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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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      "text": "PGNY's presentation of its treatment protocol suggests it is the right course for all patients, ignoring that highly variant fertility issues and diagnoses require a highly individualized approach to reproductive health. The science clearly suggests that there are logical (and for the patient, financial) arguments for using IUI before IVF.",
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      "text": "PGNY's presentation of its treatment protocol suggests it is the right course for all patients, ignoring that highly variant fertility issues and diagnoses require a highly individualized approach to reproductive health.",
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      "text": "The PGNY approach to fertility suggests that more intensive treatments yield better outcomes. However, the question of whether IUI or IVF is a preferred primary treatment is widely debated. Fertility treatments should be driven by the precise diagnosis rather than a corporate policy based on financial incentives. For example, IVF, and specifically intracytoplasmic sperm injection (ICSI), may be appropriate when the issues are low sperm count or motility, problems with the fallopian tubes, advanced age. However, for other cases, IUI is much less costly and invasive, has fewer health risks for women, requires milder hormonal stimulation, and does not create supernumerary frozen embryos. In fact, the 2020 ASRM guidelines note that IVF is ‘substantially more invasive and more costly’ than other treatments and state that ‘current evidence does not support IVF as a first-line therapy for unexplained infertility’; usually ‘the best initial therapy is a course (typically 3 or 4 cycles) of ovarian stimulation [...] and intrauterine insemination (OS-IUI)’. Moreover, PGNY and others often frame IUI as presenting a potentially decisive timing delay, yet we note that three cycles of IUI would take just three months, which is immaterial for most patients.",
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      "text": "IUI is generally about one-tenth the cost and one-third as effective as IVF. Success rates for both procedures are most heavily impacted by patient age, fertility diagnosis, ovarian reserve, stimulation protocol, presence of male factors, use of donor eggs, and other health conditions. IUI costs and outcomes will be higher/better when accompanied by stimulation medicines. Costs of both procedures are impacted by the clinic and location. Subsequent rounds of IVF may not require egg retrieval and/or may be discounted by a clinic.",
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      "text": "There Is A Case For IUI",
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      "text": "cost per cycle: $2K",
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      "text": "‘current evidence does not support IVF as a first-line therapy for unexplained infertility’; usually ‘the best initial therapy is a course (typically 3 or 4 cycles) of ovarian stimulation [...] and intrauterine insemination (OS-IUI)’ — ASRM, 2020a",
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      "kind": "source-note",
      "text": "Source: Disrupting the biological clock: Fertility benefits, egg freezing and proactive fertility management, Lucy van de Wiel, Reproductive Biomedicine & Society Online, Volume 14, March 2022, Pages 239-250",
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      "text": "IUI vs IVF: Highly Generalized Costs vs Probability. Success Rates: Average 10% (IUI) 35% (IVF), Range 0-20% (IUI) 7-47% (IVF). Cost per Cycle: Average $2K (IUI) $20K (IVF), Range $1K-$4K (IUI) $15K-$30K (IVF).",
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      "kind": "title",
      "text": "We Believe The Science And Math Behind PGNY's “Direct To IVF” Approach Is On Weak Grounds",
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