IVF in Europe. The good and the bad.

Each year, millions of families struggle with infertility.

The World Health Organization estimates that 1 in every 4 couples is affected.  According to Fertility IQ, a database providing information about costs and treatments, the average American patient pays more than $20.000 for a single IVF cycle.

More often than not, this price does not even include the necessary fertility drugs and testing, which can add up to an additional $3,000 per cycle. Which is why thousands of American women travel to Europe for assisted medical reproduction. A classic IVF cycle with stimulation meds included may cost anywhere between 3000-10000 Euro in France, UK or Spain, depending on the techniques and the kind of protocol (low vs high dose).

This logically prompts the question: why is IVF in the Unites States so expensive?

The answer is simple: because most insurance companies won’t cover it. Statistic tells us that up to 70% of the couples using IVF in the USA have to pay out of pocket.

Unfortunately no one can guarantee success on first try, therefore in most cases people have to brace themselves for paying for two or more cycles, sometimes ending up several tens of thousands in debt, with no baby to show for it for some unlucky ones.

Therefore it is only normal to try and come up with creative ways of managing IVF finances, in order to make them last longer and have them get you the best outcome.

Some choose Mexico, some choose the East Coast for slightly lower prices, some get second jobs at Starbucks to benefit from their IVF coverage, and some choose to go to Europe.

It is Europe I will be writing about, because I live here, and I have my personal experience as best testimony.

Time to ask that question again, in a slightly different manner: why is IVF in Europe so cheap?

First of all: the medication. Americans pay for prescription drugs prices that are two to six times higher than anywhere in the world. Europe has policies to lower drug prices, including price controls, and this applies to stimulation drugs for IVF too.

I am based in Paris, France. We are lucky here. Probably the luckiest if I am to be honest, regarding healthcare and health coverage. A French resident is entitled to benefit from 6 free IUI tries (meds included) and 4 IVF free tries (meds included) until she is 43 of age. When I would go to the pharmacy to pick up my shots, I would pay zero, but I would still see the price on the ticket. The highest ever was around 3500 Euro, and that was for my highest dose protocol, with 450 Gonal F and 150 Menopur, Cetrotide started by cd 5 and Ovidrel included. I stimmed for 12 days that cycle. (Unsuccessfully but that’s another topic)

A Gonal F 900ui pen costs 338 euros in France (369 USD) whereas in US it is around 900 USD if out of pocket, and up to 2000 USD through insurance.

So there you go!

Regarding the prices of the procedure itself, I have done 3 out of my 7 IVF cycles at the American Hospital in Paris, a private hospital certified under the French healthcare system and recognized by the American Congress. It isthe only civilian hospital in Europe accredited by The Joint Commission(TJC), an independent organization that accredits hospitals in the United States.

My bill shows I paid the following :

Hospital : 1165 Euro

Lab : 702 Euro

RE fees : 420 Euro

Anesthesiologist fees : 250 Euro

Total : 2537 Euro

I happened to have other cycles in public hospitals, for far less than the above, but the conditions are better at the American Hospital, obviously.

My monitoring was also funded by insurance, yet a scan costs 120 euros for the first one and 80 Euros for the subsequent ones, and blood tests anywhere around 100 euros the full pack (FSH, LH, Estradiol, Progesterone).

We can safely say a full high dose protocol with meds, monitoring and the procedure performed at the American Hospital in Paris costs around 6500 Euros.

This price can be lower if the protocol implies lower doses of stimulation meds.

To this you should add the flights and the stay, and consider you have been on vacation.

These are the pros, for France. The cons are that there is no PGS testing in France, the law prohibits it for ethical reasons, unless the couple has know genetic issues, and there is no embryo banking.

That is, we retrieve, we fertilize, we transfer fresh, we freeze the rest of the embryos and we don’t do another fresh cycle unless we have transferred the frozen ones first.

Then again, if you want PGS, embryo banking and frozen transfers whenever you decide, Spain might be your option.

Barcelona IVF charges 4970 Euro for an IVF cycle (medical appointments, scans during the cycle, hormone tests during the cycle, egg retrieval).

They offer PGS and Embryo banking.

They have IVF packages with guarantee and refund for women under 38 with normal ovarian reserve.

Egg donation costs 6980 Euro with 8 mature eggs and 2 guaranteed blasts, ICSI and transfer included.

And they also have egg donor packages with guarantees and refunds in case pregnancy is not achieved, for women up to 50 years of age.

If you are over 40, with low ovarian reserve and little to no response from conventional IVF protocols, and you love England, Create Fertility might be a good option for you.

They specialise in low dose and natural IVF, which is almost never the first choice, but can very well be the last one, when you have exhausted every possibility and are not yet ready to go to donor eggs. Last webinar I attended they mentioned they accept women up to 49 with own eggs for natural IVF. Sure enough, there are no guarantees, but everything is worth a try when we feel the need to know we have done everything. They offer, among other interesting packages, a 3 cycle Mild stimulation IVF package with own eggs for around 11.000 pounds (including monitoring and meds).

When choosing to travel to Europe for IVF, you have to take into account several important aspects, beyond the financial aspect.

Maximum female age is a legal limit in 18 countries, ranging from 45 years in Denmark and Belgium to 51 in Bulgaria. There are no legal age limits in Finland, Germany, Norway, while current legislation in France sets a female upper limit at "normal reproductive age", Spain at the "age of the menopause", and the Netherlands at age 49.

Some REs in France may refuse you IVF if you’re over 43 though-it happened to me.

Donor sperm for IVF and IUI is possible almost throughout Europe.

Egg donation is not allowed in Germany, Norway, Switzerland and Turkey.