Good morning, everyone, and welcome to the JP Morgan Healthcare Conference. My name is Annie Samuel, and I cover Healthcare Technology and Distribution here at JP Morgan. We're excited to kick off Women's Health Day with Progyny. We've got a full team here today. We've got CEO Pete Anevski, CFO Mark Livingston, President Michael Sturmer, and Chief Medical Officer Dr. Janet Choi. Pete's going to do a quick presentation, and then we will open it up to questions.
Thanks, Annie. Thank you so much. Thanks, everybody, for joining us today. Michael Sturmer, Progyny's President, Mark Livingston, our CFO, and Dr. Janet Choi, our Chief Medical Officer, are here and going to join me for Q&A after the presentation. As a women's health company, we couldn't be more excited to kick off Women's Health Day at this year's conference. The industry has made a lot of exciting progress in recent years, and we're happy to see this highlighted on the agenda. The progress we've seen inspires every person at Progyny and will help you better understand what Progyny is doing to raise the bar with respect to women's health benefits. Before we get started, I'll pause so you can take note of the caution regarding any forward-looking statements or non-GAAP financial measures that we may discuss today. I'll start with our investment highlights.
First, we are far and away the leader in a large and persistently growing market, despite a global pandemic, rising interest rates, periods of sustained high inflation, and fears of a recession. And since launching our benefit nine years ago, we've seen an increasing number of companies providing coverage for our services, and we've built a large, highly diverse customer base. We began with a focused effort in fertility and family building and now have a broader portfolio addressing more areas of women's health. And our model was designed to provide multiple pathways through different products, channels, and relationships for achieving our growth objectives. We're unique in that our model has been proven to create meaningful value for all key constituencies. And finally, we're profitable, generating meaningful cash flow, and we see opportunities to further leverage our scale as we continue to grow. Let's dive in a little deeper.
We went live in 2016 with five clients and 110,000 lives, and now we're over 530 clients and 6.7 million lives. Since inception, over 99% of our clients have chosen to continue offering Progyny to their employees, an incredible testament to the value of our solution. We started in just two industries, we now span more than 45, demonstrating the universal appeal of our services, and our unique, data-driven approach has driven this growth, and we've consistently earned an NPS score above 80 over the last nine years. We're a mission-driven company, and we understand women and families need a healthcare system built for them, and there are many areas where we focused our efforts and differentiated our solution. I'll focus on just three of them.
First, we have a solution and foundation that results in unparalleled favorable clinical outcomes and member experience, demonstrated by clinically validated metrics measuring the efficacy and efficiency of our program. We've reported on every metric, every year, and for every member journey, demonstrating the meaningful results we're achieving for both employers and members. No one else has either been willing or able to show this level of transparency, commitment, or insight. Next, our plan design provides comprehensive and flexible coverage to give members the best chance at realizing their family-building goals. We've been doing this for nearly a decade, and we've proven you can provide comprehensive coverage and still do it in a better, cost-effective way.
Third, we've aligned our provider network to the benefit through plan design, responsible, clinically-based utilization management with our providers, data sharing, and an unprecedented level of coaching and support, helping members at every stage of their complicated journeys, and we continue to be differentiated. None of those areas are quick or easy to do, which makes them very difficult to replicate, and we're broadening our solution wherever we see opportunities to address areas that are either overlooked or underfunded. We'll use the same pillars that built our core family-building solution for any future expansions. Now, for many in healthcare, value-based healthcare is an aspiration. For us, it's a reality. We're delivering on the promise of value through our unique approach to plan design, benefit management, network access, personalized coaching, and digital tools.
That starts with creating solutions that are flexible and customizable, delivering the right care at the right time for each and every person. We'll never be a one-size-fits-all benefit. Every member is different, and our plan design is uniquely flexible to the individual patient while simultaneously being equitable for all members and good stewards of our clients' spend. We've pioneered and have in place an unparalleled level of collaboration across our provider network, empowering providers to deliver care more effectively while uniquely enabling us to do active benefit management for every single member. And when you deliver an unparalleled solution, which includes leading outcomes, you deliver industry-leading member experience and cost control for employers. Let's spend a moment reviewing the impacts of our benefit. We capture data, including clinical outcomes, across hundreds of thousands of patient journeys for every member since the first journey with us in 2016.
With this vast, unique data set, we're able to drive unparalleled, continuous improvements in care. To begin with, more than half of Progyny members engaging with our benefit pursue non-medical treatments, including coaching in our preconception program, to satisfy their journey. Now, one in five people do suffer from infertility per the CDC, and when medical care is required, we're getting members to better results faster through fewer rounds of care to get pregnant, fewer high-risk pregnancies, fewer miscarriages, and fewer babies in the NICU. Let me give one extremely meaningful example of our impact. If you or someone you know has experienced this journey, you'll know how the retrieval is one of the most costly aspects of care in IVF and is also physically grueling to the patient. Reducing the number of retrievals necessary to achieve a live birth is hugely consequential to the members and plan sponsors.
And because of our innovative approach, we're achieving a substantial reduction in average retrievals per patient. The average Progyny member requires one and a half fewer retrievals to achieve a live birth. That's an extraordinary result, and none of our competitors are measuring, never mind reporting, an impact like this. Our plan design centers on complete and effective treatments. On an overall basis, our solution, including our clinical outcomes and effective treatment management rooted in clinical efficacy, drives meaningfully lower costs for clients, delivering roughly 30% savings when compared to alternative options. And our approach ensures the optimal member experience where our members never run out of coverage partway through treatment, eliminating the scarcity mentality and enabling patients to make decisions driven by medical need. Our solution also drives improved recruitment and retention, higher productivity, lower absenteeism, additional areas where we have a significant impact for our plan sponsors.
In fact, our model is the only one in market with a documented history of delivering substantial value to the three constituencies every healthcare solution must address: the members, the clients who sponsor the coverage, and the providers who deliver the care. Now, other solutions may do something beneficial for one, sometimes two of these stakeholders, though usually not equally well. It's difficult to do that when they are employing the traditional approaches, such as attempting to control costs by restricting utilization through dollar maximums, step therapies, and treatment exclusions. Our moat is so big, and the things we're doing are so difficult to replicate, it isn't necessarily surprising to see that newer entrants who lack the capabilities we do revert to these practices. Nonetheless, it's disappointing to me that companies marketing themselves under the guise of women's health are reverting to practices that effectively underinsure members.
We've proven there's a better way. That's why employers continue to increasingly turn to Progyny. We deliver value-based care, member experience, and cost containment simultaneously, and our mission is to help people realize their dreams, and we've proven that can be done in a way that's better for all. We're so proud of what our clients say about us. The impact we're making is captured in this quote from the head of benefits at HCA, the largest hospital system in the country, and they say, "Progyny is easily their most-loved benefit and the one they're expanding because we've proven to successfully manage their program." The impact of our overall offering is evident across our solutions, starting from preconception and conception, supporting journeys that either do not require medical intervention or journeys that do, and extending through to pregnancy, postpartum, menopause, and midlife.
Each of our offerings is designed to get members to the right care at the right time without unnecessary and counterproductive delays. To do this, we've made significant investments in clinical education and emotional support, simplifying every member's journey. We provide high-touch, one-on-one engagement with inbound and outbound outreach from a dedicated Patient Care Advocate. And the experience is wrapped within a comprehensive set of digital tools. We've clinically integrated the PCA into the journey, allowing them to initiate proactive AI-assisted outreach at critical points along the way, such as health risks affecting conception, nutritional information to improve perinatal health, or alleviating the symptoms of menopause to improve the quality of life. This high-touch model then pairs with the virtual and in-person access we've curated to specialized providers for the appropriate clinical care. When you're the leader for a decade, you expect others will likely throw stones.
Some who desire Progyny's leadership position have suggested inaccurately that we drive members to specific treatments out of our own interest, not theirs. Nothing could be further from the truth, and every metric we have confirms that. First, more than 50% of all enrolled Progyny members engage with our preconception coaching program and digital tools and satisfy their journeys without ever seeking formal medical treatment. Second, our higher success rates point to the hard work we do to deliver the highest quality, most efficient care. That starts with ensuring clinical best practices are followed only for those in need of medical care, and for those needing care, many variables, including age, medical history, comorbidities, and personal goals, factor into the decisions that members make with their physician for treatment. Now, to further ensure alignment to best medical practices, we look to metrics like the average age of those using IVF.
With Progyny, it's 36 years old, which aligns perfectly with the national average. And as mentioned before, our members require significantly fewer treatments to achieve their goal, driving down usage and once again illustrating our approach of getting the right care at the right time for everyone. With our proven value, we're in our strongest ever competitive position, reflected in the number and quality of the relationships we've forged among clients, channel partners, and clinics. We've built a strong partner ecosystem comprised of health plans, TPAs, PBMs, care navigation solutions, and other benefit aggregators. And as a result, going forward, we're going to be able to reach even more potential buyers. Our most recent additions include Cigna as our first national health plan.
You may have seen the press release they issued yesterday to announce our exciting relationship, as well as another large regional health plan demonstrating our ability to convert competitors into partners through the strength of our offering, and some of these groups are also Progyny clients. That's a remarkable testament to our solution, the experience we create for members, and the value that we provide. Building partnerships is one way to create value. There are many others listed here, which collectively have had a significant impact on our financial results. In each area, whether it's new client acquisitions, client retention, member experience, new product development, and TAM expansions, we've delivered every year we've been in market.
And we're often asked, "What do people most misunderstand about our business?" The answer is simply, it's how little variability in utilization and care consumption in the short term actually impacts our overall growth in the long term. Over the years, we've seen periods of timing where members use the benefit in slightly different ways, slightly favorable or unfavorable to expectations. But that variability in the short term and utilization has been a relatively insignificant contributor to our financial results, as shown in the chart on the right. What the chart demonstrates is that when you average out utilization rates over the last seven years and apply that average to each year versus actuals, there's only a $22 million differential in revenue on a cumulative basis over a seven-year period. That variability hasn't in any way altered the overall health and growth of our business.
And the biggest impact to our business is our delivery of excellent care, coupled with an extraordinary member experience and cost control for our clients. This has enabled us to grow our client base significantly throughout our history. The last four sales seasons, we've added at least one million lives. And with 6.7 million members, we're nearly 5x our size just over five years ago. Consistent with what we said at our Investor Day, our goal is to add at least one million new lives annually. And we do this by continually innovating our go-to-market strategies, developing new channel partners, and expanding our offerings. In this past sales season, we tested different structures and guarantees that align with what our clients value.
This contributed to one of our most successful sales years amongst jumbo accounts, where we competed against all competitors, including the VC-backed competitors, and we won every single jumbo client, and given our data and tight benefit management, we're uniquely enabled to offer these guarantees through our scale, experience, and continued clinical success, and we expect to employ these tactics even further in the upcoming sales season. Our average client won this past year was larger than the year-ago period, excluding the large federal population with a unique benefit structure, and we've seen a strong appetite across all industries and amongst companies of all sizes, and the distribution of our member base by client size is nearly identical as it was a year ago across an even larger base, with essentially the same number of members coming from clients with at least 10,000 lives.
This continuity reflects the new clients and our high retention rate, and this year, we achieved our lowest number of absolute client losses since 2021 with just five. As we've disclosed, one of those five was a large client, and while we never want to lose any clients, we believe this was a single client's decision and not representative of our overall book of business. We also earned continued commitment from more than 99% of our other clients for 2025. In recent years, 20%-25% of our client base grew their Progyny relationship through upsells. This year, that grew to approximately 30% of clients, increasing their program with us for 2025. Historically, that meant adding more Smart Cycles or adding other services such as egg freezing or Progyny Rx.
While those still occur, upsells now also include our newest services in maternity, postpartum, and menopause, giving us a robust platform to grow across every client. We're extremely pleased with our first year offering these services, where approximately 20% of existing clients and 40% of our newest clients are adopting one or more of these programs. 20% of our clients with more than 1.5 million of our covered lives will have at least one additional program beyond the core fertility and family-building solution, laying the foundation for what will ultimately be a more diversified book of business with different revenue streams. As we've said, we aren't expecting the newer services to be significant contributors right away, given their different unit economics, which are flat case rates, as well as our need to build awareness for the new products across the member populations.
We do expect, however, them to deliver a meaningful and growing contribution over the next few years. Even with our success to date, we're still at a very early stage of penetrating our TAM. There are over 8,000 large self-insured companies in the U.S., and we only work with about 7% of them today, and we're even less penetrated in covered lives, given our expansion into both labor and federal government relatively new markets for us. Our next steps include expanding our TAM, first into the middle market employers with under 1,000 lives, which are both traditional ASOs as well as fully insured populations. Second, expanding more into global across all categories on the heels of our first-ever acquisition to enhance our existing capabilities in global. To date, we've grown our addressable market by more than 50% over the past five years.
With our focus into middle markets, we have visibility to a further 50% expansion in a market we currently don't sell to today. Focusing now on the value we're creating for our investors, we're the only company in our space, and quite frankly, one of the few in the broader digital health ecosystem that is both profitable and has been generating significant cash flow from an early stage. Scaling for us is about expanding margins and increasing cash flow. In fact, we're approaching $500 million in cumulative operating cash flow generated over the last five years. Our priorities with that capital are one, continuing to evaluate further share repurchases to the extent we believe the stock is undervalued. We completed $300 million of buybacks in 2024, reducing our shares by over 12%.
Two, strengthening our business by investing in new products that could profitably address other key milestones of life. Three, continuing to invest in our go-to-market resources to ensure we're achieving our growth targets. And finally, M&A that can complement our strategic vision, but only through a disciplined and selective approach that achieves value creation. As we look into the near term and beyond, we see additional opportunities where we can further leverage the platform we've built. The center area reflects where Progyny is today. The surrounding space are areas where women need improved access to care, better education and support, or both. By leveraging the competencies we've already built to support complex care needs, we see opportunities to expand over time using these criteria. They're the conditions that, when unaddressed, lead to costly outcomes, delayed care, or misdiagnosis.
There are areas in healthcare where closing gaps where traditional coverage may not exist. And finally, expanding access to high-quality care to everyone. There are a lot of possibilities we're considering as we've earned the right to do so because of our history of driving to better outcomes while reducing costs. Hopefully, today's presentation has helped you see why we enter 2025 excited and confident about our future. We're a differentiated solution in a large and growing market. And because of the work we've done over the past five years to expand our TAM and build out our offering, we believe our market opportunities are greater today than ever. Our proven model is creating meaningful value for all our stakeholders: our clients, members, providers, partners, and investors. Thanks so much for your time today. Michael, Mark, and Dr. Choi will now join me for Q&A.
Great. Thanks so much, Pete.
That was a really informative presentation. You know, I want to start with you recently purchased a lot of stock, despite things in 2024 having been somewhat difficult. So you clearly have a long-term vision for the performance of the company. Can you share what is giving you that confidence to kind of step in here?
Sure. I'm already a significant shareholder before that purchase. But I made the purchase as I went through all the highlights in my presentation as to why we're excited about the future, that I thought we were undervalued. And so I doubled down on my investment, basically.
Great. You just completed the first selling season with an extended offering of some of these adjacent solutions, areas like menopause. How did this impact conversations during the selling season? How receptive were your employer customers to new products?
Sure.
I'll let Michael answer that.
Sure. Thanks. So yeah, the conversations were received really well. It allows us to certainly, those that are looking to expand into their family, into family building and covering family building benefits, go really deep in that area because of the cost involved in it. What was nice about the additional services that we've rolled out this year is it really allows us to expand the conversation with them and show not only our ability to support what is a relatively small population, but our ability to support much bigger and broader portions of their female population and employees. So really excited and excited to sort of be able to take that momentum into this year.
Great. Pete, you kind of touched on competitive differentiation. Maybe we could touch on the competitive landscape because it's something that everybody's really focused on right now.
Have conversations with employers changed at all in the past year? I know you kind of lead with outcomes, right? But can you maybe walk us through the pitch to an employer on why you should win?
I'll start with conversations haven't really changed in the past year versus prior sales season or the sales season before that. Over time, the conversations have changed more towards no longer about whether or not you do or don't need a fertility or family-building solution or some of the other products, but more about just prioritization and when they're going to do it. And then obviously differentiating our solution versus everybody else. Michael, I don't know if you want to add anything there.
Yeah.
The only thing I would add is the level of sophistication has certainly grown and expanded, including those groups that employers look to for guidance in our consultant populations, where most of the large consultants now have Centers of Excellence that are specifically focused around family building and other component parts within women's health. And so that's been beneficial in being able to get to a next level and a more sophisticated conversation where, frankly, our value prop shines even more.
And can you just speak to, as employers think about prioritization of benefits and how they're kind of thinking about all of the moving pieces in a benefits offering? Obviously, cost has been a really big impact for them this year. How are they thinking about kind of fertility within that?
I mean, I think there's a lot of discussion around that, but in some of our checks, what we're hearing is the thing that employers are really focused on is access. So can you just maybe talk about that?
Yeah, I think employers continue to focus on and have strategies around access to care, which certainly, without a benefit coverage, you're significantly hampering access to care, so coverage starts sort of that conversation, but it's access with the highest clinical outcomes, and it's access with the highest clinical outcomes for an experience with their members, and then all wrapped around the ability to control within that ecosystem, and the way our services are set up, we're able to influence each part of that, and it certainly does start with access, but it continues on to those other levers that have driven design decisions and benefit decisions over the years.
And are rising costs impacting their decisions on kind of how fulsome their benefits should look in this environment?
Cost is always going to be a factor. And certainly, this past selling season, that was true. We anticipated that being the case in the upcoming sales season. But it's cost control, and these employers really want to do this. It's cost control while providing enough coverage for their members. And that is a balance that they look at. And again, we've shown, and Pete referenced. I think there's also a big reason why we had so much success with our jumbo clients last year. We were really able to show the ability to provide a complete benefit, a full benefit that allows for enough coverage while still controlling that cost in a very meaningful way and putting performance guarantees around that.
And so again, I think that really helped differentiate us last year, and we anticipate the same this year.
Great. Dr. Choi, we don't always get to hear from you, so I would love to bend your ear here. Kind of along those lines of differentiation, can you talk about, from a physician's perspective, how is Progyny's model different from its competitors? And maybe kind of along the lines of what Pete was saying in terms of not directing benefits, right? I guess in my personal experience, my insurance did not necessarily direct my care so much as they said, "No, you can't do this." So can you maybe talk about that?
So before I joined Progyny full-time as our Chief Medical Officer, I was part of the provider network for several years.
I can tell you the reason why I'm such a huge proponent of this benefit is even before I knew who what Progyny was, I started to tell almost overnight which patients of mine coming through the door had Progyny coverage versus the rest of the population. The reason why it was very apparent to me is, and to my staff, were historically and unfortunately much continuing into the present day, typically patients who are unfortunately paying out of pocket or who have the more traditional capped model of insurance where they're partially covered for some of the things, but not everything.
And as you discovered, being told sometimes you can't do this even if your doctor is telling you to do so, I would try to have a very extensive conversation with them about what are the best clinical practices and based on their test results, based on their history, based on their family-building needs, what's the most appropriate fertility treatment for them. And unfortunately, when you have this financial constraint in the background, this sort of, as Pete alluded to, this kind of scarcity mindset, it makes it very hard for patients to think rationally and clearly. And again, I could talk to them about the best practices until I'm blue in the face. But at the end of the day, for them, they're like, "Clock is ticking, money is running out.
How can I get the best short-term bang for my buck truly before I can't afford more care and end up walking out childless?" And so that leads to poor decision-making on the patient's part. In contrast, suddenly, literally overnight, I started to see first a trickle and more of an influx of patients on Progyny where they came in very well educated because their patient care advocate had explained to them extensively what their benefit covered, which is basically anything that was medically recommended and appropriate for them. So the stressors of the financial aspects of treatment were checked at the door.
They were able to think more clear-headed in a more sort of, "What is appropriate to my medical care about the best treatment to pursue?" which leads to things where they're not trying to, with a balance sheet, check off, "All right, can I delete ICSI even though my partner has sperm issues because I can't afford it and my insurance doesn't cover it?" Or, "Can I forgo anesthesia during my retrieval?" which is what some patients asked about, right? And so that leads to this sort of false assessment that, "Well, I'm going to be able to kind of shove all my treatment into this sort of minimum coverage box," and they end up getting poor outcomes, unfortunately needing to pursue or dropping out of treatment. In contrast with Progyny, all the benefits are covered.
They know what they need, and they're able to accomplish a live birth in a more efficient manner.
That's really helpful. And I think maybe something that's misunderstood, or this was my experience anyways, it feels like in fertility, there's much more of a discussion around the financial part of it. Whereas most times you go into the doctor's office and they treat you, and then you get the bill, right? But in fertility, there's always the conversation around, "Is this covered? Can you pay for this?" And the first thing you do when you go to a fertility clinic is meet with a financial counselor, not with your doctor. So can you maybe talk again? I kind of want to go back to Pete's point on the insurance isn't necessarily kind of directing the kind of treatment path.
But can you maybe just help people understand that relationship or maybe as a practicing physician in a fertility clinic, how you're interacting with the financial part of it? Because that seems like it's very unique in fertility.
So again, as a physician, when I was practicing, I did not, except for what my business office told me, pay attention too much to what different plans covered. All I knew were, "Here are the restrictions." So they'd say, "Here's the X plan for your patient. You can't do this treatment. You can't recommend this treatment. You can't recommend this treatment until they fail these certain more conservative therapies." And you're right. And then those kind of situations, patients would first meet with a financial advisor and then come to see me.
Again, in the Progyny model, because everything has been explained and preset, there isn't that pre-meeting, and they kind of walk through the office and actually pursue their medical treatment.
That's really helpful. Thank you. Maybe, Michael, this is a question for you. As you look at 2025, how would you frame the backdrop for fertility benefits? What are benefits managers looking for from their vendors?
Yeah. I think it's a few things. First, it's the things that we've covered already, right? It continues to be about clinical outcomes, member experience, and cost control. And that is where the conversation usually starts. It's usually where the conversation ends. So that's part one. Part two is they're looking for comprehensive coverage, but without trade-offs in best-in-class.
And what I mean by that is, again, because fertility has a smaller population but highly complex, they want to understand that you can manage that level of complexity with that particular population, but also have the toolsets to manage a much broader population like the menopause population, which has a much, much higher volume to it. So they're looking for comprehensive, but they want to make sure that they're not making trade-offs down to lowest common denominator during that process. That's sort of number two. And then number three, they want an easy path to contracting and an easy path to being able to launch. And that's really where our partnerships come in and allow us to create that easy path once we've sort of passed those first two evaluations.
That's great. Mark, I've got one for you.
You recently established some long-term targets at your 2024 Investor Day, and obviously, it's been a rocky 2024. So I was wondering if maybe you could talk to maybe some of the levers you have in the business today to kind of help you reach those targets. Obviously, they're not 2025 targets, right? They're long-term targets. So how do we think about what levers you can pull to kind of reach those targets going forward?
Yeah. I think the key term here, which Pete talked about a little bit in the presentation, is the multiple pathways for growth. Obviously, we've had great success with the core fertility product and then expanding that through the Rx add-on and the variety of increased Smart Cycles, etc., in the earlier years. But now we've introduced new products. We have our menopause product, for example.
And incredible uptake in that, even really just in our first year. So with the new products, 1.5 million lives. I mean, it's literally 20% of what we have in our first year. A tremendous uptake of that. And so driving expansion of the new products, it'll take some time, as Pete said, because they're case-rated based and it's going to be about employee awareness for those benefits and building those in the coming years. So that's one part. But even in the core fertility product, I think you can see our strategy continuing to unfold. The Cigna announcement, for example, continuing to create more and more pathways to bringing folks in and reducing that friction in the sales process.
All of those things are the different levers that we're pulling to ensure that we continue to add lives and add products and add value to our customers over the years.
Lastly, as we talked about before, increasing the TAM, right, and going into middle market and expanding our global is another area.
That's great. And maybe just on that point, can we talk about your partnerships? Can you just help us understand how those work, right? Because theoretically, they have their own products. So can you talk about why they want to kind of promote your benefit? Is it a frenemy relationship, or is it kind of really, truly they're out there promoting your benefit?
No, it's a real partnership, and they're promoting the benefit. So if you think about it, right, they manage a tremendous amount of different health conditions, right? We're focused on this one.
And they've recognized that we do a really good job solving the problems around this condition. And therefore, partnering with us is a better solution as opposed to what they were doing in the past, which is competing against us. So they are promoting it. They give us a license to kill for a lack of a better term, but they become a better solution overall for their client base. I don't know, Michael, if you want to add anything.
Yeah. No, I mean, I frame all of our partnerships into really two or three categories. First is they do. They help us bring to market within our traditional group, which is sort of the large employers.
Secondly, some of the partnerships allow us to enable us to better expand that TAM that Pete referenced as the sort of our salesforce going into a larger middle market group that's now supported by our other partnerships. And then, as Pete said, it's a great endorsement, for lack of a better term, of the value that we're bringing and the credibility that we have during that process. And importantly, we do these things with all of our partners, whether they're health plans, whether it's the PBMs, our benefits admin partners, and others, is that the services and product that you get from Progyny, whether it's through a partner or it's direct, is that same quality and that same service and that same value that you would get no matter how we go to market.
That's really helpful.
I think maybe in the last minute, I think one thing that would be really helpful is there's been so much volatility in utilization, but it seems like maybe big picture, the underlying demand for fertility is still very strong. Can you just kind of speak to that and maybe speak to kind of the fertility demand more broadly? How do people get comfort with that?
Yeah. There's a couple of things I'll highlight that demonstrate demand. One, we've been adding more than a million lives over the last four years. That alone is a testament to it. The fact that the healthcare partners that we continue to sign up, including the Cigna announcement and the national payer, large regional payers, is another example.
The fact that every large benefit consultant has a center of excellence relative to fertility and family building because that's the demand from their clients and that's what they expect in terms of advisement is another example. And the persistent demand in utilization for the benefit, where we do nothing to promote the benefit within those employers, but it's just a need that they have, is the last example. So all of those are continued examples of the continued demand. National fertility rates are still declining. The average age of a woman having a baby in the U.S., over 30 versus under, continues to grow and has been doing so since 2000. The biological need is real and scientific, if you will. And so that trend isn't changing. That macro trend is continuing.
We're there to help members and plan sponsors achieve their goals of helping their members achieve their dream of building their families.
Terrific. Thank you so much, all of you, for this really informative discussion.
Thank you.
Thanks for having us.