Fertility Clinic KPIs

About the expert

David Stern

Boston IVF

David Stern is the CEO of Boston IVF, where he led the expansion from 5 to 11 clinics within five years. With over 30 years of experience in women’s health, he has dedicated a significant portion of his career to the fertility industry, holding multiple leadership roles. Before joining Boston IVF, he served in C-level positions for several women’s health and fertility focused companies. His extensive expertise spans business strategy, operational growth, and improving patient access to fertility care.

Silvia

When you joined Boston IVF in 2020, it was your job to expand the group. Which KPIs were the first ones you looked at?

David

At the end of 2018, leading into 2019, Eugin, a global IVF group based in Spain, had just acquired Boston IVF, and for most of that year, there was no CEO in place. When I joined, I wanted to see our insurance reimbursement contracts, and then I wanted to understand — how much does it actually cost us to deliver care? But when I asked, nobody had a clear answer. So, literally, in my first week or two as CEO, I said, “Okay, we need to figure this out.”
We gathered all the data — how much we were paying nurses, doctors, embryologist and other costs — and determined whether we were even making a profit on these contracts. Reimbursement structures are complex, and you need to realize how profitable, or unprofitable, certain arrangements are. When operating in an insurance mandated state, you receive less reimbursement per cycle, and need to rely on higher volumes and efficiencies to be profitable.
To answer your question, there were very limited key performance indicators (KPIs) in place on the business side, no customer relationship management system to track patient interactions, and while there was a contract with Salesforce, it wasn’t being used.
I implemented Salesforce, set up a marketing cloud, and introduced systems to track patient journeys, monitor dropouts, and improve engagement.

Silvia

Since then, you’ve grown the group from 5 to 11 IVF labs and 25 offices. When evaluating potential acquisitions, what were the first factors you considered before diving deeper?

David

Our acquisition strategy was largely relationship-driven. Either myself or our Medical Director, Dr. Michael Alper, had a connection with one of the physicians. That said, we had clear criteria — we targeted clinics in the top third of their market, looked for areas with strong growth potential, and prioritized geographic expansion.
Interestingly, the clinics we acquired in Ohio, Salt Lake City, and North Carolina — were all cash-pay markets, meaning there were no insurance mandates. Delaware, on the other hand, had an insurance mandate, which operated differently from Massachusetts.
Many of these practices lacked basic business infrastructure — no KPIs, no marketing, and in one case, no in-house lab. In Ohio, they outsourced all their lab work, so we built them a lab from the ground up and put our protocols into place.

Silvia

So when you stepped in, it wasn’t about improving KPIs but first figuring out what was happening. How did the teams react?

David

Our approach was very consultative. We didn’t come in and dictate changes. Instead, we took the position of being another partner— because physician involvement in growth is crucial to us.
Our pitch to physicians was simple: Over five years, we’d grow the business to a point where their retained shares would be worth as much or more than when they initially sold. Then, we offered a “Chinese menu” of services — marketing, operational improvements, technology upgrades — and let them prioritize what they needed.
Most of these practices had no marketing in place at all. We leveraged our existing strategies — social media, web presence, and OB-GYN outreach — tailoring them to each acquired clinic. We also introduced physician liaisons to track OB-GYN referrals and set up structured monthly meetings to review lab KPIs, new patient starts, follow-ups, intrauterine insemination (IUI) cycles, egg retrievals, and financials with the physician-owners and administrators.

Silvia

How important is it for the team to understand KPIs from your experience?

David

The operations team, nurses, and embryologists don’t necessarily need to be deeply involved in financial KPIs. But physicians absolutely should be. The other teams have to be accountable for their departmental KPIs and understand the trends.
For instance, one clinic we acquired was charging only $500 for an IUI — already a low-margin procedure. When we broke down the costs, we realized it wasn’t sustainable and raised the price to $1,000. Some physicians were initially hesitant, but we conducted secret shopper research and competitive analysis to show what the market could bear.

Silvia

Which KPIs can be improved the fastest with minimal effort? And at Boston IVF, which have been the hardest to improve?

David

The easiest KPI to improve is simply how much you can track — understanding how many new patient appointments are happening each month, monitoring cancellation rates, and measuring dropout rates. Just collecting that data to get transparency is an easy win.
But driving real change? That’s tough. I’ve worked with physicians for over 30 years, on both the industry and provider side, and changing habits is hard.

Silvia

Would you agree that a fertility clinic’s most important KPI is how many couples who don’t get pregnant on their first cycle return for another?

David

Absolutely. That’s essentially a retention rate, and it’s crucial. When patients return for another cycle, their outcomes often improve because doctors learn from the first stimulation cycle and can optimize treatment protocols, leading to better success rates.

Silvia

How disruptive is staff turnover in maintaining or improving KPIs?

David

Very. Training new financial counselors and nurses takes time, and burnout is a real issue — especially for financial counselors dealing with insurance delays. Patients want to start treatment immediately, but prior authorization can take weeks, leading to frustration and pressure on staff. Burnout massively impacts KPIs.

Silvia

What’s the biggest misconception about KPIs in fertility clinics from your point of view?

 David

People need to remember we’re dealing with biology. Unlike other industries, you can’t just adjust weekly numbers. If retrievals are down, you can’t simply add more procedures that month — it takes weeks to move patients through the pipeline. Understanding that timeline is key.

Silvia

Thank you, David!