Tuesday 20 February 2018

How to control costs when going down the IVF route

IVF toon
IVF toon
Louise McBride

Louise McBride

Having a baby is something that many people take for granted – yet for those couples who are struggling to conceive, it can be a financial and emotional nightmare.

You could have to fork out €15,000 or more to have a baby through in vitro fertilisation (IVF) – and there is no guarantee that you will have a baby after it.

This expense is a "massive issue", according to Orla O'Connor, director of the women's lobby group, the National Women's Council of Ireland.

"Right now, assisted reproduction is only there for those who can afford it," she said. "None of this treatment is covered by medical cards or the public health system."

You can expect to pay between €4,000 and €4,500 for one course of IVF treatment, according to Helen Browne, founder of the National Infertility Support and Information Group.

"For 40 per cent of couples who have difficulty conceiving, it's a male thing," said Browne. "If the couple go for intracytoplasmic sperm injection (ICSI – a technique used to treat male infertility), the cost of one round of treatment could be between €5,000 and €5,500. People normally go for three rounds of treatment."

As well as paying for the treatment itself, there are a number of other bills to bear in mind.

Expect to pay between €160 and €200 for an initial consultation – and between €100 and €150 for return consultations.

You must have a number of tests carried out before starting the treatment – and these tests will usually set you back several hundred euro.

"There are four things that must be considered," said Dr David Walsh, medical director with Dublin fertility clinic Sims. "Does the man have sperm? Does the woman have eggs? Is the woman's womb okay? And are the bloods clear of infections – mainly, HIV, Hepatitis C and Hepatitis B."

You will typically pay a few hundred euro to get your bloods tested. For example, at the Hari National Fertility Clinic, which is based in Dublin's Rotunda Hospital, a viral blood test costs €150 for each partner.

An AMH (anti-mullerian hormone) test, which tells a woman how many eggs she has, usually costs between €50 and €150. The price of semen analysis, which measures a man's sperm count, is generally between €120 and €150. Saline infusion hysterosonography – a test which checks if there are any problems with the womb – typically costs about €400.

Dr John Waterstone, medical director at Cork Fertility Centre, says those thinking about IVF should be aware of the full cost of treatment. "Some clinics have additional costs, such as blood tests and these can all add up to be quite expensive," said Waterstone.

Many couples who go through IVF or ICSI also receive additional treatments such as blastocyst culturing – where the embryo is grown in a laboratory before being returned to the womb, or embryo freezing – where good embryos are frozen for future use. Getting both of these additional treatments will typically add between €1,200 and €1,900 to your bill.

"A typical IVF cycle will cost between €4,700 and €5,900, depending on whether blastocyst culturing and/or embryo freezing applies," said Paul Delaney, financial controller with Hari. "The corresponding range for ICSI is between €5,200 and €6,400."

So when should you consider IVF? "If you've been unsuccessfully trying for a baby for between 12 and 18 months, talk to your doctor and do some initial tests," advised Walsh.

"IVF should only be considered after at least two years of trying – though if you're a woman who is heading towards 40, you'll need to consider it earlier."

How to curb the cost of IVF:

* Improving your health could save you the expense and ordeal of fertility treatment. If you or your partner has a particularly unhealthy lifestyle, this could be hampering your chances of having a baby.

"Smoking or drinking is a no-no," said Browne. "You should eat well. If you are stressed, go for reflexology or something like that."

* Don't jump into IVF too quickly, but consider affordable alternatives. "Not all patients require IVF," said Waterstone. "Some may only need ovulation induction (OII) or intrauterine insemination (IUI)." The latter "is often recommended as a first-line treatment when a couple's fertility difficulties are unexplained and results of all tests are normal". OII costs €200 in Cork Fertility Clinic while Hari charges €400 for IUI.

* See if it works out cheaper to get treatment abroad. In the Czech Republic, it typically costs between €2,000 and €2,500 for one round of IVF, according to Browne.

If you have to go through three cycles of treatment, the total bill would come to between €6,000 and €7,500.

Bear the costs of travelling in mind, however – particularly if you need to return to the foreign country for more treatment. You will need flights and accommodation – and also need time off work.

* You'll knock a fifth off the cost of fertility treatment, and any drugs you are prescribed, if you claim tax relief.

Be sure the practitioner who carries out your infertility treatment is on a register which is recognised by the Revenue Commissioners. Otherwise, you won't qualify for the relief. If you receive treatment abroad, you should still be able to get relief, as long as the practitioner is entitled to practise medicine under the laws of the country you have travelled to.

* Join the State's Drug Payment Scheme. Under it, you will not pay any more than €144 a month for approved prescribed drugs.

* Before choosing a fertility clinic, check how its refund policy compares to others. "Refunds where no embryo transfer takes place can vary from €200 to €900," said Delaney.

* Find out where you stand financially if you stop or postpone your treatment.

"There is a large variation in how clinics charge for stopped, cancelled or postponed cycles," said Delaney.

For example, if you stop your treatment before oocyte collection (where the egg is collected so that it can be mixed with a partner's sperm) the charge varies between €400 and €1,200, according to Delaney.

* Research the success rate of the clinic you are considering. Ultimately, you want to have a baby after going through infertility treatment – so ask the clinic the number of live births that arose after treatment in its centre.

* Remember, there is no guarantee that IVF or fertility treatment will work. "There's a 30 to 40 per cent success rate with IVF," said Browne.


Worried about fertility? Best be prepared

If you're planning to have a family, it's worth your while choosing a private health insurance plan that offers cover for infertility treatment as well as good maternity cover – even if it'll be some time before you start trying for a baby.

To be covered, you must have your private health insurance for a year before you have your baby – or a year before you start any fertility treatment.

The cover you'll get for IVF under private health insurance is very limited – and is only available from some insurers and under certain plans.

Most VHI Healthcare plans do not cover IVF. However, VHI's PMI 0411 plan (which costs a whopping €4,240 a year) offers one-off cover of €2,000 per customer per lifetime towards the cost of intrauterine insemination (IUI), IVF or intracytoplasmic sperm injection (ICSI).

To be covered for the treatment, the procedure must be carried out in a centre approved by VHI. Laya offers cover of up to €1,000 per lifetime towards the cost of IUI, IVF or ICSI. The cover is available under certain plans, including Advantage 125 Choice.

To qualify for the cover, you must get the treatment in a facility approved by the insurer and accredited by the Irish Medicines Board. These are: The Cork Fertility Centre, The Galway Fertility Unit, Clane Assisted Conception Unit, The Sims Clinic, Merrion Clinic, Hari (based in the Rotunda) and The Morehampton Clinic.

Aviva Health and Glo Health do not cover IVF. Both insurers provide limited cover for infertility tests. For example, Aviva's Family Focus and Future Focus plans offer a refund of up to €100 off the cost of semen analysis and AMH (which determines the number of eggs a woman has) tests.

This refund is available once every two years. Most VHI and Laya plans also offer some cover towards the cost of fertility tests.

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