What Is The Cost of IVF Treatment In India?Dr Maheshwari
What Is IVF?
IVF or In-Vitro Fertilization is a process through which the eggs are extracted from the would-be mother’s ovaries and is then fertilized by the sperm of the partner in the lab. This fertilization outside of the womb is termed as “In-vitro”. Post-fertilization in the laboratory, the embryo is cultured and allowed to grow for a few days. One or two healthy embryos are then transferred into the uterus for further growth.
IVF costs explained.
IVF can be an expensive treatment and the cost of a cycle depends upon various factors depending on the clinical situation of the couple. When you hear the term “cost of IVF cycle”, each clinic or infertility treatment centre means different things. Some centres mean include the cost of egg pick up, embryology and embryo transfer procedures only. A few others include all consultations and scans. Certain clinics include the costs of all investigations and the cost of injections too.
When comparing the costs of IVF cycles, make sure you are clear about what is included and what is not included.
IVF cycle cost can be broken down into the following heads and sub-heads.
This includes all the charges for the services that are offered in the outpatient area. It includes the following subheads.
Consultation: Typically, a clinician does about 6 to 10 consultations during one IVF cycle – from the day2 when the stimulation starts until the egg pick-up (or embryo transfer if it is a fresh transfer)
Ultrasound monitoring: Follicular monitoring with a baseline scan is an essential process for an IVF cycle. Along with hormone levels, this is the ‘measure’ that indicates the progress of the ovarian hyper-stimulation process. Usually, there are 5 to 10 scans done by the clinician in one IVF cycle.
Counselling: Couples need clinical, psychological and financial counselling when they go through an IVF cycle.
Blood and other investigations:
A key aspect of the IVF cycle is the host of blood investigations that are needed to start, continue, stop or end an IVF cycle. In addition to this, other investigations need to be done with very high precision when compared to other normal tests. This is because the IVF cycle’s plan, the protocol, the dosage and many other attributes are determined by the values got from the tests. If the tests are not very accurate, they will affect the IVF cycle drastically. Therefore, it is important to use high-quality equipment, top-quality reagents and kits, employ highly qualified people and follow proper predefined procedures. Hence, the cost of quality is primary in an IVF.
Pre-IVF investigations: Investigations are conducted at the start of the IVF cycle, to ensure that the patient is ready to start the IVF. It can include investigations for the wife as well as the husband. The costs for this are usually not included in the IVF cycle.
Investigations conducted during the cycle: Once the IVF cycle starts, investigations are to be done regularly. Some hormone levels are tracked often – FSH, LH, P4, E2, Prolactin etc. This is essential as it indicates how your body is responding to treatment. Based on this, the clinician makes many decisions, including increasing or decreasing the dosages, changing the drugs, cancelling the IVF cycles or advancing the pick-up dates etc. It will also include the semen analysis for the husband
Post IVF investigations: Once the egg pick-up is done, the IVF cycle ends (if there is no fresh embryo transfer). There are a few investigations to be done after the end of the IVF cycle. This could be to rule out Ovarian hyperstimulation syndrome(OHSS) or other risks.
Cost of injections and medicines:
One of the most significant items that affect the cost of the IVF cycle is hormone injections and medicines. In a typical cycle, more than 40% of the cost is due to injections and medicines.
Injections of different qualities are available in the market. However, the response from the ovaries, the quality of the retrieved eggs and the success rate of the IVF is highly dependent on the quality of injections, how it is preserved in the cold chain from the point of manufacturing to the point of administration, etc.
As an example, hormone injections are available in India for as low as Rs.1000 and as high as Rs.10,000. The low-cost ones are not manufactured under stringent quality conditions and the cold chain may not be maintained effectively. These will not give a good result eventually and ruin all other treatments given so far.
Hormone injections during the IVF – The woman has to take hormone injections every day, from day 2 until the end of the cycle. The dosage depends on the woman’s age, the response of her ovaries, whether she has PCO or not and more factors. Choosing the right hormone, the right dosage, and the right manufacturer and maintaining these in the right conditions will give good results. However, this will entail a certain increase in cost.
The cost of the injections may vary from patient to patient significantly based on the woman’s response. We have seen patients require injections worth only Rs.30,000 and also seen patients who needed injections more than Rs.1,20,000!
Injections and medicines after the embryo transfer – After the embryo transfer, the woman has to take medicines and certain injections regularly, until the beta HCG test. If the result is positive, then the injections and medicines will have to be continued. This is more like a supplement to the uterus and endometrium to provide proper nurturing to the embryo that is growing.
This is usually not included in the package.
OT Procedure Charges:
This includes two crucial steps – the retrieval of the egg from the ovaries and then embryo transfer. Both require the usage of the operation theatre.
Egg Pick-Up Procedure: This is done under anaesthesia and the procedure takes approximately 30 minutes to 1 hour. The retrieved eggs are then handed over to the embryology lab for evaluation and further processing
Embryo Transfer Procedure: This is also done in the OT, but usually does not need anaesthesia. In rare cases, patients may be anaesthetized. In this procedure, the embryologist loads one or more embryos onto an ET catheter and hands it to the clinician. The clinician then pushes the catheter into the uterus slowly and deposits the embryos there, under the guidance of ultrasound. This is a very crucial step and determines the fate of the IVF cycle. It requires a lot of skill, practice and stability.
Embryology includes the process of embryo evaluation, fertilization, its culture, freezing, storage, thawing, recovery, growth and then preparation for transfer. This is a highly skilled procedure that requires a well-equipped and well-maintained IVF lab, a supporting team that is highly skilled & well trained and highly motivated. All of the above incurs high costs.
Embryo Culture and monitoring
Once the eggs are handed over to the embryologist, he/she will evaluate the quality and the quantity received. These eggs are then prepared for IVF or ICSI. Once the fertilization is done, the embryos are then cultured in the lab using a special liquid called culture media. The selection, maintenance and changing of culture media as per defined protocol is a crucial step in embryo growth.
Culture media is available at various costs, based on the manufacturing process, the tests done, the way it is maintained, etc. We use some of the world’s best media which gives amazing results, but they are very expensive.
Using substandard media will reduce the cost of the IVF cycle drastically, but will give very bad results.
Freezing and thawing:
Embryos are usually frozen once they reach a particular stage of development. Many centres now follow the freeze-all policy and so will only do the frozen embryo transfer.
This involves a certain additional cost, as the embryos have to be frozen to -190 deg Celsius, without harming the embryo. The media required to do this is expensive and the skills are of the highest order. Thawing these frozen embryos requires specialized thawing media and techniques and bringing them back to ‘life’ requires special culture media. This ensures that they start growing again with required monitoring and then preparing them for the embryo transfer requires excellent skills.
Embryologist and team:
A team of embryologists – senior embryologist, junior embryologist, andrology lab technician, maintenance personnel and supporting para-medical staff – all of them play a very important role. These are specialized roles and require special training and skills.
Embryology Lab charges
The setup of the IVF lab is the single most expensive investment in the setup of an IVF centre. The equipment needed in the IVF lab is all specialized and delicate, as they have to work on microscopic sperms and eggs. In addition, the cleanliness in the lab has to be of the highest standards as the embryo development has to happen in a perfectly clean and sterile environment.
If the lab is of very good quality, if the media is of the highest quality, if the eggs are of good quality and if the skills of the team are of the highest order, then the lab will consistently produce blastocyst embryos. This will increase the success rate of the IVF cycle significantly. This will also increase the cost of the IVF cycle, as the process of pushing an embryo to blast stage and then culturing in blast stage and then transferring the same requires special culture media, skills and techniques.
In some cases, the embryo has a thicker outer layer, which may prevent it from ‘hatching’ properly. In such a situation, the embryology team may decide to use a special process called laser-assisted hatching. Here, the embryo wall is punctured at a select place to reduce the thickness and allow the hatching to happen more easily. This is done using specialized laser equipment handled by highly trained people.
Documentation and consent
The whole process of IVF requires a lot of documentation, consent forms and record keeping. This is to ensure that legally, all parties are safe and clear about the process, the risks, the treatment being given and the progress. We use a combination of software and physical documents to fulfil the legal and clinical guidelines. Some specific people are employed and trained for managing this.
Nursing, housekeeping and support teams:
Quite a few other teams play many important roles in the full IVF cycle of a couple – the nurses, the OT technicians, the housekeeping staff, the pharmacists, the facilities people etc. Many of these are not generic skills and some are trained for infertility and IVF. This involves its own cost and expenses.
Donor and Surrogate charges:
This includes the payment made to the egg donor, the cost for her screening, the charges to be paid to the ART bank or the agent who gets the donor and any other treatment that may be needed for the door – before the donation or after the donation.
If the couple requires an egg donor these additional costs have to be considered and budgeted. Please note that the treatment now involves 2 people – the donor and the wife. So there is an additional cost for consultations, scans, medicines etc.
If the couple is looking for some rare qualities in the donor – like very tall, or very fair or Caucasian or African etc., then the costs become higher.
This is not a large expense but still is an expense. If the donor semen is sourced from a good and professional semen bank, it costs a little more than getting semen from a common person. The professional bank would have done a lot of tests and quarantines to ensure quality and safety.
If the couple requires a surrogate mother, then the cost of the whole program increases drastically, as surrogate mothers and the process of surrogacy is expensive.
Other optional procedures:
Diagnostic or operative Hysteroscopy
In many hospitals, diagnostic hysteroscopy is mandatorily done to ensure there are no surprises in the uterine and pelvic areas. This procedure will give the clinician clarity on what to expect during pick up and transfer. It will also help the doctor plan the treatment better.
If there is some unwanted growth or anatomical abnormalities, they can be addressed before starting the cycle. If needed, the doctor may also ask for an operative hysteroscopy to resolve any identified issues.
This adds to the cost.
Diagnostic or operative laparoscopy
In some cases, a diagnostic or operative laparoscopy may be advised if there are cysts, fibroids, polyps or some other anomaly to be resolved. This is an expensive treatment, but not everybody will need this.
TESA / PESA / Micro Tese
If the husband is not able to provide healthy sperm in his ejaculate, then the doctor may decide to go in for a surgical sperm retrieval process. This is not needed in most cases, but may be needed if the patient is diagnosed as having azoospermia or severe morphological issues or if very low count. Sperms are retrieved surgically from the testes and can be used for IVF. This increases the cost of the overall IVF cycle.
If the doctor decides that the woman needs sequential transfer, instead of just 1 embryo transfer, then a FET is done on day 3 and a blastocyst is transferred on day 5. This increases the chance of pregnancy significantly.
This adds to the cost as there is an additional FET procedure being done which includes additional embryology work and blastocyst culture.
When all these factors are considered as a whole, one will begin to understand why specialised IVF centres with high success rates are slightly more expensive. But the results are high and one has to consider the time and effort a woman has to go through for an IVF. When you go with a good IVF centre, you can rest assured that only the best treatment and protocols are used.
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