Hide and seek

Costs that go bump in the night and take your bank account unawares

We have been at the receiving end of a huge shock in the last week. One of our Easter embryos reached blastocyst but couldn’t be biopsied for PGT-M and the genetic consultant called to discuss it. She explained that occasionally, as cell division is occurring so quickly, it isn’t possible to get a cell sample for biopsy. However, it is possible for a ‘no result’ embryo to be thawed, re-biopsied and re-frozen…

…and our clinic doesn’t charge for the re-biopsy.

When the consultant said this, Matt and I actually exchanged such a comical double-take look that she laughed at us.

Not paying for something in private IVF treatment is basically unheard of in our experience so far. It is incredibly hard to get a straight answer on what you will need to pay and when, but the bottom line is that there will be plenty of costs.

When I started researching private clinics, I discovered that they all have individual systems for putting generic cost plans online; different numbers of embryos they will test as a batch, store as a batch etc before adding on additional ones; varying definitions of multi-cycle plans and so forth. I tied myself in knots trying to figure out what all their costing plans meant, gave myself a migraine and had a little cry on Matt.

What the hell was ICSI and why could I only find specific pricing for it on some clinics’ websites and not others? Why do only some tell you about PGT-M costs? If they do a ‘fertility MOT’, would they accept an existing set of NHS results or do you have to pay for that too?

I am looking back at the spreadsheet I compiled at the time of my first research and laughing at poor, naïve Helen for thinking she could stick all this in one spreadsheet before even choosing a clinic and it would all be so simple. But I am now less naïve, though financially undeniably poorer, Helen, and I am here to let you in on some of the costs that you may never have added in to the IVF equation (as well as some you have undoubtedly thought of).

I haven’t assigned monetary value to these things for two reasons: first, I’m not keen to put a detailed breakdown of our IVF expenditure on the internet; and second, different clinics will assign different costs to many of these things and I don’t want to mislead anyone. But if you have a cost that you’re second-guessing and want to talk it through with me, drop me a line!

Finally, it all looks horrifying and bank-breaking. But while it has required significant belt-tightening and budgeting, as I’ve said previously we think every penny has been worth it.

So where might these hidden costs pop up?

Before you get started

Initial consultations: there’ll be at least two of these – one so you can discuss what a clinic does and if it’s the right fit for you, and one when you decide to go ahead to establish what your treatment plan will look like.

Fertility screening: sperm count, AMH…the basics they need to know about your fertility before you start out.

Diagnostic tests: in the case of PGT-M, DNA diagnostics will be necessary to establish the gene you will want to later screen for, and to set up genetic markers to test potential embryos.

Treatment preparation

Vitamins and supplements: folic acid, vitamin D, Pregnacare supplements, CoQ10…you name it, you’re advised to take it to start getting yourself ready for fertility treatment.

During treatment

Medication: obviously this is the big one, and hefty costs here are largely expected. But the medication you take, as well as the quantity, can change even within a cycle – leading to an unexpected additional bill if, for example, you need to order more medication to stimulate for a few more days or add in an extra trigger injection. Or if, as is currently the case for us, there’s a Europe-wide shortage of a particular kind of progesterone pessary and you’re given a different (and more expensive) brand.

Blood tests: it didn’t occur to me that blood tests carry a cost, but they do (of course they do) and they crop up everywhere. Not least one before every transfer to check progesterone levels.

ICSI: if you’ve had previous egg collections where few eggs have fertilised, you might be directed to intracytoplasmic sperm injection (the injection of a single sperm directly into the cytoplasm of an egg) for the next round.

Zymot: another embryo creation ‘add-on’, this process helps to fertilise eggs by prioritising the best-quality sperm.

Embryo testing: clinics offering PGT-A and -M will automatically test a set number of embryos as part of the genetic testing package – but if you’re lucky enough to create more than that number, it’ll cost you per additional embryo.

Embryo storage: something we didn’t expect is that clinics will store ALL your embryos, including any that have undergone testing and aren’t viable for transfer. They also (certainly at our clinic) don’t destroy partial batches; i.e. you can’t pick and choose which to keep. So you’ll paying the annual storage fees for embryos that you can’t use until such a point as you have used all your viable embryos or decide to no longer store any of them.

Transfer fees: as with the embryo testing, a fresh or frozen transfer is included in the cost of a cycle. But if you’re lucky enough have more than one embryo from a round and unlucky enough to have to use it, there will be separate transfer fees attached.

Transport: it seems silly to note this as a cost, but during your treatment periods you can be attending numerous appointments over a short space of time. Unless by some twist of fate you live at a walkable distance from a clinic, you can factor considerable travel expenditure into your IVF bill.

After transfer

Pregnancy tests: good lord, there’s a lot of these on the market. And they’ll cost you. Whether you want a basic two-line affair or you’re looking for a super-early-result-digital-all-singing-all-dancing-bells-and-whistles test, you’ll be paying at least £10 a pop for something reliable. Not much in the grand scheme of IVF but it all adds up by the time you’re on your fourth…especially if they’re all depressingly negative.

Mini thrombophilia: after two failed transfers, it was suggested to us that I undertake a mini thrombophilia screening to check for lupus anticoagulant and anticardiolipin antibodies, thyroid antibodies and thyroid function. Good to be on the safe side, but still an additional invoice.

Implantation clinic: should we have a third failed transfer (pray for us, please), it’s been recommended that I have a full thrombophilia screening and attend an implantation clinic. Which, naturally, comes at quite a price.

After successful transfer

Well, we don’t yet know what this one looks like. But if it goes well, then you’ve got a baby and you can guarantee those aren’t cheap.