IVF- All inclusive or pay as you go?

[Bryterlayter1]

Hello!

Looking for some advice/views. I am about to start IVF. I'm 40 but the reason for the fertility treatment is that I am in a same sex relationship. We opted for IVF over IUI given my age. We will be using donor sperm.

I'm paying privately and the clinic offers a pay as you go model or an all inclusive set fee of £9000 for a cycle of IVF. I've copied what it includes below.

I have no idea if this is a good price. I was adding up their pay as you go prices (basic IVF with no meds or blood tests is £3600), it seemed to come out a bit cheap (not much) on pay as you go but if we need to freeze embryos and do an embryo transplant in a future cycle, then the all inclusive looks cheaper. I'm mindful in Covid times to prepare for the unexpected.Any views?

What's included- ONE IVF fresh cycle. •If the fresh cycle becomes “freeze all” (e.g. due to risk of OHSS, then the package includes the subsequent frozen transfer cycle, but no further frozen cycles). •ALL Scans In treatment•ALL Blood Tests during treatment cycle (not including pre-treatmenttests) up to and including pregnancy test •ALL IVF Medications including antibiotics and IV cover after procedures, •Progesterone support in form of pessaries and injections up to pregnancy test date•Nurse Consultationsincluding Injection Technique•Egg collection: Sedation, Surgeon and Anaesthetist fees.•HFEA Fees for both the fresh and frozen cycle•Embryology Services Semen Preparation (Fresh or Frozen) + Analysis Time Lapse Monitoring & Imaging Assisted Hatching (If required) Blastocyst Culture Embryo Glue Embryo Freezing*First year storage Fees (£300 per year thereafter)•Blood Tests (after Embryo Transfer up to and including first pregnancy test)•Counselling service–one session include

Very similar situation so can offer you some comparison (41 when started, same sex couple, donor sperm).
We’re with one of the big London clinics and did pay as you go. First cycle including basic cycle, the mandatory blood tests, initial scan, monitoring scans and tests, covid tests, sperm storage and blastocyst culture and meds came to about 7300. We got meds from the in house pharmacy, and I was on short protocol, menopur and fyramedel, and needed 8 days of injections in total.
We decided to pay as we go rather than a package deal, and for us I think it’s worked out ok as we didn’t get anything to freeze. We also have left over meds, so second cycle looks to be cheaper (first one didn’t work).
I haven’t included the initial consult, donor speed etc.
It’s a bit of a gamble in that for some people (you have lots to freeze, or need to stim for longer, or need lots of meds etc) then it’s probably cost effective, but if you end up like we did it’s not - and you just don’t know before the first round!

@Aprilia123

Thank you for your response. Firstly, I'm really sorry the first cycle didn't result in embryos. Sending you positive thoughts and good wishes for round 2.

Yeah, I get the feeling it's a gamble, it really depends on the cycle on pay as you go it could end up more or less than £9000, and there is no way to know until we go through it.

We've already paid the initial consultation and most of the pre-IVF fertility tests, I still have a blood test to go, so that is basically covered. The other cost is sperm! My goodness, who knew that would be so expensive!! But unless my wife magically starts producing it, we're stuck with spermbank prices!

Hi @Bryterlayter1

The all inclusive package price sounds like a lot for what you get. I'd imagine a number of the things they list are included as standard in PAYG, then there are some additional bits like the embryoscope incubator which can help select the best embryos, but it's not essential. The main cost that is included that you would need to pay extra for with PAYG is the medications, you should expect to pay £1500-3000 for medications for a fresh cycle, you can reduce the cost by getting a private prescription and going to Asda pharmacy where they sell the meds at cost price.

Have you looked at any finance packages? I'm with access fertility and these usually work out cheaper, they provide prices based on age so you would need to call them to find out if they can provide a package and if so what the cost will be. The package I'm on includes 2 fresh cycles and unlimited FET until I have a live birth or run out of embryos.

The next thing I would advise is that you need to budget for multiple cycles/transfers. The chance of a cycle working is around 1 in 3/1 in 4, so you will need to budget for 3-4 transfers, whether these are fresh cycles or frozen will depend on how many embryos you are likely to get with each fresh cycle.

The final thing I would bring up is whether you plan to Pgt-A test the embryos, at your age I believe about 1 in 3 embryos are likely to be euploid (23 pairs of chromosomes), if the embryo is not euploid then it can fail to implant, miscarry or result in a condition like Downs, so are you going to pay to find out which are euploid, this may reduce the time taken until success or do double transfers and hope for the best?

@Bryterlayter1 Thank you, and good luck to you too! So it doesn’t sound too depressing, we did have a good quality embryo put back, just a didn’t stick this time. But as the previous poster says, we’d planned for multiple cycles anyway (and have set cycles / time / financial limits).
My wife too refuses to produce sperm, which is rather unreasonable I think - so yeah, at the mercy of crazy prices! We found the US banks to work out a tad cheaper with more info, especially as some of them do cheaper shipping if you’re with a clinic that uses them a lot.
We’ve looked at Access mentioned above as well and probably would have done that before the first cycle just to know the second was paid for.

Thank you both! Gah! So much to think about. I think I'll make a spread sheet of the likely costs and weigh that up against the all inclusive price.

Also, good advice to make a plan on spending. We've put a 2 year window on the TTC, just so we have a cut off point, but we didn't put a price cut off, which is probably a much more sensible approach! I think this weekend will be full of planning. We have the money in the bank needed for 1 cycle (up to 3/4 transfers) + the sperm , but if we need more than one cycle we will need to look at financing.

Thanks again both! Really helpful tips and things to consider.

Hi @Bryterlayter1 the more I've thought about this the more horrified I have become that your clinic want to charge you £9000 for a cycle. Please don't pay for it.

I've broken down the things from your bullet point list of what's provided.

These things should be provided with the standard package

• ALL Scans In treatment
• ALL Blood Tests during treatment cycle
• Nurse Consultations including Injection Technique - my clinic has online videos, you don’t need a one on one session with a nurse to learn this.
• Egg collection: Sedation, Surgeon and Anaesthetist fees.
• HFEA Fees for both the fresh and frozen cycle- I think this is included but if not I don't think it's that expensive.
• Embryology Services Semen Preparation (Fresh or Frozen)
• Embryo Freezing
• Counselling service–one session included- I thought all ivf clinics provide free counselling during cycles

These are things you will need to budget for with the standard package:

• First year storage Fees
• Blastocyst Culture - for some reason clinics charge a few hundred pound extra for this, even though it’s the norm to transfer 5 day blasts.
• ALL IVF Medications including antibiotics and IV cover after procedures, Progesterone support in form of pessaries and injections up to pregnancy test date. Budged £1500-3000 for a fresh cycle.

Add ons that aren’t essential

• Analysis Time Lapse Monitoring & Imaging - normally this costs about £700, it’s only useful if you have a lot of embryos as it will help select the best one
• Assisted Hatching (If required)- debatable as to if this provides any advantage
• Embryo Glue - if embryo is hatching this can’t be used. And again debatable if it's any use.
• Blood Tests (after Embryo Transfer up to and including first pregnancy test)- I have never needed any blood tests after a transfer.

I hope this is helpful, I feel like you are being taken advantage of with the package for £9000 and would even suggest it is against HFEA guidance for how much a cycle should cost.

Yes to the spread sheet, please call access fertility and see if they can provide a quote and consider this too.

I made a spreadsheet of paying the clinic directly vs the access fertility package. If it took more than one cycle I saved money with access (I am 35 and I'm on my third transfer with very good embryo quality and euploid rates).

Most of what is described in the all inclusive are routine things which would be included in any IVF cycle quote to be honest. Time lapse monitoring is included as standard at some clinics. Assisted hatching and embryo glue are both unproven in terms of effectiveness as far as I am aware so probably not worth including in your head as a 'benefit'. Counselling isn't overly expensive (£60-100 per session) so again not a huge 'benefit' when overall cost is £9000! The main thing the all inclusive package seems to add to my mind is the freezing and first year storage costs if needed, plus the first frozen transfer if needed, and the fact they include meds costs. However, you can shop around for meds to find the cheapest rate and freezing costs aren't huge - £700 including first year fee at our clinic from recollection. And you might not need to freeze anything or do a frozen cycle.

For comparison, our cycle at a London clinic cost £5600 total (including meds and time lapse monitoring but no freezing). We were given a price by the clinic at the beginning which included everything except meds, and we didn't have anything added to our bill at the end. My meds cost was high as I was on a high dose of stims.

Personally I think it sounds a bit pricey and would shop around a bit more. The whole process is such a gamble all round unfortunately 🙁 good luck 👍