Thematic investing. Venture capital. Private equity. Democratization. Lorin Gu, the founding partner of Recharge Capital- which has financially backed fertility companies across the globe (including KindBody), joins the show this week to explain his fresh-eyes approach to capitalizing on the empirical growth rate of the fertility industry. Tune in to Inside Reproductive Health with Griffin Jones for the latest episode.
Listen to hear:
Private equity and venture capital being used together--to align incentives in the provider and vendor chains.
Griffin ask Lorin how he can be sure to handle the speed of investing in reproductive medicine. How does he know he’s closer to world-class competence than to a Sam Bankman-Fried?
Globalization: How Recharge is deploying its capital across borders in North America, Europe and Asia
What makes up the capital stack and value chain across the fertility field.
Which countries are attracting the most international patients, and who will be the ‘winner’, and why, in Lorin Gu’s opinion.
Is this the end of globalization? Why supply chain issues are happening now across the fertility industry.
Lorin Gu’s info:
LinkedIn: https://www.linkedin.com/company/recharge-capital
Twitter: https://twitter.com/rechargecapital
Website: https://www.rechargecapital.com/
Transcript
Lorin Gu 00:04
At the end of the day, when you have that kind of healthy margin, whether last venture capital or private equity, the business should run on a similar scale off the pursuit of profitability, cost control, quality standard. And that, to us is not so different. I have not so much of a distinction between the two asset classes of investments.
Griffin Jones 03:00
Your team contacted me at an interesting time because I've done 160 170 episodes. At this point, I've talked to a lot of CEOs of either venture backed companies or private equity backed companies, but very few of the capitalists themselves very few of either the venture capitalists or the capitalists behind private equity. And someone suggested to me recently that I interview a couple of these folks. And so your team serendipitously contacted me and I looked you up and thought this is pretty interesting for a young guy. So I'd love for you to first give us your the principle of recharge capital, and the founding partner there. And I'd love for you to just give us a little bit of background on how your company came to be how you've built your portfolio thus far. And and then we can start talking about what's drawing your eye to reproductive medicine.
Lorin Gu 04:02
Sure. Very happy to talk a little bit about recharged capital. So here we're a little bit differently structure compared to the typical venture capital or private equity funds. We are very thematically based, which means that we pick out three to four macro themes that we believe to be you know, having the longest macro tailwinds behind it. And we play a very deep value chain driven model for each of those themes and have a global approach in terms of portfolio construction as well as integration analysis. So was in healthcare, which is obviously a very big sector. We've looked at a bunch of different sector verticals within healthcare and have determined that fertility and reproductive health is going to be the biggest growth and most profitable sector in the years to come. So there we are, we are spending a ton of time in the fertility sector.
Griffin Jones 04:58
So how did you yourself get into venture capital. If I if if I'm reading correctly, I believe that there was one magazine dated a couple years ago that said you were 26. So I'm putting you at 28 or 29. That was an article from Channel NewsAsia, that two and a half years ago, so I'm putting you at 28 or 29. Today, so am I correct? And understanding you're under 30?
05:24
Yes.
Griffin Jones 05:26
How do you get to be the founder of a venture capital firm at such a young age?
Lorin Gu 05:34
so I started my career after college in a hedge fund focused on distressed assets. So that was a really good training for both credit and equity, both public and private. While I was doing that, I think I really had a very interesting discovery about like investment, which was, there's so many people who are very confined by the so called asset classes, right? People think about a public market, primary market credit and equity being very different. But actually, to really understand a company or to really understand even a sector, you have to be able to look across the entire capital structure and be able to play along the entire value chain. So with that in mind, I wanted to set up a practice that is different from most of the other firms out there. And I couldn't find another firm to join to have this kind of investment approach. So I just decided to start it myself.
Griffin Jones 06:27
couldn't find a firm that was interested in having a strategy across the value chain,
06:34
across the value chain across the capital stack.
Griffin Jones 06:38
Talk to us a little bit more about what that means, because some of my audience will understand that without further explanation, and then others, myself included, don't talk to us about what that means the the value chain and across the capital stack.
Lorin Gu 06:56
Sure. So if you, let's say just take fertility as an example, right? How do we see the advancement of this sector going forward? I think, you know, there's two components of new technologies being developed. There's a component of consolidation of independent practices, there's a component of providing both equity and debt for some of those row of strategies. So essentially, what you're playing is you're doing some portion of venture capital, you're doing some portion of private equity or doing some portion of credit. And by combining all those different things together, you have a portfolio along the entire value chain, and you can actually integrate them and create synergies for this particular value chain was all the different players of us basically playing a different role in the ecosystem. So if you are just a typical venture capital firm, you're probably only investing in more frontier technology, we're very new business models for clinics. And that has scalability issue, it will take time for you to scale, you might not have access to the best doctors might not have access to the biggest networks. So for us, if you think about sort of how new technology can be adopted, we think, you know, why don't we invest, you know, venture dollars into new technologies, invest private equity type of dollars into clinic, roll ups, and then just have those clinics adopt those technologies, given that there's a synergy of being in the same portfolio. So the interests are a lot more aligned for us, and also for the different management teams.
Griffin Jones 08:36
So are you talking about deploying both venture capital and private equity? Yes. So I think this is kind of a follow up from a conversation recently that I had with venture capitalists Abigal, Abigail Sirus and her colleague, Dr. David Sable, who manage a fund. And they were talking about different solutions for scaling, access to reproductive medicine, and I posed the question about, well, I see a lot of new solutions coming into the field. They're an AI solution for something that med techs do that they they can do 10x What a current med tech can do, or 100x, or, or whatever. And I see this happening in the lab and in the clinic. Augmenting what embryologist can do, what our eyes can do, nurses can do, et cetera, et cetera. I see a terrible bottleneck in those technologies being adopted, because even though these technologies do, like I can see the value in them, I could see what they do. But they're it's just like, the clinic can't adopt them. And so I asked David and Abigail like, why is this the case? How do you replace that and they're like, Well, you may need to build the system around that and then build the providers to align with that. And so is that what you're Is that what you're talking about when you're talking about being across the value chain? And, and using venture capital on the scalability side and private equity on the consolidation side? Am I understanding that correctly? Or would you phrase it differently?
Lorin Gu 10:23
Yes, I think you're understanding it correctly. But let me just sort of give a little bit more clarification on that. Right. So you mentioned this new technology adoption issue, which is very prevalent, not just in the US, but also like everywhere in the world, right. I think a lot of times, people tend to not appreciate to certain intrinsic conflict of interest between the new technologies and the clinic owners or practitioners, right. So we have this capability of increasing, say, the single cycle IVF success rate, the clinics are paying for this. What is really interesting is, the clinic has a difficult time of charging those kind of software solutions to the patients, because the patients don't feel that this is a real test or real diagnosis that they're getting. And you are technically reducing the number of cycles that each patient will be doing, which cuts into the top line of some of those clinics. So there's the moral hazard, where the clinic owner feels like sure this is a great technology, it's benefiting the patients. But is it hurting my own clinic financially, both top line and bottom line? Sometimes that is the case. And therefore, you start to see a lot of push backs where you know, the clinics are more than happy to pilot some of those programs. But when they actually becomes like widely used, adopted or getting paid, it is not the case. So for us, the way that we really think about it is how do you make sure the clinic or the chains are incentive aligned. And that requires number one capital for consolidation. And number two, to your points and to your previous guests points, built that incentive aligned with new technology providers. So you can have a different pricing model for the patients, you can have a different service model for the patients, and basically reinvent what the typical IVF packages are to the patients.
Griffin Jones 12:19
I want to talk a little bit more about the bottleneck. I don't want to lionize doctors here, because there probably are some doctors that would push people into IVF and want to do more IVF cycles, I know that some ducks that might want to throw some rivals under the bus might think that about a couple of their contemporaries. The vast majority of them, they are patient centric people, and I do see them being kind of led astray here and there. But but these are people with ethics they are they want to do right by their patients. But also, you can have that and then you can have external forces that put pressure external pressures on them that cause them to betray their ethics. I just also don't see the external factors causing them to betray their ethics in this case, meaning like they're they can do 1500 IVF cycles, 2000 IVF cycles, if they have that many Doc's or a doc generally doesn't have a problem doing 200 IVF cycles, if they just have halfway decent marketing relationships in their community. And with referring providers, they could, they could probably do more, they have long waitlist in many cases. And so I see it being more of just like, they just don't know how to implement these solutions a lot of the time, or it's, it's so much more work for them to implement it. And until they fully integrate it, it's still an additional cost.
Lorin Gu 13:53
Yes, that is absolutely the case. Actually, if you think about a lot of the process for the clinics, it's already a mature established process, people run it like a well oiled machine. So when you introduce new technologies, whether that's for the doctors, for the embryologist, they are pushing back because to your point, there's a ramp up period. They don't know if this actually flows well, seamlessly it was the rest of the operations and lack cost is harder to measure. They don't know if they'll actually be able to serve more patients were actually served less patients. And that's why I think the best way of thinking about technology adoption is you need to have clinics or chain of clinics who have a baseline of revenue that is able to support groups financials and gradually introduced them from like one clinics to five clinics like 30 clinics where you start to have a protocol and embryologist and doctors can really learn from my protocols of seeing this actually works. This is actually switch law It has proven to be efficient. And a lot of times that certainty really provides comfort for the doctors and practitioners. And I think that is why having an external force from a capital provider perspective, really there’s the concerns for a lot of those doctors and doctor, owners of the clinics. Talk to us a bit
Griffin Jones 15:19
about how a venture capital structure and private equity structure can work in concert. And you've talked about how it works in terms of being able to align the incentives to talk to us about how the actual structure can work, because this is unfamiliar territory. To me. When I think of venture capital, I think of something like Dr. Sables Life Sciences Fund, like that's pure VC, as far as I understand, I think of like Lee Equity, who I think is the current private equity owner behind inception, I think they're, I think they're trying to sell their stake, if I'm not mistaken, I don't know if they have already. But I think of that is pure private equity. And so talk to us about how do you have both in the in the same structure?
Lorin Gu 16:07
Sure. So I mean, even if you think about, you know, building out a new consumer friendly, technology, standardized chain of modern clinics, there are different ways of building it right, you can take an approach of KindBody, which is basically building new locations, from the ground up, you can also have the model where you're rolling up existing clinics was accessing patients, you are adding on a light layer of tech enablement, in terms of streamlining the customer experience, storage of data for patients interactions, and a new consumer brand equity. So the in that case, you are creating a new company, and technically it is venture capital, but the way that new company is being built is through the typical private equity roll up structure. So if you look at international scale, us probably has both of those things that you've seen played out. In that end, it is more like a, you know, venture capital model with new builds, because a lot of existing clinics simply don't have the standard that the current patients would demand. Europe, it's more of a private equity rollout model, because a lot of clinics already set up art, so as Southeast Asia, and then you look at Saudi Arabia, which is just starting to push for the private clinic practices, that is going to be more like a KindBody model of building from the ground up. So each geography has its own unique market flavors to it. And if you're really thinking about in the long term, you have, you know, all different geographies, having this kind of consumer friendly technology standardize chain operation with scalability and cost efficiency. The paths to get to that can be different depending on the geographies, depending on the market dynamics, depending on this condition of the existing clinics,
Griffin Jones 18:04
or the limited partners different behind each type of funding. So for
Lorin Gu 18:09
us, it's the same pool of LPs. And obviously, for a typical fund, the LPS for venture capital and private equity will be different. And alas, why, as mentioned, we're structured a little bit differently where we're purely value chain, we're sector focused, and we have the flexibility of moving across a capital stack.
Griffin Jones 18:29
And you're based in Singapore. Am I correct? In that
Lorin Gu 18:32
we are based between New York and Singapore. When
Griffin Jones 18:35
I had the folks from Ouma fertility on we talked about their raise in Silicon Valley, and I said, Well, why Silicon Valley and they lived in the bay area for years. So that was part of it. But they're originally from New Delhi and I thought, Well, New Delhi has to have a burgeoning VC scene Singapore surely does there is in New York and London wise, why still Silicon Valley? And they said, because of the institutional structure of Silicon Valley, the the way deals are done, there's such a proven template to follow and that they felt it it's still the, you know, it's still the place for for venture capital. So what does a place like either Singapore or other emerging venture capital hubs have to offer Do you
Lorin Gu 19:25
suppose so, it's very interesting, if you look at the opportunity sets, a lot of US investors will tell you that a very major growth area for fertility is actually the international market. But if you look at sort of venture capital or even private equity funding, most of the emerging market hubs for funding, do not touch fertility is still a very foreign subject to him. And this is where we like to come in and play because we have the US experience we have to underwriting standards in the US and we have added capability of accessing those emerging markets. So part of the arbitrage that we play is really being able to, you know, have this kind of understanding from the US markets and us the investments we made, and then apply it to the emerging markets where there's literally almost no competition from a capital providing perspective.
Griffin Jones 20:19
This is probably a one on one question, but I'm going to ask you, because I have you in front of me do limited partners typically come from the areas where the fund is based,
Lorin Gu 20:30
not necessarily. In our case, our LP base is pretty global and diverse from the US, from Europe, from Asia, a little bit everywhere.
Griffin Jones 20:41
Let's talk a bit about a hot issue, I think, and just in terms of being a young entrepreneur, so being a young entrepreneur, there is and I mean, you're under 30. And you're you're you're the founder of this capital firm, and you've got big plans for businesses that you're investing in and and are currently investing in. And the tale of the young entrepreneur, and has all of the ups and downs, right as a prototype, like on one end of the spectrum, you have Mark Zuckerberg, and I think a lot of people don't like Mark Zuckerberg, but even if you don't, it would be remiss to not acknowledge Him for the highly competent entrepreneur that he has. And he took fate, not only did he create the social media platform in a way that nobody was able to do before that he also did it again, by making it mobile. He's made some really smart acquisitions. And so I put him on one end of the spectrum of the young entrepreneur. And on the other end, I put somebody like Sam Backman freed who is a complete fraud. And so how do you navigate the necessary naivete of youth versus the seasoned experience that that comes from learning some hard lessons when you're moving at such a fast speed?
Lorin Gu 22:19
So I think the biggest thing for that is knowing what you know, and knowing what you don't know. In my particular case, I know what I'm good at, which is the financial part to financial engineering, analysis, etc. What I'm lacking, of course, compared to most of the doctor practitioners out there are the expertise in the fertility space, the knowledge in terms of assessing what kind of new technology, even just within AI, there's so many of them, are actually, you know, adaptable and scalable. And that's why we have a team of scientists, MDS, senior people, as well as advisors to really help our team was that decision and assessments. And that I think, is a very important call safety net for preventing hubris getting into the way. And for us, I think we have, you know, very exciting visions as a young person for the fertility space, we see a lot of interesting ways where consolidation can play for better technology, better standardization, better access for people if we believe the fertility needs are really going up. And you have to be able to cater to all different socio economic classes for equity reasons. And we have creative ideas of how to, you know, bridge fragmented international markets to provide better access to patients from any places, but that is what we call the investment or financial engineering aspect of it. When it comes to the actual operations, we rely on the seasoned experienced doctors and management team. So we try not to get too much into the way of how they operate their own businesses, because that is not our place to be.
Griffin Jones 24:14
you've narrowed down what you don't know you're a pretty smart guy, you have competent advisors that are subject matter experts really so extensively come I don't know them, but but extensively competent people that you've surrounded. There are still unknown unknowns in business and one of the reasons why I for my business, I started a client services firm and it was completely bootstrapped. I never took out any type of investor money. I never took any money from family and friends. I never took out a bank loan. And part of the reason why I did that is because there are so many unknown unknowns, the speed at which I was capable of navigating Getting those unknown unknowns was better mitigated by not having floods of money behind it, when I screw up, and when I fail clients, and yes, that that does happen, it's in a way where I can, I can either fix it, or it's one screw up amid successes, like even if it's like, okay, we didn't hit this goal, we really helped them hit this goal and we return the overall investment, I still feel bad about not hitting one goal. But the speed at which we're going that which we're delivering, I'm able to correct for mistakes. If I if I don't do fully right by a client, I can make it up over time, either in the engagement or after. And it's because I don't have investor obligations. I'm not, I'm not buying things all over the place and not buying inventory. I'm not acquiring companies, I'm going at a at a little speed. Now, I think that that's probably more because of where I am on the entrepreneurial scale. If if somebody like Sara Blakely and Elon Musk is a 100, on the entrepreneurial scale, and someone like a school teacher that won't even invest in the stock market is zero. You know, I'm probably like, somewhere in the 60s, I'm more of a small business owner getting into entrepreneurship. So I need that, that level of speed right now until I get smarter, and I'm starting to get smarter. But to have it coming at you that fast, like how do you mitigate the like, I see how you've narrowed down the unknown unknowns and you have competent people. But how do you navigate like, you're gonna have unknown unknowns come up all the darn time? How do you? How do you navigate them coming at you that fast?
Lorin Gu 26:45
Well, I think, again, there are like three things about it, right? Like, number one is, before you get into something, you think about what are the worst case scenarios? What are the downsides? What are the legal risks, what are the operational risks, and if those happens, what's the worst thing that could happen to his entire investments or having to, you know, the roll up, and you have to have that planned out. So even if the unknown happens, you know, it could come in any different form, you have a little bit of a plan for it. The second part is the composition of the investments, right. So if you think about the way out, we like to run, say, like a roll up strategy for a new modern clinic chain, the underlying assets are still, you know, independently operated by the doctors and a management team. The reason that a lot of those people are interested in becoming part of this is because no lay are independent, smaller business owners, they like what they do, but they also wish to have a little bit more upside, the upside could come from the form of by joining a larger group. So there's economies of scale, so the equity gets valued higher, or that upside could come from the form of, you know, they can get partial equity about out and have the remaining equity appreciate was the rest of the investment practices in the roll up. So when you have those kinds of like very grounded, people still involved in the actual day to day operations, you are less concerned about, you know, the operating mistakes from a investment side, because the investors are not operators, we can never get into the weeds of serving, saying individual clients or managing like the order book of a single clinic. What we can do on the other side is really try to control the overall trajectory of the larger ship, and make sure that the different participants of the smaller entrepreneurs are feeling confident, comfortable and feeling like they're getting the upside. So again, it's kind of about narrowing down to the responsibilities within the value chain of this operating ecosystem.
Griffin Jones 29:01
Let's talk a bit more about the fertility field and what you see there. So your team had sent me a note that you believe that the decision to overturn Roe will lead to a global increase in medical tourism and internet international partnerships. Why a global increase? Do you mean from the United States to various countries throughout the globe?
Lorin Gu 29:26
Not just that, I think what's been really interesting is if you look at the effect that US has on the rest of the world, when the woman empowerment movement started in the US is sort of blue to you know, Europe and then blue to Asia has a ratification effect across the globe. And when you have this overturn. What is triggering is a lot of other countries with polarizing current political or religious beliefs are also thinking about what they should be doing in turn. himself to regulations in terms of the policies. And it is not unthinkable to start to wait for us to start to see some of those governments will enact on something that is not so different from what the US is enacting on. So that is what we consider single country political risks or regulatory risk for women. So us now, even for countries that do not have very strict restrictions on fertility, you still have certain things are allowed, and certain things are not allowed for a customized IVF journey, right, for instance, in China, like single woman cannot freeze your eggs. And, you know, they have to resort to international tourism in order to get your egg frozen, so they can have an insurance policy, right, a lot of places doesn't allow you to do genetic testing a lot of places doesn't allow you to do gender selection, a lot of places doesn't allow you to do anything. Any diagnosis that is considered, quote unquote, invasive. So for people to satisfy their medical needs, you'll start to see a lot more of international tourism. So a lot is from the political side, and policy side. On the other side, where you will also start to see is this affordability issue, right. So us obviously, has always been considered having the best medical standard for fertility in the world. But the US is perhaps also the most expensive one. If you go from, you know, just egg freezing to IVF process. And if you want to have like a surrogate, that cause could run, most of the families broke, and it's really catering to probably just have 0.1% Elise, but there are a lot more demand than that, right? So people need to seek for more alternative solutions, sometimes, like alternative solutions, international solutions, where the medical standard is high. But the labor costs and material costs are lower. And it makes the entire process much more affordable for families to have children. So for instance, like in that me in Southeast Asia, a similar experience to the tub standard US clinical experience will run about 25% of the cost compared to the US. And that just puts a lot more families into the affordable bucket, and therefore increasing the access for
Griffin Jones 32:30
I don't have the data. But I'm my gut tells me my anecdotal experience tells me that the US is still far and away a net importer of quote unquote, this will I'm not going to use the word tourists but I will say visiting patient and for IVF, as opposed to a net exporter. There is some there are US patients, they go see Dr. Joe Davis in the Caribbean, they go they go see Dr. Mario Vega, and Panama other clinics in Mexico and elsewhere. But but but there's more people coming from China and Japan and Australia and New Zealand and the UK and Canada for third party IVF for PGT for sex, election, et cetera. Do you have any kind of data on what the Import Export ratio is of, of patients that leave the United States for IVF versus people that come in from elsewhere.
Lorin Gu 33:25
So people are coming in from elsewhere, that totals to about 20,000 cycles a year, which is, you know, a sizable number, but small compared to the domestic demand. But remember that 20,000 cycles are basically from the wealthiest of all of all US international markets. And when it comes to export, the US is probably just starting off. So you start to see Mexico being a hot destination for both egg freezing as well as IVF. Starting from about 2022, you start to see in some of the newer clinics, you know, between 15 to 20% of their cycles being from American tourists, and you start to start have some of them going to Portugal, Spain, some of them going to Malaysia, Thailand, especially when there are needs for surrogacy, because surrogacy is one of the most expensive process in this entire IVF journey. And most of the times people find it very challenging to afford a surrogate in the US. And that's where a lot of the export is triggered.
Griffin Jones 34:42
You talked about a few of the different countries that are winners I want to ask you about or about who could be winners in in terms of the number of patients they're seeing from elsewhere. Even in the US it it is far from an equal distribution of those 20,000 Right there. Click unex all over the country that see virtually zero international patients. And then there are clinics in Southern California where 60% of their IVF cycles are from Chinese patients. And so so it's it's probably the highest end of parados distribution where a square root of the of all the clinics are doing half of the cycles for international patients in the US, I suspect. You talked about Mexico, you talked about Portugal, Spain, Thailand, who among them or among others, do you who would you bet on as being among the winners in terms of seeing farm far more than their distributive share of international patients in the next half decade.
Lorin Gu 35:50
So if I were to bet, I would say to Southeast Asia region will be the biggest winner. The Southeast Asia region is very interesting, because it's a rather fragmented market, in terms of regulation. So a lot of people will tend to start their journey in Singapore, and then go to Malaysia for genetic testing and gender selection, and then go to Thailand for surrogacy. The reason that Southeast Asia is very interesting is because it is the number one choice for the export of Chinese medical tourism. So China every year exports between 300 to 500,000 cycles of IVF, for international medical tourism, most of which actually flows into Southeast Asia. And that number is only going to grow now that Singapore, in 2023, is allowing single woman to freezer x. So a lot more women are signing up to traveling out of China, post this COVID lockdown situation to get that life insurance for themselves. The very, very wealthy ones, obviously, you will still choose to us, but a lot is still a small number compared to the overall size. So from a volume perspective, Southeast Asia will definitely be a definitive winner. And then that's seconded by lat am most likely Mexico, as you start to see a lot of American couples seeking more affordable solutions. Last a natural destination for them. It is familiar, it is close. They have a lot of American educated doctors practicing in Mexico, like gives them a sense of comfort and level of quality assurances. So Mexico will be the near second in terms of the global winning market.
Griffin Jones 37:38
So am I correct in understanding that the Southeast Asia region will be can be both an exporter and importer still in that if people are leaving Singapore, they're going to they're going to Thailand, for example, where you're saying people are going to Singapore,
Lorin Gu 37:53
people are going to Singapore. So Singapore itself has about domestically 6000 to 7000 cycles of IVF on an annual basis. But there's a huge flow of IVF demand that's coming in from China and some of the neighboring countries. So they will be the net importer of cycles, for sure. And so it's Malaysia and Thailand.
Griffin Jones 38:20
Do you suspect that the number of Chinese and Japanese patients going to the US will decrease? Or do you suppose that the number of patients leaving China in Japan for either third party IVF or four types of PGT that they can't do in their countries? Do you think that will grow so much that the 20,000 might not decrease, but it will just simply be a much smaller share of the total number of patients leaving those countries.
Lorin Gu 38:55
So I would say the US import number from the international demand will continue to rise. Because overall demand for IVF is increasing. It is hard to say whether you know from a percentage perspective, it will be an increase or decrease because they really depends on the total base. But from an absolute number perspective, it will for sure be on an upward trajectory.
Griffin Jones 39:22
Then Mexico and Latin America also increasing and that makes me think of some content that I've been following recently. Are you familiar with the futurist Peter Zai? Han? He's a natural resources global supply chain energy futurist, are you familiar with him at all? I've heard of him. Well, analyzing him is above my pay grade. So I'm going to try to summarize his thesis but he posits an end to globalization as we know it that having the United's States Navy provide absolute, free commerce between all countries of the world is coming to an end. And really having said that one purveyor of security being the US and the one really disproportionate manufacturer of inexpensive goods being China. He views that as is coming to an end. If people want to know more about why he says that I suggest checking out him as opposed to hearing it from me, but but he posits that we're coming to an end of globalization that we're going to see far more regionalization Do you Do you see that?
Lorin Gu 40:41
I absolutely see that. Actually, we've been talking about this trend of D globalization since about 2017. But what we define it more granularity is you're seeing both globalization and the globalization happening at the same time. So again, if we go back to this whole value chain of any sector, I just take no fertility this example, right, you have fundamental technology, innovation, technology, application and business application, right? fundamental technology, innovation will continue to be global winners, because once we invented a technology that works, there's no need for other countries to really invent their own thing unless it has so much sensitivities, around patient data or demographic data. But a lot of those can be offshored. In terms of data storage to comply with the government regulations. When it comes to technology applications, which in cases are produced manufacture products, or business applications, in this case are the service providers, you will start to see a lot more regionalization. Each government is now very aware that technology has the potential of winners take Hall. And in order to protect their own economic, selling potential as well as the consumer spending power, they want to champion local champions, they want to foster local business to become the de facto dominant player in the market. So we definitely start to see a lot more push in terms of supporting local operated chains or clinics, rather than really allowing an international chain to come in and just brand and operate and consolidate in that sense. So the way that we think about investment from that perspective is also that we believe that regional investments make sense we do not force Regional Clinic operations or service provider to go across continents, because we think it's just not not necessary obstacle to jump through. We prefer to have them really deep growing their own domestic market and provide the best service quality standard they could.
Griffin Jones 42:49
So talk more about what that does to your global investment thesis. Because could if this is the case, if if there is less trade between countries, because there isn't a US Navy, ensuring that every part for every piece can go to every place and then be bought and sold in each place if there is more regionalization. What What about the the risks of supply chain risks that could make some business models less viable or not viable? All together?
Lorin Gu 43:25
Yeah, so there's definitely a supply chain risk. And that supply chain risk is not just specific to this sector, right? It is specific to almost every sector. So for us, the way that we think about it is you have this risk in mind, but at the same time, just because you have a risk, you cannot not make investments and not have those companies advanced in terms of their service qualities and in terms of their business growth. So the way that we really think about this is do we have backup plans for each of those operating businesses? If we can't have backup plans, then we let the business run grow the way they would? If we don't have backup plans, then we will reevaluate the geopolitical risks of a certain market and see if we want to exit or continue to double down on a market. I don't know if that answers your question, but I'm happy to delve in more.
Griffin Jones 44:21
Well, I've done about Jack zero research on supply chain conflict in the fertility field. Maybe I should I don't, I don't know if there's PE that's in shortage or if there's materials for lab equipment or for a culture that is low or in serious jeopardy. Are there supply chain issues happening right now that the audience should be aware of and if so, what are they?
Lorin Gu 44:55
Yeah, so I think there are a couple of things that are quite interesting when it comes to the medical equipment perspective, I think China over the last 10 years or so has really emerged as a very economic and powerful producer of a lot of the medical supplies. But in terms of clearing, compliances, and regulatory approvals, especially in us, in the US and Europe, there are a lot of push backs. So a lot of times the clinic will have to go for the more expensive, domestically produced products that as to the cause of the overall process as well. So now, what's been really interesting is you start to see, some Chinese companies really export their manufacturing capability out to Southeast Asia, a more neutral ground of geography, and relocate some of the manufacturing plants outside so that the products are produced with the same kind of supply chain cosmic optimization, but much more acceptable to the western countries and Western practices. And that is actually helping with the supply chain in the sector.
Griffin Jones 46:03
So let's talk about some of the new technologies that are emerging to optimize sperm and egg quality, particularly with evaluation. Sounds like you have a particularly focus on the sperm side, he talked to us a little bit about what's happening there.
Lorin Gu 46:21
Yeah, sure. So I think what's been really interesting is that, you know, 50% of the infertility issues actually come from men by men rarely get tested, or have the willingness to get tested. And a lot of times, it's really up to the decision of the woman to really force them and to get tested. And therefore the market has historically been very small or almost no incentive for scientists to go into developing analysis tools for sperm. And what has been really interesting over the last two years or so, is given the overall heat for the fertility market, both from a capital perspective, as well as from an entrepreneurship perspective, you start to have people entering those places for sperm analysis. So we've seen companies that are using AI technologies, of course, we've seen companies that are using non invasive methods to really assess the sperm quality through chemo, physic come off physics structure, we've also seen technologies that basically allow the freezing and thawing of the sperms to be done more efficiently and more productively. So that is one area where we think there's actually very unsaturated market demand for it. And we place a lot of emphasis in terms of investments in this particular sector vertical.
Griffin Jones 47:54
Talked about half of being in fertility being male factor, I've never seen half have seen a third. Just essentially mostly what I see is a third male factor, third, female, and then either a third combined or unexplained, are you taking AI? Are you seeing other research that points to half? Or are you taking some of that? combined? Yeah. And so I do know that there is a problem with referring providers very often not referring the male partner to either an end geologist or a urologist to, to do a semen analysis that before they get to the REI, there definitely is a problem with OBGYN doing IUI or doing just doing maybe timed intercourse or any kind of protocol that isn't IVF without ever testing, the male partner. I know that happens, I don't know how often it happens, happens often enough. As far as I understand, semen analysis is standard operating procedure before IVF at REI practice, Am I incorrect?
Lorin Gu 49:09
No, it is a standard practice.
Griffin Jones 49:11
So but you So then where? Then where's the opportunity that like so if it is happening, then is it this opportunity big enough of an opportunity.
Lorin Gu 49:28
this opportunity refers more specifically for the sperm freezing and then later on being used for the IVF process? So after you thought the frozen sperm how to quickly identify the most vital ones without necessarily hurting or impacting the sperms. So that part is where this big opportunity is. So that part is directly related to the rise of the overall IVF cycles as well.
Griffin Jones 49:56
Talk to us about the egg side where Do you see the opportunity for evaluation technologies there.
Lorin Gu 50:03
So it's kind of similar. When it comes to the air quality testing, you start to have a combination of software as well as diagnosis test. What's been really interesting, as we see in one of our portfolio companies is that for some unexplainable reason, they figure that if the egg is just gently poked, actually has more vitality compared to the X when they were evaluated and not poked. So in a way, people are still trying to figure out what will be the best way of evaluating the quality. But there are some interesting discoveries along the way. And it is a more saturated market compared to a sperm analysis. But we do think that there are still interesting innovations that are happening, they might be marginally improvement, it might not make, you know, milestone improvement. But it's always interesting to just observe
Griffin Jones 51:02
risk of reaching the border of clinical discussion where I have no business participating, it's very interesting that you're saying that, it could be the case that eggs that are biopsied have more vitality than those that don't?
Lorin Gu 51:23
Well, it depends on how the biopsy was done. So in this particular company's case, they've developed a very, very gentle needle, for just a gentle poke, to test out the tension of the surface. And they've found out through their trial experience that it's got more vitality. So it's an interesting discovery, the company is still working on, you know, getting to the conclusion. But you know, we were pleasantly surprised and amazed by this thing, and we continue to observe,
Griffin Jones 51:58
that would be interesting. I've heard of artificial intelligence applications that look to grade in egg based on imagery so that they don't have to biopsy the, the egg. And so if this finding is correct, it could be the case that that may be that isn't the most desirable outcome.
Lorin Gu 52:25
Yeah. So you know, people have always pursued for us non invasive as possible. But there's still a lot of things that people don't exactly know about the process. So, you know, I think it's always interesting to be plugged into the scientific community and just hear what they're saying and see, you know, what will be the eventual best practice outcome?
Griffin Jones 52:47
What companies have you invested in thus far?
Lorin Gu 52:52
So we've invested mostly in service providers, aka clinic roll up chains. So you know, in China back in 2017, it was changing fertility, and the US KindBody in Southeast Asia, generation prime, and in Portugal, Spain, seed, and then the invested in some technology companies that are basically trying to push for new, non invasive methods for either sperm analysis, egg quality analysis, a company for imaging analysis, window of ideal implementations, etc, etc. Most of those technology companies actually come from either Europe or Israel. So the way that we're thinking about our entire investment ecosystem is really being able to have the service providers to be the first line of assessment. Are those technologies really needed by the patients by the market? Can this really help? And then we go back to evaluate, do the companies have the right to the technology companies have the right approach to address the market needs rather than the other way around?
Griffin Jones 54:06
This could be an interesting distinction between private equity and venture capital that I don't know that I've touched on the show before so typically, with private equity, there isn't more than one private equity firm behind a networker company. That's typically the case until they flip is that correct? Normally, they're buying a controlling stake and so they might own 60% 80% Whatever, but typically, it's one private equity firm behind fertility network. And that typically is not the case in venture capital. Am I right? Because you do you do multiple rounds, you you sell your you do a meet, you have an angel round, perhaps you do a seed round, then a series a series B, etc. And so there are often multiple venture capital firms behind one company so you're one of The venture capital firms that owns equity in KindBody, is that a correct interpretation? Yes.
Lorin Gu 55:06
So there are certain clinics chains that we are the majority owners of, and there are certain investments that were the minority owners have. And this is where the flexible investment structure for us comes in. We believe that by first deploying minority investment in certain businesses allows us to really study and learn to market and see what are the things that worked and what are things that didn't work. And then we will have more operational confidence and insight in terms of how to buy up majority ownerships of different clinic chains in other emerging markets.
Griffin Jones 55:41
How do you turn determine what's too big or too small for? You know, it's like, okay, maybe we want to be, we value the company at this. But if we can't get X percentage of it is now us worth it being a part of or they already have too many VC partners, they've already sold too much of the company that we're not going to be able to get what we need out. How do you? How do you make that calculation?
Lorin Gu 56:08
So I mean, I didn't have a day for an investment firm, it is a return expectation, right? So for the venture type, we tend to be more passive, because there are multiple investors involved before the private equity ones, where you have to spend a lot more time in terms of rolling them up, operate, streamlining the operations, making sure that cost structure makes sense, etc, etc, that we have a very dedicated analysis team that allows us to figure out what is the right size of each individual row of investments? What is the right multiple for those? Do we add a creatively to the overall chain that we're building out and investing into. So that is a much more granular process of the investment than, you know, taking a venture capital investments into, you know, a typical, a more typical startup company experience. So as I said before, I think you know, the eventual outcome for those businesses are all consumerize, technology, standardize, chain, operating businesses, but the way to build towards that can be very different.
Griffin Jones 57:24
I want to let you conclude with our audience on the thoughts that you want to conclude on first, I want to touch on this as we start to see more venture capital coming into the field, there's a word that venture capitalists tend to use all the time and private equity really almost never uses which is democratize that's a word that that VCs use all the time. And I think like, Okay, if you're looking at it as the through the most positive lens, that's what it would be democratizing care, democratizing access, if you're looking at it. On the other end of the spectrum, perhaps on the most cynical side, I think up Did you ever watch The Simpsons? Did you ever get into the Simpsons, you know, Monty Burns is for the two people that never watched The Simpsons, Mr. Burns is the evil billionaire that owns the nuclear power plant in town. And that in one of the earlier seasons, he gets into recycling and it looks like he's doing such a good job and really, it's just using this recycling operation to create a really unethical well fishery or something and, and Lisa Simpson, our protagonist confronts him and says, You're evil. And when you're trying not to be evil, you're even more evil. And so I look at that as like okay, that's the opposite end of the spectrum is like it democratized really just a buzzword for squashed the crap out of mom and pop shops, in every vertical we can and be a monopoly. I'd see it more though I, I tend not to look at things either hyper positively or hyper cynically, I do look at it, as I see a ton of companies that have a social pressure to do social good that I don't actually think is a net social positive. In other words, that the, the role of a company is to make profit period, if it does not make profit, it is not a company. Therefore, if you are asking a company, to if you're asking a company, to be the leader in social change in cultural values, then you are asking them to tie that in a way that makes money and that inevitably becomes a perversion of the values. I see that and I see that being different from what business ethics is, which is having a baseline of Have of ethics that okay, we our job is to make a profit, we have to do it within the standards. That's what business ethics is. That's different from being the Oh, seen as the purveyor of global positive social good, and how do you see it?
Lorin Gu 1:00:24
So I wouldn't use the word democratizing, but I do think that if you believe that this demand for IVF is really increasing significantly, then as I mentioned before, this should be made more accessible to different socio economic classes, which means that more affordable options should happen. But being more affordable, whether that is through, you know, International Medical Tourism options, or through, you know, technology enhancement, does not mean that it should be free, or it should be, you know, net non profitable for businesses, right. What is really concerning, especially over the last cycle of bull market is a lot of venture capital firms, or subsidizing a lot of businesses basically trying to do good for the people. And those businesses tend not to be sustainable. And those businesses in the long run tend to run into a lot of ethical issues as they were just scrambling to survive. So we think that a healthy margin for a business is very important. And at the end of the day, when you have that kind of healthy margin, whether that's venture capital or private equity, the business should run on a similar scale off the pursuit of profitability, cost control, quality standard, and that, to us is not so different have not so much of a distinction between the two asset classes of investments.
Griffin Jones 1:01:57
We've talked about globalization and regionalization. We've talked about venture capital and private equity and how they are different structures and also how they can be used to align in centers. We talked about financing, we talked about business ethics. The final thoughts are yours, Lorin Gu, how would you like to conclude?
Lorin Gu 1:02:20
Well, thanks for if and law was very comprehensive discussion around almost all aspects of the fertility investments. For me,
Griffin Jones 1:02:31
why it's not a 10 minute podcast, so I can't, I can't I can't do 10 minute episodes.
Lorin Gu 1:02:37
For me, I think I would really encourage people to look more internationally as we believe that the future of IVF or fertility practices will not be so Doctor centric will be much more technology standardize, and we believe that having the right protocol with the right technology adoption should really allow for more access to different socio economic classes of people demanding IVF not just for the Americans, but also for the global people.
Griffin Jones 1:03:07
Lorin Gu founding partner of Recharge Capital, thank you very much for coming on inside reproductive health.
Lorin Gu 1:03:13
Thank you, Griffin.
1:03:16
You've been listening to the inside reproductive health podcast with Griffin Jones. If you're ready to take action to make sure that your practice thrives beyond the revolutionary changes that are happening in our field and in society. Visit fertility bridge.com To begin the first piece of the fertility marketing system, the goal and competitive diagnostic. Thank you for listening to inside reproductive health