DISCLAIMER: Today’s Advertiser helped make the production and delivery of this episode possible, for free, to you! But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the Advertiser. The Advertiser does not have editorial control over the content of this episode, and the guest’s appearance is not an endorsement of the Advertiser.
Daniel Madero, VP of Partnerships at LEVY Health, gives an inside look at the fertility industry throughout Latin America, breaking down the market from major players to major growth potential throughout the region.
Tune in to hear Daniel discuss:
The growth of the Latin American Fertility Market in the last 20 years [Revealing the countries that are major players by market shares]
Regional Regulations [And their impact on everything from taxes to gestational carriers for same-sex couples]
How Post-Covid Inflation is affecting the IVF-space throughout the region.
Why it costs 40% more to set-up the IVF lab in Latin America [As compared to the US and even the same country 10 years ago]
Dan Madero, LEVY Health LinkedIn
Transcript
Daniel Madero 00:00
It's a Greenfield, the amount of things that can be done in Latin America overall, just pick the country. You know, you have countries with populations of 20 million that are doing 2000 cycles, 3000 cycles, 50,000,000, 4,000 cycles, right? The conversation, I think should be, how can we get into Latin America. Straying away from the traditional model that we see in the US and Europe.
Sponsor 00:30
This episode was brought to you by BUNDL. To learn more about the BUNDL with Medications℠ program, and how they can optimize treatments for your practice and patients, please visit www.bundlfertility.com/medications-cost. That's bundlfertility.com/medications-cost. Today's advertiser helped make the production and delivery of this episode possible for free to you. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the advertiser, the advertiser does not have editorial control over the content of this episode. And the guests appearance is not an endorsement of the advertiser.
Griffin Jones 01:21
This IVF market just keeps getting bigger, the number of people in the world that need IVF services is much greater than the number of people that are getting it now, that is much greater than any one given country. That's part of the reason why we've been covering so many different regions and players in different regions on Inside Reproductive Health recently, because you didn't see many national players 10 or 20 years ago, now you see plenty, and now we're starting to see those national players from different nations become global players. The region we zoomed in on today is Latin America, because from Mexico to the bottom of the South American continent lives in a population about double that of the United States. Yes, this is for the execs and doc's that aren't the most familiar with the Latin American market yet, but you practice owners, lab directors and executives in Latin America, I want your feedback. And I want you to share this with your audience. Because whenever I delve into a new region or new topic, I start broadly the more you ping me with you should have mentioned this dataset, you left out this player you left out this development, the more specific we make our content, the better it gets. If you want to see more content about Latin America, give me your feedback about this episode, and give it to my guest, Daniel Madero. Because I approached this topic broadly, I needed someone that seen a lot of different areas of both the industry and the clinic side in Latin America and globally, for some context as to how it compares. Daniel was the chief financial officer of a clinic in Colombia before it was acquired by Eugin than his general manager after the acquisition. He's been a consultant. He's led bizdev corporate partnerships, third party services in different areas of the quote industry side, and he takes us through the countries that have the biggest market share, starting with the top three, what their market share is how many IVF cycles they're doing, how many IVF cycles they're doing per million people how that compares to a country like the US or a really advanced IVF country like Israel. He talks to us about regulation, like same sex gestational carriers, or gestational carriers for same sex couples going through IVF. Now being allowed. And Daniel, welcome to Inside Reproductive Health.
Daniel Madero 03:22
Thank you, Griffin, it's a pleasure to be here with you.
Griffin Jones 03:25
You're going to take on a new geography today, one I haven't covered on the show before. So you're swimming into new waters, we've started to cover more of Europe, more of the UK, some of India, some of East Asia and Southeast Asia really have not even had one topic on Latin America. That is until today. And I think that it is beyond due time and want to delve into it partly because I think that we're going to see more of this consolidation, as you and I speak, there's a number of fertility networks that are for sale that are already cross continental, that may likely be purchased by other cross continental buyers, I suspect that we're going to see more of that. And so I just don't think it's going to be this backyard or that backyard in the future, even if globalization slows down for a while. So let's maybe start broadly with just what's going on in the IVF market and Latin America right now.
Daniel Madero 04:27
You know, say you had other Latin Americans in your podcast.
Griffin Jones 04:31
I have Latin Americans on the podcast, but I've never talked about that in America. No, no.
Daniel Madero 04:41
So overall Latin America is it's a special place. Because we have twice the population of the US are about 350 million, but only a fraction of IVF cycles. Within the space you're going to see that there are major players, we'll talk about it today, but the the rest of the continent is lagging behind. So we have Brazil, Argentina and Mexico, leading the way in that order. And then the rest of the continent is smaller on it. So in total, we're doing about 107,000 cycles, including egg freezing transfers, like fresh and frozen transfers, egg donation. So, you know, in total, and this is projected, so about 85% of IVF centers report into REDLARA, which is, you know, the equivalent of ASRM or x rayed for Latin America. And this 106,000 represent the the potential total, with those extra 50%.
Griffin Jones 05:57
So 100, so about 100,000, you're saying from all the way from Mexico, down to Chile and Argentina, we're talking about Mexico, Central America, South America got 100,000 cycles, maybe a little bit more coming from all of those countries?
Daniel Madero 06:14
Correct
Griffin Jones 06:14
And that total population, you said is twice the the US so from all the way from Mexico down to the tip of South America, we're talking about 600 or so million?
Daniel Madero 06:24
Yeah. So we doubled the population, and we only do 1/3 of the cycles.
Griffin Jones 06:29
So are we seeing a really unequal distribution, you already said there is an unequal distribution, in that Brazil, Argentina, Mexico leading the way? And then and then it's a distant fourth from there is, is Brazil? Like, is their market? What's the market share chunks of those countries do you know?
Daniel Madero 06:48
So Brazil is gonna represent about 43% of cycles, followed by Argentina at 20% of cycles, and then Mexico at 15% of cycles. Everything else, you know, the fourth one is Peru at seven and a half percent. And Chile at 5%.
Griffin Jones 07:10
I'm not surprised by Brazil leading the way I am a little bit surprised that Mexico is a little bit further behind, because we're talking about I think, what is it 110 million? Are we talking about somewhere around 100 million in population, Mexico? And it seems to me like with the explosion of new tech industry, and a lot of reshoring, that's coming back to the US a lot of that manufacturing, coming to Mexico, is that part of the reason why you're seeing Texas just explode, you're in Austin, you part of the reason why you're seeing that area blow up is because you have the tech sphere in Austin, then you have the semi skilled manufacturing in Mexico with regard to that. That's how it's called in the channel. And so I would have thought that given what I perceived to be an explosion in their economy, that they would have been further ahead, are they? Are they catching up real fast? Is this 15% been stagnant? What what's it like if we zoom in on Mexico?
Daniel Madero 08:14
So we want to talk about Mexico, I think let's talk about now more challenges within like each one of these countries. And one of the things that is going to be ubiquitous across Latin America is the price of IVF cycles. They're extremely expensive compared to what a regular person will make. So what we end up with is that IVF cycle represents a higher percentage of their total income, thus becomes harder to attain, the prices tend to be on the higher end. So and, you know, bear in mind that there is a difference, a major difference between pricing the US and the rest of the world overall. So in Latin America, you could say that, for multiple cycles that are three cycles, you're going to end up spending $10,000 $11,000, depending on where you are, and that represents a really high percentage of the total income of the patient.
Griffin Jones 09:27
So if we're talking about three cycles going to add about 10, or 11,000, is that just to the clinic, or does that include meds? Typically, an estimate?
Daniel Madero 09:38
I'm gonna say that this depends on the country, but yes, it this will be meds included.
Griffin Jones 09:43
Okay. So all in we're talking about maybe 10 or 11,000, where that could be 50,000 in the US, but it's still we're still looking at something that is proportionate to income, out of a lot of people's range. Correct? What other challenges are Are our countries facing? So are they are they seeing from as far as you can tell the same shortage in embryologist and fertility specialists that we've seen in the US and Canada.
Daniel Madero 10:13
On the one hand, in Mexico, that is not a challenge just because all OB/GYNs in Mexico are trained with reproductive endocrinology as well. So any OB/GYN in Mexico can perform ART services. So in Mexico, doctors are not a challenge. What I have seen though, is that, embryologist, if they have good English, will often get exported. So they will be hired for by outside clinics. So from personal experience, I have a friend that after being in Colombia, he went to Dubai did a short stint there, and then came back to Colombia and is now in Cairo. perfect English, highly skilled. And of course, the salaries are gonna be a lot higher in dollars than they are in Colombian pesos or insert the currency
Griffin Jones 11:21
so lesson to all the lab directors listening don't teach your embryologist English, you're gonna lose them. So then are there operational challenges that you're seeing that are different than in the EU, I suspect it varies country to country, but are we typically seeing the same workflow where it's, you call you maybe get a referral, you come for your new patient visit, typically you do your testing between your new patient visit in your follow up some clinics, of course, do testing before new patient, but most I think are still doing it in between the patient and follow up, what's the operational system look like?
Daniel Madero 12:01
It will look very similar. You know, I'll give you a very specific example, in Colombia, a lot of the patients come from referrals. So a lot of the times the clinic's name will be very closely tied to the doctor's name. So the patients will come to the doctor referred to by a gynecologist. In other cases, you will have something that happens in Mexico, given that they can do their own cycles, instead of sending them to a clinic, they would rather keep them get them pregnant, and then keep that patient all the way through to delivery. So you're gonna see, you know, different dynamics, but for the most part, there is a referral system, it functions in the same way than in the US. So you have lower cycles per per doctor, you know, so we're not talking about doctors or clinics that are doing your 800 cycles per doctor. But on the, you know, on the 150, 200 cycles, 250 cycles per doctor, which is on the lower end.
Griffin Jones 13:15
Yeah, I would say it's on the lower end. And so you're saying that some clinics are practicing obstetrics that they're keeping those patients because that would change the referral pattern?
Daniel Madero 13:25
Yes, in Mexico, it does. And in Colombia used to be that case, and it's changed over time. I cannot speak to Brazil. And I know in Argentina, and you know, here we can talk more specifically about about dynamics in Argentina, IVF cycles are covered by, you know, healthcare. So that's one of the other reasons why you see such a high percentage of cycles being performed in Argentina, because they're just covered, unlike in Colombia, where we have a socialized health care system. So on average, when you go to the hospital here in Colombia, you'll pay maybe a couple bucks, when you're when you leave. But when you have to pay out of pocket, you just don't like to pay out of pocket, right? Like you don't pay out of pocket, because you're not used to it. So when you see a bill that's for, I was gonna say pesos, because it would be millions of pesos. You're not used to it, and you're a little more careful of your money in those cases, right? Healthcare is healthcare. So if you're used to going to a hospital not paying any money, when you get to a fertility clinic and you're charged, you know, $5,000, $10,000 then you're like, wait, wait, wait. I don't know if I if I want to do this. I don't know if they have the money to do this.
Griffin Jones 14:50
I want to come back to this question of coverage in a second. But on the on the obstetrics part I could see that disrupting, I could see that limiting some new patient growth because if, I'm going to go on an assumption is that the reason why they want to keep the patients for obstetrics is for volume and revenue, they don't have enough IVF volume, they make more revenue if they keep them from obstetrics. But that by definition means that there's some type of valuable revenue happening in obstetrics, which means that in a situation wouldn't want to lose that revenue. And so yeah, if you have a gynecologist, it's also practicing obstetrics, are the partners in their practice? Are we less likely to refer to that group? And I, that could be part of the reason why you see fertility clinics getting less referrals in Mexico, if in fact, that's happening?
Daniel Madero 15:44
Yeah, I would agree. I don't want to say that's the case. But I can see that definitely happening. I know that that was a dynamic here in Colombia, that has changed.
Griffin Jones 15:55
Why did it change in Colombia?
Daniel Madero 15:57
Because doctors stuck to just doing fertility. So the other doctors, their friends, would know, hey, this patient that can't get pregnant, instead of me trying to do you know, my seventh IUI, you're going to send it to Dr. X, Dr. Madero, and my dad, and my dad would return a pregnant patient. So it made more sense to just ship out everything that they couldn't do, and then get back a presentation, which is where the, which is the revenue they're looking for. Now, here's the other thing in Mexico, you have, you have doctors taking patients to labs. So that's another model that is common in Mexico, there is a clinic. And instead of having, you know, a set of doctors that are affiliated to that clinic, there are different doctors that bring their cases to the clinic. So say, you know, the clinic has Dr. X, and that Dr. X is doing 30% of all cycles that are being done at the lab, yet 70% of the cycles come from outside doctors that can bring their own patients. So that's another dynamic that you see in Mexico as well.
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Griffin Jones 18:02
So I wonder if it's a question of like just where the development phase in the market place is. And Columbia has reached that level of maturity and development where they now can have fertility specialists that only do fertility cases and, and so they don't, they're not practicing obstetrics. Is that on the, I know I'm asking you to speculate so maybe you can't, but is that on the horizon? From what you can tell in Mexico? Or do you think fertility specialists are gonna be practicing obstetrics for a while?
Daniel Madero 18:36
That is a really good question, but I cannot speculate on that, to be honest, I would get I would try to ask Paco, for example. He might, he might have a better idea on it.
Griffin Jones 18:46
And this is how I approach all of these topics. They start really broadly. And then the more I do, the more I'm able to zoom in and ask better questions in any one of these countries, particularly the top three could be there could be their own topic, and then you could have certain players in each of those three, that could be their own topic. So you mentioned my assumption would have been, and this is why we don't assume, but my assumption would have been I didn't conclude it that the entire Latin American IVF market was cash pay or almost 100%. But you said in Argentina, the government pays for cycles?
Daniel Madero 19:27
Yep. So I was reading the law this morning, actually. And I think it's if you're a woman that is looking to do IVF it will be covered with your own eggs up to 44.
Griffin Jones 19:41
Two cycles, one cycle?
Daniel Madero 19:43
I don't have specific numbers to be honest.
Griffin Jones 19:45
So that would, because it did kind of surprise me, to see Argentina almost double what Mexico is in terms of their their share of the Latin American IVF market. Argentina is a smaller country by population, probably a higher per capita wealth, but it's still,
Daniel Madero 20:05
In Mexico?
Griffin Jones 20:06
I mean, like the total, the total like so if you took the averages of, of Buenos Aires, but I would imagine, again now I'm really, I'm really be sticking my foot in my mouth and talking about what I what I don't know. Um, so it's just a guess but I would suspect that Mexico has a higher GDP total, but but in the per capita wealth is is higher in in Argentina would would be my guess. But so so they're they're paying for cycles on there. Are there other countries in Latin America where they're paying for IVF besides Argentina?
Daniel Madero 20:44
Yep Peru, oh well no, actually that IVF is covered you mean?
Griffin Jones 20:48
Yes.
Daniel Madero 20:50
I don't know, I don't know to what degree I know that here in Colombia there is a there's a push to try to get covered. Given that, you know, most of healthcare is socialized, why not IVF? Right? It's still a disease. Right. So there has been a push to try to get that through. And it's been really difficult. I don't know how it works in Brazil. I don't think it's covered. I think it's cash pay. The one that I'm sure of is Argentina. I would I would like to say Chile, but like looking at the numbers, maybe, maybe not, because Chile's is very small country anyways. So I wouldn't really know.
Griffin Jones 21:34
So what's happening with regard to people trying to scale IVF in these markets. So in the US, it's all about let's get from 250,000 into at least 2 million cycles. We need to be automating the lab, we need to be practicing at top of license, we need to be training more specialists and advanced practice providers. We need artificial intelligence for case management. And you have a lot of players and by players I mean, on the vendor side, these are the people that we see in booths at ESHRE and ASRM that are trying to break into the US market some with more success than others, are people trying to break into the Latin American market in the same way, like do they see it as an opportunity where well, if we can really drive the cost down, then then the markets even bigger or is the US the place where people generally want to try to do that because the margins are greater up front? And then then then if they can scale in the US that they'll be able to take some of those economies of scale to, to higher population, lower per capita income regions like the Indian subcontinent, Latin America.
Daniel Madero 22:51
So I'm gonna go on a small tangent that I think it's related to this. But if you think about all the different technology that we have in IVF, it's the same across the board, be it in India, China, Colombia, the US, what we have is same incubators, the same laminar flow cabins, you have, you know, state of the art labs, all of those are very expensive. And if you have a weak currency, setting up one of those labs, he's going to be way more expensive. So to give you an idea, when I set up a lab here, like a clinic here in Colombia, the price of all the equipment was put here in my lab, about 30% to 40%, more expensive than what it would have been in Spain, or in Europe or in the US. So that right there, it's an indication that there's something that's happening within that it's the media is more expensive. The petri dishes are more expensive, though, XYZ just put it in there, because most of it is made in dollars. So without these technologies that you're talking about, if they're going to be charging $500 a patient, then in a country like Argentina, that is now going to represent about, you know, 25% of the total cost of the cycle. So I don't think we're doing the same. I think that we've been looking at how things are being done in the US and Europe and basing it on that. And when you just transpose whatever it's being done elsewhere here, the prices are not going to change much. The other part is medication. Medications are extremely expensive. Nevertheless, they're not as expensive as in the US, right? Like, for example, this is a conversation I bumped into the other day with someone in the US and Menopur was considered the low cost option. Here in Colombia verses a Gonal-F, or Follistim. So when you think about that, now, you bring a completely new dimension into the equation, right medication ends up being a higher percentage of the total cost of the full cycle than what it would be elsewhere. All of that, because, you know, things are being brought in, in dollars. And when the dollar goes up, and the pestle goes down, that means that, you know, intrinsically IVF is going to get more expensive.
Griffin Jones 25:35
Has that happened in the last three years with inflation? So I, the only Latin American currency that I follow is the boliviano. And it hasn't changed it is, it's hooked to the US dollar, it's always around 6.9, sometimes you'll see it 6.8, something you might see it six point, it's always around 6.9, somewhere around there. And an even with the inflation that we've had post 2020 through 2022. And maybe even in now, it hasn't gone, it hasn't gone up, it hasn't changed. It's always hooked to whatever the US dollar does. Now, you can get a ton of variance in Latin America, especially in Argentina, where when I was living in Latin America, Argentina had 40% inflation year over year. And that wasn't like a COVID stimulus. That was like that was like the status quo. And so, so did did we see like an extra did this come into play more with the inflation that has happened globally, post COVID.
Daniel Madero 26:40
So I'll give you the the Colombian peso example. Before COVID, it was sitting at, let's call it, you know, $3.5 to $1, $3.5,000 to $1. By the end of last year, we were sitting at five, to $1. And now we are at four, for $1. So it's like playing jump rope 10 years ago, it used it was 1.82. So that has a huge incidence in, in the result, right? Because what ends up happening is when I set up the lab, 10 years ago, 12 years ago, the all the equipment costs have avoided what it would cost today to set up a ladder, because everything has to be imported. And now you want to talk about local regulation. Brazil is a complicated country, in terms of bringing in external technology, media, that it's a completely different story, when you want to bring in, for example, gametes, and all of these are going to be at a premium, if you will, just because of the currency exchange. So the challenges of bringing new technology in, for example, here in Colombia, you're going to pay? I think it's depends depending on the on the type of equipment between 20 and 40% taxes on the equipment.
Griffin Jones 28:11
And you're saying taxes as in like an as an import tax and tax not, you're not talking about the the lowercase t tax of inflation, you're talking about actual government taxes,
Daniel Madero 28:24
Government taxes, correct,
Daniel Madero 28:26
Yes. It will depend on the country and it will vary. I know that Brazil is very, there tends to be heavy on on taxes for importing things. And it tends to favor locally made things here in Colombia it goes up and up and down. But it depends on the type of technology. I would say it's similar in Argentina. Also, you want to talk about politics, which I really don't want to talk about, but overall Latin America is leaning left at this stage. And when you have governments like leftist governments taking over, then there is a higher price on specific types of products and services as well. So you see those taxes going up. And as a company, if you're buying something that sales tax, you know, so you have the input tax plus the sales tax. So it just balloons to the point that you're going to be paying 40% more than what you would pay in the US.
Griffin Jones 28:26
in that 20 to 40%. I want to I want to talk about taxes, I want to talk about regulation, I should mention that what you're saying on the on the side of the jump rope of the Colombian peso, that that's just currency rate exchange, I'm not and when so when I say that the boliviano is attached to the dollar I should be making the caveat that that doesn't mean that there isn't inflation in Bolivia, there is, because the you know, the the purchase power of of a boliviano and the dollar has gone down. And so that's just currency rate exchange. So you can be getting it on multiple set you can be getting on the currency side, you can get it on the purchase power side. And then And then you mentioned taxes are due those really vary from country to country. Is that 20 to 40% pretty standard? Are there some that have really high taxes and then like Mexico being a NAFTA does that change?
Griffin Jones 30:23
So before we talk about regulation, I want to see so it seems like just from a cost perspective of materials, media technology, at least hardware technology, I, I'm thinking HSGs, and things like that, it's it's going to be far more expensive because of the currency rate because of the taxes. What about these AI companies that are really trying to break into the US and Europe? Are they trying to break into Latin America? Or not really yet? They're trying to figure the US out first, and then and then they'll come to Latin America?
Daniel Madero 31:02
So I know that, you know, IVF 2.0, is based out of Mexico. So I'm guessing and hoping that they have partnerships in Mexico and are willing to spread that technology down into Latin America. I know that which one is it, Life Whisperer, is already available in a few countries in Latin America as well. And I don't know how the pricing structure works, but I'm guessing it's going to be a different pricing tier for a clinic in the US than a clinic or a patient in the US and a patient in Latin America. But to be honest, I don't know of other ones that are trying to get into the market. Now, if you think about the reasons why I'm gonna play, I'm gonna try to, you know, put myself in their shoes, you have 106,000 cycles, that are distributed to a pretty small, total percentage of the population with a high price sensitivity in very difficult, it's not like you get one certification, like CE mark in Europe, and you're everywhere. It's you have to go to Colombia, you have to go to Mexico and learn how to deal with Mexican system with the Colombian system with the Brazilian system, you know, insert Portuguese here, Argentina, Peru, Ecuador. And when you're talking about, you know, a couple of 1000, few 1000 cycles, the legwork might not justify coming into these markets.
Griffin Jones 32:42
So it could be a while before we start to see some major innovation happening, let's say in Bolivia, I don't know, there has to be a fertility clinic with an IVF lab and in Santa Cruz, Bolivia, I suspect that there, there's I suspect that there's one in Santa Cruz and there might be a one in the Paz and Cochabamba there's probably at least one in Santa Cruz.
Daniel Madero 33:05
There are three, there's three, they're doing in total 1000 cycles.
Griffin Jones 33:09
Okay. So you got three clinics doing 1000, look at you with the data. I asked Daniel to do some some homework, because I know he's good with this stuff. But I wanted him to be able to pull up a couple of those numbers that I don't know. Thank you for that. So three clinics doing 1000 cycles. So because of the reasons that you just mentioned, the variance in regulation, the variance, it's not like, it's not like you're you just get that CE sticker good for the whole EU, you get the FDA approval, you're good for 330 million people in the US, you you're going from country to country, and some of those countries are so small market, it could be a while before we really see, like a scale and innovation in a place like Bolivia?
Daniel Madero 33:49
I would say so, right? I think the focus is going to be on those markets that are bigger. Argentina, Brazil, Mexico to start with, and then trickle down into other ones. There are some ways to do homologation of certifications here in, in Colombia. So like, I know that the regulatory entity is a little more lax with devices that have gone through FDA approval already. So if you have FDA, it's easier to get into one of these markets. I don't know for other countries, but in the end, that could be the case if you have gotten through FTA then getting into one of these countries is going to be easier. I'm gonna guess on this, I'm not gonna guess anything actually. Rather not.
Griffin Jones 34:41
Well, then then talk to me about what's happening in Brazil as in as in what ways is Brazil an outlier to the rest of the region? Because it's one it's a larger country. It's got a higher GDP, higher per capita income and While none of not not a highest GDP, not a highest population, not as high as per capita income, anywhere close to the US, I could still see it having a lot of what these companies are attracted to in the US. And and that also might be more cash paid in the US is right now could be attractive to different people coming in tell me but in what ways is Brazil an outlier?
Daniel Madero 35:26
Let's start with your average middle class yearly salary. In Brazil, it's about $9,000. As I said, a year the average cost of an IVF cycle is $5,400. That's about 60%. It's pretty high. But if you look at the population of Brazil, there are a lot of people with a lot of money, I'm also going to guess that financial institutions are a little more advanced, does access to capital comes easier. It's also a country, the sheer size of the country. It's a market that big. It's, you know, a big opportunity, however you see it. And now we're talking about Brazil doing 50%, sorry, 50,000 cycles, how much does that represent? Like the total potential amount of cycles that could be done, it's just a fraction, right? With with a, with a population that big, we're seeing a very low penetration overall. So Brazil, to give you an idea, it's doing about 230 cycles, for every 1 million people in the country. In the USA, we're doing 800 for every 1 million people. And you know, the ideal, right, like, the place we want to get to is an Israel at 4300 cycles for every 1 million people. So I think there's still a lot of potential of growth. And like I mentioned before, just doing an IVF cycle is going to be 60% of your yearly salary. So just bringing those costs down, is going to really open up a big opportunity in any one of these countries that we're talking about. Now, what I know is that in big population areas, like Sao Paulo, you have mega clinics, by clinics that are doing 5000 cycles in you know, per year, which you know, challenges or like it goes head to head to those big mega centers that we have in the US, like big centers. So, we have those in Latin America, but there's still so much room for growth Majan, if you took that number of 230 cycles for every 1 million people in Brazil, and we're able to get to the 800 in that they have, we're talking now about 150,000 cycles being done in Brazil, unlike where they are today, which is like 50,000. So one of the major challenges and I think you know, you're talking about technology, one of the major challenges that we have here in Colombia, in Brazil and Argentina in Latin America overall, is how do we stop looking at the rest of the world? And how they are doing things? And how can we figure out a model that works for our own economies for our own populations, frameworks, like legal frameworks, how do we get to that? To give you an idea, Colombia is a country that has now regulation, it's great area regulation, but it's legal to do surrogacy, and same sex surrogacy as well. And it's become a destination now. There are there are clinics now they're just focusing on surrogacy here in Colombia. And that's a great thing, right? We are increasing the number of cycles we're doing. The caveat though, is that we are not offering services to our own population. So the need is still going on map. And if we find a way to change the way the process is being done, say like a Paco and positive, then now we are we're getting into the meaty, the good of how can we grow the market in Latin America. So I don't think that the opportunity lies in the traditional ROLAP which has been tried before. With IVI like either IVI came to Mexico. There's a history with IVI and Latin America. I don't personally know it. But it would be for example, a great thing to to research you But IVI, Eugin, so you know, the same group that's going up for sale that you put an article up on a few weeks ago, they are here. I was I was part of the first acquisition of Eugin outside of the nuclear clinic here in Colombia. And, you know, I'm not gonna say it's not going great. But it's still not growing the market significantly, like we should be doing. So I think the the key to success in Latin America is in how can we change process? Or how we can help? Can we create technology or develop technology that suits the needs of our populations? And I know that, by the way, like, I want to give thanks to, I'm advising a company here in Colombia, and they were the ones that provided a lot of the information that I'm giving to you right now. But they're working on increasing access, here in Colombia, right? Like, how can we take what we have here today, and we improve it, we change it, and we get to more people, instead of going to from sort of doing a recycle recycles for 100 million people in Colombia? How can we do 800 cycles for every one 1 million people in Colombia?
Griffin Jones 41:19
And so is when you're going through this, you can't make legislative changes, you can't remove taxes, but you might see some things as you're visiting clinics in these different countries that that you think, but they could do this? They could do this? What is what's the lowest hanging fruit that you see that if you if you ran? If you were the CEO of that clinic group, that that would be one way that you're able to do more volume?
Daniel Madero 41:50
That is such a good question. I would think it's the doctors, you know, REs, for the most part, doing most of the cycle. And they're the ones that have to do it all. I'm generalizing. I don't know if this is the case in most clinics, in all clinics, but I think there's an opportunity there to offload a lot of the work to the different parts of the of the clinic. On the other hand, it's precisely that right, if you're talking about going to a public hospital is how do you create a good referral flow for those patients in need of fertility treatments? Because sometimes, and I remember this from my conversations with OB/GYN here in Colombia, they would, you know, try time relations for eight months to a year with a 39, 40 year old woman. And at that stage, it's like, wait, you need more education, right? That's not That's not how it's supposed to be done. Or earlier at the eighth, ninth IUI, the patient would come to us and be like, well, I've done nine IUIs, what do I do now? Like, well, there are other options out there. So general education, both to doctors, patients, but also those creating those flows with her hospitals overall, or OB GYN groups, you know, insert however the country works to get those referrals earlier and faster.
Griffin Jones 43:32
You talked about some of the key players who are you talked about, you know, Eugin, which is a Spanish company and owns Boston IVF and they own Trio in Canada, and they're owned by Fresenius Helios right now, you talked about IVI which is merged with RMA to become IVI-RMA. IVI started in Spain and that RMA started in New Jersey, but who are like the who are the big networks there that, you know, like who's their equivalent to the inceptions preludes us fertility panic calls. And I guess I'm the like, maybe there's not as much of a difference between the MSO name and the clinic name. But like the Shady Grove Fertility, the Boston IV of the HRC, like, who are the really big groups that are in Latin America, and where are they?
Daniel Madero 44:20
Brazil? And okay, let's talk about groups because I don't think there is, or there are like big networks here. Other than the ones that are coming in from outside. So Eugin owns the biggest if not one of the biggest clinics in Brazil, Huntington's. you have the ones in Argentina, same. They own one of those in Argentina. So they've been buying the big ones, right, because that's where the profits will be.
Griffin Jones 44:49
You talked about networks coming in like IVI and Eugin, and those would be like the US Fertility's and the Inceptions, and the Pinnacles, and then who are they, who are they buying? Like who are the Shady Groves, the Boston IVFs, the HRCs, the the really, the Vios, the big groups that are in different areas that people are buying, like who are those big clinic names in different countries, or at least a couple of them?
Daniel Madero 45:20
In Argentina, we have CEGYR. And I know that they also have a lab of their own. So CEGYR, Huntington's in Brazil is a major one as well. So here being CEGYR, Dr. Sergio Papier, being the medical director there, you have Huntington's in Brazil, in Brazil, there are more than one, I'm just gonna give you one Brazil, Huntington's owned by Eugin. Now in Mexico, you have a group that's in finance, and I know they have more than one clinic across Mexico. There's one in in Peru, and they're the biggest by a good chunk by a margin called Concebir. They're in Lima, but they also have like clinics in Aliquippa and in other places. Here in Colombia, you have two big ones now one called Inser ,of the other one ReproTech written the same way as the cryo storage in the US, ReproTech, those would be the ones that I would focus on. Because the rest, I don't know that many clinics in other parts that are going to be as big, you know, on that scale. It's a Greenfield, the amount of things that can be done in Latin America overall, just pick the country. You know, you have countries with populations of 20 million that are doing 2000 cycles, 3000 cycles, 50,000,000, 4,000 cycles. Right, the conversation, I think should be how can we get into Latin America, straying away from the traditional model that we see in the US and Europe. And insert, Africa, any country in Africa, it's going to be very similar. You're seeing the sheer size of India makes it that it's an incredible market. But you're seeing it in India, you had a great series on it. But yeah, I think the opportunity in Latin America with 660 million people, or 650 million people projected to be like 750 by 2050. It's a massive opportunity that we shouldn't be overlooking.
Griffin Jones 47:45
And we'll be getting into more specific topics about Latin America and IVF market as it progresses. But I needed somebody to walk me through the one on one. So sorry, that didn't go too deep into any of the the the particular verticals that we could have, I will want to and want to have you back. And for some it may have been too elementary, but I think you got to start somewhere. And my questions that is we're we're too elementary for your scope. But I think that this market is going to be one of the ones that you see a lot of big growth in, whether it's whether it's next month or in a few years, I don't have a crystal ball, but it's time to get the one on one, one on one out of the way because you're gonna see more of it. And you are the guy to come on and do it. Daniel Madero, my friend, thank you very much for coming on Inside Reproductive Health podcast.
Daniel Madero 48:39
Thank you. It's a pleasure. It's all it's awesome to be on this side of the mic, and I can't wait to see what else you put out there.
Sponsor 48:47
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