How do you navigate IVF clinics, costs and treatment recommendations?

[LostLadyBug]

Please help. I’m new and so lost in the world of infertility and IVF. We’ve had some fertility checks at TFP Wessex and been given a costed plan - ICSI and PGT-A testing. We were told to bank a couple of rounds of egg gathering to maximise chances of best eggs (we’re both 40). From what I can tell there is no way to do this other than direct to the clinic with possibly endlessly sprawling fees. How do you navigate the whole process when all the clinics seem to offer different things and their financing partners don’t seem to remotely align with what you’re being recommended as a patient!? I’m so lost.

Hello! I have a similar situation to you in which I need to bank embryos. As you said, I haven’t found a fertility plan which allows it. So we’ve costed up doing it piecemeal through the clinic we’ve chosen (honestly I’ve gone for the one closest to work, the results for my age near me seem pretty similar). We have a limit on what we’ll spend, and probably an emotional limit on what I can cope with. We’ve also decided that if the first round is complete duff we’ll stop there, as that will be proof that there’s obviously no eggs left to get. We don’t have this money lying around, we’ll be paying it off for years.

If you don’t mind me asking, how have you managed to make your decision to go direct to the clinic? I’m really struggling to know what the best option (out of what feels like two bad options!) is!

I feel like I need to decide between an access fertility multi cycle package that won’t allow anything to be banked and isn’t what my consultant has recommended for around £15k. Or alternatively try and follow what my consultant has recommend directly with the clinic that looks like almost £15k for one cycle and who knows what that rockets up to when we try and add in a second collection before transfer… a lot of money certainly!

@LostLadyBug Where are you based and what are your AFC/ AMH? And are you aiming for one child or more than one?

I think Access do allow PGTA but it's an add on cost through the clinic and you have to transfer them as you go. Alternatively, some clinics do multicycle discounts. Nowhere should be 15k for a round - is that ARGC?

I’m based on the south coast so not feeling flush with options. Im rounding up a bit, but fully costed breakdown from TFP Wessex comes in at £13.8k. It’s not that London clinics aren’t an option but it feels like staying local is surely the better option.

I’m still waiting for the consultant letter following appointment last week and felt too overwhelmed in the session to remember all my numbers. I think it was 3.5 for AMH but not sure what units.

Male analysis suggests slightly lower than average morphology

Missed a question… would love to have the option for 2 but being pragmatic that I’ll be very lucky to have 1

Do you have the breakdown of the £13.8k cost? With your AMH you could also choose to skip PGTA (if in pmol).

Of course I don’t mind. Like you we went round and round the options, and eventually decided to go with the option most likely to give us a child (based on our circumstances, could obviously be very different for someone else). We only decided which route we were taking last night. I costed everything out on a spreadsheet, allowing for IVF rounds, a second or third transfer (when going direct each IVF round at my clinic only comes with one transfer included), what individual rounds of PGT-A would cost v doing it in one batch etc etc. From what I can best work out from the spreadsheet we realised that the costs would balance out, unless we need to do 3 x egg collections or multiple transfers. So that’s where we’ve drawn our line at stopping.

@sirensongI’m interested that you would base PGT-A testing on AMH rather than age - if you don’t mind, please could you tell me the reasoning for that?

@overwork age is the primary guide to PGTA benefit but if you are likely to get 1 or 2 embryos it may be worth just transferring and giving them a chance, possibly as a double depending on fertility history. The most likely outcome for abnormal embryos is non implantation or very early loss. Obviously the worst case scenario is having to consider TFMR 12 weeks< so it might be worth banking first regardless of whether you do PGTA.

That’s really helpful - thankyou!

Firstly, just wanted to say thanks so much for engaging with my post. It is so so reassuring being able to talk about this stuff!

Got my letter back from the clinic. Everything listed as normal (womb, lining, ovaries etc) and AMH 3.6pmol/L.

My partner has a high sperm count a motility of 70% but a morphology at 3%.

Cost breakdown:
1 freeze all and transfer cycle = £7525
FET = £2870
Bloods (for both) = 2 x 300 + 100
Meds = £2719
ICSI = £1455
PGT-A = £890 (+500 additional per embryo)

I feel like you are in a way more knowledgeable place than I am! It’s very reassuring to know I’m not the only one trying to get clarity an come to the best conclusion in this really confusing space.

Where are you based? You mentioned that you picked the place closest to work I think? Did you consider travelling further afar or looking at any stats? It feels like being closer to home would be the right option (I work from home half the week) but don’t know if that’s creating limitations

I’m in London so I almost have two many choices. Even by narrowing it down to closest to work there were 4. So I just decided to try and not overthink it. It might depend on how flexible your boss is too. Mine has been absolutely brilliant, he just has a private note in his calendar of the week I expect egg collection and the week I start drugs so he knows when to expect the slightly later starts / day off work. If you’re not a chronic over sharer, you might need to plan things carefully!

This medication cost is high, is the quote specifically for you?

And does the frozen cycle cost of £7525 definitely not include a transfer? In case you're double counting the FET.

As a guide to the more affordable end - a cycle at King's in London is about 4k. Unfortunately they recently scrapped their 10k for 3 rounds deal but the third cycle is now 25% off. Meds were about 1.5k and ICSI and PGTA are extra but there are no hidden extras like at the private equity clinics. The following are included in the cost (the rip off places start nickle and diming and end up costing thousands more): all blood tests during the cycle, blastocyst culture, embryoscope.

Meds are for long cycle freeze all… It looks like the more expensive protocol but the one recommended…

You’re right about the FET double counting though - that’s the cost for additional FET

Consider a second opinion on doing the long protocol. If you have diminished reserve ovarian suppression is often avoided. Short might be fine.

Sperm parameters can also improve with a healthy diet (vegetables and no alcohol etc), exercise and supplements. Possible you could get away with not doing ICSI after a few months of the above but if you have male factor issues the above is worth targeting regardless.

Prioritise the maximum number of rounds for your available budget - if that is with Access, do that.

@sirensong would you prioritise multiple cycles with Access even though you can’t batch embryos and have to use everything before moving onto a second cycle?

Any would you have any idea why the long cycle might have been recommended if suppression not optimal for low reserve??

It's always difficult to weigh these things. Overall for the best chance at 40, you want to have as many eggs made into embryos as possible, because that's like having extra raffle tickets. That priority leans towards as many rounds as possible for your money.

However, back to back freezing without yet transferring addresses the other big priority - time. It locks down embryos at the quality of the age you are right now. The risk of transferring as you go is if you get pregnant with an abnormal embryo it could take months to resolve, meaning you could be 6 months older before you can do another cycle (though as earlier post, only a minority actually reach clinical pregnancy. Most don't implant at all). On the other hand, if a transfer works you don't need to do the extra cycles at all - it could be that doing ICSI fixes things straight away.

Are you newly 40 or nearly 41? And do you know your FSH and AFC?

I'm not sure why long protocol would be recommended for DOR - it could be that it's their clinic default for everyone or because they want to focus on follicle synchronicity.

@sirensong how are you this knowledgeable about all this stuff!? What has your journey been!? I’m finding it incredibly reassuring just to know that this is a hard decision and a bit of a balance of the unknown rather than where I was assuming I was missing something!

FSH and AFC aren’t mentioned in consultation notes following initial tests. Are these extra tests I should be asking for?

I was 40 in December and generally fit and healthy

@LostLadyBug I'm very familiar with the whole subject because I did multiple back to back embryo banking rounds with PGTA ahead of surgery! I'm about to start transferring.

Clinics are not at all good at helping patients know the best path forward. You don't know if their recommendations are purely medical or with an eye on profit. The price lists do not explain what the overall cost would be. It's also tricky when doctors disagree, leaving you as a layperson to work out what the hell to do.

AFC and FSH are both relevant - did you have a scan? The first one is the count of the follicles in your ovaries. Antral follicle count can fluctuate each month but it gives a guide to egg numbers that might be collected. An AMH of 3.5 implies you might get 2-5 eggs but sometimes AFC doesn't match AMH. FSH tested on day 3 gives a sense of how robustly your ovaries are likely to respond to stimulation. The drugs that you inject are basically FSH so ideally you don't want very high natural levels, as then the extra dose administered is less likely to make a difference.

Unless you have a history of loss, in your shoes I'd consider transferring everything without PGTA to save money. It depends what your overall budget is and whether you have any fertility issues beyond age and sperm morphology.

I’m starting to think that banking a couple of rounds feels like the right idea right now. We are in a fortunate position to be able to make either option work financially but think we’ll probably cap this at two rounds then transfer and if we want to change strategy after that we can see where we get. I’m on the fence about the PGTA from reading what you’ve said @sirensong, why did you opt for it?

I have no history of loss or any other known factors. It’s just taken me a long time to meet the right guy!! They did a scan but other than suggesting that they would expect to yield 3-4 eggs they haven’t really given me any other numerical info.

Must be so excited to be starting transfers - I have everything crossed for you to be successful!! Where have you had treatment?

@overwork I’m impressed you’ve felt it so easy to communicate so openly with your boss! I’m not quite sure how I’m planning to navigate it at this end - feels like it’s going to be a bit of a logistically challenge navigating around work commitments. I’ll maybe just use AL

Yeah I had to think long and hard over whether it was wise and whether it might cause me problems. But realised I’d need so much time off / late starts that I either needed to confess or he’d think I was seriously ill!

I opted for PGTA because I did IVF at 42/43. At 40 there is still a decent chance of conceiving either spontaneously or via IVF. This is not true by 42 - odds start to change very fast - and I needed to quickly sift through as many eggs as possible and know whether any were normal or if I needed to keep going.

40+ it is best to brace for multiple rounds so you aren't blindsided and then if you're successful sooner it's a pleasant surprise.

The expected attrition is: 80% of collected eggs are mature, 80% fertilise, 30-50% of fertilised eggs reach blastocyst (day 5 or 6 embryo which is the stage needed to do PGTA) and then around 30-40% of embryos are normal (euploid) at 40. When you do the maths you see the challenge but having lower starting numbers of eggs often results in lower attrition.

Trying to get costs out of Wessex to understand ££ of trying to do two rounds before transfer to try and maximise the number of good eggs… I really wish they made it easier to work out total costs!