Understanding infertility treatment

How expensive are infertility treatments?

The cost of infertility treatment in India is dependent on a number of factors. Couples who are young and seek help early on can often be treated with inexpensive procedures such as medical management, counseling, or ovulation induction and timed intercourse.

Approximately 20-30% of patients would require more advanced procedures such as IUI or IVF which may be more expensive.

A typical IVF cost could range from Rs. 80,000 to Rs. 125,000 for a cycle depending on individual factors like the clinic and doctor. The IUI cost for a single treatment could be Rs. 7500 to Rs. 20,000 again depending on the clinic and doctor.

What are the treatments commonly done for infertility?

Infertility is a situation where a couple cannot conceive after at least 12 months of unprotected sexual intercourse. It may be due to problems with ovulation, sperm production, hormones in the male or female partner, or other underlying medical conditions, amongst other things.

In India, there are five major treatments for infertility: Medical management, surgical management, ovulation induction-timed intercourse (OI-TI), intrauterine insemination (IUI), and In vitro fertilization (IVF).

Conditions such as thyroid disorders, hyperprolactinemia, low testosterone in males, diabetes, etc that may present as infertility can be managed by medications or in other words medical management. Structural abnormalities in the uterus, fallopian tubes, or ovaries such as polyps, fibroids, adhesions, etc may require a surgical correction. Procedures such as laparoscopy or hysteroscopy may be required in these cases.

Ovulation-induction timed intercourse is an inexpensive procedure where your doctor would stimulate and track the release of eggs from the ovaries with medicines and scans and advice the couple to have intercourse at the correct time to maximize the chances of natural conception.

IUI is a minimally invasive procedure that involves injecting sperm directly into the uterus with a thin tube-like instrument called a catheter.

IVF is an advanced procedure that involves removing eggs from a woman's ovaries and combining them with sperm in a lab dish to create embryos that are then transferred into the uterus.

Treatments for Infertility (English)

Who should I approach for fertility treatment?

Fertility treatments in modern medicine are done by reproductive medicine specialists and gynecologists. Reproductive medicine specialists are gynecologists who undergo 1-2 years of super-specialty training in the management of complex infertility cases after completion of their specialization in obstetrics and gynecology (MD Obg). Such specialists, as in other fields of medicine such as cardiology or neurology would have a Fellowship of National Board (FnB), MCh, or Fellowship in Reproductive medicine in addition to their MD/MS is obstetrics and gynecology.

Approaching the right type of doctor would help in ensuring that you get the correct diagnosis and treatment. Couples often waste critical time, undergo emotional turmoil, family pressures, and waste money with often complex unnecessary procedures if they do not approach the right doctor for the problem.

How does a doctor decide on what treatment is right for me?

What treatment do we need? How does a doctor decide on the ideal treatment for us as a couple?

Doctors usually look at a few factors before suggesting treatment for couples. The important factors for decision making are

  1. semen analysis results in the male partner.

  2. age of the female partner

  3. ovarian reserve-number of eggs available

  4. duration of infertility

  5. tubal status

5. previous treatment details

6. previous pregnancy if any

How do I select a doctor/clinic for fertility treatment?

Fertility treatments are one of the most exciting medical advancements in the world in the last 30 years. You can find many fertility clinics all over the world that offer these treatments. However, finding the right clinic for your needs may be a daunting task.

There are many factors that you should consider before deciding on an IVF clinic. Some of the most important ones are the doctor's experience, accessibility to the doctor, quality, evidence-based treatment, cost and infrastructure, and facilities available at the clinic.

- Doctor’s experience: When you are looking for a new doctor, it can be hard to tell which ones may be the best for managing infertility. Knowing the qualifications and reviews from patients can help in narrowing down your selection and finding a doctor that you will feel most comfortable with. The more experience they have in this field, the better they will be at their job. One of the easiest ways to tell is through recommendations from other patients that have seen them before. If these patients come back for retakes on their treatments, then they must have been satisfied with what the doctor did before.

- Accessibility of the doctor: Fertility treatment is not a one or two-day event but a journey that can take 3-6 months. It is therefore important that your doctor is accessible through this time for your treatment and response to your questions. The journey may have some steps where couples would fail to conceive before they see the light of success. It is important for your doctor to stand with you during these failures as much as it is with success. When you're in need of regular medical care - like when you are undergoing fertility treatment - it's important to find someone who is available when you need them most.

- Quality: Clinics in India are not regulated as a result of which many clinics often project unrealistic success rates. It is important for couples to educate themselves on success rates seen the world over so as to not fall prey to false marketing claims. Government bodies such as the centers for disease control (CDC) in the united states provide IVF success rate calculators and data on success rates across clinics. A good indicator of quality in IVF clinics includes the degree of transparency in sharing details of your treatment, laboratory reports, and diagnosis.

- Use of Evidence-based treatments: Patients and healthcare professionals alike are looking for proven treatments. Evidence-based treatments help doctors and patients avoid ineffective treatments and practices, which can also reduce the waste of time, money, and resources. Evidence-based medicine is ‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients'. There are several expensive, ineffective, and often harmful treatments in infertility often used as a blanket protocol in certain fertility clinics. Clinics that advertise and push proprietary or new techniques must be approached with caution. It's always advisable to educate oneself and take a second opinion when one is not sure and then make an informed decision on the value of a treatment being offered.

- Cost: Fertility treatment may often be very expensive. Having said that, there are techniques available to perform even the most advanced procedures at reasonable costs. It's important to select a clinic or doctor who understands your financial expectations and offers value for money. There are many sad stories of people who have landed into debt, broken marriages, family problems, and financial ruin because of wasteful spending and false expectations. Clinics often have visible and invisible costs. The cost of an IVF procedure may be a visible cost as it is often asked by patients. The costs of procedures such as scans, embryo transfers, laboratory tests, medications are often invisible and can often add up to 50% or more than the IVF costs

- Infrastructure and facilities: Facilities such as cleanliness, availability of parking, adequate privacy and comfort during consultation and procedures, ease of access, ability to teleconsult with your doctor, round the clock nursing access for injections, backup systems for critical failures such as power, etc are important when selecting a clinic

Conclusion: Knowing how to evaluate a fertility clinic or doctor will save you time, heartache, and money. Getting the right information will help you make an informed decision about which one is best suited to your needs.

Are fertility treatments painful?

Most fertility treatments are not painful. Some fertility treatments require daily injections for 7-14 days. These injections may cause some mild discomfort. Your doctor can advise on alternate medications in the form of tablets or use pen-based injections with thin needles to minimize your discomfort.

Procedures such as transvaginal scans are usually not painful for patients. Rarely in patients with anxiety, there may be a fear of pain. Talk to your doctor so that they can minimize the pain or discomfort and in severe cases perform the procedure under mild sedation.

Procedures such as IUI, IVF, and embryo transfer are not painful. Some women may experience mild abdominal discomfort, cramps, bloating, or heaviness after some procedures if the ovaries are enlarged. Your doctor should be able to provide medications and guidance to relieve any such discomfort that you may experience

How painful are fertility treatments?

Do I need to take leave or stop working during my fertility treatment?

Most treatment including IVF can be accommodated with you continuing to work. You will have scans, scheduled prior and you can plan your workdays accordingly. You may have to take a day off on the day of the IUI/ egg pick up/ embryo transfer procedure as they need to be followed by a small period of observation or stay in the hospital.

Are there any side effects of fertility treatments and medications?

Most fertility treatments include manipulation/administration of hormones, which are naturally produced by the body. Hence they can cause a transient increase in the number of eggs or if pregnancy is successful, cause twins or higher-order pregnancy

Are infertility treatments covered under insurance?

The treatment of infertility is a heavily debated topic due to its costs and not having 100% success rates. It is currently not covered under most insurance policies in India. However, in the recent past, there are some insurance companies and products which provide a limited cover for infertility and related procedures. Group medical insurance policies in some companies also ensure limited or complete coverage for fertility-related procedures. The central government health services scheme (CGHS) and employee state insurance schemes also provide conditional fertility cover for up to 3 cycles. Recently, there are also some non-banking financial companies that are offering EMI schemes to back fertility treatments.