Specialist
Former executive at IVI RMA Global SL
Agenda
- Ivirma's dominant position in the Spanish IVF market, as well as European and global geographic positioning
- Recent acquisition of Create Fertility in the UK market and outlook given natural IVF approach
- Regulatory dynamics and possible TAM expansion
- European IVF market M&A and consolidation outlook and possible sale of Ivirma, including likely valuations
Questions
1.
How sustainable is Ivi’s position in the Spanish IVF market vs competitors’, given it is very much the leading partner?
2.
What key regions present strong growth opportunities for Ivi over the next 3-5 years?
3.
What key regions in the wider European market do you think will drive growth?
4.
How should we assess the competitive landscape, especially with Eugin’s acquisition by Fresenius in December 2020? GeneraLife was also recently sold and has announced that it’s seeking large expansion. How much more of a threat are these two players, particularly for Ivi’s future position?
5.
You mentioned Ivi acquiring Create Fertility in the UK market in July 2021. This has historically arguably been a weaker UK player. How optimistic are you for this acquisition and what is your outlook, particularly for Ivi’s UK market position?
6.
You mentioned Create having an alternative, natural IVF offering. How much of a disadvantage might going after something different to Ivi’s typical offering be for its UK market penetration? Could it need to acquire more medically aligned or mainstream IVF clinics within the UK to increase its penetration?
7.
You said Ivi isn’t necessarily capturing the broader segment of the consumer base. How much do you think it’s limiting its UK TAM with the Create acquisition?
8.
What is the European IVF TAM and how is it growing with the introduction of new laws such as legalising state-sponsored IVF for female same-sex couples in France and Spain?
9.
You’ve mentioned the more liberal approach towards IVF regulations, perhaps with more regions opening up such as France. What is your long-term outlook for fertility tourism? Could there be a long-term decline in tourism patients, particularly in key hubs such as Spain, or could there still be a stream of tourism patients due to the cultural impact?
10.
How would you position Ivi in capturing domestic vs tourism patients? How could that split trend over the next 3-5 years?
11.
How can we think about the gross margins difference in treating international vs domestic patients? Are international patients more profitable than domestic IVF patients?
12.
Can you break down the major service lines of a typical IVF clinic such as Ivi? How might they differ around reimbursement and margins?
13.
One key driver is the high treatment success rate the market is trending towards. How is the success rate trending and how, if at all, is this encouraging stronger IVF treatment uptake?
14.
You mentioned two features that may be less important, one being price. Could price become an important feature again and might there be pricing pressure over the next 3-5 years, given more competition and increased IVF uptake? Or do you think price will stay level over the next 3-5 years?
15.
Egg freezing seems a fast-growing treatment within fertility services, highlighted by previous specialists [see Spanish IVF Clinics – Fertility Tourism & Regulatory Dynamics – 14 October 2021]. What is driving this growth and how well-placed is a player such as Ivirma to drive adoption?
16.
There has an increase in offerings such as PGT-A [pre-implantation genetic testing for aneuploidy] and PGT-SR [pre-implantation genetic testing for structural chromosomal rearrangements] from players in the genetic field. What is the demand for genetic services and how does their profitability compare to typical services’?
17.
Ivi was valued during the sale at around 20x EBITDA. Valuations have ranged from around EUR 1.5bn to EUR 2.5bn. How are valuations across the sector trending? What multiples would you note?
18.
What are Ivi’s future opportunities to drive organic or inorganic growth?
19.
How do you assess Ivi’s senior management and its strategy?
