How Much Does Treatment Cost?
from the book How to Have a Baby:
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.
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)
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
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