The U.S. fertility market is experiencing unprecedented growth, creating a unique moment for practice owners. For physicians in North Carolina, and specifically in Raleigh’s thriving fertility market, this presents a significant opportunity. Selling your practice is a major decision that requires a clear understanding of market dynamics, valuation, and the transaction process. This guide provides the insights you need to navigate the sale of your Fertility & IVF practice with confidence.
Market Overview
Your practice doesn’t operate in a vacuum. Its value is heavily influenced by broader market trends and the local competitive landscape. Right now, both are pointing in a very favorable direction for fertility practice owners.
A National Boom
The entire U.S. fertility services market is on a remarkable growth trajectory. Valued at $7.9 billion in 2022, it’s projected to more than double to $16.8 billion by 2028. This isn’t just gradual growth. It’s a strategic expansion fueled by increasing patient demand, technological advancements, and growing investor interest. For practice owners, this translates into a larger pool of sophisticated buyers willing to pay premium prices for well-run clinics.
The Raleigh Hotspot
Zooming in on North Carolina, Raleigh stands out as a key hub for fertility care. The presence of established clinics like Carolina Conceptions, Atlantic Reproductive Medicine, and Shady Grove Fertility confirms a strong, consistent demand for services. While this means competition, it also proves that Raleigh is a mature and desirable market for acquirers looking to enter or expand their footprint in the southeast. A well-positioned practice has a clear opportunity to stand out.
Key Considerations for Sellers
When a potential buyer evaluates your practice, they look past the surface-level numbers. They want to understand the core drivers of your success and stability. You should be prepared to discuss these areas with clarity.
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Your Clinical Reputation and Success Rates. Buyers will verify your outcomes. Having clean, accessible data, especially from SART reports, is critical. Your reputation within the Raleigh community, built on patient reviews and physician referrals, is an intangible asset that we help quantify.
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The Patient Financial Experience. IVF is a significant investment for patients, with costs in North Carolina often running from $7,500 to $16,000 per cycle. How your practice helps patients navigate this with financing options or insurance support is a key indicator of operational maturity.
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Team and Operational Strength. Is your practice dependent solely on you, or do you have a stable team of physicians and a highly-skilled lab staff? A strong, autonomous team is a massive value driver. We help owners showcase their team as a key asset for future growth, not a risk.
A comprehensive valuation is the foundation of a successful practice transition strategy.
Market Activity
The theory of a strong market is confirmed by real-world transaction data. The fertility space is one of the most active sectors in healthcare M&A today, and this activity directly benefits sellers.
A Surge in Transactions
Across North America, the pace of acquisitions is accelerating. With over 25 significant deals in 2022 and another 11 in just the first three quarters of 2024, the market is buzzing. This isn’t a trickle. It’s a wave of consolidation. This high volume of deals creates a competitive environment where multiple buyers may bid for the same practice, driving up valuations for sellers who run a structured sale process.
The Modern Buyer Profile
Todays buyers are not just other local doctors. The most active acquirers are sophisticated private equity firms and large strategic players like Kindbody and IVI RMA. These groups have ambitious growth plans and the capital to execute. For you, this means access to buyers who can pay a premium for a practice that fits their platform strategy. It also means you need to be prepared for a professional, data-driven negotiation process.
The Sale Process
Understanding the path from your initial decision to the closing table helps you prepare for what lies ahead. While every deal is unique, a successful transaction generally follows four key phases.
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Preparation and Valuation. This is the foundation. We work with owners to analyze financials, normalize EBITDA, and build a compelling growth story before a single buyer is contacted. A proper valuation sets a realistic and defensible price target.
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Confidential Marketing. Your sale should not be public knowledge. We run a confidential process, approaching a curated list of vetted buyers from our proprietary database. This protects your staff and patients while creating competitive tension among qualified acquirers.
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Negotiation and Structuring. The highest offer is not always the best one. We help you compare offers based on cash at close, equity rollover potential, and tax implications to ensure the deal structure aligns with your personal and financial goals.
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Due Diligence and Closing. This is where the buyer validates everything you have presented. It is the most intensive phase and where many deals encounter problems. We manage this process for you, organizing data and anticipating requests to ensure a smooth path to closing.
The due diligence process is where many practice sales encounter unexpected challenges.
What Is Your Practice Worth?
A practice’s value is determined by its profitability and the level of risk a buyer perceives in its future cash flows. For fertility clinics, the key metric is Adjusted EBITDA. This is your practice’s earnings before interest, taxes, depreciation, and amortization, normalized for any owner-related or one-time expenses.
Buyers then apply a multiple to this figure. The fertility sector currently commands some of the highest multiples in healthcare, typically ranging from 8.0x to 11.2x Adjusted EBITDA.
Calculating your true Adjusted EBITDA is the most important step. Here is a simplified example:
| Financial Item | Amount | Explanation |
|---|---|---|
| Reported Net Income | $600,000 | The “on paper” profit. |
| Add: Owner’s Excess Salary | $150,000 | Difference between owner’s pay and a fair market salary. |
| Add: One-Time Legal Fee | $25,000 | An expense not expected to recur. |
| Equals: Adjusted EBITDA | $775,000 | The true measure of profitability buyers use. |
In this scenario, a practice with a $775,000 Adjusted EBITDA could be valued between $6.2M and $8.68M. Achieving the higher end of that range depends on how effectively your practice’s story is told to the market.
Post-Sale Considerations
A successful sale is about more than just the closing day. Its about setting up your future, protecting what youve built, and maximizing what you take home. The best time to plan for these outcomes is before the sale process even begins.
Your Future Role
Do you want to retire immediately, or continue practicing for a few more years? Your transition plan is a key point of negotiation. We help you structure an arrangement that respects your timeline and goals, whether that means a clean exit or a new role as a clinical leader within a larger organization.
Protecting Your Legacy
You have spent years building your team and your practice’s reputation in the Raleigh community. A sale shouldn’t undo that. Finding a buyer whose culture aligns with yours is critical for ensuring a smooth transition for your staff and continuity of care for your patients. We help you vet buyers on these “soft” factors, not just their financial offer.
Optimizing the Financial Outcome
The sale structure has huge implications for your after-tax proceeds. Decisions about asset vs. stock sales, or whether to “roll over” a portion of your equity into the new company, can significantly impact your net financial outcome. Planning for this with a tax-efficient strategy can be the difference between a good result and a great one.
The right exit approach depends on your personal and financial objectives.
Frequently Asked Questions
What is driving the growth in the U.S. fertility market, and how does this impact practice owners in Raleigh, NC?
The U.S. fertility market is expanding rapidly due to increasing patient demand, technological advancements, and growing investor interest. This growth translates into a larger pool of sophisticated buyers willing to pay premium prices, creating a favorable selling environment for fertility practice owners in Raleigh, NC.
How is the fertility market in Raleigh, NC unique compared to other regions?
Raleigh is a key hub for fertility care in North Carolina, with established clinics confirming strong and consistent demand. This mature and desirable market attracts acquirers looking to enter or expand in the southeast, offering well-positioned practices a unique opportunity to stand out despite existing competition.
What factors do buyers consider most important when evaluating a Fertility & IVF practice for purchase?
Buyers prioritize clinical reputation and success rates (verified by accessible data such as SART reports), the patient financial experience (including financing and insurance support), and the strength of the team and operations. A practice with a stable, skilled team and clear, positive outcomes is seen as a more valuable and less risky acquisition.
What is the typical valuation range for Fertility & IVF practices in the Raleigh market, and how is this valuation determined?
Fertility practices often command valuation multiples between 8.0x to 11.2x Adjusted EBITDA. Adjusted EBITDA is calculated by normalizing earnings to exclude owner-related or one-time expenses. For example, a practice with a $775,000 Adjusted EBITDA could be valued between $6.2 million and $8.68 million depending on how effectively its growth story is presented to buyers.
What should sellers expect during the sale process of their Fertility & IVF practice in Raleigh?
The sale process typically includes four phases: 1) Preparation and Valuation, where financials and growth potential are analyzed; 2) Confidential Marketing to vetted buyers to protect patient and staff privacy while fostering competitive offers; 3) Negotiation and Structuring, comparing offers for best financial and personal outcome; and 4) Due Diligence and Closing, a detailed verification phase managed by professionals to ensure a smooth transaction.