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  "documentTitle": "Progyny, Inc. (PGNY)",
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  "authorName": "Spruce Point Capital Management",
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  "presentationDate": "2023-02-07 00:00:00",
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  "notes": "The slide uses a combination of narrative argument and a supporting chart showing the industry-wide trend toward single embryo transfer to undermine PGNY's performance claims.",
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      "text": "Individual fertility treatments and outcomes are strongly dependent upon the fertility diagnosis. Moreover, the PGNY fertility benefit prioritizes IVF and effectively mandates single embryo transfer. Finally, comparing outcomes for patients using the PGNY benefit (often valued at $50K or more, and inclusive of preimplantation genetic testing) to patients using a more limited benefit or self-funding their treatment entirely is not an apples-to-apples comparison.",
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      "text": "Individual fertility treatments and outcomes are strongly dependent upon the fertility diagnosis. Moreover, the PGNY fertility benefit prioritizes IVF and effectively mandates single embryo transfer.",
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      "text": "Percentage of Embryo Transfers in Which a Single Embryo Was Transferred—United States, 2010-2019",
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      "text": "Percentage of Single Embryo Transfers: 77.3%",
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      "text": "One of the fundamental tenets (and in fact, a marketed advantage) of the PGNY fertility benefit is that it allows patients to bypass alternative processes such as intrauterine insemination (IUI) and proceed directly to IVF. IUI is less expensive and has a lower success rate than IVF (10-25% depending on age), but it is viewed as an appropriate first treatment for less severe fertility diagnoses. Therefore, PGNY's outcomes data includes \"easy cases\" that could have gotten pregnant through IUI, and non-PGNY patient data is skewed toward more difficult IVF cases, thus lowering expected outcomes.",
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      "text": "PGNY pushes single embryo transfer. Therefore, PGNY's higher single embryo transfer rate and resultant lower multiples birth rate is a business decision more than a health outcome. Regardless, SART and the CDC both recommend single embryo transfer, and CDC data (right) clearly indicates this is becoming the standard of care, which will reduce the difference between PGNY and non-PGNY outcomes in the future.",
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      "text": "Even Milliman acknowledges that fertility diagnoses impact outcomes: \"Other factors that may contribute to differences in fertility outcomes include infertility diagnosis, which may include diminished ovarian reserve, endometriosis, male factor, uterine factor, tubal factor, ovulatory dysfunction, or unexplained infertility\"",
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      "text": "IVF is very expensive. However, non-PGNY member data includes self-pay patients that, due to the financial burden, pursue alternative treatment protocols and/or go without valuable ancillary services and treatments that can improve outcomes. We believe comparing these two data sets is incorrect.",
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      "text": "Other factors that may contribute to differences in fertility outcomes include infertility diagnosis, which may include diminished ovarian reserve, endometriosis, male factor, uterine factor, tubal factor, ovulatory dysfunction, or unexplained infertility — Milliman Report",
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      "text": "Source: Milliman Report, CDC 2019 Assisted Reproductive Technology, Fertility Clinic and National Summary Report",
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      "text": "Fertility Treatment Processes Are Influenced By Numerous Factors And Directly Impact Outcomes",
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