Today’s Advertiser helped make the production and delivery of this episode possible. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the Advertiser. The Advertiser does not have editorial control over the content of this episode, nor does the Advertiser's sponsorship constitute an endorsement of the guest or their organization. The guest's appearance is not an endorsement of the Advertiser.
What if 30% of your fertility clinic’s egg retrievals were for egg freezing?
That’s the reality at FertGroup in Brazil, where Dr. Marcus Dantas Martins, Chief Operating Officer, is leading a transformative approach to fertility care. In this episode, Dr. Dantas reveals how Fert Group is leveraging technology and private equity to expand their influence in the rapidly growing Brazilian market.
Join us as Dr. Dantas discusses:
The Rise of Egg Freezing (And how the trend is reshaping fertility care in Brazil)
How Private Equity has shaped their rapid expansion
FertGroup’s Impact on patient outcomes (And its implications in the broader fertility landscape)
How FertGroup is making egg freezing more accessible across Brazil.
Why they bought >50% of the embryoscopes in Brazil to make it happen
Tune in to hear more about the future of fertility care in Latin America and how private equity is shaping the industry.
120-Day Free Trial for Qualified Fertility Centers!
Experience the future of embryo evaluation with a risk-free 120-day trial of EmbryoScope
See all the benefits that EmbryoScope’s time lapse technology can bring to your clinic, including:
Continuous uninterrupted culture
Improved embryo development
Streamlined workflow for maximum lab efficiency
No risk. See if your IVF lab is eligible to participate.
Don’t miss this exclusive opportunity—email here to see if your IVF center is eligible to participate in a 120-day Embryoscope trial to measure the impact it can have in your lab.
-
[00:00:03] Marcus: 30 percent of the cycles are egg freezing, 70 percent are IVF. So this is the number. Before the COVID 19, this number is something around 15 to 17 percent of egg freezing. So the market has doubled terms of egg freezing. In our group, the clinics in the southeast of the country are doing around 35 to 40 percent of egg freezing. Ha!
our group recently bought many embryoscopes, many, many time lapse incubators. So , we are now around 12 percent of the cycles in Brazil. And our clinics around 50 to 60 percent of the embryo scopes in Brazil.
[00:01:02] Griffin Jones: What if 30 percent of all of your egg retrievals were for egg freezing? It's not happening in the vast majority of fertility clinics, but it is happening somewhere. According to my guest, it's happening in Brazil. And he talks about the technology they've invested in that he sees as necessary to grow and serve that egg freezing population.
His name is Dr. Marcus Dantas Martins. He goes by Marcus Dantas. He's an MD by training, but he doesn't practice clinically anymore. He's the chief operating officer of Fert Group. He says they're the first private equity backed informed fertility clinic network in Brazil. They're buying clinics. IVF labs across Brazil, and even though they were only formed about a year and a half ago and have 10 clinics, their 10 clinics are doing 12 percent of the IVF cycles in that country.
Brazil is a country of 200 million people, the 10th largest economy, and they have 175 fertility clinics. Doing roughly 42, 000 IVF cycles, 30 percent of which, according to Dantas, are egg freezing. He shares how this group was formed and what specific technologies they've been investing in and how they plan to further grow the market.
If you're in the IVF space in Latin America, or if you're anywhere that wants to grow your egg freezing program, enjoy this conversation with Dr. Marcus Dantas.
[00:02:12] Announcer: Today's advertiser helped make the production and delivery of this episode possible for free to you. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the advertiser. The advertiser does not have editorial control over the content of this episode, and the guest's appearance is not an endorsement of the advertiser.
[00:02:33] Griffin Jones: Dr. Dantas, Marcus, welcome to the Inside Reproductive Health Podcast.
[00:02:38] Marcus: So thanks for having me, Griffin. It will be a pleasure to be with you today.
[00:02:43] Griffin Jones: I want to ask about what it's been like being one of the first groups in South America to go with private equity. I want to get an idea of how growth in different continents can inspire growth in the IVF space in other continents because I think everyone's doing some different things that will be adopted by others, and I would like to hear about that
from you, but before we go into that level of detail, will you lay out for us an overview, a bird's eye view of what the IVF marketplace is like in Brazil right now?
[00:03:20] Marcus: Yeah , as you know, is a huge country. So we are more than 200 people living down here in Brazil. We are among the 10 biggest economies in the world. Inflation is under control. But of course, as a developing country, we are facing significant challenges, especially regarding that almost half of our population is either poor, in the low income group, , the Brazilian market for reproductive health has its own set of challenges, Brazil performs around 48 to 50,000 IVF cycles per year, about 60 to 65 of these treatments occur in South and Southeast regions of the country. Sao Paulo is the biggest city and also the biggest state of Brazil. São Paulo alone accounting for approximately 40 percent of the IVF cycle. So cycles are concentrated, far away for the rest of the country. So we are facing a challenge and also an opportunity here in Brazil. And is of course a significant opportunity to expand into other parts of the country. And we are actively pursuing that. pursuing this. Another important point is that the government does not pay for IVF treatments, except in few centers at specific locations. Around 25 percent of the Brazilian population has private health insurance. But these plans typically do not cover fertility treatments. So leaving patients to pay out of pocket is completely self So we think we have some challenges on it, but also opportunities to partnerships with corporations and for us. A network of clinics spreads over the country. I think it's a good opportunity for us too.
[00:05:37] Griffin Jones: Is there a business case to be made for expanding IVF? What is the basis of access to care? Not just an ethical case, but is there a business case to be made for doing more IVF cycles in Brazil? Very often when you have a population in certain countries with an economic disparity, the rich get healthcare and those that can't afford it simply don't.
And It has been that way for many decades in many segments of healthcare. Is there a business case to be made for why IVF should be made more accessible to those that can't afford it?
[00:06:21] Marcus: I think that's the opportunity here in Brazil. Is not to lower the prices because of the low income of the population. I think that democratize includes spread clinics all over the country. So it's very common in Brazil that people in another states take a plan to come down to Sao Paulo to have a treatment, to have a treatment done.
So I think that opportunity, it's not only democratizing. lowering price, also make the treatments, done when, wherever the patients are,
[00:07:07] Griffin Jones: And what does that look like? Does that look like training more doctors? Does it look like training more embryologists? Does it look like automating the IVF lab? Does it look like having nurses do certain things like IUIs? Tell me more about how you would expand into different parts of the country.
[00:07:34] Marcus: I think that, we have important barriers, so one of them is the price of the IVF treatment and the other one, I think that the gynecologists in Brazil stay with the patients for a long time before refer to a specialist, so I think that we have opportunities in educational issues, not only for the patients itself, but also for the gynecologists.
I think that they are, with the patients for a long time. And, of course, we have to have more doctors doing IVF, we have to have more embryologists, and we are investing on it. We are investing in medical education and embryologist education because to spread, to increase the number of treatments here in Brazil, have more people doing it along the country.
[00:08:34] Griffin Jones: And so what technology do you see as being necessary to aid you in doing that, to make this all possible? And not just technology that might be currently available, but technology that might not be available yet. What kind of technology do you need?
[00:08:53] Marcus: And I'm particular. Part of my executive career, I have spent some time visiting health companies in Silicon Valley. I have studied data science at Oxford, Columbia, and many other executive courses here in Brazil. So I'm especially interested in technology and I think breakthrough in IVF.
For example, our group recently bought many embryoscopes many time lapse incubators. So , we are now around 12 percent of the cycles in Brazil. And our clinics around 50 to 60 percent of the embryo scopes in Brazil. So we are investing in it. We believe that technology could improve the results and could improve the access for the treatments. We recently established a partnership with HOMU. I don't know if you have heard about HOMU. Robo is an incubator and accelerator for biomedical startups to developing solutions for the IVF market. We are the only site in Brazil developing and testing these technologies.
For example, remote ecographies for control the cycles away from the IVF lab. are investing a lot in technology and we believe that it can make the market more accessible for people who live from the biggest cities in Brazil.
[00:10:27] Griffin Jones: Yeah, homo, that's Santis incubator, isn't it? Santiago Mnet. And so they invest and they incubate in various technological solutions the fertility space. And so our your group, is your clinic group a sort of tester for those different companies that are in. The HOMU incubator?
[00:10:53] Marcus: we are testing some of the new technologies, for example, in automatic vitrification, we are planning to test the remotes. Ecography. So we are now the only site in Brazil to do it.
[00:11:09] Griffin Jones: Tell me more about that.
[00:11:12] Marcus: And I think that if you want to spread technology, if you want to spread clinics, one of our pillars is to have a national footprint. So we believe that a big network of clinics here in Brazil, you have to be over the country. Brazil is a continental country, so there are long distance to travel to have a treatment done. We believe that, for example, if you can have remote control of the cycles with gynecologists in a lot of cities around the country, patient just need to travel to retrieve to make, for example, an embryo So patients can do almost all the process. away from the clinics, and we are spreading many sites where the patients can do it.
[00:12:15] Griffin Jones: What technologies that you've been testing, either through HOMU or other technologies that you've been testing, what technologies have you been pleasantly surprised by?
[00:12:30] Marcus: We have started a partnership with Future Fertility, for example. We are now offering Violet and Magenta, the two algorithms, in some of our clinics. So we did a retrospective study with and thousands of egg images, and we believe that's something new on it. for example, if the, if a patient come to a egg freezing you can tell her how many percent she can have an embryo or a baby, I think it's something important. Something important in the decision process to have more eggs for the future or not. I think it's a technology, we are testing it, we are very excited to move forward and think there is some value in it.
[00:13:28] Griffin Jones: What about it has been pleasantly surprising? Is it, is the performance been better than you thought it was going to be? Is it just been, you've been able to use it in more ways? Tell me more about that.
[00:13:41] Marcus: I think that the accuracy is not perfect, it's not, We expect, but I think we are moving forward. We are increasing, we are submitting more and more images to the system. And I think that the accuracy will increase step by step. And I think in the future, you can put together embryoscope image, artificial intelligence images, and embryo biopsies.
Because I think in the future you We will put all together and have better results in terms of IVF treatments.
[00:14:22] Griffin Jones: What will these technologies do to scale care? Is this just about improving the quality of care or is this some combination that will lead to being, you being able to see thousands more patients than you're currently serving?
[00:14:40] Marcus: think both. I think we are very worried about quality. Quality is another pillar of our thesis. Usually people when some, someone heard about a private equity in the markets it, for us, to have lower quality. No, it's not. It's really not. The private equity the team is always worried about stay with the most quality that you can have. And also. Some technologies that can spread the treatments around the country. So it's quality and it's also to have more and more patients doing treatments we have to do it. We are facing a problem about build families we think that reproductive techniques, there is a place for it on it.
[00:15:33] Griffin Jones: Me more about Private Equity and your group's partnership with Private Equity and I guess let's start off with a little bit of the history of Fert Group and the size of the group, how many doctors you all have, how many offices and how many cities, how many IVF cycles that you do, and then how did Private Equity come into the picture?
[00:15:55] Marcus: We are just starting, the first oh, I'm sorry the first acquisitions were one year ago our clinic I have working a, as executive director in a group in Rio de Janeiro, so our group was the first one to be acquired. Since then, 10 clinics in Brazil.
The Brazilian market has around 175 clinics spread the country. are now 10 of these clinics, but we are doing 12 percent of the cycle, so our clinics are growing. Not the biggest but among the 10 to 20 biggest clinics in Brazil, we around 20 clinics at the end of 2025. So we are just starting, it's a it's a new culture in Brazil. The clinics are most of them familiar. The owner has run the business for a long time, so it's a challenge to move on, but I think we an extraordinary team, and I think we are doing a very good job here in Brazil.
[00:17:08] Griffin Jones: If I'm understanding correctly, then this is private equity coming in and forming a network and acquiring and consolidating existing clinics, as opposed to something like, something like a Shady Grove or a Boston IVF in the United States, which were a group themselves and then got larger and then got financial partners.
This is a private equity. So you're the chief partner coming in and helping to form the network and consolidating and acquiring networks. Is that right?
[00:17:38] Marcus: So,
[00:17:40] Griffin Jones: And so how did you come into play for all this? Because you're the chief operating officer of the group now. You're also a medical doctor by training.
How did you come into the role that you're in now?
[00:17:55] Marcus: I use it to be a doctor, I'm not a doctor anymore, I graduated in 92, 92. I think I have, had a very good career on it, but the turning point was an MBA in finance, so I start to work part time as executive director in one of our clinics. So we opened a second one and we are thinking of be part of a huge group of clinics, a network of clinics. And it happens one year ago. So for I'm the COO of the group. So here I am as the COO of the group. I'm traveling a lot. I'm traveling a lot. Only. to visit our clinics, to run in our clinics, but find clinics to be part of our network. As I said, we are just starting we are working very hard here down in Brazil. To have the biggest network in South America and of course with pilars of democratize the access quality is very important for us. And of course, I think we are doing a very good job here. 48,
[00:19:13] Griffin Jones: And about how many cycles, IVF cycles are done in Brazil in total per year?
[00:19:19] Marcus: to 50, 000.
[00:19:23] Griffin Jones: Okay. As a group that's emerging, one of the challenges that has happened in other countries with private equity is making the standard of care uniform in Brazil. Across the network because this doctor practices this way in this city and this doctor at this clinic practices a different way in a different part of the country.
How are you building the infrastructure to have quality control and to have a certain replicable standard of care?
[00:19:52] Marcus: There are a lot of things to do, of course, it's not easy. example, now we are rolling out the electronic medical records for all the clinics. Each clinic of our group will be at the same system at the end of 2024. So at the end of this year. We will have at the same electronic medical record. I think it's a first step to to have everybody together at the same platform. One of the things we are doing to integrate it. the clinics.
[00:20:29] Griffin Jones: Do you have any kind of physician advisory board or how do your lab directors come together? How do your doctors come together? And then what, is there, are there protocols being made that they follow?
[00:20:43] Marcus: Yeah. We have a medical he and his group is working a lot in medical protocols. It's a, I think it's the the doctors can prescribe the medicine that they believe, drug that they believe. But of course, as a group, you have to have some protocols on specific points, for example, egg freezing.
I think that Edson Borges is medical director. He is the former president of our Brazilian Society of Reproductive Health, and he's doing a very good job here with our group, and we think we are moving as fast as we can to have our protocols and educate also the doctors with some of our protocols.
[00:21:37] Griffin Jones: I didn't realize that this timeline was so recent, about a year and a half ago. Is Fert Group the first private equity backed network in Brazil?
[00:21:47] Marcus: first one is and is the only one here in Brazil.
[00:21:53] Griffin Jones: I think UGN has maybe a, a clinic or two in Brazil, or has some clinic presence in Brazil. Now, do you have other international clinic networks come in to Brazil and have a little bit of presence there?
[00:22:09] Marcus: Yeah. Brazil, there is a second network of clinics. And some foreigners, private actually are coming to Brazil and make some investments in specific clinics. But our group is one for . And we are buying week . And month by month, new clinics, and we are planning to be the biggest one, and not only the biggest one, but also the largest. Based on quality and we are trying to really be the biggest and also the not the best is something to say, but it's, we are very worried about the quality of our clinic. So are coming down here to Brazil, but I think we have a presence, a very important presence here.
[00:22:59] Griffin Jones: So this started in late 2022 or early 2023. What was true about the market conditions in Brazil that have now, it now has been the right time for private equity to come in and start buying clinics wasn't true 5, 10, 15 years ago?
[00:23:23] Marcus: I'm not sure the right time, the markets, the IVF markets flat. It's it's a behavior all over the world there are less families, there are less women having children, so we have to face it but I think we have a lot of opportunity on the other hand, because egg freezing is increasing a lot. I think that the COVID 19 made a challenge, made a different way of thinking about the future. So more women are looking for us and looking for each clinic in the world to have her eggs freezing. So I think there is a huge opportunity on it. I think that the economy Of course, we are facing our problems in economy, but Brazil is, as I said, is a huge country, is a huge economy, so I think that you can offer as a benefit, for example, for each large company to offer for her employees to have I think that there is an opportunity on it in Brazil.
[00:24:41] Griffin Jones: How much of this is speculation and how much of it is happening now? So how many egg freezing cycles does your whole group do? Is it a couple hundred or a couple thousand for just egg freezing retrievals?
[00:24:58] Marcus: I think that in Brazil 30 percent of the cycles are egg freezing, 70 percent are IVF. So this is the number. Before the COVID 19, this number is something around 15 to 17 percent of egg freezing. So the market has doubled terms of egg freezing. In our group, the clinics in the southeast of the country are doing around 35 to 40 percent of egg freezing.
So the biggest city. More egg freezing than small cities. I think that if you can spread clinics around the country, you can make a different way of think and of course offer egg freezing in different parts of the country. So I think there is a huge opportunity to need here in Brazil and of course all
[00:25:54] Griffin Jones: It sounds like it.
[00:25:55] Marcus: I'm sorry.
[00:25:56] Griffin Jones: did that number, why did that number double as far as you can tell? Is it, was it just because of, was there, was Money coming into the marketplace it because of inflation elsewhere or and then other people were to amass more money and decided to put that to egg freezing.
Did employers start covering it in some way? Why did that egg freezing market double in just a short period of time?
[00:26:21] Marcus: I think that the main trigger the COVID-19. I think that women are thinking about being mothers and, but they are buying insurance to do it to, to, would do it in the future. So I think this, it's a behavior. It's just behavior. And I think happening all over the less in some countries, but it's, I think it's a tendency the world.
[00:26:47] Griffin Jones: Has that behavior sustained since? COVID. Maybe you saw a spike in 2021 and 2022. Has that increase continued in 2023 and 2024?
[00:27:02] Marcus: It's stable for the last two years, but it's around 30%. So I think doubled since the beginning of COVID-19 think it's it come to, to stay with us. Of course, as treatments are completely self paid in Brazil, if you offer as a benefit, you have a huge opportunity to increase this number a lot. We are working on it. We are I know that in the U. S. many companies are offering it. as a benefit, but in Brazil it's not common. So it's cultural. I think it's come in a near future.
[00:27:43] Griffin Jones: Is that part of the reason why you're using future fertility as well? I forget if it's magenta or violet or which product they use for egg freezing, but is the number of egg freezing patients, does it have anything to do with how you use? Future fertility or I guess vice versa. Do you use that to grow or serve the egg freezing patients in some way?
How do you use that?
[00:28:06] Marcus: Violet is the algorithm for egg freezing. And I think it's a tool, it's an important tool to offer something. You can read a report made by artificial intelligence and you can make a decision. So I have enough eggs. Or I do not have enough eggs and I, I will do a second cycle.
So I think it's important to, as a, to, to make a decision to have more eggs or not. I think it it's important of course the has to develop bit more, but we are working with Dan and we are sending. Egg images retrospectively, and I think the model will be better day by day, step by step.
[00:28:53] Griffin Jones: And why time lapse imaging? That sounds like a big investment to do so early on and it sounds like you made a big investment in time lapse imaging. Why did you choose that?
[00:29:06] Marcus: I think that it's another tool that you can the safest environment the development of embryos. I know that there is different cultures. Europe use time lapse a lot and U. S. do not. in Brazil of course, it's a technology, it's expensive, but we think it's there is a place in the future when each of these tools talk together and we have to increase it. To make the results better in terms of IVF. So I think that time lapse, including the artificial intelligence technology, will do a job on it. So we are investing on it and we think that it will be important to for better results in terms of
[00:29:59] Griffin Jones: I'm imagining your conversation with your investors and they're thinking, Marcus, hang on, we just bought a bunch of clinics, we want to buy many more clinics, you want to buy all of these time lapse image machines. How did you convince your investors that it was a good idea?
[00:30:21] Marcus: I do not have to convince. They are completely convinced that this is we have to work with quality. you don't deliver a baby for someone who is looking for it, You are, you will fail, so we are investing in as much technology as we can to have the better results, to be the best network of clinics, and of course the return on investment is a consequence of doing a good job of or invested in quality or invested in democratize the assess or have more and more people doing IVF, freezing their eggs.
I think it's a consequence.
[00:31:06] Griffin Jones: You talked about the opportunity in Brazil for employers to pay for the treatment of their employees as a benefit. Is this an opportunity that you see Fert Group approaching employers directly for? So are you all contacting employers and trying to work out arrangements with employers? Or is this something that you're hoping to do?
Somebody like Progyny or Carrot or Maven or one of those companies will come into Brazil or that a Brazilian company will emerge in that space. Is it direct that you're going or are you hoping that some sort of employer carve out insurance company will
Fill that void?
[00:31:51] Marcus: yeah, I'm not sure but we are working on do it by ourselves. I think as a network of clinics spreads over the country we can offer in a lot of places and you can. Make the arrangements by ourselves direct to the companies. I think that there is, Brazil is different from US.
So you have a lot of companies doing intermediating the negotiation with clinics and. Groups and corporations in Brazil. Do not it yet, so we are doing it by ourselves. Of course it's not easy, I think we will have it on, on, on the near future.
[00:32:38] Griffin Jones: I want to give you the opportunity to conclude on whatever thoughts you would like to conclude our conversation with, whether it's improving quality, whether it's introducing the new technology, whether it's the IVF market in Brazil and Latin America. What do you want other. IVF providers and lab specialists and fertility clinic network executives both in South America and in other parts of the world to think about.
[00:33:10] Marcus: I think that it is what it is. It's not easy. To wake up every day in the morning working hard. So we have a extraordinary team with us. Many people working hard every day to make things done. I think Brazil is a huge country, as I said. We have a lot of opportunities.
We have a lot of people living down here. And I think we are the biggest country in Latin America. We are the biggest economy in Latin America. And I think that we have to start From here, from Brazil, I think the Brazil will make the IVF cycles more affordable. I that we will have an important an important level of responsibility. As the first active group here but we think we are really doing a good job and I'm expecting good things from Brazil and from this private active group of clinics.
[00:34:14] Griffin Jones: I look forward to bringing you back on in a couple of years and hearing about the progress and hearing about the expansion and I think talking more about that expansion in egg freezing because 30 percent of the total retrievals is a high number and I think Brazil might It might be an outlier in that, and so I think that's interesting, and I'll be interested to follow your progress some more.
Dr. Marcus Dantas Martins, it was very nice to meet you. Thank you for coming on the Inside Reproductive Health podcast.
[00:34:46] Marcus: Thank you very much Griffin to be with you today and have a good day.
Our group recently bought many embryoscopes, many, many time lapse incubators. So , we are now around 12 percent of the cycles in Brazil. And our clinics around 50 to 60 percent of the embryo scopes in Brazil.
[00:35:12] Announcer: Today's advertiser helped make the production and delivery of this episode possible for free to you. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the advertiser. The advertiser does not have editorial control over the content of this episode, and the guest's appearance is not an endorsement of the advertiser.
[00:35:33] Sponsor: Thank you for listening to Inside Reproductive Health.
Dr. Marcus Dantas Martins
LinkedIn
