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On Friday, 13 March, a businesslike group of enterprising people assembled at the Development Fund for a round-table discussion on reproductive medicine (artificial insemination) focusing on opportunities for exporting the service. An informal exchange of ideas led to the following conclusions:

The cost of artificial insemination is significantly lower in Estonia than elsewhere and therefore we are quite attractive as providers of this service for other countries.

The overall success rate of an artificial insemination procedure is rather low (an average of 30%), moving on to other clinics is common for clients, subsequent to a failed attempt.

In Estonia, the success rate is higher, amounting to 37%.  Andres Salumets (Nova Vita Kliinik) suggested that one of the secrets behind the success was the use of better biosensors for selecting embryos (http://en.wikipedia.org/wiki/Biosensor).

Estonia has a geographic advantage since we are located just 350 kilometres from St. Petersburg and its 6 million inhabitants. It was concluded that if a Russian patient was to choose between Finland and Estonia, he or she would rather come to Estonia. It was also highlighted that in specific cases patients had been refused an Estonian visa. In cross-border medical co-operation good trust-based interpersonal relations between doctors are essential and, consequently, the Baltic markets are the most approachable at the moment.

A component in the artificial insemination value chain is prenatal diagnostics. An Estonian company offering such a service, Asper Biotech, estimates the potential market value of genetic testing to be approximately 3 billion euros a year. This is an area with multiple barriers that require smart solutions. If, for example, Russian law does not allow gene samples to be taken out of the country, one might develop a local network of co-operation partners or set up a testing centre in the target market. A locally tested patient can then freely come to Estonia to receive the service in one of the clinics. For example, Nova Vita Kliinik is already now performing some 500 embryo transfers per year. All in all, Estonian clinics annually service some 1500 patients, of whom 500 come from Estonia while others are foreigners. Hence, already now two-thirds of the service is actually exported and since opportunities for increasing capacities do exist, it is exactly the right moment to undertake something together for the sake of growth.

What are the things that we in Estonia could do better than others?

While competing with other countries it is evidently not sufficient to just offer a cheaper service. The determining factor will be the skills and the knowledge that we possess locally and how efficiently we can manage the process of offering the service.

During the discussion the following promising areas to be jointly developed were highlighted:

- prenatal diagnostics, multi-aspect testing;
- non-invasive treatment of endometriosis and prostatitis (treatment based on blood testing);
- examining genetic causes of male infertility;
- further development of biosensors;
- identification of possible fetal abnormalities (e.g. Down syndrome).