Beware of add-ons to fertility clinic bills

Couples seeking IVF and other treatments are ‘vulnerable to being exploited’, writes Louise McBride

IRISH couples could spend thousands of euro more on fertility treatment than they need to should they opt for expensive, yet unnecessary, additional tests and treatments, leading fertility experts are warning. “Couples who go for IVF (In Vitro Fertilisation) desperately want to succeed — so they’re slightly vulnerable and slightly open to being financially exploited,” said Dr John Waterstone, medical director of the Cork Fertility clinic.

“Some couples will spend thousands extra on additional things which a clinic might suggest will increase the couple’s chances of success.

“However, the add-ons may not make a difference to the chances of having a baby. If a couple spends an extra few thousand euro on something they don’t need and they are then unsuccessful in conceiving, they would have been better off keeping that money for a second round of fertility treatment.”

Couples are already facing bills running into tens of thousands for fertility treatment — before add-ons come into play.

Some of the fertility tests and treatments Dr Waterstone is referring to include tests for immune problems, IMSI (intracytoplasmic morphologically selected sperm injection), the placement of embryos in a time lapse incubator, and routine pre-implantation genetic screening.

Couples embarking on fertility treatment should avoid spending money on natural killer cell testing — blood tests which look for signs that a woman’s immune system is preventing a pregnancy, according to Dr Mary Wingfield, clinical director of the Merrion Fertility Clinic.

“These tests have not been validated, are not supported by the general medical and scientific literature, and the treatments recommended are similarly not properly tested and may even do harm,” said Wingfield.

These warnings mirror those made in a BBC Panorama documentary last November. That documentary found that there was no solid evidence to prove that many of the add-on treatments offered by British fertility clinics work. The programme highlighted cases where patients had spent tens of thousands on fertility treatment and add-ons — but had never succeeded in having a baby.

A round of fertility treatment typically costs between €4,500 and €5,000 in Ireland but that bill could rise to as much as €10,000 if donor eggs are required. As the average number of treatments per couple is around four, a couple could face bills of as much as €40,000. The bill however could be even higher than €40,000 if add-on treatments are bought.

How can I cut down the cost of fertility treatment?

Do your research and know exactly what treatment you need before approaching a clinic.

Before signing up to treatment, find out what the total bill will be for everything you need — and compare that to what other clinics will charge. Most clinics display their prices online. “Before choosing a clinic, look very carefully at what the treatment seems to cost — and find out what add-ons there may be,” said Waterstone.

Be aware that some clinics will charge extra for certain treatments while others won’t.

For example, about half of the IVF or intracytoplasmic sperm injection (ICSI — another common fertility treatment) treatments given to patients in Cork Fertility involve blastocyst culture — a technique used to maximise the chance of pregnancy, according to Waterstone. “A similar proportion of IVF and ICSI cycles in other units probably also involve blastocyst culture,” said Waterstone.

The price charged by Cork Fertility for a round of IVF or ICSI includes blastocyst culture, however, some other clinics charge as much as €1,000 extra for this.

You should also find out where you stand financially with a clinic if you stop or postpone your treatment — and how its refund policy compares to others.

Don’t jump into IVF too quickly — more affordable alternatives, such as intrauterine insemination (IUI) or ovulation induction (OII) could be all you need, particularly if your fertility problems are unexplained.

It could also work out cheaper to get treatment abroad. In the Czech Republic, it typically costs about €2,500 for one round of IVF, according to Helen Browne, co-founder of the National Infertility Support and Information Group. Bear the costs of flights and accommodation in mind, however — particularly if you need to return to the foreign country for more treatment. “If you have any side effects when you get back, you can go into a maternity emergency department here — but it is always best to be seen by the consultant who originally treated you,” said Browne.

Mind your health

Leading a healthy lifestyle can boost your chances with IVF — and so should keep your costs in check as it could eliminate the need to pay for a subsequent round of treatment.

“Smoking reduces your chances with IVF by at least 20pc,” said Wingfield. “Also, if you have a normal body mass index of between 19 and 30 — and are not over or underweight, your chances [of conceiving] will be better.”

Of course, a healthy lifestyle could also cut out the need to go for fertility treatment in the first place.

Should you need fertility treatment, getting it sooner rather than later can also help.

“Generally if prospective parents are younger — that is, if women are under 35 and men are under 45, the IVF success rates are much higher,” said Wingfield.

Treating problems with the reproductive system early on in one’s life — even if one has no plans for a baby at that stage — could also reduce the cost of or need for IVF, according to Browne. “We have come across a lot of cases of people who had endometriosis or polycystic ovary syndrome in their late teens or early twenties,” said Browne. “If their conditions were treated when they had first complained of them, their chances of having a baby later on in their lives would have been better.”

Is there cover under the public health system?

Ireland and Lithuania are the only European countries where the public health system offers no cover for fertility treatment. It’s over a year since the then Health Minister, Leo Varadkar, said he would make fertility treatments available through the public health system under legislation to be published in 2016. This legislation has not yet been published.

A spokesman said officials are currently drafting it and plan to complete it by the end of June.

Is there any tax relief?

You can claim back a fifth of the cost of fertility treatment, and any drugs you are prescribed, in tax relief. Be sure the practitioner who carries out your infertility treatment is on a register recognised by the Revenue Commissioners, otherwise you won’t qualify.

If you receive treatment abroad, you should still be able to get relief, as long as the practitioner is entitled to practise medicine under the laws of the country you have travelled to.

It is also worth joining the State’s Drug Payment Scheme before embarking on fertility treatment.

Under this scheme, you will not pay any more than €144 a month for approved prescribed drugs.

Put yourself first

Research the success rate of the clinic you are considering — particularly for people of your age. Ask the clinic the number of live births — rather than pregnancy rates — that arose after treatment in its centre. Get a second opinion if you suspect that a clinic is recommending unnecessary expensive tests. Check if the clinic is regulated and inspected by the Health Products Regulatory Body.

Be sure to choose a clinic which is putting your interests first. There has been an increased commercialisation of assisted reproduction in recent years, according to Waterstone.

“As IVF units become more commercial, to some extent, they’re becoming owned by their shareholders — whose main interest is profits,” said Waterstone.