The average IVF cycle in the United States costs between $15,000 and $20,000—and that's before medications, biopsies, or other add-ons. For many families, that price point puts fertility care out of reach. For others, it's not just cost but geography, time, or clinic availability that creates barriers. Sarthak Sawarkar, founder and CEO of Sama Fertility, believes these obstacles aren't inherent to the science—they're artifacts of how the system evolved.
In this episode of The Growth Layer, Sarthak shares how Sama is reimagining fertility care with a fully at-home protocol that starts around $6,000. We discuss why IVF became so expensive, how removing brick-and-mortar overhead and operating labs at scale drives savings, and why declarative patient management software makes clinics eight times more efficient. We also explore Sama's model—"Invisalign for fertility"—and what it means to empower existing providers rather than replace them.
Why IVF Is So Expensive
Sarthak starts by reframing the question. Instead of asking "How is Sama making IVF affordable?" he asks: "Why is it so expensive in the first place?"
The science of IVF feels like magic. Creating human beings in a petri dish, moving those cells into a person, watching them grow—it's nothing short of extraordinary. That sense of wonder often leads to an assumption that such advanced care must be expensive. But assumption isn't the same as necessity.
IVF evolved the way most scientific experiments do: by bringing everyone and everything under one roof. Scientists, embryologists, nurses, doctors, billers, coordinators—all housed in capital-intensive clinics with beautifully designed lobbies and fully staffed operations. It's like flying a plane: you run it whether it's full or empty, and all those fixed costs get passed on to patients.
The first major cost driver is the traditional brick-and-mortar setup. Sama eliminates this by delivering care where patients already are: at home. Patients don't need to sit in lobbies, take time off work, or commute hours for routine monitoring. The care is still clinically rigorous, but the overhead is dramatically lower.
The second cost driver is the lab. Embryology labs operate like airplanes too: you hire senior embryologists, open bottles of media, and maintain equipment whether you're running one cycle or ten. Most IVF clinics don't operate their labs at scale, which means costs stay high per patient. Sama works with partner labs that can optimize for volume, filling the metaphorical seats and passing savings on to patients.
The third cost driver is operational inefficiency. Most clinics run on procedural workflows—processes that exist because "that's how we've always done it." Over time, these workflows accumulate variation. Different nurses have different approaches. When something doesn't line up, people either bypass steps or create new workarounds that live forever in the system.
Sama built what Sarthak calls a declarative patient management software. Instead of encoding the steps to follow, it encodes the rules and outcomes that matter. This approach reduces variation, compresses handoffs, and makes clinics about eight times more efficient. Fewer staff members can manage more patients without sacrificing quality, which lowers payroll and, again, benefits patients.
The Founder Story: From Lab Scientist to Accidental Entrepreneur
Sarthak has spent the better part of a decade and a half in fertility, starting on the lab side before moving into care delivery. He describes himself as an accidental entrepreneur—someone whose career path led here without an explicit plan.
The personal catalyst came during COVID-19, when he and his partner (now his wife) were thinking about elective embryo preservation. Despite knowing many of the top doctors in the field, accessing care proved nearly impossible. They lived in New Jersey, far from the clinics Sarthak wanted to work with. His wife would have had to leave her job to accommodate the monitoring schedule. Clinics had shut down during the pandemic. And even when care was theoretically available, the cost and time commitment felt insurmountable.
Those three barriers—time, geography, and cost—became Sama's founding pillars. If you can solve those, you solve most of the access problem in fertility. And likely in much of healthcare.
Before launching Sama, Sarthak spent six months shadowing IVF clinics. He had never worked inside one, and he needed to understand why they operated the way they did. What he observed confirmed his hypothesis: the procedural nature of clinic operations created inefficiency, and that inefficiency was expensive.
He also heard stories from friends and patients that reinforced the urgency. One friend in Texas had been seeing an OB-GYN for seven years who kept telling them to "keep trying." Seven years. By the time someone finally suggested fertility treatment, the patient was aging past their prime reproductive window. These are the stories that don't make headlines but shape millions of lives.
Sarthak eventually used Sama's own protocol to freeze embryos with his wife. That personal experience—being both founder and patient—deepened his conviction that this model works.
The At-Home Model: Pulmonology as a Blueprint
Sarthak draws a parallel to pulmonology. A decade ago, sleep studies required patients to spend the night in a clinic, hooked up to electrodes, sleeping in an unfamiliar bed. They'd be woken at 4 a.m., sent home, and wait for results. Today, roughly 95% of sleep studies happen at home. No one goes to clinics anymore unless the case is complex.
Fertility is heading in the same direction. Routine monitoring—ultrasounds, bloodwork—can be done at home when there are proper guardrails in place. Sama's software ensures safety by flagging when a case is too complex for at-home care and requires in-clinic attention. Most cases, however, can be managed remotely.
This benefits both patients and clinics. Patients receive convenient, affordable care without disrupting their lives. Clinics can scale faster because they don't need hundreds of physical locations to grow their footprint. By handling patient management remotely, Sama frees up clinic capacity for the high-margin activities like retrievals and lab work.
The Invisalign Model: Empowering Existing Providers
Sama doesn't build its own clinics. Instead, it partners with existing providers, much like Invisalign empowers dentists and orthodontists. Invisalign didn't open Invisalign clinics—it gave professionals a tool to expand their patient base by offering an alternative to traditional braces.
Similarly, Sama offers fertility clinics a way to serve more patients without expanding their physical footprint. The clinic performs the surgical procedures and lab work (the high-margin services), while Sama handles patient management, monitoring, and logistics. This arrangement allows clinics to focus on what they do best while Sama handles the operational complexity of at-home care.
Patient management has traditionally been a low-margin, high-effort part of fertility clinics. By outsourcing it to Sama, clinics can reduce overhead, improve efficiency, and reach patients they otherwise wouldn't serve.
Who Sama Serves: Remote and Urban Patients Alike
Sama initially operated on a leap-of-faith assumption: the product would primarily serve patients in remote areas. They opened centers in cities with large airports—Los Angeles and New York—so patients could fly in for procedures while managing everything else from home.
That assumption proved wrong by the second patient. While Sama does serve people in underserved areas (patients who send handwritten notes saying they couldn't have received care otherwise), the split is roughly even. Half of Sama's patients are in urban centers, choosing the service for convenience rather than necessity.
One patient lived in Santa Monica, surrounded by IVF clinics. She still chose Sama because the at-home model fit her life better. This revealed an important insight: access isn't just about geography. Even in major metros, time, distance, and scheduling create barriers. Sama solves for those too.
Since launching two and a half years ago, Sama has worked with approximately 350 patients, frozen thousands of eggs, created hundreds of embryos, and helped deliver around 40 babies. All of this with minimal in-clinic monitoring—patients only came in for surgical procedures.
Building Trust Through Clinical Validation
Sarthak is a scientist first. His background is in bringing scientifically validated technology to consumers, and that ethos shapes how Sama operates. One of the core strategies for building trust—especially with providers—is publishing.
Sama has had more than four abstracts accepted at the American Society for Reproductive Medicine (ASRM), three of them in a single year. These publications validate every piece of Sama's technology, from the AI-powered tools to the at-home monitoring protocols. By contributing to the scientific literature, Sama demonstrates that its approach isn't just convenient—it's clinically sound.
Publishing also opens doors with providers. Fertility specialists are cautious, as they should be. They want evidence that new models maintain or improve outcomes. Sama's research provides that evidence, making it easier for clinics to partner with confidence.
The Retention Story: Patients Come Back
One of the strongest indicators of Sama's success is retention. Patients who complete one cycle with Sama almost invariably come back for subsequent treatments. That kind of loyalty doesn't happen by accident. It happens when the experience works—when care is affordable, convenient, and effective.
Sarthak also notes that Sama has created market pull. Patients are asking clinics about at-home options. That demand, combined with clinical validation, positions Sama as a tool that expands access rather than a competitor threatening to displace providers.
The National Conversation We're Not Having
Sarthak conducts an informal experiment: he walks into cafes in urban and rural areas and asks people if they've heard of IVF or fertility care. The findings are consistent. Society has barely scratched the surface of creating a national dialogue around fertility. Forget infertility or IVF—people aren't even having basic conversations about family planning, reproductive health, or the options available.
He believes the company that can start that conversation—that can build a brand with national presence and trust—will fundamentally shift the landscape. For Sama, this isn't just about marketing. It's about telling real patient stories, making information accessible, and normalizing conversations that have been taboo or invisible for too long.
Sarthak gives every patient his cell phone number. The stories they share—stories of access gained, families built, hope restored—are what matter most. This isn't about any one company. It's about the future of how people build families.
What's Next for Sama
Sama is focused on expanding partnerships, continuing to publish research, and building brand awareness among patients. Sarthak acknowledges that consumer marketing is expensive, but he believes some conversations need to happen before Sama is even part of them. The goal is to elevate the entire discourse around fertility, making it easier for people to access information, ask questions, and find care.
The company has also partnered with CNY Fertility, one of the largest fertility networks in the U.S., which expands Sama's reach significantly. These partnerships validate the model and demonstrate that established providers see value in what Sama offers.
Sarthak's long-term vision is clear: Sama should be a tool that clinics and patients use to expand access and improve outcomes. The current system serves maybe 340,000 cycles per year, but estimates suggest the true need is closer to 1 to 1.5 million cycles. Closing that gap requires thinking outside traditional models and using every available tool—Sama being one of them.
Why This Matters
Sama Fertility challenges foundational assumptions about how care must be delivered. The idea that IVF requires expensive clinics, always-on staffing, and centralized operations is an artifact of history, not a requirement of the science. By unbundling care—delivering monitoring at home, partnering with labs for scale, and using intelligent software to reduce variation—Sama makes fertility treatment accessible to people who couldn't afford it or fit it into their lives.
For operators building in health and wellness, Sama's story offers lessons about operational efficiency, patient-centered design, and the power of partnerships. The future of healthcare isn't about replacing providers—it's about empowering them with tools that expand their reach and improve patient experience.
Key Takeaways for Operators
1. Cost doesn't equal care. Much of healthcare pricing is operational overhead, not clinical necessity. Reducing that overhead creates room to deliver better value.
2. Home is a valid care setting. With proper guardrails, many clinical activities can move to patients' homes, improving access without compromising safety.
3. Software can drive order-of-magnitude efficiency. Declarative systems that encode rules (not steps) reduce variation and free up human capacity for higher-value work.
4. Scale unlocks pricing, partnerships unlock scale. Operating labs at capacity and partnering with providers creates win-win economics that benefit patients and clinics alike.
5. Access gaps exist everywhere. Even in major metros, time, distance, and scheduling create barriers. Solving for convenience isn't just about rural access—it's about meeting people where they are.
6. Publishing builds trust. Clinical validation through peer-reviewed research opens doors with providers and demonstrates that innovation doesn't mean compromising quality.
7. Patients remember how care feels. When treatment is affordable, convenient, and effective, patients return and refer others. Loyalty is the strongest signal that a model works.
Sama Fertility offers at-home IVF monitoring and works with partner clinics to expand access to fertility care. Learn more at samafertility.com.
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