Spire Healthcare Group Plc · LSE:SPI
Spire Healthcare — Investor Presentation (February 2011)
41 slides from Spire Healthcare's investor presentation, Feb 12, 2011
Slide 1: Spire Roding Fertility Services
Spire Roding Fertility Services Mr Anil Gudi MBBS, MD, MRCOG Mr Amit Shah MB BS, MD, MRCOG
Slide 2: Full range of fertility services through Spire Roding
•March 2011 •Full range of fertility services through Spire Roding •Spire concept of fertility- fixed price private care •Provides advanced fertility care close to patients with the option of east London or Harley street
Slide 3: Age and fertility - Ovarian aging
Age and fertility-Ovarian aging Ovarian reserve testing Post 1960s Increasing age and delayed motherhood
Slide 4: Live Birth Rate and Ovarian Ageing
Live Birth Rate and Ovarian Ageing 16 % 12 live births / cycle 8 4 20 30 40 AGE
Slide 5: Miscarriage rate by age
Age (Years) Total Number of Miscarriage Rate pregnancies 20-24 350,395 9% 25-29 414,149 11% 30-34 235,049 15% 35-39 93940 25% 40-44 25132 51% ≥45 1865 75%
Slide 6: Number of conceptions reaching each stage of pregnancy
3 I Number reaching stage & | nN “ Conception Implantation Recognised Fetal Livebirth pregnancy stage Figure 1: Number of conceptions expected to reach each stage of pregnancy* Se Spire Healthcare
Slide 7: Delayed wish for conception
Delayed wish for conception •Career women •Financial considerations •Single women •Late desire to have a baby
Slide 8: How old is old in fertility?
How Old is old in fertility ? How do you define ovarian ageing?
Slide 9: The Aging Ovary
The Aging Ovary Birth 1-2 million germ cells Menarche 300,000 follicles 35-37 years 10,000 - 25,000 follicles 50 years 1,500 follicles Menopause +3 years 0
Slide 10: Egg count, age and fertility stages
Egg count, age and fertility stages Birth Maximum fertility Declining 1000,000 Fertility End of Fertility 750,000 Eggs (N) 500,000 r ty be u 250,000 ↓) P(75%↓ ↓ 90%↓ 0 10 20 30 40 Age 36y IVF success Critical point
Slide 11: Fertility on Parallel Curves, Suggestive of POA
Fenility on Parallel 4 Curves, Suggestive of , POA 1 Spire Healthcare badig Tm
Slide 12: Spire Healthcare
Se Spire Healthcare
Slide 13: Diminishing ovarian reserve - symptoms
Diminishing ovarian reserve -symptoms •Shorter follicular phase •Premature LH surge, ovulation •Early luteinization •Poor response to stimulation
Slide 14: Predictors of ovarian reserve
Predictors of ovarian reserve Static Age Day 3 FSH Inhibin B AMH Antral follicle count
Slide 15: Predictors of ovarian reserve: dynamic
Predictors of ovarian reserve Dynamic Clomiphene challenge GnRH agonist test Poor or absent response to FSH
Slide 16: Reliable ways of predicting ovarian reserve
Are there reliable ways of predicting ovarian reserve •Antral Follicle count •Anti-Mullerian hormone
Slide 17: Follicle distribution in the human ovary
Follicle distribution in the human ovary Hansen, K. R. et al. Hum. Reprod. 2008 23:699-708
Slide 18: Follicular development in humans
Follicular development in humans The wastefulness of sexual reproduction: AMH Paracrine Control Endocrine Control DAILY FSH and LH Dependent Ovulatory Initiation Environmental 20 mm Factors Dominant 1st year 12 mm 200 Small Antral Age 16y 2-5 mm 80 Age 40y 3 Atresia Recruitment I Growth Menstrual cy
Slide 19: Anti-Müllerian hormone
Anti-Müllerian hormone β superfamily: Müllerian duct regression in male (TGF-β embryos) Maximal expression occurs in preantral and small antral follicles1,2 Expression disappears in maturing pre-ovulatory follicles (expression restricted to GCs of the cumulus)2 Circulating concentrations consistent
Slide 20: AMH and action
AMH and action y — Clale Q primordial _preantral antral Se Spire Healthcare
Slide 21: Mean serum AMH levels and the menstrual cycle
Mean serum AMH levels and the menstrual cycle AMH and the menstrual cycle: re LH peak Values are (generally) consistent across the menstrual cycle La Marca A et al. Hum. Reprod. Update 2010;16:113-130
Slide 22: Validated AMH-age nomogram
Log scales The curve of decay of Validated AMH-age AMH through the reproductive years is nomogram best described by a Power model, or a Quadratic curve 25 This precisely 750 20 matches that of the 500 15 PFP decay of NGFs 250 10 5 10 20 30 40 Age (years) 0 25 30 35 40 45 Age (years) Nelson et al. Fe
Slide 23: What environmental factors influence AMH levels?
What ‘environmental’ factors influence AMH levels? smoking Recoverable?? Radio / chemo therapy Permanent Post 20 Pre (2m) Pregnancy Pregnancy 15 10 1 Recoverable 5 2 3 Pituitary suppression: Recoverable “down-regulation” for > 3 months Recoverable Hormonal contraception: We know of no way to increas
Slide 24: Antral follicle recruitment by FSH: Age and AMH
Antral Follicle recruitment by FSH: Age and AMH 4 Follicles recruited per day Age Follicles/day 3 2.9 to 1.1 n 2 Differential per day 1.8 1 NB. The normal AFC of a woman in her 30s is ca 12. <30 30–36 37–39 40–45 Therefore < ¼ of all follicles Age seen can be recruited. group There is no follicular
Slide 25: Chances of success - important factors
chances of success – Important factors •1- AGE •2-AGE •3- AGE •4- AGE •FSH,E2,AMH ETC
Slide 26: Role of waiting for normal baseline FSH
Role of waiting for normal baseline FSH High fsh Low fsh • Mean days of • Mean days of stimulation 15.4 stimulation 16d days • No of oocytes 4.5 • No of oocytes 4.2 • LBR 12% • LBR 5.1% Human reprod 2006,abdallah
Slide 27: Spire Healthcare
Spire Healthcare
Slide 28: Oocyte banking
Oocyte banking Biology unfair to women! Men at big advantage. Slow-rate of freezing of oocytes -extracellular & intracellular cystallization of ice causes irreparable damage to spindle. - eggs are particularly sensitive to chilling injury
Slide 29: Oocyte vitrification
Oocyte vitrification Rapid freezing -- less tortuous than slow freezing -- avoids intracellular ice crystallization -- less expensive - less time consuming Eggs in highest concentration of cryopreservative for < 60 seconds -
Slide 30: Oocyte vitrification outcomes
Oocyte vitrification Survival rates of oocytes >90% Fertilization rates 75-90% Pregnancy rates/ET 32-65% Live-birth rates >50% Homerton is the only NHS unit with a live birth from oocyte freezing in the UK Katayama et al, 2003;Kuwayama, 2005,2007; Stehlek et al ,2005;Selman et al,2006;Al-Hasani et a
Slide 31: Egg Donation
Egg Donation • Realistic option • Ethical and personal reservations • UK? • USA ($5000 payment) $10000 to 25000 offered!!!
Slide 32: Conclusion
Conclusion •Age continues to be the most important predictor of successful fertility outcome •AMH and antral follicle count are the best indicators of ovarian reserve •Over the age of 40 ,ovarian reserve predictor tests have limited value •It is important to be realistic about chances of success of
Slide 33: Launch on 28th February 2011: services offered
•Launch on 28th February 2011 •Services offered led by Mr Shah and Mr Gudi »Ovulation induction »Advanced fertility investigations »Reproductive surgery » Super ovulation and IUI »IVF/ICSI »Male infertility management »Egg donation »PGD and PGS for genetic abnormalities
Slide 34: Amit Shah and Anil Gudi
• Amit Shah • Anil Gudi • Consultant at • HFEA person Homerton Fertility responsible at Centre and London Homerton Fertility Fertility Centre Centre and Consultant at London Fertility Centre Working together as spire fertility team Nursing and counseling support
Slide 35: Spire offers entire range of treatment
Spire offers entire range of treatment Except for final part of treatment patients can access all treatments and commence treatment
Slide 36: Arrangement of satellite
ARRANGEMENT OF SATELLITE Spire Healthcare - | SAU]
Slide 37: Fixed pricing and packages
•Fixed pricing •Packages from 1st appointment to treatments •Avoid multiple costs and a clear pricing structure • Quality with excellent proven success at Homerton and LFC
Slide 38: Fertility assessment package pricing
•Fertility assessment package (2 consultations , 2 scans ,ovarian reserve tests and semen analysis) £650 (£1033 with out package) •Cycle tracking with 2 scans and blood test £249 ( £408 without package) •Super ovulation with cycle tracking With 3 scans and a blood test £349 (£612 without package)
Slide 39: IUI, IVF and ICSI costs
IUI, IVF AND ICSI COSTS • IUI £650 • IVF £3275 • ICSI £3550 Plus medications (£1000 to £1800) – includes, anesthesia, blastocyst culture.
Slide 40: Local treatment and referral
•Local treatment •Personalised care with individualised protocols •Referral to the fertility services- Mr Anil Gudi or Mr. Amit Shah at the Spire Roding hospital
Slide 41: Early investigation and full range of private fertility service
•Infertility is often caused by a disease but fertility is a desire •Early investigation with specialists and treatment often helps patients •Spire offers a full range of private fertility service with excellent success rates at London Fertility Centre and Homerton Fertility Centre
Spire Healthcare Group — Investor Presentation (February 2011) on 6ix