Current Policy for In Vitro Fertilization – March 1, 2008
In order to maximize the pregnancy rate per cycle, we will be culturing all embryos for five days after egg retrieval. Healthy embryos should then be at the blastocyst stage. A maximum of two blastocysts will be selected and transferred to patients less than 38 years old.
We recommend the long protocol with Lupron, Gonal F, and Repronex to all patients, because this has given the highest pregnancy rate, principally by providing a high number of good quality eggs. A young patient, that is 34 years old or younger, may attempt to 'economize' with Natural Cycle or Mini-Lupron Cycle IVF.
Pricing and Cost-Benefit Analysis:
IVF Analysis |
Mini-Lupron Cycle < 35 y.o. |
Long Protocol < 38 y.o. |
Long Protocol >38 y.o. |
Clinic Fee (Deposit) |
$5,000 |
$5,000 |
$5,000 |
Medications (foreign) |
$580 |
$2,307 |
$3,418 |
Lab tests (Chemistry) |
$680 |
$948 |
$948 |
Price/cycle |
$4,260 |
$6,255 |
$7,366 |
|
|
|
|
Clinical Pregnancy Rate/Embryo Transfer |
50% |
44% |
38% |
The Clinic Fee includea ll professional and facility fees related to super-ovulation, egg retrieval, embryo culture and embryo transfer. We require that this be paid in full at the baseline ultrasound at the start of an IVF cycle.
The Medications are principally gonadotropins used to grow multiple follicles on the ovaries. Typically, older patients will use more medication, but still get fewer quality eggs than young patients. Medication costs also include Lupron, HCG, progesterone and estrogen, which are all utilized in this process.
Lab Tests include blood draw fees and same-day chemistries, mostly stat estradiols. Additional tests include serum progesterone and pregnancy tests. Lab costs are not paid in advance, but are added to your clinic account. Lab costs vary from patient to patient based upon days of gonadotropic stimulation.
Total cost is the estimated total cost of an IVF cycle. We are proud to offer some of the best prices and pregnancy rates above the average available in this state and the nation.
Natural Cycle IVF is restricted to patients 34 years old and younger, because the pregnancy rate with older patients is very low. Some will prefer Natural Cycle because it avoids ovary-stimulating drugs and virtually eliminates the risk of ovarian hyper-stimulation and multiple births. An egg is retrieved in about 85% of cycle starts, but about 40% of embryos will die before forming a blastocyst. The implantation rate per blastocyst is 40-50%. Clearly, Natural Cycle is inefficient of time with the possibility of no embryo for transfer.
Mini-Lupron Cycle IVF is restricted to patients 34 years old and younger, because the pregnancy rate with older patients is low. The lower mediation costs with this type of cycle is attractive only if it generates at least four fertilized eggs, and two blastocysts for transfer. I would recommend a maximum of two Mini-Lupron Cycles to young patients, before moving on to Long Protocol.
Long Protocol IVF is the national standard. Younger patients will typically respond to lower dosages of gonadotropins, and there fore have a lower mediation cost. Long Protocol IVF gives the highest expected pregnancy rate, and therefore is the most time-efficient protocol.
Preparatory to an IVF cycle we require lab testing on day 3 of a normal cycle. These tests include FSH, LH, TSH and prolactin. A semen analysis is required as practice for the husband, and for the lab to determine the feasibility of in vitro fertilization with the given specimen. A sonohysterogram excludes uterine and tubal abnormalities. A uterine sounding is a practice embryo transfer, to determine the depth and direction of the uterine cavity. established patients will already have had many of these procedures. the price for each item is listed in Basic Infertility Prices - 2008.
Mini-Lupron and Long Protocol IVF Cycles may result in more than two blastocysts on day 5 after egg retrieval. There is the option of cryo-preserving (freezing) the extra blastocysts for possible transfer at later date. Cryopreservation costs $600. Later thawing and transfer of same embryos costs $1,500. There is no guarantee that embryos will survive freezing and thawing. Pregnancy rates from frozen-embryo cycles are typically about 25%. A couple with extra blastocysts on the day of embryo transfer my opt to discard the extra embryos, donate them for research, or donate them for transfer to another patient, thereby avoiding the costs of cryo–preservation, thawing and transfer.
It is recommended that you have some health insurance in effect at the time of an IVF cycle. It is true that most insurance will not pay for infertility treatment, but such health insurance will also exclude the resulting pregnancy if the policy is not in effect at the time of conception. Furthermore, there are occasional complications of IVf treatment that may require hospitalization, such as ovarian hyper-stimulation, depp vein thrombosis, internal bleeding, ectopic pregnancy or miscarriage. medical insurance will usually cover these conditions, even when IVF is excluded.
Discounts
The Natural Cycle IVF clinic fee (not medications or lab costs) is discounted to $500, if the follicle ruptures before aspiration. The clinic fee is $1000, if an aspiration is attempted. A clinic fee of $2,000 is charged if an egg is obtained, even if it fails to fertilize or develop into a transferable embryo.
Mini-Lupron and Long Protocol cycles may occasionally result in no eggs obtained. In this case, the clinic fee (not medication or lab costs) is discounted to $2,000. If there are no transferable embryos on day 5 after egg retrieval, the clinic fee is discounted to $3,000.
If a repeat cycle of IVF is attempted, a discount of $500 is applied to each subsequent cycle.
Patients undergoing stimulated-cycle IVF, that is Mini-Lupron or Long Protocol IVF, frequently choose to buy less expensive medications from overseas. The cost saving of foreign medications is included in the above calculations. Olympia Women's Health neither endorses nor condemns the use of foreign medications. See handout entitled, ‘The Use of Foreign Gonadotropin for Infertility Treatment'.
Egg Donation in a Shared Cycle permits a young patient (<35 years old) to donate half of her eggs in exchange for the egg recipient paying most medication and lab costs. The egg donor must still pay half of the Clinic Fee, that is $2,250, on an Egg Sharing Cycle, and her medication and lab costs after egg retrieval.
Experimental Discount
In order to further improve the pregnancy rates by in vitro fertilization, Olympia Women's Health is making efforts to stabilize the transferred embryos within the uterus. The experimental discount is applied against the Clinic Fee. The amount of the discount will vary depending on the newness of the protocol. Established protocols in a data accumulation phase will have smaller discounts, typically $500.
Financing
The Clinic Fee must be paid in full at the start of an IVF cycle, that is, before starting the gonadotropin injections (Menogen and Gonal F). Olympia Women's Health is pleased to offer some of the most affordable IVF services in the country. We prefer personal checks as payment, but will accept cash or credit cards. If you are unable to prepay the deposit, it is better for you to continue a birth control pill until the deposit is available.
If you need some financial assistance consider one of these options:
Disclaimer
The entire staff at Olympia Women's Health will make every effort to help you attain pregnancy through in vitro fertilization. We are proud to have achieved the high pregnancy rates stated above, and expect the future to be as good or better. But, there is no guarantee that you will succeed in a particular cycle. The pregnancy rate remains about the same for subsequent cycles. Many patients will achieve pregnancy with persistence.