Monash IVF Group Limited (MIS.F) Earnings Call Transcript & Summary

Thank you for standing by, and welcome to the Monash IVF Group Limited FY '25 Full Year Results Announcement. [Operator Instructions] I would now like to hand the conference over to Mr. Malik Jainudeen, acting CEO. Please go ahead.

Thank you, Rocco. Good morning, everyone, and thank you for your time. And as Rocco said, my name is Malik Jainudeen, currently in the acting CEO capacity, and I'm joined by Andrew MacLachlan, who is the Interim CFO, as the Board and the company searches for a new CEO. It's obviously been a big year for Monash and the information presented today relates to performance in FY '25, key priorities going into FY '26. You would have noted early guidance comments for FY '26. And no doubt there's some interest in some of the comments we made on the incidences that were announced in April and June in addition to the announcement we made on Wednesday, which was on the completion of Fiona McLeod's independent investigation into the incidences. If you can turn over to Slide 4. So in late May 2025, we provided an update on guidance, guiding towards underlying NPAT of $27.5 million, and this was met as we achieved NPAT of $27.4 million. The updated guidance commented on weaker market operating conditions in March 2025 that worsened in April 2025 that was experienced in all geographic markets. You'll see later in the presentation that Q4 industry activity was down by 6%, which validated what we were seeing in our business. I'll speak further on the other points as we progress through the presentation. Over to Slide 6. Andrew will talk more on the financial outcomes, but ultimately, what we saw in the result was reasonably pleasing in the circumstances we experienced during the year. Revenue grew by 7%, which was largely driven by price. Notwithstanding domestic stimulated cycles were down, we delivered EBITDA growth in an environment where activity was down. That was a pleasing outcome. And again, considering a number of factors that went positive for the business, but there were also some elements that were weak, and we'll talk about that in a little bit. Margins were held again, activity was down and with the leveraged nature of this business, you'd expect there to be some margin pressure, so we did well to hold that. And commenting on the inflationary pressures that we've experienced in the last 4 years, I think the majority of it has now subsided. The Board decided not to declare a final dividend for FY '25, and that was largely on the back of earnings in the second half, cash flow generation in the second half. And we're still focused on our strategic intentions going forward, and it was just a prudent decision to defer the dividend declaration. And the Board has an intention to recommence subject to performance in the second half, particularly delivery of the guidance that we will talk about later. Turning over to Slide 7. I'll touch on most of these points as we progress through the pack. I've commented that STIM cycles were down by 5%. Much of this was experienced in the Victorian business. We've clearly lost market share in that state, and we're working towards improving that business and ultimately be more competitive with our service offering in what is a tough market. On the back of that, our market share declined by 70 basis points, and much of it was in Victoria with some weaknesses in Queensland as well. If I speak on the industry, it's been pretty resilient. I think we're all aware of the macro conditions, cost of living and for the industry, it declined by close to 2%, wasn't a bad outcome. But if you do look at Q4, it was down by 6%, and that was consistent with what we had anticipated when we updated guidance in May. The company's domestic new patient registration, which is a good lead indicator going into next year, was down 7% for the full year, and much of that again is in the Victorian business. Just touching on pregnancy rates. We obviously stand on what we can deliver from that perspective, and it increased by 20 basis points to 40.3%. Clearly, our scientists have done a good job in terms of ensuring that our pregnancy rates are still solid. I'll speak to ultrasound genetics-based surgery and international as we progress through the slide pack. Over to Slide 8. Again, just some information on the industry. You'll see that the industry has declined for three of the last halves. For the last 18 months, there's no doubt been some consumer sentiment weakness and cost of living pressures that have clearly impacted the sector. But the way to look at this is consumer sentiment has started to improve in the last 6 months. Interest rates reduced recently. There's probably more to come. The way the pipeline works in IVF is patients making decisions 9 to 12 months ago are those that are cycling today. So on the back of improvements on consumer sentiment, we'd assume that the industry will return to growth in the medium term. If you look into the data, what were the weakest markets, Victoria, Queensland, South Australia in the first half, and those are the company's three biggest markets. So naturally, it has had an impact on our performance and our activity. But what's also important to note, and if you look back at the last 15 years of Medicare data, it's not uncommon for the industry to experience volatility. And in periods of negative growth that comes out of that, it returns to growth in the short to medium term. If we turn over to Slide 9, Again, stimulated cycles down by 5%. The industry declined by close to 2%. Naturally, our market share declined by 70 basis points. Our frozen embryos are pretty strong, up by 7%, and that's an indicator of patients returning for subsequent treatment and utilization of the embryos. And I'll hand over to Andrew right now to take us through the financials, and then I'll come back to talk through some more operational matters.

Thanks, Malik, and good morning, all. I'll take you through the detailed financial results and then hand back to Malik, as he said. So if we start on Slide 11 on the P&L summary. As Malik has mentioned, the group delivered on its updated earnings guidance and delivered an underlying NPAT of $27.4 million. In the appendices on Slide 31, we've provided a detailed reconciliation of our statutory to underlying results. Our underlying EBITDA of $66.3 million was an increase of 5.6% on the prior year, largely due to the contribution from the Australian IVF business. As Malik has mentioned, EBITDA margins remained largely flat with the prior year at 24.4%. Going forward, we see margins benefiting from ongoing efficiency programs, the introduction of a new IVF patient management system and volume leverage. Underlying EBIT was $43 million, in line with the prior year, which reflects the higher D&A costs related to the full impact of the group's infrastructure investment in new facilities at Cremorne, Gold Coast and Singapore as well as leases on existing premises. The group statutory NPAT was $25.7 million compared to a loss of $5.9 million in the prior year, which reflected the impact of the class action settlement. On the next slide, Slide 12, we've set out a revenue bridge here, which highlights the key movements that help explain the year-on-year growth of $16.9 million or 6.7% from $255 million in '24 to $272 million in '25. The domestic IVF business contributed $6.5 million in additional revenue compared to '24 due to price increases linked to inflationary cost pressures and a full year contribution from Fertility North in Perth, and that more than offset some of the softer industry volumes and market share performance in Victoria and Queensland that Malik mentioned. In our international business, we reported revenue growth of $2.1 million on higher revenue mix, which more than offset volume declines due to macro factors and increased competition. We also reported pleasing growth of $8.3 million across our ultrasound, day surgery and genetics businesses, reflecting positive scan mix in ultrasound, the full year impact of our new day surgeries in Cremorne and Gold Coast, together with high genetic testing volumes. If I turn then to the EBITDA analysis slide on Slide 13, we've provided a bridge here to illustrate the movements year-on-year. So our underlying EBITDA grew from $62.8 million in '24 to $66.4 million in '25, largely due to an increased contribution from the Australian IVF business, which grew by $3.6 million. This was largely due to positive net price inflation, a full year contribution from Fertility North and cost base alignment measures, which more than offset the impacts of industry contraction and a small loss of market share. Other factors which contributed to the growth in '25 underlying EBITDA in total were only about $0.1 million, with small contribution increases from the international business of $0.2 million, which was partly offset by small declines in EBITDA across day surgeries and ultrasound as we saw the impact of fixed cost inflation, coupled with lower utilization rates than expected. Reported EBITDA of $65.4 million for the year compared to a prior year reported EBITDA of $13.2 million as the prior year was significantly impacted by the class action again. I'll finish with this next slide, 14, which summarizes the group's capital position as at 30 June '25. Our operating cash and free cash flow were both adversely impacted by payments made as a result of the class action settlement, which amounted to $39 million net of the insurance proceeds. Excluding the class action payments, our operating cash flow conversion was 86%, down on 103% in the prior year, largely due to timing of creditor payments. And we'd expect operating cash conversion to be in the 90% to 100% range in FY '26. CapEx for the year was $14.5 million or 5.3% of revenue, reflecting newly completed infrastructure projects in Singapore and ongoing spend on the new Brisbane clinic, which we expect to complete in late second half '26. We also invested in new lab assets and upgrades across all large domestic IVF clinics. Our CapEx in '26 is expected to be around $15 million. Whilst our leverage ratio increased to 1.7x as a result of the class action payments, it's still comfortably within our debt covenants, and we expect to generate positive free cash flow in '26, which should see our leverage remaining relatively flat. I'll now hand back to Malik to continue with his comments.

Thank you, Andrew. So I'm on Slide 16 at the moment. So as previously announced, the company became aware of two adverse events at its Brisbane and Clayton clinics. It should be noted that they were unrelated, different in nature and occurred many years apart. And what was important was that the Board commissioned King's Counsel Fiona McLeod to investigate what was the root cause analysis of the incidents. And as was announced on Wednesday of this week, the Brisbane incident was due to human error and the Clayton incident was due to a combination of human error at multiple stages of the process and patient management system limitations for a treatment type that is rare in the business whereby an embryo of a patient was transferred to them as opposed to their partner. In regards to recommendations that were made by Fiona McLeod, many were already implemented post the company's own internal investigation, and the company is committed to implementing the remainder of those recommendations that have been provided by Fiona McLeod. We've spoken about this a little, but this is continuing in our business. We've implemented interim safeguard measures over and above what is industry best practice in IVF, and this includes enhanced nursing and scientific protocols, additional verification steps and patient confirmation safeguards, and initial feedback from patients is that they understand these extra measures and understand the reasons for the extra checks. Our nurses and scientists continue to be trained and kept up to date with human material custody and witnessing checks that occur in our business, including the use of the new Matcher Electronic Witnessing system. In regards to the actual Fiona McLeod report, this has been provided to the Victorian regulator. The report has been made available to the Queensland government and regulator and the report has been made available to the IVF industry accreditation body being RTAC, who provides accreditation for all IVF providers in Australia and New Zealand. In regards to the federal government, the report will be made available to that government agency as well. I do have to reiterate that the company cannot release the report to the public as the privacy of the patients impacted by the incident is critical. And I have to say that it's paramount to looking after the patients impacted. At the same time, as an organization and me personally, we obviously can't explain the sadness that this may have caused the patients, and it's obviously had a profound impact on the people within the company. In regards to the business performance, there's questions about what the incidents may have impacted the business. But again, it's early days. We look at a number of key metrics and nothing has come to our attention at this stage in terms of adverse impact on those metrics. Our fertility specialists remain in the business. New patient registrations are down, and we've spoken about it being down for all of FY '25 as well as the second half, and that trend hasn't changed. And I think we'll get an opportunity to talk about it more at the AGM as we get better visibility of what's happened in the first half of this year. We turn over to Slide 17. We're obviously highly focused on attracting fertility specialists into our business. We've called out that we've got 132 specialists, and that continues to grow. And you've seen the trend over the last 5 or 6 years in terms of our ability to attract clinicians into the business, and that will be a heavy focus for us. Retention, obviously, critical in this environment, and we're working closely with our clinicians to meet their expectations. We're pretty excited by the Brisbane new facility that's being built that Andrew mentioned. It is a new fertility clinic. It's a day hospital that's integrated into that facility. It will be ready in late FY '26 and the value proposition for our patients, our doctors and our employees will be significant and improve their experiences with the organization. Speaking to the day hospital businesses, they are improving and the key success to those operations is utilization of theaters, obviously. Cremorne came on board towards the back end of last year and the full year impact of it of this year has been negative as it ramps up to a utilization that gets us to beyond breakeven. And our focus is very much on attracting non-IVF procedures into those -- into that -- into those theaters, which will obviously naturally improve earnings, and we've got some traction on that we can talk about later in the year. If we go to Slide 18, success rates, obviously, are critical to our business in terms of our value proposition to our patients and doctors. You'll see that in the period January to April 2025, it's at 40.3% for women under the age of 43, and that's a 0.2% or 20 basis point increase, critical to our business and something that we will obviously keep focusing on. Just talking about a couple of things that we're doing in the space, the mitoHOPE project with the university being Monash University is a landmark partnership for the organization and it's hopefully assisting patients who have mitochondrial issues and disease. The Symex project is an exciting initiative that will hopefully create a wearable fertility tracker. They may reduce certain aspects of the fertility journey such as the number of blood tests or any blood tests that are required whilst you're in cycle. The Felix clinical trial, which is all about automation of finding suitable sperm as part of the process, is continuing with another listed organization called Memphasys and is getting closer to commercialization, which is pretty exciting. Turning over to Slide 19, and there's been a lot of commentary about electronic witnessing at Monash and within the industry. I just wanted to call out what we utilize in the business, which is a technology called Matcher witnessing. It's fully rolled out in our Australian business, which actually commenced in early 2024. Clearly it will strengthen safety and traceability of human material and reduce the risk of sample mismatching. I do have to say that electronic witnessing is obviously a critical important safeguard in the business and remains a vital part of risk management in our laboratories. But at the same time, it has constraints, and it's critical that we have a highly skilled embryology workforce to manage that type of technology to ensure that it is operating in the best way that it can. Over to Slides 20 and 21, just briefly touch on a few things. The ultrasound business was mixed in terms of performance. Melbourne performed well. Sydney performed weaker than expected. And there hasn't been many years where both of them are positive at the same time. So you've seen that Melbourne is positive, Sydney has gone backwards. If we talk about genetics, genetics and PGT-M cycles and reproductive genetic screening is all part of the strategy of increasing patients that will ultimately have PGT-M stimulated cycles within the business. During the full year, PGT-M was down by 9%. But what's important to note is that the second half was up by 23%. So there's a little bit of traction in terms of activity and patients seeking prevention of disease through reproductive genetic screening that is now available through Medicare funding. You would have seen some data, at least in the presentation or through Medicare that reproductive genetic screening testing in the industry is pretty strong. I think there's been about 140,000 annual tests that have occurred, and we expect that to convert to PGT-M cycles in due course. Some of the data is indicating that close to 60% of the testing is for patients between the age of 25 and 34. So it will take a bit longer for that age cohort to convert to IVF treatment, but we'll continue to monitor that, and we think that's a long-term tailwind into the business. Slide 22, just talking on the international business, challenging in the second half. We talked about a strong Asia business in the first half, and we've seen some weakness in the second half. In saying that earnings in Asia was up by -- was up compared to last year, although cycles are down by 6%. Earnings was improved or enhanced on the back of higher average revenue per cycle. And I think we're well placed for stronger performance in FY '26. Singapore was disappointing. We were impacted in the Singapore business on the back half of the first half as we were moving to a new facility. The second half was not as strong as we had anticipated, and we think that's largely due to macro conditions. We're hoping that, that will subside in the short to medium term. Just turning over to Slide 24. And I'll quickly take you through our focus as an organization into FY '26 and beyond at this stage. And we've got eight key pillars. First one is all about doctor retention and attraction clearly remains a critical element of the business in terms of growth. In the current environment, we see the best opportunity for stability in the business is retention of our clinicians and to continue to work and grow the pipeline of clinicians to bring into the business. We think that's still highly possible with where the business is at the moment. IVF fundamentals have not changed. And given our market position with over 20% market share as an organization, we're turning our attention to converting what demand there is at the moment on the back of those IVF fundamentals and what we see as improvements in consumer sentiment in the short to medium term. And our conversion activities are very much focused on getting patients through into the doctors' rooms and then through into treatment. There are parts of the business that have been challenged in the current macro conditions and have underperformed. But I do say that the Board and management are aligned in how we're going to move forward considering the incidences and any potential impact from the incidences. But our focus is on regaining trust on the back of what we are is a high-quality IVF provider. I call out digital transformation as a critical element in improving our value proposition in an IVF setting whereby change is continuing to occur, and we are recognizing that we have to adapt at a quick pace in what is ongoing changes to structural elements of the IVF sector, and that's whether it's changes in segments of patients that require our services and whether there's changes in the regulatory environment. And I know there's been a lot of commentary about it, and we're very much apply national approach to regulation in this country. Our patients, our doctors, our employees probably have never had higher expectations from providers like us, and we'll focus to continue to improve our value proposition to all those key people. Risk and governance, obviously heightened in the current environment. I have to say that human error is a medical malpractice type that occurs in health care. We have to minimize the risk of this, and that's where we're focused. Much of this -- the risk enhancement is around utilizing technology to place more control in some of our systems. And at the same time, we'll drive high performance with our people in the business through expectations. I've spoken about genetics, which is an important part of our strategy going forward. Our Asian business, we're in a stage of consolidation. We see the positivity to what we can get out of the Singapore and KL, particularly on the back of the KL experience that we've had over the last 10 years. So we're still heavily focused on growing in that part of the region. If we turn over to the next slide, I'm just going to touch on guidance. And the company is expecting underlying NPAT of between $20 million and $23 million in FY '26. We've called out that new patient registrations are down by 10%, and that's reflected in what we're seeing and what we're commenting on guidance. In terms of patient pricing, we've called out that we have deferred that, and that's in Victoria, Queensland and New South Wales, and we see that as a prudent step to take in the current environment, and we'll reconsider that decision in due course during the year. And I'll also provide some more update on performance potentially at the AGM, which is planned to occur at the end of November, and we'll provide more clarity on first half performance and any impact from the incidences on the business. In closing, I'd like to acknowledge the people in Monash IVF, including the company's doctors and employees who have experienced an environment that has been challenging for everybody. But I have to be honest and say that I'm really excited about what we can achieve together and where we can take this business going forward. Thank you, Rocco. That's the end of the presentation. And I think we'll turn our attention to Q&A.

[Operator Instructions] Today's first question comes from Craig Wong-Pan with RBC.

Just looking at the number of fertility specialists in that second half, I noted there was 1 added, but 5 departed. Could you just provide any color as to the reasons for those departures?

Craig, those departures are trainees and retirements. So we've had 3 or 4 retirements in Queensland, and that's hurt us a little bit from a market share point of view. So that's the gross impact of a net -- a growth of 3 doctors.

Okay. And just looking to FY '26 or even '27, is there many retirees that are due to occur in that period?

It's not unusual. See, on average, if I look back in the last 10 years, we would have at least 2 to 3 every year. I'll have to look at this, but I don't think we'll have any more than maybe 1 or 2 next year, if any. But I don't think it's unusual to have 2 to 3 every year.

Okay. And just on the guidance, thanks for providing the NPAT guidance this early in the year. Just wanted to see if you could provide any indication of what your leverage ratio might be under that -- sort of within that guidance range. I kind of -- my back of the envelope is that it gets to sort of 1.9x. Is that sort of in the ballpark of where it could get to?

It's Andrew MacLachlan here. I've made some comments in my section that we expected leverage to remain largely flat with where we ended in June '25. So that was at the 1.7x.

And our next question today comes from David Stanton with Jefferies.

Yes, I agree with Craig, thanks very much for giving guidance this early in the year, and I'm going to ask a few questions on it. Just very broad brush, volume decline that's implied in guidance to get you to that '23 number. Is there any at all? And if so, what are you sort of thinking?

Dave, I'm not sure if I got your whole question, but I'll just talk to the buildup of guidance. We called out the 10% reduction in new patient registrations in the second half. And we're assuming that type of impact on activity will continue in the second half, but we'll comment on that at the AGM as we'll get more insight into new patient registrations over the next few months. Pricing circa $1 million to $2 million impact on full year earnings, assuming we don't move on pricing until the second half. Interest and D&A will probably be another $1 million to $2 million. So you wrap that up, that takes us to the $27.5 million that we've done in FY '25 through to, call it, the midpoint of guidance.

Understood. So very broad brush, it's fair to say that you might see within guidance, you've got the same scale of volume decline in '26 that you saw in '25?

Yes, in the first half -- it's Andrew here. That's right. We do expect that with consumer sentiment improving through the first half off the back of some more rate reductions that we'll see some improvement in the second half, not significantly, but some modest improvement in the second half. And we also see some of the cost efficiencies that we're working on helping the second half as well in particular.

Understood. And last one for me before I get back in the queue. So it's fair to assume that there will be a decent second half split in terms of profitability, at least in your view?

Yes. As Malik said, we'll provide some more guidance on first half, second half at the AGM once we've got a few months under our belt.

And our next question comes from Rachael Harwood at Macquarie.

Just first one again on guidance. So I guess you said that you're expecting to kind of return to mid-single-digit growth in the medium to longer term. I guess should we think about kind of FY '26 kind of resetting the base and then some growth into '27? Is that how we should be thinking about it?

Yes. Rach, that's right. Assume FY '26 as a base, delivering within that guidance range. And then we're thinking high single-digits growth from that point in time. And we need to see how the environment plays out for us over the next 12 months. And as Andrew said, I think at some point, we'll provide more color on expectations even beyond FY '26.

Perfect. That's great. And just another one, I guess, on doctors. You did do a great job this year of recruiting another 11 kind of new doctors. Could you maybe just talk to how you're finding existing doctor engagement at the moment?

Yes. I think I'd be lying to say that the incidence has had an impact on engagement with clinicians. But I think as a business, we've done a great job to keep them informed. Many, if not all of them, are supportive of decisions made by management in terms of how we're responding to the incidences. And I think engagement with them is all about keeping them informed about things that are happening every time we have some media noise that we have to manage them the right way. And I think that goes a long way to ensuring that they're highly engaged. And ultimately, the thing at the top -- close to the top of the agenda is focusing on our doctors.

That's great. Just last one for me. Just on that new patient registration number, I mean, could you maybe just talk to key drivers? Do you think it's kind of the macro or Victoria just being a little bit weaker? Or do you think it is a little bit of an impact from the incidents?

It's early for us to conclude on the incidences, Rachael. As I said or Andrew said earlier is that nothing has come to our attention that is indicating anything different in the pipeline prior to the incidences. I spoke to how the pipeline works from a sentiment point of view that it's a 6- to 9-month type time frame to see the impact of certain things in these types of businesses. So we'll keep looking at it. We'll keep monitoring it. And every time we get an opportunity to speak publicly, whether that's at the AGM or half year, I'm sure we'll provide updates.

And our next question today comes from Patrick Cockerill with Ord Minnett.

Just one on the sustainable efficiency program you guys outlined at the first half results. Following the incidents in the second half, how should we think about these targets? And is there any change to them or to the time line?

Tom (sic) [ Patrick ], yes, so we spoke about -- I think it was 6 or 12 months ago about implementation of a new patient management system as well as some other cost initiatives, and we called out 200 basis points is the opportunity that we see we can get out of it within a 2-year period. I don't think those aspirations have changed. We're looking to fast track digitization within our business and the patient management system is a big lever for margin improvement in the business. And it's not just about margin improvement. It's about patient doctor staff experience as well. We're not putting a cost through that aspiration, Tom (sic) [ Patrick ].

The only other thing I'd add is -- sorry, Tom (sic) [ Patrick ], it's Andrew here. The only other thing I'd add is we do see some procurement opportunities as well in the business. There's some large suppliers that we see some opportunities to drive some better efficiencies through that as well.

And then just one more from me. You've noted the deferral of the pricing in Australia. How should we be thinking about that over the medium term?

The intention is still, and we think it's very possible that 3% type increases in line with inflation indexation, Tom (sic) [ Patrick ]. I think that's -- I can't see why from an IVF fundamental point of view, that can't be achieved.

Thank you. There are no further questions at this time. I'll now hand back to Mr. Jainudeen for closing remarks.

Thank you all for your time today, and we'll see a lot of you on the road over the next few days. Thank you very much.

Thank you.

Thank you. That does conclude our conference for today. Thank you for participating. You may now disconnect.