2026.09.29 | TB | MedTech | IVF Expert: Kitazato & Vitrolife

Client-led • 18 Sep 2026

Companies: 368A JP, VITR SE

Expert CEO at a Spain-based Diagnostics Firm

Agenda

• Around five years' experience in the IVF & ART (assisted reproductive technology) industry, focusing on non-reproductive genetic testing
• Deep insights into the industry's competitive landscape, including Vitrolife, CooperSurgical, Nexpring Health, Irvine Scientific, Cook Medical and Hamilton Thorn
• Knowledgeable on the commercial relationship between Kitazato, Dibimed and Ivirma, including distribution arrangements, purchasing concentration and pricing implications
• Well-placed to discuss Vitrolife’s strength in IVF culture media, including its premium positioning, product quality, pricing power and market presence

Questions

00:03:59] We've done quite a lot of work around Kitazato. We're trying to understand the partnership with Ivirma and Dibimed. Our understanding is that Kitazato sells exclusively to Dibimed in Europe and the US. Can you give us some of the background and how that came about?

Expert [00:05:46]: Kitazato started as a company focused on vitrification. Vitrification is the process to preserve under very low temperatures cells like oocytes, embryos and sperm. Also it is not using sperm because there are so many sperm cells inside a sample of semen that conventional freezing is used. Conventional freezing kills around half of the cells. That's why it is not used in oocytes and embryos. Kitazato developed a very great quality vitrification technology covering the media that is the liquid, the hardware, the consumables, it works very well, very high survival rate and easy to use, which is the most important reason why Kitazato is the most used choice and the preferred choice for vitrification because it is easy to use. Vitrification is the process, in the step, that is most difficult for an embryologist because if done badly, they can kill the cell. They can kill the oocytes or the embryo. As you can imagine, it has a huge impact. When vitrification started, if I remember correctly around 15 or almost 20 years ago, Ivirma was really interested into this new technique. They created a joint venture called Dibimed to sell in Europe to Ivirma clinics, but also to other clinics to sell the vitrification technology.

Dibimed is a distributor of Kitazato products. It is led by Ignacio Bermejo. They are based in Valencia, and it's a small team, around 20 people, more or less. Then what happened later is that the company grew up, they gained regulatory approvals, licence and so on. Then Ivirma started to grow either by creating new clinics or acquiring clinics. Later, Ivirma was acquired by KKR, a private equity fund that merged Ivirma together with Genera and other networks. What they decided because they are finance-oriented shareholders is we need to increase the value of the company. Let's implement the synergies. Besides revenue synergies, there are cost synergies. One of the main cost synergies is to concentrate all the purchasing into a single supplier in order to obtain better price and that was Kitazato, thanks to the Dibimed distribution. You might be aware that doctors have a huge ego, sometimes they don't want to switch the practice. It's an exercise that has resistance to change that is being implemented.

In theory, Kitazato must be the single supplier for vitrification, pipettes, embryo transfer catheter and needles, if I recall correctly, they offer also needles, but Kitazato can sell the products to other competitors. It's not exclusive. Other clinics in Spain, for example, they love Kitazato's vitrification technology. I think that if you are looking to understand the thesis if Kitazato price will grow, it depends more on the underlying growth of IVF market that is low. Cycles are growing between 2-3%. Kitazato in order to grow more than that, they need to grow by taking share from others.

I will not be worried about Vitrolife. I will be worried about Nexpring Health. Nexpring Health is a new company that has been created by merging three standalone companies, Cook Medical, Irvine Scientific and Hamilton Thorne. Kitazato competes with them in vitrification, legacy product of Irvine. In pipettes and embryo transfer catheter, legacy product of Cook. That was in a summary the answer to your question, what's the relationship with Ivirma and what's the region of Dibimed.

00:11:46] Do you think that there is any risk that Ivirma may switch suppliers away from Kitazato to someone else?

Expert [00:12:04]: No, for two reasons. One, because the high-quality products Kitazato is on great vitrification, (inaudible) catheter, and good terms and also the cost of switching. Once you have validated and gotten used to including the products in your operational procedures, it is hard to switch. There is a switch cost that must be compensated by either really great procurement terms of much, much better quality, which is not the case, no. I consider the risk of switching supplier in Ivirma as very low.

00:12:50] Do you think Dibimed being owned by Ivirma is negatively perceived by other chains in the market? It's similar to buying products from a competitor, potentially.

Expert [00:13:11]: Some could, yes. That's a great point. Not all of them because the reality is that Kitazato sells also outside Ivirma. Maybe they disclose publicly the split of revenue by Ivirma or other, I don't know. I don't have accurate information. That will be important to know. You had to be disconnected from a large chain in order to be able to sell to others. In reality, many clinics in Spain, they buy the catheters from Kitazato and the vitrification media. I will answer to your question. Yes, there may be some resistance, but it's not extremely high. It's not high, neither zero.

00:15:43] Do any other big chains in Europe besides Ivirma buy a lot of Kitazato products?

Expert [00:15:56]: I cannot say names, but I'm sure that many other chains are buying them.

00:16:05] Is Kitazato in a weak position as a supplier compared to Dibimed?

Expert [00:16:46]: Vitrolife had many distributors in the past. Now they have started to in-source and create direct sales team. Normally, distributors were managing regulatory approval. Regulatory approval is obtained by creating a complete dossier with all the evidence that the product is safe and there is enough evidence that is working well, high performance according to the claim specifications. The two aspects, safety and efficacy must be proven that is submitted to the competent authority. In Europe, Kitazato's products are classified as medical device. The competent authority is called notified body. They confirm that they meet the requirements and they issue the CE Mark. They provide the licence. In the UK, it's a very similar process, the UKCA. If Dibimed loses, for example, Dibimed goes bankrupt or whatever and they lose the CE Mark, Kitazato will need six months to obtain again the licence under the legal entity of Kitazato. The licences are owned by a legal entity, a society of limited responsibility normally.

One another aspect is that no regulatory approval is needed in Japan or very little. Japanese companies are not familiar with this process. They do not have internal capabilities called regulatory affairs to manage this process. They can always outsource that to an external consulting thing, which is also common.

Client [00:19:03]: Are you saying that it's quite common in the industry to have this setup?

Expert [00:19:21]: Yes.

Client [00:20:00]: Ignacio Bermejo's LinkedIn says that he's CEO at Kitazato/Dibimed. It looks like he considers himself a Kitazato as well as a Dibimed employee.

Expert [00:20:28]: Yes, that is right.

00:20:58] Do you think Kitazato would be considered an attractive acquisition prospect for Nexpring, Vitrolife, Cooper or one of the big players?

Expert [00:21:11]: Yes, especially it was considered for Vitrolife. It will be complex to integrate Kitazato inside a European company. Japanese management style is very different. It's not just the culture, the values, less extrovert, they are very introverted. It's also [that] the decision-taking process takes a lot of time, involving the entire organisation. That will be one of the main reasons preventing a European company to acquire Kitazato. On the other side, an American company, they are much more aggressive and also distributed. An American company could buy Kitazato and put under the management of American executive sent to Japan for living, relocated to Japan. The price is also high. It's a significant match.

Client [00:22:39]: Yes, it's a few hundred million. Kitazato's valuation looks very low compared to Vitrolife or Cooper, considering its earnings.

Expert [00:23:00]: I'm looking at it right now. EBITDA is low, yes. Now I can understand why you consider this as an entry point in Kitazato. Now then I think why the valuation fall below? Is there a management problem? Is there low growth forecast? I'm not sure, honestly.

00:23:36] Why has Kitazato given a very low growth forecast of around 4% for this year?

Expert [00:23:59]: The sector is growing around 2-3%. You need to understand also that the growth of IVF treatment is driven by the number of patients, but also there is a negative factor, a headwind that is the increase in the success rate. Clinics are trying to minimise the amount of attempts needed to get a baby born. They are trying to increase the success rate. That means less use of products by clinics. If, for example, they reduce on average the number of cycles needed by 10%, that means that with the same patients, they are using 10% less products from Kitazato, Vitrolife and so on. That is affecting a lot the growth rate of the suppliers of Vitrolife, Kitazato, Cooper, the entire industry. At the same time, also couples are infertile and there is a huge demand for IVF. Many couples are only going for one kit instead of two or three as before. That is also negatively impacting, that results as a consequence in a forecasted growth of the IVF products and services market between 2-3%.

If they forecast 4%, I'm doing a search and there is also some consensus on a forecast between 4-6%, that means that they are growing at the market level, plus some share gain, which makes sense because they have a very great portfolio, doing a great exercise in expanding portfolio. It will not be possible to grow at 10%, even 20% not possible. It's not a growth stock.

00:26:14] Do you agree that the cryopreservation or vitrification part of the market should grow faster than the overall market?

Expert [00:26:37]: Yes, because of the adoption of vitrification, not all cycles were using vitrification or not all samples and cells were frozen, but it's now arriving to a failing. It was highly growing 5-6 years ago, and now it's much more stable. It was an innovation and now it's widely adopted. Instead of 2-3%, it can grow between 3-4%, maximum 5%, but not more.

00:30:47] Do you think that Dibimed is a good distribution partner for Kitazato, especially outside of Ivirma for other clinic chains?

Expert [00:31:17]: Good question. The question is, how active and commercially aggressive are they promoting the products outside Ivirma? It's true that they are less active than others that could be, for example, EMB that is a distributor in Spain of IVF products or other distributors. You're right. It's a subjective evaluation, it's not a fact, but yes.

Client [00:32:00]: It just surprises me that Kitazato hasn't invested more in distribution.

Expert [00:32:11]: That is Japanese culture. Sony, Philips, they don't sell their products. They make very great products, Japanese quality and they rely on distributors. it's normal. Even still, I will consider Kitazato as a small, medium enterprise. The CEO is a previous engineer of the company that still gets involved in some projects. They don't have a corporate structure. They went public, if I remember correctly, around three years ago. They have a potential to evolve, but it's not a company with separate commercial network, I assume.

00:33:11] Do you think Vitrolife is interesting again at this point? I know it had issues with a few different things. How well would you say it is positioned for growth currently?

Expert [00:33:53]: Same growth as Kitazato, not more. The good thing about Vitrolife is that they have a huge margin on profits. They are offering quality products able to charge a premium price. The current valuation multiple is around 14x, which is aligned with other multiple. It's much lower than the historical average of three years around 22x, but that's because the growth forecast of the entire sector has decreased. The company will keep very great margins, even improving them. They have a very defensive position in media.

The liquid used to grow the cells because it's the best possible media in the market. If Kitazato is the leader in vitrification, Vitrolife it is in media. I think that now the company is at the right price, the current multiple. In order to increase the multiple, the growth should be higher, which is not going to happen, neither for market reasons nor because the management team cannot still share. The Nexpring company is an important company. Now that Cooper might also be under restructuring, they might stand out from the restructuring and the transformation stronger. You might be aware that Cooper is considering or might consider split the company into two, lens and vision plus, surgical on the other side, so medical device and contact lenses.

00:37:29] What's your opinion of CooperSurgical?

Expert [00:37:35]: American company, revenue focused, they are sometimes too much focused on sales and they have had quality issues in the past or they don't have the right market perception, but the facts are there, they are the bigger company and the widest portfolio possible, also low margins around 10% EBITDA on fertility, I estimate. The structural change in the sector in IVF is that expectations or historical growth was much higher because IVF was increasing and also the adoption rate of the products was increasing. It was a square growth. Now cycles are stable and adoption is stable. The market is concentrating. The Porter Hypothesis model, the competition, if the market is higher, that means lower margins because companies start to fight on price. Also the consolidation of clinics into chains and the sophistication of purchasing processes drives down the prices because there are more requests for proposals or more consolidated procurement in a single supplier.

00:39:51] You sound quite negative on the overall industry's growth outlook, compared to other people I've spoken to. Do you see any potential for a recovery? To me, it seems that the industry would grow due to demographic issues with declining population and fertility.

Expert [00:40:24]: I think that many women have frozen their eggs, social freezing means when they are young, vitrify the oocytes while they still have high quality and those women will later pursue IVF. There will be a hike in demand, thanks to that. We still need five years now for that to happen. Then there is another positive tailwind that is affordability or reimbursement. Governments are seriously considering to reimburse or to cover IVF cost. In the US, it's part of Trump's administration claims, 23 states have now demanded insurance providers to cover partially IVF. In China now it's free IVF, in Japan as well. The forecast of the population shows a huge decrease and those countries doesn't want to face those problems. In Europe, it might happen. In Europe, what happens is that normally, a couple spends around EUR 12,000-15,000 per baby born. It's not extremely high compared with the standards of living. This is, for example, between one-third to half of the average salary. Even in the UK, there is NHS, for example, covers most of the cycle, so it's public. In order for the market to recover, those two things will happen, especially the reimbursement.

Client [00:42:18]: Japan made public reimbursement a couple of years ago.

Expert [00:42:24]: Yes. In China, it came into effect on January of this year, 2026.

00:42:34] If you could work at Vitrolife, Kitazato or Cooper, which company would you be most excited about from a growth and general outlook perspective?

Expert [00:43:20]: Kitazato. Cooper is through a restructuring, and they are now trying to reassess the strategy. Vitrolife has a lot of internal complexity. Maybe with the new CEO, the situation changes, that is something to look after. Kitazato is a company with products that are Japanese quality with more potential than they are currently having by selling the product outside Ivirma or keep expanding the portfolio. I'm more optimistic on those. I think that Nexpring is going to grow more the market than Kitazato, later Cooper, later Vitrolife.

Client [00:44:13]: I think maybe Nexpring would be interested in buying Kitazato. It has already made lots of acquisitions.

Expert [00:44:21]: Maybe, yes. However, what they want is to grow the company and to divest it. If you make a company to relax, it's difficult to divest it.

00:44:36] Kitazato's product portfolio is mostly cryopreservation, but it also has catheters, needles and pipettes. It has talked about culture media as EmbryoGlue's competitor. I think it has potentially talked about trying to make an EmbryoScope competitor as well, similar to time-lapse stuff. Do you think there is any potential for them to do well in those markets? Is Vitrolife so strong there that it would be difficult for it to compete?

Expert [00:45:24]: I will consider three different markets. Liquid consumables, Kitazato can do very well. They have the experience in vitrification. They can offer great competing products for EmbryoGlue, culture media, whatever. Gamete handling media, perfect. Physical consumables, like pipette needle is the market in which Kitazato is trying to expand. Capital equipment, EmbryoScope, but others like wind system, even software automation, laminar flow cabinets that is difficult because it's a different mindset. It's not only about sales, the engineering is very different. That will be the market with lowest visibility of Kitazato entering successfully. They can do, again, yes, but a better move will be maybe to acquire a company that is present on that segment of the market that there are many small companies in the field. If I had been there, I will choose that strategy, acquire capabilities and later expand rather than to build initially from using internal effort.

00:47:04] Are you aware of any time-lapse companies that might be interesting?

Expert [00:47:12]: Esco and Astec, both are companies based in Asia. One is in Singapore, the other I don't remember that might consider acquisition.

Client [00:47:45]: Do you think those companies have good products?

Expert [00:47:51]: Yes. What they did I think to copy Vitrolife in EmbryoScope. Yes, they have great products.

Client [00:48:04]: I'm surprised that you think that they have a chance against Vitrolife in EmbryoGlue because I've lots of Vitrolife customers' interviews saying EmbryoGlue is the best culture media, and they would never really switch.

Expert [00:48:24]: It has a market presence and a lot of evidence and studies demonstrating that it has evidence, for example, in the UK the authority governing the recommendation or the approval of IVF products recommends EmbryoGlue, the HFEA, the Human Fertilisation and Embryology Authority recommends EmbryoGlue, but does not recommend most of the optional products. EmbryoGlue is rich in evidence, but in the end, it's media enriched with vitamin and hyaluronic acid. It's nothing more than that. Kitazato can make a formulation.

00:49:29] Is the flip side also true that in five-plus years, Cooper, Nexpring and Vitrolife will be able to copy Kitazato products in cryopreservation? I think that at some point, if they can get products that are quite close in quality, it might be difficult for Kitazato to compete because it'll be competing against companies with much broader product portfolios?

Expert [00:50:10]: You need to understand the strategy of the companies is different. Kitazato is a niche player traditionally in vitrification, and they are expanding the portfolio based on the great recognition as leaders in vitrification. Vitrolife is a niche player in culture media, EmbryoScope and later genetic testing. Both try to become the leaders in the category. Cooper on the other side is like Costco. They offer everything that you need in an IVF clinic at a more affordable price. Nexpring is going on the same route, Costco. Less differentiation, more low prices. Kitazato has been able to keep a great position and growth because they have a very great product and still that matters a lot in the industry, the quality.

Client [00:51:24]: Is there anything else that we haven't talked about that you think we should understand about Kitazato?

Expert [00:51:34]: No.