IVF provider Reproductive Medicine Associates of Philadelphia doubled the size of its Wayne clinic

Reproductive Medicine Associates of Philadelphia, one of the region’s largest fertility clinics, doubled the size of its Wayne clinic this year to help it meet growing demand for in vitro fertilization and other services to help people become pregnant.

Growth had slowed for the practice, which is part of IVI RMA, one of the world’s largest fertility companies, because its former location in King of Prussia was at capacity.

”We wanted to help people get in the door, get seen faster, get treatment faster,” said Jeffrey Thorne, a physician and medical director for IVF at RMA of Philadelphia. The practice saw 2,800 patients last year and helped more than 1,000 patients become pregnant, Thorne said.

Thorne declined to say how much was invested in the new, 16,000-square-foot facility, which is on Swedesford Road across from the King of Prussia Town Center shopping mall.

Like its biggest competitors in the Philadelphia region, Shady Grove Fertility and Main Line Fertility & Reproductive Medicine, RMA is part of a company backed by private-equity firms attracted to the anticipated growth in IVF. Combined, those three practices grew by 130% from 2018 to 2022, more than twice as fast as the whole market.

The only nonprofit health system in Southeastern Pennsylvania with a fertility practice that competes with the for-profits is Penn Medicine.

RMA’s expansion came amid national discussions of how to expand insurance coverage for the services nationally. Pennsylvania does not mandate fertility services coverage. New Jersey is one of 16 states that require insurers and employers to pay for the service.

Globally, one in six couples has trouble conceiving, according the World Health Organization. That has propelled a global fertility market valued at $34.7 billion in 2023 and projected to grow to $62.8 billion in 10 years, according to a July editorial in Lancet, a British medical journal.

The majority of the people who come to Thorne are couples having a hard time getting pregnant — often because they are trying to conceive at older ages, but that’s not the only type of patient he and the other RMA doctors see.

They also serve the LGBTQ community, individuals who are not part of a couple and choose to become pregnant with donor sperm, people who want to freeze eggs when they are relatively young, and people diagnosed with cancer who want to preserve fertility, Thorne said.

Lori Krause, 41, and husband, Rocco Vernacchio, 46, are trying to start a family at an age when fertility is declining. Krause’s gynecologist referred the South Philadelphia couple to Thorne after they had trouble conceiving.

The couple also had to deal with an additional complication: Vernacchio has a genetic heart condition. Krause had insurance coverage for fertility treatments, but the heart condition was a factor in how to proceed.

Her insurer did not want to cover intrauterine insemination (IUI), which involves a doctor placing a sperm near the egg, due to the risk of the baby inheriting the heart condition.

IUI is typically tried before IVF, but the couple skipped it and advanced straight to IVF. This allowed them to screen for the heart condition.

“There was a 50-50 chance of the child having that condition if we got pregnant naturally,” Krause said.

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Krause went through four in vitro fertilization cycles. That process typically involves stimulating the ovaries, then monitoring the eggs during development. Eventually, the eggs are retrieved from the ovaries and fertilized by sperm in a laboratory using in vitro fertilization. The growing embryos are ultimately transferred into the uterus. Each cycle takes about two weeks, including daily visits to the clinic for part of the time.

“We ended up with one genetically viable embryo, and one that had the heart condition. This transfer was our one chance, essentially, and so it’s a miracle that it worked,” said Krause, who was five months pregnant on Oct. 8, when she talked to The Inquirer.

“It’s an emotionally taxing thing to go through,” she said.

Krause, who works in sales, was glad to have insurance that covered much of the cost.

A single IVF cycle costs $15,000 to $20,000 at RMA, Thorne said. The medications used to stimulate egg production cost thousands more for each cycle.

For many people, the treatment is out of reach financially.

Thorne tells people who have the means to pay for IVF: “You’re paying for a year of day care in advance. I’m sorry about that, but that’s the way it is.”

RMA and its competitors promote financing plans through lenders with terms up to seven years. They also offer package deals that cover numerous attempts to get pregnant.

Despite having insurance that covers IVF, Krause and Vernacchio still had thousands in out-of-pocket costs, for office visits, medications, and procedures. Her insurance did not pay for the storage of embryos.

Before transfer, every embryo is genetically tested to ensure that it has the right number of chromosomes. The couple had to cover the $300 cost of each test. Krause and Vernacchio also had to pay $3,000 for the creation of a special probe to test for Vernacchio’s heart condition, Krause said.

Krause received treatment in the old and the new RMA locations. Her egg retrieval happened at the former site, but RMA did the embryo transfer in the new clinic, which opened in May.

An advantage of the new center is that it has two floors, which allows RMA to separate the clinic from the surgery center.

In the first-floor clinic, 150 patients a day are monitored for hormone levels and ovulation, Thorne said. RMA has an in-house lab down the hall that can produce results from blood tests in 18 minutes.

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On the second floor, egg retrievals, in vitro fertilization, and embryo transfers happen. It’s also where frozen embryos are stored in canisters filled with liquid nitrogen. “Typically, we have four or five patients coming in for retrieval, four or five for a transfer” daily, Thorne said.

RMA’s footprint in Philadelphia also includes smaller offices in Center City, Abington, and Langhorne, employs more than 100 people, including four full-time doctors, one part-time doctor, and two advanced practitioners.

One day in early October at its new facility, Beth Raneiro, a senior embryologist, sat a table in front of a microscope looking into a small dish with eggs and sperm. The sperm were in a viscous liquid that slows them down.

Raneiro used a hollow needle, controlled by her right hand, to pick a sperm that had a good shape and swam well. Then she used what is called a herding pipette, controlled by her left hand, to hold an egg in place while she injected the sperm into it.

The process can resolve many causes of infertility, from limited egg availability or blocked fallopian tubes to low sperm count.

“He may only have 10 sperm, but you can actually just shoot each one of those tiny sperm into an egg,” Thorne said.