{ "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": 89, "pageCount": 100, "prevPage": 88, "nextPage": 90, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "dense", "nDataPoints": 0, "notes": "Uses academic citations to refute company marketing claims.", "elementsJson": [ "headline_text", "callout_box", "bullet_list", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b99-4fdf89a4b224/89", "deckHref": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224", "deckJsonHref": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224#slide-89", "components": [ { "bbox": { "h": 0.11, "w": 0.9, "x": 0.05, "y": 0.17 }, "kind": "callout", "text": "We believe PGNY's intimation that “Sarah” suffered a miscarriage due to the lack of PGT is marketing fluff. We believe PGNY is capitalizing on patients’ (often reasonable) assumption that the increasing use of new technologies must improve health outcomes. Once again, the actual science does not fully support their claim.", "attrs": null, "subkind": "primary", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "f76e5a88-9f57-4a37-ba28-c2a0eeed08d6", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "callout", "text": "We believe PGNY's intimation that “Sarah” suffered a miscarriage due to the lack of PGT is marketing fluff. We believe PGNY is capitalizing on patients' (often reasonable) assumption that the increasing use of new technologies must improve health outcomes. Once again, the actual science does not fully support their claim.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-2b61-7647-86f3-bc21b7abd07a", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.55, "w": 0.9, "x": 0.05, "y": 0.36 }, "kind": "list", "text": "Recall in PGNY's investor presentation excerpted on page 86, Sarah's story suggests she suffers a miscarriage without genetic screening and a full-term pregnancy (after fewer cycles) after PGT-A. However, the effect of PGT on miscarriage rates is contentious; some recent studies, including multi-center randomized controlled trials, show a reduced risk of miscarriage (Verpoest et al., 2018, Scriven, 2020), while others found that it did not affect miscarriage rates (Munné et al., 2019, Murphy et al., 2019, Sato et al., 2019), or that miscarriages were rare even following the implantation of embryos classified as ‘abnormal’ (Patrizio et al., 2019). Similarly, the reduction of implantation cycles has also been questioned; a recent systematic review of 26 studies on PGT-A confirms that the add-on should, in theory, be able to enhance clinical outcomes on a per-transfer basis, but finds that the ‘current available literature is sparse or of insufficient quality’ and concludes that the routine use of PGT-A ‘with the aim of improving clinical outcomes is not supported by substantial evidence’ (Toft et al., 2020). In fact, ASRM notes that PGT-A may actually decrease the birth rate per cycle as a result of the embryo’s culturing conditions and cell biopsy, which could adversely affect the embryo, or due to the risk of unnecessarily discarding embryos that are classified as ‘abnormal’ (Penzias et al., 2018). For example, Patrizio et al. (2019) found that the transfers of such ‘abnormal embryos’ nevertheless resulted in ‘robust pregnancy and live birth chances with low miscarriage rates’ and raised concerns about PGT-A leading to the disposal of ‘many normal embryos with excellent pregnancy potential’ (also see Mochizuki and Gleicher, 2020). Far from a straightforward improvement of the IVF cycle that enables single embryo transfer, PGT-A is thus a contested technology.", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "b07ab556-e146-472d-8937-3912e3816b0a", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.05, "w": 0.9, "x": 0.05, "y": 0.29 }, "kind": "paragraph", "text": "PGNY's Suggestion That PGT Can Reduce Miscarriages and/or Implant Cycles is Dubious", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "c83f90e9-a2dd-47c3-9179-29d851d3bd00", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "‘current available literature is sparse or of insufficient quality’ and concludes that the routine use of PGT-A ‘with the aim of improving clinical outcomes is not supported by substantial evidence’ — Toft et al., 2020", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-2b61-7647-86f3-c327d90d57cf", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.04, "w": 0.9, "x": 0.05, "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": "fff385a3-f471-450a-9a11-a7957087e6b7", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.07, "w": 0.65, "x": 0.31, "y": 0.03 }, "kind": "title", "text": "We Believe PGNY Embellishes The Value of PGT (Continued)", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "95cce155-7f6c-441e-9fbd-1eca179fb38a", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "authority-citation", "slug": null, "matchId": "b8b69e7f-1f00-4dbb-aae3-9c7c60f932db", "evidence": "Uses multiple academic citations to refute company claims.", "confidence": 0.9 } ], "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 }