Daybreak - Clinics have made IVF the new C-section. VCs can't get enough

Episode Date: July 30, 2025

IVF chains in India aren’t deterred by paltry things like probabilities. They’ve made IVF the new C-section—essentially, a revenue-generating procedure pushed before natural alternatives are even considered. All at 4X the cost of a C-section, or around Rs 2 lakh for a single cycle.The result is a $1.4 billion IVF market in India—10 times the market for cataract surgery, the most common procedure worldwide.Unsurprisingly, venture-capital and private-equity firms have swooped in for the kill. That this growth is coming at the cost of quality care is the real problem. Tune in.Daybreak is produced from the newsroom of The Ken, India’s first subscriber-only business news platform. Subscribe for more exclusive, deeply-reported, and analytical business stories.

Hi, this is Rohan Dharma Kumar. If you've heard any of the Ken's podcasts, you've probably heard me, my interruptions, my analogies, and my contrarian takes on most topics. And you might rightly be wondering why am I interrupting this episode too. It's for a special announcement. For the last few months, I and Sita Raman Ganeshan, my colleague and the Ken's deputy editor, have been working on an ambitious new podcast. It's called Intermission.

We want to tell the secret sauce stories of India's greatest companies. Stories of how they were born, how they fought to survive, how they build their organizations and culture, how they manage to innovate and thrive over decades, and most importantly, how they're poised today. To do that, Sita and I have been reading books, poring over reports, going through financial statements, digging up archives, and talking to dozens of people. And if that wasn't enough, we also decided to throw in video into the mix. Yes, you heard that right. Intermission has also had to find its footing in the world of multi-camera shoots in professional studios, laborious editing, and extensive post-production. Sita and I are still reeling from the intensity of our first studio recording.

Intermission launches on March 23rd. To get alert, as soon as we release our first video. episode, please follow intermission on Spotify and Apple Podcast or subscribe to the Ken's YouTube channel. You can find all of the links at the ken.com slash I am. With that, back to your episode. Meet Beena. For the last several months, she has been shuttling between fertility clinics across Bangalore hoping to conceive a child. Each clinic told her the same story, how women just like her, 36 years old, had successfully conceived, thanks for her.

thanks to the magic of IVF or in vitro fertilization. So, after months of trying and failing to conceive naturally, Bina finally gave in. She coughed up $3.5 lakh rupees and went through just one round of the IVF cycle, only to learn what her test results had predicted all along, that her chances of conceiving were slim, to be precise, around 30%. To put that in perspective, the average woman in her 20s has a near 50% chance. of conceiving a child.

So, Beena ended up learning, like many before her, that IVF is a game of probabilities. It's hugely dependent on a bunch of different factors like age, uterine health and sperm quality. Only one in every 12 retrieved eggs may result in an implantation-ready embryo. But IVF chains are hardly thrown off by that math. They've managed to turn IVF treatment into the new C-section. They are convincing more and more women to opt for the expensive procedure before even trying to conceive naturally. And the result is a $1.4 billion IVF market in India. To put that in context, that's 10 times the market for cataract surgery, which is the most common procedure worldwide.

And with 250,000 IVF cycles each year, it's growing at an annual compound rate of 16%. Now, we all know that when there's growth, especially growth this rapid, there's venture capital. and private equity. These firms have been swooping in for the kill. But of course, this growth comes at a cost, a massive one at that. Quality care. These clinics are adopting a sales first approach. But in the process, they're feeding women a diet of false hopes and bloated odds

and setting back infertility treatment in the country by years. In this episode, we uncover the forces driving the IVF boom here in India. Welcome to Daybreak, a business. business podcast from the Ken. I'm your host Rahil Philippeux and I don't chase the news cycle. Instead, every day of the week, my colleagues Nikda Sharma and I will come to you with one business story that is worth understanding and worth your time. Today is Wednesday, the 30th of July.

There's an interesting paradox that emerges when you look closely at the whole conception business here in India. Any expert you speak to will tell you that Indians are willing to pay anything at all for a biological child. But at the same time, a recent study by the UN, Population Fund found that four in every 10 reproductive age adults have cited financial limitations as a barrier to actually having children. It's that desperation that forms the foundation of India's IVF boom. Take something as basic as the definition of infertility. According to the World Health Organization, a couple is infertile if they can't conceive naturally after a year of actively trying in the right fertility windows. IVF clinics in India, however, think they know better.

My colleague Sudejana Ray visited 10 IVF clinics in Bangalore, and she noticed the same trend being followed at every single one. They would all coax women to give IVF a go, even if they had the option of conceiving naturally. They would say things like, there's no harm trying it, or at your age, it's safer to go for it if you can afford it. If the odds of conception through IVF are slim, counselors and doctors simply don't mention it. And if they do, they encourage women to hope for a miracle. Essentially, clinics don't describe. no matter your age, your fertility numbers like AMH and AFC, or conditions like endometriosis, their message is clear.

IVF is for everyone. Come one, come on, come all. 38-year-old Sujata was a victim of this. Her chances of conceiving were already at a low 20%. Over and above that, her AMH levels were merely 0.96 nanograms per milliliter, which is very low. For context, the optimal requirement for IVF is about 1 to 3.5.5. nanograms per milliliter. But despite this, her doctor convinced her to give it a shot.

She braved three IVF cycles, spending nearly three lakh rupees total, and none of them worked. Bottom line is, in the middle of all of these clinics are skipping the fundamental steps of the treatment process. For instance, several male partners suffer from conditions like barricorously and large crotale veins. They naturally affect fertility. But instead of prioritizing their treatment, the blame is often shifted on. onto the woman's shoulders.

In fact, this is a structural issue. You see, most IVF centres are led by OBGYNs, but their counterpart, andrologists, are brought in as consultants on a need basis. So, unless a couple explicitly seeks out treatment for the male partner, it's often overlooked. And then there's the murkier underbelly of the whole process, where clients are rarely provided DNA proof of parentage

either before or after the implantation of the embryo. The twisted logic that these clinics often deploy, like a weapon, is have faith in your doctors. But women like Beena and Sujata are increasingly asking how they can blindly trust and they have no reason to. Stay tuned. Now, ideally, an embryologist should be at the heart of the IVF procedure. But they're a rare breed. For context, currently, there are only about 1,500 of them in the country. Which is why most clinics invariably end up having OBGYNs winging through these steps.

It's only large IVF chains that actually have full-time embryologists. Smaller chains and standalone centres are forced to share embryologists who work across multiple clinics on a freelance or consultant basis. And then to make matters worse, experts we spoke to said only 10% of existing embryologists are actually trained correctly. The same experts said many of them have no idea how to be. to handle crucial steps like selecting sperm. So positive results end up seeing a massive drop.

All this means that patients who walk into IVF clinics in India rarely see or hear from an embryologist throughout their time there. And when they do, it's often just at the end, when they're dragged in to justify why the procedure failed. But it's not like IVF chains aren't trying to deal with a shortage. Some have even started their own training programs for embryologists and OBGYNs who want to specialize in infertility. These courses typically last three to six months,

but even that's not enough. A more sustainable solution has been universities increasing their embryology bat sizes to add around 500 such professionals to the mix every single year. But guess who's not happy about the new rush of embryologists? Well, of course, it's the OGs, the 1500 that were already in high demand. they are now falling over each other to extract the most money from the current market's unmet demand. That is, before they can't anymore. Stay tuned.

No one is more bothered by the IVF boom than insurers. Because now they feel like there's no way of asserting whether an IVF procedure is genuinely required in the first place. The fear of a supply-induced demand is real, especially in an industry that pushes invasive treatment when natural alternatives may suffice for some. That's exactly what happened with C-sections in India too. In that case, insurers had to put an ailment cap on the procedures, becoming increasingly ubiquitous to limit payouts. We spoke to an expert who explained the predicament for insurers and for patients. They explained that logically, insurers should be open to covering necessary infertility treatments.

But it's difficult to verify whether a couple could not conceive naturally. So the easiest way is to say, hey, we're not going to cover. it at all. But while insurers are running away from it, investors cannot get enough of IVF. That's because the margins are huge. We're talking 50 to 60%. That takes care of the setting up costs. The OPD model induces further cost savings and allows doctors to sidestep the working at odd hours obligation of multi-specialty hospitals. And then low operational costs and high revenue per IVF cycle combined to form a heavy cocktail. We're talking high. high abeta. Growing infertility and more couples having children late into their 30s and 40s

are only making this industry a more lucrative bet. But the couples actually opting for the procedure often realised too late that it is a gamble of sorts. If you win, the cost is worth it. But it's far more likely that you will lose and it'll all have been for nothing. Daybreak is produced from the newsroom of the Ken, India's first subscriber-focused business news platform. What you're listening to is just a small sample of our subscriber-only offerings. A full subscription unlocks daily long-form feature stories, newsletters and podcast extras. Head to the ken.com and click on the red subscribe button on the top of the website. Today's episode was hosted by Rahil Filippo's and edited by Rajiv Sien.