{ "docId": "019dd923-622c-750b-8b99-4fdf89a4b224", "docSlug": "bcbeb3ac7b21", "documentTitle": "Progyny, Inc. (PGNY)", "authorId": "54_Spruce_Point_Capital", "authorName": "Spruce Point Capital Management", "documentKindSlug": "activist-deck", "documentKindLabel": "Activist deck", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2023-02-07 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 88, "pageCount": 100, "prevPage": 87, "nextPage": 89, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 4, "notes": "The slide uses a red flag icon to signal a warning or 'red flag' issue.", "elementsJson": [ "headline_text", "paragraph", "callout_box", "bullet_list", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b99-4fdf89a4b224/88", "deckHref": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224", "deckJsonHref": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224#slide-88", "components": [ { "bbox": { "h": 0.09, "w": 0.96, "x": 0.02, "y": 0.4 }, "kind": "callout", "text": "To better understand the materiality of this issue, PGNY completed 28,413 ART cycles in 2021. Assuming they all involved PGT at $5,000 per cycle, that represents $142 million of revenue, or about 40% of PGNY's medical revenue that year. Therefore, it is obvious why PGNY would want to encourage PGT as a standard practice.", "attrs": null, "subkind": "primary", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "5e0b0eda-95ad-4625-ac88-3e0336a2652a", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "callout", "text": "To better understand the materiality of this issue, PGNY completed 28,413 ART cycles in 2021. Assuming they all involved PGT at $5,000 per cycle, that represents $142 million of revenue, or about 40% of PGNY’s medical revenue that year.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-2b61-7647-86f3-9eb2fa8facbf", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.35, "w": 0.96, "x": 0.02, "y": 0.57 }, "kind": "list", "text": "PGT-A analyzes cells from embryos to test whether they have the correct number of chromosomes (i.e. are euploid) and thus are likely to be viable if implanted\nPGNY markets PGT-A as a technology that prevents miscarriage and thus enables single embryo transfer\nHowever, PGT-A is highly contentious because the evidence for its efficacy is limited while its costs are high (an additional $3000–12,000 per cycle), and thereby present a significant means of increasing clinic revenue (Theobald et al., 2020, FertilityIQ, 2020a)\nIn the UK, the fertility regulator [Human Fertilisation and Embryology Authority (HFEA)] gives PGT-A a red (negative) rating, stating 'there is no evidence that this add-on is effective and safe' and that there is a 'risk of misdiagnosing a healthy embryo' as abnormal. HFEA also claims that PGT-A 'can sometimes cause damage to the embryo and prevent it from developing once it has been transferred into the womb' (HFEA., 2018, HFEA, 2020).\nASRM states that 'there is insufficient evidence to recommend the routine use of blastocyst biopsy with aneuploidy testing in all infertile patients' and that 'large, prospective, well-controlled studies are needed to determine not only the effectiveness, but also the safety and potential risks of these technologies' (Penzias et al., 2018).", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "21f0d675-621e-451e-b908-275a7bf05153", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "metric", "text": "revenue: $142 million", "attrs": null, "subkind": "primary", "toolName": "Quantification", "toolSlug": "quantification", "confidence": null, "componentId": "019dd953-2b61-7647-86f3-a5a665a02fd1", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.22, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "Preimplantation genetic testing (PGT) is effectively a standard feature of the PGNY treatment protocol and typically costs around $5,000. While the logic of PGNY's marketing pitch surrounding PGT seems reasonable (leverage advanced, and more expensive, technology to implant better embryos for better fertility outcomes), the reality is far more murky. The efficacy of PGT has been called into question, and the inherent financial conflicts of interest for benefit providers and clinics has not been lost on the scientific community. For this reason, industry bodies still officially characterize some genetic tests as \"experimental\", and many other providers view PGT as only appropriate in limited circumstances.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "dd7892e7-d6cc-4dc3-a479-31caf2ecb642", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "‘there is no evidence that this add-on is effective and safe’ and that there is a ‘risk of misdiagnosing a healthy embryo’ as abnormal. HFEA also claims that PGT-A ‘can sometimes cause damage to the embryo and prevent it from developing once it has been transferred into the womb’ — HFEA., 2018, HFEA, 2020.", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-2b61-7647-86f3-a03d3afa41b5", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.96, "x": 0.02, "y": 0.95 }, "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", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "a200a8aa-25a1-414a-ba5f-9f4e2f2c072b", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.12, "w": 0.65, "x": 0.31, "y": 0.05 }, "kind": "title", "text": "The Value of A Core Element of The PGNY Treatment Protocol (And Source of Revenue), Preimplant Genetic Testing, Has Been Called Into Question", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "9e82b32b-50a9-4b3f-87df-44ed0bfdefb7", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.05, "w": 0.96, "x": 0.02, "y": 0.5 }, "kind": "title", "text": "The Science Behind PGTI Is Less Clear, Calling PGNY's Claims And Standard Treatment Protocol Into Question", "attrs": null, "subkind": "subtitle", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "e47046fc-d6ba-4ab5-81de-51f8d602a87b", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 100, "from": 61, "beatId": "470ad4dd-317c-46c8-baea-551e7894c3b9", "arcName": "Overcoming the Monster", "arcSlug": "overcoming-monster", "beatName": "Resolution", "beatSlug": "mountain-resolution", "evidence": "The document concludes with a detailed analysis of PGNY's valuation and downside risk.", "position": 4, "confidence": 0.8, "parentBeatName": "Resolution", "parentBeatSlug": "resolution" } ], "loops": [ { "to": 100, "from": 61, "name": "Mece Breakdown", "slug": "40-mece-breakdown", "bestFor": "Problem structuring, ensuring completeness, strategic analysis", "matchId": "db636762-5e9e-4cb6-8376-e0923a5a5438", "evidence": "The document presents a detailed analysis of PGNY's valuation and downside risk.", "position": 3, "objective": "How do PGNY's issues impact its valuation?", "structure": "The Whole -> Category A (distinct) -> Category B (distinct) -> Category C (distinct) -> Complete Coverage", "confidence": 0.7, "description": "Divide a complex topic into mutually exclusive, collectively exhaustive categories" } ], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }