Thinking about IVF but don't know where to start?
With 15% of Australian couples struggling to conceive a baby, overcoming infertility has become big business. In-vitro fertilisation (IVF) is one of the most invasive treatments, but it's also very effective. IVF expenditure by Australians more than tripled between the late 1990s and 2008, to reach more than $90m according to IbisWorld.
Close to one in 30 babies is conceived via IVF.
IVF can be very expensive for prospective parents though. A single IVF cycle can amount to more than $3000 in out-of-pocket costs at some clinics. It can also be a very emotionally taxing undertaking, not only because of the stress you go through, but because of the hormones a woman has to take to increase her chances of becoming pregnant.
Given the emotional and financial cost, you'll naturally want to choose the clinic that gives you the greatest chance of success. And considering that IVF clinics are privately-run enterprises, how do you know if the one you choose has your best interests at heart. Will paying more for IVF ensure better outcomes?
How does it work?
In an IVF cycle, a woman takes fertility drugs to stimulate egg production. Once the eggs are mature, the doctor collects them and the eggs are fertilised with a man's sperm. Then, after the embryos have developed, they're transferred into the woman's uterus. Most patients who become pregnant do so during the first three cycles.
Selecting the right IVF clinic and doctor
Your GP may know a fertility specialist (FS) suited to treat your specific issue with falling pregnant; they may also be able to run some diagnostic tests and outline other treatment options. Online forums can also be a good place to find specialist and clinic recommendations.
Some clinics allow egg collections and embryo transfers on any day of the week, while others have set days of operation. In clinics aligned with public hospitals, some procedures may be performed by trained gynaecologists under the supervision of a fertility specialist. In other clinics – Genea and IVF Australia, for instance – procedures will usually be done by your own specialist.
Consider these questions when you call the clinic or at your first appointment:
- What treatment options – for example, genetic screening of embryos – are available? And if surgery is a treatment option, as in the case with endometriosis, will it be performed by a specialist in the area?
- How individualised is the treatment? Is there just one protocol for a group of patients?
- Which diagnostic tests are available?
- What are the thaw survival rates in case there are leftover embryos that can be frozen?
- Does the clinic handle the Medicare claim? Do they have a gap agreement with your health fund?
- Is egg retrieval and embryo transfer offered any day of the week?
- Would these procedures be done by your specialist personally?
Consider getting a second opinion if you have any doubt that your FS is offering the best treatment protocol, especially after two failed cycles.
How much does IVF cost?
IVF clinics charge per cycle of IVF treatment, so your overall costs will depend on how many cycles you choose to have. On top of this, there can be charges for diagnostic tests, some medications, and theatre fees that aren't always included in the initial quote. The level of service provided and procedures used also vary across clinics.
In January 2010, the government capped the benefit for assisted reproductive treatment (ART) procedures under the Medicare Safety Net. This means out-of-pocket costs have gone up by $500-1500 per IVF cycle. In addition, since 2009 the median total cycle fees (before Medicare) have gone up by $2300-8300.
There are significant price differences between clinics. In Sydney, for example, the out-of-pocket costs after Medicare benefits and safety nets for three IVF cycles can range from $1870 at the private Westmead Fertility Centre (aligned to a major public hospital) to almost $9000 at major private clinics Genea (owned by its shareholders) and IVF Australia, which belongs to the largest network of clinics in Australia and is partly owned by private equity company, Quadrant.
Measuring IVF clinic 'success'
Choosing a clinic according to how many successful births it has produced is somewhat futile, since there are many variables at play, including the definition of "success". Success rates depend on your individual circumstances, and the most expensive clinic won't necessarily provide the best treatment for you. You may be able to get the same quality of treatment at a lower cost somewhere else.
Some larger, more expensive clinics told us they have better success rates than the less expensive ones, but both industry experts and other clinics hotly dispute this claim. The truth is that success rates can vary widely between clinics of all sizes and prices levels.
In 2010, an average of 18.1% of IVF cycles resulted in a baby. But the range of performance rates across the 35 fertility centres in Australia and New Zealand is reported by the Australian Institute of Health and Welfare (AIHW) to be between 4.4% and 31% per fresh embryo transfer cycle, and between 5% and 33.3% per frozen embryo transfer cycle.
The wide variation is likely caused by individual centre averages being drawn from different patient groups and sometimes very small numbers. Some clinics don't accept all patients, and so other clinics may see a higher proportion of patients with difficult fertility problems.
This doesn't mean it's not worth asking a clinic about their success rates, but the only success rate that matters is the one for people in your particular circumstances. The most important factors are your ages and specific issues. There can also be large variations in success rates per cycle commenced, per egg collection, per embryo transfer and whether a fresh or thawed embryo is transferred.
Another factor is the developmental stage of the embryo. Some clinics and doctors transfer the embryo on day two or day three after fertilisation, when it consists usually of up to 12 cells. Others wait until day five, when it usually consists of more than 100 cells and is called a blastocyst. Blastocyst transfers usually have a higher success rate than day two or three transfers, but not all embryos will develop into blastocysts in the laboratory, so the number of embryos you have available for transfer and freezing will be lower.
Each clinic should be able to tell you live birth rates per cycle commenced, as they're obliged to report these to the AIHW.
Improving the odds
Sometime lifestyle changes can resolve a fertility problem naturally or improve the outcome of IVF treatment.
Balanced diet and exercise
Obesity in women is a risk factor in pregnancy and delivery, and weight loss may improve general health and, in turn, help with ovulation problems. Obesity can also cause fertility problems in men.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists advises doctors not to start assisted reproductive treatment for women with a BMI of 35 or higher.
For men with a high percentage of sperm DNA damage, sometimes vitamin C, vitamin E and zinc supplements are suggested. Vitamin D deficiency in women may cause problems and while there's no evidence that multivitamin supplements help with fertility problems, in general it probably can't hurt to take a pregnancy supplement.
Alcohol is not advised in pregnancy, and can cause weight gain. For men, excessive alcohol consumption can also damage sperm.
If one or both partners smoke, your chances of conceiving decrease dramatically.
Some research suggests that acupuncture before and after embryo transfer can increase the blood flow in the uterus, and, therefore, help with implantation. To date, the evidence for this is inconclusive. However, there is an indication that acupuncture can help to relieve stress and in dealing with the side effects of the treatment.
A number of other natural options, such as naturopathy, Chinese herbs or chiropractic are available, but there's no conclusive evidence that they make any positive difference. If you want to try them, be mindful not to lose too much time pursuing natural treatments before seeking medical treatment, as your fertility and chances of conception decrease dramatically with time, especially if you are aged 35 or over.