While it's true that a baby is priceless , it's equally true that infertility treatment is expensive ! How can you make sure you get cost effective medical care ?
From the book
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
How much does infertility treatment cost ?
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 IVF Cost, 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 IVF Costs. Remember to include travelling costs; lodging and boarding if you are from out-of-town; and the cost of time taken off work.
Do insurance companies cover infertility treatment ?
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 IVF Cost 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.
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!)
In fact, reproductive tourism has become very popular; and about half the patients we see in our clinic come to us from the US and UK.
Medical tourists can be demanding patients ! They have often lost faith in their own medical system; and many of them are doctors and nurses who make their own medical decisions. They are challenging to treat and I enjoy doing so, because they are well-informed and capable of thinking out of the box - it does take guts to travel toIndia for medical treatment !
I just did an interview for BBC, and one of the first questions I was asked is - "Why do patients come to your clinic from all over the world ?"
In the beginning, I think the major reason was the fact that our prices were much more competitive than what clinics in the USA and UK charge. However, our major USP is no longer our labour arbitrage . I think what sets us apart is the fact that we are a "focussed factory" ( a concept described by Michael Porter and Regina Herzlinger). We run a lean and mean unit , which does IVF and only IVF ! Because we do so many cycles, we are very good at it; and because we do nothing else, we have to be very good at it !
Initial consultation Rs 500 to 1000 (US $ 20 )
Semen Analysis Rs 200 to 500 (US $ 10)
Hysterosalpingogram Rs 500 to 2000 (US $ 40)
Hormonal blood assays (FSH, LH, prolactin, estrogen, progesterone) - Rs 200-400 for each test
Testicular biopsy Rs 2000 to 10000 (US $ 200)
Endometrial biopsy Rs 500 to 2000
Diagnostic Laparoscopy Rs 10000 to 40000 (US $ 1000)
Operative Laparoscopy Rs 25000 to 50000 (US $ 1200)
Major surgery (microsurgery for tubal repair) Rs 40000 to 65000 (US $ 1000)
IUI (insemination) Rs 3000 to 15000
TID (Therapeutic insemination by donor), per cycle Rs 8000 to 20000
HMG treatment cycle (for superovulation) Rs 8000 to 20000 (US $ 400)
GIFT Rs 50000 to 120000 (US $ 3500)
IVF Rs 50000 to 120000 (US $ 3000)
Embryo freezing Rs 20000-40000
Microinjection (ICSI) Rs 80000 - Rs 150000 (US $ 3500)
Preimplantation genetic diagnosis Rs 150000 - 200000 (US $ 5000)
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