Fertility segment in India to see quick growth; onus on healthcare providers to make it accessible and affordable

Fertility segment in Indian has grown 20% CAGR in the last five years. The country sees about 2-2.5 lakh IVF cycles in a month and has the potential to do about 5-6 Lakh IVF cycles. Given the population and the infertility rate, it’s more about how healthcare providers can reach these people and make IVF treatments accessible and affordable while generating awareness about reproductive health for all. During the conversation with Dr. Kshitiz Murdia, Cofounder and CEO, Indira IVF, Financial Express Online’s Tarun Bhardwaj unearths more information on the sector. Excerpt:

Please provide a brief on the journey of Indira IVF from its inception?

The organisation was initially conceptualised by Dr Ajay Murdia, chairman of Indira IVF. In one the first attempts to address male infertility, Dr Murdia co-authored a research paper “Sulpha-Trimethoprim Combinations and Male Fertility” published in The Lancet in August 1978. This is unique in two regards – firstly, at that time and the societal background, infertility was blamed only on women, and secondly, the paper was published in the same issue of The Lancet where the world’s first test tube baby, Louise Brown born in July 1978 in the UK was documented.

With his unique vision and a quest to address infertility four decades ago, Dr Murdia founded the country’s first sperm bank and Indira Infertility Clinic & Research Centre (IICRC), an infertility check-up and diagnostic clinic in Udaipur in 1988. This is ten years after his research paper was published.

In 2011, my brother Nitiz Murdia and me, joined our father and co-founded Indira IVF in Udaipur. This was done in order to provide treatment solutions (IVF) to couples who were diagnosed with infertility problems. When more couples started to visit Udaipur from across the country to Indira IVF, it was evident that the organisation needs to go closer to the people, instead of the other way round, and provide them affordable treatment using state-of-the-art technology. With this vision, the second Indira IVF centre was inaugurated in 2014 in Pune, and we had inaugurated the 50th centre in 2018 to become the largest IVF services company in India performing 20,000+ cycles annually.

Currently, Indira IVF now has 94 centres across the country (almost double since 2018) with over 2,200 dedicated employees that have heralded the clinics to the highest number of IVF procedures that are performed in India, that is, over 33,000.

The biggest challenge faced is the lack of understanding about fertility and limited awareness about infertility treatments. The topic was considered a taboo and the major understanding was that women are the cause of not being able to have a child after marriage. People are even seen to resort to unscientific treatments and practices such as jhaar-phoonk. Over the last decade, to address this deep-rooted issue, Indira IVF has implemented the “Nisantanata Bharat Chhoro” campaign that has held over 2,100 awareness camps across India in 24 states and have educated more than 65,000 couples so far.

What are other challenges you have faced in your journey as an organization?

One of the standing pillars of Indira IVF is accessibility and over the last decade we have been striving to stay true to our tenets. We observed that good IVF centres were not easily accessible for people in India. Couples had to take leaves from work and travel to metro cities for their treatment which wasn’t financially feasible in the longer run. We thought of providing solution by making world-class IVF facilities accessible throughout the length and breadth of the country. From opening our first clinic in 2011, second clinic in 2014 to 94 centres in 2021 despite the lockdown and effects of pandemic. Our dream is to reach more and more people and spread the joy of parenthood.

Another challenge we faced as an organization was assurance. Once people are spending finances in the process of IVF cycles, they begin to expect certain results and successful conception. Back when Indira IVF began, success rates were around 30-35% across the country. Now, with the skill level, best-in-class technology brought in from various parts of the world we have been consistently touching 70% (approx.) clinical success rates. India is a cost conscious market but with our skill, technology and success rates have motivated couples throughout the nation to turn to IVF and realize their dream of becoming parents.

Given the scenario of male infertility can you provide any data to compare its prevalence as compared to female infertility?

To start with the figures, roughly 30% male factors, 30% female factors, 30% male plus female and 10% unexplained infertility are responsible.

I remember my father telling me when they used to do semen counts and sperm analysis in the 1990s and all, the normal sperm count used to be around 70-90 million which has now gone further down to 20-30 million. Even if we see the WHO parameters, they have also reduced the normal sperm count from 60-120 million to 15 million.

Factors like lifestyle changes, genes, stress in the environment, pollution, quality of food etc. can put pressure on the fertility potential of both male and female.

What is the differentiator that sets Indira IVF apart from the industry?

At Indira IVF our process and system-driven approach is one of the major attributes setting us apart. We do not depend on star-doctor culture or referrals for our patients. It’s the brand that’s running at the fore-front and has gained the trust of patients by assuring them with standard treatment for all. Our doctors are young, driven and they follow a strict structure of protocols for the treatments across all our centres. We are very much fond of technology and are constantly looking to add new cutting edge technology to make IVF treatments cost-effective and safe.

One great example of the same would be our “Closed Working Chamber Technology” imported from Australia in 2011. When the eggs and sperms are manipulated outside the body, they can experience temperature shock due to the room temperature which is not suitable to develop eggs and embryos leading to failure in outcomes. This technology enables us to maintain a temperature of about 37 degrees, optimum levels of oxygen and carbon dioxide which are similar to inside-body conditions. Our experts and their microscopes are placed in these chambers so eggs and embryos can be developed in body-like conditions eventually producing better results and providing higher success rates.

Second important technology is RI witness technology; you might have seen the movie Good Newwz recently, where they have shown a sperm mix-up in the IVF lab. A situation like this can turn out be a nightmare for the doctors, patient, and embryologists; just to make sure something like this never happens in our labs we have imported this RFID technology. In this technology, every sample is labelled with an RFID chip and the moment you bring two samples close to each other, if they are of the husband and wife they would allow you to do the procedure. If you by chance bring a different sample even in 1 or 1½ foot vicinity forget about fertilization, mixing or inoculation; the alarms would set off, all screens would turn red, the process would be halted, somebody senior will need to come in and unlock the system, give remarks and inform the head office.

We are also trying to stay ahead of the curve through artificial intelligence (AI). So far eggs, sperms and embryos have been graded manually through human eye under microscopes, which has risk of human-error. We started using AI to grade embryos; we click pictures and the software grades the embryo based on the database of millions of embryos. This software is equipped with machine learning and through its database it can analyse which embryo is good, bad, pregnancy rate, more prone to conception etc. and recommends the embryo which can be implanted first maximizing the chances or pregnancy and reducing any risks.

All of these technologies combined with our strict SOPs, trained embryologists across all our centres in the country and an entirely scalable model make Indira IVF stand apart. Additionally, we have gone a step ahead to provide quality healthcare to our patients by getting our centres recognized and affiliated by QAI which is the sole accreditor for IVF centres. Five to six have already been recognize, rest centres are awaiting their inspection and certification. Very soon we will be the only IVF healthcare chain in India that has been QAI certified and follows all the international norms for patient care, safety and outcome scenario. Our commitment towards the quality of healthcare we provide also differentiates us from others.

What is the growth plans for Indira IVF going forward?

Our centre distribution among the 94 centres in the country spans to about 50% in the North, 30% in the West, 14% in South and 6% in the East. Our reason to grow more so now is to increase our accessibility in East and South and touch more lives. Given the expertise and training capabilities we have at Indira fertility academy, we are also planning to move abroad in the nearby countries such as Nepal, Bangladesh, Indonesia, Malaysia, Philippines. We already have many candidates in these countries through Indira Fertility Academy that we have set up to generate skilled manpower. We recruit young gynaecologist and embryo, they are trained and certified and then allowed to practice at our centres. Our institute is certified by the MERCK Foundation, Egypt and therefore we keep hosting and training international delegates in the field of embryology while collaborating with like-minded organizations, doctors, embryologists and practitioners who can work in this field.

Apart from a closed working chamber to provide suitable environment for embryo development, RI witness technology to avoid mix-up of samples. We are only transferring frozen embryos which increase our success rate from 35% to 75% and reduces risks. We focus on implanting only upto two embryos to avoid complications and cases of triplets and quadruplets. We are also using AI for embryo grading and Pre-Genetic Testing (PGT). A lot of people come to us with their child diagnosed with thalassemia or a family history of this disorder. What we can do to help such couples is that post preparing the embryo, we can take a small biopsy or small piece of the embryo and send it for genetic testing. This test can recognize such genetic diseases and whether the embryo is carrying it or not. We can eliminate such embryo and choose the implant healthier embryo in the patient. Through this testing we can also find an HLA matching embryo for a couple’s thalassemia child. The HLA matching embryo can be implanted and later the sibling can donate bone-marrow for the sibling and help save lives.

What is the market size of ART and IVF segment in India? What has been the growth of Indira IVF have been in the last five years?

Dr Kshitiz Murdia: Our revenue during FY18 and FY19 is Rs 470 crore and Rs 674 crore, respectively. In revenue, Indira IVF has seen a 63% CAGR (FY 15 to FY 20). The Indian market has grown 20% CAGR in the last five years. In terms of revenue, we are 3x of the market growth and in numbers of cycles 40% CAGR which is two times more than the market.

The market looks pretty promising and has capability. The country does about 2-2.5 Lakh IVF cycles in a month and has the potential to do about 5-6 Lakh IVF cycles. Looking at the population, infertility rate, it’s more about how we can reach these people and make IVF treatments accessible and affordable while generating awareness about reproductive health for all.

Have you witnessed any couples being wary to opt for IVF especially during Covid-19. How has Indira IVF been able to instill trust in them? Also, how can the pandemic affected Indira IVF?

The number of IVF procedures had seen a dip initially during the lockdown to limit the physical contact between people. Respective authorities had also suggested halting of IVF procedures. Indira IVF believes in the complete wellbeing of its patients and not only their reproductive health and as such, had discontinued processes for a while. In June 2020, Indira IVF opened its doors to aspiring couples and we witnessed 200% sudden increase in the number of IVF procedures post the unlock. Things have started to look better and we are seeing V-shaped recovery. If things go well, the pre-COVID volume of IVF procedures should be restored by November or December 2021 and by February- March 2022 we will cross our number of cycles on y-o-y basis as well. The pandemic has proved that while the process could be postponed or cancelled, the desire of fulfilling our families and having a child is inherent in humans.

What is the growth plan for Indira IVF in future domestic and internationally?

Indira IVF has an optimistic view for its holistic growth. With time, Indira IVF wishes to help provide IVF solutions to people aspiring for a successful pregnancy to every nook in the country. We are also trying to expand internationally through acquisitions or buying out business chain in Europe, Middle East or South East Asia. We also plan to focus on genetics and latest technologies in the coming future. But the initial focus is to strengthen the IVF network and keep creating opportunities to manifest our vision of becoming a global leader the next decade.

What are the trends in health and lifestyle in the IVF industry?

We are seeing a lot of rapid lifestyle changes that can potentially affect fertility such as delaying child bearing, getting married at later stage, smoking, pollution, alcohol etc. The couples who come to us are usually in the age of 34-35 and they start facing challenges in achieving pregnancy due to these factors. Age is a major determinant in fertility; the older you grow, higher the likelihood of having infertility and other problems associated with it. This is why we have also initiated egg freezing as a concept; which basically states that if you’re a working female or male and if you want to focus on your professional life, studies or career before becoming a parent, you have the option of freezing your egg, sperms and embryos early in life. We can freeze these eggs, sperms and embryos as per the government guidelines extracted at a younger and healthier age of 30-33. Later, when the person or couple mentally and physically prepared to have a child, we can use the same embryos, eggs or sperms at later stage in life to achieve pregnancy. This would enable them to have the same results at the age of 41-42 which they would have experience at let’s say the age of 33. Given the lifestyle changes both females and males have been experiencing decline in fertility., especially in women since the quality and quantity of their eggs starts to decline post the age of 35 rapidly. This concept is also recommended for cancer patients, who can preserve their eggs before radiotherapy and can later have the chance of having a child.