Fertility (Outpatient) sector across EMEA

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  • Detailed research report on Fertility (Outpatient) services with marketshare and growth rates for 18 countries and information on a further 98 (HBI Intelligence)
  • Database of 98 Fertility (Outpatient) service providers, including profile and major external investors (HBI Intelligence)
  • Merger and acquisition (M&A) intelligence showing likelihood of sale (HBI Intelligence)
  • News stories and interviews with Fertility (Outpatient) operators (HBI Deals and Insights)
  • Events that cover healthcare services globally including Fertility (Outpatient) (HBI 2020)
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Sector Report
Fertility (Outpatient) Sector

Updated: January 2021

Executive Summary

Impact of Covid-19 
We are in the process of analyzing the impact of Covid on the sector and we should have updates for every country’s growth forecasts for 2020 and 2021 by end of May. This is a partially elective sector and there has been a strong short-term impact which we have already reported in news. A serious recession will further hit demand and leave many investors breaking their bank covenants.
Definition of fertility
For the purposes of this report, we are defining the total fertility market as medically assisted reproduction - substantially ICSI (intracytoplasmic sperm injection, which accounts usually for up to two-thirds of all IVF treatments, where a single sperm is injected directly into an egg and the fertilised egg implanted into the womb) and conventional IVF (in-vitro fertilisation, where the remaining third, where sperm and egg are mixed and the sperm fertilises the egg naturally) . Our figure also includes IUI (intrauterine insemination, where sperm is placed inside a woman’s uterus), surrogacy, gamete and embryo donation.
Where we refer to infertile couples, we adopt the World Health Organisation definition of a medical condition characterised by the failure to achieve pregnancy after 12 months.
Who pays, and for what?
It is hard to generalise about the extent to which the for-profit sector is involved in the fertility market across EMEA, and the extent to which private individuals pay for it in the countries we looked at because the systems in place vary so wildly.
Fertility is a sector which public payors can de-prioritise (particularly in Eastern Europe in places like Ukraine, because of more pressing needs). Even the most (historically) publicly funded healthcare system feels it can retreat gently surrendering part of the services available to the for-profit market without fear of too much criticism (like the UK).
And while there is some state funding for medically assisted reproduction in almost all the markets we looked at, the level of support in each country varies from almost complete financial support to negligible.
Health, and delaying birth
One in six couples globally experience infertility problems, and the age at which women are having a first child is on the rise, which can lead to fertility problems.
Eligibility for state funding
Treatment eligibility criteria for state-funded services vary widely and inter alia encompass a mix of:
  • Patient age
  • Previous treatment
  • Relationship status
  • Existing medical conditions and BMI
  • Sexual orientation – not all countries offer same-sex couples’ access to assisted reproduction
See the full report for further details on drivers in the fertility sector. See the table of contents for details on what to expect in the report.
Lack of uniformity in reporting success rates
While some countries maintain excellent standards when it comes to reporting success rates, others have no agreed standards. Doing a like-for-like comparison in these countries is therefore extremely difficult.
It is worth noting that alongside quality, fertility is a sector where brand matters.
The medical tourism market
Medical tourism is a substantial part of many markets, like Czechia and Spain. Routes in medical tourism are well worn – the Chinese head to Russia, the French and Germans head to Spain (as did the Italians until legislation in 2015 opened up that market), Germans head to Austria, or Czechia where the ability of a doctor to speak German as a second language can double their salary. GCC patients often head to UAE along with neighbours in Africa and there has been a well-trodden route to Europe, while Swedes head to Denmark.
Some countries are substantially dependent on medical tourism in the fertility sector.
Most attractive markets
Below is a sample of the most and least attractive markets for for-profit operators and their investors. You can find far more information in each country’s full entry in the report, including data, marketshare of major players and growth.
Most attractive: UAE
80% of the revenue in the private-pay fertility market comes from ex-pats, and that market is willing to pay handsomely for fertility treatment with cycles costing €6,000 to €9,000 each on average - and three cycles being required. It is one of the fastest growing of any of the markets we looked at (10-12%). By 2020 the UAE could have over 5% of the global IVF market.
Least attractive / uninvestable: Sweden
A tiny market (6-7,000 cycles), with all for-profit work consolidated by one group after 2012 legislation allowed IVF outside the public hospitals. Low population and a sperm shortage see many couples go abroad especially to Denmark.
Unsurprisingly, consolidation will be far easier in some markets than others. In Spain, the market is heavily consolidated, with “most of the good hospitals with the best reputations” already consolidated, according to an operator looking to buy again in that market. In Sweden, the market is completely consolidated under one market. Other markets, like the UK remain far more fragmented, and offer more opportunity,
As you head further east, into less established markets, consolidation opportunities open up even if the markets are often smaller and / or less attractive generally. A source watching the Bulgarian market tells us: “If a Western brand appeared and bought several small clinics, they could immediately complete with the established brands.”
Sample report pages and data
What we offer
-       Instant overview of the EMEA fertility care market and players This report gives you visibility of this important, fast-growing market across 7 countries with market data on all, as well as detailed profiles of the Top 50 players.
-       Ever green!  Updated throughout your subscription As part of our HBI intelligence platform this report is updated throughout the period of your subscription. You will also receive additional news stories and interviews on fertility throughout the period.
-       Insights on business models The report is based on in-depth interviews with many operators. The report also looks at how fertility players can best build customer loyalty.
-       Identify national opportunities We assess opportunities at national level based on the regulatory environment, proposed reforms and radiologist shortages.
-       Size markets This report enables you to swiftly see market sizes and market shares
-       Save time and money This report will save you weeks researching these opaque markets and enable you to swiftly identify investment opportunities, new partners and markets.

Table of Contents

Table of Contents
EMEA overview
Size of EMEA market 2018
Marketshare of major EMEA players 2018
Comparison of market sizes 2018
Comparison of market growth rates 2016-2020
Our definition of fertility
Who pays, and for what?
-       Health, and delaying birth
-       Eligibility for state funding
-       Regulation
-       The attitude of the local population towards donation and surrogacy
-       Pricing
-       Waiting times for public treatment
Lack of uniformity in reporting success rates
The medical tourism market
Market attractiveness
-       Most attractive
-       Worth a look
-       Least attractive / uninvestible
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.
United Kingdom
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.

Fertility (Outpatient) News & Interviews

Our indepth stories dig deep and cover profit multiples, revenue, EBITDA and CEO thinking.

143 news stories on Fertility (Outpatient).

NMC tells its $6.4bn creditors to take it over, or lose money 3w ago

Creditors of in administration GCC-based NMC Health face a stark decision between now and May 28. Buy us, or face a 'distressed sale' - and possible liquidation. Accepting the deal will see creditors losing out on billions of dollars in the short term. But not a...

Gulf Capital takes re-branded IVI into India 1mo ago

Gulf Capital is taking its Middle East-based IVF platform, acquired from global player IVIRMA last year and now re-branded as ART, into India with the rollout of 18 IVF clinics nationwide. ...

Spanish fertility and cosmetic group plans hospital network 1mo ago

Madrid-based holding company Otsu Group, which operates Eva Fertility Clinics, the cosmetic Dorsia Clinics chain, and Origen Clinics, a network psychology and psychiatry clinics, is looking to build a hospital network following the acquisition of Hospital Poli...

2021: A boom year for health care M&A 1mo ago

The M&A market has roared out of Covid in the first quarter according to the HBI Panel Discussion. Are multiples likely to drop and what is investor appetite?...

New off-payroll worker legislation could cost UK operators 2mo ago

Healthcare operators could fall foul of UK legislation designed to target tax avoidance which is due to come into force next month. For the first time, IR35 will force for-profit groups to assess the legal status of contractors receiving payments via an interm...

NMC CEO: Any sale will be a competitive, traditional process 3mo ago

Will the creditors of NMC Healthcare, the GCC's largest for-profit healthcare operator which has been in administration since April 2020, choose a sale of its core UAE business in the next 3-6 months or a longer-term, creditor-led restructuring? We talk exclusi...

Canadian investment into Bourn Hall 4mo ago

UK-based fertility clinic specialist Bourn Hall has secured "significant investment" from Triangle Capital Corporation, a Canadian-based investment firm, in partnership with Toronto-based Bulldog Capital Partners....

Fresenius Helios buys Eugin, Elsan buys C2S 5mo ago

German and Spanish for-profit hospital operator Fresenius Helios has acquired global IVF operator Eugin from in-administration NMC Health, while French number two hospital group Elsan has bought smaller competitor C2S. What does the deal pricing for both say a...

HBI 2020: Investor interest in hospitals increases while outpatient valuations drop 5mo ago

Investors from varied backgrounds - infrastructure, private equity, and REIT, are all bullish about the prospects for healthcare investment in 2021, according to a panel of experts speaking at the HBI 2020 European Investment Panel discussion. But the pandemic...

Database of 98 Fertility (Outpatient) service providers

HBI has built a unique database of the Top 4,000 operators globally in health care services. As part of this, we have identified the top 98 Fertility (Outpatient) operators in Europe and will soon add the major players in Emerging Markets.

Profiles include revenue/sales data as well as EBITDA and other profit margins where known. They also cover private equity ownership with dates and mergers and acquisitions.

Mergers & Acquisition (M&A) Intelligence

Our deal pipeline shows how likely all private equity and some privately companies are to sell based on algorithms and journalistic know-how.

HBI 2020 – the only CEO-level conference to cover healthcare services globally

HBI 2020 – the only CEO-level conference to cover healthcare services globally
In 2019 this event brought together 700 delegates from over 40 countries. Over 60% are CEO level and they included 150 specialist investors in health care services. HBI 2020 includes a panel session on fertility, with three CEOs who operate in the Danish, GCC and Indian regions. They will be joined by Katya Zubareva, a partner at L.E.K Consulting.
Other sessions look at trends in the investment and merger and acquisition, digital health and telehealth.  
Contact us in the UK on 0207 183 3779 for more information.