Financial Information for Patients
Introduction Thank you for considering attending Bourn Hall Clinic for your fertility treatment. This information sheet details the fees for the treatments available. In order to make the pricing of your treatment as clear as possible we have organised our prices into Treatment Packages and detailed what is included in each package. The costs detailed are valid from 01 January 2015 however we reserve the right to alter prices in exceptional circumstances. Treatment is subject to our standard terms and conditions (Page 11). Treatment of infertility includes a wide range of possibilities and we hope to have included most of them within our price list. Should you have any queries on the cost implications of your treatment, or any comments on how we can improve this information pack, please contact the Patient Services Finance team as below:
Telephone +44 (0) 1954 717223 +44 (0) 1954 717243
Fax +44 (0) 1954 717259
email
[email protected]
IS301R23.00 Issued: 31/05/2016
Page 1 of 11
Table of Contents 1
Fertility Checks .................................................................................................................. 3
2
Consultations ..................................................................................................................... 3
3
Ovulatory Stimulation and Monitoring Treatment Package ............................................ 3
4
Intra-Uterine Insemination (IUI) Treatment Package........................................................ 3
5
In-vitro Fertilisation (IVF) Treatment Package ................................................................. 3
6
Frozen Embryo Transfer (FET) Treatment Package ........................................................ 4
7
Sperm Retrieval.................................................................................................................. 4
8
Treatment with Donor Gametes and Embryos ................................................................. 4
9
Egg and Sperm Donor Programmes................................................................................. 4 9.1
Egg share providers ...................................................................................................... 4
9.2
Egg Recipient................................................................................................................ 4
9.3
Sperm Sharers .............................................................................................................. 5
9.4
Altruistic Egg / Sperm Donors ....................................................................................... 5
10
Egg Freezing and Embryo Transfer .................................................................................. 5
11
Semen, Egg and Embryo Storage ..................................................................................... 5
12
Scanning Packages ........................................................................................................... 6
13
Additional Treatment Costs .............................................................................................. 6
14
Tests and Screening Requirements ................................................................................. 6 14.1
Bacteriology/Virology/Immunology ................................................................................ 6
14.2
Andrology ...................................................................................................................... 7
14.3
Haematology/Biochemistry............................................................................................ 7
14.4
Cytogenetic/Cytology .................................................................................................... 7
14.5
Endocrinology/Hormone Tests ...................................................................................... 7
15
Drug Costs ......................................................................................................................... 8
16
What if I don’t complete treatment? ................................................................................. 9
17
16.1
In-vitro Fertilisation (IVF) Cycle ..................................................................................... 9
16.2
Blastocyst Culture ......................................................................................................... 9
16.3
Eeva plus Blastocyst Culture ......................................................................................... 9
16.4
Intra Uterine Insemination (IUI) cycle ............................................................................ 9
16.5
Frozen Embryo Transfer (FET) Cycle............................................................................ 9
16.6
Donor Sperm................................................................................................................. 9
16.7
Egg Share Programme ................................................................................................. 9
16.8
Egg Freezing................................................................................................................. 9
16.9
Embryo Donation .......................................................................................................... 9
Fees and Payment Details ............................................................................................... 10
Terms & Conditions of Treatment at Bourn Hall Clinic .......................................................... 11
IS301R23.00 Issued: 31/05/2016
Page 2 of 11
Package price (Per couple)
1
Mini £400
Fertility Checks
Semen Analysis Anti-Mullerian Hormone test (AMH) Pelvic Scan LH (luteinising hormone) urine test, FSH (follicle stimulating hormone), Estradiol (E2) Medical consultation (30 minutes) Progesterone HyCoSy Blood tests (Rubella and Chlamydia; if required) Medical consultation (60 minutes)
2
Full £800
Consultations
Initial or Full consultation with Consultant Gynaecologist / IVF Specialist
£200
Review consultation with Consultant Gynaecologist / IVF Specialist
£200
Consultation with Andrologist
£250
Missed consultation – 50% of consultation fee is payable unless 24 hour notice of cancellation is received
3
Ovulatory Stimulation and Monitoring Treatment Package
Three treatment cycles All trans-vaginal scans Nurse discussion
4
5
Pregnancy urine test Pregnancy ultrasound scan Follow-up consultation (if taken within two months of treatment completion)
Intra-Uterine Insemination (IUI) Treatment Package
Medical and nursing care All in-treatment laboratory tests and procedures All scanning costs Insemination procedure HFEA registration fee
IS301R23.00 Issued: 31/05/2016
£800
Pregnancy urine test Pregnancy ultrasound scan Follow-up consultation (if taken within two months of treatment completion)
In-vitro Fertilisation (IVF) Treatment Package
Medical and nursing care All in-treatment laboratory tests and procedures All monitoring and scanning costs Cyst aspiration (if required) Local anaesthetic or Intravenous sedation (for egg collection procedure only) Egg collection Embryo transfer
£900
£3300
Freezing of suitable embryos HFEA registration fee Pregnancy urine test Pregnancy ultrasound scan Follow-up consultation (if taken within two months of treatment completion) First year storage Counselling
Page 3 of 11
6
Frozen Embryo Transfer (FET) Treatment Package
Medical and nursing care All in-treatment laboratory tests and procedures All scanning costs Thawing of embryo(s) Embryo transfer
7
£1200
HFEA registration fee Pregnancy urine test Pregnancy ultrasound scan Follow-up consultation (if taken within two months of treatment completion)
Sperm Retrieval
Surgical sperm retrieval – PESA or TESE Micro-TESE
8
£1600 £3500
Treatment with Donor Gametes and Embryos
Donor Sperm Family Reservation Fee (per 5 ampoules of donor sperm) Donor sperm (per vial used) Purchase and administration costs for transfer of reserved donor sperm to another UK licensed centre (per vial) Donor Eggs Donor Embryos
9
Egg and Sperm Donor Programmes
9.1
Egg share providers
Medical and nursing care All in-treatment laboratory tests and procedures Drugs up to pregnancy test All monitoring and scanning costs Cyst aspiration (if required) Local anaesthetic or Intravenous sedation (for egg collection procedure only) Egg collection ICSI
9.2
Egg Recipient
Medical and nursing care All in-treatment laboratory tests and procedures All monitoring and scanning costs Donor oocytes Fertilisation with IVF Embryo transfer Freezing of suitable embryos
IS301R23.00 Issued: 31/05/2016
£1000 £600 £700 £2950 £1500
Free of Charge Embryo transfer Freezing of suitable embryos HFEA registration fee Pregnancy urine test Pregnancy ultrasound scan Follow-up consultation (if taken within two months of treatment completion) First year storage Counselling
From £6250 HFEA registration fee Pregnancy urine test Pregnancy ultrasound scan Follow-up consultation (if taken within two months of treatment completion) Counselling
Page 4 of 11
9.3
Medical & nursing care All in-treatment laboratory tests and procedures All monitoring and scanning costs Cyst aspiration (if required) Local anaesthetic / Intravenous sedation (for egg collection procedure only) Egg collection Embryo transfer
9.4
Free of charge
Sperm Sharers
Freezing of suitable embryos HFEA registration fee Pregnancy urine test Pregnancy ultrasound scan Follow-up consultation (if taken within two months of treatment completion) First year storage Counselling
Altruistic Egg / Sperm Donors
Altruistic egg and sperm donors are entitled to claim compensation for visits to the clinic in accordance with HFEA regulations. Alternatively you can nominate a friend or family member, who needs fertility treatment, for a free cycle of IVF. Your nominee will receive the IVF package described in section 5 above, once you have completed your donation.
10
Egg Freezing and Embryo Transfer
Stimulation, monitoring, egg collection and egg freezing Medical and nursing care All in-treatment laboratory tests and procedures All scanning costs Cyst aspiration (if required)
Local anaesthetic / Intravenous sedation Egg collection Egg freezing (including first year of storage) Counselling
£2200
Embryology and embryo transfer Egg thawing Fertilisation with ICSI Embryo transfer Pregnancy urine test
11
£3300
Pregnancy ultrasound scan HFEA registration fee Follow-up consultation (if taken within two months of treatment completion)
Semen, Egg and Embryo Storage
Semen freezing of three ejaculates up to a maximum of 12 ampoules of sperm, including three semen assessments Storage of semen for second and subsequent years and part thereof (annual fee) Storage of eggs for second and subsequent years or part thereof (annual fee) Initial freezing/administration fee for suitable spare embryos and first year storage Storage of embryos for second and subsequent years or part thereof (annual fee) Administration charge for preparing frozen gametes or embryos for transfer to another UK clinic Administration charge for preparing frozen gametes or embryos for transfer to an overseas clinic
IS301R23.00 Issued: 31/05/2016
£600 £300 £300 Nil £300 £100 £200
Page 5 of 11
12
Scanning Packages
Pelvic ultrasound scans for Bourn Hall patients outside of treatment
£120
Non-treatment pelvic ultrasound scans package (three scans) – ovulatory monitoring
£300
Early pregnancy / viability Scan (6 – 12 weeks) including report and up to 5 black and white prints
£80
Reassurance, Gender and Growth Scan (12 weeks to term) including report, up to 5 black and white prints and a CD of images. Gender scans may be performed from 18 weeks onwards. Singleton Twins 3 & 4D Scan Bonding Experience including report and DVD of 3D images. Singleton Twins
13
£115 £150 £125 £150
Additional Treatment Costs
Additional costs General anaesthesia
£300
Endometrial scratching
£225
Local anaesthetic / intravenous sedation
£150
HyCoSy
£400
ICSI
£1000
Surrogate consultation
£200
IMSI (including ICSI)
£1200
£5350
Blastocyst culture
£800
Eeva + Blastocyst culture Assisted Hatching
£1600 £450
IVF with surrogacy (this includes a £500 non refundable deposit) IVF with surrogacy with donor eggs (this includes a £500 non refundable deposit) Blood tests and screening requirements Drugs required for treatment
Hysteroscopy
£800
£200
Intralipid 20% infusion
£250
Outpatient visit – Scan and E2 blood test (non Bourn Hall patients) Set of copy notes standard or full
14
£8300
See 14 See 15
£35/£50
Tests and Screening Requirements
The tables below detail the charges for the most frequently required tests and screening requirements. You will be advised at your consultation which tests you will be required to have. Test results from other sources may be acceptable – please bring them to your consultation for review. Occasionally additional tests may be required; if this is the case you will be informed of any fee prior to the additional service being carried out.
14.1 Bacteriology/Virology/Immunology HTLV 1 & 2 HIV Hepatitis B Surface Antigen Hepatitis B Core antibody Hepatitis C Rubella APCA Toxoplasmosis Semen culture High vaginal culture Cervical swab culture or cytology smear Lupus anticoagulant Phospholipid antibodies Cardiolipin Cytomegalovirus (CMV)
IS301R23.00 Issued: 31/05/2016
£ 50 50 50 50 50 30 30 40 60 60 60 80 60 60 100
Page 6 of 11
14.1 Bacteriology/Virology/Immunology continued TORCH screen Syphilis (VDRL/TPHA) Chlamydia (blood test) Chlamydia (urine test) Gonorrhoea (urine test) Zika – PCR (urine or blood test) Zika – Serology (blood test)
14.2 Andrology Semen assessment Sperm antibody test Sperm DNA fragmentation test
14.3 Haematology/Biochemistry Full blood count Blood group Blood cross match Haemoglobin Haemoglobin electrophoresis Sickle-cell screen Glucose Fasting insulin
14.4 Cytogenetic/Cytology
£ 120 50 100 40 40 200 100
£ 120 120 400
£ 30 30 30 30 150 30 30 30
£
Chromosomes – blood Cystic fibrosis screen Karyotyping/cystic fibrosis/Y-deletion (together) Y-deletion test Cytology cyst fluid (per sample)
250 160 590 180 200
14.5 Endocrinology/Hormone Tests
£
AMH (anti-Mullerian hormone) test FSH (follicle stimulating hormone) LH (luteinising hormone) Prolactin Estradiol (E2) Progesterone (P4) Beta-HCG Androstenedione Testosterone DHEAS SHBG Thyroxine (T4) TSH (thyroid stimulation hormone) T3 Cortisol
IS301R23.00 Issued: 31/05/2016
100 30 30 30 30 30 30 70 60 50 50 30 30 30 30
Page 7 of 11
15
Drug Costs
Please note: the cost of drugs are additional to the treatment cycle costs. We routinely check our prices against those of other suppliers to ensure that our prices remain competitive.
Intra-Uterine Insemination (IUI) Drug package
£300
All treatment drugs necessary for one IUI cycle up to the pregnancy test (excludes adjuvant drugs)
Frozen Embryo Transfer (FET) Drug package
£200
All treatment drugs necessary for one FET cycle up to the pregnancy test (excludes adjuvant drugs)
The cost for Bourn Hall Clinic supplied drugs for an IVF treatment cycle is from £1200. Patients purchasing drugs from Bourn Hall Clinic are given training in the administration of the drugs, a sharps bin and a drug storage case free of charge. Drugs may be dispensed / purchased from the Pharmacy at Cambridge or delivered to your home address through a homecare provider; there is a £45 charge per delivery.
In-vitro Fertilisation (IVF) Drugs – Individually priced
£
Cetrotide 0.25mg injection Suprecur (buserelin) sc injection Synarel (nafarelin) nasal spray Synarel (nafarelin) nasal spray Gonal F (75 IU) injection Gonal F (300 IU) Gonal F (450 IU) Gonal F (900 IU) Luveris (75 IU) Pergoveris (75 / 150 IU) Ovitrelle injection Clexane (20 mg) injection Clexane (40 mg) injection Cyclogest 400 mg Crinone 8% Microgynon tablets Cyclo-Progynova 2 mg tablets Progynova 2 mg tablets Estraderm 100 mcg MX patches Intralipid Infusion Cabergoline 0.5mg tablets Aspirin 75 mg dispersible tablets Prednisolone 5 mg tablets Clomifene citrate 50 mg tablets Norethisterone 5 mg tablets Lamberts Vitamins (for female) Lamberts Vitamins (for male) Lamberts Vitamins (two packs)
37 25 70 38 31 124 186 372 58 62 61 51 51 15 35 6 5 12 10 250 35 1 3 6 5 19 19 35
1 ampoule 1 vial 60 dose 30 dose 1 ampoule 1 pre-filled pen 1 pre-filled pen 1 pre-filled pen 1 ampoule 1 vial 1 vial (250 mcg) Pack of 10 syringes Pack of 10 syringes 15 pessaries Box of 15 1 pack 1 pack 1 pack 1 pack 1 infusion 1 pack 1 pack 1 pack 1 pack 1 pack 1 pack 1 pack 1 pack
Although the above prices were correct at the time of printing Pharmacy prices are subject to change without notice. If other products are required check with the Pharmacy for prices.
IS301R23.00 Issued: 31/05/2016
Page 8 of 11
16
What if I don’t complete treatment?
When we discuss and agree your treatment plan, we’re committing to take the journey alongside you and to work together in a spirit of trust and collaboration. Our commitment to the success of your treatment is reflected in our refund policy, which ensures that we share the risks – and costs – involved. It is sometimes necessary to discontinue treatment for medical reasons. Under these circumstances we will make every effort to refund your treatment costs or discount your next treatment cycle. Here are the most common examples of our refund or discount rates. Please note that we do not refund any of the costs relating to the pre-treatment procedures or drugs.
16.1 In-vitro Fertilisation (IVF) Cycle If an IVF cycle is discontinued for medical reasons before any eggs are collected, we will refund you the full cost of the IVF Treatment Package. Once eggs are collected then no refund will be made. If your IVF treatment is halted for medical reasons prior to transfer of your embryos, necessitating the freezing of the embryos created in the treatment cycle, the cost of the first frozen embryo transfer will be reduced by 50%.
16.2 Blastocyst Culture In the event that the blastocyst culture fails prior to the transfer of the embryos we will refund you the blastocyst fee.
16.3 Eeva plus Blastocyst Culture In the event that a day 2 or day 3 embryo transfer is recommended we will refund you the blastocyst fee.
16.4 Intra Uterine Insemination (IUI) cycle In the event that insemination does not take place we will refund you the cost of the IUI Treatment Package.
16.5 Frozen Embryo Transfer (FET) Cycle If an FET cycle is discontinued for medical reasons before thawing, we will refund you the full cost of the FET Treatment Package. If embryos fail to thaw or cleave, there will be a 50% refund of the Treatment Package fee.
16.6 Donor Sperm Sperm donors are permitted to create a maximum of 10 families. In order to help you achieve your family we reserve a maximum of 5 (five) ampoules of sperm for you from your chosen donor. We recommend that same gender couples who both wish to have treatment using the same donor consider paying two reservation fees to reserve 10 ampoules of sperm. If your treatment using donor sperm is unsuccessful, either after IUI or after all frozen embryos created from the use of donor sperm are used, the ‘sperm reservation’ charge will be refunded.
16.7 Egg Share Programme A minimum of 8 eggs are required to enable egg sharing to take place. Should the monitoring scans indicate it is likely that less than 8 eggs will be collected the egg share provider has the option to transfer to a self funded treatment cycle. If egg collection proceeds with the expectation of sufficient eggs being obtained but subsequently there are insufficient eggs obtained to enable sharing to occur then the treatment fees paid by the egg share recipient will be refunded and Bourn Hall Clinic will bear the cost of the egg share providers’ treatment cycle.
16.8 Egg Freezing If eggs are collected, but none are successfully frozen, we will refund the full treatment package fee. If there is no subsequent embryo transfer, we will refund the full embryo transfer package fee.
16.9 Embryo Donation If you are not accepted onto the embryo donation programme or decide not to proceed with treatment the donated embryo reservation fee will be refunded in full. If your treatment with donated embryos is discontinued for medical reasons, or if the embryos fail to thaw or cleave, the treatment fee will be refunded in full. We do not refund any of the costs relating to the pre-treatment procedures or drugs.
IS301R23.00 Issued: 31/05/2016
Page 9 of 11
17
Fees and Payment Details
Comprehensive financial information is provided at your first consultation. A general guide to when payments are due is shown below:
Activity
When payment is due
Consultation; any tests carried out in the Clinic (e.g. semen analysis or blood test)
On the day of the consultation or test
Treatment package
Before or on the commencement of the treatment cycle
Screening tests and/or investigations additional to the treatment package
Before or on the commencement of the treatment cycle or on the day the test is advised and agreed
Additional treatments during the treatment cycle (e.g. ICSI or Blastocyst culture)
On the day the decision is made to include the additional treatment
Collection of drugs from Pharmacy
At the time of collection
Arranging drug delivery by a homecare provider
On placing the order
All assisted conception treatment cycles are required to be registered with the Human Fertilisation & Embryology Authority (HFEA). The HFEA charge a registration fee that becomes due at the start of a treatment cycle. This fee is included in the treatment fee collected by Bourn Hall Clinic and passed on to the HFEA.
Payment may be made in full by debit or credit card, or bank transfer. Credit card payments are accepted over the telephone prior to treatment. We accept most major credit or debit cards and bank transfers. For bank transfers please contact the Patient Services team at your local Bourn Hall Clinic.
Please see the Terms & Conditions of Treatment at Bourn Hall Clinic (Page 11)
Refunds Any refunds due will be paid once the Patient Services team has received confirmation of the change of treatment from the medical staff. Refunds will be made by card (but only to the card used for the initial payment), bank transfer or cheque.
IS301R23.00 Issued: 31/05/2016
Page 10 of 11
Terms & Conditions of Treatment at Bourn Hall Clinic Version 6 valid from April 2016
1.
Place and Time of Payment
Payment must be received by Bourn Hall Clinic on or before the first day of any treatment cycle. Payment should be in sterling, we accept most major credit or debit cards and bank transfers.
2.
Place of Treatment
Unless otherwise agreed between the parties, treatment shall take place at Bourn Hall Clinic. Bourn Hall Clinic will not give advice, assistance or treatment outside the United Kingdom except by prior agreement.
Where patients attend Bourn Hall Clinic having begun treatment, or taken advice elsewhere, Bourn Hall Clinic accepts no liability whatsoever for the consequences of that treatment or advice and gives no warranty that such treatment or advice was properly given.
3.
Duration
The Terms & Conditions shall apply for so long as the patient(s) are undertaking any treatment which is recommended by and directly under the supervision of the staff of Bourn Hall Clinic.
4.
Jurisdiction
The proper law for the construction of this agreement is the law of England and Wales and the parties hereby irrevocably agree that all disputes, claims, complaints, issues and proceedings arising out of treatment, assistance and advice given at or by Bourn Hall Clinic shall be subject to the exclusive jurisdiction of the Courts of England and Wales.
The Parties hereby agree that all claims for injury, loss or damage connected with or arising out of the advice, assistance and/or treatment given at or by Bourn Hall Clinic shall be subject to the laws of England and Wales and the exclusive jurisdiction of the Courts of England and Wales, howsoever that injury, loss or damage shall be said to have been caused and whatsoever the cause of action raised.
5.
Frustration
In the event that it shall be impossible or unlawful to embark on, continue or complete an agreed course of treatment or provide a service substantially the same as that agreed, neither party shall, after the event giving rise to the impossibility or illegality of performance, be liable for further performance of the agreement, always provided that the impossibility or illegality does not result from a breach of the terms of this agreement by either party.
6.
Withdrawal
In the event that the patient shall unreasonably refuse to accept or follow advice given by any employee or agent of Bourn Hall Clinic, either party may withdraw from the terms of the agreement to provide advice, assistance and treatment and treat itself as discharged from its terms, provided always that the withdrawal be communicated in writing and that reasons for that withdrawal be given.
7.
Definitions
“Bourn Hall Clinic” shall mean any Company that is a wholly owned subsidiary of Bourn Bioscience Limited, including, but not restricted to Bourn Hall Limited. “the patient(s)” shall mean the person or couple seeking advice, assistance and/or treatment from Bourn Hall Clinic. “Advice, assistance and/or treatment” shall have the meaning necessary for their context and shall be defined by reference to the services from time to time offered by Bourn Hall Clinic.
IS301R23.00 Issued: 31/05/2016
Page 11 of 11
