With 1 in every 6 Australian couples having trouble conceiving children, the demand for IVF treatment in the country is growing significantly. Melbourne-based healthcare organisation Monash IVF Group (ASX:MVF), as one of the earliest pioneers of treatment in the country and the world, continues to innovate and investigate methods for providing safe, effective assisted reproductive treatment for those unable to conceive naturally.
“I’m what you might call a career healthcare manager,” says group CEO and Managing Director James Thiedeman. “I started my career in healthcare over twenty-five years ago now, and I went into healthcare after completing a Bachelor of Business degree in Health Administration.”
After completing his degree, Mr. Thiedeman was lucky enough to move into a policy and planning position with the Queensland Department of Health.
“It was a period in time when the Queensland government was looking to put in place a more rational model for funding its hospitals,” he explains, “and it was going through a significant ideological transition.”
The government was moving away from a historical cost-plus funding model, and towards funding its hospitals on the basis of their outputs. Mr. Thiedeman’s early career was therefore primarily based in the policy side of health service delivery.
“It was a period in time where healthcare in Australia was going through something of a transformation,” he explains, “and some of the well-trodden improvement pathways of other service sectors… were finding their way into healthcare.”
The benefit of being involved with Queensland Health was the chance to work with a large network of health services, and Mr. Thiedeman found himself witness to a period of large cultural change within the organisation and healthcare in general.
“I think that gave me an insight into what an exciting sector healthcare could be, but also some of the challenges associated with working with a range of different professional groups—doctors, nurses, allied health professionals and healthcare administrators, all trying to move them in a shared direction.”
Over the years the demand for healthcare services in Australia, as tends to be the case with developed countries, has continued to grow at a rate generally far exceeding the expenditure being put into the public delivery of services.
“Technology continues to have quite a profound effect on healthcare delivery,” Mr. Thiedeman adds, “particularly our ability to intervene and treat and manage diseases which in decades gone by we didn’t have the capacity to do.”
This increase in technological innovation has had a clear effect on the escalating costs of healthcare delivery in the country. “It’s wonderful for patients and consumers who benefit from improved clinical outcomes; the challenge is how we continue to underwrite and fund these services.”
Mr. Thiedeman believes the pathway forward is to make better use of the country’s broad spectrum of providers available to patients, suggesting that this will likely see a greater move towards the use of private healthcare services.
The Birth of IVF
In the early 1970s, a group of well-regarded and inquisitive doctors, scientists and nurses began to look at the impact of infertility on couples’ lives, and started investigating how treatment options could help more of these couples conceive.
“Monash IVF really had its genesis with two visionaries,” Mr. Thiedeman explains, “Professor Carl Wood, who has since passed away… and Professor Alan Trounson… along with some very dedicated support people.”
Professor Wood and Professor Trounson were responsible for innovating, researching and investigating some quite profound approaches to dealing with conception in the laboratory.
At the time Melbourne was a hotbed of activity in the scientific community. Though work continued around the globe to develop the science, Victoria is where it truly began in this country, leading to the team achieving the world’s first IVF pregnancy in 1973.
“Since that time the company has been at the forefront of fertility care, and there are a whole range of both Australian and world firsts which were achieved by Monash IVF during those heady 15-20 years after the team achieved that pregnancy in 1973.”
The technology itself was very new at the time, and quite esoteric, understood by just a small number of people around the world. In that respect, it was unlikely that the idea of Intellectual Property was in the mind of those pushing this innovation.
“The approach and the research they were doing and the clinical technology they were driving was moving so quickly,” Mr. Thiedeman explains. “That IP effectively was sitting in the heads of the team who were working on the new technology.”
It was probably not until recently in fact, perhaps within the last ten or fifteen years, that the notion of trademarking or protecting some of the constituent processes of In Vitro Fertilisation was first seriously considered.
“Over the forty years or so that we have been providing care, we’ve been very much at the forefront of both clinical innovation but also delivering the best outcomes for our patients, and when we talk about outcomes, we talk about pregnancy success rates.”
Monash IVF remains an industry leader in terms of its pregnancy success rate, which Mr. Thiedeman stresses is the main goal, but the organisation also continues to explore new technologies it hopes will dramatically improve the treatment process.
“In the last several years, we’ve embraced something called Pre-implantation Genetic Screening [PGS],” Mr. Thiedeman says, “a technology… that allows us to peer into the actual DNA of the embryos that are created through the IVF process.”
PGS allows for the selection of an embryo most balanced in its chromosomes, and to move forward with the knowledge that those embryos are more likely to carry through to a full term pregnancy.
“What that does then,” Mr. Thiedeman explains, “is give our patients a quicker path to achieving that pregnancy through a single embryo transfer, and that’s pretty important, as you can imagine.”
Considering the substantial cost involved in IVF treatment, as well as the fact that the process itself can be uncomfortable for some, it stands to reason that the more expeditiously the process can be completed, the more beneficial it is to the patient.
“In a normal ovulation cycle, a woman will produce one egg, and in spontaneous conception or natural conception… that egg gets fertilized within the woman’s body, an embryo implants in the uterus, and nine months later you have a wailing baby.”
“The way it works in the IVF process is, rather than one egg being produced by the woman, we use hormones to stimulate anywhere between about 8 and 15 eggs, and those eggs are then surgically collected from the patient.”
A pick-up needle is inserted trans-vaginally, into the ovaries, where the eggs are effectively sucked out, before being transferred into a laboratory where the sperm is either left to fertilise or, if needs be, given a helping hand.
“We use something called ICSI—which is intracytoplasmatic sperm injection—where we take a single sperm and, using a very, very small needle, we actually inject it into each of the eggs, and that gives generally a higher chance of that egg fertilising.”
Once fertilisation has occurred, the embryo is grown for five days in the laboratory, before one of those embryos is transferred back into the woman’s uterus. There is also the opportunity of preserving the remaining embryos that weren’t transferred.
“We only put one embryo back,” Mr. Thiedeman says. “As you can imagine, if you put more than one embryo back, you get more than one baby. So the extra embryos we can freeze, and they basically go into suspended animation.”
If it’s discovered later on that the patient is not pregnant after the transfer of that single embryo, they can return at a later date, when one of the frozen embryos can be thawed and transferred to the uterus in order to try again.
“We’re up to 22 clinics now,” Mr. Thiedeman says, when asked about the company’s growth, “and we also have 17 women’s imaging practices. Essentially what happened was, in the early days, the reputation of the organisation spread far and wide.”
Additional doctors sought to become part of the organisation, prompting the group to work with those new doctors, training them in IVF treatment, and essentially helping them become part of the Monash IVF Group.
“The organisation expanded, first in Victoria, and we opened clinics in Richmond and then in regional parts of Victoria. We then moved up into Queensland and opened clinics up there.”
More recently the organisation has acquired a number of independent clinics and brought them into the network, allowing them to grow into South Australia and New South Wales, as well opening new clinics in Darwin.
“We have an affiliation with a clinic in Canberra as well, so we have a very strong network, a strong footprint of clinics up and down the Eastern Seaboard, and about two years ago we acquired a clinic in Kuala Lumpur in Malaysia.”
This latest international acquisition was part of the organisation’s broader strategy to begin taking its services into South East Asia.
“Our growth has been through either starting up our own clinics,” Mr. Thiedeman tells us, “or 100% acquiring existing clinics, and then bringing them into the broader group. In some instances we have re-branded the acquired clinic.”
In situations where the clinic has an existing reputation or strong brand credibility, the organisation has retained the brand and begun to market the clinic as being a part of the wider Monash IVF Group.
“A year and half ago we acquired a clinic called Next Generation Fertility, which operates out of the western suburbs in Sydney, in Parramatta, so we’ve retained that brand… we then say it’s a part of Monash IVF Group as a sub-brand.”
In June of 2015 the organisation acquired a network of women’s imaging practices called Sydney Ultrasound for Women (SUFW), as part of a strategy to broaden the services it offers its patients.
“For many years we have operated a women’s imaging network here in Victoria,” Mr. Thiedeman says, “called Monash Ultrasound for Women, and what that allows us to do is provide a more holistic service to our IVF patients.”
Part of the IVF process involves some monitoring and scanning of how the eggs are developing in the patient, and having its own imaging practice allows the organisation to achieve some synergy between the different stages of the process.
“Once our patients achieve a pregnancy, and we pass them onto the obstetrician for them to manage their period of confinement, we then are able to offer them monitoring over the course of their pregnancy through our ultrasound service here in Victoria.”
This union, in terms of working with patients and delivering care all the way through pregnancy, has been priceless for the organisation. When the opportunity arose to purchase SUFW, it immediately seemed like a good fit to continue to drive synergies.
“Also, broadening our income base to outside, solely IVF services. Sydney Ultrasound for Women has a long history of providing high quality care and high quality management of patients through their pregnancy, so it was an excellent cultural fit.”
Additionally, the acquisition offered further scale in Sydney, where the group now has a fledgling operation of three IVF clinics, as well as one in Albury NSW. The acquisition of SUFW was therefore an opportunity to bolster its geographic footprint.
“Certainly one of the key drivers of demand for IVF services is this shift in the age of women having their first child… this is happening across most developed countries, and in Australia we’re seeing the age of first child for women shift from the mid-20s to close to age 31.”
Chronological age is one of the single most important determinants of a woman’s fertility. 1 in 4 of Monash IVF’s patients are 40 or over, and though not all expecting their first child, many are conceiving for the first time at over 40 years of age.
“So, what we see is, as people are leaving this decision to have kids until later in life, many of them unfortunately are struggling to conceive naturally, and heads are turning to IVF to start that family.”
One of the most telling statistics is that 1 in 6 couples in Australia have issues conceiving organically, followed by the fact that one child in every classroom across the country is now an IVF child.
“So IVF has become quite pervasive in Australia,” Mr. Thiedeman says. “The other thing we’re lucky to have in Australia is a reasonably generous government subsidisation scheme via Medicare.”
“What Medicare does is contribute a significant portion of the cost of going through IVF, so that makes it more affordable for the community. Broadly speaking, the cost of what we call an IVF cycle is about $10,000.”
Medicare contributes about 70% of this figure, meaning the cost for a patient is around $3-3.5k, making IVF very affordable in Australia, particularly when compared with other jurisdictions such as the US or UK, where it can be 2 or 3 times the cost.
In 2014 the organisation opted to list with the ASX, a decision driven by a number of factors, but perhaps most prominently the listing of one of its competitors the previous year, which gave an insight into how successful the process could be.
“At the time… we were majority owned by a private equity firm, called Ironbridge Capital, and Ironbridge was five or so years into its ownership period… and typically that’s the trigger point that private equity firms look to exit their investment.”
Given the financial environment at the time, and the way in which the capital markets were receiving floats, listing the company was deemed by Ironbridge as the most appropriate path to go down, as opposed to a trade sale.
“One of the key aspects of becoming a listed company that we’ve noticed as an organisation is the additional reporting and governance requirements, given we now have a myriad of different shareholders and significantly more transparency.”
This increased level of transparency and external reporting creates some internal challenges, but has also been very positive for the organisation, encouraging it to look deeper into a number of issues, such as risk management, and how they work across the organisation.
“[It’s] probably forced us to be even more pragmatic about how we run the organisation and report on performance and report on outcomes, so in that respect it’s been a very positive transition.”
With its extra responsibility as a listed company, and the continuing needs of couples across Australia for innovative, effective methods of in vitro procreation, the wheels of the Monash IVF Group vehicle appear to have a lot more spinning to do yet.
“From a personal perspective,” Mr. Thiedeman concludes, “it’s certainly an extremely rewarding organisation to work with. There aren’t too many organisations that you can go to work everyday and know you’re doing something so special.”
“It’s a very special group of people, all who share that vision and that view of wanting to do everything we can for our patients, and that’s pretty energising as a CEO of an organisation, working with such a committed team.”
Find out more about Monash IVF by visiting:
To read and download the full profile click on the cover image below. To view this editorial as it appeared originally in The Australian Business Executive magazine, click here.
Written by Nicholas Paul Griffin
Research and interview by Jesse Landry