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市場調査レポート
米国の不妊治療クリニックおよびサービス：業界分析
U.S. Fertility Clinics & Infertility Services: An Industry Analysis
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Abstract
This analysis by Marketdata examines a controversial $4 billion healthcare
service sector - infertility services. This loosely regulated “baby
business” has come under the spotlight lately, as the Nadya Suleman
(OctoMom) case brought up issues of unethical practices by some fertility
doctors practicing “assisted reproductive technology” (ART) and
implanting multiple embryos.
ART now produces more than 50,000 babies per year in the U.S. via 142,000 IVF
procedures (nearly tripled since 1999), and demand is growing from the ranks
of 7+ million infertile women, many of which delayed childbearing due to
careers. There are 483 U.S. fertility clinics, 100+ sperm banks, an unknown
number of egg donors, and 1,700 reproductive endocrinologists competing for
the business, which is lucrative. In addition, the global market for
fertility drugs tops $1 billion. Only one corporate “chain”,
IntegraMed, exists, as most programs are run by small MD practices or are part
of a hospital or University.
This unique new study by Marketdata examines the nature/evolution of the
business, national receipts/growth from 1988 to 2013 forecast, extensive
infertile customer demographics, key industry trends, industry regulation,
pricing, industry consolidation, insurance coverage, ethical issues and calls
for reform, effects of the recession, and more. The study presents the
findings of Marketdata' s mail/phone survey of fertility clinic managers, with
average costs and number of specific diagnostic procedures. Contains results
of the latest (2006 & 2007) CDC ART surveys, with IVF success rates, plus a
name/address directory of 400+ fertility clinics, as well as European ART
cycles survey data. Examines the sperm banks, egg donors, and fertility drugs
markets, and surrogacy programs.
This study is believed to be one of the few in-depth publicly available
business analyses that exists of this market. It' s All here in one place.
Table of Contents
Introduction
- Report Scope & Methodology, Sources used
Executive Overview of Major Findings
Analysis of fertility treatment services industry: nature of the field,
no. of ART clinics, how patients pay/insurance, ethical issues and calls for
Federal regulation, treatment methods (diagnostic, therapeutic approaches, no.
of procedures performed per year and cost), infertile customer demographics,
results of Marketdata interviews, industry size/growth/segments (1988, 1995,
1999, 2000, 2004, 2006, 2008, 2009-2013F - $ value of: MD consults, semen &
hormone analyses, lap & dye, tubal reversals, IVF and GIFT procedures,
fertility drugs mkt., sperm banks, egg donor mkts.), discussion of rationale
for future growth, list of top 20 competitors.
Nature & Definition of the Market
- Definition of market segments (IVF clinics, sperm banks, egg donors,
fertility drugs, surrogacy programs, surgeries)
- Industry evolution - when clinics first appeared
- Market demand and potential: Number and percent of women of childbearing
age infertile, increase in IVF procedures from 1987-2007, reasons for
continued growth, past estimates of industry size
- Insurance coverage: typical fees and client affordability, state mandated
coverage, financing programs
- Causes of infertility: discussion of main reasons for infertility in men
and women, treatment methods (HSG procedures, lap and dye procedures -
description, cost, estimated number of procedures). Tubal reversal surgeries
(description of, success rates, costs, percent of women having procedure,
estimated number of surgeries).
- IVF procedures: discussion of procedure, cost. GIFT procedures: discussion
of procedure, cost, number of procedures.
- Ethical guidelines and government regulation of clinics: status report.
Industry Size, Structure and Growth
- Summary and Analysis; historical estimates of industry size - 1988,1995,
2000 (gov' t. & private sources)
- Marketdata estimate of mkt. size in 1999, by diagnostic procedure, IVF,
drugs, surgeries
- Harvard Business School estimate for 2004
- Discussion of no. of IVF clinics 1985-2008, avg. revenues, value of
this segment
- 2006-2008 market performance: estimated growth, impact of
recession, pricing, Integramed revenues.
- 2009 market outlook & forecast: discussion of key factors:
recession, healthcare reform, small clinics vs. IntegraMed performance,
demographics, Marketdata forecast of IVF volume, $ value of the market.
- 2009-2013 Forecast: Factors affecting current and future industry
growth: IVF tourism, Economic recovery, public policy, improved success rates,
etc.
Tables:
- Size of fertility services industry - 1999: diagnostic & therapeutic
procedures (no. performed, avg. cost, estd. $ value: office consultations,
semen analysis, hormone evaluations, tubal reversals, IVF & GIFT procedures,
fertility drugs, donor eggs, donor sperm, surrogacies)
- Size of fertility treatment industry: 2004 (Debora Spar, Harvard Business
School book)
- Top 21 U.S. fertility clinics, by no. of IVF cycles performed: 2002, 2006
- Size of fertility services industry - 2008: diagnostic & therapeutic
procedures (no. performed, avg. cost, estd. $ value) - breakdowns as above
- Estimated historical size of mkt., by segment: 1988, 1995, 2000, 2004,
2006, 2008
- Status of the European Market, report of ESHRE, IVF volume in 2005,
percent distribution of IVF vs. ICSI (1997-2005), which nations infertile
couples come from, reasons, reimbursement ESHRE headquarters address.
Customer Demographics
- Summary and discussion of number and percent of infertile female
population in the U.S. (U.S. Census Bureau data, American Society for
Reproductive Medicine)
- Reasons why the market is largely untapped: how price deters most
candidates
- Birth control trends: analysis of why birth control rises during recession
and birth rates fall, effect of current recession
- IVF tourism increases for European couples due to U.S. economy and
progressive laws
- Health status: percent of women age 18-44 reporting receiving infertility
services (by race, age, type service)
- Fertility of American women: 2006 (U.S. Census Bureau data - highlights
of the report) (birth rates and fertility rates by race, education, state,
income), level of childlessness by age, race
- Completed fertility for women 40-44 years old
- Current fertility rates
- Marital status and cohabitation
- Citizenship status, race and Hispanic origin
- Educational attainment
- Birth rates: data for 2006 - report highlights regarding number of
births, birth rate for teenagers, mean age of mother, percentage of mothers
with prenatal care, total births in the United States, crude birth rate,
general fertility rate
Tables:
- Women aged 18-44 who have ever received infertility services, by
race/ethnicity, 2002
- Women aged 18-44 who have had an infertility related medical appointed in
the past year, by age, 2002
- Number of married women 15-44 years of age and percentage who have had a
sterilizing operation by type of operation and percentage whose husband has
had a vasectomy, by selected characteristics: United States 2002
- Number of women 15-44 years of age, percentage who have ever received any
fertility services, and percentage who have ever received the specified
infertility
Fertility Clinics
Fertility Clinic Business Operating Ratios: Results of custom Marketdata
survey (Aug. 2000, June-July 2009)
2009 Survey
- Number of new patient visits per year
- Average cost of new patient consult
- Average cost of a semen analysis
- Average cost of a hormone evaluation
- Average cost of a HSG
- Average cost of a tubal reversal surgery
2000 Survey
- Location (MD practice vs. hospital, %)
- Title of Lab Director (MD, PhD)
- Full-time staff (clinical, admin. Laboratory)
- Starting salaries for clinic job functions (embryologist, lab director,
HCL director, LPN, RN, lab technician)
- Annual Patient volume for: new patient visits, IUIs, surgical procedure,
retrievals
- Prices charged for services (see above, plus semen analysis, ultrasound,
pkg. Price for IVF - % by price ranges)
- Percent of revenues paid by insurance
- Most important issues for clinics over next three years.
Major Competitor Profiles
Summary
Tables:
- Ranking of top 21 IVF clinics, by no. of cycles performed: 2002 & 2006
- Ranking of top 21 IVF clinics, by estim. no. of cycles performed in 2008,
2008 estd. revenues
Descriptions of activities, specialties, mission, 2006-2008 revenues if available, address, for:
- Resolve
- Allan Guttmacher Institute
- Genetics and IVF Institute
- IntegraMed America, Inc.
Findings of 2006, 2007 & 1997 CDC Surveys on Assisted Reproductive Technology Success Rates
- Preliminary findings of 2007 survey: success rates, by age of woman, fresh
& frozen embryos from nondonor eggs, donor eggs, percent of clinics offering
services by type.
- Discussion/analysis of: type ART procedure used, pregnancy success rates,
ART cycles using frozen embryos, ART cycles using donor eggs, ART cycles
using nondonor eggs and embryos, success rates by women' s age
Extensive tables and analyses of 2006 report:
- Total no. of ART procedures performed, % by type.
- No. of infants born through ART
- Percent multiple birth deliveries
- Percent of ART transfers resulting in a pregnancy.
Text, analyses & discussion, tables covering these topics: (1996-2006 trend data) 86
- Is the use of ART increasing?
- Have there been changes in the type of ART cycles performed among women
who used fresh or frozen nondonor eggs or embryos?
- Improvements in % of transfers resulting in live/singleton births among
women using fresh/frozen eggs (by age group)
- Has the no. of embryos transferred in fresh non-donor cycles changed?
- Has the no. of embryos transferred in each ART cycle changed for women
under 35?
- Have there been improvements in ART success rates by no. of embryos
transferred?
- Has the % of multiple-infant live births changed?
- Has the % of singletons, twins and triplets or more changed for ART cycles
using fresh non-donor eggs or embryos?
2006 survey Results (analysis and discussion of results)
- Where are U.S. ART clinics located, how many cycles performed in 2006?
- How old were women using ART in 2006?
- What types of ART cycles used in United States in 2006?
- Why are some ART cycles discontinued?
- How is the success of ART measured?
- What % of ART cycles result in pregnancy?
- What' s the risk of a multiple-fetus pregnancy?
- Using ART, what are the risks for preterm birth?
- Using ART, what is the risk for low-birth-weight infants?
- Do ART success rates differ by age of woman?
- How does a woman' s age affect chances of progressing through stages of ART?
- What are the causes of infertility among couples using ART?
- ow many women who use ART have previously given birth?
- Success rates for women who had both previous ART and previous births.
- Specific types of ART performed among women who used fresh non-donor eggs
or embryos.
- Success rates for couples with male factor infertility when ICSI is used?
- How many embryos transferred in an ART procedure?
- Is an ART cycle more successful if more embryos used?
- Is an ART cycle more successful if embryos transferred on day 5?
- How does the multiple-infant birth risk vary by day of embryo transfer?
- Risks of multiple-infant live birth for day 3 and day 5 embryo transfers.
- Success rates for women using gestational carriers.
- How is the clinic size related to success rates?
- Success rates for ART cycles using frozen nondonor embryos.
- Risk of having multiple-fetus pregnancy or live birth from ART cycles
using frozen nondonor embryos.
- Are older women undergoing ART more likely to use nondonor eggs or embryos?
- How do success rates differ between women using frozen donor embryos and
those using fresh donor embryos?
European ART Survey Data (from ESHRE)
- Total IVF and ICSI cycles reported for 30 nations, by type: discussion and
results, pregnancy rates, differences between countries, single/double/triple
embryo transfers, ART cycles per nation, % IVFvs. ICSI, trends, comparisons to
USA
- Preimplantation genetic diagnosis/screening in 13 nations.
Directory of 400+ Fertility Clinics in the U.S.
- Name, address, phone, fax, accreditation
The Fertility Drugs Market
- Summary of the global fertility drugs market: estimated size, key
competitors (Organon, Merck Serono, Ferring)
- Outlook and sales results from Merck' s 2007 & 2008 annual reports for
North America versus rest of world, outlook for Gonal-f and Pergoveris
- Estimated market share for Merck Serono, $ sales
- Discussion of increase in illicit drug market developing between buyers
and sellers
- Marketdata estimates of fertility drug sales: 1995 - 2009, four year
forecast.
Sperm Banks and Egg Donors
Sperm Banks
- Summary and discussion: number of U.S. sperm banks, typical fees, main
activities
- How the process works: requirements and screening of sperm donors, who
typical donors are, fees, contracts
- Estimated value of the market
- Market trends
- Major competitors: Cryos International Sperm Bank (Denmark), California
Cryobank - typical procedures and requirements of donors
Egg Donation
- Discussion of egg donors, fees, who they are, differentiated pricing
structure, estimated market value
Surrogacy Programs
Discussion of the need for it, mkt. size, fees, etc.
Tables
- No. of women receiving fertility services, by selected characteristics
(1995)
- Childless women and children ever born, by race, age, marital status (1998)
- Total US fertility rate (1960-1997), projected rates by age group (to 2010)
Industry Reference Directory
- List of adoption and fertility services industry trade groups,
associations, surveys, consultants, and other sources.
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