¿Is artificial insemination cost-effective?

 

Artificial insemination (AI) is a simple technique and usually the first choice for women who have difficulty getting pregnant naturally or single women. It is considered the most widely used assisted reproduction method.

The main objective is to help the sperm reach the egg, in a time close to ovulation. The sperm is processed to obtain the best and most motile spermatozoa and to remove the seminal fluid. After this, the sample is deposited in the female reproductive tract, generally inside the uterine cavity.

Although the first reported pregnancy is from the 18th century, this treatment became more popular during the seventies. Obviously, the technique has been developed since then and so the results have increased. The first approach was to perform the sperm deposit in the cervix, the opening from the vagina to the uterus. This is known as paracervical insemination. Although this method is generally successful, currently the most used is intrauterine insemination, since it increases the chances of getting pregnant.

Artificial insemination is a cost-effective treatment if it is well indicated. It is much cheaper than the complex, technology demanding in vitro fertilisation (IVF). If we include medication in the comparison, cost of an AI versus IVF can be a five times lower.

There are some criteria to be met if we want AI to be successful. First, we need a valid sperm sample. Slight alterations such as moderate motility problems can be solved, but the total amount of highly motile spermatozoa once the sample has been treated should be higher than 5 million.

We also need a mature egg to be ovulated right before the insemination. Usually medication is used to mildly stimulate the ovaries to produce one or two mature eggs. Another drug, called HCG is used to determine the ovulation time. It is possible to perform AI without any medication, but the results can be lower so you should ask your doctor about this option.

In addition, for the spermatozoa and the egg to meet at least one of the fallopian tubes must be permeable. To check for this, a hysterosalpingogram should be performed. This technique consists of a series of x-ray of the cervix, uterine cavity, and fallopian tubes right after a radiopaque liquid is introduced in the cervix.

When the specialist has detected using ultrasound that the follicles have a minimum diameter, it triggers ovulation injecting the chorionic gonadotropin (HCG). 36 hours after, the ovulation will occur, and so the IA  is performed around that time. The process of introducing the sperm sample contained in a plastic catheter inside the uterus is easy and not painful.

More information about inseminación artificial (spanish)

Egg donation cost

The IVF with egg donation is a particular case of In Vitro Fertilization Treatment where the embryos are created from eggs of an egg donor and are fertilized in the laboratory with the spermatozoa of the recipient couple. (Sperm bank can be used additionally if required)

The treatment is very simple for the recipient, and basically consists of hormonal endometrial preparation. A hormonal combination of oestrogens and progesterone is used to increase endometrial receptiveness and open the implantation window. This is the technical word for the days where the uterus is ready to receive embryos and let them implant.

In the same way as IVF, egg donation costs can vary considerably between clinics and countries. The legal framework for this treatment is not the same around Europe, being even banned in some countries like Germany. This is the reason why so many patients travel to other countries where it is allowed like Czech republic, Greece or Spain.

In these countries an egg donation cycle can cost from 6,000 euro to 10,000. Usually all the screening, medication and anesthesia for the egg retrieval of the donor is included, as well as her economical compensation.

As we discussed in the previous post, it is important to understand exactly what is included in a budget before comparing between clinics or even countries. For instance, sperm microinjection and embryo freezing are frequently not included.

Another additional cost should be the recipient medication. Notwithstanding, it is cheap and easy to find, since the drugs for the ovarian stimulation are administered to the egg donor and not to the recipient.

Egg donation is the most efficient assisted reproduction technique, with around 70% clinical pregnancies per cycle. One of the most common side effects of the assisted reproduction treatments is multiple pregnancy. Due to the high implantation potential of these kind of embryos, the clinic staff must be conservative with the number of transferred embryos. Statistically, the more embryos transferred the more chances of getting pregnant, but the chances of having a multiple pregnancy increase as well.

The maximum number of embryos that can be transferred is limited by law in some countries. In any case, the trend is to transfer one or two embryos. The average number per transfer is decreasing every year in the official activity registries, and the results are not diminished if the cases are properly selected.

There are financial consequences of transferring only one embryo, since usually the frozen embryo transfer is not included in the price. In any case, this disbursement seems to be more than justified taking into account the health consequences of a multiple pregnancy.

IVF cost

Determining the exact price of an In Vitro Fertilization treatment is complicated because it depends on the circumstances of each woman, the attempts she undergoes, the diagnoses and, of course, the clinic and the country where the treatment is going to be provided.

In Vitro Fertilization consists of the fertilization of the ovum by the spermatozoid in the laboratory with special media and incubators, hence its cost. This techniques require highly trained staff using expensive medical instruments and to carry them out. On top of this, the cost of the fungible materials, like surgical instruments or culture media is expensive as well.

Most private centers do not give their patients a budget until the first or even second visit and have a complete diagnosis about them.

Comparing pricelists of different clinics can be difficult sometimes. Additional techniques like ICSI or embryo freezing may or may not be included in the budget, for instance. It is very important to read the pricelist carefully and ask exactly what is included in the prices.

The prices for in vitro fertilization in Europe are around 3,000 to 4,000 euros per cycle and they usually include:

Ultrasound and blood controls during ovarian stimulation
Egg retrieval under anesthesia
Semen processing
In Vitro Fertilization
Embryo Culture
Transfer of embryos

Also, you should keep in mind that this would be the price in the case of a standard IVF. Usually, the use of sperm microinjection (ICSI) or embryo freezing are not included. With these additional techniques, the cost can increase up to 5,000 euros.

The medication needed for the ovarian stimulation has to be added to this price. These drugs are highly purified or recombinant hormones, and their cost is high. The IVF patient needs the administration of this medication for 10 t0 12 days, with an approximate cost (total treatment) of 1,000 to 1,200 euros.

It is very important to keep in mind that these prices include only one IVF cycle, that is to say one attempt. If as a result of the IVF cycle there are surplus embryos that can be frozen and the first transfer results are negative these embryos can be used. If the results are positive, they can be used to achieve another pregnancy in the future. In any case, the price for thawing these embryos and transfer them into the uterus is around 900 euros. This technique is known as frozen embryo transfer.

If there were no surplus embryos frozen, it will be needed to start the cycle again, and therefore another IVF payment scheme should apply and more medication would be needed.

Knowing the price of an In Vitro Fertilization treatment can be frustrating. Most of the clinics offer financing for the treatments, but in any case the choice should not be made with only financial terms in mind. Objective data regarding clinical outcome and subjective feelings towards the clinic staff should be considered.

More information: www.invitrov.com (spanish)

Welcome

The very highly developed technologies that are used to treat infertility are geared to providing services to couples in countries where salaries and living standards are high, or where public funding or health insurance cover some of the cost of treatment. Modern Assisted Reproductive Technology (ART) treatments involve the use of expensive drugs to stimulate egg production, costly consumables and sophisticated laboratory equipment. Most clinics are run in the private sector and salaries for specialist gynecologists, endocrinologists, laboratory and, nursing staff, counsellors, management and financial advisors contribute to the high cost of ART. These costs need to be recovered from patients, so conventional ART is therefore unattainable for most couples in developing countries.

We want to promote the provision of simplified clinical IVF services for a minimal cost that will allow couples, who could otherwise not afford it, access to IVF treatment for their infertility. We aim to demonstrate that the material costs for a cycle of IVF can be less than 200 €. We seek to identify donors that will provide funds to establish Low Cost IVF Clinics in low resource economies where having a child greatly improves the social status of a of woman and reduces her risk of being rejected from her family and community and left destitute. The costs will vary from country to country, but our objective is to minimize costs to make treatment affordable to a much greater number of people.

Our mission:

To reduce the burden of childlessness among couples in resource constrained countries.

– Establishing Low Cost IVF Clinics at several sites in low resource countries and ensures that local clinicians and scientists who are identified as key personnel  receive adequate training.
– Nominating one or more observers for each site to provide expert advice, ensure that established protocols are followed, and monitor success rates for the simplified procedures.
– Promoting an education program for awareness of reproductive health forms an integral part of the established Low Cost IVF Clinics.  This program is aimed at improving couples’ knowledge about reproductive processes, infectious diseases, and safe sex practices.

Participation:

We offer different possibilities for donor support.

‘Adopt a clinic’
Large and well resourced IVF centres are encouraged to ‘Adopt a clinic’. One we identify a suitable site for a new Low Cost IVF Clinic and local key personnel to run it, any willing IVF centre can nominate to ‘adopt’ the clinic by providing equipment, training, technical expertise and support.

Financial
We warmly welcome financial contributions from corporations, companies and individuals.

Equipment
Any kind of functioning laboratory equipment or ultrasound machine can be donated to a Low Cost IVF Clinic. We will advise where a particular piece of equipment is needed and the donor undertakes to carry the cost of transporting it there.

Training
For local doctors, nurses, scientists and counsellors to be able to run Low Cost IVF Clinics they need to be adequately trained. Donors can offer to send experts to a selected site to provide training there or they can sponsor a health care professional  to travel to an established IVF centre for training.

BILL OF RIGHTS

Philanthropy is based on voluntary action for the common good. It is a tradition of giving and sharing that is fundamental to the quality of life. To assure that philanthropy merits the respect and trust of the general public, and that donors and prospective donors can have full confidence in not-for-profit organizations and causes they are asked to support, Low Cost IVF declares that all donors have these rights:

• to be informed of the organization’s mission, of the way the organization intends to use donated resources, and of its capacity to use donations effectively for their intended purposes.

• to have access to the organization’s most recent financial statements.

• to be assured their gifts will be used for the purposes for which they were given.

• to receive appropriate acknowledgement and recognition.

• to feel free to ask questions when making a donation and to receive prompt, truthful and forthright answers