White Paper: The Fertility Field Mergers & Acquisitions (M&A): Frothy or the Next Frontier?

By Lisa Ditkowsky, CFP®

HEALTHCARE WATCH WHITE PAPER: FERTILITY
The Race To Go Global and to Win Big PE Multiples - with IVF / Donor Eggs / Third Party Reproduction

The Approx. $1B Genetics M&A Deal That Makes You Go Hmmm...

San Francisco private equity firm GI Partners announced a mammoth biotech and human genetics M&A deal June 16th worth approximately $1B. The $16B firm deployed capital into a fifth investment from its $2.8B GI Partners Fund. The fund paid $530M cash to buy Cord Blood Registry from publicly traded AMAG Pharmaceuticals, Inc. In an unrelated transaction, the fund acquired the companies of California Cryobank / Donor Egg Bank USA. GI Partners says it plans to merge the frozen sperm and donor egg bank with the AMAG Cord Blood Registry to create a life sciences company. The GI Partners’ epic acquisition is one of four deals valued more than $500M out of 255 ranked healthcare M&A deals in Q2 2018. Since GI Partners’ acquisition price of California Cryobank has not been disclosed, it is not possible to know the exact value that GI Partners placed on acquiring the combined donor sperm bank, Donor Egg Bank USA, and FamilyCord registry subsidiaries of California Cryobank.
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Chicago-based Golub Capital announced that it contributed $450M in senior credit facilities to back GI Partners in its acquisition of California Cryobank and Cord Blood Registry. In addition to capital from its own $2.8B GI Partners Fund, GI Partners also reported that Owl Rock Capital provided a third source of funding for the buyout. The debt provided by Owl Rock has not yet been made public, but the SEC requires public filings for Owl Rock’s retail-marketed non-traded business development company investment vehicles. Two years ago Reuters reported that private equity firms’ capital contributions to leveraged buyouts were nearing historic highs reaching 60 percent of the capital outlay in M&A due to “fierce competition from cash-rich corporate buyers”. Owl Rock states on its website that its $4.8B in loans range from investments of $100M to $500M. Together the three Capital firms’ investments in California Cryobank and Cord Blood Registry make for quite a rich deal.
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Cord Blood Registry is the largest cord blood bank in the U.S. with more than 500,000 cord blood and cord tissue units stored since inception. Cord blood banking carries promising implications for advancements in stem cell research and curing genetic diseases. Parents bank their newborns' cord blood for potential later personal use, destruction or donation to science.

AMAG Pharmaceutical's $530M Cord Blood Registry seems largely irrelevant and non-synergistic to growth objectives in the GI Partners separate acquisition of California Cryobank and Donor Egg Bank USA (a California Cryobank Company as of December 2016), except for combining the two entities’ cord blood banks into one. California Cryobank’s new combined cord blood bank announced on August 8, 2018 a discount of $1500.00 on cord blood banking for babies that are born from eggs and/or sperm purchased at California Cryobank. Yet, the cryobank only advertises about 500 sperm lots and 300 egg lots and can end the introductory offer at any time. BioInformant reports a drastic slowdown in parents using cord blood banking since the early 2000s and utilization rate of only 2.6 percent.  California Cryobank began banking cord blood in 1997 through its FamilyCord subsidiary. Customer educators at California Cryobank cite the size of FamilyCord as approximately 80,000 units of cord blood as of July 2018.  NovaQuest Capital Management and Longitude Capital first acquired the sperm bank and cord blood bank in 2014.
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Whereas cord blood banking is marketed to parents as a form of personal insurance against genetic diseases, frozen donor eggs and donor sperm are exclusively marketed to intended parents needing fertility and third party reproduction services.

California Cryobank started freezing donated sperm in 1977, and as of recently became one of a handful of sperm donor companies in the United States to advertise more than 500 sperm donor profiles at any one time. A man that passes screening and wants to donate a specimen will usually be encouraged to donate 2-3 times per week for a month and can earn about $100.00 or more for each quick and non-invasive effort.

Donor Egg Bank USA: The Little Egg Bank That Could

The SEC Form D shows that Donor Egg Bank USA, the brainchild of businesswoman, Heidi Hayes, was incorporated in Maryland (2011) and originally funded with an offering of $1.25M. Heidi Hayes worked as a regional executive director for IntegraMed America, Inc. and its member-clinic, Shady Grove Fertility, at the time of her lucrative brainstorm. Shady Grove Fertility COO, Mark Segal, and founding partner, Dr. Michael J. Levy backed Ms. Hayes's visionary frozen egg bank business plan and secured her a group of reproductive endocrinology limited partners.
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Heidi Hayes' big launch of Donor Egg Bank USA coincided presciently with the American Society of Reproductive Medicine (ASRM) lifting the "experimental" label from egg freezing. This Fertility and Third Party Reproduction development lead to the ability of Fertility Clinics and Surrogacy and Donor Egg Agencies to market to more young women compensation starting at approx. $7000.00 - $8000.00 for an initial cycle of medicated stimulation of the ovaries and surgical retrieval of up to dozens of human eggs. These donated eggs could then be chosen and purchased by infertile couples needing younger, healthier eggs than their own to have a baby.

The ASRM's lifting of the experimental label off of egg freezing opened the door for elective, social egg freezing. It likewise led to the eponymous egg freezing cocktail parties. Fertility benefits companies, such as Gina Bartasi's Progyny, Inc., appeared and offered employer-sponsored plans covering fertility and social egg freezing. While Shady Grove Fertility is a pioneer in treating infertility in America and performs social egg freezing cycles for women, Donor Egg Bank USA (now California Cryobank) focusses exclusively on marketing egg donation to young women so that infertile couples can choose from those young women’s frozen genetics (gametes) to make their own children.
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Heidi Hayes, Dr. Michael Levy and Mark Segal built Donor Egg Bank USA to the number of "egg lots" where she and the Shady Grove Fertility pioneers were able to bill and sell it as "The Largest U.S. Frozen Egg Bank". Not long after Donor Egg Bank USA had 150+ donor profiles (now 250+ and quickly growing via networked clinics), they were able to profit handsomely in a buyout by Longitude Capital and NovaQuest Capital Management. Harris Williams & Co. advised California Cryobank on its acquisition of Donor Egg Bank USA, announced December 16, 2016.
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Publicly available SEC and written information on the two private equity funds that bought Donor Egg Bank USA - combined with published statements by founder Heidi Hayes - indicate a deal valued at approximately $200M. Heidi Hayes told Inc. Magazine, "We didn't follow the traditional business rules to calculate the multiple of revenue. We priced the business for what we know its potential to be years down the road." Annual revenue of Donor Egg Bank USA (DEBU) at the time of buyout by California Cryobank was $17M. According to Fortune Magazine, "It is not uncommon in the private markets to see companies valued at 10x, 20x or even 100x revenue depending on the stage." The laws of compounding showcase nicely on early-stage, high-growth companies.
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Shady Grove Fertility Bails Out a Staid Sperm Bank with the First Frozen Egg Bank and All That "East Coast Jazz"

California Cryobank had tried unsuccessfully for years to add on a frozen egg bank to their frozen sperm bank, as evidenced by prior website marketing. California Cryobank's December 2016 acquisition of Donor Egg Bank USA (DEBU) would seem to be a match made in fertility heaven: if true that DEBU's success can indeed be sustained without the handholding and medical oversight of the asset-rich Shady Grove Fertility empire. In 2015, Shady Grove Fertility leased a 50,000 square-foot medical space in Rockville, Maryland and proceeded to build the largest and most technologically advanced IVF Lab and space in the United States. The IVF giants subsequently rolled out a similar state-of-the-art facility in Fairfax, Virginia and a full-service IVF office in Fredericksburg, Virginia. In July 2017, Shady Grove Fertility announced its expansion to Santiago, Chile. The fertility leaders have also opened in China in the past year and hired an essential Mandarin-speaking care team. China relaxing its one-child policy, and phasing it out in early 2016, propelled an even greater cascade of Chinese intended parents to seek Fertility treatment in the United States. In late July, 2018, China’s top health authority announced it is likely that China will soon change its laws to allow single women to utilize IVF medicine to boost the Chinese population. This would allow clinics such as Shady Grove more opportunity in China, though egg donation and gestational surrogacy would likely remain illegal in China. If single women are soon allowed access to fertility preservation (egg freezing) in China, the marketing of social egg freezing that has swept countries such as the United States and Japan, will likewise sweep China. Shady Grove Fertility will be a ready-and-waiting beneficiary.
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Shady Grove has added on a Canada program - Shady Grove Fertility Canada. Only altruistic egg donation and surrogacy are allowed in Canada, per Health Canada's 2004 Assisted Human Reproduction Act. So, Shady Grove Fertility has a Canadian Reproductive Endocrinologist (RE) on staff in the U.S. to oversee Canadian citizens undergoing donor egg treatment in the more favorably legislated USA. Shady Grove Fertility likewise facilitates a donor egg program by treating patients in the UK and Ireland.
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Shady Grove Fertility, a Fertility Centers of IL Doctor, and an IntegraMed America Employee Enjoy A Virtual Monopoly on International Fertility Financing

Shady Grove Fertility launched Access Fertility UK in October 2013 to replicate its related Arizona company, CapexMD. CapexMD was started by a relative of Shady Grove Fertility COO, Mark Segal. CapexMD is the Fertility Industry's leading Fertility Financing company.  The leading IVF clinic now markets international financing programs for its international IVF, Surrogacy and Donor Egg treatments. It uses Arizona company CapexMD (founded by Jules Segal) to offer fertility financing to U.S. patients. UK news source iNews reported in August that Access Fertility UK already has 60 partner IVF clinics around the UK. The news article said that in August, Access Fertility UK launched a program that it said would “change the face of the sector”. The Shady Grove founders are guaranteeing an IVF baby within two years for one set fee or a 100 percent refund of costs, within program qualifications.
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A winsome foursome's Access Fertility in the UK is quickly succeeding in becoming the international leader in Fertility Financing programs. The two Shady Grove principals, Mark Segal and Dr. Michael J. Levy are owners. IntegraMed Fertility partner, Dr. Brian Kaplan - the world-famous reproductive endocrinologist at Fertility Centers of Illinois - is also an Access Fertility Management Limited UK partner. The fourth partner of Access Fertility Management Limited UK is IntegraMed America’s Director of Strategic Initiatives, Pamela Schumann. IntegraMed America is a healthcare management company backed by Sagard Capital / Sagard Holdings, a subsidiary of publicly traded Power Corporation of Canada (TSE: $POW). Power Corp states, “Sagard Holdings holds a 91.6% interest in IntegraMed.”
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The Shady Grove Fertility principals incorporated Access Fertility Limited UK, along with Access Fertility Management Limited UK, in October 2013. The ownership difference is that incorporation papers for Access Fertility Limited UK do not have Dr. Brian Kaplan and Pamela Schumann involved. Instead, Mark Segal and Dr. Michael Levy have a young British man, Ashley Craig Carroll-Miller as a third Director and CEO.  Annual reports through 2016 show that Access Fertility Limited company assets and cash on hand ballooned from approx. $3M to well over $6M between 2015 and 2016. Projected to today, cash on hand could be close to $20M, because their debt is so low and demand for IVF and Human Reproductive services is so high. “Related Party Disclosures” for Access Fertility Management Limited’s Financial Statements through 12/31/16 state: “Loans were made to Access Fertility Limited, a subsidiary of the company. No interest was charged on these loans. At the balance sheet date, the amounts due from this subsidiary were £4,218 (2015: £3,768).” International fertility financing is a part of the fertility economic frontier where Americans Dr. Brian Kaplan, Dr. Michael J. Levy, IntegraMed insider Pamela Schumann, and Shady Grove's Mark Segal enjoy a virtual worldwide monopoly. The partners and their members fund the patient fertility loans with their own capital, so the interest rate spread is not going to an outside lender. They "deposit" the funds directly to their buy-in partners' fertility practices - seamless.

Since Shady Grove Fertility’s 2013 UK incorporations, the Shady Grove duo of Dr. Michael Levy and Mark Segal have gone on to incorporate 4 additional UK-related companies. On 12/1/16, The Access Fertility Group incorporated Fertility Finance Limited. At the helm is 34-year-old Danny Aaron Girnun, also South African. Mr. Girnun is likewise the Director of Merchant Money Limited, the majority owner.

Through July 2018, Shady Grove Fertility has incorporated three brand new UK companies this year. Access Fertility Building Limited was created for “buying and selling of own real estate” and is owned one share by Access Fertility Limited and one share by Ashley Craig Carroll-Miller. Access Fertility Ireland Limited shares the same ownership, as does Access Fertility International Limited; with Access Fertility Limited maintaining greater than 75 percent control.
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The fertility business world is closely watching where these Untouchables - the three South African golden boys of human reproduction - are swimming upstream next. As the Shady Grove Fertility empire follows suit with IVI Spain, which bought Reproductive Medical Associates of New Jersey last year, and continues to expand globally, Fertility Financing will be needed globally, across currencies. IVI-RMA is the largest Assisted Reproductive Technology group in the world. RMANJ, interestingly, refers LendingTree to patients and uses IntegraMed Fertility’s own Attain IVF / Attain Fertility programs. They also use a fertility lending consolidator called ARC (Advanced Reproductive Financing) with different packaged loan programs from a variety of lenders.
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The most streamlined and integrated Fertility Financing solutions, however, are CapexMD and Access Fertility Management Limited UK, founded and funded by The Shady Grove founders, Dr. Brian Kaplan and IntegraMed's Pamela Schumann. Due to the platform-user having to buy-in to offer CapexMD and Access Fertility Management Limited UK’s lending programs, loans are coming straight from the Fertility financiers to the Fertility clinics. There are no outside lenders. This model could easily be expanded across the globe as fertility practices grow and develop internationally. Any other entity offering fertility financing to clinics' patients is not going to have the built-in relationship with the physician lenders and patient borrowers. These extremely personal relationships with both provider-lenders and patient-borrowers create a captive banking system, similar to a captive insurance company often used by family offices and institutions such as hospitals. CapexMD and Access Fertility UK enjoy a competitive advantage as a result of this innovative lending model.

It should be noted, however, that, while not fertility specific, employer-sponsored retirement plan loans, non-purpose loans against securities accounts, current HELOCs and intrafamily loans likely have more favorable terms and much lower rates.
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Definition of Genius:  Flipping an Asset Twice and Still Owning Its Twin At the Same Time

GI Partners may not understand the steepness of the uphill climb post Private Equity (PE) deal with California Cryobank / Donor Egg Bank USA. There will no longer be Shady Grove Fertility kingdom to hold Donor Egg Bank USA's hand steady. Shady Grove Fertility has its own cloned proprietary version of Heidi Hayes' frozen egg bank vision to attend to and cultivate. The SGF “Egg Donor Database” website link refers to its in-house proprietary egg donor program as “The Largest Egg Donor Program in the Nation”.  It is interesting to consider that the whole Donor Egg Bank USA is virtual (networked clinics). Relatively quick returns were made to the original contributors of the $1.25M to the tune of about $200M by NovaQuest Capital Management and Longitude Capital. Now, 18-20 months later, GI Partners is cashing out the partners yet again, likely for up to $500M - for a virtually networked egg bank, sperm bank, a modest cord blood registry, and a business plan. Since 2012, there is abundant competition in the donor egg marketplace. It’s just that donor sperm banks have been in existence since the 1970s, and donor egg banks have only really started marketing since the American Society of Reproductive Medicine (ASRM) lifted the experimental label from egg freezing in October 2012.
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GI Partners has potentially paid hundreds of millions of dollars for a collection of clinics' frozen eggs that are only connected by Donor Egg Bank USA / CA Cryobank arranging shipping and giving some guarantees. It may be difficult for a limited number of many different clinics' frozen eggs to generate a return on investment. This, in particular, is because success of an egg donor program depends on continual high-volume recruitment of young egg donors. If most of Donor Egg Bank USA's donor egg lots were resulting from the Shady Grove Fertility collaboration, once Shady Grove withdraws, egg donor recruitment becomes a wildcard. It is nebulous how exactly a virtual network of clinics and labs will grow their own donor egg programs. Frozen Egg Bank Network (FEBN) - the Donor Egg Bank USA startup subsidiary created to virtually network national clinics’ frozen egg programs – has appeared to take down its website. FEBN’s 2016 press release states that the new subsidiary was necessary to address serious quality gaps in egg vitrification (freezing) standards in the gamete marketplace. The seemingly shuttered training and quality control subsidiary of Shady Grove-executive-founded Donor Egg Bank USA would have put the highly respected Shady Grove Fertility founders’ seal of approval on all databased egg lots. Donor Egg Bank USA was, in essence, a Shady Grove Fertility egg bank twin sister until Longitude Capital and NovaQuest Capital Management acquired it. In the past 20 months, a virtual network of clinics was added to DEBU, giving the appearance of scale. The actual quantity of donor eggs and epigenetic diversity is lacking. There is always a severe shortage of ethnically diverse egg donors - especially Jewish and Asian egg donors, tall, height-weight proportionate egg donors, educated egg donors, talented egg donors, etc.
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How will GI Partners get a return on California Cryobank's Donor Egg Bank USA and continually recruit egg donors from a scattered compilation of a limited number of many different clinics' frozen egg programs? Shady Grove Fertility’s robust medical and scientific infrastructure was an enormous advantage to Heidi Hayes building out the world’s first ever frozen donor egg program / bank, alongside SGF’s first ever fresh / frozen donor egg program. This enabled the pioneers to build their own Shady Grove Fertility egg bank right alongside Donor Egg Bank USA. SGF advertises its exclusive “Shared Donor Egg Program” and “Shared Risk 100 Percent Refund Program” on its website. The Fertility pioneers are able to use frozen eggs from a single donor in their proprietary database to make babies for 2-3 families, driving down the potential cost of IVF treatment per family. Eligibility for these Shady Grove Fertility guarantee programs is based on the eggs and/or embryos having been cryopreserved at a Shady Grove Fertility laboratory only. This spurs an interesting financial question: How many of California Cryobank’s / Donor Egg Bank USA’s 327 ‘egg lots’ as of 08/04/18 inventory were retrieved at Shady Grove-owned and run labs, and are only these genetic profiles deemed superior and eligible for all the “Shared Risk” and Guarantee financial programs? Going forward, will California Cryobank be able to offer all the same Shady Grove Fertility-developed “Shared Risk” and Guarantee financial programs regardless of where California Cryobank acquires new egg donors?
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California Cryobank bundled themselves for acquisition along with 555 sperm donor lots. Collectively, the company's eggs and sperm represent the genetics of only about 800+ humans. California Cryobank's Donor Egg Bank USA - a relatively new entity - will have to keep proving its ability to recruit young egg donors year after year amidst a growing field of competitors competing in “red-ocean space”. The explanation for Donor Egg Bank USA remaining steady at 250+ egg donors in the 18 months, since the first acquisition, is by adding separately owned clinics to its branded network. Since the GI Partners acquisition, the frozen egg bank donor lots has increased to 327 donor profiles as of 8/04/18, perhaps rapidly consolidating its networked Fertility clinics’ egg donor programs resultant of GI Partners’ definitive agreement to purchase the entity.

However, signing fertility clinics onto the California Cryobank / Donor Egg Bank USA brand name is not organic growth. DEBU has simply partnered with clinics (some of whom contribute their own scant donor egg lots to the "numbers"). Donor Egg Bank USA can arrange cryogenic transport between labs in their network. For this development, GI Partners cashed out the egg bank partners a second time in 18-20 months. GI Partners' press release states the pending life sciences company will serve 600K families in 30 countries - "The two best-in-class companies will join to serve nearly 600,000 families across more than 30 countries." Yet, they only have 327 egg lots all here in the U.S. 500K comes from the number of cord blood and tissue samples - wholly unrelated to IVF. California Cryobank is also quoted as saying its sperm donors have resulted in 75,000 live births globally since 1977. California Cryobank does not report any live birth statistics on the hundreds of egg donors it has recruited since 2012. Past press releases cite only numerical milestones of embryo transfers from dozens of clinics combined.
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People who depend on egg donors for their fertility are hoping that Donor Egg Bank USA can anoint Heidi Hayes "The Easter Bunny" and actually see all the carefully crafted California Cryobank / Donor Egg Bank USA press releases materialize into multiples (PE multiples). The ability to coax young women to endure an invasive, not-without-risk, one-month process in droves is the big, unanswered question mark. What does it really take to convince genetically desirable young women to undergo the invasive, surgical egg donation process for a modest paycheck? There are no proven long-term risks to egg donation, but does that mean there won't be any?

Progyny founder Gina Bartasi launched her latest “Blue Ocean Strategy” in August 2018 (a marketing strategy by which one carves out clear and uncontested ocean waters amidst a red field of blood-thirsty competitors). Bartasi’s startup, Kindbody, aims to transform the conversation around Fertility and women’s reproductive health. Kindbody has launched with pop-up Fertility “clinics” in yellow mobile trucks, doing to Fertility what food trucks have done to lunch for millions. A few years ago, MIT AgeLab helped determine that 47 percent of Millennials have patronized a food truck. As of 2015, there were more than 83 million Millennials. Millennial women comprise the majority of the market for egg freezing and all of the market for donor eggs, as the health of a woman’s eggs deteriorates in one’s 30s and rapidly after 35. Bartasi clearly saw that for the past 5 years, Fertility clinics were doing the same “egg freezing cocktail parties” over and over with limited success and turnouts. So, she decided to change it up and arm women with on-the-go Fertility information instead of lubricating them with after-work alcohol. On Kindbody’s yellow truck’s first afternoon in Manhattan, Bartasi proved that a bartender does not equal a marketing plan. 150 interested women signed on for free Fertility testing and a follow up treatment plan.
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On August 8, 2018, Cryos International and CAN-AM Cryoservices announced a business arrangement by which Cryos International’s USA headquarters in Orlando, Florida, would make their frozen egg bank available to Canadians via CAN-AM Cryoservices. The BusinessWire news release calls Cryos USA “the only freestanding, independent egg bank in the United States” and states that all donor selection, surgical retrievals and oversight is done at the egg bank itself. The release specifies their “excellent statistics” and provides data. For the past 2.5 years, Dr. Mark Trolice has been the RE managing the egg freezing program for Cryos USA. The Cryos USA frozen egg bank lists 133 donor egg lots as of August 12, 2018.
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Research N Reports released a "Global Donor Egg IVFs Market Research Report Forecast to 2025". In a preview of the QYResearch March 2017 report, it lists "Shady Grove Fertility" and "Donor Egg Bank USA" as key competitors in the global vendor market for fresh and frozen donor eggs. While QY Research is trying to sell the report for $3300 to $6600, it is already 18 months old, and totally out of date. Absent is the Canadian market, as well as the Latin American market, since opened wide up by Shady Grove Fertility, CAN-AM Cryoservices and Cryos International. Absent is any mention of Prelude Fertility's "My Egg Bank" as a key global competitor, and Martin Varsavsky is an Argentine entrepreneur who has successfully entered the U.S. Fertility market and is on a major acquisition spree.
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The multi-billion dollar question will remain to be if any other egg freezing and donor egg bank / programs can compete with Shady Grove Fertility’s robust domestic and international fully medical infrastructure.

Shady Grove Fertility's Proprietary Egg Bank Grew Bigger Than Their Now Twice-Acquired Donor Egg Bank USA

Shady Grove Fertility's proprietary egg donor program / bank, which their website states gets more than 300 donors a year from more than 10,000 applications, was replicated alongside Donor Egg Bank USA. Shady Grove Fertility has 44 physicians in 32 offices to recruit their 300+ egg donors a year. If a realistic recruitment rate for egg donor applicants is their 3 percent, and it takes roughly 30 fertility clinic offices across the country to reap Shady Grove Fertility 300+ egg donors per year, recruiting egg donors is hard, very hard. It remains a complete unknown how California Cryobank will recruit egg donors without Shady Grove Fertility's national/international clinic structure and extensive national/international oversight and marketing to young women.
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Shady Grove Fertility’s UK website marketing cites 18,000 of their own egg donor applicants per year with a 3 percent acceptance rate. SGFertility Chile specifies that 15,000 egg donor applicants apply per year with a 3-4 percent acceptance rate into the program.
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It is highly likely that Shady Grove Fertility will eventually attempt a $1B deal with its own already international egg program / bank. This is because, at current, there are high barriers to entry via an elite medical specialty, lopsided egg donation laws favoring the United States, and the competition is just in its infancy. The Fertility sector - and in this case, egg extraction, donation, technicalities of vitrification, cryogenic storage and cryogenic transport - is new to Private Equity. For example, the UK’s 10-year limit on the cryopreservation of women’s eggs is already igniting bioethical debates and preventing women from using their own frozen eggs at the very time they may most need to thaw them to create embryos for IVF. If PE understood the nuances of egg vitrification, GI Partners would have gotten the Shady Grove Fertility egg bank along with the Donor Egg Bank USA that the Shady Grove Fertility partners financially backed for Heidi Hayes. It is an unlikely and unusual scenario for a company to sell an asset to private equity but retain an even better "same" asset still attached to their own Fertility empire. Now, that the GI Partners’ acquisition of California Cryobank closed on August 6, 2018, Shady Grove Fertility profits massively and still retains its own, bigger, better competing egg program / bank. "Genius" is a word that comes to mind. Shady Grove CEO Mark Segal is the man the moniker fits.
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It will be riveting to follow future mergers and acquisitions in this new and ever-so-green healthcare sector – fertility / human reproduction / embryology / genetics.

Shady Grove Fertility and Entrepreneur-Award Winner CEO, Mark Segal: On Expansion and Acquisition Spree in Assisted Human Reproduction and Sciences

Shady Grove Fertility touts 44 physicians in 32 offices throughout Maryland (its flagship location), Pennsylvania, Virginia, Washington D.C., Georgia and Florida. When Shady Grove Fertility bought Georgia Reproductive Services in July 2017, to give it a foothold in Atlanta (nearer its Santiago Chile subsidiary), CEO Mark Segal said more Mergers and Acquisitions are possible. He also stressed interest in partnerships. The Atlanta practice acquisition brought total Shady Grove employees to 800, and rapidly growing.
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Mark Segal's LinkedIn profile states that he worked as Regional President of IntegraMed America from 1998 through June 2015. In 2015, Shady Grove Fertility used its clout to walk from IntegraMed America, its physician practice management company. It is during the following 2-3 years that, while independent, Shady Grove rapidly expanded domestically and internationally. Shady Grove Fertility's Santiago, Chile location, SGFertility Chile, is its fully operating South American stronghold. SGFertility Chile has a robust egg donor program aligned with Shady Grove Fertility in the U.S., and it advertises California Cryobank’s sperm bank for South American patients. Shady Grove Fertility's China operations are robust, as are their egg donor programs with the UK, Ireland, Canada and South America. The fertility giants remain ready to pounce when Canada changes its reproductive laws, when/if Spain allows surrogacy, and when much other restrictive global human reproduction legislation updates. Even in the United States, only four states do not allow paid surrogacy (MI, NY, WA and LA; but WA will change to allow paid surrogacy on 1/1/19). Couples from all over the world come to the United States for IVF because of the United States' favorable reproductive laws. All babies born in the United States via IVF and third party reproduction to foreign parents become U.S. citizens, which makes the U.S. an especially popular fertility tourism (cross border reproductive care) destination. Fertility treatment might be cheaper in places like Barbados, but the price of American citizenship is priceless to many.
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While apart from IntegraMed America and having sold off Donor Egg Bank USA, Shady Grove Fertility could fully develop its own frozen Donor Egg Bank program, and it did. During Shady Grove's leave of absence from the IntegraMed America management, it permitted them to sweeten their "on paper" appeal for likely acquisitions of assets within the Shady Grove Fertility asset kingdom. Much of the Shady Grove Fertility empire sits legally protected by international and domestic corporate structures far outside the reach of IntegraMed America / Sagard Capital / Power Corporation of Canada. For example, IntegraMed Fertility confirmed that it has no ownership in the Access Fertility UK conglomerate of corporations. IntegraMed/Sagard/Power Corporation of Canada employee, Ms. Pamela Schumann, however, owns shares in Access Fertility Management Limited UK.

On March 11, 2015, Shady Grove Fertility incorporated Shady Grove Fertility Inc. in Delaware. Then, on January 4, 2016, Shady Grove Fertility incorporated Shady Grove Fertility, LLC in Maryland at the new 50,000 square-foot IVF Center in Rockville. Prior to these two new United States corporate structures, they were operating their Shady Grove Reproductive Science Center, P.C. - owned by Shady Grove Fertility Center – and still active. On July 30, 2018, Shady Grove Fertility CEO, Mark Segal, appeared on NBC 4 Washington. Right beside him, a large binder reads, “CLOSING DOCUMENTS FOR SHADY GROVE FERTILITY CENTERS INTEGRAMED AMERICA INC. TRANSACTION”. The closing funds flow in Private Equity can be filled with a plethora of closing documents between multiple parties. For now, Shady Grove Fertility still has many of its domestic IVF centers listed on the IntegraMed website. However, it has also already separated off many other domestic IVF clinics, all its international operations, and has created the brand new Delaware and Maryland corporate structures independent of IntegraMed America.
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More recently, Shady Grove Fertility's U.S. clinics, minus their Latin-America touchpoint Atlanta, new Tampa, FL clinic, 2 other Georgia clinics, Philadelphia, PA clinic, Silver Spring, Maryland clinic, Richmond, VA clinic and Fairfax, Virginia clinic, re-appeared on the IntegraMed website as managed by IntegraMed. The IntegraMed website does not indicate that IntegraMed owns any of Shady Grove Fertility’s global financing companies, newer corporate entities, frozen donor egg bank, international donor egg programs, international fertility companies, Florida IVF Center, Atlanta IVF Center or six of their other domestic locations. IntegraMed headquarters would only recently confirm that it still has an "economic relationship" with Shady Grove Fertility – a vague statement. It does not appear that the largest U.S. Fertility Clinic group, Shady Grove Fertility, would any longer need a physician management company, since it has successfully built out Chile and South America, China, Canada, Europe, Georgia, Florida and six of its other domestic clinics on its own management merits.
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The Chairman of the Board of IntegraMed Fertility is 44-year-old Samuel D. Robinson. Robinson's LinkedIn profile lists him as "Chairman of the Board of the leading North American Fertility center network, a private company controlled by Power Corp of Canada". Likewise, Paul Desmarais III of PowerCorp, and the Desmarais billionaire family of Canada, serves on the IntegraMed Fertility Board. Robinson is Managing Partner and President at Sagard Capital. Desmarais is Managing Partner and Executive Chairman at Sagard Capital. The two investors appear to comprise the entire Board of IntegraMed Fertility, as Bill Hughson (listed as Vice Chairman of the Board), Anil Shrivastava (listed as Board member and a Sagard Partner) and Rick Pfenniger (just listed as a Board member) no longer hold any IntegraMed or Sagard roles, according to their LinkedIn profiles.
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IntegraMed America is listed on LinkedIn under “Management Consulting”. GP Strategies Corporation ($GPX) is Power Corp’s other related “Management Consulting” company. While listed on its website as a global management company serving Fortune 500 companies, GP Strategies, with an approx. $300M market cap, seems to just make acquisitions. Its recent Form 8-K filed with the Securities and Exchange Commission on June 29, 2018 said of its new Financing and Credit agreements, “The Credit Agreement is secured by substantially all of the Company’s assets.” Hence GP Strategies discloses its near 100 percent leverage. According to Investopedia, “No more than half of (a) company’s assets should be financed by debt”.
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Notably, The Florida Recorder reported on August 13, 2018, “Sagard Capital Partners Management invested 85.49% of its portfolio in GP Strategies Corporation (NYSE: GPX).” Its stock is approx. 40 percent off its 52-week high as of August 16, 2018. On August 15^th, 2018, GP Strategies announced new Board Members. Prior to August 15^th, Samuel D. Robinson held powers as a member of GP Strategies Executive Committee, Compensation Committee, Nominating Committee, Corporate Governance Committee and Audit Committee. As of August 15^th, Robinson has had those Committee positions revoked and is now called an “Independent Director” of the Board. Independent directors, when even appointed to Boards, serve a more administrative and communications, impartial role. When considering that IntegraMed was purchased by Sagard Capital in 2012 and heavily financed by Golub Capital, that the company has recently lost its General Counsel, CFO and three Board members, it is worth considering that IntegraMed is also a likely acquisition target. IntegraMed’s financials, from the parts that are public, indicate that the company could be acquired at a discount during its current troubles. If Shady Grove Fertility accounts for approx. 40 percent of IntegraMed’s human capital, Shady Grove Fertility may be a potential buyer of IntegraMed. Shady Grove Fertility has more than proven its ability to grow internationally without a Management Consulting company, growing its egg donor and third party reproduction programs internationally. A Shady Grove Fertility acquisition of IntegraMed’s owned and managed clinics would make sense in light of all the position vacancies at IntegraMed headquarters. Once acquired, Shady Grove would manage HR and could use its own lawyers to do Mergers and Acquisitions within the IntegraMed clinic groups, keeping clinics that synergize with their Shady Grove Fertility culture.
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Shady Grove Fertility recently added its brand new Tampa, Florida IVF Center to its locations after advertising job board postings and announcements this year on the big Tampa, Florida project. Shady Grove Fertility Tampa is helmed by new Shady Grove hire, Dr. Celso Silva. Dr. Silva is South American with Florida training and experience. Tampa, along with Atlanta and Georgia locations, are two extremely desirable fertility tourism (cross border reproductive care) destinations in good proximity to Latin America. SGF Tampa Bay – Westshore is likewise excluded from IntegraMed locations. It should also be noted that while the media continues to discuss “Fertility Tourism”, the global professional human reproduction and embryology community prefers the terminology “Cross Border Reproductive Care”. On August 2^nd, Shady Grove Fertility came out with their big Florida press release and said, “This location also expands SGF’s donor egg treatment and gestational carrier programs, creating access for egg donor recipients and for patients needing a gestational carrier traveling from South America.” The press release states that SGF is building a full IVF Fertility center in Tampa Bay and implies that more Sunshine State Fertility locations are in the works.
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Two facts stand out on the IntegraMed America / IntegraMed Fertility job board page. First, Fertility Centers of Illinois, an IntegraMed-managed, Sagard/Power Corp-owned IVF clinic group, has approximately 20 open positions, most for critical roles or positions in which employees have left. Secondly, IntegraMed Fertility clearly does not manage any of the hiring for Shady Grove Fertility, which makes it even less clear why Shady Grove Fertility retains any affiliation with the struggling management company. IntegraMed America has experienced high recent turnover rate at both its New York headquarters and at Fertility Centers of Illinois locations. On August 8^th, 2018, IntegraMed announced that it’s only Connecticut Fertility location, CT Fertility, will be closing down on October 31, 2018.  25 years of patient volume will only have until December 31^, 2018 to find a new storage facility for their eggs and embryos. Just two years ago, IntegraMed opened a Barcelona, Spain office to complement its New York and Connecticut offices for third party reproduction specialist REs working for its CT Fertility. If an IntegraMed exodus continues with Shady Grove Fertility, IntegraMed Fertility will effectively lose human capital of approximately 40 percent.
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Power Corporation of Canada’s earnings release through 2^nd quarter of 2018 only lists IntegraMed’s adjusted net earnings in “Corporate and Other Subsidiaries”, which lost $156M through Q2 2018, trailing a $153M loss through Q2 in 2017. Yet, Power Corporation also lumps newspapers and sustainable and renewable energy investments under “Corporate and Other Subsidiaries”, so it is not possible to know if IntegraMed specifically is running at a net loss or if newspapers and renewable energy investments are dragging the category so negative. Newspapers, however, generally do not keep publishing at big losses. In 2012, IntegraMed was still publicly traded before Sagard Capital took it private for approx. $170M. From 2012 IntegraMed financial reports, it appears that IntegraMed’s Fertility centers brought in approximately $100M in revenue for the first half of 2011 and approximately $100M in revenue for the first half of 2012. Net income for the same periods, including their vein clinics at the time, averaged approximately $1.5M. Regardless, Fertility is a booming global healthcare sector, and Sagard Holdings is well-positioned to support IntegraMed, as Sagard Credit Partners has almost closed its fund targeted at a $500M capital raise. Golub Capital provided $95M in debt financing, along with making an equity co-investment in the 2012 Sagard Capital purchase of IntegraMed America. With Golub’s just-announced $450M debt financing of GI Partners’ California Cryobank purchase, Golub Capital once again makes a newsworthy risk-reward investment on Fertility and human reproduction.
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Mergers and acquisitions and private equity deals have been heating up the past couple of years in global Fertility and genetics. Interestingly, on July 16, 2018, IntegraMed USA’s General Counsel in charge of M&A for IntegraMed Fertility, Gregory Radke, announced he was stepping down from his almost 5 years at IntegraMed. Attorney Gregory Radke’s LinkedIn states that he “oversaw all legal matters plus expansion strategies, M&A transactions, human resources, risk management, and medical malpractice insurance while serving on related company boards.” IntegraMed Fertility CFO John McDonough was also terminated or left in April 2018. The whole IntegraMed USA network is under the current financial watch of an interim CFO. There is much uncertainty at IntegraMed Fertility headquarters amidst a major $11.2M expansion project in the Chicago suburb of Glenview, IL in an exclusive area known as “The Glen”. The Glen community sits in Cook County, IL, with property taxes ranking 2^nd highest in the entire nation. Commercial properties are assessed even higher. IntegraMed’s Fertility Centers of IL also lost its Director of the FCI Center for Collaborative Reproduction, Julie Lasch Wiese, R.N., in July, 2018. As an almost 17-year Fertility Centers of IL veteran infertility nurse executive, Julie Wiese left a position supporting one of the busiest third party reproduction REs / teams globally. Dr. Brian Kaplan and his army of nurses was skillfully lead by Ms. Wiese, who inexplicably left one of the busiest REs in the world for unemployment, and her LinkedIn says she is looking for a similar job. IntegraMed is currently trying to fill her critical position for Fertility Centers of Illinois.
57, 58, 59, 60, 61, 62, 63, 64

Shady Grove COO, Mark Segal, is playing a game of cat and mouse with Prelude Fertility’s Martin Varsavsky. Varsavsky’s aggressive acquisition pace, is forcing leaders in the Fertility healthcare sector to change their game. Varsavsky finalized his merger with fertility practice management company, Viviere Health, in December 2017. Shady Grove Fertility realigned in some capacity with its old prior long-time partner, IntegraMed America. IntegraMed America redesigned its website to separate off IntegraMed Fertility from its Vein Clinics of America and Women’s Diagnostic Imaging clinics. IntegraMed America is now simply IntegraMed Fertility. Power Corporation of Canada’s 2018 financial reports state, “Vein Clinics of America was disposed of on December 29, 2017”. Martin Varsavsky is trying to be to Fertility what Nicholas Schorsch was to the Brokerage industry – an asset eater. Shady Grove Fertility is picking up its M&A mode and geographic expansion plan to keep pace with Varsavsky. Varsavsky is an Argentine entrepreneur, so Shady Grove Fertility should feel the heat in Latin America, the U.S. South and parts of Europe, such as PE hub, Spain, which hosted the European Society of Human Reproduction and Embryology’s 34^th Annual Meeting in Barcelona, Spain July 1^st-4^th, 2018.
65, 66, 122, 123

The M&A Poker Game: Shedding Some Light on Where Shady Grove Fertility Grows From Here

A Chicago, IL middle market investment banking firm, Dresner Partners, published a June 2018 Healthcare Newsletter focused on the Fertility sector. It centers on consolidation in the Fertility clinic space. Dresner Partners has recently represented top sellers in some seismic acquisitions. Dresner represented RMANJ (Reproductive Medical Associates of New Jersey) in its merger with IVI Spain, creating 70 clinics across 13 countries.
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In October 2016, a serial global entrepreneur, Martin Varsavsky, used some of a $200M investment from Lee Equity Ventures to buy an IVF clinic and a donor egg bank. Martin Varsavsky acquired Reproductive Biology Associates (RBA) along with My Egg Bank in Atlanta to create Prelude Fertility. Varsavsky has since moved swiftly to acquire Viviere Health, Advanced Fertility of Chicago and San Francisco-based Pacific Fertility Center. Dresner Partners represented Advanced Fertility of Chicago in its sale to Prelude Fertility.
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Dresner also represented IGENOMIX, a Fertility genetics company, in its sale to European private equity firms. IGENOMIX was started as an extension of IVI Spain and first bought by Private equity (including Charme Capital Partners) in August 2016.
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Dresner Partners' June 2018 Healthcare newsletter says that Dresner is "Representing a Midwest Fertility clinic group in its pending sale." There is one Midwest Fertility ‘clinic group’ (the biggest non-hospital program in the Midwest) trying to restructure to ready itself for sale - Fertility Centers of Illinois.
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There are two jaguars in the Fertility sector, both vocal about wanting to swoop up fertility practices - Shady Grove Fertility's Mark Segal and Prelude Fertility's Martin Varsavsky. Whereas Martin Varsavsky comes from other industries, Mark Segal is one of the original "godfather" creators of the fertility industry. Martin Varsavsky is an outsider. Mark Segal is the ultimate insider - already working with Fertility Centers of Illinois and IntegraMed America across various published business deals and economic alliances.

Fertility Centers of Illinois, as indicated by asterisk on the Centers for Disease Control and Prevention Assisted Reproductive Technology (CDC ART) report, has undergone "reorganization" and is undergoing one since the last published ART reports (2015). Fertility Centers of Illinois has experienced a mass exodus of reproductive endocrinologist (RE) talent and staff since 2013. So, there exists reason to want to cash out the current practice at big PE multiples, if possible. Beloved RE, Dr. Kevin Lederer, passed away in January 2013. Dr. Lederer, President and Managing Partner, passed around the time that a founding partner, Dr. Aaron Lifchez, retired. Fertility Centers of Illinois’s two most successful women REs quit to launch and helm competing Fertility centers in the summer of 2016. Dr. Angeline Beltsos made a big splash with her multi-state Vios Fertility Clinic. Dr. Angeline Beltsos is the founder and Medical Director of her all-women RE Fertility clinic with labs and locations throughout IL, WI and MO. Dr. Beltsos has a male urologist and reproductive health doctor on staff too, making her practice somewhat unique.

Dr. Beltsos runs the not-for-profit Midwest Reproductive Symposium International and is on the scientific advisory board of Viviere Health. She is respected internationally and one of the most connected and high-energy reproductive endocrinologists in the world. Dr. Beltsos was formerly the Medical Director at FCI River North, as well as the Medical Director of FCI’s contracted lab in Highland Park, IL, aParent IVF. Dr. Eve Feinberg left Fertility Centers of Illinois to become the Medical Director of Northwestern Medicine’s Fertility programs. As Northwestern’s Fertility program is hospital-affiliated, it is much different than the independent clinics being snapped up by private equity. Top Fertility doctor Eve Feinberg is in high demand with an approximate 3-month long waiting list. Northwestern Medicine’s Fertility and Reproductive Medicine is led under Dr. Eve Feinberg’s medical direction in both Chicago and Highland Park, IL. The two RE female powerhouses of Dr. Beltsos and Dr. Feinberg - and their respective teams – are capturing a lot of the footprint of Chicago and Chicago’s Northshore. Chicago, IL is an internationally respected fertility care destination.
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In August 2018, Northwestern Medicine’s Dr. Lauren Streicher interviewed Dr. Feinberg on Facebook Live. In the video Dr. Streicher speaks of being “blown away” by how well Northwestern Medicine Fertility is doing when Dr. Feinberg recently presented the numbers to Dr. Streicher’s department. About 9 minutes and 26 seconds into the video, the women physicians are speaking about celebrities and how women in their mid 40s and even 50s are having babies. They repeat, “Donor Eggs” about six times. Inevitably the terminology “Donor Eggs” will become more commonplace vernacular as women delay childbearing and word spreads about Third Party Reproduction resources. Recent market research reports confirm that the Donor Egg marketplace will continue growing.
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After losing four of the top five REs, Fertility Centers of Illinois began closing down locations and eventually hired three young REs and consolidated. Fertility Centers of Illinois’ ace in the hole has always been its sole remaining founding partner, Dr. Brian Kaplan. Dr. Brian Kaplan is one of the busiest and most successful Fertility doctors in the world. His biography describes this South African RE as having one of the largest international third party reproduction practices. Due to the sheer volume of IVF cycles performed by Dr. Brian Kaplan and his unparalleled and disciplined work approach, IntegraMed America has always allowed Fertility Centers of Illinois to contract a separate and independent lab for Dr. Kaplan - aParent IVF Laboratory in Highland Park, IL. The other 10 Fertility Centers of IL REs all shared one FCI-owned lab at FCI River North. Prior to founding Vios Fertility, Dr. Angie Beltsos was partnered with Dr. Kaplan and also worked out of aParent IVF Laboratory. She supported Dr. Brian Kaplan’s ample international Fertility practice and her own busy IVF practice. Since losing their superwoman, Dr. Beltsos, Dr. Lawrence Jacobs (69) has been supporting Dr. Brian Kaplan’s practice at the aParent IVF lab. Still, it is logical that 40 percent of the IVF cycles performed annually at FCI are performed by the globally acclaimed Dr. Brian Kaplan. 2016 SART (Society for Assisted Reproductive Technology) data places FCI’s aParent IVF’s 2016 IVF cycles at 2409 and FCI River North IVF Cycles at 3198. The rest of FCI’s physicians, other than Dr. Brian Kaplan, are either just building practices or they have unremarkable patient volume. The CDC website also wrongly still lists Dr. Angeline Beltsos as being Medical Director of the IntegraMed contracted aParent IVF Laboratory, but the SART website has it updated with Dr. Brian R. Kaplan. To the contrary, Dr. Beltsos is currently Medical Director of her own company, Vios Fertility. Thus, aParent IVF has also been forced into restructuring too, just as Fertility Centers of IL River North. The Fertility Centers of IL Highland Park restructuring is not accurately annotated on the CDC government website since the RE partner shuffle.
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Fertility Center of Illinois’ contracts for space in River North and at Highland Park Hospital are likely coming to an end soon. MB Real Estate represented Fertility Centers of Illinois concerning their 2007 lease negotiation of River North medical office space on the Chicago River from real estate company Jones Lang LaSalle. Then, in 2010, FCI River North sustained extensive flood damage, and FCI River North did an exhaustive 25K square-foot renovation in 2011. In December 2017, it was published that Fertility Centers of Illinois is fully leasing a custom-built $11.2M 30,000 square foot IVF center in Glenview, IL’s The Glen. The Sanders Trust commissioned the property for its 25-state real estate trust portfolio. The stand-alone IVF clinic should be similar to IntegraMed’s Shady Grove Fertility’s 50,000 square foot leased property in Rockville, Maryland. The Glen property should also resemble Shady Grove Fertility’s new 19,000 square foot, high-tech IVF Center in Fairfax, Virginia. This will allow Fertility Center of Illinois’ REs that do not retire or jump ship to consolidate into one state-of-the-art facility with a long-term lease when it opens - should the leasing plan even stay with Fertility Centers of Illinois amidst all the shuffle in the fertility sector. Shady Grove Fertility is already leasing and building all of the largest stand-alone IVF centers in the country: “The Virginia IVF Center is home to the fifth embryology lab operated by SGF, joining the largest freestanding IVF laboratory in the United States in Rockville, Maryland as well as Towson, MD; Atlanta, GA; and Chesterbrook, PA. Full-service SGF IVF Centers are coming soon to Tampa Bay, FL and Richmond, VA, in the coming months.”
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This past spring, Fertility Centers of Illinois posted a prominent sign / billboard in The Glen in front of its new construction project displaying the development team and funding and representation for the building. Notably absent was any involvement of IntegraMed America and Sagard Capital. Instead funding was listed as CBRE and CIBC (construction sign picture accompanying this white paper). This would seem to mirror the strategy of growth - without the IntegraMed physician practice management company - that Shady Grove is successfully executing. Shady Grove Fertility could acquire the lease on The Glen IVF center from Fertility Centers of Illinois Partners if Shady Grove Fertility desires expansion into Chicago and the Midwest. Shady Grove Fertility could also acquire IntegraMed’s shares in Fertility Centers of Illinois and lend their global real estate expertise to FCI.
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In the IntegraMed Fertility February 2017 press release announcing FCI Partners as equity partners, the FCI partners talk of “new and updated professional services IntegraMed offers” and leveraging “IntegraMed’s latest investment in technology advancements”. However, the new state-of-the-art 30,000 square foot technological IVF center being built by FCI is not being developed, funded or represented by IntegraMed America. In the past few months, three FCI REs are being repositioned to the non-IntegraMed owned Highland Park lab, another shift away from IntegraMed America.
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Another sign that Dresner’s stated pending “Midwest Fertility clinic group” sale is Fertility Centers of Illinois is a recent job posting for an “FCI – Director of Operational Affairs” in Glenview, IL. The job description goes on to say the Director “Is jointly responsible with the Executive Director for FCI’s profit and loss, budget variances and new patient visit volumes.” This key position will also create “FCI’s new business development strategy.” Fertility Centers of Illinois is also the only long-established “Midwest Fertility clinic group” with multiple locations still open that is private, non-hospital-affiliated, and not already part of a recent deal.
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It is likely the medical practice of Dr. Brian Kaplan and his key medical team will be separated in a purchase from the rest of the physicians, since he uses his own independent lab and has always performed a grossly disproportionately high number of the IVF cycles for the whole Fertility Centers of Illinois / IntegraMed practice. IVF cycles are the big profit center, and Dr. Kaplan has his own huge team of third party coordinators and nurses for international egg donor and surrogacy cases. If other doctors are slow or nearing imminent retirement, they are not producing profitability for the Fertility Centers of IL practice. In other words, there is one rainmaker left since four top REs retired, passed away and now act as competing Medical Directors at nationally and internationally respected programs at Northwestern Medicine and Vios Fertility. In recent months, Fertility Centers of Illinois has assigned some younger REs to also work at the aParent IVF contracted FCI lab in Highland Park, IL. In July, 2018 Fertility Centers of Illinois begin Facebook advertising of the planned re-positioning of REs to the non-IntegraMed owned IVF lab in Highland Park, IL.
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Shady Grove Fertility is a likely acquirer of the Fertility practice of the renowned Dr. Brian Kaplan, due to their cultural synergies and historical business deals together. It is also likely that Shady Grove Fertility, through IntegraMed America, is looking to divest some of its domestic clinics and focus on key international strategies and domestic locations that will support its continued global expansion. GI Partners would be a potential acquirer of Shady Grove’s IntegraMed-related assets, as would any healthcare PE fund that is positioned to invest in Fertility. However, FCI partners are likely looking to get cashed out again by PE before saying goodbye and going their separate ways. Dr. Brian Kaplan’s sheer volume of current patients and current IVF cycles determine the bulk of the value of IntegraMed America’s Fertility Centers of Illinois practice. The Fertility Centers of Illinois partners recently became equity partners of IntegraMed in February 2017. Shady Grove Fertility does not have any Midwestern presence, and Dr. Brian Kaplan could be their Chicago Gold Coast presence, since his IVF cycle volume alone carries FCI. Dr. Kaplan’s embryologist, Colleen Wagner Coughlin, moved an embryology suite to the Gold Coast just for him (and possible future physicians) in the prime Gold Coast Neiman Marcus Building. Coughlin set up her Ova Egg Freezing on Chicago’s famed Magnificent Mile too; again featuring just one RE to date, Dr. Brian Kaplan. Ova Egg Freezing markets social egg freezing and fertility preservation, capitalizing on former Bachelor Nation star, “Bachelorette” Whitney Bischoff’s fame, friends and early and outspoken advocacy of egg freezing. Whitney Bischoff is an experienced Fertility Nurse advocate for aParent IVF and Dr. Brian Kaplan. Wagner Coughlin likewise recently branded her international “Intended Father Center” to publicize Dr. Kaplan and her team’s decades-long work bringing the dream of parenthood to gay couples around the globe. aParent IVF’s same-sex couples and single-parent third party reproduction practice is one of the largest in the world.
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Since no other FCI REs enjoy profitable international business synergies with Shady Grove Fertility, if Dr. Brian Kaplan leaves the FCI practice after a cash out, Fertility Centers of Illinois, becomes relatively unsustainable and cash-strapped without him. Without Dr. Brian Kaplan, the practice would become roughly the number of IVF cycles then performed per year by remaining REs times the revenue produced, minus expenses, and a pending, exorbitant, long-term lease on a soon-to-be-finished, 30,000-square-foot, $11.2M building in sky-high property taxed Glenview, IL. It does not always happen that “if you build it, they will come”. Leasing a custom built $11.2M Fertility center for the long term with one remaining superstar RE nearing retirement is perilous. It seems risky to lease an $11.2M building when it is undetermined which REs would even use it or if any could even be hired to use it with all the competition just steps away. Dr. Angie Beltsos has one of her own many state-of-the-art offices and labs right across the street from the slated new IVF complex in The Glen and in Chicago’s West Loop and Wicker Park too. It takes 11 years post college to become an RE, and Forbes Magazine says that there are only 34 new REs per year. There are 1000 REs total in the United States, as it is an elite OBGYN-based medical specialty. Thus, recruiting successful REs is a years-long courting and wooing process.
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Dr. Brian Kaplan has always worked with his own embryologist, Colleen Wagner Coughlin, founder of the aParent IVF Laboratory. He has been quoted in the media pledging his loyalties and synergies with her. Coughlin and her team have an international reputation as a best-in-class embryology lab. Coughlin also opened Ova Egg Freezing in early 2017 to market egg freezing with Dr. Brian Kaplan. The top embryologist is sole owner of at least four 100 percent woman-owned business entities in Illinois – Gamete Resources Inc. (AParent IVF, Highland Park IVF), Ova Institute LLC (Ova Egg Freezing), Cryovault, Inc. and Egg Bank Foundation. Colleen Wagner Coughlin was among the first labs in the country to actually market social egg freezing. New York City’s Extend Fertility is another egg freezing practice, focused on extreme cost cutting for the procedure. Fertility Centers of IL incorporated their own Egg Bank Chicago, LLC in June 2011, but it is unclear from their Donor Egg program links on their website how successful the in-house program is and whether FCI has its own social egg freezing program similar to Ova Egg Freezing or Extend Fertility. One thing is certain, however, that most RE and IVF practices in the United States, and many globally, are trying hard to market social egg freezing as an additional profit center to IVF practices.
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The M&A Fertility Deal Landscape, and Why Many REs Are Being Forced To “Go Big or Go Home”

Shady Grove Fertility is positioning itself globally to give IVI-RMA a run for its money. In the past few years, the healthcare sector has seen numerous Fertility and genetics companies cashed out by private equity multiple times within short time frames. A theme of having one’s cake and eating it too seems to be emerging in the field of human reproductive medicine, gametes, biotech, genetics and embryology.

Colorado Center For Reproductive Medicine (CCRM) is another Fertility clinic brand that Private Equity backed in August 2015 (TA Associates). Since receiving the PE ownership interest, CCRM has been able to expand nationally at a rapid pace. Dr. William Schoolcraft is the founder and medical director of CCRM and is known for his advanced research and proprietary genetic testing. Subsequent to CCRM’s private equity infusion, the leading RE has expanded nationally and rolled out cutting-edge marketing and advertising. California-headquartered HRC Fertility received a $198M investment in its Fertility practice from Huasheng Assisted Reproduction Hong Kong Co., Ltd. in mid-2017. The subsidiary of Huasheng Asset Management Co., Ltd. acquired the stake in the U.S. Fertility practice for its Overseas Fertility M&A Fund LP. The Dresner Fertility Healthcare newsletter cites HRC’s number of IVF cycles as 5409 yearly cycles. It is interesting math on that $198M deal, as it indicates a value of approx. $37K placed on each IVF Cycle that goes through the clinic.
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In Vitro Sciences is a healthcare management company that partners with Fertility Clinics. Parent company, Women’s Health USA, sold a majority stake to Sverica Capital Management in August 2017. Dresner’s current Healthcare report states that In Vitro Sciences does 4478 IVF cycles per year. Sverica closed its Sverica Capital IV GP LLC fund in March 2016 with $275M. Managing partner David E. Finley’s May 2018 SEC Form ADV puts the fund at approx. $316M across four investments. The fund states that it targets businesses with enterprise values up to $100M with “exceptional growth potential” and that it is “less interested in the company’s size than in its reputation with customers, employees and suppliers, as well as its potential for growth and development.”
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Capstone Partners published a comprehensive Fertility Clinics report in Q1 2017. The Capstone Partners report put IntegraMed Fertility’s 2014 IVF Cycles at 16,108. Compared to the almost $200M recent HRC Fertility PE deal, valuation of Shady Grove Fertility based on IntegraMed IVF Cycles could be $600M. Yet, Shady Grove Fertility also owns a veritable treasure trove of Fertility assets outside of IntegraMed America, and reported IVF cycles are always 2-3 years behind. Shady Grove owns its own fully built out international operations across continents and countries, domestic and international Fertility financing companies, international donor egg programs and any real estate acquired with Georgia, Florida, other domestic and international operations. Remarkably, Shady Grove Fertility also owns its 300+ donor profile first ever frozen donor egg bank which it built neck-in-neck with Heidi Hayes’ Donor Egg Bank USA. Shady Grove Fertility, as the international Fertility company that has quickly expanded to China, Europe, Canada and South America, has possibly surpassed the $1B valuation level.
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Dresner Partners' June 2018 statement that it is “Representing a Midwest Fertility clinic group in its pending sale” is most likely the IntegraMed Fertility holding, Fertility Centers if Illinois (FCI). Capstone Partners 2017 report put FCI’s 2014 IVF cycles at 4326, but that was when FCI still employed its two leading women REs in the nation, Dr. Eve Feinberg and Dr. Angeline Beltsos. While Dr. Brian Kaplan, of international name recognition, is currently still with FCI, he is likely responsible for up to half the success of this number one Midwestern Fertility clinic, as he is synonymous with FCI and the only founding partner still with the clinic.
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Shady Grove Fertility is going full speed ahead replicating its successful fresh and frozen egg donor programs in South America by way of Chile. The SGFertility Chile website says, “We are looking for donors who live an hour away by car from any of our 18 full-service offices”. The SGFertility Chile website does not specifically list the 17 other SGFertility South America offices. SGFertility Chile also markets, “Shady Grove Fertility has become the main provider of oocyte treatment in the United States, with more than 1,000 cycles performed only last year.” They state, “We are the first egg donation program in Chile where our patients can choose their egg donor, as in the United States.” The IVF experts also test all their egg donors for 175 genetic diseases. SGFertility says they find all their South American egg donors via “word of mouth referrals” and “through marketing efforts”.
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The starting pay for one cycle of egg donation in the United States can usually range between $7000 and $15000. Whereas egg donation is legal in the United States, compensated egg donation is illegal or morally considered wrong in other countries. So, many countries throughout the world that allow egg donation, only allow altruistic egg donation, by which only reasonable expenses are compensated. In the UK, compensation cannot exceed £750.00. In Spain, compensation is usually up to €1000.00. One article cites compensation in Mexico ranging from $456.00 - $1305.00 for the ova (entire amount of eggs extracted). Laws regarding egg donation in most of South America are unclear, and in most of the world egg donation is banned, frowned upon or only allowed to be altruistic.
137, 138, 140, 141

Based on Fertility geography trends and regulations ex-USA, an honorarium of $1000.00 would seem likely for a South American woman donating to SGFertility Chile. This means that when Shady Grove Fertility sells South American donor eggs to U.S. Fertility patients or any international Fertility patients, their profit margin could be ten times higher than with oocytes (eggs) originating from compensated donors in the United States. The Fertility pioneers are already replicating their Shared Cycle and Shared Risk donor egg programs in South America and other countries. Now that the California Cryobank / Donor Egg Bank USA acquisition by GI Partners closed August 6th 2018, Shady Grove Fertility is poised to fully brand and market its growing international donor egg bank. Shady Grove Fertility is the second largest IVF program in the world and the largest and only far-reaching international donor egg program / bank. Favorable third party reproduction laws in the United States give Americans the edge, along with America’s healthcare costs being highest in the world and solidly capitalist.

GI Partners Managing Director, Dave Kreter, said, “We are excited to collaborate with management to extend the combined entity’s capabilities internationally and make critical investments to support its next phase of growth.” There are already top cord blood banks globally. Sperm banks exist internationally and have been around for 50 years. It is only the donor egg banks / programs that are new since Heidi Hayes dreamt up the idea of freezing and shipping frozen eggs. Since human eggs have a high water content, prior stumbling blocks to successfully freezing and thawing them have been resolved with vitrification (fast-freezing). But the business of egg and embryo vitrification is anything but foolproof. Just this year, 4000 eggs and embryos were accidentally destroyed at University Hospitals in Cleveland, Ohio. Thousands more eggs and embryos were accidentally thawed at Pacific Fertility Center near Sacramento, California. Freezing eggs is a high-tech operation, thawing them is a delicate technical process, and shipping them domestically and internationally (when allowed by law) is also fraught with risk.
142, 148, 149, 150

While GI Partners is speaking of plans to extend capabilities internationally and invest in international growth of California Cryobanks’s Donor Sperm Bank, Donor Egg Bank and cord blood bank/registry, Shady Grove Fertility is already international with its own Egg Bank / program. Shady Grove Fertility, doing all its own press releases, just announced a Fall 2018 London Seminar on Surrogacy and their Egg Donation resources. Extending an egg bank’s capabilities internationally is going to take Third Party Reproduction professionals’ boots on the ground booking consults around the globe, as Shady Grove Fertility is already doing. Cryos International already ships to 100 countries between its Donor Sperm Bank and Donor Egg Bank in Florida. The CAN-AM  deal with Cryos makes Cryos’ 305 sperm and egg lot profiles available through CAN-AM and to Canadians. CAN-AM also handles the business transactions in Donor Eggs for NW Cryobank, Fairfax Egg Bank and First Egg Bank. There are a limited number of desirable and diverse phenotype egg lots in the world. Donor Egg laws vary drastically by country, with the United States being the largest marketplace, followed by Europe. Right now, recruitment of diverse and willing young Egg Donors - agreeing to a lengthy process with medications, injections, outpatient surgery and accepting the legalities and physical risks - is the problem of growing this field rapidly to keep up with demand. There are only so many Egg Donors to go around.
162, 183

CAN-AM is transparent with its pricing, and 6 eggs are priced at $16,500 on average. When considering that a young woman can produce 20-30 good eggs during an egg retrieval, is encouraged to donate up to 6 times if a good donor, that might be 150 eggs. At $2750.00 per egg, one donor might generate revenue of $412,500. If the donor averages $9,000 a cycle, the donor is paid a total of $54,000. It is easy to see that there is a lot of profit in Donor Eggs for the leading banks. If the eggs are coming from countries that only allow about $1000.00 compensation to the donor, the Donor Egg banks and IVF Clinic Donor Egg programs would be making even more enormous profit.
160

Private Equity and Venture Capital firms are sitting on historic amounts of dry powder (sidelined cash). Fertility is a specialty industry group within the healthcare sector newer to investment banking and misunderstood by most people, including those in Finance. The whole business of human genetics, human reproduction and embryology has been opaque for decades. Now, the combination of social media, patient advocates / entrepreneurs, the precarious economy for 99 percent of the population, and extraordinary wealth for 1 percent, makes for an interesting business cocktail. IVF is only 40 years young, and only 1.7 percent of babies born in the United States are resultant of use of IVF. Technologies are evolving rapidly, and there is pressure on broadening access to the technologies and bringing down the cost of Fertility services. The timing is perfect for Private Equity and the business world to understand and help with the opportunities in the Fertility specialty of healthcare.
155

An August 9, 2018 “Market Research Future” report states, “The Global Fertility Services Market is Likely to Mushroom in Size and Reach a Significant Valuation by the end of 2023”. In reaching significant valuation by 2023, the report cites a Compound Annual Growth Rates of 8.5 percent. Fertility is poised for takeoff in the same way as biotech by the 1990s. Biotech was a nascent industry in the 1980s which really got fueled up as a sizeable real sector of healthcare and technology in the 1990s.
158, 159

The private equity deals in Fertility, human reproduction and genetics will no doubt continue. But, will the companies really grow holistically to mandate these heady multiples, or is the Fertility industry riding an M&A seesaw?

Lisa A. Ditkowsky, CFP®, owns a Wealth Management business and focuses on Family Offices, Business Consulting and Financial Planning.

Copyright © 2018 by Lisa A. Ditkowsky, CFP®
All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written consent of the author/publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law. For permission requests, contact through www.PLLUSH.com.

BIBLIOGRAPHY / SOURCES CITED:

1. California Cryobank / California Cryobank Life Sciences , PR Newswire,
   https://www.prnewswire.com/news-releases/california-cryobank-and-cord-blood-registry-to-be-combined-by-gi-partners-to-create-a-leading-life-sciences-platform-300666886.html
   (accessed July 19, 2018)
   
   
2. AMAG Pharmaceuticals, GlobeNewswire,
   https://www.barchart.com/story/stocks/quotes/AMAG/458892/amag-pharmaceuticals-announces-divestiture-of-cord-blood-registryr
   (accessed July 19, 2018)
   
   
3. California Cryobank, PR Newswire,
   https://www.prnewswire.com/news-releases/california-cryobank-announces-acquisition-of-donor-egg-bank-usa-300376959.html
   (accessed July 19, 2018)
   
   
4. Longitude Capital, PR Newswire,
   https://www.prnewswire.com/news-releases/california-cryobank-ccb-announces-acquisition-by-longitude-capital-and-novaquest-capital-271974241.html
   (accessed July 19, 2018)
   
   
5. Hayes, Heidi, Chief Executive Officer, Donor Egg Bank USA, LLC, United States Securities and Exchange Commission,
   https://www.sec.gov/Archives/edgar/data/1523194/000152319411000001/xslFormDX01/primary_doc.xml
   (accessed July 19, 2018)
   
   
6. Hagan, Caitlin, “Experts: Egg Freezing No Longer ‘Experimental’”, CNN,
   https://www.cnn.com/2012/10/19/health/egg-freezing/index.html
   (accessed July 19, 2018)
   
   
7. Gorman, Anna, “At Egg Freezing Parties, Women Sip Wine, Chat About Postponing Motherhood”, Chicago Tribune,
   http://www.chicagotribune.com/lifestyles/health/ct-egg-freezing-parties-20171116-story.html
   (accessed July 19, 2018)
    
8. Covert, James, “It Turns Out It’s Really Tough To ‘Disrupt’ Childbirth”, NY Post,
   https://nypost.com/2016/06/01/uber-for-ivf-under-fire-for-marketing-tactics/
   (accessed July 19, 2018)
    
9. Harris Williams & Co., Harris Williams & Co.,
   https://www.harriswilliams.com/news/harris-williams-co-advises-california-cryobank-inc-its-acquisition-donor egg-bank-usa
   (accessed July 19, 2018)
    
10. California Cryobank, PR Newswire,
    https://www.prnewswire.com/news-releases/california-cryobank-announces-acquisition-of-donor-egg-bank-usa-300376959.html
    (accessed July 19, 2018)
     
11. Longitude Capital Management Co., LLC (CRD# 161916, SEC# 801-80602), United States Securities and Exchange Commission,
    https://www.adviserinfo.sec.gov/Firm/161916
    (accessed July 19, 2018)
    
    
12. Novaquest Capital Management, LLC (CRD# 160359, SEC# 801-73992), United States Securities and Exchange Commission,
    https://www.adviserinfo.sec.gov/Firm/160359
    (accessed July 19, 2018)
     
13. Yacowicz, Will, “How This Company Found a Better Way to Help Women Get Pregnant”, Inc.,
    https://www.inc.com/magazine/201703/will-yakowicz/exit-interview-heidi-hayes-donor-egg-bank-usa.html
    (accessed July 19, 2018)
     
14. Vellanki, Mahesh, “This Is Why Public and Private Tech Valuations Are Completely Different”, FORTUNE,
    http://fortune.com/2015/09/29/this-is-why-public-and-private-tech-valuations-are-completely-different//
    (accessed July 19, 2018)
     
15. California Cryobank, Internet Archive: Wayback Machine,
    http://web.archive.org/web/*/http://cryobank.com/
    (accessed July 20, 2018)
    
    
16. Margulis, Ronald, The Broe Group, Business Wire,
    https://www.businesswire.com/news/home/20150915006676/en/Shady-Grove-Fertility-Leases-50000-Sq-Ft
    (accessed July 20, 2018)
     
17. Handler, Max, “Shady Grove Fertility Acquires One Company, Expects More To Follow”, Washington Business Journal,
    https://www.bizjournals.com/washington/news/2017/07/17/shady-grove-fertility-acquires-one-company-expects.html
    (accessed July 20, 2018)
     
18. Shady Grove Fertility, “Shady Grove Fertility’s IVF Center In Fairfax, VA Earns Highest Standard Laboratory Accreditation by the Accreditation Association For Ambulatory Healthcare (AAAHC)”, PR Newswire,
    http://markets.businessinsider.com/news/stocks/shady-grove-fertility-s-ivf-center-in-fairfax-va-earns-highest-standard-in-laboratory-accreditation-by-the-accreditation-association-for-ambulatory-health-care-aaahc-1027325768
    (accessed July 20, 2018)
     
19. Clabaugh, Jeff, “Shady Grove Fertility Expands To Chile”, WTOP,
    https://wtop.com/business-finance/2017/09/shady-grove-fertility-expands-chile/
    (accessed July 20, 2018)
     
20. Hudson, Sara, “Shady Grove Fertility (SGF), Largest Fertility Center in United States, Launches SGF China – Now Offering Mandarin-Speaking Patient Care Team, Signature Programs, New Website, And Two Patient Seminars in Shenyang and Xi’an”, Shady Grove Fertility,
    https://www.shadygrovefertility.com/newsroom/Shady-Grove-Fertility-Launches-SGF-China-1
    (accessed July 20, 2018)
     
21. Agence France-Presse, “Chinese Parents-to-be Seek More Fertile Ground Abroad: Scrapping One-Child Policy Has Fuelled Test-Tube Baby Boom in Southeast Asia an US”, South China Morning Post,
    https://www.scmp.com/news/china/society/article/2151423/chinese-parents-be-seek-more-fertile-ground-abroad/
    (accessed July 20, 2018)
     
22. Shady Grove Fertility, “Canada: Why Shady Grove Fertility”, Shady Grove Fertility,
    https://www.shadygrovefertility.com/our-centers/international-patients/canada
    (accessed July 20, 2018)
     
23. Assisted Human Reproduction Act (S.C. 2004, c.2), Justice Laws Website,
    http://laws-lois.justice.gc.ca/eng/acts/a-13.4/
    (accessed July 20, 2018)
     
24. Shady Grove Fertility, “International Patients: Traveling To Shady Grove Fertility”, Shady Grove Fertility,
    https://www.shadygrovefertility.com/our-centers/international-patients/
    (accessed July 20, 2018)
     
25. Access Fertility UK, About Us Page, Access Fertility UK Website,
    https://www.accessfertility.co.uk/about-us/
    (accessed July 21, 2018)
     
26. Access Fertility Management Limited – Higham Ferrers, Financial Statements of Access Fertility Management Limited (Registered Number 08754656) signed 03/24/17 by Director Mark Segal, Check Company UK,
    http://www.checkcompany.co.uk/company/08754656/ACCESS-FERTILITY-MANAGEMENT-LIMITED
    (accessed July 21, 2018)
    
    http://www.checkcompany.co.uk/accounts/6126153/access-fertility-management-limited---accounts-to registrar---small-17.2
    (accessed July 21, 2018)
    
    Access Fertility Limited – Higham Ferrers, Financial Statements of Access Fertility Limited (Registered Number 08753396), data updated on 01/07/18,
    https://www.bizdb.co.uk/company/access-fertility-limited-08753396/
    (accessed July 21, 2018)
    
    Access Fertility Management Limited, Access Fertility Limited, Access Fertility Building Limited, Access Fertility International Limited, Access Fertility Ireland Limited, Fertility Finance Limited, “UK Incorporation Records”, bizDb,
    https://www.bizdb.co.uk/companies-search/
    (accessed July 21, 2018 and July 28, 2018)
    
    https://www.bizdb.co.uk/company/access-fertility-building-limited-11223503/
    
    https://www.bizdb.co.uk/company/access-fertility-international-limited-11437172/
    
    https://www.bizdb.co.uk/company/access-fertility-ireland-limited-11441212/
    
    https://www.bizdb.co.uk/company/access-fertility-limited-08753396/
    
    https://www.bizdb.co.uk/company/access-fertility-management-limited-08754656/
    
    https://www.bizdb.co.uk/company/fertility-finance-ltd-10508524/
    
    Access Fertility Group, “Privacy & Cookies, Privacy Policy of Access Fertility”, co.uk,
    https://www.accessfertility.co.uk/privacy-cookies/
    (accessed July 27, 2018)
    
    
27. CapexMD – “The Specialists In Fertility Financing”, com,
    http://www.capexmd.com
    (accessed July 22, 2018)
    
    
28. Capex Management, LLC, “Company Profile”, bizstanding Business Directory,
    https://bizstanding.com/p/capex+management+llc-158216772
    (accessed July 22, 2018)
    
    
29. Capex Management, LLC, “Entity Details”, Arizona Corporation Commission,
    https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=L15514690
    (accessed July 22, 2018)
    
    
30. Power Corporation of Canada, “Organization Chart”, powercorporation.com,
    https://www.powercorporation.com/en/companies/organization-chart/
    (accessed July 22, 2018)
    
    
31. Power Corporation of Canada, “News and Earnings”, Newswire.ca,
    https://www.newswire.ca/news-releases/power-corporation-reports-first-quarter-financial-results-and-dividend-increase-682377591.html
    (accessed July 22, 2018)
    
    
32. Weinmann, Karlee, “Sagard Capital’s $170M Buy To Take IntegraMed Private” dated 06/11/12, Law360, A LexisNexis Company,
    https://www.law360.com/articles/348725/sagard-capital-s-170m-buy-to-take-integramed-private
    (accessed July 22, 2018)
    
    
33. Rochman, Bonnie, “Are Fertility Financers Productive or Predatory? – Businesses that dole out loans to infertile couples to help them pay for treatment are springing up around the country. But in some cases , fertility doctors are part owners”, dated 07/13/12, TIME,
    http://healthland.time.com/2012/07/13/are-fertility-financers-productive-or-predatory/
    (accessed July 22, 2018)
    
    
34. Ubel MD, Peter, “Do Doctors Take Advantage Of Desperate Couples With Infertility Loans?”, dated 01/30/13, kevinmd.com,
    https://www.kevinmd.com/blog/2013/01/doctors-advantage-desperate-couples-infertility-loans.html
    (accessed July 22, 2018)
     
35. Shady Grove Fertility, “Shady Grove Fertility CEO Mark Segal Receives EY Entrepreneur Of the Year® 2015 Award, dated 06/24/15, shadygrovefertility.com,
    https://www.shadygrovefertility.com/blog/why-shady-grove-fertility/shady-grove-fertility-ceo-mark-segal-receives-ey-entrepreneur-of-the-year-2015-award/
    (accessed July 22, 2018)
     
36. IntegraMed Fertility, “About Us – Our Management Team – Pamela T. Schumann”, integramed.com,
    https://www.integramed.com/about-us/our-management-team/pamela-t-schumann/
    (accessed July 22, 2018)
     
37. Fertility Centers of Illinois, “Our Center – Meet Our Doctors – Dr. Brian R. Kaplan”, fcionline.com,
    https://fcionline.com/our-center/meet-our-doctors/dr-brian-r-kaplan/
    (accessed July 22, 2018)
     
38. Reproductive Medicine Associates of New Jersey (RMANJ), “Reproductive Medicine Associates of New Jersey (RMANJ) and IVI (The Valencian Infertility Institute) Announce Creation of IVI-RMA Global, The Largest Global Fertility Network,” dated 02/16/17, PR Newswire,
    https://www.prnewswire.com/news-releases/reproductive-medicine-associates-of-new-jersey-rmanj-and-ivi-the-valencian-infertility-institute-announce-creation-of-ivi-rma-global-the-largest-global-fertility-network-300408517.html
    (accessed July 22, 2018)
     
39. RMA (Reproductive Medicine Associates of New Jersey) / IVI-RMA Global), “Fertility Financing”, rmanj.com,
    https://www.rmanj.com/understanding-the-ivf-process/fertility-financing/
    (accessed July 22, 2018)
     
40. Segal, Troy, “Sometimes It Pays To Borrow From Your 401(k)”, dated 01/23/18, Investopedia,
    https://www.investopedia.com/articles/retirement/08/borrow-from-401k-loan.asp
    (accessed July 22, 2018)
     
41. TriState Capital, “Access TSC Securities-backed Line of Credit”, tristatecapitalbank.com,
    https://www.tristatecapitalbank.com/AccessTSC.aspx
    (accessed July 25, 2018)
     
42. Shady Grove Fertility, “Egg Donor Database – The Largest Donor Egg Program in the Nation”, shadygrovefertility.com,
    https://www.shadygrovefertility.com/treatments-success/donor-gestational-carrier/donor-egg/egg-donor-database
    (accessed July 22, 2018)
     
43. Donor Egg Bank USA, “Locations”, donoreggbankusa.com,
    https://donoreggbankusa.com/financial-plans/assured-refund-plan/preferred-locations
    (accessed July 22, 2018)
     
44. Donor Egg Bank USA, “Browse Our Egg Donor Registry Online”, donoreggbankusa.com,
    https://donoreggbankusa.com/our-egg-donors/egg-donor-search
    (accessed July 22, 2018)
     
45. A Jewish Blessing, com,
    https://www.ajewishblessing.com
    (accessed July 22, 2018)
     
46. Chong, Elaine, “Why I Chose To Donate My Eggs”, dated 11/15/17, BBC News,
    https://www.bbc.com/news/stories-41936041
    (accessed July 22, 2018)
     
47. Witkowsky, Chris, “GI Partners To Buy and Combine Sperm and Egg Donor Bank, Stem Cell Storage Company,” dated 6/15/18, The PE Hub Network – A Community For Professionals In Private Capital,
    https://www.pehub.com/2018/06/gi-partners-to-buy-and-combine-sperm-and-egg-donor-bank-stem-cell-storage-company/#
    (accessed July 22, 2018)
     
48. Shady Grove Fertility, “Locations”, shadygrovefertility.com,
    https://www.shadygrovefertility.com/locations
    (accessed July 22, 2018)
     
49. Segal, Mark, “Mark Segal, CEO – Shady Grove Fertility”, LinkedIn,
    https://www.linkedin.com/in/mark-segal-46225a9/
    (accessed July 22, 2018)
     
50. SGFertility - Medicina Reproductiva Chile, sgfertility.cl,
    https://www.sgfertility.cl
    (accessed July 22, 2018)
    
    
51. Simon, Alexandra, “Medical Tourism: Barbados Fertility Clinic Sees High Demand From U.S.”, dated 05/03/18, Caribbean Life,
    https://www.caribbeanlifenews.com/stories/2018/5/cl-barbados-fertility-center-in-usa-2018-05-04-i.html
    (accessed July 22, 2018)
     
52. Melley, Brian, Associated Press, “Gay Couple Sues After 1 Twin’s U.S. Citizenship Denied”, The Hindu,
    https://www.thehindu.com/news/international/gay-couple-sues-after-1-twins-us-citizenship denied/article22514342.ece
    (accessed July 22, 2018)
     
53. BBC News, “Why One Man In Singapore Was Not Allowed To Adopt His Child”, dated 01/21/18, bbc.com,
    https://www.bbc.com/news/world-asia-42577024
    (accessed July 23, 2018)
     
54. FindLaw, “U.S. Citizens Through Parents Or By Birth”, findlaw.com,
    https://immigration.findlaw.com/citizenship/u-s-citizenship-through-parents-or-by-birth.html
    (accessed July 23, 2018)
     
55. IntegraMed Fertility, “Locate A Practice”, integramed.com,
    https://www.integramed.com/locate-a-practice/
    (accessed July 23, 2018)
     
56. Williams, Eric, Managing Director, Capstone Partners, “Fertility Clinics – Q1 2017”, capstoneheadwaters.com,
    http://capstoneheadwaters.com/sites/default/files/Capstone%20Fertility%20Clinics%20Report%20Q1%202017.pdf
    (accessed July 23, 2018)
     
57. Pitzer, Kyong, “Global Infertility Treatment Market 2018 – The Cooper Companies Inc. , Cook Group Incorporated, Thermo Fisher Scientific, Inc., Vitrolife Ab, Esco Micro Pte. Ltd.”, dated 07/10/18, The Book of Kindle,
    https://thebookofkindle.com/global-infertility-treatment-market-2018-the-cooper-companies-inc-cook-group-incorporated-thermo-fisher-scientific-inc-vitrolife-ab-esco-micro-pte-ltd/24981/
    (accessed July 23, 2018)
     
58. Radke, Gregory, Global General Counsel at EF Education First, LinkedIn,
    https://www.linkedin.com/in/gregory-radke/
    (accessed July 23, 2018)
     
59. McDonough, John, CFO – Tricenna, Greater New York City Area, LinkedIn,
    https://www.linkedin.com/in/john-mcdonough-19900032/
    (accessed July 23, 2018)
     
60. IntegraMed Fertility, “About Us – Our Management Team”, integramed.com,
    https://www.integramed.com/about-us/our-management-team/
    (accessed July 23, 2018)
     
61. Fertility Centers Of Illinois, “Collaborative Reproduction”, fcionline.com,
    https://fcionline.com/collaborative-reproduction/collaborative-reproduction-for-family-planning/
    (accessed July 23, 2018)
     
62. Wiese, Julie Lasch, “Women’s Health / Infertility Nurse – Currently Seeking New Opportunities, Former Director, Center For Collaborative Reproduction at Fertility Centers of Illinois March 2002 – July 2018”, LinkedIn,
    https://www.linkedin.com/in/julie-lasch-wiese-63542591/
    (accessed July 23, 2018)
     
63. Hirebridge LLC, “Fertility Centers of Illinois: Manager, Center for Collaborative Reproduction, Job #424260, Posted 07/20/18”, recruit.hirebridge.com,
    https://recruit.hirebridge.com/jobseeker2/viewdetail.asp?joblistid=424260&come=&page=1&logo=yes&s=&acceptShift=0&cid=6656
    (accessed July 23, 2018)
     
64. Cleaver, Joanne, “You Know Illinois’ Property Taxes Are Sky-high. But the Calculation Process Might Surprise You,” dated 04/05/18, Chicago Tribune,
    http://www.chicagotribune.com/classified/realestate/ct-re-0408-property-taxes-primer-20180402-story.html
    (accessed July 23, 2018)
     
65. Cain Brothers – A Division of KeyBanc Capital Markets, “Viviere Health Has Been Acquired By Prelude Fertility”, dated 12/14/17, cainbrothers.com,
    https://www.cainbrothers.com/transactions/vivere-health-has-been-acquired-by-prelude-fertility/
    (accessed July 23, 2018)
     
66. Figari, Luciano, realdeals – The Independent Voice of European Private Equity, “Spanish Private Equity Industry Posts Record-breaking 2017”, dated 01/18/18, realdeals.eu.com,
    https://realdeals.eu.com/news/2018/01/18/spanish-investment-levels-break-records/
    (accessed July 23, 2018)
     
67. Dresner Partners Investment Banking IMAP, “Staying Ahead Of the Curve – A Dresner Partners Newsletter, Healthcare – Women’s Health Sector, June 2018, The Continuing Consolidation of the Fertility Sector”, dresnerpartners.com,
    http://www.dresnerpartners.com/ace-files/Fertility_June_2018.pdf
    (accessed July 23, 2018)
     
68. Helft, Miguel, “Meet Prelude Fertility, The $200 Million Startup That Wants To Stop the Biological Clock”, dated 10/17/16, FORBES,
    https://www.forbes.com/sites/miguelhelft/2016/10/17/prelude-fertility-200-million-startup-stop-biological-clock/#1dbd6017260f
    (accessed July 23, 2018)
     
69. Robbins, Rebecca, “Investors See Big Money In Infertility. And They’re Transforming The Industry”, dated 12/04/17, STAT,
    https://www.statnews.com/2017/12/04/infertility-industry-investment/
    (accessed July 23, 2018)
     
70.  Dorbian, Iris, “Spanish IVF Genetic Testing Company Igenomix Snags Funding”, dated 08/08/16, Buyouts Insider - The PE Hub Network – A Community For Professionals In Private Capital, pehub.com,
    https://www.pehub.com/2016/08/3346843/
    (accessed July 23, 2018)
    
    
71. CDC (Centers For Disease Control And Prevention), “Assisted Reproductive Technology (ART) Data – Fertility Centers of Illinois – River North IVF”, data from 2015 (most recent year published online), nccd.cdc.gov,
    https://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&ClinicId=275&ShowNational=0
    (accessed July 23, 2018)
    
    
72. Kremer, Gina, “In Memory Of Kevin J. Lederer, M.D. of Fertility Centers of Illinois”, dated 01/11/13, Daily Herald,
    http://www.dailyherald.com/article/20130111/submitted/130119981/
    (accessed July 23, 2018)
    
    
73. Vios Fertility Institute, “Locations & Doctors, Angeline N. Beltsos, MD”, viosfertility.com,
    https://viosfertility.com/locations-doctors/angeline-n-beltsos-md/
    (accessed July 23, 2018)
     
74. Vios Fertility Institute, “Blog – Category: Team Vios”, viosfertility.com,
    https://viosfertility.com/category/team-vios/
    (accessed July 23, 2018)
     
75. Vivere Health, “Scientific Advisory Board”, viverehealth.com,
    http://www.viverehealth.com/physicians/scientific-advisory-board/
    (accessed July 23, 2018)
    
    
76.  Northwestern Medicine, “Eve Feinberg, MD, Named Medical Director of Northwestern Medicine Fertility And Reproductive Medicine Highland Park,” dated 07/10/16, nm.org,
    https://www.nm.org/about-us/northwestern-medicine-newsroom/press-releases/2016/eve-feinberg-md-named-medical-director
    (accessed July 23, 2018)
     
77. Kemp Pick, Julie, JWC Media, Daily North Shore, “Life Foundation Helps Create Families”, dated 12/25/17, jwcdaily.com,
    https://jwcdaily.com/2017/12/25/life-foundation-helps-create-families/
    (accessed July 23, 2018)
     
78. Northwestern Medicine- Fertility and Reproductive Medicine, “Fertility and Reproductive Medicine – Let Our Family Help Build Your Family”, fertility.nm.org,
    http://fertility.nm.org
    (accessed July 23, 2018)
     
79. Fertility Centers of Illinois, “Our Center – Meet Our Doctors”, fcionline.com,
    https://fcionline.com/our-center/meet-our-doctors/
    (accessed July 23, 2018)
     
80. aParent IVF Laboratory, “About – The aParent IVF Laboratory Team”, aparentivf.com,
    https://www.aparentivf.com/our-team-1/
    (accessed July 23, 2018)
     
81. CDC (Centers For Disease Control And Prevention), “Assisted Reproductive Technology (ART) Data – Fertility Centers of Illinois – Highland Park IVF Center”, data from 2015 (most recent year published online), nccd.cdc.gov,
    https://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&ClinicId=63&ShowNational=0
    (accessed July 23, 2018)
     
82. Bisnow, “The Deal Sheet”, dated 04/26/11, bisnow.com,
    https://www.bisnow.com/chicago/news/commercial-real-estate/The-Deal-Sheet-9340
    (accessed July 23, 2018)
     
83. Kukulka, Alexandra, “Plan Commission Oks Fertility Clinic Project For Prairie Glen”, dated 08/14/17,
    http://www.chicagotribune.com/suburbs/glenview/news/ct-gla-fertility-centers-of-illinois-tl-0817-20170814-story.html
    (accessed July 23, 2018)
    
    Village of Glenview, Plan Commission, Staff Report, “Case #: P2017-027, Location: 2555 Patriot Boulevard, Project Name: Fertility Centers of Illinois”, dated 08/08/17, glenview.granicus.com,
    http://glenview.granicus.com/MetaViewer.php?view_id=2&clip_id=1675&meta_id=73317
    (accessed August 9, 2018)
    
    Ciorogar, Alex, “Chicago MOB Breaks Ground – The Sanders Trust recently broke ground on a 30,000-square-foot medical office building in Glenview, Ill. The asset will be fully leased by the Fertility Centers of Illinois.”, dated 12/08/17, Commercial Property Executive, cpexecutive.com,
    https://www.cpexecutive.com/post/chicago-mob-breaks-ground/
    (accessed August 9, 2018)
     
84. LinkedIn, Job Posting, “Director of Operational Affairs – IntegraMed Fertility, Glenview, IL”, linkedin.com,
    https://www.linkedin.com/jobs/view/fertility-centers-of-illinois-director-of-operational-affairs-at-integramed-fertility-738188027/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic
    (accessed July 23, 2018)
     
85. Hirebridge LLC, “Fertility Centers of Illinois: Manager, Director of Operational Affairs, Job #424259, Posted 07/20/18”, recruit.hirebridge.com,
    http://www.hirebridge.com/jobseeker2/viewdetail.asp?joblistid=424259&come=&page=1&logo=yes&s=&acceptShift=0&cid=6656
    (accessed July 23, 2018)
     
86. aParent IVF Laboratory, aParent IVF Laboratory Intended Father Center, aparentivf.com,
    https://www.aparentivf.com/intendedfathercenter/
    (accessed July 23, 2018)
     
87. PR Newswire, “Shady Grove Fertility’s IVF Center in Fairfax, VA Earns Highest Standard in Laboratory Accreditation by the Accreditation Association for Ambulatory Health Care (AAAHC)”, dated 06/28/28, PR Newswire,
    https://www.bizjournals.com/washington/prnewswire/press_releases/Virginia/2018/06/28/UN40156
    (accessed July 27, 2018)
     
88. Facebook, “Fertility Centers of Illinois / @FertilityCentersofIllinois”, Facebook,
    https://www.facebook.com/FertilityCentersofIllinois/
    (accessed July 27, 2018)
     
89. IntegraMed Fertility, “IntegraMed Fertility Announces Equity Partnership With Physicians Of Fertility Centers of Illinois – Leading U.S. Fertility Provider Solidified Ties With Largest Fertility Network in North America ”, dated 02/21/17, PR Newswire,
    https://www.prnewswire.com/news-releases/integramed-fertility-announces-equity-partnership-with-physicians-of-fertility-centers-of-illinois-300410205.html
    (accessed July 23, 2018)
     
90. Mapquest, “aParent IVF Laboratory, 737 N. Michigan Ave., Chicago, IL 60611, (312) 374-1063”, mapquest.com,
    httphttps://www.mapquest.com/us/illinois/aparent-ivf-laboratory-376055634
    https://www.superpages.com/bp/ chicago-il/aparent-ivf-laborat ory-L2605037622.htm
    https://www.aparentivf.com/ cryo/
    (accessed August 12, 2018)
    
    
91. OVA Egg Freezing Specialty Center, ovaeggfreezing.com,
    https://www.ovaeggfreezing.com
    (accessed July 23, 2018)
     
92. OVA Egg Freezing Specialty Center, “Physicians Working With OVA”, ovaeggfreezing.com,
    https://www.ovaeggfreezing.com/physicians/
    (accessed July 23, 2018)
     
93. Vios Fertility Institute, “Locations & Doctors”, viosfertility.com,
    https://viosfertility.com/locations-doctors/
    (accessed July 23, 2018)
     
94. Sable, David, “Entrepreneurship in Reproductive Medicine”, dated 01/27/18, FORBES,
    https://www.forbes.com/sites/davidsable/2018/01/27/the-case-for-entrepreneurship-in-reproductive-medicine-1-industry-overview/#499a70e93fe1
    (accessed July 24, 2018)
     
95. Leiner Grant, Barri, “Meet Chicago’s Top Embryologist”, dated 02/09/12, Michigan Avenue Magazine by Modern Luxury,
    https://michiganavemag.com/embryologist-colleen-coughlin-helps-parents-start-families
    (accessed July 24, 2018)
     
96. Fisher, Jennifer, “Bachelor Financée Back To Work At Highland Park Lab”, dated 12/17/15, Chicago Tribune,
    http://www.chicagotribune.com/suburbs/highland-park/news/ct-hpn-whitney-bischoff-ivf-tl-0319-20150317-story.html
    (accessed July 24, 2018)
     
97. OVA Egg Freezing Specialty Center, “OVA Blog & News”, ovaeggfreezing.com,
    https://www.ovaeggfreezing.com/newsblog/
    (accessed July 24, 2018)
     
98. Illinois Secretary of State, “Office of the Illinois Secretary of State – Corporate and LLC Search”, ilsos.gov,
    https://www.ilsos.gov/corporatellc/CorporateLlcController
    (accessed July 24, 2018)
     
99. Crocker, Lizzie and Haglage, Abby, “Inside New York’s Radical Egg-Freezing Clinic For Women”, dated 08/10/16, The Daily Beast,
    https://www.thedailybeast.com/inside-new-yorks-radical-egg-freezing-clinic-for-women
    (accessed July 24, 2018)
     
100. Zarya, Valentina, “This Medical ‘Boutique” Says It Can Cut the Cost of Egg Freezing in Half” dated 08/10/16, FORTUNE,
     http://fortune.com/2016/08/10/egg-freezing-extend-fertility/
     (accessed July 24, 2018)
      
101. Fertility Centers of Illinois, “Collaborative Reproduction – Egg Donation – What Intended Parents Need To Know”, fcionline.com,
     https://fcionline.com/collaborative-reproduction/egg-donation/
     (accessed July 24, 2018)
      
102. TA Associates and BackBay Communications, “TA Associates Announces Investment in CCRM”, dated 08/04/15, Business Wire,
     https://www.businesswire.com/news/home/20150804005381/en/TA-Associates-Announces-Investment-CCRM
     (accessed July 24, 2018)
      
103. U.S. Campaign, “New Campaign From Terri and Sandy Starts Dialogue Around Fertility”, campaignlive.com,
     https://www.campaignlive.com/article/new-campaign-terri-sandy-starts-dialogue-around-fertility/1463098
     (accessed July 21, 2018)
      
104. “Wing Tai Energy: Announcement on the acquisition of the US HRC Medical Group's assisted reproductive project by the overseas assisted reproductive M&A fund of Huasheng Assisted Reproductive Hong Kong Co., Ltd.”, 7/1/17 Yongtai Energy Announcement No.: Pro 2017-072, finance04.com,
     http://finance04.com/sbdm/stock/share,disc,2017-07-01,600157,0000000000000ij9vg.shtml
     (accessed July 21, 2018)
      
105. Asia America, “International M&A – Asia America Helped Wintime Energy Group Acquire Fertility Clinic No. 2 In U.S. Ranking”, changleon.com,
     http://changleon.com/the-firm/mergers-and-acquisitions/
     (accessed August 1, 2018) 
      
106. Sverica Capital, 8/10/17 Press Release,
     https://sverica.com/news-article/sverica-capital-management-announces-acquisition-womens-health-usa/
     (accessed July 21, 2018)
      
107. Sverica International, Crunchbase,
     https://www.crunchbase.com/organization/sverica-international
     (accessed July 21, 2018)
     
     
108. Investment Advisor Public Disclosure Website, United States Securities and Exchange Commission,
     https://www.adviserinfo.sec.gov/IAPD/IAPDSearch.aspx
     (accessed July 21, 2018)
      
109. Sverica Capital Management, LLC, Business Wire,
     https://venturebeat.com/2016/03/22/sverica-capital-management-closes-fourth-private-equity-fund-with-275-million/
     (accessed July 21, 2018)
      
110. Frozen Egg Bank Network, “Frozen Egg Bank Network – A Creation of Donor Egg Bank USA”, dated 06/13/18, Internet Archive: Wayback Machine,
     https://web.archive.org/web/20180613030425/https://www.frozeneggbanknetwork.com/
     (accessed July 28, 2018)
     
     Donor Egg Bank, USA, “Donor Egg Bank USA Launches Frozen Egg Bank Network to Address Quality Gap in Egg Freezing”, dated 04/13/16, Globe Newswire, globenewswire.com,
     https://globenewswire.com/news-release/2016/04/13/828547/0/en/Donor-Egg-Bank-USA-Launches Frozen-Egg-Bank-Network-to-Address-Quality-Gap-in-Egg-Freezing.html
     (accessed July 28, 2018)
      
111. Maryland Business Express, “Business Entity Search – Frozen Egg Bank Network”, egov.maryland.gov,
     https://egov.maryland.gov/BusinessExpress/EntitySearch/
     (accessed July 28, 2018)
     
     
112. Tang, Didi (Beijing), “China May Let Single Women Have IVF to Boost Birth Rate”, dated 07/25/18, The Times UK,
     https://www.thetimes.co.uk/article/china-considers-allowing-single-women-to-have-ivf-to-boost-birth-rates-jx9nhgktf
     (accessed July 31, 2018)
      
113. Yan, Alice, “How a Ban is Forcing China’s Single Women to Put Their Fertility on Ice Overseas”, dated 08/20/17, South China Morning Post,
     https://www.scmp.com/news/china/society/article/2107287/how-ban-forcing-chinas-leftover-women-abroad-freeze-their-eggs
     (accessed July 31, 2018)
      
114. Kresho, Thad, “PwC Deals – US Health Services Deals Insights Q2 2018”, PWC.com,
     https://www.pwc.com/us/en/health-industries/publications/assets/us-health-services-deals-insights-q2-2018.pdf
     (accessed August 1, 2018)
      
115. State of Delaware – The Official Website of the First State, Department of State: Division of Corporations, Entity Details – File # 5708155, dated 03/11/15, icis.corp.delaware.gov,
     https://icis.corp.delaware.gov/Ecorp/EntitySearch/NameSearch.aspx
     (accessed August 2, 2018)
      
116. Maryland Business Express, “Business Entity Search – Shady Grove Fertility, LLC”, Department ID # W16970519, dated 01/04/16, egov.maryland.gov,
     https://egov.maryland.gov/BusinessExpress/EntitySearch/BusinessInformation/W16970519
     (accessed August 2, 2018)
      
117. United States Securities And Exchange Commission, Form 10-K, IntegraMed America Inc., for the fiscal year ended December 31, 2011, sec.gov,
     https://www.sec.gov/Archives/edgar/data/885988/000088598812000006/form10k2011.htm
     (accessed August 1, 2018)
      
118. Securities And Exchange Commission, Form S-1, IntegraMed America Inc., dated 05/06/97, edgar.brand.edgar-online.com,
     http://edgar.brand.edgar-online.com/efxapi/EFX_dll/EDGARpro.dll?FetchFilingHTML1?ID=1390591&SessionID=yX3sqWRLX2nsRU7
     (accessed August 1, 2018)
     
     
119. Deboer, Dana, Shady Grove Fertility, “Shady Grove Fertility Expands to Tampa, Offering Highly Specialized Fertility Care as an Affiliate of Women’s Care Florida, and Welcomes New Physician to the Practice,” dated 08/02/18, CISION PRWeb,
     https://www.prweb.com/releases/shady_grove_fertility_expands_to_tampa_offering_highly_specialized_fertility_care_as_an_affiliate_of_womens_care_florida_and_welcomes_new_physician_to_the_practice/prweb15660424.htm
     (accessed August 4, 2018)
     
     
120. Shady Grove Fertility, “Shared Donor Egg Program”, shadygrovefertility.com,
     https://www.shadygrovefertility.com/affording-care/discount-programs/shared-donor-egg-program
     (accessed August 4, 2018)
      
121. Ahuja, Dr. Kamal, Gurtin, Dr. Zeynep and Venessa Smith of London Women’s Clinic, “The Social Pioneers of Egg Freezing are Facing Tough Choices”, dated 07/30/18, BioNews (Issue # 960),
     https://www.bionews.org.uk/page_137508
     (accessed August 4, 2018)
      
122. Power Corporation of Canada via Canada NewsWire / PRNewswire, “Power Corporation Reports Second Quarter Financial Results”, dated 08/03/18, benzinga.com,
     https://www.benzinga.com/pressreleases/18/08/r12139204/power-corporation-reports-second-quarter-financial-results
     (accessed August 4, 2018)
      
123. Power Corporation of Canada, “Power Corporation Reports Second Quarter Financial Results,” dated 08/03/18, powercorporation.com,
     https://www.powercorporation.com/en/news/press-releases/2018/power-corporation-reports-second-quarter-financial-results-122577/
     (accessed August 4, 2018)
      
124. Sagard Holdings, “Sagard Holdings Announces First Closing of Sagard Credit Partners – Total Commitments of US $260 Million”, dated 01/18/18, sagardholdings.com,
     http://www.sagardholdings.com/news/sagard-holdings-announces-first-closing-of-sagard-credit-partners/
     (accessed August 4, 2018)
      
125. DeBoer, Dana, Shady Grove Fertility, “Shady Grove Fertility Opens New Full-Service Office in Fredericksburg, Virginia and Welcomes Reproductive Endocrinologist, Nancy Durso, M.D. to the Practice, dated 07/31/18, Virtual Strategy Magazine from PRWeb, virtual-strategy.com,
     http://virtual-strategy.com/2018/07/31/shady-grove-fertility-opens-new-full-service-office-in-fredericksburg/
     (accessed August 4, 2018)
     
     
126. Coughlin, Joseph F. and Felts, Adam (MIT AgeLab), “Millennials are the Food Truck Generation”, dated “over a year ago”, bigthink.com,
     https://bigthink.com/disruptive-demographics/millennials-are-the-food-truck-generation
     (accessed August 5, 2018)
      
127. O’Brien, Sara Ashley, “’Fertility Van’ Hits Streets of New York City”, dated 08/03/18, CNN Tech – Startups, money.cnn.com,
     https://money.cnn.com/2018/08/03/technology/fertility-tests-kindbody/index.html
     (accessed August 5, 2018)
      
128. IntegraMed Fertility, Home Page – Careers, integramed.com,
     https://www.integramed.com/home/careers/
     (accessed August 5, 2018)
      
129. CIBC (Canadian Imperial Bank of Commerce), “CIBC Capital Markets”, cibcwm.com,
     http://www.cibcwm.com/cibc-eportal-web/portal/wm?pageId=home&language=en_CA
     (accessed August 5, 2018)
      
130. CIBC (Canadian Imperial Bank of Commerce) U.S., “Commercial Real Estate Lending”, cibc.com,
     https://us.cibc.com/en/commercial/commercial-real-estate-lending.html
     (accessed August 5, 2018)
      
131. CBRE, “Debt and Structured Finance”, cbre.com,
     https://www.cbre.com/real-estate-services/investor/debt-structured-finance
     (accessed August 5, 2018)
      
132. SGFertility – Chile, “Programa Ovadonación (Egg Donation Program) / Donación de óvulos (Donation of Eggs)”, sgfertility.cl,
     https://www.sgfertility.cl/nuestros-tratamientos-y-programas/tratamientos-avanzados/donacion-de-ovulos/
     (accessed August 5, 2018)
      
133. Shady Grove Fertility, “Acerca De Nuestras Donantes (About Our Egg Donors)”, dated October 2017, sgfertility.cl,
     https://www.sgfertility.cl/wp-content/uploads/2018/07/About-Our-Egg-Donors_Oct2017.pdf
     (accessed August 5, 2018)
      
134. SGFertility, “Preguntas Frecuentes Sobra La Ovadonación (Frequently Asked Questions About Egg Donation)”, sgfertility.cl,
     https://www.sgfertility.cl/como-postular-para-ser-una-donante-de-ovulos/preguntas-frecuentes-sobre-la-ovodonacion/
     (accessed August 5, 2018)
      
135. SGFertility, “Receptoras de Óvulos (Ovum Recipients)”, Four PDF files , sgfertility.cl,
     https://www.sgfertility.cl/receptoras-de-ovulos/
     (accessed August 5, 2018)
      
136. California Cryobank, “SG Fertility Chile and California Cryobank Donor Sperm Bank”, criobanco.com,
     http://www.criobanco.com/sg-fertility-chile/
     (accessed August 5, 2018)
      
137. SGF / Shady Grove Fertility UK, “How Shady Grove Fertility Selects Egg Donors” dated 02/09/17, shadygrovefertility.co.uk,
     https://www.shadygrovefertility.co.uk/resources/shady-grove-fertility-selects-egg-donors/
     (accessed August 5, 2018)
      
138. Human Fertilisation & Embryology Authority, “Donating Your Eggs”, hfea.gov.uk,
     https://www.hfea.gov.uk/donation/donors/donating-your-eggs/
     (accessed August 5, 2018)
      
139. Collins, David and Trigiani, Antonia, Catalyst Global for IntegraMed, “IntegraMed Q2 Revenue Grew 10.3% to $76.2M”, dated 08/02/12, Business Wire, businesswire.com,
     https://www.businesswire.com/news/home/20120802005284/en/IntegraMed%C2%AE-Q2-Revenue-Grew-10.3-76.2M
     (accessed August 5, 2018)
      
140. Yucatan Times, “Mexican Women Sell Their Eggs Starting At U.S. $456 Each”, dated 05/04/15, theyucatantimes.com,
     http://www.theyucatantimes.com/2015/05/mexican-women-sell-their-eggs-starting-at-us456-each/
     (accessed August 5, 2018)
      
141. Kenney, N and McGowan, M, “Egg Donation Compensation: Ethical and Legal Challenges”, dated 09/26/14 (published), Dovepress – Open Access To Scientific and Medical Research, dovepress.com,
     https://www.dovepress.com/egg-donation-compensation-ethical-and-legal-challenges-peer-reviewed-fulltext-article-MB
     (accessed August 5, 2018)
      
142. California Cryobank, “California Cryobank and Cord Blood Registry Combine to Create A Leading Life Sciences Platform”, dated 08/06/18, PR Newswire, gurufocus.com,
     https://www.gurufocus.com/news/718346/california-cryobank-and-cord-blood-registry-combine-to-create-a-leading-life-sciences-platform
     (accessed August 7, 2018)
      
143. Street of Walls, “Private Equity New Investment Process”, www.streetofwalls.com,
     http://www.streetofwalls.com/finance-training-courses/private-equity-training/private-equity-investment-process/
     (accessed August 7, 2018)
      
144. Cho, Aimee and Cioffi, Chris, “Fertility Doctor From Bethesda Killed in Watercraft Crash”, dated 07/30/18, NBC 4 Washington, nbcwashington.com,
     https://www.nbcwashington.com/news/local/Fertility-Doctor-Remembered-For-Being-Passionate-About-Helping-People-489568821.html
     (accessed August 7, 2018)
      
145. Cunningham, Caroline, “Shady Grove Fertility Started as a Tiny Maryland Clinic. Now It’s the Country’s Biggest Babymaker”, dated 05/01/17, Washingtonian, Washingtonian.com,
     https://www.washingtonian.com/2017/05/01/shady-grove-fertility-started-tiny-maryland-clinic-now-countrys-biggest-babymaker/
     (accessed August 7, 2018)
      
146. Shady Grove Fertility, “International Donor Egg Program”, internationaldonoregg.com,
     http://internationaldonoregg.com/medical-team/?lang=en
     (accessed August 7, 2018)
      
147. Fertility Centers of Illinois, “Our Center – Our Locations”, fcionline.com,
     https://fcionline.com/our-center/our-locations/
     (accessed August 7, 2018)
      
148. Hildreth, Cade, “Top 10 Cord Blood Banks Worldwide”, dated 09/07/16, BioInformant, bioinformant.com,
     https://bioinformant.com/top-ten-most-influential-cord-blood-banks-worldwide/
     (accessed August 7, 2018)
      
149. Rege, Alyssa, “University Hospitals Denies Liability For Loss of 4,000 Eggs, Embryos”, dated 07/03/18, “Becker’s Clinical Leadership & Infection Control”, beckershospitalreview.com,
     https://www.beckershospitalreview.com/quality/university-hospitals-denies-liability-for-loss-of-4-000-eggs-embryos.html
     (accessed August 7, 2018)
      
150. Montes, Daniel, Bay City News, “Fertility Clinic Facing Class Action Lawsuit For Potential Damage To Eggs, Embryos”, dated 03/15/18, sfexaminer.com,
     http://www.sfexaminer.com/fertility-clinic-facing-class-action-lawsuit-potential-damage-eggs-embryos/
     (accessed August 7, 2018)
      
151. Ditkowsky, Lisa CFP®, President – Pllush Capital Management, from the LinkedIn post- dated 08/05/18,
     https://www.linkedin.com/feed/update/urn:li:activity:6431386293770559488 from
     https://www.linkedin.com/in/lisaditkowskycfp/
     (accessed August 8, 2018)
      
152. Fertility Success Rates, “IVF Success Rates for Fertility Clinics in the United States”, fertilitysuccessrates.com,
     https://fertilitysuccessrates.com
     (accessed August 8, 2018)
      
153. California Cryobank, “Protect Your Family With Cord Blood Advantage – Free Cord Blood Processing ($1500.00 Savings)”, cryobank.com,
     https://cryobank.com/services/cord-blood-banking/
     (accessed August 8, 2018)
      
154. Hildreth, Cade, “What Percentage of U.S. Parents Store Cord Blood Publicly and Privately?” dated 02/08/15, BioInformant, bioinformant.com,
     https://bioinformant.com/market-penetration-rates-revealed-for-u-s-cord-blood-banking-industry/
     (accessed August 8, 2018)
      
155. Sanders, Laura, “40 Years After the First IVF Baby, A Look Back at the Birth of a New Era”, dated 07/25/18, ScienceNews, sciencenews.org,
     https://www.sciencenews.org/blog/growth-curve/40-years-ivf-baby-louise-brown
     (accessed August 8, 2018)
      
156. CT Fertility, “An Announcement From CT Fertility”, dated 08/08/18, ctfertility.com,
     https://www.ctfertility.com/an-announcement-from-ct-fertility
     (accessed August 9, 2018)
      
157. CT Fertility, “CT Fertility Celebrates Its 25^th Anniversary With the Opening of a New Fertility Center in Trumbull, CT and New Office in Barcelona, Spain, and Expands Services Designed”, dated 06/08/16, CISION PRWeb, prweb.com,
     https://www.prweb.com/releases/ct_fertility-surrogacy/25th-anniversary-new-docs/prweb13471564.htm
     (accessed August 9, 2018)
      
158. Market Research Future, Pune, India, “Fertility Services Market Size at 8.5% CAGR With Recent Technologies and Global Industry Trends by 2023 MRFR”, dated 08/09/18, Globe Newswire, globenewswire.com,
     https://globenewswire.com/news-release/2018/08/09/1549518/0/en/Fertility-Services-Market-Size-at-8-50-CAGR-with-Recent-Technologies-and-Global-Industry-Trends-by-2023-MRFR.html/
     (accessed August 9, 2018)
      
159. Wikipedia – The Free Encyclopedia, “History of Biotechnology”, en.wikipedia.org,
     https://en.wikipedia.org/wiki/History_of_biotechnology
     (accessed August 9, 2018)
      
160. Chapman, Jacob, Editor, “Donor Egg IVF Market to Exhibit Impressive Growth during 2016-2026”, dated 08/10/18, Fair Columnist, faircolumnist.com,
     https://faircolumnist.com/donor-egg-ivf-market-to-exhibit-impressive-growth-during-2016-2026/
     (accessed August 12, 2018)
      
161. Herp, Betsy, Cryos International, “Cryos and CAN-AM Cryoservices Cement Relationship”, dated 08/08/18, BusinessWire, businesswire.com,
     https://www.businesswire.com/news/home/20180808005059/en/Cryos-CAN-AM-Cryoservices-Cement-Relationship
     (accessed August 12, 2018)
      
162. Bissessar, Haimant, Preisdent, CAN-AM Cryobank, “CAN-AM Cryoservices Donor Egg & Sperm Bank”, CAN-AM Cryoservices, canamcryo.com,
     https://www.canamcryo.com/en/why-canam
     (accessed August 12, 2018)
      
163. Trolice, Mark P, MD, “Director, Fertility CARE – The IVF Center”, LinkedIn, LinkedIn.com,
     https://www.linkedin.com/in/marktrolice/
     (accessed August 12, 2018)
      
164. Feinberg, Eve, MD and Streicher, Lauren, MD, “ Streicher interviews Northwestern Medicine fertility expert Dr. Eve Feinberg about enhancing fertility at any age!”, dated 08/08/18, Facebook Live, Facebook.com,
     https://www.facebook.com/DrStreicher/videos/1780864791949000/
     (accessed August 12, 2018)
     
     
165. Dorbian, Iris, “Golub Capital Supports GI Partners’ Buyouts of California Cryobank and Cord Blood Registry”, dated 08/09/18, The PE Hub Network, pehub.com,
     https://www.pehub.com/2018/08/golub-capital-supports-gi-partners-buyouts-of-california-cryobank-and-cord-blood-registry/#
     (accessed August 12, 2018)
     
     
166. Schwarzberg, Jonathan and Parker Deo, Leela, “LPCL Private Equity Firms Put More Capital, Less Debt into LBOs, dated 08/26/16, Reuters, reuters.com,
     https://www.reuters.com/article/marketo-equity/lpc-private-equity-firms-put-more-capital-less-debt-into-lbos-idUSL1N1B70MD
     (accessed August 12, 2018)
     
     
167. GI Partners, “GI Partners Completes Acquisition of California Cryobank and Cord Blood Registry”, dated 08/06/18, PR Newswire, prnewswire.com,
     https://www.prnewswire.com/news-releases/gi-partners-completes-acquisition-and-merger-of-california-cryobank-and-cord-blood-registry-300692657.html
     (accessed August 12, 2018)
     
     
168. Owl Rock, “Bespoke Financing Solutions – Direct Middle Market Private Credit”, owlrock.com,
     https://owlrock.com
     (accessed August 12, 2018)
     
     
169. Porter, Kiel and Bakewell, Sally, “Owl Rock is Finalizing Fund With $3 Billion for Loans”, dated 08/10/18, Bloomberg, bloomberg.com,
     https://www.bloomberg.com/news/articles/2018-08-10/owl-rock-is-said-to-be-finalizing-fund-with-3-billion-for-loans
     (accessed August 12, 2018)
     
     
170. SART (Society For Assisted Reproductive Technology), “Find a Clinic”, sart.org,
     https://www.sart.org/clinic-pages/find-a-clinic/
     (accessed August 12, 2018)
     
171. Golub Capital, “Golub Capital Provides One-Loan Financing To Support Sagard Capital’s Acquisition of IntegraMed America”, dated 09/20/12, CISION PR Newswire, prnewswire.com,
     https://www.prnewswire.com/news-releases/golub-capital-provides-one-loan-financing-to-support-sagard-capitals-acquisition-of-integramed-america-170567316.html
     (accessed August 12, 2018)
     
     
172. Market Sector, Research N Reports, “Donor Egg IVFs Market Research Report With CAGR +9 From 2014-2020”, advertisement dated 08/03/2018 for 18-month-old report dated 03/2017, themarketsector.com,
     https://themarketsector.com/donor-egg-ivfs-market-research-report-with-cagr-of-9-from-2014-to-2020/628/
     https://www.researchnreports.com/pharma-healthcare/Global-Donor-Egg-IVFs-Market-77914
     (accessed August 12, 2018)
     
     
173. United States Securities and Exchange Commission, Form 8-K, “GP Strategies Corporation”, dated 06/29/18, www.last10k.com,
     https://www.last10k.com/sec-filings/gpx/0000070415-18-000101.htm
     (accessed August 16, 2018)
     
     
174. Delgado, Lisa, “GP Strategies Corporation (GPX)’s Wedge Down Pattern Points to Higher Stock Risks”, dates 08/13/18, Florida Recorder, floridarecorder.com,
     https://floridarecorder.com/2018/08/13/gp-strategies-corporation-gpxs-wedge-down-pattern-points-to-higher-stock-risks/
     (accessed August 16, 2018)
     
     
175. IntegraMed Fertility, “Our Board”, integramed.com,
     https://www.integramed.com/about-us/our-board/
     (accessed August 16, 2018)
     
     
176. Sagard Holdings, “Our Team – Leadership”, sagardholdings.com,
     http://www.sagardholdings.com/team/
     (accessed August 16, 2018)
     
     
177. GP Strategies, “About Us – 50 Years at the Forefront of Performance Improvement”, gpstrategies.com
     https://www.gpstrategies.com/about-us/
     (accessed August 16, 2018)
     
     
178. GP Strategies, “GP Strategies Elects New Board Members”, dated 08/15/18, gpstrategies.com,
     https://www.gpstrategies.com/news/gp-strategies-elects-new-board-members/
     (accessed August 16, 2018)
     
     
179. IntegraMed, “Integramed Fertility – Management Consulting”, LinkedIn,
     https://www.linkedin.com/company/integramed/
     (accessed August 16, 2018)
     
     
180. The Guardian, “America’s Hottest Export” Sperm”, dated 08/15/18, theguardian.com,
     https://www.theguardian.com/science/2018/aug/15/americas-hottest-export-sperm-fertility
     (accessed August 16, 2018)
     
     
181. Wikipedia, “Leverage (finance)”, en.wikipedia.org
     https://en.wikipedia.org/wiki/Leverage_(finance)
     (accessed August 16, 2018)
     
     
182. Investopedia, “Understanding Leverage Ratios”, investopedia.com,
     https://www.investopedia.com/articles/investing/080113/understanding-leverage-ratios.asp
     (accessed August 16, 2018)
     
     
183. Shady Grove Fertility, “Shady Grove Fertility Joins Center for Surrogate Parenting (CSP), at their London Seminar, September 29, 2018” dated 08/16/18, PR Newswire, markets.businessinsider.com,
     https://markets.businessinsider.com/news/stocks/shady-grove-fertility-joins-center-for-surrogate-parenting-csp-at-their-london-seminar-september-29-2018-1027463710
     (accessed August 16, 2018)
     
     
184. Gallagher, Paul, “Fertility Charity Concerned Over New ‘Unlimited’ IVF Treatment Programme”, dated 08/15/18, i News – The Essential Daily Briefing, inews.co.uk,
     https://inews.co.uk/news/health/unlimited-ivf-treatment-fertility-charity-concerned/
     https://www.accessfertility.co.uk
     (accessed August 17, 2018)

*Readers – Please be aware that at the speed of which corporate transactions are occurring both domestically and internationally in the Fertility space, this research will continually evolve. All reference sources used to ensure the accuracy of information at the time of publishing are provided for verification and your own updating capabilities in “Bibliography / Sources Cited”. Questions can be submitted through www.PLLUSH.com. Thank you.

DISCLOSURES: Content in this material is for general information only and not intended to provide specific advice or recommendations for any individual. Companies and industries/sectors mentioned are for informational purposes only, and are not included as a solicitation or recommendation to invest in their securities. Investing involves risk including loss of principal.