizations across the board says, oh, we're not going to tell doctors how to practice medicine. And I always say, yeah, but like, you are, because there's just a threshold or an overlap of business ops and clinic ops that can't be totally divorced. And so if you're telling people, like, here's the business op stuff, then you are telling them how to practice medicine. What they mean is, we're not telling them what you know, protocols to use. We're not telling them what you know, medications to write, what procedures to use. I think that's mostly true. But when you're telling someone you are not going to be seeing new patients anymore because you take way too long to do new patient visits and you suck at converting patients to treatment, you're just gonna do retrievals or you're just gonna do transfers. You are telling people how to practice medicine. And so again, there is good and bad in that, like, part of the, like, there is a problem with the way IVF has been delivered up to this point. 90% plus of people cannot afford IVF. The majority of your audience, if it's a sample of the American public, cannot afford ivf. And that's in no small part because doctors were just doing their thing, practicing good medicine, but not having this titanic operational system driven by business interest to widen how many people they can serve and how quickly. The plus side, I think, is, all right, you're going to be able to see a lot more people. I do have concerns, though, that can bleed too much into medicine. And I just See doctors making less decisions than they used to when they owned the practice, but then it goes. [00:18:17] Speaker C: Back again to patient care and who is genuinely putting the patient first. [00:18:24] Speaker A: They should be. And I get it. [00:18:26] Speaker C: We're all in business. Clearly you have to keep the doors open, you have to be able to make money, you have to be able to pay staff, you have to be able to have the lights on all of the things. [00:18:38] Speaker A: Completely understandable. [00:18:39] Speaker C: But what about when it affects patient care? You are not being available to the patient and giving them 10 minutes when their problem is way more than what a 10 minute conversation is going to be able to do and then then just shuffling them along like they're cattle. [00:18:59] Speaker A: I mean, I literally had a conversation. [00:19:01] Speaker C: With someone recently who told me, you. [00:19:03] Speaker A: Know, I was at the fertility CL. [00:19:05] Speaker C: And I'm just a commodity. That's all I am, is commodity. And it's about how much money they can make out of my pocket right now. [00:19:11] Speaker B: So your concern is that gets worse as you have bigger companies with more money buying more of the clinics. [00:19:19] Speaker C: That's right. And dictating more. [00:19:21] Speaker B: I'm not convinced that it gets worse. It could get better. I'm not convinced that it gets better either. Here's why. When I first got into the space, I manually analyzed hundreds, maybe even thousands of online reviews. And then we've done a lot of content about online reviews. And I would see that complaint that you just described, I feel like cattle. I feel like a number. I feel like I'm being pushed through an assembly line. Big practices, ones that were part of networks, but also tiny practices that were independent. I know how many patients they see, it's not enough. Like I know that clinic, they do 200 cycles a year. Like if you're a number, you're part of a very, very small number. So people have that complaint. I might have a story that, that illustrates that even more carefully. There's a practice that I know, I know the doctor, I know the people that work in the practice. It's one of the leanest practices I've ever been in. Like well under 10 people run the whole thing. Very boutique, really lovely people, really, you know, nice clinical staff and great doctor. Someone that I know well went through that clinic as a patient and had a really lousy experience. Not because of anything that the doctors or the staff did, but because she needed to get her script authorized by the payor, an insurance company or one of those employer carve out companies. Clinic is telling her, oh, you got to call that company. That company is telling her you got to call the pharmacy, pharmacy's telling her you got to call the clinic. So Eloise, she's on the phone for hours trying to track all this crap down. It's delaying her cycle start. She, she's project managing her own cycle. That shouldn't be her job. On the face of it, you could say, oh, this is a really boutique clinic. They're independently owned, they're small scale. It's not a boutique experience because they don't have that stuff automated, they don't have the systems to take care of that stuff. So what I'd like to see, what I would like to see is really strong systems that are like Swiss army. Maybe it is a little like factory in air quotes in terms of how mechanical it is. Asterix with the ability for the clinicians and whomever else to take time to provide whatever extra care is needed in that moment. And I think of the best companies that do that, like Disney World and a few of those other, like the companies that provide the best customer service at scale are those that have super tight operational systems. And then because they don't, it's not like the doctor has to run to like go do this thing right now. They've got other people that can take care of these things. They, the doctor's got more room to maneuver. He can say, you know what, I have to take X more time with this patient or whatever it may be. So that's what I'd like to see. I think that can happen. To your point, it might not be happening yet. [00:22:22] Speaker C: And obviously it takes money to be able to do something like that and put something together and put that type of infrastructure together. Which means it's going to be more money. Which means that money has to be passed down to somebody. [00:22:35] Speaker B: Yep. So who's going to spend the money? And that's the question is, does private equity, do they make investments or do they siphon money? And I think the answer is both. I the scenario I described where they're putting in these automated systems so that they go from X thousand unanswered phone calls to zero, that's a private equity backed company. They're making that investment because they want to be able to scale care so they can ultimately make more money. Independent practices are much, much slower to make those kind of investments. One, because at the end of the day it's a proprietor operated business. Physician partners are just, they're taking away from their own take home pay when they make those investments. But even if they're willing to do that, they don't have two. They don't have the operational infrastructure to support that. So private equity backed companies, they are making those investments on one hand and on the other hand I also think there are investments that I suspect that they should be making that they're not because they don't see a way to return that investment in the next 12 to 18 months and they're trying to flip this thing in three years. I think both things are happening. [00:23:53] Speaker C: Yeah. What's something that might be happening inside the industry that most people outside of it don't see? Or is there anything. [00:24:02] Speaker B: I think that what people might not see is the inflection that we're at with technology. I think a lot of people inside the field don't see it. Like I think that the nurse just doing her job or the doctor that's just doing her or his job and maybe goes to one conference a year to learn their CME credits, but not really paying attention to the big picture. I don't think most of them are paying attention to that. This field is about to become a much higher volume field of medicine and that means that their job is going to look fundamentally different. And I don't know if it'll happen in two years or if it's going to take much, much longer than that. There's no way that the future. Trying to think of how many years, five, 10, whatever, that we're going to be doing 200 cycles on average for a doctor, 150 cycles on average per REI. That is not going to happen. REIs are going to be doing many, many more cycles per physician, which means that their entire infrastructure is going to be different. There's going to be far more automation of the patient journey. There's going to be far more top of license. Maybe OB GYNs are doing retrievals, nurse practitioners are always doing IUIs and HSGs that a doctor's never doing those things. Maybe it's the case that doctors are doing your ultrasound, that a sonographer is doing those and there's an REI supervising a team of all of that stuff, has AI to help synthesize their cases, focuses on the most complex cases and manages those teams. I don't think that most people in the field are paying attention to that right now. For me it feels like they do because the people on my podcast tend to be, or the people that we interview tend to be more forward thinking or the meetings that I find myself at, people are talking about that kind of stuff. But I don't think that your average fertility doctor or Fertility clinic team member thinks about that. [00:26:04] Speaker A: Well, in which it has to. [00:26:05] Speaker C: Because if you think about it, fertility care isn't just the person who had infertility. It is lgbtq. It is single individuals, it's trans people. It is all people from all kinds. [00:26:18] Speaker A: Of walks of life. [00:26:19] Speaker C: And then we haven't even talked about individuals who are in these rural areas who still haven't been able to get. [00:26:26] Speaker A: Access to care, that we still need. [00:26:28] Speaker C: To try to figure out how they're going to get access to care. Again, we always talk pre. Covid post. Covid. [00:26:33] Speaker A: Right. [00:26:34] Speaker C: You mentioned about how when you first started, there was no remote of anything. Now there is remote. Now there's more remote health care, there's more remote telehealth with mental health stuff and all of these things. And so I'm curious as to if that is also something that the fertility industry is needing and is going to have to shift in how we look at the day to day of how we provide fertility care. [00:27:04] Speaker B: You made me think of two things. One, if people are interested in this inside baseball business stuff that you and I are talking about, they should check out a doctor named David Sable. He's REI trained. [00:27:16] Speaker C: He's been on our podcast. It was episode 100 and it was phenomenal. So, yes, absolutely, go and listen to David. [00:27:22] Speaker B: They should listen to that podcast of yours with him. He no longer practices rei, but he works in venture capital. And. And he's done all of the math. And so I'm going to paraphrase some of his math, but there's half a million IVF babies born worldwide right now based on the needs that you said, people from LGBTQ background, people with infertility, people with secondary infertility, people who need PGTA or other or PGTM or other PGT for preventing genetic diseases. He thinks that we should be at a million IVF babies born per month worldwide, and then we should double that. The market is much, much smaller. One of the things that I think is going to happen with remote care is a lot more triage, so that you're really only going to the REI when you need ivf. And people might think, I don't want my doctor to be pushing me to ivf. It should maybe be the case that they're pushing you away from IVF if you don't need it. So that the reis are really just seeing those complicated cases and the fertility centers are really only seeing people that need ivf. So I think you're going to see a lot more remote care. I think you're going to see a lot more at home testing that at home testing being integrated with artificial intelligence and patient journey automation. So that you're getting all of that stuff before you even go to the rei when you're talking about remote care. Otherwise I think what's probably going to happen is that remote care is maximized and you don't even get to see the REI until it's pretty damn clear that you need ivf. And so these where we're at right now where go and you fill out some new patient paperwork, you go to your new patient visit and then you do all your workups and then you come back for your follow up. I think that's going away. I think that should have gone away. Just as a guy who knows very little about medicine, not my place to say, but from my point of view that's way too cumbersome. I think it's going away and that you're only going to an REI after you've done all that stuff remotely and then maybe some stuff with your OB GYN and then to the REI things. [00:29:40] Speaker C: That these networks and private equity and all of that are these conversations that they are already having and looking at and trying to figure out how do we actually cover care for the masses, not just one segment of the population. [00:29:56] Speaker B: I think that's happening more in the venture capital circles than in the private equity circles. You've probably made the distinction for your audience before. I'll make it now. Private equity both can come from the same sources of money. They come from sources of money called limited partners. Those limited partners are often high net worth individuals or families. Sometimes they're funds, sometimes they are like pension funds or retirement funds like the teachers union pension fund and these like Ivy League school endowments. Like these different types of funds. Individuals and families that are looking to make a higher than average return on their money because they got lots and lots of money, they don't want to make an 8% return on it like you and I do in the stock market. They want to make a 30, 40% plus return. And so there are different ways of doing that. One way of doing that is private equity. Private equity typically buys a controlling stake in existing businesses that have proven that they are profitable and have good systems. So like if somebody buys family inceptions right now, it's most likely going to be a private equity company that is has looked at your books and said Eloise has done a really good job making this thing profitable. She's clearly built the systems in that it can run not Just with her. And we think we can increase the profit by a certain amount to then flip it at a higher price in three to seven years. That's private equity. Venture capital is. We are much earlier stage investing usually in tech in. In companies that are supposed to scale huge. They often haven't even proven themselves a revenue level yet. Oftentimes it's pre revenue or early revenue and they're usually not taking a controlling stake. So that's like your Ubers, your Airbnbs and stuff like that. Had lots of private equity coming in to the field. And I think that David Sable would still say that venture capital is still underrepresented in the fertility space. We have had some big venture capital fundraises, but I don't feel like a lot relative to other sizes of industries. They're the ones who are more interested in how do we scale this private equity. I think they do want to scale somewhat, but they're really just trying to stay above the tidal wave. Right? They're trying to stay above the tidal wave of the payers. They're going to decrease the margins. They do want to scale somewhat because they need to be more profitable so they can sell at a higher level. But like the people that want to a field of medicine where there are a million IVF babies born every single month, that's coming from venture capital. Now people will say like you're not actually going to bring down the cost of IVF or make things scalable. That is part of their business thesis. I think they fail if they don't do that. These venture capital companies you see like conceivable who's automating the IVF lab. And so those companies are thinking about. [00:32:58] Speaker C: That, which has to be because put a post sometime last month I think on LinkedIn about clearly there's decrease in having babies and our infertility rates are increasing at a rapid rate. Our president, or should I say the president is talking about free IVF as you alluded to earlier, does not hold our breath. So all of these people are having fertility issues. And my thought all the time as well, if all these people are having infertility issues and we as an industry are seeing this, then we need to start forward thinking about how we're going to help all of these people. And then I even go further and say if all of these people have infertility issues and eventually it's going to start trickling down to we're not going to have enough surrogates to carry all of the pregnancies that people are going to need. We're not going to have enough donors that are going to be actually producing eggs that people are going to need. We're not going to have enough sperm donors that are going to have quality sperm in order to be able to, you know, service all of these people that are going to be in need. What, as an industry, are we all going to do? [00:34:11] Speaker B: What you're talking about, some people refer to as natalism, the birth rate. But I think that's starting to really kick up in the bigger picture. All sides of the political spectrum are trying to figure out how they're going to own that issue, but everybody's concerned about it in the west as well as in East Asia, it's even worse. It's real bad in South Korea and Japan, and I believe in China as well. And I think that if, unless we're totally replaced by machines and we all become cyborgs, which I think is distinctly possible. Eloise, I don't want to take your podcast ass down. Like the Terminator route. It definitely could offline. But I think that barring that, governments and economies are going to have to throw whatever they can at this. Because you have in Japan, for example, an average of every one minute, three Japanese citizens pass away. And in that same minute, I think it's like one point something, Japanese babies are born. So you can't, over time, in the next 20 or 30 years, you're talking about net population loss in the tens of millions. And if that's happening in it, people just say, oh, get immigration. That's happening in every country as soon as they get above a certain economic threshold. And so eventually it's like, there aren't any more immigrants either, because it's happening in the same countries that they're happening. So I think this is an issue that people are paying attention to. I think governments, in those instances, will throw everything in the kitchen sink to try to do what they can about that, and that includes supporting ivf. [00:35:57] Speaker C: But they need to actually start doing it instead of just talking about it, because that's been the problem. [00:36:03] Speaker B: Yeah, right now, they're most. [00:36:04] Speaker C: Everybody is talking about. Yeah, yeah, everybody. That's all we want to do is just talk about things, have meetings and talk. Nobody. There's no action to anything. Final question. What do you think needs to change in this space if we actually want to make things better? [00:36:19] Speaker B: One thing that I think should happen is a lot of your audience people. They're people going through the fertility journey. Right. Or people who recently have or are. [00:36:30] Speaker C: About to or surrogates or donors, but people that are, yes, actively in this. [00:36:36] Speaker B: Space, I think they should be giving real feedback about what was unsatisfactory in their journeys in really measured ways. There's a number of different things that I think need to change about the V. I think there should be more automation. I do think that doctors should be more top of license. But at the same time I also think that doctors should be buying more practices again so that they have more control. Like all of those things I think should happen. But what will force particular change is when there's concentrated specific feedback from the customer. And patients should view themselves as customers. And people might not like that. Oh, it's like we're patients, we're not just dollar signs. Yes, you are also dollar signs. You're a human being as a patient and you are entitled to certain things. As a patient, you are also a dollar sign. And so that brings with it a certain forces as a customer and delivering that feedback. What I mean by that specifically is Google reviews, reviews on sites like fertilityIQ. And what I would like your audience to do when there are things that they find really unsatisfactory. I don't mean just nitpicking for the sake of it, but there are probably things where you're like, that totally sucks. And when that happens to give that feedback if you're giving a negative review, unless there is zero redeemable things about that. But what I often see is a polarity in reviews. It's like five stars or it's one stars. There's very few things in between. When that happens. When you see these one star reviews and someone's like, everything sucked here and they get tuned out. If you really want to get somebody's attention, leave them a three star review. Leave them a three star review. Mention the things that you really liked. I really loved the nurse there. I liked it. How kind they were this one time. They had really good communication, whatever. Clearly show that you are not blinded by disappointment or anger or whatever. And then say, but this specific thing happened. And give them a maybe a two star but probably a three star review. Because people look at that and they're like, oh, that's the one that gets them. I really think that is the easiest and most actionable thing for people to get some kind of change. If people are doing that and they're not just leaving the negative, crazy one star reviews, very measured and specific, not positive reviews with those three stars, then that's the thing that makes people go, all right, we need to change this. [00:39:13] Speaker C: And hopefully they will be willing to change it isn't, it's not just lip service. But we'll see. We'll see. We'll, we'll have to come back to this conversation again. [00:39:22] Speaker B: It's easier to give lip service if only a couple people are, are being a squeaky wheel, if way more people are complaining about the same thing. That's what elevates something to the top of the priority list. To get changed. [00:39:36] Speaker C: Absolutely. [00:39:36] Speaker A: Well, Griffin, thank you for your perspective. [00:39:39] Speaker C: And the behind the scenes that, you know, we don't often hear about. Always, you know, front end stuff when it comes to fertility stuff, but never really behind the scenes on actually what's happening. So I appreciate your perspective in sharing it with us. So. And before we wrap up, how can people Hear about you? [00:39:56] Speaker B: Insidereproductivehealth.com, just go to Insidereproductivehealth.com we have hundreds of podcast episodes, hundreds of news articles. You'll see the subscribe thing. If you want to get news on what's happening on the business side of the fertility field, just go to InsideReproductiveHealth.com all right. [00:40:12] Speaker C: Well, thank you so much. [00:40:13] Speaker A: I appreciate it. [00:40:14] Speaker B: Thank you, Eloise. It's been my pleasure. It's nice being on your side. Thanks. [00:40:18] Speaker A: Thanks for spending time with us today on Fertility Cafe. If you found today's conversation helpful, hit that subscribe button, share it with someone who might need to hear it and come hang out with us over on social media. FertilityCafe. Until next time. Remember, love has no limits. Neither should parenthood.