The Times they are changing
With increasing age of marriage in women , stress filled lifestyles and multiple pollutants, the number of both men and women facing fertility issues is rising. The WHO recently revised it’s criteria for ‘normal’ semen parameters to lower sperm counts and motility. Many of these couples would benefit from simple measures. But for those who have extremely low sperm counts or absent sperms[ azoospermia] in semen [ necessitating extraction from the testes-TESA / PESA/ TESE] or for those women whose tubes are blocked or even those couples where all other treatments have failed, a ‘test tube baby’ is the right if not only option.
What is the real cost of a ‘test tube baby’
The actual process using even the best of internationally available media with the machines the clinical set up and staff salaries costs around 40-50,000 Indian rupees. The injections given to stimulate the ovaries cost from 40,000 to around 2,00,000 based on the woman’s age, ovarian reserve and type of stimulation protocol used. Tests cost around 5,000-10,000. So the actual cost is from around 80,000 to 2,50,000.
Can the cost of a test tube baby be brought down?
Using the newer ‘soft stimulation’ protocols where fewer injections are given to patients, the cost of a cycle- including medications-can be brought down to as low as 80,000 rupees. These protocols suit the needs of most patient-s give excellent results in experienced hands- with very few really needing the conventional long protocols. All patients do not need a scopy though it does increase chances of a pregnancy. A good sonography is sometimes good enough.
Why do doctors quote high charges for IVF?
Many factors can inflate the cost of a test tube baby treatment- who and where the clinic is located for one. Rents and real estate in a city can add to the cost.
Many doctors start IVF cycles [ injections] but send patients elsewhere for sonography and the actual IVF to another centre. Some batch patients and take them by the bus load or a team flies down for 4 days when the egg pick ups embrology and embryo transfers are done. This raises the cost since soft stimulation protocols cannot be used in batching patients. And more people are involved hiking costs.Some clinics call embryologists for ICSI -again raising costs. Some doctors call an endoscopic surgeon as they are not experienced in endoscopy. This further raises costs
Part of a whole
If the IVF centre is attached to a large hospital or is a chain of IVF clinics or has multiple owners, the costs of the cycle can go up since a larger staff, marketing teams, paying of specialised doctors and lab staff increases. A single owner can be flexible in charges and charge lower amounts.
Cost of complications
If hyperstimulation occurs- as in PCOS patients freezing embryos and transferring them later is standard practice now. This hikes costs. If too many embryos are formed, freezing them does add to costs.
Old is not gold
Women in their late thirties and forties or who have had surgery done on their ovaries or suffered a severe infection or have endometriosis have fewer eggs and a higher percentage of abnormal eggs giving fewer good quality embryos. They need high doses of the costly gonadotropins to get a reasonable chance of pregnancy. – thus increasing costs. Using soft stimulation , freezing embryos and accumulating and transferring the best ones after thawing is a better option -it costs nearly the same and yields more pregnancies. Using an egg donor is also sometimes better-cost and result wise.
The ‘soil’ factor
If the inner lining of the uterus doesn’t grow, docs add injections or instill drugs to improve it -increasing costs of cycles
What’s the good news?
Competition- so many IVF centres and media providers as well as pharma companies making gonadotropins have brought down the cost with many claiming to be ‘Budget test tube baby’ centres
Experience As doctors and embryologists grow in experience they can give pregnancies with very few eggs, so cost of injections and hence the cycles is getting reduced.
Two for the price of one?
While there are journal articles showing that pregnancy rates increase at the second attempt, you could end up paying double for nothing.
Think it out. Plan well. Choose well. Be informed. But don’t spoil your chances by bargaining with your doctor or dictating your treatment. Sometimes trust is best.