In Conversation With Dr. Kshitiz Murdia
How has your company performed in the last year? How far has the pandemic impacted your business?
In the beginning of the pandemic, ART centres were directed to close since the procedure is elective in nature. As such, new treatments were halted, and on-going procedures were advised to resume at a time when it would be safe for both the patient and the staff to see them through. During the first year, a drop in the total number of procedures performed in the country was observed; in India, about 2-2.5 lakh cycles are performed every year, and this number dropped to about 1.5-1.8 lakh in 2020. We observed a proportional drop in the cycles we perform in AY2020 where the total number of cycles stood at 23,595 – down by almost 7,500 since AY2019.
Now, with increased patient confidence through immunisation drives and the adoption of safe practices, these numbers are back to pre-pandemic levels, if not more. This is because patients who had deferred treatment are now approaching ART centres. We witnessed a 40% growth in performance from FY2021 to FY22.
Recently, the government passed the ART Bill. How will it impact the overall IVF industry? What are your thoughts on this Bill?
The ART Bill is a commendable move on the part of the government as it will regulate the ART sector which has a high number of unorganised players. It will help bolster the network of organised players to provide treatment with transparency. The Bill has provisions for the set-up of National and State Boards to monitor registered ART centres – this enables keeping a track of the work done as well as empower individuals and couples to make an informed decision on the clinic they want to trust for their future family thus, increasing patients’ trust and confidence for the procedure. Additionally, the legislation brings us at par with best global practices, opening doors to international patients who seek affordable treatment that comes with assured results.
How many centres does Indira IVF have currently and what are your expansion plans in India?
Currently, we have 108 centres covering the length and breadth of India. In terms of our presence in different regions, our presence is highest in the North with 50% of our total centres in the region, followed by 30% in the West, 14% in the South, and 6% in the East. Since we have an established presence in the North and West regions, our focus is now to have an increased footprint in the South and East geographies. We have already begun our endeavour in the South where we have recently added centres in Karnataka. Our focus will now be to add more business from Andhra Pradesh, Telangana, and then Tamil Nadu where we are looking at prospects for acquisitions, mainly in Kerala and Tamil Nadu to reach as many patients as possible.
Our overall plan in FY22-23 is to inaugurate 25 centres in total in the country.
How is the demand of IVF treatment growing in India?
As discussed earlier, the Indian IVF market stands at 2-2.5 lakh IVF cycles every year, and the fertility industry is only slated to grow more. We are at a juncture wherein about 15% of our population has been noted to have struggles with fertility. In fact, the latest report by the National Family Health Survey conducted between 2019-2021, NFHS-5, India’s total fertility rate (TFR) has dropped below replacement levels for the first time to less than 2.0 children per woman; rural centres show a trend of 2.1% and urban centres an even worrying trend of 1.6%. A part of this can be attributed to increasing lifestyle transitions leading to conditions such as diabetes, obesity, and hypertension that have a direct co-relation to a person’s reproductive health. With the coming in of the ART Bill and increasing awareness about the importance of seeking timely treatment, the number in India can increase to about 5-6 lakh IVF cycles annually by 2025.
We understand you are also expanding to other countries. Please tell us about your plans and by when those will be fully operational.
We are looking to expand our presence to South-East Asia countries. In the first phase, our aim is to inaugurate centres in Nepal and Bangladesh; this can be via acquisitions as well as setting up our own infrastructure. Our next destination will be Africa UAE and Latin American Countries.
We have been training potential candidates at the Indira Fertility Academy in Udaipur where aspirants from international markets gets certification in the field of embryology. This institute is certified by the MERCK Foundation of the philanthropic arm Merck KGaA Germany and is highly recognised globally.
There is still lot of reservation among people about IVF treatment. How much is its success rate in today’s context?
When IVF procedures had initially begun in the world, the technology was very nascent – hormones were injected into the female to stimulate ovaries to produce eggs, retrieve the eggs, post which eggs and sperms were introduced in a petri dish to allow them to fertilise, and transfer the blastocyst into the uterus. The success of these procedures was highly dependent on probabilities.
Today, more than four decades since the first IVF baby was born, a number of technologies have come about to further streamline the process and ensure that every check point is backed by technologically sound outcomes. Not leaving anything up to chance, technological interventions such as using RFID technology, closed working chambers to ape the human body, advanced incubators, surgical techniques, as well as investment into artificial intelligence (AI) and machine learning (ML) are ensuring better outcomes.
We are now leaps and bounds ahead of the success rates that IVF had initially begun with. At our centres, we observe close to 74% (monthly average) success rate which accounts for a positive beta-human chorionic gonadotropin test in about two weeks since implantation. In addition to the technology we use, this can also be attributed to thorough training of our staff on standard operating procedures and a rigorous course at our in-house Indira Fertility Academy.
What do you think about the awareness level of such treatment in the country? How is it perceived in tier II markets?
When we had started off in 2011, we had observed that the awareness pertaining to infertility and its medical treatment was exceptionally low. While awareness has been comparatively more in the urban centres where scientific methodologies have more acceptance, most of the tier II and tier III population resorted to superstitious practices such as jhaar-phoonk and advice from babas for a cure. Females are thought to be at fault when a couple is unable to conceive in this diaspora due to their close association with the entire process – from conception, gestation, delivery, and to upbringing. Males are seldom at the receiving end of the blame. Research, however, has established that while in one-third couples, the female may have infertility-causing conditions, in one-third cases, males are the cause behind a couple’s inability to conceive, and in the remaining third, both partners may be infertile.
To address such myths and enlighten people with the knowledge of scientifically backed treatments, at Indira IVF, we have implemented the Nisantanta Bharat Chhodo campaign. Under this banner, we have held 2,141 free infertility awareness camps across the country’s 24 states, educating over 65,000 couples. The mission of spreading awareness everywhere is an ongoing process and we are committed to dispel misinformation.
What are your plans on fundraising? Are you looking for any kind of investments that can give you more scope to grow?
We are a cash-rich organisation with the backing of TA Associates who had invested in us in 2019, we are currently well placed with capital for any kind of investment requirement. Our plans of growing with 25 centres this year is on track and are determined to maintain our CAGR of 63%.
Do you think, there is still much more required in terms of policies, to give prominence to such treatment in India?
Once actioned, the ART Bill will provide the required push for ART treatment in India by increasing transparency and accountability. Medical tourism in our country for the purposes of ART is an already existing source of revenue due to an intersection of high success rate and affordability. We hope that the Bill will further bolster this, and we will observe higher footfall of patients from abroad who come to us to fulfil their aspirations for parenthood. Moreover, with changing times and evolving trends, legislations in our country can be amended; such interventions for the ART Bill, if needed in the future, should help us be at par with the rest of the world, if not ahead.
How is your offering different from your competition?
We are committed to provide technologically backed treatment to our patients and thus, invest in the most advanced solutions that would aid our goal to have couples conceive with the least number of cycles. In line with this, we have actively invested in research of AI & ML software for better prediction of embryos for implantation, which may further increase our IVF success rates.
We are committed to provide our patients treatment that is accessible and close to home. From one centre in Udaipur in 2011 to 101 in 2021 and counting, we are the first infertility treatments provider in the country to hit the number. Operating in a hub-and-spoke model, we strive to reduce financial and mental pressures on our patients by going close to them instead of the other way round.
Our state-of-the-art training centre, Indira Fertility Academy is where all our staff – from doctors to back-end – are coached on standard operating procedures so that standardised care can be provided across all our centres. Due to this uniform training, we do not have a star doctor culture; we level up young IVF specialists to perform procedures with the same success rates as a specialist with more years of experience would.
How are the IVF treatments in India perceived on global front and what its way forward in gaining global recognition is?
India is a hub for medical tourism hitting about $9 billion due to excellent treatment standards at comparatively economical rates. IVF is no different as people from abroad travel to us every year to access technologically backed, affordable IVF treatments with success rates at par with global standards. At our clinics, we have noted an influx of patients from our neighbours to centres close to them. For instance, we have observed that over 200 patients from Bangladesh visit our centres in Kolkata yearly. With borders slowly re-opening after the impact of the pandemic, patients who had deferred their treatment, are beginning to trickle in.
The Indian IVF infrastructure and talent that is organised has specialists at par with the rest of the world and is adept at treating even the rarest of cases. With the passing of the ART Bill, international patients will be able to access proof points about treatments in India, heralding the IVF sector in the country to even more global prominence.
