Basking Ridge hosts one of the global leaders in an innovation category that’s growing faster than almost any other.
And you’d never know it. … Unless, that is, you’re one of the not-insignificant number of couples in New Jersey affected by infertility. That’s roughly 1 in 6 people worldwide, according to World Health Organization data.
IVI RMA, which employs more than 4,400 people across 14 countries, has a local base in Basking Ridge. The company is among the world’s largest providers of fertility solutions, centered around in vitro fertilization, or IVF.
Before it merged with IVI, a leader in fertility treatment in Europe and Latin America, RMA was founded by three reproductive endocrinologists locally in 1999. Dr. Thomas Molinaro, a director at IVI RMA America, said IVF was still a relatively new, experimental treatment at that time.
The timing was nearly perfect. Two years after the launch of the business, New Jersey policymakers mandated insurance coverage for fertility treatments.
“With more patients having access to this care, the practice was able to grow and expand,” he said. “And we, along the way, were able to invest significant resources back into IVF technology.”
As a quick rundown: During IVF, a woman is stimulated to produce multiple eggs that are removed from the ovaries. That’s combined with a partner’s sperm to make embryos, which are grown in a lab and then transferred back into the uterus through an implantation procedure.
“Early on, the company realized genetic testing of embryos during that process was going to be an important aspect of improving care,” Molinaro said. “We knew that, as women age, their embryos typically make more chromosomal mistakes. And those can be responsible for negative pregnancy tests, miscarriages or babies with chromosomal disorders such as Down syndrome.”
As assisted reproductive technology has improved — and as the median age of first-time mothers has moved upward over the years — the market for it has increased to more than $500 million globally, according to recent market forecasts.
“There’s also a whole growing field of egg freezing,” Molinaro said. “Young women are freezing their eggs to preserve their fertility for later in life, especially those without partners or career-focused. We believe that field will continue to grow. And we’ll continue to grow our business along with it.”
Lynn Mason, named the company’s CEO this fall, admitting to some bias, is bullish on the growth of fertility solutions. The whole industry is expected to grow upwards of 10% over the next five years, she said.
The interest in egg freezing is an added bonus. She noted that Society for Assisted Reproductive Technology data indicates that the number of healthy women freezing eggs about doubled from 2016 to 2022, from roughly 7,200 to nearly 12,500.
Their global business expects to do more in that area, as well as genetic testing of embryos that fertile couples can take advantage of, as well. Mason expects there might also be potential in the future to get more involved on the men’s health side of the reproductive medicine industry.
“For us, we’re constantly looking at trends, listening to clients and patients and thinking about how we can make sure we’re providing the best care whatever direction the market goes in,” she said.
Taking a digital innovation angle, Molinaro said there are opportunities to leverage artificial intelligence technology to better examine genetic variables and analyze patterns in which embryos grow.
“I shudder to say that AI is going to take over our field, but, I think, ultimately, there’s a real opportunity to use machine learning to understand what makes a good embryo,” he said. “We can still improve the efficiency of growing embryos in a lab. Ultimately, there’s a lot on the horizon we just don’t know about yet.”
Efficiency and success rates are a veritable obsession among fertility clinics. IVF is one of the only medical procedures that the federal government collects, and publishes, success rates on. So, there’s an industry arms race to move success percentage rates higher at clinics and thus stand out in a competitive field.
IVI RMA’s leaders are pleased with how they measure up in the crowded Northeast, where 200-plus clinics can be found in a 50-mile radius around New York City.
“We are constantly, consistently on the top of those reports in terms of outcomes,” she said. “The delta between the top outcomes by provider and the rest of the field was pretty shocking to me. There’s lots of providers, but competition at the highest performance level — I see it as thin.”
Molinaro and Mason both expressed that they believe the best is yet to come from their locally-based organization. And that starts with more satisfied patients.
“At the end of the day, we want people holding their child,” Mason said. “That’s what matters.”
Multiple choice
Mothers undergoing in vitro fertilization might have crossed their fingers for two (or three) sets of everything at the baby shower. Because, as reproductive endocrinologist Dr. Thomas Molinaro said most people have heard, twins or triplets (yikes) were once a relatively common outcome.
“But we’ve tried to get the word out that today’s IVF isn’t the same one you may have heard about growing up,” he said. “No longer do we have to worry about multiple pregnancies the same way.”
In the early days of this assisted reproduction technology, Molinaro explained, specialists weren’t able to easily determine whether they had made a healthy embryo that would lead to a pregnancy when transferred back to the patient or not. Each of those embryos might have had a 10% or less chance of success.
So, the solution for reproductive endocrinologists was to put back two, three or more embryos.
“So, with IVF of 20 years ago, many of those patients had twins or triplets, because we put back multiple embryos in hopes of improving pregnancy rates — and just exchanged one problem for another, due to the risks involved,” Molinaro said. “We turned their infertility into a multiple pregnancy situation, which comes with its own complications.”
IVF laboratories have gotten better at identifying embryos that have the characteristics of those that are successfully implanted. The live birth rates of the ones IVI RMA selects today can have a success rate of 60% or 70%, Molinaro said.
Because they only transfer one embryo at a time into patients, the only twins this process might lead to are identical twins, or monozygotic twins.
“That happens when an embryo splits,” he said.
And that one, he added jovially, isn’t his fault.
