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.

Embryo testing for chromosomal status (PGS) is not permitted in Denmark, France, Germany, Hungary, Lithuania, Norway, Slovenia, Sweden and the Netherlands.

Embryo sex selection (by PGT-A) is not allowed in any country.

What is that you should know, when considering traveling to Europe for IVF.

There is legislation within the EU, which sets standards for quality and safety. However, not all EU countries have implemented this legislation and clinics in these countries are not necessarily accredited by a national body.

Go for western European clinics when in doubt, they have stricter rules and they respect them.

Some clinics (like Barcelona IVF) offer a first free Skype session during which you can discuss at length with their doctor, and see what options suit you best. You would have to send them your medical files first, so they can have a good idea of your situation and be able to suggest the most appropriate treatment.

Think of paying for logistic help: Medical concierge services usually cost up to 10% of your medical bill (that would be under 1000 euros in most of the cases) and help you with everything: best flight solutions, special rates at hotels. They accompany you at your appointments, may organise visits and trips and shopping sprees while you’re in town, so that you can make the best of it. Last but not least they are well connected with the best clinics and can make a sound recommendation.

How do couples travelling from overseas organize their European IVF journey?

There are basically two ways.

Either you both take a 3 weeks vacation and do the monitoring, ER and transfer in Europe, before flying back home, or you do the monitoring at home and only come here for the egg retrieval plus transfer (if you decide to transfer fresh).

In that last case, the male partner usually comes to the clinic alone, before the beginning of your cycle, leaves a sperm sample to be frozen (even if he joins you for the ER, a frozen sample may always come in handy), takes your meds from Europe and flies them back home to you. Or you can come alone. Or you can come together on a city-break. Your choice! Remember: in order for you to benefit from stimulation meds at European prices you have to buy them on prescription in Europe and fly back home with them. You cannot have prescription meds shipped to US.

You may then do the monitoring at home and only come to the clinic 2-3 days before egg collection.

These details are better to be discussed with the clinic, and costs need to be evaluated to see what fits you best.

No one, or almost no one, anyway, starts trying for a child thinking they might need IVF.

For most of us this comes as an emotional shock. When the emotional shock is immediately doubled by a financial shock, the frustration is even deeper.

Sometimes we manage back home, sometimes we end up getting treatments abroad, sometimes we fail, other times we succeed.

What helped me most during my journey was the sense of control I gained when I started doing research for myself. When I started putting two and two together and I had the smallest say in the process.

I felt empowered and more at ease, knowing I did my best and there was no stone I left unturned. It may seem little, but it helped me cope with the whole situation better then when I knew nothing about what was happening to me and I would just go with the flow.