How
Much Does Treatment Cost?
from the
book How to Have a Baby: Overcoming Infertility
by Dr. Aniruddha
Malpani, MD and Dr. Anjali Malpani, MD.
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The
Economics of Infertility Treatment
Being infertile
can be very expensive ! Tests and treatment cost considerable money, and
since there is no definite endpoint, budgeting for medical expenses can
be very difficult.
The availability
of modern assisted reproductive techniques, such as IVF , have made treatment
even more expensive - since so much expertise and technology is needed
for these procedures. This means that there really is no upper limit to
how much you can spend in your pursuit of a baby !
You need
to control your finances - and it is unfortunately only too common to
find patients who are so desperate to have a baby, that they have begged
and borrowed, and even sold their lands, possessions and belongings, so
that they could continue trying to have a baby.
Of course,
for infertile couples, a baby is priceless, but you cannot afford to waste
money . You may need to shop around to get a realistic estimate of how
much treatment costs. Charges vary widely - and don't automatically assume
that the more expensive a clinic, the better it is .
You need
to consider the cost-effectiveness of each treatment option. While it
is true that an IVF cycle is four times as expensive as an IUI cycle,
the chance of a pregnancy is also four times as great ! A common mistake
patients who are not very well off often make is that they repeat the
treatment of IUI repeatedly, because they feel that they cannot afford
IVF. However, in the long run, they often end up spending even more !
You need to have a plan of action, and to stick to it, rather than to
keep on trying the same treatment over and over again, just because it
is less expensive !
When considering
expenses, you need to consider not only the money you will be spending,
but the time and energy you need to invest as well ! All of us have finite
resources – and you need to invest them carefully !
Ironically,
infertile patients who are rich are subject to the risk of overtreatment.
Just because they can afford it, doctors advise them to go in for an IVF
cycle, while simpler treatments such as IUI could also have helped them
to get pregnant.
It is important
to get a breakdown of the expenses for all procedures - preferably in
writing . For example, for surgery, find out what is included in the quoted
figure - does this include just the surgeon's fees ? the assistant's ?
anesthesia? theatre charges ? hospitalisation ? followup visits ? Often
what is excluded can add up to a pretty penny ! This is especially true
for IVF treatment, where "hidden expenses" can lead to your spending much
more than you had bargained for.
Patients
are often reluctant to talk about money and expenses with doctors - but
remember, it's your hard-earned money you are spending . You can't afford
to shy away from this topic. Doctors are also sometimes vague about money
matters - and this makes getting specific figures so much more important.
You need
to calculate what your total expenses will be , not just the medical costs.
Remember to include travelling costs; lodging and boarding if you are
from out-of-town; and the cost of time taken off work.
Unfortunately,
most insurance companies in India will not reimburse you for the medical
expenses for treating infertility - they still take the old-fashioned
view that infertility is not a medical problem ! A number of couples are
also reluctant to claim for medical expenses for treatment, since they
do not wish to disclose to anyone else that they are infertile. Also,
Government medical facilities rarely provide quality care for infertility,
since this is not a primary concern for them . Until these attitudes change,
a number of patients will be deprived of infertility care, because of
financial constraints - and this is a shame !
Infertile
couples in USA have used the courts to get their medical bills paid. In
1998, the city of Chicago agreed to cover infertility treatments for its
employees after a female police officer sued the city for violating the
Americans with Disabilities Act. The officer said her infertility was
a disability because it impaired a "major life activity." In 13 states
in the USA, insurers are required by law to offer some form of infertility
coverage. Hopefully, infertile couples and their advocates will be able
to successfully lobby for similar changes in India as well.
However,
patients have devised ingenious methods to overcome these financial hurdles.
For example, young women who can grow lots of eggs and who need IVF but
cannot afford to pay for this, have agreed to " share " their eggs. Older
women, who need donor eggs and are well-off, can then pay for the entire
IVF cycle, and the two can share the eggs, giving both of them a chance
to get pregnant. Egg sharing allows the doctor to match financial and
reproductive resources, and is beneficial for both donor and recipient.
You can also
get coverage for some of your medical treatments (such as laparoscopy)
by requesting your doctor to say that the surgery was done for treating
pelvic pain (which means your expense will be reimbursed by the insurance
company ) rather than for treating infertility.
Approximate
costs for procedures, tests and treatments is summarized in this chart.
These figures are for the year 2000 in the city of Bombay, and are only
meant to be representative - do remember there can be considerable variation
! These are "all-inclusive" medical expenses.
Note:
1 US dollar
= Rs 45.00
1 UK pound = Rs 75.00
Compared
to the UK and USA, IVF treatment is much less expensive in India, and
the quality is as good. This is because doctors charge much less - so
that by international standards, IVF in India is very cost-effective,
and quite a few patients do fly down to India for treatment (and have
money left over, even after paying for air-fare!)
--------------------------------------------------------------------------------
Initial consultation
Rs 250 to 500 (US $ 10 )
Semen Analysis
Rs 100 to 200 (US $ 5)
Hysterosalpingogram
Rs 500 to 1000 (US $ 25)
Hormonal
blood assays (FSH, LH , prolactin, estrogen, progesterone)
Rs 200-400
for each test
Testicular
biopsy Rs 2000 to 5000 (US $ 125)
Endometrial
biopsy Rs 500 to 2000
Diagnostic
Laparoscopy Rs 3000 to 10000 (US $ 250)
Operative
Laparoscopy Rs 5000 to 25000 (US $ 600)
Major surgery
(microsurgery for tubal repair) Rs 10000 to 25000 (US $ 600)
IUI (insemination)
Rs 3000 to 15000
TID (Therapeutic
insemination by donor), per cycle Rs 3000 to 15000
HMG treatment
cycle (for superovulation) Rs 5000 to 15000 (US $ 400)
GIFT Rs 25000
to 60000 (US $ 1500)
IVF Rs 25000
to 60000 (US $ 1500)
Embryo freezing
Rs 20000-30000
Microinjection
(ICSI) Rs 60000 – Rs 100000 (US $ 2500)
Preimplantation
genetic diagnosis Rs 150000 - 200000 (US $ 5000)
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