印度医疗：没有人类的世界？日益加剧的不孕不育危机与老龄化世界

India Healthcare: World without humans? A growing infertilitycrisis, an aging world, Biopharma's growth engine In a world obsessed with AI, every investor worries about AI replacing humans.We believethat Humanity's biggest challenge may be human intelligence—specifically, notcreating enough of it.World Population Day of 2026 (observed annually on 11thJuly)highlights a historic demographic shift: the world's two most populous countries - Indiaand China - are now below the replacement fertility threshold of 2.1 births per woman.As infertility rises and birth rates fall, we believe global and Indian Biopharma’s nextopportunity is solving this silent crisis-Female and Male Infertility. We estimate the globalinfertility market in assisted reproduction technology at about $45-50Bn while India’sInfertility opportunity at about two to three Billion dollars. We believe that over the nextdecade,~11-13% of incremental healthcare spend will be on the infertility valuechainand thus represents a deep market opportunity for Indian biopharma. Nandan Kulkarni+91 22 6842 1436nandan.kulkarni@bernsteinsg.com Shirsh Sawarna+91 226 842 1492shirsh.sawarna@bernsteinsg.com We believe three drivers of the infertility deficit are a) Social norms reshaping pregnancynotions; average conception age going up b) Lifestyle fueling chronic diseases during thefertile years c) Environmental burden impacting biology both for male and female infertility.We believe the growth play for Indian Biopharma as well as Indian hospital sectors is indiagnostics, hormones, and assisted reproductive technology solutions.We estimateIndian Biopharma to capture about half a billion dollar additional revenuesover thenext five to six years from these levers. We believe the right business model to play in theinfertility stack is patient centric specialty portfolio and devices rather than consumerizedor OTC play and the winners will build an integrated franchise of diagnostics, Biologics andhormonal portfolio, and ART delivery mechanisms. We believe the primary attractivenessof this market segment is that it pulls through diagnostics, stimulation drugs, ICSI, embryofreezing, genetic testing and repeat cycles and thus has a flywheel kind of effect. Globally,we are excited by Abbott’s, Merck’s, and Ferring’s pivot to diagnostic and hormones infemale health We like Ferring’s approach in systematically building a broader fertility basketaround personalised ovarian stimulation, cycle control, trigger products, and progesteronesupport.. Welike Sun’s global leadership aspirations through Organon’s strong female healthfranchise, and we believe the hormones, inception ART platforms provide it a competitiveadvantage. In the medium term we believe Sun Pharma’s increasing portfolio and capabilitydepth in the fertility value chain from the Organon deal will provide a material revenue andearnings ramp up whereas Mankind’s right to win in this space significantly eroded due toBSV integration issues and half-hearted innovation efforts. We like Lupin’s early explorationthrough diagnostics and partnership with IVF Chains to unlock the gynecology market.Lupin’s repositioning in specialty portfolio for female fertility is in early stages while weexpect a limited to mute play by Biocon, Aurobindo, Zydus in the infertility space. BERNSTEIN TICKER TABLE INVESTMENT IMPLICATIONS We reiterate Outperform on Zydus, Lupin, and Sun Pharma with a TP of INR 1,457, INR 2,707, and INR 2,235 respectively,Market-Perform on Aurobindo Pharma with a TP of INR 1,498, and Underperform on Mankind and Biocon with a TP of INR2,057 and INR 326 respectively. DETAILS GLOBAL INFERTILITY IS ON THE RISE World Population Day usually gets a read through a population-control lens. We believe that framing is now incomplete. Theworld is still adding people, but fertility is falling fast enough to change the long-term question. The UN estimates global fertilityat 2.25 live births per woman, roughly one child lower than a generation ago, and expects it to decline toward 2.1 by the late2040s. The same UN population work projects the world population to peak at around 10.3bn in the mid-2080s. The Lancet/IHME fertility work estimates that 76% of countries will be below replacement by 2050 and 97% by 2100. So we believe that ifobesity drugs are creating a market to help people live longer, fertility medicines will create a deeper market to ensure there areenough people in the first place. Our research suggests that the world’s two most populous countries - China and India - have also moved in the same direction.NFHS-5 has estimated, and we concur that India’s total fertility rate is now at 2.0 children per woman in 2019-21, below thereplacement level of 2.1. Our analysis ofSRS 2024 data in public reporting suggests that India’s fertility rate is lower at1.9, with a large rural-urban gap of 2.1 versus 1.5.We therefore believe that India is no longer the high-fertility market at thenational level, but is becoming