Roughly one in six people worldwide are affected by infertility. That figure has been climbing over the last 50 years. That should be reason enough to develop the diagnosis and treatment of childless couples.
By Bertrand Beauté
She turns 40 in 2025. Who is she? Her name is Yelena, Switzerland’s first test-tube baby, born in 1985 at Locarno hospital as a result of in vitro fertilisation (IVF). At the time, she was an exception, but those days are over. More than 2,000 babies are born every year in Switzerland after IVF, representing almost 3% of all live births. That percentage has stagnated in our country since 2010 due to less accommodating legislation, but it is rising in most Western countries. An editorial published in The Lancet in July 2024 reported that IVF is now used in 9% of births in developed countries, up from around 2% in 2010.
"Since the birth of the first baby using in vitro fertilisation in 1978, the global IVF market has seen rapid growth," says Kay Eichhorn-Schott, portfolio manager at Berenberg. "However, it is important that utilization remains relatively low. According to the European Society of Human Reproduction and Embryology, there were about 1 million IVF babies born globally in 2018, which represents less than 1% of the total number of births. The market will continue to grow."
Marine Dubrac, co-manager of the Wellness fund at Thematics Asset Management, agrees, "Growth in the fertility market is driven by increased demand and supply." On the demand side, infertility – defined as the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse – now affects 17.5% of the global population, or about one adult in six, according to the World Health Organization (WHO). This figure has been rising steadily over the last 50 years, mainly because adults are deciding to become parents at an ever later age.
"Age – especially for women, but also to a lesser extent for men – is the main factor in infertility," Marine Dubrac says. "At age 25, a couple has a 25% chance per cycle of getting pregnant; at 35 chances are 12% and after age 40 less than 5%." For example, in Switzerland the average age of women at the birth of a child was 32.4 in 2023, compared with 27.7 in 1971, according to data from the Swiss Federal Statistical Office (FSO). The average age of men is following the same curve, at 35.3 today compared with 34 in 2007. "Firstly, we expect a continuation of the trend of women deciding to have their child at a later stage in life, which increases the likelihood of IVF coming into play," Kay Eichhorn-Schott says. At the same time, demand is driven by more open legislation in some countries making it possible for single individuals and same-sex couples to seek medically assisted reproduction (MAR) techniques.
Also, the medically assisted procreation sector is being bolstered by developing countries, especially India and China. "The rise of a middle class is fuelling demand," Kay Eichhorn-Schott explains. "In countries like China, the sector is growing fast." On the supply side, advances in medicine have brought about technologies that improve diagnosis and sperm and egg preservation (oocyte vitrification), along with a whole host of solutions for treating specific reproductive issues. In fact, traditional in vitro fertilisation is just one of many MAR solutions available, which also include artificial insemination, intracytoplasmic sperm injection, preimplantation genetic testing and surrogacy. "Innovation in the fertility market stimulates growth, a typical phenomenon in the medical sector," Kay Eichhorn-Schott says. "In fact, innovation is essential to improve the success rates of medically assisted reproduction procedures."
Marine Dubrac, co-manager of the Wellness fund at Thematics Asset Management
What does all that mean? The research firm Imarc Group predicts that the global fertility market will grow from $46.1 billion in 2024 to $142 billion by 2033, an average annual increase of 12.65% over the period. The scientific journal The Lancet is a little more cautious, estimating that the sector was worth $34.7 billion in 2023 and expects it to grow to $62.8 billion by 2033. "It’s difficult to estimate the size of the global fertility market, because it depends so much on what you include in it," Marine Dubrac points out. "But what we can be sure of is that it’s a rapidly developing sector, with expected growth of 8% to 10% per year."
This potential has not escaped the attention of investment funds. In a paper published in October 2023, Westcove, a private bank, wrote, "The fertility services market has consistently garnered strong interest from private equity investors." A case in point, in January 2023, the US investment fund KKR paid $3 billion to acquire IVI RMA, a leading global fertility group with more than 190 clinics in 15 countries. More recently, in September 2024, Amulet Capital Partners announced the acquisition of Genetics & IVF Institute, a specialist in sperm and egg freezing, for an undisclosed sum.
In December 2024, French venture capital firm Astorg simultaneously acquired Hamilton Thorne, an assisted reproduction equipment supplier previously listed on the Toronto Stock Exchange, and the reproductive health activities of Cook Medical. With this double acquisition, Astorg has created one of the world leaders in MAR, producing the clinical equipment, diagnostics and consumables required for IVF. In this market, Astorg will be up against two other listed champions of the sector: the Swedish company Vitrolife, valued at around €2.5 billion on the Stockholm Stock Exchange, and the US firm CooperSurgical, a subsidiary of Cooper Companies, which is worth almost $20 billion on the Nasdaq.
"Private equity is all over the fertility market," Marine Dubrac notes. "Many highly innovative companies have been bought out by these firms in recent years. So we’re likely to see a series of IPOs in the sector as they withdraw."
Marine Dubrac, co-manager of the Wellness fund at Thematics Asset Management.
In the meantime, few companies focused solely on fertility are publicly listed. And, apart from Vitrolife and CooperSurgeries, they are often micro-businesses, such as the Germany company NanoRepro and Singapore’s NewgenIVF. "Legislation on medically assisted procreation still varies significantly from one country to another, making it difficult for global players to emerge," Marine Dubrac says. "What’s more, although its fast growth is driven by major innovations, the market is still in its infancy. Currently, only 2% to 3% of births a year worldwide require MAR, which makes it a niche market. Over the very long term, companies active in the field could be a worthwhile investment, although short-term stock market performance is likely to be volatile. For unsophisticated investors, the sector is complicated and lacks maturity."
Kay Eichhorn-Schott is more optimistic. "Given the strong long-term growth fundamentals, we believe that the fertility sector can be attractive to private investors," he says. The Berenberg portfolio manager expects the market to become more streamlined in the short term, after which larger players will emerge. "In recent years, we have seen consolidation in the fertility clinic sector, and chains have formed, especially in the United States." "These groups don’t want to deal with a large number of suppliers. By choosing fewer providers, they will stimulate consolidation among IVF equipment manufacturers – an industry in which Vitrolife and Cooper Companies are currently the biggest players."
