This is my son Luke. He and his twin brother were born almost 12 years ago after multiple IVF cycles and draining our savings account. A lot has changed since then, and much has not.
Over the last dozen years, the fertility industry has more than doubled their success rates from roughly 30% success to 60%+ success per IVF transfer; and those success rates are mostly consistent across U.S. practices. When you see a fertility clinic with very low success rates or very high success rates, the fertility practice is either taking a highly disproportionate percentage of poor prognosis, or good prognosis, cases. In addition to much higher success rates, the incidence of twins – and resulting premature babies in NICU costs – is significantly lower. Where a dozen years ago, one out of three IVF cycles resulted in twins or triplets, today, those numbers are single digits – again, it’s consistent across the U.S. The fertility industry has more than tripled as families look different today than they did a couple of decades ago. And the biggest, most dramatic change is in how patients pay for treatment. Historically, IVF was for a privileged few who could add a second mortgage to their home to pay for treatment or borrow from parents to cosign a loan. There was virtually no state mandated coverage and no employer coverage.
Despite success rates improving dramatically and at parity across the country, the cost for IVF remains prohibitively high. Demand for treatment is outstripping supply causing fertility practices to keep prices artificially inflated with long wait lists. A tremendous divide remains for a privileged few who can afford to have the family of their dreams versus those that cannot. And historically, that’s been true for employers too with only a small percentage in a position to sponsor fertility coverage for their employees.
Today, that changes. Today, we accelerate our mission to democratize care and to provide fertility coverage for all.
We are grateful to share that Walmart has selected Kindbody as its Centers of Excellence for fertility and family-building care. All eligible Walmart associates will have access to more than 30 state-of-the-art Kindbody clinics nationwide, including a new clinic in Northwest Arkansas opening to the entire community this Fall. Walmart and other innovative employers are disrupting how employers pay for care by taking insurers out of the equation and contracting directly with leading provider groups such as Geisinger, the Mayo Clinic, Johns Hopkins, Virginia Mason, and now – Kindbody. Walmart and other leading employers are crafting bundled payment arrangements that cover the cost of an employee’s care from start to finish. They’re also picking up the tab for any necessary travel, lodging, and meals. Walmart began these efforts almost a decade ago which were highlighted in a March 2019 cover story from Harvard Business Review titled, “How Employers Are Fixing Healthcare”.
After spending the last dozen years in the fertility industry, what I’ve learned is that only three things matter in healthcare: patient experience, patient outcome and costs – and, that you must be in the provision of care to effect change. Insurance companies and care navigation firms who are incentivized to steer patients to the highest priced doctors do not have aligned incentives to reduce the costs of care. The only way to bring down the costs of care is to align goals between the patient, the provider and the employer. Only doctors can reduce the costs of care because only doctors can show the courage to replace legacy fee-for-service plans with bundled case rates, and publish them on their website so there are no surprises. And, Sam Walton knew all too well that it couldn’t only be about providing a more affordable solution, you must delight the customer. So, while I’m proud of our more cost effective solution, I’m most pleased to share that our average NPS (net promoter score) has stayed above 88 since inception – unheard of in the healthcare industry; and, our preliminary SART (Society for Assisted Reproductive Technology) data for 2021 across our network average for pregnancy rate per IVF transfer is 76% and our live birth rate is 58% compared to the national average of 51% and 44% respectively.
I grew up in a small town in North Carolina, the first in my family to graduate from college. We were at Walmart often. During the early months of the pandemic, I was again at Walmart often not only to shop, but to socialize and connect with my community. I was grateful to the cashiers and shelves’ stockers who worked tirelessly throughout the pandemic. Walmart provided hope, and a place to reconnect with my community, when other stores were closed.
When I think of Walmart, I think of Family. Community. Courage. Leader. I think of being a leader like Sam Walton who said, ”You can’t just keep doing what works one time, everything around you is changing. To succeed, stay out in front of change”. At Kindbody, we’re fortunate to have customers committed to leading from the front and who share our mission to unapologetically bring down the high costs of fertility and family-building care and improve service – making it transparent and friendly for all.
So today, I thank all of Walmart’s employees and leadership for selecting us to help you build the family you’ve always dreamed of. We know the responsibility you’ve provided us, and we do not take it lightly. And, to my twin boys, Dream big. Take chances. And, know that change takes courage.
This press release was originally posted on Walmart.
Walmart associates will have access to more than 30 state-of-the-art clinics across the U.S., including a new clinic in Northwest Arkansas
BENTONVILLE, Ark., Sept. 27, 2022 – Today, Walmart Inc. (NYSE: WMT) named Kindbody, a leading family-building benefits provider for employers, as the fertility provider for its new Center of Excellence (COE) for family-building benefits. Associates will have access to Kindbody’s network of facilities across the U.S., including a new state-of-the-art clinic and in vitro fertilization (IVF) lab in Rogers, Arkansas that will provide comprehensive virtual, at-home, and in-clinic care. The new facility is expected to open later this year.
“Providing access to high-quality health care is very important to us, and we’ve heard from our associates that improved access to fertility, surrogacy and adoption support is a priority for them and their families,” said Kim Lupo, senior vice president, Walmart Global Total Rewards. “Through Kindbody, Walmart associates in every corner of the country will have access to a variety of services to aid in their family-planning journey.”
Through this new Center of Excellence, Walmart associates and their dependents who are enrolled in a self-insured Walmart medical plan will be able to receive fertility care from Kindbody’s highly-trained team, inclusive of board-certified reproductive endocrinologists and senior embryologists, at one of Kindbody’s Signature Clinics nationwide. Services include fertility assessments and education, fertility preservation, genetic testing, in vitro fertilization (IVF) and intrauterine insemination (IUI).
Kindbody will also be available to help eligible associates access Walmart’s surrogacy and adoption benefits, as well. These Walmart benefits include financial support of up to $20,000, lifetime max, for eligible surrogacy and adoption expenses. Walmart benefits will continue to include enhanced maternity and parental leave for qualified full-time hourly and salaried associates that allows birth moms to receive up to 16 weeks of paid time off. New parents, including adoptive and foster parents, also receive six weeks paid parental leave to bond with a new child.
“We’re incredibly honored to become a Walmart Center of Excellence and provide high-quality care to Walmart associates, furthering our mission to make fertility and family-building care affordable and accessible for all,” said Gina Bartasi, founder and chairwoman of Kindbody. “Our partnership with Walmart signals that fertility benefits have joined medical, dental, and vision as standard workplace benefits for leading employers.”
This center will build on Walmart's existing COE model, which provides benefit support and coverage for certain heart, spine and joint surgeries and cancer treatments, in partnership with some of the best healthcare providers and facilities in the country. Walmart chooses Centers of Excellence through a highly selective process, which requires health care providers to demonstrate an ability to provide excellent care, a dedication to addressing the root cause of a patient's condition, and an outstanding patient experience, amongst other key criteria that are reviewed.
About Walmart Walmart Inc. (NYSE: WMT) helps people around the world save money and live better — anytime and anywhere — in retail stores, online, and through their mobile devices. Each week, approximately 230 million customers and members visit more than 10,500 stores and numerous eCommerce websites under 46 banners in 24 countries. With fiscal year 2022 revenue of $573 billion, Walmart employs approximately 2.3 million associates worldwide. Walmart continues to be a leader in sustainability, corporate philanthropy and employment opportunity. Additional information about Walmart can be found by visiting corporate.walmart.com, on Facebook at facebook.com/walmart and on Twitter at twitter.com/walmart.
About Kindbody Kindbody is a leading fertility clinic network and family-building benefits provider for employers offering comprehensive virtual and in-person care. Kindbody's clinically managed program includes fertility assessments and education, fertility preservation, genetic testing, in vitro fertilization (IVF), donor and surrogacy services, and adoption, as well as physical, mental, and emotional support from preconception through postpartum. Kindbody is the trusted fertility benefits provider for more than 100 employers, covering more than 2.4 million lives. Many thousands more receive their fertility care directly from Kindbody throughout the country at signature clinics, mobile clinics, and partner clinics. As the fertility benefits provider, technology platform, and direct provider of high-quality care, Kindbody delivers a seamless, integrated experience with superior health outcomes at lower cost, making fertility care more affordable and accessible for all. Kindbody has raised $190 million in funding from leading investors including Perceptive Advisors, GV (formerly Google Ventures), RRE Ventures, Claritas Health Ventures, Rock Springs Capital, NFP Ventures, and TQ Ventures. Kindbody signature clinics are located in: Atlanta, GA; Aurora, IL; Austin, TX; Century City, CA; Chicago, IL; Crest Hill, IL; Dallas, TX; Denver, CO; Glenview, IL; Geneva, IL; Hoffman Estates, IL; Houston, TX; Minneapolis, MN; New York City, NY; O’Fallon, MO; Orlando, FL; Princeton, NJ; San Francisco, CA; Rogers, AR; Santa Monica, CA; Silicon Valley, CA; Southfield, MI; St. Louis, MO; Swansea, IL; Vancouver, WA; Washington, D.C; and Wauwatosa, WI.
This interview originally appeared on the Namely blog.
In this interview with Dr. Fahimeh Sasan, Kindbody’s Chief Innovation Officer and Founding Physician, we explore what is included in fertility benefits, their recent rise in popularity, and why your company should consider including them in your benefits package.
What are fertility and family-building benefits? What is included?
Kindbody: Fertility and family-building benefits include a wide range of treatments and services that are covered by employers to support their employees on their path to parenthood. They can include fertility assessments, fertility preservation, in vitro fertilization (IVF), donor and gestational surrogacy services, and adoption.
Infertility is more common than diseases like diabetes and cancer. In fact, one in eight couples experience infertility in the U.S. Fertility treatments are very expensive and inaccessible to most. Without the financial assistance of their employer, many people won’t get the high-quality care they need.
Employers have stepped up and they are changing how this critical part of healthcare is delivered. Fertility benefits have also become an important part of building an inclusive workplace culture. They have taken their place next to medical, dental, and vision as standard workplace benefits.
Why are fertility and family-building benefits an important part of an inclusive benefits package?
Kindbody: It’s important to note that today we speak about fertility care as healthcare. That hasn’t always been the case. Until recently, when we spoke about fertility, it was a conversation about infertility. Infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex. Therefore, if an employer’s benefits package doesn’t offer fertility benefits beyond an infertility diagnosis, it’s leaving out part of its workforce.
LGBTQ+ individuals face barriers to accessing fertility care since they often don’t meet the definition of “infertility” that would qualify them for covered services. The same is true for single parents by choice. It’s also well-documented that there are significant disparities in access to fertility care amongst racial minorities.
For instance, Black women are twice as likely to suffer from infertility but are half as likely to access care as white women. A comprehensive, inclusive fertility benefits program can address some of these health inequities in the workplace. That’s why we’re hearing from more and more employers that family-building offerings support their organization’s diversity, equity, and inclusion (DEI) goals and objectives. More than half of employers are expected to cover fertility services beyond the diagnosis of infertility this year.
Why now? To what do we attribute the extreme growth in popularity of fertility benefits?
Kindbody: A series of macro trends have brought us to where we are today. 61 percent of women have a child over age 35, compared to 8 percent a decade ago. One in three women struggle with infertility over 35 and may need assisted reproductive technology (ART) to become pregnant. Just a decade ago, the experimental label was removed from egg freezing, making it much more acceptable for women. Shortly after, marriage equality was passed, opening up more options for LGBTQ+ people who hope to start or build their families. Interest in learning about one's fertility skyrocketed during the pandemic. More than 10,000 people have attended Kindbody's virtual fertility education events in the last two years.
So, what we’re seeing is that people not only need access to fertility care, but they are also more knowledgeable about their fertility in general. This is a big shift from just a few years ago when this topic was very rarely talked about. Employers should know that there is now mainstream awareness that there are companies that offer benefits that help their employees pay for family building and workers are making important career decisions with this in mind. Our recent survey found that 81 percent of employees will stay at their company longer if their employer offers family-building benefits.
That’s an eye-opening stat! How can HR convince employers to add fertility benefits to their benefits package?
Kindbody: I believe most will agree that supporting people in this critical part of healthcare is a good thing. Employers should also know that fertility benefits help attract and keep great talent, support DEI objectives, and save on healthcare costs.
HR leaders are actively using family-building benefits as a tool to attract candidates. Our clients say that these offerings have been important to their talent strategy over the past three years. There’s a good reason for this: people want family-building benefits. When we surveyed employees, 61 percent said they would change jobs for fertility benefits.
Retaining employees leads to significant cost savings for organizations. The Society for Human Resource Management (SHRM) found that it costs a company around six to nine months of an employee’s salary to replace them. Framed another way: replacing an employee who makes $60,000 per year could cost around $30,000 to $45,000.
A comprehensive, inclusive fertility benefits program can address health inequities in the workplace. Our clients tell us that Kindbody’s family-building offerings support the organization’s DEI goals and objectives.
And finally, most employers naturally assume that offering fertility benefits will increase their healthcare costs. However, there is no evidence to support this. Studies show that there are areas where employers actually saved money when adding fertility benefits. There’s a reason for this: patients that receive financial support for fertility treatments like IVF are more likely to make decisions based on outcomes and not cost. This, in turn, leads to safer, lower-risk pregnancies that don’t lead to unnecessary healthcare costs for the employer.
My advice to HR leaders that want to make a case for fertility benefits is to focus on the business case. As long as talent, DEI, and cost savings continue to be a priority for organizations, so should fertility benefits.
What makes Kindbody different from other fertility benefits providers?
Kindbody: Kindbody is unique because it's the only fertility benefits provider that is in the provision of care with clinical expertise. Kindbody owns and operates clinics. We save employers 25 to 40 percent by contracting directly with them to provide comprehensive virtual and in-person fertility and family-building care to their employees. We remove the middleman, and in doing so, Kindbody is uniquely positioned to provide a seamless continuum of care, decrease cost, improve patient experience, and deliver better health outcomes.
Kindbody is also able to provide a broad spectrum of care in modalities to serve employees when and where they need it through virtual appointments, Kindbody Signature Clinics, mobile clinics, and our robust global network of partner clinics. Kindbody is the only fertility benefits solution that can provide employees and consumers with clinical visits in the comfort of their homes, no matter where they are.
Also unique to Kindbody is that we model the DEI values that are so important to our clients. Kindbody is women-owned and women-led. Our clinics are staffed to reflect the communities we serve so each individual feels seen and understood. Today, 80 percent of Kindbody’s physicians are women, 50 percent of Kindbody’s physicians identify as BIPOC, and 45 percent of Kindbody patients are BIPOC. This is incredibly rare in healthcare. Numerous studies show that sharing a racial or cultural background with one’s physician leads to a better patient experience, better adherence to medications and treatment plans, and better health outcomes. We built diversity into Kindbody’s delivery model, which is one of the things I am most proud of as Kindbody’s Founding Physician.
Kindbody is a leading fertility clinic network and family-building benefits provider for employers offering comprehensive virtual and in-person care. Kindbody's clinically managed program includes fertility assessments and education, fertility preservation, genetic testing, in vitro fertilization (IVF), donor and surrogacy services, and adoption, as well as physical, mental, and emotional support from preconception through postpartum. Kindbody is the trusted fertility benefits provider for more than 90 employers, covering more than 2.4 million lives. Many thousands more receive their fertility care directly from Kindbody throughout the country at signature clinics, mobile clinics, and partner clinics. As the fertility benefits provider, technology platform, and direct provider of high-quality care, Kindbody delivers a seamless, integrated experience with superior health outcomes at lower cost, making fertility care more affordable and accessible for all.
Interview with Vin DiDonna, Namely’s National Practice Lead, Benefits Consulting
We know interest in fertility benefits has accelerated in recent years. What do you attribute this uptick in interest to? What are you hearing from your clients?
Overall, employers are trying to “be more” for their employees. Most recently, due to the Great Resignation, employees have never been more focused on benefits that impact their quality of life. While attractive benefits like PTO and remote work may come to mind first, our clients have noticed that employee family benefits now play a major role in attracting and retaining their employees.
How are companies handling employee benefits, and family-building benefits in particular, during the current economic climate?
Reproductive health, in general, is at the center of philosophies relating to employee benefits. Most companies who do not offer traditional family-building benefits do so because of the cost. These benefits can be quite expensive. However, the landscape is changing and new vendors are bringing products to market at more affordable prices that make it possible for more companies to offer such benefits. The demand for them has only increased since the pandemic, and it’s not going anywhere. More employers are partnering with vendors in this space in an effort to provide benefits that are both personal and impactful.
How are benefits packages used for attracting and retaining top talent?
The search for top talent has never been more competitive than it is at the moment. While total earnings do play a major role in candidates’ decisions to choose one employer over another, benefits factor into that equation as well. Candidates are “doing the math,” so to speak. Although the term “total rewards” has been around for some time now, it is really starting to resonate with candidates who will sit down and calculate contributions and other expenses to see which company is truly providing the best offer.
With Open Enrollment on the horizon, what should companies be thinking about when it comes to benefits in 2023?
An employer’s benefits package should be looked at as something that constantly needs to evolve. Using COVID-19 as an example, employees now operate in a different world than they did prior to 2020. Employee benefits should mirror that because their needs and wants change. Benefits should evolve simultaneously with the employee experience.
It is important to know what employees need and want. This has never been more difficult for employers to figure out with so many employees working remotely. It has become increasingly difficult to keep a finger on the pulse of your workforce. At Namely, we recommend surveying employees at least once a year to identify and address potential gaps in your benefits plan. Namely offers clients a proprietary employee benefits survey to do just that. From there, our Managed Benefits Team can make pointed recommendations based on clients’ specific workforces.
Our Chief Revenue Officer Taryn Branca sat down with Dr. Angeline Beltsos, Kindbody’s CEO of Clinical, to discuss the metrics that matter most for employers when evaluating fertility benefits solutions. Dr. Angeline Beltsos is a board certified reproductive endocrinologist (REI) and an internationally recognized expert in her field.
Why is it important to evaluate fertility outcomes when choosing a fertility benefits solution?
We’ve never had as much data about fertility patients as we do today. The ability to collect and review fertility outcomes is an essential component of a comprehensive workplace fertility benefits program. Similar to how physicians use data to understand how their patients are responding to treatment and to drive decision making on future treatment options, when employers have access to high-quality data about their fertility benefit, it helps them better understand whether their employees are achieving their family-building goals. Quality data can help employers drive decision making surrounding the continued use and expansion of fertility benefits for their employees.
How do comprehensive fertility benefits directly impact fertility outcomes?
Patients with comprehensive fertility benefits have better outcomes when undergoing fertility treatments when compared to patients who pay for fertility treatment out-of-pocket. Patients that have access to fertility benefits and financial support for fertility treatments like in vitro fertilization (IVF) are more likely to make decisions based on physician recommendations and outcomes rather than make care decisions based on cost. When patients make physician-supported, outcome data-driven decisions, it leads to safer, lower-risk pregnancies, and ultimately healthier outcomes for both mother and baby.
What fertility outcomes and metrics should employers review when evaluating fertility benefits solutions?
When employers are evaluating their fertility benefits solution options, they should evaluate a variety of outcomes and metrics. In creating the Kindbody benefit, Kindbody evaluates its signature clinics and partner clinics using strict criteria covering access, quality/success rates, cost, and experience.
Accessmetrics should relate to both how and where employees will access care. Kindbody has both brick and mortar clinics staffed with fertility specialists, as well as a robust partner clinic network. Additionally, Kindbody is the only fertility benefits solution positioned to impact access to care outside of traditional care modalities. Through our Kind at Home testing solutions and our mobile fertility clinics, we are able to expand our reach to patients and markets that may not otherwise have convenient access to fertility care. Finally, Kindbody is the only fertility benefits solution that can provide employees and consumers with clinical visits in the comfort of their homes, no matter where they are.
Quality and successmetrics such as elective single embryo transfer (eSET) rate, pregnancy rate, miscarriage rate, and live birth rate all help employers understand how well a benefits solution is helping their employees achieve their family-building goals. As a direct provider of care, Kindbody is able to provide clinical performance guarantees that lead the industry, including IVF pregnancy rate, eSET rate, multiples rate, and miscarriage rate.
Metrics like bundle case rates and total cost for patients help employers understand both their costs and their employees’ costs for fertility care. Kindbody negotiates direct bundle national case rates that allows employers to provide equitable benefits across the country and results in 20-35% savings for their employees. Additionally, as direct providers of care, Kindbody is able to leverage strategic volume-based partnerships with vendors to decrease operational costs, savings which we are then able to pass along to employers and employees.
Experience-based metrics should be top of mind for employers as they help tell the story of how their fertility benefits solution impacts how employees feel as they are going through treatment. Kindbody routinely monitors various forms of data including, but not limited to Fertility IQ scores, NPS Scores, public reviews, and patient feedback. This data allows Kindbody to implement improvements quickly with our care providers and signature clinics.
What kind of clinical standards should employers look for when evaluating a fertility benefits solution?
When a fertility benefits solution includes the provision of care, it gives employers an opportunity to ensure their employees will be receiving care that adheres to the highest clinical standards. Kindbody’s partner clinics go through a rigorous vetting process and must meet the highest standards of care used for our signature clinics.
Clinics in the Kindbody network must be registered and inspected by the U.S. Food and Drug Administration (FDA), assuring safeguards are in place for donor suitability and use. Clinics must also be members in good standing with the Society for Assisted Reproductive Technology (SART) and be led by a board-certified Reproductive Endocrinologist (REI) and a board-certified laboratory director. Additionally, as members of SART, these clinics are accredited by regulatory agencies such as the College of American Pathologists (CAP), which performs an onsite inspection to assure appropriate staffing, safety, and use of effective standards.
What should an employer fertility benefit include to drive better outcomes?
A high-quality employer fertility benefits solution should include financial support, clinical care navigation, genetic testing, and eSET standards. When fertility benefits include these elements the risk of multiples is far lower and patients are far more likely to achieve healthy pregnancies. A lowered risk of multiples means a lower risk of miscarriage, C-section, NICU stays and prolonged and/or complicated postpartum care. This means better health outcomes for employees who give birth and for their babies.
Why is Kindbody the best outcomes-driven fertility benefits solution for employers?
Kindbody is unique because it's the only fertility benefits provider that is in the provision of care with clinical expertise. Kindbody owns and operates clinics. This means Kindbody is designed to deliver optimal clinical outcomes. It also gives employers a unique opportunity to gain visibility into comprehensive data directly from the providers delivering care. By eliminating the middleman, Kindbody is able to provide a seamless continuum of care, decrease cost, improve patient experience, and deliver better health outcomes. Kindbody is also able to provide a broad spectrum of care in modalities to serve employees when and where they need it through virtual appointments, Kindbody signature clinics, mobile clinics, and our robust global network of partner clinics. Kindbody is the only fertility benefits solution that can provide employees and consumers with clinical visits in the comfort of their homes, no matter where they are.
Kindbody delivers culturally competent care. Our clinics are staffed to reflect the communities we serve so each individual feels seen and understood. Today, 80% of Kindbody’s physicians are women, 50% of Kindbody’s physicians identify as BIPOC, and 45% of Kindbody patients are BIPOC. This is incredibly rare in healthcare. Numerous studies show that sharing a racial or cultural background with one’s physician leads to a better patient experience, better adherence to medications and treatment plans, and better health outcomes.
As the direct provider of clinical care through our signature clinics and specialty providers, Kindbody is able to nimbly access and evaluate large and interconnected health outcome data sets related to all types of fertility treatment. We are then able to swiftly identify opportunities for improving outcomes and continuously adapt care delivery to the changing needs of the fertility patient population.
Kindbody is more than a fertility benefits solution provider. We’re the doctors taking care of your employees. Employers can feel confident that their employees will receive best-in-class outcomes-driven care with their Kindbody benefit.
Preimplantation genetic testing (PGT) of embryos is an additional step in the IVF process. The goal of PGT is to test embryos for a specific genetic condition or a chromosomal abnormality in order to increase the chance of implantation, reduce the chance of miscarriage, and improve the odds of a healthy live birth.
The most common type of PGT is PGT-A, or PGT for spontaneous aneuploidy screening. Aneuploidy is defined as an abnormal amount of chromosomes. PGT-A is often recommended when a female patient is over the age of 35. The odds of a chromosomal abnormality in an embryo increases as the age of the egg increases.
Additionally, if you or your partner have any of the following medical conditions your provider may recommend PGT:
Two or more miscarriages have occurred
Two or more IVF cycles have not yielded a pregnancy
Family history of genetic disease
One or both partners are a carrier of genetic disease
One or both partners are diagnosed with genetic disease
The female partner is of advanced maternal age (>35)
The male partner is of advanced paternal age (>40)
In each cell of the body, 23 pairs of chromosomes are present. When these chromosomes are incorrectly arranged or when an extra chromosome is present, missing or partially altered, a chromosomal abnormality known as aneuploidy is present.
Process of PGT
How is PGT performed?
All types of PGT involve a similar sequence of events. The patient undergoing IVF has their egg retrieval as scheduled. The eggs are inseminated with sperm and the resulting embryos are monitored in the lab until they develop to an expanded blastocyst (typically days 5 – 7 after egg retrieval). At this stage, a small number of cells are removed (biopsied) by an embryologist. This consists of a small catheter removing a few cells from the trophectoderm that will later develop into the placenta. The catheter does not impact the inner cell mass (future baby). The embryo is then immediately frozen and stored at the clinic while the biopsied cells are shipped to a PGT lab. Patients are notified of the PGT results typically about 3 weeks after the egg retrieval procedure.
Frequently Asked Questions about PGT
When do I need to decide if I want PGT?
We ask that patients decide if they will be doing PGT before starting an IVF cycle.
If I already have frozen embryos without PGT, can I still do PGT?
Embryos can be thawed and biopsied so, yes, you can do PGT after freezing them. At Kindbody, the odds that an embryo survives being frozen is 95-98%, so there is a small chance that it would not survive the thaw process. The embryo would need to be thawed twice in this case – the first time to be biopsied, then frozen again to await results, and thawed a second time just before it is transferred to the uterus. So there would be a small additional risk of loss after the second thaw.
If your intent is to move forward with PGT, we strongly recommend that you do this prior to the first cryopreservation if able.
Is PGT recommended if I am using a donor egg or sperm?
PGT is always an option. The age of the egg or sperm donor is often considered in this decision but there are unique circumstances to every case so we recommend you discuss this with your provider. In some situations, the use of PGT may further increase success even when using donor eggs or sperm. For donor eggs that are previously frozen, as compared to fresh, there may be a small additional risk of an additional freeze and thaw as mentioned in the question above.
What are the risks of PGT?
With every procedure there are always risks and benefits. First, to complete the PGT procedure, the embryo must develop into a blastocyst and be expanded enough to be safely biopsied. This typically happens 5 – 7 days after fertilization in the IVF lab. If the embryo is too small or less developed, we cannot complete PGT on that embryo.
PGT requires a biopsy. Most data suggests that the blastocyst biopsy is safe but it does require this procedure to obtain genetic results.
There is a risk of contaminating cells from sperm or cumulus cells, which nourish the egg as it matures in the body and are stripped from the egg after it is retrieved. This is why most labs strongly recommend or require ICSI (intracytoplasmic sperm injection) of a single sperm into the egg to reduce this risk.
Finally, PGT is not perfect and cannot test the entire genome. PGT is 96-99% accurate using the best technologies. There is a small chance that what we say is normal may be abnormal, and what we say is abnormal may be normal. Sex of embryos has a small error rate, so, if you are completing PGT for sex selection, keep this in mind.
Completing PGT means this will be a “freeze all cycle” in order to await results expected in a few weeks. This means you cannot do a fresh embryo transfer unless it is of an untested embryo or one tested in a previous cycle.
The risk of cost should also be considered as there is additional cost for the PGT procedure.
Finally, it is important to remember that embryos that aren’t healthy tend not to implant when transferred, and if they do implant, they tend to miscarry. There is currently no test or screening process that will completely eliminate the chance of miscarriage.
What does the biopsy entail? Does this hurt my embryo or future child?
Once a blastocyst forms, typically between days 5 – 7 after fertilization, the distinction between cells that will become a fetus (baby) and the placenta become more obvious under a microscope. The biopsy consists of a catheter removing a small number of cells from the trophectoderm that will later develop into the placenta. The catheter does not impact the inner cell mass (future baby). Most published data suggests the blastocyst biopsy does not hurt the embryo or impair outcomes in subsequent transfers.
I do not have a family history of chromosomal conditions. Which type of PGT test is best for me?
PGT-A is a screening tool recommended for all patients undergoing IVF, especially as age of the egg increases, as it screens for chromosome abnormalities that occur randomly when a sperm and egg joins and the cells begin to divide.
Even if you have no personal history of chromosomal abnormalities and no family history of genetic conditions, everyone is still at risk for abnormal embryos. Conditions such as Down’s Syndrome, Turner syndrome, or other chromosomal imbalances can occur with egg or sperm from any age individual. We do know that as we age, the likelihood of chromosomally abnormal embryos increases. This is particularly true as the age of the egg increases.
Do I need to do anything to prepare for PGT?
Most importantly, discuss PGT with your provider in your consult. Once you have decided to pursue PGT, notify your team. Depending on the type of PGT the team may need to get approval from the PGT lab directly before proceeding. You must complete the associated PGT modules and consent forms prior to the start of your IVF cycle.
If we are doing PGT to test for a specific disease (PGT-M), then we need to take time to understand your DNA mutation or your partner’s DNA mutation. This often means blood or saliva samples are needed from the egg and sperm source or the carrier of the mutation in order to create DNA “probes” to test and compare to the embryo DNA. In some cases it is important to understand the heritage of the mutations so additional samples may be requested from your parents, siblings, or living children. If this cannot be done there are some situations where additional information can be gathered from embryos that have stopped developing in the lab as well. Extra information that is requested is done so to improve the accuracy of the results.
PGT-SR stands for structural rearrangement where a piece of DNA may be broken off or broken off and flipped on itself. In the process of DNA separation, in order to send only half of the amount to an egg or sperm, there tends to be more errors than predicted in cases of PGT-SR which is why it is very useful to reduce this risk. PGT-SR can detect larger deletions and duplications but may not be able to detect small ones. Most of these cases are unique and may require a consultation with a genetic counselor prior to preceding.
How accurate are my results?
PGT is 96-99% accurate using the best technologies. It is considered a screening test and does not have the capacity to screen for every possible scenario, so will not be 100% accurate in identifying all potential chromosomal or genetic anomalies. Make sure you discuss your results with your provider. We also recommend that you follow your provider’s recommendations on non-invasive prenatal testing once you are pregnant as well as amniocentesis recommendations in pregnancy to improve accuracy of and confirm results (in order to directly test fetal skin cells in fluid).
How long does it take to get my results?
Typically results are available about 3 - 4 weeks after the egg retrieval.
How will I receive my results?
Your Kindbody care PGT team will call you with your results and will share them in your patient portal. They will ask you if you want to know sex of the embryo when the report is shared. They will review your embryos and next steps. You do not need to call us to check in on the progress.
What is the cost of PGT?
The cost of PGT can range depending on many factors. Our pricing information is here. If you are a Kindbody member, your PGT may be included in your benefit.
If you are completing PGT-M there are potential added fees for running additional tests and creating a probe. If your case requires additional familial samples there also may be additional cost.
You will be responsible for fees from both the processes that occur in the lab to biopsy and freeze the embryo as well as lab fees for the genetics tests and shipping of samples.
Who should receive PGT?
We recommend that all patients undergoing IVF consider PGT. It is an optional test and it can potentially improve success of getting pregnant and staying pregnant. Please discuss PGT and types of PGT with your provider.
What is mosaicism?
Mosaicism is a result of PGT-A detecting a mix of abnormal (unbalanced) DNA in cells and normal (balanced) DNA in other cells. It is possible this result may be real or an artifact of the processing of the DNA or the testing. Some labs refer to low or high levels of mosaicism. All mosaic results must be discussed with your provider. There are circumstances where we consider transfer of mosaic embryos and some may still result in healthy pregnancies.
Does Kindbody transfer aneuploid (abnormal number of chromosomes) embryos?
At this time, we consider all cases on an individual basis. When embryos are mosaic or missing a partial amount of DNA they may be considered for transfer after extensive counseling with a genetic counselor and your provider. We also recommend that amniocentesis be performed to do further testing in the pregnancy.
What happens to my abnormal embryos?
The abnormal embryos are not discarded unless you direct us to do so after consultation with a provider and an additional consent. They are kept frozen primarily because we don’t know which are normal and abnormal until after PGT results are available. In the future these embryos can be discarded or donated to research. In many clinics, abnormal embryos would never be transferred, but as we continue to explore and understand the strength of PGT, in the future some abnormal embryos may be allowed to be transferred or considered for rebiopsy or additional testing.
How does the doctor know which embryo to transfer first?
If you did PGT, we start by looking at the embryos that are euploid (or suggest a normal balance of DNA). Of these embryos, we first look at when they were frozen. Those frozen on day 5 are a tiny bit stronger than those frozen on day 6, which are a tiny bit stronger than embryos frozen on day 7. Next, we look at the embryo grade and choose the highest grade.
Why did my embryo come back as “Undetermined”, “No result” or “Quality or quantity of DNA insufficient” when I did PGT?
Imagine this embryo is like a tiny piece of cells, smaller than a grain of sugar. We take a tiny pinch of that cell, so the amount of DNA that is examined is so incredibly small, it has to be sent to a lab where the lab amplifies the DNA on a machine. Any of the steps along the way could result in an embryo that we don’t get results for, however, you could go ahead and transfer the embryo depending on your own personal story and circumstances, or you could ask for the embryo to be retested. Consultation with a provider and a genetic counselor may be recommended or required.
This is my son Luke. He and his twin brother were born almost 12 years ago after multiple IVF cycles and draining our savings account. A lot has changed since then, and much has not.
Over the last dozen years, the fertility industry has more than doubled their success rates from roughly 30% success to 60%+ success per IVF transfer; and those success rates are mostly consistent across U.S. practices. When you see a fertility clinic with very low success rates or very high success rates, the fertility practice is either taking a highly disproportionate percentage of poor prognosis, or good prognosis, cases. In addition to much higher success rates, the incidence of twins – and resulting premature babies in NICU costs – is significantly lower. Where a dozen years ago, one out of three IVF cycles resulted in twins or triplets, today, those numbers are single digits – again, it’s consistent across the U.S. The fertility industry has more than tripled as families look different today than they did a couple of decades ago. And the biggest, most dramatic change is in how patients pay for treatment. Historically, IVF was for a privileged few who could add a second mortgage to their home to pay for treatment or borrow from parents to cosign a loan. There was virtually no state mandated coverage and no employer coverage.
Despite success rates improving dramatically and at parity across the country, the cost for IVF remains prohibitively high. Demand for treatment is outstripping supply causing fertility practices to keep prices artificially inflated with long wait lists. A tremendous divide remains for a privileged few who can afford to have the family of their dreams versus those that cannot. And historically, that’s been true for employers too with only a small percentage in a position to sponsor fertility coverage for their employees.
Today, that changes. Today, we accelerate our mission to democratize care and to provide fertility coverage for all.
We are grateful to share that Walmart has selected Kindbody as its Centers of Excellence for fertility and family-building care. All eligible Walmart associates will have access to more than 30 state-of-the-art Kindbody clinics nationwide, including a new clinic in Northwest Arkansas opening to the entire community this Fall. Walmart and other innovative employers are disrupting how employers pay for care by taking insurers out of the equation and contracting directly with leading provider groups such as Geisinger, the Mayo Clinic, Johns Hopkins, Virginia Mason, and now – Kindbody. Walmart and other leading employers are crafting bundled payment arrangements that cover the cost of an employee’s care from start to finish. They’re also picking up the tab for any necessary travel, lodging, and meals. Walmart began these efforts almost a decade ago which were highlighted in a March 2019 cover story from Harvard Business Review titled, “How Employers Are Fixing Healthcare”.
After spending the last dozen years in the fertility industry, what I’ve learned is that only three things matter in healthcare: patient experience, patient outcome and costs – and, that you must be in the provision of care to effect change. Insurance companies and care navigation firms who are incentivized to steer patients to the highest priced doctors do not have aligned incentives to reduce the costs of care. The only way to bring down the costs of care is to align goals between the patient, the provider and the employer. Only doctors can reduce the costs of care because only doctors can show the courage to replace legacy fee-for-service plans with bundled case rates, and publish them on their website so there are no surprises. And, Sam Walton knew all too well that it couldn’t only be about providing a more affordable solution, you must delight the customer. So, while I’m proud of our more cost effective solution, I’m most pleased to share that our average NPS (net promoter score) has stayed above 88 since inception – unheard of in the healthcare industry; and, our preliminary SART (Society for Assisted Reproductive Technology) data for 2021 across our network average for pregnancy rate per IVF transfer is 76% and our live birth rate is 58% compared to the national average of 51% and 44% respectively.
I grew up in a small town in North Carolina, the first in my family to graduate from college. We were at Walmart often. During the early months of the pandemic, I was again at Walmart often not only to shop, but to socialize and connect with my community. I was grateful to the cashiers and shelves’ stockers who worked tirelessly throughout the pandemic. Walmart provided hope, and a place to reconnect with my community, when other stores were closed.
When I think of Walmart, I think of Family. Community. Courage. Leader. I think of being a leader like Sam Walton who said, ”You can’t just keep doing what works one time, everything around you is changing. To succeed, stay out in front of change”. At Kindbody, we’re fortunate to have customers committed to leading from the front and who share our mission to unapologetically bring down the high costs of fertility and family-building care and improve service – making it transparent and friendly for all.
So today, I thank all of Walmart’s employees and leadership for selecting us to help you build the family you’ve always dreamed of. We know the responsibility you’ve provided us, and we do not take it lightly. And, to my twin boys, Dream big. Take chances. And, know that change takes courage.
This is my son Luke. He and his twin brother were born almost 12 years ago after multiple IVF cycles and draining our savings account. A lot has changed since […]
This press release was originally posted on Walmart. Walmart associates will have access to more than 30 state-of-the-art clinics across the U.S., including a new clinic in Northwest Arkansas BENTONVILLE, […]
This interview originally appeared on the Namely blog. In this interview with Dr. Fahimeh Sasan, Kindbody’s Chief Innovation Officer and Founding Physician, we explore what is included in fertility benefits, their […]
Interview with Vin DiDonna, Namely’s National Practice Lead, Benefits Consulting We know interest in fertility benefits has accelerated in recent years. What do you attribute this uptick in interest to? […]
Our Chief Revenue Officer Taryn Branca sat down with Dr. Angeline Beltsos, Kindbody’s CEO of Clinical, to discuss the metrics that matter most for employers when evaluating fertility benefits solutions. […]
Preimplantation genetic testing (PGT) of embryos is an additional step in the IVF process. The goal of PGT is to test embryos for a specific genetic condition or a chromosomal […]
