Over the past two decades, fertility services have experienced significant shifts in ownership structures worldwide, transitioning from predominantly public or physician-owned clinics to a market increasingly influenced by private equity. These changes raise debates about treatment efficacy, cost transparency, and the ethical implications of profit-driven health care. This review provides an evidence-based overview of trends in fertility clinic ownership (public, physician-owned, and private equity-backed), along with reported success rates and implications for treatment quality, cost transparency, and patient well-being. A narrative synthesis was conducted using peer-reviewed literature, registry data, and industry reports published between 2000 and 2025 (projected). Ownership distribution, reported live birth rates, and financial transparency were examined. Regional studies, market analyses, and professional guidelines were used to infer trends when global data were unavailable. Ownership trends show a decline in public- and physician-owned clinics, with private equity projected to control up to 50% of fertility centers in some regions by 2025. Treatment efficacy improved across all clinic types, with live birth rate per in vitro fertilization cycle rising from ~25 – 30% in 2000 to ~35 – 45% by 2020 in younger cohorts; higher rates in private equity clinics may reflect patient selection and reporting variability. Cost transparency remains inconsistent, particularly in private equity networks where bundled pricing and aggressive marketing may obscure true costs and incentivize unnecessary add-ons. The consolidation of fertility centers under corporate ownership has reshaped reproductive health care. Ongoing concerns include pricing opacity, the clinical value of “add-on” treatments, and the ethical positioning of clinicians in profit-driven settings.