What’s happening in the business side of the fertility field in what’s soon to be the most populous country on the planet? Dr. Biswanath Ghosh Dastidar shares the origin of IVF and the fertility business model in India, as well as the challenges and coming trends for reproductive medicine in the country.
Who was India’s contemporary to Patrick Steptoe? Did you ever hear of his tragic end?
Listen to hear:
The tragedy behind the Patrick Steptoe and Howard Jones of India.
About Dr. Dastidar’s connections to the pioneers of the fertility field in India.
What models look like in India, how they differ from the US and Europe.
About the new trend of large companies consolidating and forming new companies.
About the future potential of the IVF industry growth in India
Dr. Dastidar’s info:
LinkedIn: https://www.linkedin.com/in/biswanath-ghosh-dastidar-51428b178/
Website: www.gdifr.in
Transcript
Dr. Baswanath Ghosh Dastidar 00:04
You just cannot ignore India in the global context because such a huge population, if you leave everything else apart is to such a huge population a burgeoning population of reproductive, of you know reproductive age group couples. India is what is known as in the demographic sweet spot in global terms right now. So we are going to have a young growing population over the next 30 years, say up to 2000 2000 42,050. And the needs of this population, the requirements for reproductive healthcare the requirements for fertility for IVF. It just makes it a very exciting space to work in, in this field.
Griffin Jones:
1.4 billion people, and almost 100% self pay patients. Those two figures alone are probably why you're going to hear a lot more about the fertility field in India, particularly the IVF business market in India, a lot in the coming decade. Almost 5% of my audience comes from India, and I've never created any content for the Indian market, you've noticed that we're creating a lot more content recently. And as we create more, we'll give you options to segment I want this kind of content. You don't have to deliver as much of this. While we get to that you might listen to this episode, whether you live in the United States or Canada or elsewhere in the world. Because the Indian market, as far as I can tell, is going to get a larger and larger share of attention both from your side the clinical lab, scientific, peer reviewed side but especially from the business side, the genetics companies, the pharmaceutical companies are going to be spending a lot of their attention on India in the coming decade. They already are so I bring on a guest Dr. Biswanath Ghosh Dastidar, he is part of the center that is one of the pioneer centers in India, they are in Kolkata, India. So he talks about his connection to that practice group to the Pioneer history in India. He talks to us about the Patrick Steptoe and Howard Jones of India and what happened to that person, then we move on to what models are like in India, what we're used to seeing in the United States and Canada in the UK with large health systems, large research, hospital University IVF is not really the case in India, it's almost entirely private practice. Private Partnerships, partnerships between physicians sharing ownership is relatively new, according to Dr. Dastidar. And now really large companies are both consolidating in India as well as forming new companies in the subcontinent. Dr. Dastidar was trained at Cambridge University and Oxford University in embryology and I hope you really enjoy his perspective on what may become the world's largest IVF market. Dr. Dastidar, Dr. Bish, welcome to Inside reproductive health.
Dr. Biswanath Ghosh Dastidar:
Hi, Griffin. It's great to be here. And I'm sure it's morning in America. So good morning to all your viewers. And yeah, it's nice to be here. It's just after my practice here in Indian local time. It's evening and nice to be here.
Griffin Jones: I look forward to asking you questions about the partner associate model in India. But before I do that, you and I met at ASRM and we met at the business of mines talk at SRM. And we got to have a little small talk after the panel discussion. And I was telling you about how 5% of my audience comes from India, even though I've created exactly 0.0% of our content about the Indian market. And you told me if you start to cover the Indian market, the
Griffin Jones 04:10
folks that work in reproductive health and India are going to be really engaged and really interested in and you said you you will develop a following or you said something like that. What did you mean by that?
Dr. Biswanath Ghosh Dastidar: You see Griffin firstly, I completely remember our meeting at the SRM and it was a great session, I thought it was very different session to what I've been used to it past as RMS. And then we had our follow up conversation and what I meant was that both in terms of reproductive medicine and fertility or infertility or IVF as well as in terms of general reproductive health and women's health. You just cannot ignore India in the global context because it's such a huge population. If you leave everything else apart
Dr. Baswanath Ghosh Dastidar 05:00
Is this such a huge population a burgeoning population of reproductive, of you know, reproductive age group couples, India is what is known as in the demographic sweet spot in global terms right now. So we are going to have a young growing population over the next 30 years, say up to 2000 2000 42,050. And the needs of this population, the requirements for a reproductive health care the requirements for fertility for IVF. It just makes it a very exciting space to work in, in this field in India. And there's a lot of there's a lot of scope for engagement for discussion for brainstorming. And for podcasts like yours. I think there's a lot of scope for engaging with issues in India right now, requirements for IVF Tell me about that, do you mean unique considerations for in India around IVF. So, you know, India in terms of the IVF industry, though India was a pioneer country, as long as as as far as starting IVF is concerned or early development and research in IBM is concerned, India started really early. I mean, India was contemporary to the UK to the US, in terms of, you know, getting off the board with IBM Research. And I'm fortunate enough to be associated with one of those pioneer centers. So, the center that I am associated with in Calcutta, this center has been associated with the birth of India's third IVF, baby in 1986. And with the birth of India's second xe baby, which is intracytoplasmic, sperm injection, or xe, which is specifically indicated for severe male factor infertility where you know, the sperm count is really low or the sperm are not more tied and other reasons. So this center was associated within this third IVF, baby and secondary qcbs, back as far back as the 1980s and 1990s. So, so in the did get off the blocks early, but the problem is the field of infertility IVF is still underserved. There's still a lot of patients who don't have access to treatment. There's still a large nascent, vacant space available for IVF centers and IVF services. So yeah, it's it's a big market and a lot of it is still untapped. In the United States, the name is Howard Jones in the UK, it's Patrick step toe. So India's contemporary to the US and UK at that time, who was the big name in India at that who's the Patrick Steptoe or Howard Jones, of Indian IVF? So, that's a very, very interesting question, Griffin. And you have to hear me out for around, you know, a couple of minutes or five minutes here because it's an interesting and it's a slightly complex story, because the first IVF pregnancy in India and the first delivery of an IVF baby in India happened can temporary Believe me or not, happened contemporary to the first IVF baby born in the world in the UK, in Cambridge, in 1978. And the doctor Professor Robert Edwards and Dr. Patrick Steptoe as early as that contemporary in the same year, which is not what India can say about a lot of different, you know, arenas of scientific endeavor. In IVF. The first Indian IVF baby was born in the same year as the first IVF baby in the world. It was done by Professor Subash Mukherjee, by Professor Subash Mukherjee, who was based in the very city in which I'm sitting right now speaking to Calcutta. The name of the baby is is Durga. And the problem was that his contemporary Medical Society, the Society of gynaecologists, and other people with vested interests, just did not believe his work and just is not they raise doubts and questions over over his work. He was ostracized, he was hounded by politicians, by bureaucrats, and he was led to such a state of mental disarray that he committed suicide. Okay. So this is how India's IVF story begins. After this, one of his students, one of his early students, got together collaborated with a very eminent senior gynecologist in Calcutta. And they started what is possibly India's second IVF program, again here in the city that I'm working in in Calcutta. Those two names are Professor bn Chakravarthy, who was the gynecologist and Dr. Sudarshan ghost, dusty Dar, who was the IVF embryologist and the guy in the lab, they got together and started the program in Calcutta. And the second program started in Mumbai or as you might probably know it as Bombay, were a collaboration between Dr. Indira Hinduja and Professor Anand Kumar took place so there were these two Two centers and these two programs, which started simultaneously after the death of Dr. Sue Bosch Mukherjee. And these two centers both delivered IVF babies in 1986. So I belong to one of these two programs. So the program in which I am a part of right now and where I'm sitting right now speaking to you. This is Dr. Sudarshan. Ghost, the Steelers program IVF center. So this is a pioneer center and that's how early it was, you know, so the names are really Professor Subash Mukherjee to start with. And then Professor bn Chakravarthy. Dr. Sudarshan goes dusted our Dr. Indira Kumar and Dr. Hahn and Dr. Indira Hinduja and Dr. Anand Kumar. These will be the early pioneers. So, what did these two new pioneers after Dr. Mukherjee his death if part of the reason that brought him to that demise was either ridicule or lack of acceptance, then how did these two programs form in that aftermath? So you know, that story is also very interesting and it's not very, it's not very similar to each other, these are two different stories. So the the program, which developed in Mumbai or Bombay under Dr. Anand Kumar and train the Rahim Bucha was a nationally funded nationally supported program. So, it was you know, it had the support of the Indian Council of Medical Research and a big hospital. So, was very structured, very organized program. And the program which simultaneously started in Calcutta, under Professor Bian Chakravarthy and dot Sudharshan course, this data, this was a private initiative. This was a private initiative just between these two very enterprising, very courageous individuals. And they collaborated, they pulled in their own resources, their own earnings, and they started in IVF lab, and they started program in Calcutta. And those guys in Mumbai who were funded and supported by a very, very prominent Indian research agency, they started their program in Bombay. And yeah, they both lead to pregnancies again, you know, as strange as it may sound, they both lead to deliveries of IVF babies in the same year again, in 1986. Were they affiliated with research universities with academic hospital systems? Were they completely independent? These were both both were independent programs. But the Bombay program was supported by one of the prominent Indian research agencies research but not but not part of a teaching hospital, not part of a large hospital system. It was funded by a reason. The Bombay program had close links to a large hospital, but not the calculator program. It was completely privately started and privately funded program. And this is in the mid 1980s, in Kolkata. So this started off in the early 1980s. This started off in 1979 1980. And it I mean, you know, you'll you'll be interested to know that they had their first IVF pregnancies which delivered which led to a successful delivery of a baby in 1986. But the Calcutta program, interestingly, reported the first IVF pregnancy in India to be reported in an international scientific Congress in the World Congress on IVF in Helsinki, in Finland in 1984. Unfortunately, that pregnancy did not go up to term so that pregnancy resulted in a miscarriage a few months later. But yeah, the work started in 1979 1980 81. And both the center's had delivery, successful deliveries in 86. I'm wondering if this is setting us up for a different model in India than what we saw in the United States generally, what we saw in the United States after Dr. Jones throughout the 1980s, most IVF, virtually all of it was happening within research hospitals, systems, and then started to leave a little bit in the 1980s to have independent IVF centers like I think Boston IVF was among the first a lot more in the mid 1990s And then through the early 2000s. But if if there were two programs, essentially starting simultaneously in India, it sounds like Kolkata was completely independent, then what routes are there to the then then how did the model for Indian IVF develop after that? So you know, you know, Griffin, I must congratulate you because this point you just raised it's such a prescient observation on your part because you've hit the proverbial nail right on the head because that is exactly what happened. Owing to the fact of you know how these two early initial pioneer program started off. From there if we trace the history of IVF in India from then onwards, right up to today, you will find that the print dominant players in the IVF market has always been private centers. So that's the way it started off. And that's the way it continued. And that's the way it still is today. Majority of the IVF market in India is dominated by private players. It started off that way from the 1980s 1990s. It's persisted today. Yes, there are different models as well. So there are big hospitals, big free standing individual private hospitals, which have developed IVF units. There are large, freestanding government funded teaching institutions teaching hospitals, which also have IVF units do have very few ID number, let me tell you very few in number. And the very recent development, which is as recent as the last decade or so is the emergence of the IVF chain, you know, like a corporate group, which is putting in its money to set up IVF centers all over the country. So you have all these models, but it really started off with individual enterprising private individuals and doctors who set up private IVF centers. And it's the root of that could be traced back, in fact, to the way that the pioneering IVF work started in India, as you so correctly pointed out, I must tell you, I never thought of it this way.
Griffin Jones 16:16
So did the private IVF practice in India take did replicate the general practice model at first, you have other independently own general practices or maybe other specialties and subspecialties did the first RBIs in the first fertility specialist in India just say, Okay, we're just going to do that. But with an IVF. Lab, how did it differ? I'm not very sure that's the case, you know, reference. So what what really happened was, if you go back to the 1980s, and
Dr. Baswanath Ghosh Dastidar 16:50
early 1990s, health care, generally in India, has always been sought. I don't have the exact numbers of the exact data with me, but it's always been reasonably fairly divided between the private sector and the government sector, you know, between individually run private hospitals and private clinics, as well as large hospitals, chains, government hospitals, teaching hospitals. So that balance has always been there in medical practice in India, right from the beginning. It's interesting, why? And you raise a very interesting question, to be honest, you know, this is something I haven't bonded on much in the past. But I guess the reason why IVF really took off in the private sector is because of the inherent nature of the subject. IVF is such a multifactorial subject, it needs so much of quality control, it needs so much of oversight. There are so many different aspects which are going on, you know, there's the laboratory, there's the operating room, there's ultrasounds happening, there's reproductive endocrinology. So it's really different fields of expertise, which have to collaborate in a very close and well synced manner. You have the RSI, you have somebody who's doing the ultrasounds, you have a surgeon, you have a gynecologist, you have an embryologist in the laboratory, and and ologists apart from just the science part of it IVF right from the beginning, was also, you know, it's an institution, it's not just one man sitting in a clinic, seeing patients and writing prescriptions. It's a business, it's a, it's a company as well, or every IVF centers is essentially a small company as well. Right? So I think because it needed so much of collaboration and looking at so many different aspects. And we had to be perfectly attuned to each other perfectly working together, which with each other. I think that was very, very difficult to achieve in a large setup in a large government hospital where, you know, it was very watertight compartments, you know, people didn't really collaborate so much didn't really it was very difficult to get different people have different specialities to, to always work together in a coordinated manner. So it was easier to just break away from that model and start off a small center. So we have two different origins in Kolkata and Mumbai. And then do we almost instantly start to see private IVF centers opening in Bangalore and New Delhi and other parts of the country? Or did it continue to be fairly unknown in those two cities before it spread to the rest of the subcontinent? A bit of both. So you know, initially in the 1980s, particularly, there was a lot of monopoly in the IVF business, if you will, because so these these two centers were there, in Calcutta and in Mumbai, and of course, there were other centers, which were coming up other leading doctors who took charge and who, you know, set up institutes in different states in different cities of the country. But I think it is, the population largely remained underserved in terms of fertility meds, Sit in terms of Reproductive Medicine IVF services. I think it's really the last, you know, it's really the last 15 years, it's the last 15 years, which has seen burgeoning booming interest in the field all over the country and setting up of many, many new centers. And so how did the first fertility specialists in India sub specialized did they train abroad? Did they develop a fellowship program or some kind of training licensures cert to certification in India? Tell us about how they subspecialized again, you know, that's another very interesting question. So, right, in the beginning, the early pioneers I spoke to you about, they were pretty much self trained, you know. So they were self trained individuals who traveled the world, they went to conferences, they went to the European meetings in the American Society meetings at that time, you didn't have an SRM at that time, you had something which was known as the American fertility society or the AFS. Right? And the ASHRAE in Europe wasn't even formed at that time. What is now the ASHRAE, those same group of leaders, were just organizing conferences in Europe, which we're going by the name of World Congress on in vitro fertilization, stuff like that. So these early pioneers traveled to those, those early centers in Europe and the USA, they observed, they found mentors and they learned and then they really spread this education and they spread the training to the rest of the country to the rest of the doctors, these early pioneers, which we spoke about. And then gradually you find that in the organized sector, some courses and some training programs on Rei on embryology started in different hospitals, in some nodal centers, for example, the All India Institute of Medical Sciences or the Ames in Delhi, that started a very robust IVF program. But training in clinical embryology and I would like to stress on this because this is a this is a very unique phenomenon, the training, structured formal university training in clinical embryology, both theoretical as well as hands on, didn't happen until much later. So that's really an issue of the last 1015 years before that. All clinical embryologists were people who had learned by working under one of these early pioneers, or by working with somebody who had learned from these early pioneers. So the training in clinical embryology became structured only much later, training in Rei started to get structured before that. But to be honest, to this day, even now, we have very limited training available in a structured University setup format, both whether for clinical embryology or for Rei. It's available, yes, but not widely available. It's very few places which offer SAS training. And so then how did the first independent practices develop in terms of businesses was it like in the United States where you have one or two or three Doc's coming together, and then they form a partnership together? In those days, it was usually equal partnerships. But if it was, if it was a single founder, they would often retain a controlling majority partnership, if not majority plurality controlling partnership as they brought on additional partners, what was it like in India? So you know, now now, we're really getting into the meat of the matter into the core of what I'm assuming your podcast is about and what we also discussed it SRF the models, so you have to understand that the early models was exceedingly exceedingly dominated by single expert led centers, right. So the early IVF centers in the 1980s in the 1990s, even up to the early 2000s. Every leading IVF center was by and large, headed by one specialist by one specialist who was trained, either self trained or had trained themselves by visiting these other programs I spoke about in Rei, Obstetricians and Gynaecologists who wanted to sub specialize in Rei. And they established these centers, almost almost like a private limited enterprise, like a private limited company. When they hired other doctors to work with them. They hired clinical embryologist, but it was really individual single Rei specialists who were setting up these early centers, partnerships and collaborations between groups of doctors is a much more recent phenomenon. It's it's been happening maybe for the last 15 years, and, of course, the corporate entry into it.
Griffin Jones 25:00
is even more recent. So these private limited companies were often founded by fertility doctors, but they were not bringing on other fertility doctors as partners to own in their company. They were hiring them as employees and expanding their companies. And already are fertility specialists working together to form they're to partner together to own their practices. That's more recent to the last 15 years. Absolutely, absolutely. That's right. Yes. Where did you come in, in this model?
Dr. Baswanath Ghosh Dastidar 25:35
So after I, after I finished my studies and my you know, I finished my medical degree, I finished my training in OB GYN. I traveled to the UK. So I was based in the UK for a few years, my entire training in IVF, clinical embryology, in the laboratory aspects of it, so I'm a trained, I should have introduced myself, perhaps earlier. So I'm a trained Rei as well as I'm a trained clinical embryologist. So, my training in Rei and an OBGYN is mostly based in India, but my core training in the laboratory aspects of it and clinical embryology was in the UK. So I joined the University of Oxford, in the UK in 2012. I owe all my training in IVF, embryology to Oxford, then I came back to India, I super specialized in for the sub specialize in area and OBGYN. I also trained in OB GYN, again in the UK, where I headed in 2019. So I was in the University of Cambridge at Addenbrooke's Hospital, which is Cambridge University Hospital. So I finished all of that I returned to India, and then I started getting in touch with, with the leading practitioners with whom I'd had some experience working in my junior days, you know, as a research associate as a associate, clinician, and that's how I picked my field. And that's how I joined and I started working, and it's been, it's been okay so far. And are you yourself? Are you what we would call on associates and employee? Have you mentioned one of these private limited companies? Or are you a partner with with other physicians in the ownership of your practice group? So it's very interesting. So you know, when I mentioned, I should have perhaps mentioned this earlier, but I thought, let's keep this strictly professional and strictly accurate to the, to the history. But when I mentioned about these early groups of pioneers who set up these two first IVF programs in in Calcutta and in Mumbai, what I should have also told you is that one of the two pioneers who set up the first IVF program in Calcutta, Dr. Sudarshan, goes str, he's my dad. So, you know, I have grown up with IVF, from when I was really young, from when I was in high school from when I was in medical school. I've been growing up in IVF. So, so I just came back from the UK, and I joined him. And I've been working with him. I'm also associated with other hospitals now. I'm involved in this practice right now as as a consultant as a research consultant. And I consulted in the in the program, but it's just, it's a, it's a mostly academic and a research role, because I have other primary medical jobs, which I do. But yeah, that's how I'm involved right now. I thought about asking you if you were connected to that doctor, Coach Tassadar. Because, well, I had no idea how common or uncommon of a name that could be. So So you've you've you've grown up in this field, and then so I suppose that you've been able to see
Griffin Jones 28:51
things change. You talked a little bit you said, Okay, partnerships is relatively new in the last 10 to 15 years.
Dr. Baswanath Ghosh Dastidar 28:59
But But when did you start to see consolidation happen in the Indian fertility field? I would say that's, that's as recent as you know, the last the last couple of decades. It has recently in the last couple of decades, it's really been a fragmented field. Till then, it's really been the domain of small private players and small, private, privately established institutions. But in the last couple of decades, we've seen both the models you know, we've we've seen, specialists come together to join hands to form partnerships and work together. And we've also seen the entry of large chains which have funded and backed the setting up of multiple different IVF centers that's relatively recent last couple of decades. So is it the entry of large chains like you know, Evie coming in and forming new companies or is is that happening? More than the cars I'm buying this part? act like these six practices in New Delhi and merging them together and consolidating. Are we seeing one more than the other? It's a bit of both. It's a bit of both. So you mentioned Evie. So yes, Evie made its entry into India, you know, fairly recently the last couple of decades. And the model that we followed was a we approached, already established and prominent IVF centers with a leading area with the leading man who was already working in the field. And they joined hands with these private centers in these private practitioners. So they remodeled and rebranded the center as an Eevee. Center. And that's how he started to grow. But following Eevee, there have been others who have just, you know, it's just been a corporate group, which has been a business House, who don't necessarily have any experience in the medical field or don't necessarily have any experience in the IVF field, who have just financially backed the setting up of, of IVF chains. They have hired people with experience, they've hired doctors and embryologists and they form those teams, and they've set up those chains. So so both these models have had been apparent. Is there more opportunity in India, because of the way the training structure is set up for these large companies to come in to consolidate? And then to expand? I mean, it could be you could say there's less because there's no fellowship program that are funneling new fertility specialists in but is the lack of a fellowship structure, the lack of a training structure, the opportunity for these companies to come and say, Hey, we got a country 1.5 billion people, they don't have a training
Griffin Jones 31:50
a universal training system for fertility specialists, we'll set it up and we'll we'll do all the training and and then we don't have the same bottleneck problem of fertility specialists that other countries do, can that be the case? Or am I missing something? I think it's a little different reference. So I think
Dr. Baswanath Ghosh Dastidar 32:10
the issue here is that there's still a lot of scope for you know, for for setting an IVF footprint in India, for sure. There is scope to to establish a new IVF footprint in India. The problem is the training, you mentioned the REI training, you mentioned that is rather a hurdle, because you know, because there is no robust structured supply chain of adequately trained Rei is or clinical embryologist. Whenever a new entity is going to try and set up a new chain or new centers in India, there's always going to be the problem of adequately and appropriately trained manpower. Unless and until you use the model of Eevee, you know, where you already engage and incorporate RBIs and embryologist who are already working in the centers which are available. What's to stop them, though, from large companies like that we're talking to companies with hundreds of millions of dollars to say, we're going to set up either our own internal Academy, maybe we'll also will, it won't just be our academy, maybe we'll train other fertility specialists that end up working for different practices, or it will be internal. And we'll just say, Hey, if you're coming out of medical school, and you're starting to train an OB GYN come work for us what's to stop that? Oh, that would be great. I think that will be great for all of us. Because if if a big group with deep cash reserves and deep pockets and you know, requisite knowledge and requisite technical expertise, was interested in the field in India in order to set up a big, big Training Institute, that would be great for patients, it would be great for the field in general. And of course, they would have enough business. I think the only issue is that because training certification and accreditation is a very complex issue in India. You know, it's it's partly regulated, it's partly controlled by central nodal agencies, which are government agencies. So you have those loops to go through. But if, if those hurdles can be crossed, if you can start off this conversation with the national regulatory bodies, which which regulate medical education, which regulate scientific education, get the necessary clearances permits, then yeah, it would be great for the free I would be very open to actually partner with with anybody who's interested to do such a thing, because you know, so, of course, you must be aware that the IVF unit in Oxford is one of the leading and one of the most cutting edge units in the world and we've actually been in conversation with them to start off something like you just mentioned, like A really robust training program here in India. But it's just so complicated with the different legal and administrative hurdles, that, you know, it's still not happened. But that's a very exciting prospect. And yeah, there's a lot of scope for that I personally would be very, very interested with something like so there's so different government agencies regulates
Griffin Jones 35:23
ostensibly broader fields of medicine, but but reproductive medicine, but they don't, they don't have a training body for it is that is my understanding. Correct? Right. Right. I mean, there are there are specific training programs available in very small handful of hospitals and centers all over the country. But it's not very widespread. You're absolutely correct. But yes, the field is regulated, very closely. Do private IVF practices, private fertility practices run the gamut in size in India, like they do in the United States? Do you? Is it common to see single fertility specialist practices? Or is it more common to see larger groups that have maybe 10? Or 20, fertility specialists? Or Or there's there's groups where there's three or four? Does it run the whole gamut? Or is one size more common? No, I think, you know, with, with the increasing with increasing awareness about IVF, and how it is a very viable and a very exciting option to have a child.
Dr. Baswanath Ghosh Dastidar 36:24
The demand for IVF has been rising steadily over the last few decades. So it's been very difficult for a private center just to be running with one leading Rei or one leading man. So every center now will have multiple doctors will have multiple specialists areas who are part of that center. But However, having said that, the most common model is still going to be where each center is really run by one leading Rei man. And then there are others who are there associated with the center, but not in terms of equal partnerships between you know, equally shared between different areas, that is also there, that model is also there, but not as common. Talk to us then about how these models differ from
Griffin Jones 37:14
how they do in in other countries, what what you saw at Oxford, and what you saw at Cambridge? How is that different from what you see across India? Yeah, you know, so there are, there are two primary differences. I think the first one is, like I said,
Dr. Baswanath Ghosh Dastidar 37:32
in the UK, and I've, I've been closely associated with the Oxford fertility unit to the wefew. I've had some experience visiting the Cambridge IVF setup. And apart from that, I've also, you know, been part of the leading IVF unit in Glasgow, in Scotland and the gcrf on the Glasgow Center for Reproductive Medicine. And from these experiences, the differences are actually quite clear that the platelet site, all these centers, really have going, what they've got going is the concept of group practice, which you mentioned, like a partnership between two three or more different RBIs. In the UK, this particular person is, is designated as a PR or a person responsible by the hfpa, which is the human fertilization and embryology authority in the UK. So every every IVF unit needs to have one Rei designated as the person responsible. So that's just one person. But apart from that, doctor, there will always be 234 or more others who are working together as partners, you know. So what that does is that link that opens up a lot of collaborations, brainstorming, you know, academic exchanges, that says the academic side of it, if you look at the practical aspects of running the center, it eases your workload, it's easier to schedule your work, it's easier to schedule your time away from work. You have someone to share in the different aspects of both administrative administration as well as clinical work in India, because you just have really one main guy who's in charge of an IVF unit, although he might have multiple doctors working with him, it becomes more of a hassle because the smallness of the structure of a lot of these IVF units means that the same guy has to be focusing on the clinical aspects of it, the business promotion, aspect, Marketing Administration, everything really comes down to the main guy who's leading the IVF center. So you know, it's not as it's not as efficient. Of course, it has its advantages as well. There's more autonomy, there's more freedom to choose which direction you want to take and what you want to do, but it really hinders. It hinders growth. because, you know, you're just dividing your time into so many different disparate avenues. The other difference in the model, I think, is that the UK, and I think if you remember the discussion at SRM, Griffin, we were speaking about four different models of IVF. Here, it's in the UK, in the EU in the US. And one of those was the collaboration between an academic teaching based institution and a private IVF center how you know, these two entities work in very close ties with each other. And that is also the model which I experienced in the UK, both at Oxford and Cambridge. So, both the RFU as well as the Cambridge unit, they are essentially private, Li run IVF units led by, you know, a few small handful of doctors, but with very close academic research ties with the University of Oxford with the University of Cambridge. So, you know, you get the best of both worlds you have, you have the stringent quality control and the professionalism, and the SOPs, which are associated with a small, tightly run unit, but you also have the supply chain of medical students and residents and trainees and the research collaborations, the collaborations with research labs of non clinicians. So you get best of both worlds both in terms of supply chain in terms of academics research, as well as the business part of it and the day to day management part of it. So I think that is what we need more of in India, we definitely need closer ties, we need to actually establish the model where a privately run IVF center is associated with a teaching, research academic institution close ties, so that both patient care, academics, research, development, training of junior doctors can all run together.
Griffin Jones 41:54
The four models for those in the audience that were not at that S or M talk are academic someone that's purely academic, like a UC San Diego, right, an independently owned practice someone that isn't a part of any type of network such as Dallas, Fort Worth fertility associates, Dr. Ravi gota. Was their representative there, or someone that is part of a network that is it's a corporately owned, it's a corporate network, or sometimes called the corporate partnership. And that takes typically a controlling equity stake in what had been an independent practice. And they're part of a larger corporate network that's at least partly owned by private equity. And what the model that Dr. Ducharme is referring to private and make an example of that would be Boston IVF with Harvard and Brigham Women's or RMA of New York with Mount Sinai, though this what model does your center follow? So yeah, it's it's, you know, the model, which you mentioned, the private partnership that Dr. Garda clinic was following in the US, and
Dr. Baswanath Ghosh Dastidar 43:04
that's what we really are a private unit. But it's interesting that you came to this question, Griffin, because there has been a, there's been a bit of change in the last couple of years. And this needs to be addressed because although we have been a private partnership, a private IVF unit, from the time that this this institute was set up. Very recently, as recent as in the last two years, we have entered into an academic partnership with one of the leading Apex multi speciality tertiary teaching hospitals in the state of West Bengal in Calcutta. In fact, if you look it up, you'll find it is the leading and the apex referral hospital. With a glorious history of hundreds of years, it was one of the first multi speciality teaching hospitals set up in the British era before India got its independence. And this is as recent as the last one year. So we've entered into a private public partnership and it's called a PPP model, where our EU Institute has been tasked with the very exciting but also very challenging job of setting up Eastern India's first government owned government housed free funded IVF center for the poor population within the IPG MBR SSK hospital. So I PGM ER or Institute of postgraduate medical education and research is one of India's premier and oldest government sector, multi speciality tertiary referral hospitals. And they have tasked us based on you know, our history of innovation and research over the last four decades. We are setting up an IVF unit within that hospital so it's an a partnership model where we will be running this center, we will be providing the technical know how or when the trainings with the knowledge partner, and ibtm Er is going to act as you know, the the infrastructure, they are going to be helping with the infrastructure, the utilities, setting the costs of setting up the lab and the unit, and so on and so forth. It's very interesting development, very exciting development, I hope that this actually paves the way for new initiatives and ventures like this throughout the country. So that's to serve the poor population that you said, that's to serve the folks that currently don't have access to IVF. Is that my No, it's very interesting, let's yes and no, Griffin, you know, because in terms of who are the patients who are eligible to get treated at that new and upcoming IVF unit, in terms of who are eligible, there are no strict cutoff criteria as yet. I mean, the government might decide that it is going to enforce criteria for selection into that program. But it hasn't till now, unlike in the UK, so in the, in the UK, you have very strict criteria in terms of how many cycles of IVF can be NHS funded in which part of the UK depending on your address, depending on various different factors. So those things haven't yet been decided. So anybody is eligible to avail of this free treatment. But it just so happens, you know, that we don't foresee a lot of patients who are able to bear the costs of an IVF cycle are flocking to that center immediately, because you know, it's going to be rushed, we already have a we already have a waiting list of patients, which is running in 2000. And over 1000, not even in the hundreds, you know, so. So I still foresee that most patients who can afford IVF will still go to privately owned IVF units, but it's really going to be the poor population who need the subsidized treatment, who need the government funding for their treatment in the welfare country, you must be knowing that healthcare is free of cost for all who can't afford it. It's only IVF, which was not under the purview of that free government funded health care so far. So that's the attempt on the part of the government of West Bengal now to get IVF under the purview of free health care as well. So it's a bit under, it's a bit similar to the Canadian model, where you have Health Canada, you have universal health care across Canada, but in in most provinces, IVF is not funded, and even the ones that it is, to varying degrees. And I remember when the province of Ontario, this probably six or seven years ago, released their, their funding program, it was an awkward start, because you had such a need, because you had a population that was used to receiving free health care. They're not used to paying for it outside of a few few specialized things. And, and so they they you know, they did a lottery system. And I don't know if they still do that lottery system, but it was like, Oh, should I pay for my IVF cycle now and go through treatment? Or should I wait to see if I qualify in this lottery, it was I, I would love an update for those of our listeners from Ontario to give me an update, and maybe I'll even bring you on the show. And we can talk about it. But it was a that a lot to figure out in the beginning. How do you think they're going to try to do this? If you have a country of almost one and a half billion people, you have huge rates of poverty. And you we think that the number of people that can't afford IVF in the United States is high and it is it's dwarfed in India. And so how are they going? How are they going to roll this out? Well, for sure, it's going to be challenging, you know, it's going to be challenging and before you know before I come to your question, answer your question directly, if I can just touch upon the the four different models that we discussed today, SRM Griffin. So you know, the first model that we discussed was the large teaching hospital IVF unit right, which is a rarity, which is an absolute rarity in India, it is few and far in between, I think the most prominent one would be the one at the All India Institute of Medical Science raves in Delhi. There are a few here and there, but its rarity. Another model which we spoke about at ASRM was the corporate owned IVF chain where a big corporate houses a big company with deep pockets is funding setting up different IVF centers or or acquiring different currently functional IVF centers. So that is something which has been happening in India like I told you before, as well for the last couple of decades or so. By By and large, the vast majority of IVF centers in India still follow the privately owned privately run IVF unit model, which was the Dr. Goddess model, who was there at SRM. And I think it's very, very, very few private Demick IVF units, like we mentioned, the SRN are the fourth model where you have a private IVF unit with close ties linked to an established large academic research Medical Teaching Center. So I think that's really rare as well. And that's what we are trying to achieve here in Calcutta, with our partnership with IBM, er, the government investment goal. So hopefully this will lead to more such initiatives. And to answer your question, I'm not really sure you know, I don't have a clear answer for you. It's, it's just something that we have to wait, we have to wait and see how this, how this really rolls out.
Griffin Jones 51:00
We talked a little bit about models and how they're paid for mostly its teams, private payer, is it almost up? And this is the question I was fighting to remember to ask you earlier in the show. Is it almost 100% self pay in India right now? Is there any other any insurance companies that cover IVF? Are there any companies like progeny, carrot and kind body that work with employers to broker it as a benefit? Are we talking virtually all self pay for IVF patients?
Dr. Baswanath Ghosh Dastidar 51:39
Listen, if you were able to act as a facilitator, to get these guys into India, then I cannot tell you what a massive market they would come in to India to encounter because, you know, we are in dire need of that. We don't really have that. In any large scale throughout the country. There are a few schemes, there are a few healthcare schemes and insurance schemes which do have IVF under their purview. For example, some of the central government health schemes are CGH s, as we call them in India, they offer insurance and funding for a certain number of IVF cycles for their employees. There might be few schemes here and there. But by and large healthcare for IVF. In India, the vast majority of it is paid out of pocket by the patients. And apart from those few the small handful of government funded centers, where it's of course free of cost, which is also what we are trying to achieve in this new year, and that's coming up at IBM er,
Griffin Jones 52:44
how many IVF cycles does the typical fertility doctor do in India?
Dr. Baswanath Ghosh Dastidar 52:50
Oh, it varies. You know, it varies widely. So I think, are you talking about a particular Fertility Center, like one particular IVF unit?
Griffin Jones 53:00
I would say one day, I'd say so I would say in the United States, if you're doing less than 150, retrievals a year, there's either it's either it's not your full time job, or maybe you maybe you're at a private center that it's in trouble, I would usually don't see fertility specialists doing less than 150. Probably 180 is probably the average and then it's quite common to see in the two hundreds, but then you have a couple there's a couple Doc's in, in California that are doing 800 retrievals a year. And there's one fertility specialist in Chicago, Dr. Reed Jelani, who's podcast episode will have aired before yours, told me she did 1300 in 2022. Wow. And so are so what kind of range is typical for?
Dr. Baswanath Ghosh Dastidar 53:49
I think it's pretty similar here in India, Griffin. So if you find an IVF unit that's doing less than 100. And it's exactly the same numbers I was quoted to you as well, who's doing less than 150 cycles a year or maybe less than 100 cycles a year, that's really low. That's that's not possibly a very prominent IVF center. Whereas the really, really busy IVF centers would be doing around maybe 505 600 cycles a year. We in our center in our unit here, we are typically doing around in the in the four hundreds, around 404 30 cycles a year. But yeah, it would be around at least 150 cycles for most centers, which are doing well. At the very least,
Griffin Jones 54:35
you've given us such an interesting intro into the Indian IVF market into the history of Reproductive Medicine in India into how the model works. Our audience is almost entirely practice owners Doc's execs in lots of different companies in the fertility field. They are starting to pay attention to India. How would you You like to, and some of them, of course have been paying I don't I mean, as a as an aggregate they're starting to some of them, of course, have been paying much deeper attention than I for a long time. But how would you like to conclude with them?
Dr. Baswanath Ghosh Dastidar 55:14
You know, I would just like to say that there is a lot of scope in India, in the IDF field, the problem is that there are also a lot of hurdles to get across a lot of hoops that you have to get through. But there is no doubt about the fact that I think, really to two points to conclude is that, on the one hand, we need a more structured and robust supply chain in terms of training and education. That's a, b, we need more private Demick models of IVF units in India, where you have a private center, you have academics research going on and see yes, if if we could actually arrange insurance, wide coverage, and bring IVF under the purview of insurance, that would really be a game changer.
Griffin Jones 56:14
We will put your social media profiles, and that of the organizations that you work with as well in the shownotes will tag it. And I won't put your email address in any of those. But if people email me, and they say they want to talk to you, Do I have your permission to connect them with you? Oh,
Dr. Baswanath Ghosh Dastidar 56:33
yeah, absolutely. Absolutely. For starters, yeah. You can put up my social media information. And then yeah, I'll be happy to, to respond to emails, if they are channeled through you. Why not for sure. I'd love to help.
Griffin Jones 56:46
Dr. Business Coach does it are you are the first guest to talk about the Indian IVF market, I do not believe that you will be the last and you will not be the last. So I hope to have many more. Thank you so much for bringing this topic into our arsenal. Thank you for coming on the show.
Dr. Baswanath Ghosh Dastidar 57:04
Thank you so much, Griffin. It's been a pleasure. It's been interesting. And I really wish that and I really hope that your show and your podcast gets more viewers and more people engage on these very important issues which are not very frequently discussed. And it's been great to be here. Thank you so much for inviting me.
57:25
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