As explained in the Fees Introduction section, there are many service providers included in fertility treatment.  The various service providers may charge independently or may be included in the fertility clinic fee.  It is important for patients to be aware of what is and is not included in any quoted fees supplied from a fertility clinic, doctor or other service provider.

The description of the providers below is for an IVF procedure.  However the explanations and the information can be applied to other types of fertility treatment although different item numbers may apply for other treatment procedures.

1. Treating Doctor

This is the specialist doctor who is responsible for every aspect of treatment.  This is covered by Medicare item 13209.  Most fertility specialists are associated with a fertility clinic and this fee is incorporated into the clinic bill.  The clinic charges the patient and then pays the doctor.  However this arrangement is not universal.  In some clinics, especially low cost/bulk billing clinics, the doctor charges separately and this may not be made clear in the clinic literature.

The 13209 attracts a small Medicare rebate and even smaller EMSN cap so potentially the out of pocket (OOP) expense can be significant.

If patients get a quote from a clinic it is important that they understand what item numbers have been quoted, especially if they are planning on attending a low cost clinic.  Most specialists will charge around $1500 for their services and the rebate including the EMSN is only $82.90.

Note that the values change frequently and to see the current Medicare benefits please click on the following link: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home   

2. Fertility Clinic

This is the main umbrella organisation that will provide the IVF treatment.  In most full service clinics this includes all the pathology (blood and semen tests) and radiology (ultrasound) services required to monitor treatment and also includes the day to day management of treatment through dedicated nurse coordinators.

The fertility clinic will render an account and in most cases this will include all the services covered by 13200/13201/13209 and 13215.    However, it is unlikely that they will also cover the day hospital costs and patients will be referred to the hospital and their private health fund for further information.  The fertility clinic is not really passing the buck, it is just that it has proved difficult for one umbrella organisation to deal with both inpatient and outpatient services.

The caution here is for low cost services where patients may have to pay separate fees for monitoring services, like blood tests and ultrasounds.  It is important to realise what is covered, especially as blood tests and ultrasounds required for monitoring are included in the Medicare global item numbers 13200 and 13201.  Therefore if a fertility clinic does not include blood tests and ultrasounds in the clinic fee then the patient will not be able to claim a Medicare rebate for these services.

3. Counsellor

Any patient undergoing an IVF treatment cycle should have access to free counselling from the fertility clinic under items 13200 and 13201.  This applies for each IVF treatment cycle.  Although patients who have undergone previous IVF cycles may elect to waive counselling for a new cycle they have the right to receive counselling provided by the clinic counsellor if desired.  Patients should be aware of their rights regarding counselling access and fees, as private counsellors may charge up to $800 for this service.  Some low-cost fertility clinics may not provide this service, although they should under the items 13200 and 13201, and it is advisable for patients to determine if the fertility clinic provides counselling as part of its fee.  If a fertility clinic does provide access to a counsellor (these counsellors are experienced in fertility treatment) and a patient decides to attend a counsellor outside the clinic then the patient would be required to pay the costs of this independent counselling.

It is important to differentiate between counselling requirements for IVF treatment cycles and the more extensive counselling required for donor and surrogacy treatment, where the counselling cost would be additional to that provided under the IVF treatment items 13200 and 13201.  Please see the surrogacy and donor sections of this website for more information regarding the counselling requirements for these treatments.

4. Pathology/Ultrasound Services

These include blood tests and ultrasound measurements of ovarian function in order to determine the optimum time for egg pickup.  As mentioned above, these services are implicitly included within items 13200 and 13201 and most full service clinics provide these services in-house and you will not be billed separately.

However many low cost IVF services out-source services and patients may be required to pay separately.  There is no Medicare benefit available in this situation as it is expected that the fertility clinic will provide the blood tests and ultrasounds as part of items 13200 and 13201.  Therefore any blood tests and ultrasounds patients have separately from the clinic will be billed as for a non-Medicare patient.  The cost of a single blood test can be as high as $200 and a single ultrasound $150, and patients may require 3 or 4 blood tests and 2 to 3 ultrasounds.  Therefore a cost of $900 to $1250 could be expected.  Ask the fertility clinic if it is unclear who will be paying for these tests, the patient or the clinic.  Be aware that a low cost IVF service may not necessarily end up being lower in cost.

If patients live in a remote area or cannot get to the clinic for blood and ultrasound tests, and decide instead to attend a local pathology or ultrasound provider, they will almost certainly be required to pay separately, and this will contribute significantly to the OOP (out of pocket) expenses.  It is advisable to confirm with the clinic who is responsible for this cost.

5. Pharmacy

Most IVF procedures involve complex and expensive medications that are heavily subsidised via the Pharmaceutical Benefits Scheme (PBS).  The treating doctor will give the patient a prescription and each prescription will cost a patient who is eligible for Medicare benefits $38.80.  Because these are specialist prescriptions they are limited to 1 medication per prescription with no repeats.  The average IVF procedure involves 4 medications but up to 8 medications may be prescribed depending upon the patient’s medical requirements.  For 4 medications the OOP cost is 4 x $38.80 = $155.20.  It is important to note that without subsidisation from the PBS these 4 medications would cost about $2000, as in countries like the US where they are generally not subsidised.

       6.    Egg Pickup Facility

Most fertility clinics will carry out the egg pickup (oocyte retrieval) in a day hospital.  This is because the procedure is a surgical procedure and although complications are rare they can occur.  This means that the procedure is classified as inpatient and will involve a day hospital facility, a surgeon (usually the specialist doctor or another specialist doctor associated with the fertility clinic) and an anaesthetist or anaesthetic doctor.

Patients will almost certainly be billed separately by the day hospital.  In Australia IVF procedures are performed in a private hospital and any rebate will depend on each patient’s private health cover.  This is where patients will appear to get vague answers to any questions about costs.  The fertility clinic staff cannot provide advice on what a private health fund will cover for the egg pickup.  Any questions regarding fees for an egg pickup need to be directed to the hospital admission staff or the health fund staff who are the only people who can access the patient’s fund information on the patient’s behalf and provide advice on the level of cover.

The cost for the egg pickup will vary from nothing to the full cost and this depends on the private health cover and especially the excess.    It also depends upon whether the fund has a no gap contract with the hospital facility.  This agreement means that the hospital and fund have agreed on the price for the services and fund members with appropriate level of cover enjoy no out of pocket costs or an agreed fixed OOP.  Policy excess levels override this.  The fee charged by the hospital can range from as low as $850 to in excess of $2500.  If patients do not have private health insurance, or the health fund does not cover this, or patients have a large excess, then it is necessary to factor this expense into the estimated OOP expense. Not having private health cover does not prevent patients from proceeding with treatment, it just means that they have to pay extra and will likely be required to pay in advance.

Patients usually have no choice in which egg pickup facility they attend.  The egg pickup facility forms part of the fertility clinic’s accreditation and most clinics are affiliated with only one hospital for their egg pickups as this is where their equipment is located.  Some of the larger fertility clinics have multiple laboratories each of which may be affiliated with a separate hospital in which case there may be some choice of location, however it may mean attending a facility out of area and changing doctor.

This may be one area where low cost IVF fertility clinics can reduce expenses by doing the egg pickup in a procedure room outside of a registered day surgery facility (similar to a dental surgery).  This should be significantly cheaper but confirm as some low cost facilities still use day surgery facilities and therefore the same costs apply.  Regarding low cost egg pickups done in a procedure room outside of a registered day surgery, it is important to realise that the egg pickup procedure is surgery and that many specialist doctors regard it to be in the best interests of the patient that it is performed in a day surgery facility to minimise risk and optimise patient care.

7. Surgeon for Egg Pickup

The egg pickup is a surgical procedure and must be performed by a doctor.  In most cases it is done by the fertility specialist treating the patient, but if unavailable then another fertility specialist at the clinic will do it.  In some cases a suitably qualified and experienced GP will do the procedure and again this is one area that low cost centres can reduce costs by using GPs to do the egg pickups.  There are pros and cons regarding this as GPs charge lower fees for what is a relatively simple procedure.  However, as in any surgery, complications occasionally arise and it is best for the patients to satisfy themselves on this issue.

The doctor who performs the procedure bills for the procedure because it is a rebateable Medicare procedure.  In most cases full service fertility clinics will include this fee as part of the IVF treatment cost and do the billing as an umbrella organisation on behalf of the doctor and then pay the doctor accordingly.  Unfortunately this is not always the case and you may receive a separate bill from the surgeon.  The fertility clinic should make clear to you the billing policy they have adopted.  Unlike the hospital fees as outlined above, the fertility clinic can and should provide advice on the billing of the egg pickup surgeon.  Unfortunately surgeons can charge fees of $1000 for this procedure which translates to an OOP expense of $650 or more.

8. Anaesthetic Doctor for Egg Pickup

As the egg pickup is a surgical procedure an anaesthetic doctor must be present if the procedure is carried out in a day hospital facility.  The anaesthetic doctor may be a specialist anaesthetist or a GP trained and experienced in administering anaesthetics.  This doctor will bill separately for this service and patients can claim a Medicare rebate.  This fee can be as high as $400 but is normally around $200 to $250 with a rebate of about $100.

Patients generally have little choice of who the anaesthetic doctor will be as the egg pickup is usually done on a surgery list along with other procedures.  In some facilities these may all be egg pickups.  Unfortunately, it can feel a bit like a production line.  These surgery lists are generally only on weekdays and the pickup time is very difficult to predict more than a couple of days in advance.  Normally an anaesthetic doctor is associated with a particular list, and will only be known once you have been ‘lined up’ for egg pickup and placed on a specific surgery list.   Therefore clinic staff cannot know in advance who the anaesthetist will be for a particular patient, but they should be able to tell patients which anaesthetic doctors work the weekday egg pickup lists.

Only rarely does the fertility clinic include the cost of the anaesthetic doctor in the bill, so patients should expect a separate bill for this, however it may be included as part of the no gap bill from the hospital.

9. Laboratory Services

This is one of the most important aspects of an IVF procedure and involves the fertilisation, monitoring of development, and maintenance of the embryos produced in the cycle.  This service is provided by the fertility clinic and is billed to the patient under Item Numbers 13200 and 13201.  You will receive a quote from the fertility clinic for this service.  It is the largest single cost and attracts the largest benefit in the form of Medicare and EMSN rebates.  A fee of $5000 to $8000 is quite common.  There are a number of add-ons and patients should be aware of these, how much they cost and whether they are elective.  The treating doctor should discuss these options with patients and clinic staff should be able to provide accurate information on the costs and if a Medicare rebate exists.  Below is a list of the more common add-ons:

ICSI: Intra Cellular Sperm Injection is the most common add-on and has its own item number, 13251.  It has both Medicare and EMSN rebates.  ICSI is used to achieve fertilisation in situations of poor sperm quality.  It usually adds about $500 to the OOP expense after all the rebates are accounted for.  Note that in some clinics all IVF patients receive ICSI.

Blastocyst Culture  is a common add-on and is covered by item numbers 13200 and 13201.  In the early days of IVF embryos were cultured (kept in media in incubators) for 3 days.  This was extended in recent times to 5 days at which time the embryo is referred to as a blastocyst.  Some clinics still only culture to Day 3 and their fee for items 13200/13201 reflect this.  Culture to Day 5 is elective and may incur an extra cost, none of which is rebateable.  Expect costs of about $500 extra per IVF treatment.  The specialist doctor should explain this process to patients.

Cryopreservation of embryos is an essential part of the IVF procedure, is highly effective and used by 50 to 60% of patients undergoing IVF.  Patients are only charged if they have excess embryos from the cycle that are suitable for cryopreservation (freezing).  The opportunity to cryopreserve excess embryos depends upon the number of eggs collected in the IVF cycle, the fertilisation and the subsequent embryo quality of embryos produced in the cycle.  Patients can elect not to cryopreserve excess embryos, however most patients are pleased to store excess embryos for future frozen embryo transfer cycles.  There are usually 2 parts of the cryopreservation of embryos fee: a one off cryopreservation fee of between $300 to $800 per treatment cycle and a fee for ongoing storage which can be charged either monthly, biannually or annually, and varies from as low as $250 per annum to $100 per month.  Note that low cost clinics may not provide cryopreservation services.  Patients should be aware of the cryopreservation fees and if this is included in the IVF cycle fee as this may be a hidden fee.

PGSA : Preimplantation Genetic Screening Aneuploidy  is used to determine the chromosomal structure of the embryo.  In most cases cells are removed from the embryo in the fertility clinic and are sent to an external laboratory for analysis.  Patients are normally billed by the treating fertility clinic which reimburses the external laboratory.  Fees are dropping but are still around $300 to $500 per embryo with the fee per single embryo being more costly than if multiple embryos are tested.  Currently there is no Medicare or private health fund rebate for PGSA.

PGDT: Preimplantation Genetic Diagnostic Testing is less commonly done than PGSA and involves testing for a specific genetic defect, such as Cystic Fibrosis.  This testing is only performed if indicated due to known hereditary factors.  This testing would be performed by an outside laboratory and patients would need to enquire about the cost of testing from the laboratory.

Assisted Hatching is an older technique used to aid embryo implantation and is not very common in recent times.  Assisted Hatching will add about $200 to $500 to Item Numbers 13200/13201 and there is no extra Medicare or private health fund rebate.

10. Embryo Transfer (ET)

This service is normally provided by the clinic and patients are billed as part of the umbrella IVF fee from the clinic.  Most clinics perform the ET as an outpatient procedure and it is performed on site at the clinic.  The item number is 13215 and there are both Medicare and EMSN rebates available. Therefore the ET is usually of no extra cost to the patient above the IVF fee.

Although the ET is almost always included in the IVF umbrella fee, in some cases the ET will be performed in a registered day hospital and this may be for medical or other reasons.  In this situation the ET is now an inpatient procedure and is not eligible for EMSN rebates and also will incur a separate fee from the day hospital like the egg pickup.  Although an ET performed in a day hospital may be covered by private health fund rebates, some private health funds do not cover these minor procedures.  The cost of the ET as an inpatient can be as low as $90 and as high as $500 on top of the fee charged by the clinic.

11. Donor

The use of donor sperm or donor eggs is additional to the cost of IVF treatment, and varies depending upon the quantity and source of the donor gametes.

12. Surgical Sperm Collection

In certain medical conditions the male partner is unable to produce sperm by ejaculation and surgical retrieval of sperm is necessary. This requires an additional procedure which of course involves extra costs.

The above twelve points covers the source of billing in most circumstances but is not exhaustive.  Patients are advised to ask their fertility clinic questions about what is included in the IVF fee in order to more accurately calculate expected out of pocket costs, thus avoiding unexpected hidden costs.