1. Preparation
WHAT IS IVF?
In Vitro Fertilisation (IVF) literally means that an egg is fertilised outside the body. It is one of many techniques collectively known as Assisted Reproductive Therapy (ART). IVF can be physically and emotionally draining, and as such is not usually embarked upon until a couple has exhausted all other lifestyle and medical options to help them conceive. Intracytoplasmic Sperm Injection (ICSI) is a slightly more complex form of IVF where a single sperm is injected directly into an egg, and is used when there are problems with male fertility.
One cycle of IVF takes several weeks to complete, as it involves a number of steps. The steps involved in an IVF cycle are:
-
Stimulation of the Ovaries – A series of injections of a hormone called FSH are given to stimulate the ovaries to produce more than the usual one egg per cycle.
-
Prevention of Premature Ovulation – This is achieved by shutting down communication between the brain and the ovaries to gain control of the ovulation day so that the eggs are not released before they can be collected.
-
Triggering Ovulation – An injection is given to trigger the ovulation process.
-
Collection – The eggs and sperm are collected to begin fertilization.
-
Culturing – The eggs are sorted in the laboratory. The mature ones are selected and placed with the sperm in a plastic container. If more embryos are created than are required for transfer, the strong healthy ones may be put in cryo-storage (frozen) for transfer at a later date if required.
-
Transfer – The embryos are transferred through the cervix and into the uterus.
The success of IVF varies widely and is dependent upon a number of factors including a woman’s age, the cause of infertility, and the quality of sperm.
WHY IS IT DONE?
A couple is considered infertile only after 12 months of regular, unprotected intercourse. After this time they will usually be referred to a specialist who will investigate the cause of their infertility. Some common reasons include:
-
Endometriosis – This is when the lining of the womb can be found covering other pelvic structures such as the ovaries, pelvic ligaments, peritoneum (lining of the pelvis), bowel, and bladder. This causes irritation and inflammation which can lead to scarring. It is also associated with infertility, although the reasons for this are not fully understood.
-
Irregular ovulation – For ovulation to occur, part of the brain prompts the pituitary gland to secrete hormones for the ovaries to ripen eggs during the menstrual cycle. If the menstrual cycle does not occur or is irregular, ovulation may also be irregular or absent.
There are usually a number of approaches that can be tried before IVF, not least some basic lifestyle changes such as weight loss, dietary adjustments and avoiding alcohol, nicotine and illicit drugs, Medical management includes tablets or injections to stimulate ovulation, laser surgery to treat endometriosis, microsurgery to correct tubal defects.
As mentioned previously, IVF is physically and emotionally, not to mention financially, draining. Before committing to IVF you should ensure you understand all aspects of the treatment, which should help prepare you for the inevitable roller coaster of emotions that accompanies IVF. Counselling is offered through many infertility clinics, or you can source an experienced and independent counsellor through the Australian and New Zealand Association of Infertility Counsellors Association, web address http://www.anzica.org.
HOW DO I CHOOSE A SPECIALIST?
Your GP will be able to recommend and refer you to a gynaecologist who has specialised in fertility treatments. You may be happy to accept their advice and recommendation, or you may like to investigate your choices; either option is safe and valid. One way of sourcing a specialist is to access the The Royal Australian and New Zealand College of Obstetricians and Gynaecologists via their website www.ranzcog.edu.au. The website allows you to search for an infertility specialist in your area.
The list of questions below may help you better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).
To access a list of Gynaecologists who participate in HCF’s Medicover no gap arrangement:
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.
WHAT SHOULD I ASK MY SPECIALIST?
-
What are the pro’s and con’s of IVF for me? What are the success rates?
-
Make sure you fully understand the procedures that are planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of Informed Clinical Consent. Your doctor will ask you to sign a consent form giving him or her permission to perform the procedures.
-
What are my out of pocket costs going to be? Your doctor should be able to provide you with a breakdown of costs involved, including what is claimable from Medicare and from your health insurance; this is known as Informed Financial Consent .
-
In addition to what the procedure involves, you should also ask about:
-
Preparation
-
Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
-
Aftercare
-
What hospital or clinic does your doctor operate from? What facilities and support are available there, particularly in the preparation for IVF?
-
Your doctor will inform you if there are any special instructions regarding your usual medication, including herbal and homeopathic remedies, and whether or not they may interfere with the process.
WHERE IS IT DONE?
The majority of the IVF process involves outpatient services, which means that they are not covered by your private health insurance hospital cover. The procedures covered by health insurance are those that are deemed by the Commonwealth to be inpatient services:
These procedures usually take place in a specialised day facility or hospital.
HOW LONG IS THE PROCEDURE?
Egg retrieval can take anywhere from 15 minutes to one hour, dependent on the anaesthetic used, and the cause of infertility.
Transfer of the embryos does not require anaesthetic and the procedure only takes about 3 minutes to complete.
WHO IS INVOLVED?
-
Your Specialist doctor
-
Anaesthetist: they administer either a light anaesthetic or sedation during the egg retrieval process, and look after you whilst the procedure is being carried out
-
Nurses assist with the preparation, procedure and recovery
HOW DO I PREPARE FOR IVF?
To have a better chance of conception with the IVF process, hormone stimulation is required. In a normal menstrual cycle, only one egg is released, so you will be given fertility medication to stimulate the ovaries to produce a number of eggs in the cycle.
The daily fertility drugs are normally given by injection. The injections can be given by staff at your Fertility Clinic or, so that your daily routine is not continually disrupted, either you or your partner can be taught to give the injections at home. Some drugs can also be administered at home by a nasal spray.
There are some side affects from the fertility drugs and you may experience some of the following symptoms:
-
Headaches
-
Tiredness, lethargy
-
Irritation inside the nose or injection site
-
Occasional hot flushes
-
Breast enlargement or tenderness
-
Muscle pain and weakness
-
Double vision
-
Irritability and tearfulness
-
Nausea
-
Fluid retention
-
Abdominal discomfort
-
Constipation
Blood tests are done on a regular basis to measure the hormone levels and an ultrasound is done to assess the hormone stimulation response by measuring the ovarian follicle numbers and size. After careful examination of the assessment results a decision can be made about when to begin the egg collection.
When the decision is made that it is time to collect the eggs, an injection will be arranged to trigger the ovulation process. The collection of eggs is done approximately 37 hours after the triggering injection is given.
The night prior to the embryo transfer, you are required to insert a progesterone pessary. Progesterone is a female sex hormone that is produced in the ovaries in the second half of the menstrual cycle.
WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL/SPECIALISED TREATMENT CENTRE?
-
Do not bring any valuables with you.
-
Wear comfortable clothing.
-
It is advisable not to wear perfume on the day of the embryo transfer as it interferes with the embryo growth in the laboratory.
2. Costs and Charges
WHAT IS IT GOING TO COST?
Please note that, as previously explained, this section only relates to the component of IVF that is considered hospital treatment and therefore covered by your hospital product. The majority of IVF treatment is done on an outpatient’s basis and therefore not claimable under your health insurance.
Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.
IVF PROCEDURES (RETRIEVAL)
For your information, the average charges for claims paid for IVF Retrieval admissions for the financial year 06/07 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$822
|
|
$774
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$329
|
$114
|
$38
|
$223
|
61.1%
|
$0
|
38.9%
|
|
Miscellanoous Medical Services
|
$454
|
$242
|
$81
|
$254
|
34.1%
|
$0
|
65.9%
|
|
2
Total Average Medical Services
|
$683
|
$321
|
$107
|
$288
|
63.0%
|
$0
|
37.0%
|
|
Hospital and Medical Services Adverage for IVF Retrieval Admissions
|
$1,505
|
$321
|
$881
|
$288
|
63.0%
|
$0
|
5
37.0
|
Points to Note:
-
Charges are based on HCF claims for a sample size of 781 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) covered under Medicare item 13212.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
-
There is no excess payable for same day admissions.
-
These charges are for comprehensive product only. Check the level of your benefit under your hospital product.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($683) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all IVF retrieval admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
IVF PROCEDURES (TRANSFER)
For your information, the average charges for claims paid for IVF Transfer admissions for the financial year 06/07 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation and hospital related services)
|
$355
|
|
$344
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Miscellanous Medical Services
|
$281
|
$128
|
$43
|
$277
|
32.5%
|
$0
|
67.5%
|
|
2
Total Average Medical Services
|
$281
|
$128
|
$43
|
$277
|
32.5%
|
$0
|
67.5%
|
|
Hospital and Medical IVF Transfer Admissions
|
$636
|
$128
|
$387
|
$277
|
32.5%
|
$0
|
5
67.5%
|
Points to Note
-
Charges are based on HCF claims for a sample size of 471 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) covered under Medicare item 13215.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation and hospital related services).
-
There is no excess payable for same day admissions.
-
These charges are for comprehensive product only. Check the level of your benefit under your hospital product.
1 These medical services are in-patient services only.
2 These medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($281) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all IVF transfer admissions.The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
2. Day of procedure
WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL/SPECIALISED TREATMENT CENTRE?
When you arrive at the hospital, day surgery or specialised treatment centre, the admissions clerk will attend to the paperwork associated with your stay.
Retrieval of eggs:
An anaesthetist may visit you prior to your procedure. A majority of women prefer to be awake during the egg pickup as it can be viewed on the ultrasound screen and if anaesthetic is not used, your partner may be able to attend. If this is the case, a light sedative and analgesic (pain killer) will be given to ensure you are comfortable. Alternatively, you may choose or be advised to have a light general anaesthetic; this should be discussed with your specialist or anaesthetist prior to the procedure.
Transfer of embryos:
You won’t need to see an anaesthetist. The procedure may be slightly uncomfortable, but not painful; therefore no form of sedation is needed.
WHAT CAN I EXPECT DURING THE PROCEDURES?
Retrieval of eggs:
Once in theatre, either anaesthetic or sedation will be administered prior to the egg retrieval. The collection of eggs is done under ultrasound control where a probe is placed into the vagina and a fine needle is then guided into the follicle. The follicle is about the size of a grape. Liquid that contains the egg is drawn from each follicle. This process is known as follicular aspiration.
The fluid obtained during the egg retrieval is taken to the laboratory where the eggs are isolated and placed in a special dish containing a water based sodium solution with nutrients added and placed in an incubator at room temperature.
Approximately 2 hours after the egg retrieval, arrangements are made for your partner to produce a sperm sample.
About 3 to 6 hours after collection, the sample of sperm is put in the dish with the eggs for fertilisation. The dish containing the eggs and sperm is stored in the incubator for about 15 or 20 hours and then they are inspected under a microscope to determine whether fertilisation has occurred.
An embryo begins to develop once the sperm fertilises the egg. Embryos remain in the incubator until it divides into either two or four cells.
Transfer of embryos:
Transfer of the embryos is usually done two or three days following the retrieval of eggs. Once they have adequately developed the embryo transfer will take place. Each doctor or clinic will have their own feelings or policy about the maximum number of embryos transferred – and this obviously should have been fully discussed and agreed upon with you before hand. Generally, to avoid the possibility of multiple births, no more than two or three embryos are transferred.
The vagina will be cleansed with a solution before the specialist inserts a speculum to allow a better view of the cervix. A speculum is the same as the metal or plastic instrument that is used when you have a PAP smear. A thin tube called a catheter is guided high into the uterus through the cervix and the embryos are injected.
1. Preparation
WHAT IS IVF?
In Vitro Fertilisation (IVF) literally means that an egg is fertilised outside the body. It is one of many techniques collectively known as Assisted Reproductive Therapy (ART). IVF can be physically and emotionally draining, and as such is not usually embarked upon until a couple has exhausted all other lifestyle and medical options to help them conceive. Intracytoplasmic Sperm Injection (ICSI) is a slightly more complex form of IVF where a single sperm is injected directly into an egg, and is used when there are problems with male fertility.
One cycle of IVF takes several weeks to complete, as it involves a number of steps. The steps involved in an IVF cycle are:
The success of IVF varies widely and is dependent upon a number of factors including a woman’s age, the cause of infertility, and the quality of sperm.
WHY IS IT DONE?
A couple is considered infertile only after 12 months of regular, unprotected intercourse. After this time they will usually be referred to a specialist who will investigate the cause of their infertility. Some common reasons include:
-
Endometriosis – This is when the lining of the womb can be found covering other pelvic structures such as the ovaries, pelvic ligaments, peritoneum (lining of the pelvis), bowel, and bladder. This causes irritation and inflammation which can lead to scarring. It is also associated with infertility, although the reasons for this are not fully understood.
-
Irregular ovulation – For ovulation to occur, part of the brain prompts the pituitary gland to secrete hormones for the ovaries to ripen eggs during the menstrual cycle. If the menstrual cycle does not occur or is irregular, ovulation may also be irregular or absent.
There are usually a number of approaches that can be tried before IVF, not least some basic lifestyle changes such as weight loss, dietary adjustments and avoiding alcohol, nicotine and illicit drugs, Medical management includes tablets or injections to stimulate ovulation, laser surgery to treat endometriosis, microsurgery to correct tubal defects.
As mentioned previously, IVF is physically and emotionally, not to mention financially, draining. Before committing to IVF you should ensure you understand all aspects of the treatment, which should help prepare you for the inevitable roller coaster of emotions that accompanies IVF. Counselling is offered through many infertility clinics, or you can source an experienced and independent counsellor through the Australian and New Zealand Association of Infertility Counsellors Association, web address http://www.anzica.org.
HOW DO I CHOOSE A SPECIALIST?
Your GP will be able to recommend and refer you to a gynaecologist who has specialised in fertility treatments. You may be happy to accept their advice and recommendation, or you may like to investigate your choices; either option is safe and valid. One way of sourcing a specialist is to access the The Royal Australian and New Zealand College of Obstetricians and Gynaecologists via their website www.ranzcog.edu.au. The website allows you to search for an infertility specialist in your area.
The list of questions below may help you better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).
To access a list of Gynaecologists who participate in HCF’s Medicover no gap arrangement:
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment
WHAT SHOULD I ASK MY SPECIALIST?
-
What are the pro’s and con’s of IVF for me? What are the success rates?
-
Make sure you fully understand the procedures that are planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of Informed Clinical Consent. Your doctor will ask you to sign a consent form giving him or her permission to perform the procedures.
-
What are my out of pocket costs going to be? Your doctor should be able to provide you with a breakdown of costs involved, including what is claimable from Medicare and from your health insurance; this is known as Informed Financial Consent .
-
In addition to what the procedure involves, you should also ask about:
-
Preparation
-
Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
-
Aftercare
-
What hospital or clinic does your doctor operate from? What facilities and support are available there, particularly in the preparation for IVF?
-
Your doctor will inform you if there are any special instructions regarding your usual medication, including herbal and homeopathic remedies, and whether or not they may interfere with the process.
WHERE IS IT DONE?
The majority of the IVF process involves outpatient services, which means that they are not covered by your private health insurance hospital cover. The procedures covered by health insurance are those that are deemed by the Commonwealth to be inpatient services:
-
Retrieval of eggs - Medicare Benefits Schedule item number 13212
-
Transfer of embryos - Medicare Benefits Schedule item number 13215
-
Preparation and transfer of frozen embryos - Medicare Benefits Schedule item number 13218
These procedures usually take place in a specialised day facility or hospital.
HOW LONG IS THE PROCEDURE?
Egg retrieval can take anywhere from 15 minutes to one hour, dependent on the anaesthetic used, and the cause of infertility.
Transfer of the embryos does not require anaesthetic and the procedure only takes about 3 minutes to complete.
WHO IS INVOLVED?
-
Your Specialist doctor
-
Anaesthetist: they administer either a light anaesthetic or sedation during the egg retrieval process, and look after you whilst the procedure is being carried out
-
Nurses assist with the preparation, procedure and recovery
HOW DO I PREPARE FOR IVF?
To have a better chance of conception with the IVF process, hormone stimulation is required. In a normal menstrual cycle, only one egg is released, so you will be given fertility medication to stimulate the ovaries to produce a number of eggs in the cycle.
The daily fertility drugs are normally given by injection. The injections can be given by staff at your Fertility Clinic or, so that your daily routine is not continually disrupted, either you or your partner can be taught to give the injections at home. Some drugs can also be administered at home by a nasal spray.
There are some side affects from the fertility drugs and you may experience some of the following symptoms:
-
Headaches
-
Tiredness, lethargy
-
Irritation inside the nose or injection site
-
Occasional hot flushes
-
Breast enlargement or tenderness
-
Muscle pain and weakness
-
Double vision
-
Irritability and tearfulness
-
Nausea
-
Fluid retention
-
Abdominal discomfort
-
Constipation
Blood tests are done on a regular basis to measure the hormone levels and an ultrasound is done to assess the hormone stimulation response by measuring the ovarian follicle numbers and size. After careful examination of the assessment results a decision can be made about when to begin the egg collection.
When the decision is made that it is time to collect the eggs, an injection will be arranged to trigger the ovulation process. The collection of eggs is done approximately 37 hours after the triggering injection is given.
The night prior to the embryo transfer, you are required to insert a progesterone pessary. Progesterone is a female sex hormone that is produced in the ovaries in the second half of the menstrual cycle.
WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL/SPECIALISED TREATMENT CENTRE?
-
Do not bring any valuables with you.
-
Wear comfortable clothing.
-
It is advisable not to wear perfume on the day of the embryo transfer as it interferes with the embryo growth in the laboratory.
2. Costs and Charges
WHAT IS IT GOING TO COST?
Please note that, as previously explained, this section only relates to the component of IVF that is considered hospital treatment and therefore covered by your hospital product. The majority of IVF treatment is done on an outpatient’s basis and therefore not claimable under your health insurance.
Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.
IVF PROCEDURES (RETRIEVAL)
For your information, the average charges for claims paid for IVF Retrieval admissions for the financial year 06/07 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$822
|
|
$774
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$329
|
$114
|
$38
|
$223
|
61.1%
|
$0
|
38.9%
|
|
Miscellanoous Medical Services
|
$454
|
$242
|
$81
|
$254
|
34.1%
|
$0
|
65.9%
|
|
2
Total Average Medical Services
|
$683
|
$321
|
$107
|
$288
|
63.0%
|
$0
|
37.0%
|
|
Hospital and Medical Services Adverage for IVF Retrieval Admissions
|
$1,505
|
$321
|
$881
|
$288
|
63.0%
|
$0
|
5
37.0
|
Points to Note:
-
Charges are based on HCF claims for a sample size of 781 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) covered under Medicare item 13212.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
-
There is no excess payable for same day admissions.
-
These charges are for comprehensive product only. Check the level of your benefit under your hospital product.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($683) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all IVF retrieval admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
IVF PROCEDURES (TRANSFER)
For your information, the average charges for claims paid for IVF Transfer admissions for the financial year 06/07 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation and hospital related services)
|
$355
|
|
$344
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Miscellanous Medical Services
|
$281
|
$128
|
$43
|
$277
|
32.5%
|
$0
|
67.5%
|
|
2
Total Average Medical Services
|
$281
|
$128
|
$43
|
$277
|
32.5%
|
$0
|
67.5%
|
|
Hospital and Medical IVF Transfer Admissions
|
$636
|
$128
|
$387
|
$277
|
32.5%
|
$0
|
5
67.5%
|
Points to Note
-
Charges are based on HCF claims for a sample size of 471 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) covered under Medicare item 13215.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation and hospital related services).
-
There is no excess payable for same day admissions.
-
These charges are for comprehensive product only. Check the level of your benefit under your hospital product.
1 These medical services are in-patient services only.
2 These medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($281) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all IVF transfer admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
2. Day of procedure
WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL/SPECIALISED TREATMENT CENTRE?
When you arrive at the hospital, day surgery or specialised treatment centre, the admissions clerk will attend to the paperwork associated with your stay.
Retrieval of eggs:
An anaesthetist may visit you prior to your procedure. A majority of women prefer to be awake during the egg pickup as it can be viewed on the ultrasound screen and if anaesthetic is not used, your partner may be able to attend. If this is the case, a light sedative and analgesic (pain killer) will be given to ensure you are comfortable. Alternatively, you may choose or be advised to have a light general anaesthetic; this should be discussed with your specialist or anaesthetist prior to the procedure.
Transfer of embryos:
You won’t need to see an anaesthetist. The procedure may be slightly uncomfortable, but not painful; therefore no form of sedation is needed.
WHAT CAN I EXPECT DURING THE PROCEDURES?
Retrieval of eggs:
Once in theatre, either anaesthetic or sedation will be administered prior to the egg retrieval. The collection of eggs is done under ultrasound control where a probe is placed into the vagina and a fine needle is then guided into the follicle. The follicle is about the size of a grape. Liquid that contains the egg is drawn from each follicle. This process is known as follicular aspiration.
The fluid obtained during the egg retrieval is taken to the laboratory where the eggs are isolated and placed in a special dish containing a water based sodium solution with nutrients added and placed in an incubator at room temperature.
Approximately 2 hours after the egg retrieval, arrangements are made for your partner to produce a sperm sample.
About 3 to 6 hours after collection, the sample of sperm is put in the dish with the eggs for fertilisation. The dish containing the eggs and sperm is stored in the incubator for about 15 or 20 hours and then they are inspected under a microscope to determine whether fertilisation has occurred.
An embryo begins to develop once the sperm fertilises the egg. Embryos remain in the incubator until it divides into either two or four cells.
Transfer of embryos:
Transfer of the embryos is usually done two or three days following the retrieval of eggs. Once they have adequately developed the embryo transfer will take place. Each doctor or clinic will have their own feelings or policy about the maximum number of embryos transferred – and this obviously should have been fully discussed and agreed upon with you before hand. Generally, to avoid the possibility of multiple births, no more than two or three embryos are transferred.
The vagina will be cleansed with a solution before the specialist inserts a speculum to allow a better view of the cervix. A speculum is the same as the metal or plastic instrument that is used when you have a PAP smear. A thin tube called a catheter is guided high into the uterus through the cervix and the embryos are injected.
1. Aftercare
WHAT HAPPENS AFTER THE PROCEDURES?
Retrieval of eggs:
After aspiration of the last follicle is complete, you will be taken to the recovery area where you will rest for a couple of hours prior to discharge. Nurses will monitor your vital signs whilst you recover from your anaesthetic or sedation. You will not be able to drive and will need someone to escort you home.
It is not uncommon to experience mild bleeding after the procedure and you may also have some mild lower abdominal cramping for a couple of days due to your ovaries being swollen.
Scientists will supervise the process of IVF and, usually around 2-4 days later, you will be contacted and an appointment set up to have the embryos transferred.
Transfer of embryos:
You will be taken to the recovery area after the completion of the procedure because you will need to lie still for a period of approximately one hour after the transfer.
Once you are discharged you are normally instructed to return to your usual activities. Further injections of HCG or progesterone pessaries are required to keep the hormone levels suitable for the embryo to implant.
You will be advised not to use home pregnancy tests as the hormones you are given can interfere with the result. Unless you have your period, you will be given a blood test around two weeks after transfer to see if you are pregnant.