I would now like to hand the conference over to Mr. Michael Knaap, Managing Director and CEO. Please go ahead.
Thank you, Andrea, good morning to everyone, and thank you for joining us today for Monash IVF Group's results presentation for the first half of FY23. Malik Jainudeen, our CFO, joins me and will be later stepping us through the detail of our financials. I would like to start with acknowledgement of country. In the spirit of reconciliation, Monash IVF Group acknowledges the traditional custodians of country throughout Australia and their connection to land, sea, and community. We pay our respect to their elders, past and present, and extend that respect to all Aboriginal and Torres Strait Islander peoples today. By way of background, Monash IVF is a market leader in providing reproductive care in our core assisted reproductive services, diagnostics, genetics, and pathology services, with an expanding network of 49 IVF and women's ultrasound clinics and service centers across Australia and Southeast Asia.
An experienced and capable team now includes 146 doctors and in excess of 800 scientific, nursing, counseling, and support staff. I would like to take this opportunity to thank every one of our team for their unrelenting patient-first mindset and commitment to helping bring life into the world. This focus and effort of our people is the reason we have such an optimistic outlook for the future. I would now like to touch on the key points in the executive summary on slide 4 of the presentation. Our underlying profits were slightly ahead of our guidance provided at the AGM, delivering an underlying NPAT of AUD 12.6 million and a revenue increase of 2.3% versus the previous period.
With strong operating cash flow conversion and an optimistic outlook, we were able to declare a AUD 0.022 per share fully franked final dividend. Of critical importance, we have continued to drive better outcomes for our patients, with clinical success rates improving another whole 1% over the last year. In Australia, we had further growth in our ARS market share of 0.7%. We declined in stimulated cycles by 3.6%, which was almost half of the industry decline of 6.6% for the period. Our overall ARS EBITDA was down by 2.2%, which given the overall market decline and inflationary environment, was a solid result.
Our patient pipeline is strong, with new patient registrations up 1.2% in the period and accelerating in the second quarter to be 14% up on the previous period. Our ultrasound business has also recovered into the second quarter, returning to growth. We continue to see the benefits of the strength of our doctor partnerships and being a destination of choice for specialists with the recruitment of another six fertility specialists and continuing down the path of building strength in talent and numbers of our fertility specialist team. The recent acquisition of ART Associates is performing above expectations, and the peer acquisition is anticipated to be completed in the near term. Our clinical infrastructure and expansion projects are progressing very well, with Melbourne and Gold Coast all expected to be complete in the coming months.
Internationally, and specifically in Southeast Asia, our stimulated cycles increased 36.4% versus the previous period, as the region is demonstrating resilient recovery from the COVID impact. Our newer clinics in Singapore and Johor Bahru delivered good growth whilst we opened another clinic in Bali, which completed their first patient treatment in January 2023. We continue to be focused on executing on the pipeline of opportunities in Southeast Asia. I wanted to touch on the compelling underlying demand drivers in our industry to support volume growth into the future as we look to slide 5. There continues to be an advancement in maternal age as a long-term trend as people have delayed starting a family, which continues to increase infertility rates. This is demonstrated by the maternal birth age increasing two years over the last 20 years, and our average maternal age being 37.
There has been a sustainable change in mindset of the community, with greater focus on family health and wellbeing during the pandemic. Our new patient registrations continuing to grow in the first half of FY23, and particularly of late, with 14% growth in the second quarter of FY23. To further emphasize the structural growth in our industry, there has been a five-year cumulative annual growth rate in treatment of 4.6%, and now one in 18 births in Australia are as a result of IVF. Growth in our service offerings and advances in technology are driving improved outcomes that appeal to the fertility value proposition. There is good growth potential in donor, egg freezing, and genetic services into the future.
Our significant recent improvement of 5.3% in the clinical pregnancy rate over the last four years is a testament to the improved value proposition for our patients. There will be an increase in government support from November 2023 for testing and diagnosis of genetic diseases. Furthermore, the New South Wales government recently announced an additional AUD 2,000 cash rebate for patients undergoing ARS treatments, with payments effective from the 1st of January 2023. This is expected to boost demand in New South Wales. These new government funding initiatives, along with the current stable government funding regime for both IVF and ultrasound services, will support volume growth and patient affordability into the future. The attractive industry fundamentals are unchanged and industry is well above pre-COVID levels.
Going forward, growth is expected to return to more normalized rates of 2%-3% per annum, although short-term fluctuations may occur. We now look at slide 6 to focus on the broader ARS Australian market, where demand for services in Australia continues at historical high levels and significantly above pre-pandemic levels. The left-hand graph shows half-yearly growth in stimulated cycles. The first half of 2023 industry stimulated cycles remained 19.6% above first half 2020, notwithstanding a 6.6% decline in the first half of 2023 compared to the previous period. This recent decline was also impacted negatively by widespread COVID infection in the early part of the first half of this financial year. We believe this is non-recurring.
There is some short-term volatility evident in recent industry volumes, the industry is well above pre-pandemic levels. Our recent patient pipeline indicate that our market outlook for growth in the second half of this financial year is positive. The right-hand graph represents the number of Australian cycles per year, noting that the step change in volume in FY21 and maintaining volumes in FY22, with an expectation that FY23 will also be steady in comparison to FY22. Having a clear picture of the Australian IVF volumes, I would just like to cover off on more details around our growth rates and the market shares on slide 7. Our stimulated cycle activity performed better than industry as we continue to grow market share in first half 2023, which has now occurred over a sustained period.
In our key markets, our stimulated cycles declined by 3.8% versus industry decline of 6.6%, leading to a market share gain of 0.7%, achieving 21.5% market share. We had gains in South Australia and Queensland and some moderate declines in Victoria. Pleasingly, the Victorian new patient registrations were strong and above the previous period during the second quarter of FY23, indicating improvement in performance during the second half of FY23. Contribution from new fertility specialists attracted in the previous 18 months and the acquisition of ART Associates Queensland following completion in October 2022 also contributed to market share growth in the first half. Furthermore, our frozen embryo transfer market share increased by 0.4% versus the previous period with 20.3% market share. This demonstrates a steady returning patient pipeline.
As you can see from the graph, we have sustainably built market share by 1.9% over the last three years, and further market share gains are expected following full-year contributions from the ART Associates Queensland acquisition and completion of the PIVET acquisition. Also, the attraction of further fertility specialists and a strong conversion of our new patient pipeline will ensure that we grow market share. I would now like to welcome our CFO, Malik Jainudeen, to take us through the financial results of the year.
Thanks, Michael. Good morning, everyone, and thank you for listening. If you're following the pack, we're just on slide 9, and you'll see that I've got a waterfall there that has a build-up of our revenue. Our revenue grew by 2.3% or AUD 2.3 million, in the scheme of performance in July, which we called out in August, we were a fair way back, in terms of comparatives to last year. It was a pretty strong performance from August to December. If you look at the waterfall from left to right, you'll see a, you know, sort of red, orange bubble that has a AUD 5.3 million decline due to industry.
As Michael called out, industry was backwards 6.6%, and that had more than 400 cycle impact on our business. You know, much of that is coming through our Victorian business. You know, if you look at the market data, Victoria declined by about 9.5%. Naturally, it has a pretty large impact on our business, given it's around 35% of our activity. What was pleasing was if you look at the market share and the price increases, it largely covered, you know, the decline in industry. As Michael called out, 0.7% market share growth, which is around 250 odd cycles. That generated much of that AUD 2.8 million in revenue.
We moved our prices 3%-5% across all services, whether that's IVF, ultrasound, day hospital, that went a long way to offset cost-based inflation pressures that I'll talk about in a minute. Our international business contributed a further $2 million in revenue. Further in the pack, you'll see that KL grew its simulator cycles by 7%, which is a great outcome, you know, in a pretty challenging environment, particularly in KL. We also have a new Singapore IVF clinic that commenced in June, performed almost 100 cycles during the first half, and got to break even in October. Our ultrasound business had a pretty challenging first quarter. As you'll see, ultrasound revenue was fairly flat.
Activity was down by 2.1%, we moved our prices up again by 3%-4% in Sydney and Melbourne. That covered much of the decline because of the volume declines. If you go over to page 10, I've illustrated our EBITDA as a waterfall as well, and much of it comes from the revenue slide. What's most pleasing is EBITDA was maintained. If you have a look at the bar that has AUD 26.8 million, which was first half underlying EBITDA, as you flow through that waterfall, you know, essentially we're flat on last year and, you know, revenue's up by 2.3%. There's a huge amount of cost pressure, not only in our business but many sectors, we were able to offset much of that through price increases.
If, if we talk about our cost base a little bit more, you know, it comes across well managed and controlled. Labor is about 40% of our cost base. We've essentially had 3%-4% increases across, call it our major workforce, workforces in nursing and science, and expect to see 3%-4% over the next three to four years as we, as we've locked away our FY24, FY25, FY26 enterprise agreements that wi ll have some predictability in terms of wages over the next 3-4 years. A little bit of pressure in consumables. Our property is moving up in line with CPI in many properties, but again, you know, they collectively account for about 15% of our revenue.
A small component of our cost base, but again, you know, we've got processes in place to manage consumables and property where we can. If you look at our international business, it grew by AUD 0.3 million. Much of that came from KL. Just to note that Singapore generated losses between July and September, and it was about AUD 500,000 in losses, approximately. It managed to generate a profit in November. We should see upside, you know, coming out of our Singapore business in the second half. Ultrasound business earnings up or EBITDA up by AUD 400,000. You know, that's on the back of a 2% decline in scan volumes.
As I said, we passed on price increases, and we had a bit of cost come out of that business to generate that AUD 400,000 of profit. Not a big number, but, you know, going for the second half where we'd expect volume to increase, we should see earnings growth coming through the ultrasound business. If we go over to slide 11, you know, that's just summary of the profit and loss at a high level. Again, you know, we generated revenue growth at 2.3%. EBITDA was flat. You know, our business is such a leveraged business. You know, we have volume declines of 4% domestically. You know, it can have a multiplier effect in terms of earnings.
We were able to manage our cost base pretty effectively. You know, noting, you know, our insurance costs are up. We had pretty high sick leave in the first quarter, particularly in July, that has now normalized, so we don't expect to see that type of cost-based pressure in terms of sick leave, et cetera, in the second half. If we look at depreciation, it's up by about AUD 500,000. Much of that is, call it property expenditure for sites that are yet to be commissioned. You know, we're carrying multiple sites for the same operations whilst we build Cremorne and Gold Coast, Brisbane, you know, some of that, call it existing premise will come off next year.
If you look at interest, up by about AUD 900,000, call it the cost, the cash impact of that was more around AUD 600,000, purely based on our average debt is higher than this time last year, and the BBSY is a little bit higher as well. But there's also some non-cash interest expense coming through that lease accounting standard. Overall, you know, 2% growth in re-revenue. EBITDA, that was flat. NPAT, that was down by 5%. You know, we're pretty proud of this result. We're looking forward to the second half. If we go to page 12, the cash flow. Again, cash flow conversion was pretty strong in comparison to last year. 89% of EBITDA converted to pre-tax operating cash flows.
You know, it's positive compared to last year where we had 83% last year and 82% the year before, and we're well on our way to, you know, generate 100% conversion for the full financial year. If you look at CapEx for the half, it was close to AUD 14 million, and Michael spoke about, you know, some of the major projects that we're embarking on in Melbourne, Gold Coast, Brisbane. We completed Bali, we completed Penrith, and we completed Darwin. We're expecting another AUD 10 million-AUD 15 million of CapEx in the second half as we finish Melbourne and Gold Coast and start our Brisbane new building for that new facility. Other CapEx is, you know, we're rolling out Embryoscope technology across our larger clinic network. We're in the second year of this.
You know, we'll have another year of it, and we'll have around 20 embryoscopes across our network. You know, that obviously goes a long way to our scientific offering. If we turn over to slide 13, which is just the balance sheet, pretty straightforward here. Leverage ratio is at 0.5 times. Plenty of capacity to finish off, you know, major infrastructure projects, our Asia expansion, and some other non-organic activity that may emerge in short to medium term. Net debt is at AUD 20 million, and is expected to increase around AUD 10 million-AUD 15 million, you know, in six months' time as we complete these major projects and complete on the PIVET acquisition, in the coming weeks or by the end of March at least. I'll pass you back to Michael.
Thank you, Malik
I'll turn your attention to slide 15 as we start to work through some of the details of our Australian ARS operational performance, commencing with the essential and important pillar of our strategy being doctor partnerships. Our success in recruiting new doctors reflects the compelling doctor value proposition and the attraction of joining a group of highly engaged doctors across fertility and ultrasound. Our doctor value proposition is heavily geared towards our doctors' expectations on scientific leadership through excellent success rates, the patient and doctor experience, our business development initiatives for them, our leadership in marketing to drive patient acquisition, and high-quality clinical infrastructure. We continue to gather momentum in our doctor recruitment through acquisition and direct recruitment, having welcomed 60 new clinicians over the last four years and 24 being added in the current financial year.
These results can only be achieved when you have a highly engaged doctor group being advocates for Monash IVF as a result of the experience and service quality they and their patients are recipients of. Our focus remains on attracting and onboarding new and experienced fertility specialists with suitable cultural fit, outstanding clinical competencies, and industry reputation. We take a look at clinical infrastructure progress and plans outlined on slide 16. The strategic priority of clinic infrastructure continues to be a focus on the medium-term horizon as our clinics are paramount to execution of our strategic growth objectives. Our new and updated clinics will drive revenue growth through increased capacity and new day surgery revenue, whilst ensuring we maintain an amazing experience for our patients, people, and our doctors.
We are very excited as we rapidly approach the completion of our flagship clinic in Cremorne, located in the inner east of Melbourne. This site encompasses a premium, large-scale, full-service fertility clinic with a day hospital, whilst also housing corporate shared services. The clinic brings an extraordinary level of patient, doctor, and employee experience. We're also undertaking clinic relocations and significant upgrades in Gold Coast, including a day surgery, Brisbane, Albury in New South Wales, and Sunshine in the west of Melbourne in the oncoming 12 months. By early FY24, we will have five- day hospitals in our network in Australia, compared to two- day hospitals in FY22. They will be in operation, certainly they'll be enhancing the patient experience and adding new revenue streams. Take a look at slide 17 to focus on our scientific leadership.
We have a continued, unrelenting focus on investing and building scientific capability to ensure we are giving our patients the best possible outcomes and differentiating our value proposition to patients and doctors. The chart at the bottom of this slide represents the continuous improvement in our clinical pregnancy rates across our group, with clinical pregnancies in 2022 increasing by a very significant 5.4% as compared to the calendar year of 2018. We've been on this journey of continuous improvement throughout our long heritage. The Monash Way, as developed by our group's scientific advisory committee, is well embedded across our group and has been a critical driver of improving success rates. It is worthwhile calling out some of the initiatives that will drive further improvements to our success rates into the future.
We will continue to partner innovative organizations to advance new technologies such as a safer and softer method of ICSI and a more effective sperm selection device, which we anticipate will be rolled across our clinics during 2023. We continue to roll out time-lapse technology across our clinic networks, resulting in less embryo touchpoints during the development stage of the embryo, which will also facilitate artificial intelligence of embryo selection capability. Partnerships and technologies, backed up by our ongoing research focus through our various research bodies, will ensure we continue to evolve and improve our success rates and the patient experience. As we take a look at slide 18, our substantial strategic marketing investment is a key driver of our market share gains in driving growth in our future patient pipeline.
Demonstrating this is the 1.9% market share gains over the last three years in Australia and, more recently, strong new patient registrations in the second quarter, as I said, being 14% up as the COVID period has been normalized. It's worth noting that our current marketing campaign specifically targeted drivers of category growth, including egg freezing and sperm donor recruitment. These campaigns perform exceptionally well in the first half of FY23 in all of our domestic markets. Our people continue to thrive in a workplace that recognizes their contributions, and our people's positive engagement remains a key priority.
We are focused on continuing to achieve a culture of success throughout the Monash IVF Group for our doctor and employee teams as we have over the last couple of years. We continue to make positive progress in building a diverse and inclusive workplace, and our learning and development framework, and focus on personal and professional development will enable us to support growth opportunities and build capability, continuity, and retention. As we turn to the ultrasound performance on slide 19, which has demonstrated a positive turnaround as we rectified sonographer resourcing in the second quarter of FY23. Our first half 2023 ultrasound volumes declined by 2.1% compared to the PCP, following a 7.4% decline in volumes, which that was in the first quarter.
Clearly, we've had a return to volume growth of 3.6% in the second quarter. As a result, we built market share in the sector by 0.4% to be 8.2% of the market in Australia. Furthermore, we've recruited three new sonologists to increase capacity and allowing for succession planning as we anticipate demand for women's imaging to remain at high levels. We have good momentum in our rollout of our branded reproductive carrier screening test kit with over 1,500 tests performed on the platform since launching in November 2021. The test allows couples to identify potential genetic conditions in a child prior to conception. With Medicare funding increasing, affordability of these tests will become better in November 2023.
We are certainly well-positioned to optimize this opportunity, which will also be a catalyst for a new channel for stimulated cycle growth that is unrelated to fertility. As we look towards our international operations on slide 20, our Southeast Asian expansion strategy continues to gain momentum following a slow recovery from COVID across the region. We now have five clinics in Southeast Asia, and strategically, we are targeting Southeast Asia to contribute more than 25% of total group stimulated cycles by financial year 2026. It's currently only 10.6% in FY2022. This will be predominantly achieved by greenfields and suitable private hospital partnerships. Pleasingly, our international stimulated cycles increased by 36.4% in the first half of FY23, whilst our EBITDA also increased by 18% to AUD 1.5 million for the half.
In our KL clinic, stimulated cycles growth was 6.1% in the first half of 2023 versus the PCP. To support the expected organic growth, we have recruited another fertility specialist, bringing the total to five in Kuala Lumpur. In reference to our other clinics in Southeast Asia, we commenced trading in Singapore in June, having recruited four experienced fertility specialists. We have seen a rapid ramp-up in stimulated cycles, and we anticipate to be profitable in the second half of FY23, having reached profitability in November 2023. Our brand recognition and medical and scientific leadership in the region continues to build following a major launch in Singapore through a reproductive medicine conference in early February. We have added to our clinic portfolio with the clinic opening in Bali, which performed their first patient treatment in January 2023.
Our clinics in Johor Bahru, Malaysia, and Jakarta, Indonesia, are both anticipated to deliver growth and profits with the COVID impact normalizing and our brand and reputation continuing to develop. We are absolutely committed to the Southeast Asian region and to further build out our clinic footprint through a pipeline of part-partnership opportunities. If we go to slide 22 on our Vision 2026 strategic roadmap. Vision 2026 continues to remain consistent in regard to our objectives and aspirations. We have made significant progress on our strategic pillars over the previous years, as outlined in previous slides. With this platform established, we will continually evolve and improve in order to deliver our Vision 2026 objectives. Our Vision 2026 strategic roadmap will continue to enable everyone to understand the priorities, actions, and decisions required to achieve success and deliver profitable growth in the oncoming years.
As demonstrated through the previous few years' progress, we have strong momentum on our strategic growth initiatives. These have become more transparent in recent times. However, there is still much to achieve. This will become more visible over time. As we move to the all-important outlook for financial year 2023 on slide 23. The favorable underlying demand dynamics of the IVF industry remains unchanged, notwithstanding industry declines in the first half of FY 23. Advanced maternal age and access to broader service offerings, including donor egg freezing and genetics, are expected to underpin long-term industry growth, supported by our strong inbound inquiry levels during the second quarter of FY 23. In addition, new patient registrations during the second quarter of FY23 increased by 14%. This momentum has continued into the second half of FY23.
In FY22 and the first half of FY23, we made significant investments in future growth, including recent acquisitions, attraction of new fertility specialists, and further expansion into Southeast Asia. The ART Associates Queensland acquisition, completed in October 2022, will have a full six-month contribution of earnings in the second half of FY23. In addition, the PIVET Medical Centre acquisition is expected to complete during the third quarter of FY23. From a cost perspective, we expect the cost base to remain at manageable levels. Wage rates, which are the largest expense for us, on our P&L, are expected to increase by 3%-4% per annum as nursing and scientific enterprise agreements are in place for four years until FY26. In addition, low to moderate growth is expected in other expenditure categories on a comparable basis, excluding any acquisitions.
Accordingly, we anticipate FY23 underlying NPAT of AUD 25.5 million, or 15% growth compared to FY22. This is, of course, subject to any further pandemic-related disruption and/or worsening macroeconomic conditions impacting the IVF industry activity. This brings to a close the formal part of the presentation, and we are happy to move to questions.
Thank you. If you wish to ask a question, please press star then one on your telephone and wait for your name to be announced. If you wish to cancel your request, please press star then two. If you are on a speakerphone, please pick up the handset to ask your question. Our first question will come from Rachael Harwood of Macquarie. Please go ahead.
Yeah. Hi, Michael and Malik. Thanks for taking my questions. Just firstly, on cycle volumes. December Medicare looks pretty strong. Could you maybe just comment on how you're seeing exit rate volumes into the second half?
Yeah, sure. Rachel, hi, how are you?
Yeah, good, thanks.
Yeah. Yeah, certainly our second quarter comp cycles was pretty strong relative to PCP. I think the most important thing there is that probably the Medicare data in December is a little bit overstated. People do tend to rush and lodge their Medicare claims before December and it's probably a little bit of a catch up as most of the industry shuts for the latter part of December. All that being said, as I mentioned, we've got a very, very strong patient pipeline. It's not just in new patient registrations, it's also in patient inquiries, which certainly means that we're quite confident, as our guidance statement says, that volumes are gonna get back into industry growth throughout January and beyond into the second half.
That's great. You commented on price rises that you've been able to put through. Could you maybe just comment on what you expect in calendar year 2023? Just to follow on, have you seen any impact from customers from some of the macro headwinds like rising interest rates and higher cost of living at all?
Hi, Rachael. On your first question, yeah, we put prices up 3%-5% in the first half. On the 1st of January, outside of Queensland, we put our IVF prices up in Victoria and New South Wales, South Australia, Northern Territory. You know, I think depending on how the environment is, you know, there will be an intention to go again possibly in July, September. You know, we'll just see how Q2, Q3 and Q4 plays out. In terms of, you know, behavior of patients, you know, it's not like we've got a huge amount of discount requests coming in. Utilization of interest-free programs are a little bit higher, you know, I'd say it's under 5%. It's probably at 4% across our 5,000 odd cycles in the first half.
You know, macro conditions, affordability, you know, noise around interest rates, yes, it's out there, and it's obviously a factor for patients. You know, in terms of converting to IVF treatment and intention to have IVF treatment, that hasn't changed at all. You know, I think once there's a bit of stability in the market, whether that's, you know, in practical terms or in the media, you know, I think we're pretty strong in terms of our expectations on conversion of our pipelines.
That's great. Thank you. Just last one from me. Are you noticing any demand from New South Wales, you know, the cash rebate funding yet? Could you maybe just give us an update on what's happening in Victoria in terms of government support?
Yeah. In New South Wales, Rachael, really, I guess the promotion of the AUD 2,000 rebate was really launched in January. People can only really access that payment in January, even though it could have been applicable from the first of October last calendar year. Now the awareness has increased quite significantly, but as you know, it takes time from people to be aware of just going to then convert to treatment. I will say that January and February in New South Wales, we've had really strong patient inquiries on the back of, you know, heavy promotion of the AUD 2,000 New South Wales rebate. We expect to see some benefit throughout this financial year, although it is too early to tell.
That's great. Thanks very much.
Sorry, on the Victorian front, as far as government impact, certainly they have launched or announced a public IVF scheme here in Victoria. It is limited in regards to the number of treatments, and age profile and so forth. So it does have its limitations, and it is geared to make it more available for those that find the funding of the premium service a challenge. We'll see how that plays out over the next two years, depending on the levels of investment that are going to occur. Certainly we'll keep a close watch on it.
Our view is that it is a different market segment to us in the premium end of the market, and we don't expect it to have any impact of substance.
Understood. Thank you.
The next question comes from David Stanton of Jefferies. Please go ahead.
Good morning, team. Thanks very much for taking my questions. Look, I could just start with a comment by Michael during the call where he said that you expect the market to be steady in FY23 compared to FY22 in Australia. Does that mean you're basically saying that you think the market will have flat growth in FY23 compared to FY22?
Yeah. What. Market growth in the second half is gonna offset the market decline in the first half. We expect it to be fairly comparable to FY22 in the full year of FY23 based on, you know, the numbers that we're seeing in our pipeline, and, you know, what transpired in the comp half of FY22, where it was a little bit subdued, particularly early given COVID impacts.
That's very clear. Thank you. I guess, you know, could you talk to your organic market share gains in the first half of FY23? You mentioned on an overall number with acquisitions of 70 basis points. What do you think it is organically?
Without the ART acquisition, I think it's about 0.4%.
Okay.
The acquisition contributed about 0.3%. That's roughly the difference, David.
Yep. Yep. You've seen market share declines in New South Wales and Victoria. You know, firstly why and how can you correct this?
Yeah. Look, both markets are pretty competitive at the moment. Certainly in New South Wales, we are endeavoring to correct it through some fairly aggressive campaigns. I've talked about the AUD 2,000 rebate that applies to the whole industry. We are also looking to grow our doctor base in that New South Wales market. We're looking at many opportunities there, which we think we're getting close to a few opportunities that could build our doctor bench strength. You know, some clever expansion in New South Wales with a new clinic in Penrith is also assisting with getting some penetration in that western region in New South Wales.
On the Victorian front, we've been working very hard on very aggressive sort of doctor marketing sort of campaigns. We've been working very hard on, you know, donor services is a key service in the Victorian market and New South Wales market. We've worked very hard on recruiting donors to make sure that we've got full availability for patients of, and options for donor sperm. The other element there is we've had a very, very strong campaign in regards to egg freezing, particularly in Victoria, but also New South Wales. That has had a really good response rate late in the first half of FY23. All that has contributed to, as I said, strong inquiries in New South Wales post-Christmas, but also in Victoria.
We've had new patient registration growth for the last quarter and the first 2 months of this half that exceeds PCP, and our inquiry rate in Victoria has also been really strong. We think we're heading in the right direction as far as market share growth in both Victoria and New South Wales, David.
Understood. Thank you. I wouldn't want Malik to feel left out. Look, last question from me. You know, employee costs, expense of about AUD 35 million, this half. Should we expect the sort of same absolute number for the second half? I mean, Why is it gonna be different in the second half?
It will be a little bit higher, Dave. You know, we're opening our Cremorne Day Hospital and Gold Coast Day Hospital, which is new revenue stream, but new cost base as well. You'll see some increases there. You know, in terms of margin, you know, we expect that margin to grow in the second half.
The other thing we've got happening is the.
Thank you, Malik.
The other thing there is the acquisition of PIVET and Eve and any labor costs associated with those which weren't in the first half.
Yeah.
Understood. Thank you.
The next question comes from Sean Laaman of Morgan Stanley. Please go ahead.
Oh, Andrea, we're not picking that up. Is Sean asking a question?
Sean, your line is open. Are you muted on your end? We'll move on to the next question from Jonathan Higgins of Shaw and Partners. Please go ahead.
Hi, Michael, Malik. Thanks for the time today.
Hey, Jonathon.
Great to see you guys, or good to hear from you. Great to see the unrelenting focus on growth, Michael. A couple from me. Firstly, around the international market, which is starting to kick in. You've put a lot of obviously emphasis in terms of opening up some new clinics and the like. With your longer-term target of 25% of volumes, can you just let us know sort of like what you need to do around further greenfields, or whether the current greenfields are in site, sort of in the pipeline or sort of under country, current envelope that you could accomplish that?
Yeah. Yeah. It's, it's a blend of, you know, obviously optimizing the investments that we've made and capitalizing on some growth post-COVID, any good organic growth in those markets. The other element that's really important is rolling out about two to three new clinics in the region over the next three years or so to ensure that we get to, you know, a fairly substantial number of clinics and capitalize on what we think is a very significant opportunity in Southeast Asia, whereby there hasn't been much sort of Western investment in IVF clinics.
Certainly it's, it needs some sort of rationalization, but also someone with the credentials that Monash IVF have from a scientific and clinical perspective to really focus on supply and, I guess the benefits of the Monash IVF brand to build volume and make IVF available, in those regions.
Appreciate the comments. One for Malik, I think more so. Just around the half. I mean, you know, sort of a really good result, I think, in the context of the way you guys started as well as sort of the margin front. Can you just tell us a little bit more, Malik, just around some of the headwinds the group was carrying? You know, things like, I think, you know, you're carrying quite a bit of greenfields costs. You've got some duplication on various facilities, ultrasound, international, that sort of coming back. Can you sort of just sum it all up for us, what we were sort of carrying in the first half and how that could unwind potentially into, say, in FY24?
Yeah, sure. Got it. Good question. Singapore losses up until October, you know, I called out it was about AUD 400,000-AUD 500,000 that we carried in terms of losses before we started generating profit. Our ultrasound business, particularly in Melbourne, because of skills shortage, particularly in skilled sonographers, you know, hurt us quite dramatically in Q1, and much of that was rectified in November, and we've got the capacity to deliver the scan volume that is our demand just sitting there for us to service. You know, there was another AUD 200,000-AUD 300,000 in there. Darwin, Penrith, you know, new facilities, you know, relocated facilities, but new facilities with an added cost. You know, they didn't really ramp up to where they were planned to be till probably September.
In terms of headwinds, you know, that will be tailwinds, I guess, going forward, John, you know, they're right there. You know, they're in our cost base in the first half. You know, some of that pressure will come off in the second half and into FY24. Assuming the rest of the business is quite static, you know, again, you see some reasonable like for like, you know, just not very organic growth. You know, coming back to July, you know, I think we forget that July was quite dramatic in terms of impact on our business. You know, we were about AUD 1 million behind at our NPAT line just in July. You know, we ended up, you know, AUD 700 or AUD 800 behind.
Performance in August through to December was in line with a pretty strong prior year, even with those headwinds that I spoke about that will be tailwinds, you know, in the second half and beyond.
Look, that's really good clarity. Appreciate that. Just last one from me, just following on from a good question from the Jefferies fellow. Just on key market share, you guys have got a chart, I think, talking towards the people that you've added in the business. I think you've got 25 so far, 24, sorry, so far during FY23, and you've also got the acquisition in WA coming on. With your market share in key markets being sort of 21.5% or whatever is the most relevant sort of market share, with the current doctor base, where do you think that sort of can get to?
Yeah, we're not calling out a number. That certainly we'd expect to see significant growth on the current, you know, 21+ sort of number. You know, internally, we have sort of longer term targets to get to 25, but it's gonna be dependent on the transition and timing of PIVET and, you know, the run rates attached to E that is important, but also the overall market converting pretty well, given our pipeline. Yeah, certainly there's some fairly significant upside given the strategic deals that we've got in place to get leverage out of into this half, but we'll carry that forward into an annualized run rate into FY24 as well.
We do have a really good growth engine for market share growth, not only for this year, but also into FY 24, given the transactions that we've enabled.
Awesome. Thanks very much for the time, guys.
Thanks, John.
The next question is a follow-up from David Stanton of Jefferies. Please go ahead.
One or two from the Jefferies fellow here. I note that on page 10, you talk to everything else but an EBITDA for the DSU. I wonder if you could perhaps talk to the EBITDA contribution from the DSU for the first half of 2023, please.
Dave, just to clarify, the DSUs that we had operational in the first half was in Adelaide, Sydney and KL and Singapore. You know, I think your question is about, you know, what sort of contribution the day hospital will make, you know, based on the new facility at Cremorne and Gold Coast. They aren't open as yet. You know, I probably can comment on that, you know, probably at the end of this financial year in terms of how they're going. Early days in May and June.
You know, the Cremorne facility is very much there to capture or click the ticket on income through the you know, the process where we've already got, you know, 3,500 stimulated cycles in Melbourne, you know, how much of that can we push through an owned day hospital? At the Gold Coast, you know, again, we've got over 1,000 cycles there. We're broadening the services offered through that day hospital through ophthalmology and some, you know, generic gynecology as well. you know, we'll be targeting at least a 20% margin, EBITDA margin that is, at both Cremorne and the Gold Coast when they come online.
Okay. There was nothing in the first half, I guess is my question.
Nothing in the first half. Yeah, correct. Nothing in the first half.
Fair enough. It says here you've left the Tasmanian IVF market in October 2022. I mean, why and what are sort of the revenue implications from that, please?
Yeah, look, let's start with why. We really struggled broadening our doctor base in that market that is fairly narrow and small. We made a strategic decision that we put everything into it for four or five years or so, and we really battled to get any critical scale to make it, you know, substantially profitable. In fact, it was near break even slightly unprofitable. We made the decision to exit that particular market. From a revenue perspective, I think it generated about AUD 1.5 million or thereabout. From a profit perspective, it was pretty neutral, slightly profitable, nothing substantial as far as profit impact.
How much did you get for it, for selling, for exiting?
As, as we called out, if you dig into our Appendix 4D, you know, we generated an AUD 140,000 odd loss. You know, we handed it off to one of the doctors that was running the facility.
Short answer is not much, David. Not much.
Fair enough. Fair enough.
The next question is a follow-up from Jonathon Higgins of Shaw and Partners. Please go ahead.
You might be on mute, John.
Hey, can you guys hear me?
Yeah.
Yeah, sorry about that. Sorry to Dave also, name completely escaped my mind at Jefferies. Apologies for that. Last one for me. On the class action, can you maybe give us an update on that? Also after that, probably an update on the balance sheet, having spent a little bit less on CapEx in a pretty conservative position. How are you thinking about that?
Yeah, sure. I'll just touch on the class action. Clearly it's subject to the courts. It's a long, elongated, extended sort of process, with discovery still sort of underway, where we are not familiar with the number of participants or the value of the claim or any of that, anything of that nature at this particular point. Yeah, as anything becomes sort of relevant, we'll share that with the market. Obviously, you know, we're limited in what we can say, given that it's still in the legal process.
Jon, just on the balance sheet, you know, as I called out, there's, you know, our leverage ratio is pretty low. You know, I think we'll just wait to see how this class action plays out. You know, we'll make some decisions on what is the right capital management structure for us.
Thanks, guys.
There are no further questions at this time. I will now hand the call back to Mr. Michael Knaap for closing remarks.
Thank you, Andrea, and thank you so much for everyone listening and the very good detailed questions. We, Malik and I and Amy Beck, our COO, look very much forward to hopefully catching up with many of you over the week. Thanks for listening.
Thank you all.
That does conclude our conference for today. Thank you for participating. You may now disconnect.