Guide to Selling a Fertility & IVF Practice in Ohio

The Ohio fertility and IVF market is experiencing significant M&A activity, creating a valuable window of opportunity for practice owners. A successful sale, however, demands more than good timing. It requires a clear-eyed approach to navigating complex valuations, Ohio-specific regulations, and strategic positioning to attract the right buyer. This guide provides the critical insights you need to prepare for a successful transition.

Market Overview

A Sector in High Demand

The fertility services industry is not just stable. It is expanding rapidly. Globally, the market is projected to reach over $36 billion by 2028. This growth is driven by powerful trends, including greater public awareness of IVF, advancing parental age, and rising infertility rates. For practice owners, this means your specialty is one of the most sought-after in healthcare M&A today. Buyers are actively looking for established, high-quality fertility practices to add to their platforms.

Ohio’s Strategic Position

This national trend is clearly reflected in Ohio. The state has become a focal point for larger healthcare organizations and private equity firms looking to expand their footprint in the Midwest. They see Ohio’s strong patient demographics and established communities as a prime opportunity for growth. This puts independent practice owners in a strong position, but it also means the buyers you will encounter are experienced and strategic.

3 Key Considerations Before You Sell

Moving from “thinking about selling” to “preparing to sell” requires a shift in focus. Beyond the market trends, you must look inward at your practice’s operational and legal health. Here are three areas that demand your attention.

1. Ohio-Specific Legal Compliance. When you sell your practice or depart, Ohio law has a specific rule for notifying patients. Under Ohio Revised Code Section 4731.228, you must provide written notice to patients seen in the last two years. Failing to handle this correctly can create legal headaches and disrupt the sale process.

2. Your Revenue and Staff. Buyers look closely at the quality of your revenue. Is it reliant on a single physician or spread across multiple providers? Do you have a healthy mix of payors? Your staff’s expertise and the stability of your team are not just operational assets. They are key drivers of your practice’s valuation multiple.

3. Untapped Growth Potential. What are the opportunities for growth a new owner could pursue? This could include adding ancillary services, expanding marketing efforts, or opening a satellite office. Clearly identifying these opportunities helps a buyer see the future value of your practice, not just its current performance.

How Active is the Ohio Fertility Market?

The consolidation trend in fertility is not theoretical. It is happening right here in Ohio. Both strategic healthcare companies and private equity firms are actively investing, confirming the state’s importance in the national landscape. While the post-COVID boom has made buyers more selective, high-quality practices remain in high demand.

Here are just two recent examples of significant transactions in the region:

These deals signal that the time to evaluate your strategic options is now. Waiting on the sidelines could mean missing the optimal window to achieve a premium valuation for the practice you have worked so hard to build.

Understanding the Sale Process

Selling your practice is a structured journey with distinct phases. Understanding these steps helps you prepare for what is ahead and avoid common pitfalls. While every deal is unique, the path generally follows a clear sequence.

1. Strategic Planning. This initial phase is about defining your personal and financial goals. What does a successful exit look like for you, your family, and your staff? This is also when you should get a professional valuation to establish a realistic baseline.

2. Preparation. Here, you gather and organize the documents a buyer will need to see. This includes cleaning up financial records, ensuring all compliance paperwork is in order, and preparing a confidential information memorandum that tells your practice’s story.

3. Confidential Marketing. Your advisor confidentially presents the opportunity to a curated list of qualified buyers. The goal is to create a competitive environment to generate strong offers without disrupting your staff or patients.

4. Navigating Due Diligence. Once an offer is accepted, the buyer conducts a deep dive into your financials, operations, and legal standing. This is often the most intense phase and where many deals encounter problems if preparation was inadequate.

5. Closing the Transaction. The final stage involves finalizing legal agreements, navigating regulatory approvals, and planning a smooth transition of ownership for your team and patients.

What is Your Practice Really Worth?

The most common question an owner has is about valuation. The answer is more complex than a simple percentage of revenue. Sophisticated buyers value your practice based on its profitability and future growth potential, using a specific methodology.

Beyond Revenue: True Profitability

The key metric in medical M&A is Adjusted EBITDA. This stands for Earnings Before Interest, Taxes, Depreciation, and Amortization. More importantly, it is “adjusted” to normalize for expenses that would not transfer to a new owner. These can include your above-market salary, personal auto leases, or other one-time costs. This process reveals the true underlying profitability of your practice, which is often higher than what you see on a standard profit and loss statement.

Applying the Right Multiple

This Adjusted EBITDA figure is then multiplied by a number, the “multiple,” to determine your practice’s enterprise value. The multiple is not a fixed number. It changes based on several factors, including the size of your practice, your reliance on a single provider, the quality of your payor contracts, and your documented growth opportunities. Fertility practices often command strong multiples, but realizing that potential requires presenting your financial story in a way buyers understand.

Planning for Life After the Sale

The day you sign the closing documents is a milestone, but it is not the end of the journey. A well-planned sale considers what happens on day one of new ownership and beyond. Thinking about these issues ahead of time is critical to ensuring your long-term satisfaction.

• Your Legacy and Staff. What is most important for you to preserve? For many owners, ensuring their staff is cared for and their patient care philosophy continues is a major priority. Finding a buyer whose culture aligns with yours is a key part of the selection process.

• Your Financial Future. The structure of your sale has massive implications for your after-tax proceeds. An expert can model different scenarios, such as an asset sale versus a stock sale, to help you choose the path that best protects your wealth.

• Your Transition Role. Will you be staying on for a period of time, or are you planning a clean exit? Defining your role post-sale upfront prevents misunderstandings and ensures a smooth handover of clinical and operational leadership.