Price List. Valid from 01/07/2017

Transcription

1 Price List Valid from 01/07/2017 1

2 Table of Contents 1.0 Terms and Conditions Consultations Diagnostic Investigations & Ultrasonography Andrology Services Scanning services Treatment Cycles In-Vitro Fertility (IVF) One by One IVF (Available at the Bridge Centre only) Frozen Embryo Transfer IVF treatment with donor eggs Fertility Preservation Intrauterine Insemination (IUI) Additional services and fees Additional Services Additional Charges Pre-Implantation Genetic Diagnosis Embryo and Gamete Freezing Transport of gametes/embryos Donor sperm Known sperm donor / male partner proving donor sperm for surrogacy Screening Tests Individual screening tests Investigation Packages Egg donor screening Known sperm donor / male partner proving donor sperm for surrogacy screening Medication Additional information Glossary of terms 20 2

3 1.0 Terms & Conditions Before you can proceed with treatment, you will be required to have read, understood and agreed to the following terms and conditions. Your agreement is with the London Women s Clinic, 113 & 115 Harley Street, London W1G 6AP, Company Number ( the clinic ). General Terms & Conditions 1. I/We have seen the current pricelist and have discussed the treatment fees for this treatment cycle. We agree to pay these within the terms set out by the clinic. 2. I/We understand that this agreement and the pricelist is current at this time, however, the clinic may review and revise prices without notice. Prices quoted at first consultation will be valid for treatments commencing up to three months thereafter regardless of whether the price list changes in the interim. 3. I/We understand that all consultation and diagnostic work-up fees must be paid in advance or on the day of the appointment and that failure to do so, may result in the work-up and treatment cycle being cancelled and a cancellation/administration fee being charged. 4. I/We understand and agree to pay all treatment fees, prior to starting the medication and that failure to make payment will result in the treatment cycle being cancelled and a cancellation fee charged. I/We understand that the clinic does not offer the option of paying in instalments. 5. I/We understand that all outstanding balances must be cleared before treatment can commence. 6. I/We understand that any arrears apparent on accounts must be paid in a timely fashion. Failure to do so may result in the debt being referred to a collection agency. In these cases, I/we may be charged for any legal or other costs that the clinic may incur in recovering the debt, including a fee for reasonable administrative costs. 7. I/We understand the listed treatment fees do not cover the cost of medication and agree to pay for these separately. 8. I/We have an understanding of the pricing structure at the clinic and are aware that in addition to the treatment costs, we will be required to pay for any additional items/services required for our treatment. 9. I/We understand that our treatment may be cancelled due to clinical reasons or for our own personal reasons and in these cases a cancellation fee will be applied, depending upon the stage of treatment at cancellation. We are aware of the different fees applicable and agree to pay these. 10. I/We understand that the team at the clinic will order the appropriate amount of medication for our treatment, however, as dosages may be adjusted during the cycle, I/we may need to purchase more medication or may have some left over. I/We agree to pay for the additional medication (delivery charges will be applied). I/We accept that some high-cost drugs may remain unused and which cannot be returned for a refund. 11. I/We understand that if a procedure takes place (either an egg collection or insemination), the full fees for that treatment cycle are applicable (i.e. IVF/ICSI/PGD/FET/IUI etc.), irrespective of its outcome. 3

4 12. I/We understand that our treatment may require additional procedures (such as an ICSI, HyCoSy etc.) which are charged separately and are in addition to the procedure costs. I/We are aware of the costs and accept to pay these on the day of the procedure. 13. I/We understand that there is a fee for freezing and storing gametes and embryos and agree to pay this when/if I/we request to have our gametes and embryos frozen. I/We understand the pricing structure for storage and are aware that we will need to pay additional fees, prevalent at the time, for continued storage, after the initial period. Failure to pay fees may result in the cancellation of the storage facility and loss of any stored gametes and embryos. I/We understand that it is our obligation to provide the clinic with up to date contact details for correspondence. 14. I/We understand that our treatment cost covers one follow-up consultation (should the treatment cycle be unsuccessful). The appointment must be within 6 months of treatment, after which time a fee for a follow up consultation will be charged at the rates current at the time. 15. I/We understand the terms and conditions for the three cycle package as follows: Not all patients are eligible for the three cycle package. Eligibility will be discussed at your initial consultation. It is not possible to transfer the treatment package between partners or patients. Each egg collection will count as one complete cycle, irrespective of outcome. The package is deemed fulfilled if: o 3 egg collections have been performed, AND/OR o A pregnancy of 20 weeks is achieved All cycles must be completed within 12 months of purchase. No refunds or credit is given to any unused part of a treatment package. Once you have fully read and understood the price list and had an opportunity to ask any questions to the appropriate staff. Please sign and return the terms and conditions (2 pages) together with your other consent forms. Patient s full name Patient s signature Partner s full name (if applicable) Partner s signature (if applicable) Date [DD/MMM/YYYY] Date [DD/MMM/YYYY] Current contact details 4

5 2.0 Consultations Initial consultation 180 Consultation with a fertility specialist Counselling session (booked separately to the consultation) Initial consultation with scan 295 Consultation with a fertility specialist Pelvic ultrasound scan Counselling session (booked separately to the consultation) Comprehensive initial consultation package (Female) 370 Consultation with a fertility specialist Pelvic ultrasound scan and antral follicle count Anti Mullerian Hormone (AMH) blood test Counselling session (booked separately to the consultation) Comprehensive initial consultation package (Male & Female) 450 Consultation with a fertility specialist Pelvic ultrasound scan and antral follicle count for female partner Anti Mullerian Hormone (AMH) blood test for female partner Semen analysis for male partner Counselling session (booked separately to the consultation) Follow up consultation minute semen analysis follow up telephone consultation 65 Additional counselling sessions 85 Pre-pregnancy consultation at the London Ultrasound Centre Diagnostic Investigations & Ultrasonography 3.1 Andrology Services Semen analysis 120 Analysis and copy of report Semen analysis with swim up preparation 200 Analysis, swim up preparation and copy of report Semen analysis with follow up consultation 250 Analysis, copy of report and follow up consultation (30 minutes) DNA fragmentation test on sperm (TDL laboratory) 1,000 Courier, semen analysis and freeze, DNA fragmentation, copy of report and follow up with genetics counsellor by phone 3.2 Scanning services Pelvic ultrasound scan 150 Gynaecology scan with colour Doppler 270 Vaginal ultrasound scan and colour Doppler assessment of uterus, endometrium, ovaries and surrounding pelvis/adnexae HyCoSy 450 Aquascan 270 HyCoSy and Aquascan package week 2D early pregnancy scan 150 Ultrasound monitoring cycle 500 5

6 4.0 Treatment Cycles 4.1 In-Vitro Fertilisation (IVF) Stimulated IVF 3,650 Monitoring scans, clinical advice, egg collection, embryology, embryo transfer, one βhcg pregnancy blood test and one viability pregnancy scan or review consultation in the event of a negative outcome HFEA licence fee, medication, sedation for egg collection procedure, cycle monitoring blood tests, diagnostic and screening tests, ICSI, blastocyst culture, freezing and storage of additional embryos. Stimulated IVF 3 Cycle Package 7,300 Monitoring scans, clinical advice, up to 3 egg collections, embryology, up to 3 embryo transfers, up to 3 βhcg pregnancy blood tests and up to 3 viability pregnancy scan or review consultation in the event of a negative outcome Excludes (per cycle): HFEA licence fee, medication, sedation for egg collection procedure, cycle monitoring blood tests, diagnostic and screening tests, ICSI, blastocyst culture, freezing and storage of additional embryos. IVF Lite 2,990 Monitoring scans, clinical advice, egg collection, embryology, blastocyst culture, embryo transfer, one βhcg pregnancy blood test and one viability pregnancy scan or review consultation in the event of a negative outcome HFEA licence fee, medication, sedation for egg collection procedure, cycle monitoring blood tests, diagnostic and screening tests, ICSI (reduced fee), freezing and storage of additional embryos. IVF Lite three cycle package 5,950 Monitoring scans, clinical advice, up to 3 egg collections, embryology, blastocyst culture, up to 3 embryo transfers, up to 3 βhcg pregnancy blood tests and up to 3 viability pregnancy scan or review consultation in the event of a negative outcome Excludes (per cycle): HFEA licence fee, medication, sedation for egg collection procedure, cycle monitoring blood tests, diagnostic and screening tests, ICSI (reduced fee), freezing and storage of additional embryos. IVF for Egg Sharers Free Consultation with the London Egg Bank (following initial consultation), egg-sharing screening blood tests (LEB 2, 3 & 4), medication, monitoring scans, cycle monitoring blood tests, clinical advice, egg collection, embryology, ICSI, embryo transfer, one βhcg pregnancy blood test and one viability pregnancy scan or review consultation in the event of a negative outcome HFEA licence fee, sedation for egg collection procedure, mandatory screening tests (including AMH), blastocyst culture, freezing and storage of additional embryos. Cancellation fees IVF cycle cancellation before egg collection 500 Notes: 1. An IVF cycle may be converted to ICSI for clinical reasons, part way through treatment. This will incur additional charges. 2. In an egg-sharing cycle, if the cycle is abandoned prior to egg collection or not enough follicles seen to accommodate the egg-sharing arrangement, the donor can either abandon the cycle at no extra charge to her or can continue and pay 2,300 and not share. 3. If the egg-sharer withdraws from the programme for non-medical reasons, they will be liable for the costs of any investigations and medication. 4. If embryos are stored for medication reasons (e.g. OHSS) freezing and storage is chargeable. There is no additional fee for frozen embryo transfer. Medication will be charged as normal. 5. All egg-sharers will require ICSI. 6. To take part in the egg-sharing scheme, 8 mature eggs must be available for donation. All shared eggs will be frozen. If eggs are not available, the donation will be cancelled. 6

7 4.2 One by One IVF One by One IVF 6,700 Monitoring scans, clinical advice, cycle monitoring blood tests (including 1 βhcg), egg collection, embryology, time lapse technology, blastocyst culture, embryo freezing with 1 years storage, review consultation after embryo freezing, up to 2 frozen embryo transfer cycles and one viability pregnancy scan or review consultation, in the event of a negative outcome HFEA licence fee, medication, sedation for egg collection procedure, diagnostic and screening tests and ICSI (reduced fee) One by One IVF Plus 9,000 Monitoring scans, clinical advice, cycle monitoring blood tests (including 1 βhcg), egg collection, embryology, time lapse technology, blastocyst culture, embryo biopsy and testing by Next Generation Sequencing (NGS), embryo freezing with 1 years storage, review consultation after embryo freezing, up to 2 frozen embryo transfer cycles and viability pregnancy scan or review consultation, in the event of a negative outcome HFEA licence fee, medication, sedation for egg collection procedure, diagnostic and screening tests and ICSI (reduced fee) One by One IVF Plus 2 nd Cycle Package 8,000 (for patients who have 3 or less embryos biopsied in their first cycle) Monitoring scans, clinical advice, cycle monitoring blood tests (including 1 βhcg), egg collection, embryology, time lapse technology, blastocyst culture, embryo biopsy and testing by Next Generation Sequencing (NGS), embryo freezing with 1 years storage, review consultation after embryo freezing, up to 2 frozen embryo transfer cycles and viability pregnancy scan or review consultation, in the event of a negative outcome HFEA licence fee, medication, sedation for egg collection procedure, diagnostic and screening tests and ICSI (reduced fee) One by One IVF Plus PGD (Single Gene Defect) 11,700 Monitoring scans, clinical advice, cycle monitoring blood tests (including 1 βhcg), egg collection, embryology, time lapse technology, blastocyst culture, embryo biopsy, testing by Next Generation Sequencing (NGS) and Preimplantation Genetic Diagnosis for Single Gene Defects (with test development), embryo freezing with 1 years storage, review consultation after embryo freezing, up to 2 frozen embryo transfer cycles and viability pregnancy scan or review consultation, in the event of a negative outcome HFEA licence fee, medication, sedation for egg collection procedure, diagnostic and screening tests, ICSI (reduced fee) and licensing application preparation fee (where applicable) Patients who require a second cycle will not be required to pay for test development and will be charged a fee of 9,300. One by One IVF Plus PGD (Single Gene Defect) Three Cycle Package 16,500 Monitoring scans, clinical advice, cycle monitoring blood tests (including up to 3 βhcg), up to 3 egg collections, time lapse technology, blastocyst culture, embryo biopsy, testing by Next Generation Sequencing (NGS) and Preimplantation Genetic Diagnosis for Single Gene Defects (with test development), embryo freezing with 1 years storage, review consultation after embryo freezing, up to 3 frozen embryo transfer cycles and viability pregnancy scan or review consultation, in the event of a negative outcome Excludes (per cycle): HFEA licence fee, medication, sedation for egg collection procedure, diagnostic and screening tests, ICSI (reduced fee) and licensing application preparation fee (where applicable) Cancellation fees One by One IVF & One by One Plus IVF cycle cancellation before egg collection 500 7

8 Notes: 1. Both embryo transfers must be completed within one year of purchase. 2. There will be no refund following egg collection and there is no refund or credit given for any unused parts of the package. 3. One by One Plus patients who do not have embryo biopsy and testing can convert to a standard One by One package and receive a refund of 2, One by One Plus 2 nd Cycle Package patients who do not have embryo biopsy and testing can convert to a standard One by One package and receive a refund of 1, One by One Plus PGD (Single Gene Defect) patients who do not have embryo biopsy and testing can convert to a standard One by One package and receive a refund of 4, The package is deemed complete when either a) the IVF cycle and 2 FET cycles have been completed OR b) a 20 week pregnancy has been achieved. 7. There may be some situations where no embryos reach blastocyst stage (day 5/6) and are unsuitable for freezing. One by One Plus patients may find that following biopsy there may be no genetically balanced embryos to transfer. 4.3 Frozen Embryo Transfer Frozen Embryo Transfer (FET) 1,350 Monitoring scans, clinical advice, embryology, embryo transfer, one βhcg pregnancy blood test and one viability pregnancy scan or review consultation in the event of a negative outcome HFEA licence fee, medication, cycle monitoring blood tests, diagnostic and screening tests, blastocyst culture, freezing and storage of unused embryos. Frozen Embryo Transfer (FET) with donated embryos 2,700 Matching, chromosome and sexual health screening for the embryo donors, donated embryos, monitoring scans, clinical advice, embryology, embryo transfer, one βhcg pregnancy blood test and one viability pregnancy scan or review consultation in the event of a negative outcome HFEA licence fee, medication, cycle monitoring blood tests, diagnostic and screening tests, freezing and storage of unused embryos. Cancellation fees FET cycle cancellation prior to thawing 500 8

9 4.4 IVF treatment with donated eggs London Egg Bank fee 3,450 Administration, co-ordination, medical consultations, counselling and support for donor, all medical screening tests for the egg donor before and during treatment plus expenses payment to the egg donor (in line with HFEA guidelines) Fresh London Egg Bank Egg Donor / Recipient Cycle (5 fresh eggs) 5,750 Donor treatment costs up to egg collection, clinical management of donor and recipient, embryology, embryo transfer, one βhcg pregnancy blood test and one viability pregnancy scan or review consultation in the event of a negative outcome London Egg Bank fee, HFEA licence fee, medication, cycle monitoring blood tests, diagnostic and screening tests, ICSI, blastocyst culture, freezing and storage of unused embryos. Additional 1-5 eggs from the same registered donor 2,500 (Refundable if no more than 5 eggs are collected) Frozen London Egg Bank Egg Donor / Recipient Cycle (6 frozen eggs) 4,500 Donor treatment costs up to egg collection, embryology, ICSI, embryo transfer, one βhcg pregnancy blood test and one viability pregnancy scan or review consultation in the event of a negative outcome London Egg Bank fee, HFEA licence fee, medication, cycle monitoring blood tests, diagnostic and screening tests, blastocyst culture, freezing and storage of unused embryos. Egg Donor / Recipient Cycle from a known donor or partner 3,450 Monitoring scans, clinical management of donor and recipient, egg collection, embryology, embryo transfer, one βhcg pregnancy blood test and one viability pregnancy scan or review consultation in the event of a negative outcome HFEA licence fee, medication, sedation for egg collection procedure, cycle monitoring blood tests, cycle monitoring for the recipient, diagnostic and screening tests, ICSI, blastocyst culture, freezing and storage of unused embryos. Partner to partner shared donation / eggs shared between partner and matched recipient both FREE being treated simultaneously Egg-sharing screening blood tests, medication for the egg donor, monitoring scans, cycle monitoring blood tests for the egg donor, clinical management of the donor and recipient, egg collection, ICSI, embryology, embryo transfer, one βhcg pregnancy blood test and one viability pregnancy scan or review consultation in the event of a negative outcome HFEA licence fee, medication for the egg recipient, sedation for egg collection procedure, cycle monitoring scans and blood tests for the egg recipient, diagnostic and screening tests for the egg recipient, mandatory screening tests (including AMH) for both partners, blastocyst culture, freezing and storage of unused embryos. Cancellation fees Abandoned fresh cycle (by the clinic or donor) refund 5,750 Failure to thaw (frozen cycle) refund 4,500 Egg donor / recipient cycle from a known donor or partner cancellation before egg collection 2,300 Recipient cycle cancellation fee (cancellation made by the recipient) 500 Notes: 1. An administration and co-ordination fee is applicable for all egg recipient cycles using donor eggs from the London Egg Bank. This fee is non refundable. 2. If the donor s egg(s) fail to fertilise no refund will be available 3. If the recipient cancels treatment once treatment has started the recipient is liable for the full cost of treatment with no refund. 4. Donation of eggs to an unknown recipient in an egg-sharing arrangement can only take place if the eggsharer (donor) is under the age of The age limit for donation of eggs to a known recipient either as part of a known donation arrangement or intra-partner egg donation is dependent on the advice of your fertility specialist. 9

10 4.5 Fertility Preservation Egg Freezing 3,500 Monitoring scans, clinical advice, egg collection, egg cryopreservation, storage for two years and review consultation Medication, cycle monitoring blood tests, diagnostic and screening tests, sedation for egg collection procedure and subsequent storage. Egg Freezing 3 Cycle Package 8,600 Monitoring scans, clinical advice, 3 egg collections, egg cryopreservation, storage for two years and review consultation Excludes (per cycle): Medication, cycle monitoring blood tests, diagnostic and screening tests, sedation for egg collection procedure and subsequent storage. Egg thaw, fertilisation, embryo transfer cycle 3,600 Monitoring scans, clinical advice, embryology, ICSI, embryo transfer, one βhcg pregnancy blood test and one viability pregnancy scan or review consultation in the event of a negative outcome HFEA licence fee, medication, cycle monitoring blood tests, diagnostic and screening tests, blastocyst culture, freezing and storage of unused embryos. Embryo Freezing 4,100 Monitoring scans, clinical advice, egg collection, embryology, embryo cryopreservation, storage for two years and review consultation HFEA licence fee, medication, cycle monitoring blood tests, diagnostic and screening tests, sedation for egg collection procedure, donor sperm, pregnancy reservation slot, ICSI, blastocyst culture and subsequent storage. Embryo Freezing 3 Cycle Package 8,800 Monitoring scans, clinical advice, 3 egg collections, embryology, embryo cryopreservation, storage for two years and review consultation HFEA licence fee, medication, cycle monitoring blood tests, diagnostic and screening tests, sedation for egg collection procedure, ICSI, donor sperm, pregnancy reservation slot, blastocyst culture and subsequent storage. Storage of sperm for medical reasons 750 Pre-treatment screening including HIV 1 & 2, Hepatitis B surface antigen, Hepatitis B core antibody, Hepatitis C and Chlamydia, 2 x sperm freezing with 2 years storage and follow up consultation Cancellation fees Egg freezing cycle cancellation prior to egg collection 500 Egg thawing cycle cancellation prior to thawing 500 Embryo freezing refund (in the case of no embryos to freeze) 825 Notes: 1. For those purchasing donor sperm from the London Sperm Bank for the purpose of long term embryo freezing a pregnancy slot reservation fee is applicable see section If imported donor sperm is used for the purpose of long term embryo freezing no pregnancy slot reservation fee is applicable. 10

11 4.6 Intrauterine Insemination (IUI) Natural Intrauterine Insemination (IUI) 950 Clinical advice, andrology, insemination, one βhcg pregnancy blood test and one viability pregnancy scan or review consultation in the event of a negative outcome (after three attempts) HFEA licence fee, diagnostic and screening tests, LH digital test kit, second insemination on the same cycle and donor sperm Natural Intrauterine Insemination (IUI) 3 Cycle Package 1,900 Clinical advice, andrology, up to 3 inseminations, up to 3 βhcg pregnancy blood tests and up to 3 viability pregnancy scans or review consultation in the event of a negative outcome (after three attempts) HFEA licence fee, diagnostic and screening tests, LH digital test kit, second insemination on the same cycle and donor sperm Stimulated Intrauterine Insemination (IUI) 1,550 Monitoring scans, clinical advice, andrology, insemination, one βhcg pregnancy blood test and one viability pregnancy scan or review consultation in the event of a negative outcome (after three attempts) and medication (500iu Gonal F/Menopur, 1 x Ovitrelle and 1 x box Cyclogest HFEA licence fee, diagnostic and screening tests, cycle monitoring blood tests, second insemination on the same cycle and donor sperm Stimulated Intrauterine Insemination (IUI) 3 Cycle Package 3,100 Monitoring scans, clinical advice, andrology, up to 3 inseminations, up to 3 βhcg pregnancy blood tests, up to 3 viability pregnancy scans or review consultation in the event of a negative outcome (after three attempts), and medication (500iu Gonal F/Menopur, 1 x Ovitrelle and 1 x box Cyclogest) per cycle HFEA licence fee, diagnostic and screening tests, cycle monitoring blood tests, second insemination on the same cycle and donor sperm Stimulated Intrauterine Insemination (IUI) with donor sperm from the London Sperm Bank 2,495 Monitoring scans, clinical advice, andrology, insemination, one βhcg pregnancy blood test, one viability pregnancy scan or review consultation in the event of a negative outcome (after three attempts), medication (500iu Gonal F/Menopur, 1 x Ovitrelle and 1 x box Cyclogest and donor sperm for one treatment cycle as per the LSB catalogue terms and conditions of sale. HFEA licence fee, diagnostic and screening tests, cycle monitoring blood tests, second insemination on the same cycle Please see section 5.6 Donor sperm for more information Stimulated Intrauterine Insemination (IUI) 3 Cycle Package with donor sperm 4,990 from the London Sperm Bank Monitoring scans, clinical advice, andrology, up to 3 inseminations, up to 3 βhcg pregnancy blood tests and up to 3 viability pregnancy scans or review consultation in the event of a negative outcome (after three attempts), medication (500iu Gonal F/Menopur, 1 x Ovitrelle and 1 x box Cyclogest) per cycle and donor sperm for each treatment cycle as per the LSB catalogue terms and conditions of sale. HFEA licence fee, diagnostic and screening tests, cycle monitoring blood tests, second insemination on the same cycle Please see section 5.6 Donor sperm for more information Second insemination on the same cycle (excluding donor sperm if required) 595 Cancellation fees IUI stimulated cycle cancellation prior to sperm preparation

12 5.0 Additional services and fees 5.1 Additional Services Intracytoplasmic Sperm Injection (ICSI) 1,250 Intracytoplasmic Sperm Injection (ICSI) reduced fee for IVF Lite & One by One IVF 850 Blastocyst culture 600 Assisted hatching 500 Surgical Sperm Retrieval 1,500 Sperm collection and sedation Cyst aspiration/follicle reduction 200 Theatre procedure and recovery Mock cycle 1,000 Scans and medication either Progynova OR Elleste OR Estraderm, and Cyclogest OR Lutigest OR Gestone OR Utrogestan medication Intravenous (IV) sedation 300 Intralipid infusion per infusion 500 Medication and administration Natural killer cell blood tests per infusion 720 Endometrial scratch 150 Overseas treatment administration fee 2,800 Notes: 1. Storage fees for surgical sperm retrieval are additional. 2. Payment for surgical sperm retrieval procedures is due prior to the procedure. 3. No refunds are available if no sperm is retrieved following surgical sperm retrieval. 4. If sedation is required for cyst aspiration, follicle reduction or mock cycles this is an additional cost. 5. Natural killer cell blood test infusions take place on Monday to Thursday before 1pm. 5.2 Additional Charges HFEA treatment licence fee 80 HFEA treatment licence fee for Donor Insemination (IUID) 40 Surrogacy administration and co-ordination fee per surrogate 2,100 (for fresh IVF using eggs of the commissioning couple or an egg donor) Administration, Co-ordination, counselling and support for commissioning couple and surrogate Surrogacy administration and co-ordination fee (for FET or IUI) per surrogate 1,000 Administration, co-ordination, counselling and support for commissioning couple and surrogate Copy of Notes within the UK 50 Copying and checking of notes, postage and packaging Copy of Notes outside the UK 45 Copying and checking of notes plus packaging. Postage costs will be additional depending on destination. LH ovulation test kit (digital) 25 12

13 5.3 Pre-implantation Genetic Diagnosis (in addition to IVF costs) Aneuploidy Screening (Preimplantation Genetic Screening) Embryo biopsy and testing by Array CGH or Next Generation Sequencing (NGS) analysis of up to 8 samples Additional samples Courier fee Pre-implantation Genetic Diagnosis for Translocation/Chromosome Imbalances Embryo biopsy and testing by Array CGH or Next Generation Sequencing (NGS) analysis of up to 8 samples Additional Samples Courier fee Preimplantation Genetic Diagnosis for Single Gene Defects (with test development) Test preparation, embryo biopsy and testing 1-9 samples (per cycle) Test preparation, embryo biopsy and testing samples (per cycle) Licensing application preparation fee (where applicable) Courier fee Preimplantation Genetic Diagnosis for Single Gene Defects plus HLA Matching (test development) Test preparation, embryo biopsy and testing 1-9 samples (per cycle) Test preparation, embryo biopsy and testing samples (per cycle) Licensing application preparation fee (where applicable) Courier fee 3, , ,000 7, ,000 7, POA Genetic mutation testing 350 Sperm aneuploidy testing (5 chromosomes) 750 Cancellation fees Aneuploidy Screening (Preimplantation Genetic Screening) & Pre-implantation Genetic Diagnosis 150 for Translocation/Chromosome Imbalances prior to embryo biopsy Aneuploidy Screening (Preimplantation Genetic Screening) & Pre-implantation Genetic Diagnosis 500 for Translocation/Chromosome Imbalances following embryo biopsy Preimplantation Genetic Diagnosis for Single Gene Defects (with test development) 3,000 Preimplantation Genetic Diagnosis for Single Gene Defects plus HLA Matching (test 3,000 development) Notes: 1. Any embryos used in a later frozen cycle are chargeable as per the frozen embryo transfer prices. In date screening tests are required when embryos are replaced in a frozen cycle and these costs are additional. 13

14 5.4 Embryo and Gamete Freezing Embryo and gamete freezing 325 Embryo and gamete freezing plus 1 year storage year storage for gametes or embryos years storage for gametes or embryos years storage for gametes or embryos years storage for gametes or embryos years storage for gametes or embryos 1,100 6 years storage for gametes or embryos 1,400 7 years storage for gametes or embryos 1,550 8 years storage for gametes or embryos 1,800 9 years storage for gametes or embryos 2, years storage for gametes or embryos 2,200 Review consultation to discuss extending storage (including counselling if required) 130 Storage of sperm for medical reasons 750 Pre-treatment screening including HIV 1 & 2, Hepatitis B surface antigen, Hepatitis B core antibody, Hepatitis C and Chlamydia, 2 x sperm freezing with 2 years storage and follow up consultation Back up sperm freeze (including 8 weeks of storage) Transportation of gametes/embryos Administration fee for transport of gametes/embryos from another UK clinic to the LWC 150 Administration fee for transport of gametes/embryos from an overseas clinic to the LWC 1,800 Administration fee for transport of gametes/embryos to another UK clinic from the LWC 100 Administration fee for transport of gametes/embryos to an overseas clinic from the LWC 500 Administration fee for importing donor sperm from an HFEA recognised sperm bank 200 (in the UK or abroad) Notes: 1. The back up sperm freeze package is for use with immediate treatment only. If samples are not used within 8 weeks an annual storage fee will be applicable. 2. Administration fees for the transport of gametes/embryos are non-refundable and need to be paid on initial enquiry. 3. Courier fees for transporting gametes/embryos are dependent on the destination and will be quoted individually. 4. Please contact the clinic prior to paying for imported gametes to ensure that samples are suitable and meet HFEA requirements. 5. A storage fee is applicable for imported sperm if it is not used within 3 months of arrival at the clinic. This is also applicable when multiple samples are imported at one time. 14

15 5.6 Donor sperm Donor sperm from the London Sperm Bank catalogue (inc. VAT) payable to the LSB 950 Donor sperm for one treatment cycle as per the LSB catalogue terms and conditions of sale. A twenty minute consultation with one of the LSB customer service team (if required) Visit Three cycle donor sperm package from the London Sperm Bank catalogue (inc. VAT) 1,900 Donor sperm for three treatment cycle as per the LSB catalogue terms and conditions of sale. A twenty minute consultation with one of the LSB customer service team (if required) Visit Reservation of sibling sperm from the London Sperm Bank catalogue (inc. VAT) 1,100 payable to the LSB Donor sperm for one cycle as per the LSB catalogue terms and conditions of sale plus administration fee Reservation of pregnancy slot (for long term embryo freezing) payable to the LSB 1,500 Administration fee for importing donor sperm from abroad 200 Notes: 1. Three cycle donor sperm package: we cannot guarantee the same sperm donor for each cycle. Donor sperm must be used at the Bridge Centre or London Women s Clinic and treatment must be completed within one year. Storage fees are applicable. 2. The reservation of sibling sperm must take place following a pregnancy viability scan and is dependent on availability of that donor. Storage fees are applicable. If sibling sperm is not purchased at the time of the viability scan there is no guarantee that the same donor will be available for future treatment. 3. The reservation of a pregnancy slot fee is applicable for long term embryo freezing with no embryo transfer at the time of treatment. 5.7 Known sperm donor / male partner providing donor sperm for surrogacy Stage Semen analysis, test freeze and copy of report Stage Donor physical consultation and implications counselling Please see section 6.4 for screening blood tests Stage Sperm freezing (per sample) and quarantine process Please see section 5.4 for storage costs Stage 4 Post quarantine period screening see section 6.4 Subsequent storage see section

16 6.1 Individual screening tests 6.0 Screening tests *Tests to be carried out on between days 1-5 of the female menstrual cycle FSH* 50 LH* 50 Oestradiol* 50 Anti Mullerian Hormone (AMH) 95 βhcg 40 Testosterone 50 SHBG 40 DHEAS04 50 Prolactin 50 Progesterone 27 T4 50 TSH 50 HIV 1 & 2 60 Hepatitis B Surface Antigen 60 Hepatitis B core 50 Hepatitis C 75 Hepatitis B viral load 250 Hepatitis C viral load 270 HTLV 1 and Chlamydia 95 TPHA (Syphilis) 50 Rubella 50 CMV IgM/IgG 115 Cervical Smear 60 Blood group and Rhesus factor 40 Cystic Fibrosis 150 Sickle Cell 50 Tay Sachs 285 Thalassaemia Hydroxy Progesterone 115 Homocysteine 170 Trichomonas 80 Gonorrhoea 49 Chromosome Analysis (Karyotype) 280 Urine cotinine 75 CA

17 6.2 Investigation Packages Pre-treatment blood test package (Female) 150 HIV 1 & 2, Hepatitis B surface antigen, Hepatitis B core antibody, Hepatitis C, Chlamydia, Rubella Pre-treatment blood test package (Male) 100 HIV 1 & 2, Hepatitis B surface antigen, Hepatitis B core antibody, Hepatitis C Sexually transmitted infection screening repeated every 24 months 150 HIV 1 & 2, Hepatitis B core antibody, Hepatitis B surface antigen, Hepatitis C, Chlamydia Female partner screening tests 200 Varicella Zoster, Blood group, Serum TSH/free T4, Full blood count and Prolactin Baseline Hormones 200 FSH, LH, Oestradiol, AMH Female fertility health package 500 FSH, E2, AMH, Antral Follicle Count scan and Aquascan Chromosome Analysis (Karyotype) both partners 500 Male Genetic Reproduction Profile 600 Chromosome analysis, Y chromosome microdeletion, cystic fibrosis screen 6.3 Egg donor screening LEB HIV 1&2, Hepatitis B core antibody, Hepatitis B surface antigen, Hepatitis C, HTLV 1 and 2, Syphilis/TPHA, Urine Chlamydia, Gonorrhoea, Cytomegalovirus (CMV) IgM and IgG and Trichomonas LEB Chromosomes, Cystic Fibrosis, Blood group and Rhesus status, Rubella, HBEL LEB 3 [during treatment] 350 HIV 1 & 2, Hepatitis B core antibody, Hepatitis B surface antigen, Hepatitis C, Chlamydia LEB HTLV 1 and 2, Syphilis/TPHA, Urine Chlamydia, Gonorrhoea, Cytomegalovirus (CMV) IgM and IgG and Trichomonas Tay Sachs [for donors of Jewish decent] Known sperm donor / male partner providing sperm for surrogacy screening Known donor screening package (Stage 1) 1200 HIV I & II, Hepatitis B core antibody, Hepatitis B surface antigen, Hepatitis C, HTLV 1 and 2, Syphillis/TPHA, Urine Chlamydia, Gonorrhoea, Cytomegalovirus (CMV) IgM and IgG, Chromosomes, Cystic Fibrosis, Blood group and Rhesus status, Trichomonas, Semen culture, Sickle Cell and Thalassemia Tay Sachs [for donors of Jewish decent] (Stage 1) 285 Post quarantine screening tests (Stage 4) minimum of 181 days post date of last freeze 500 HIV I & II, Hepatitis B core antibody, Hepatitis B surface antigen, Hepatitis C, Syphilis/TPHA and Cytomegalovirus (CMV) IgM and IgG Post quarantine tests [inc. NAT testing] (Stage 4) minimum of 31 days post date of last freeze 700 HIV, Hepatitis B, Hepatitis C (NAT early detection test), Syphilis/TPHA, and Cytomegalovirus (CMV) IgM and IgG Notes: 1. If you test positive for Hepatitis B Core you will need to carry out a chargeable Hepatitis B viral load blood test 2. HIV 1 & 2, Hepatitis B surface antigen, Hepatitis B core antibody, Hepatitis C and Chlamydia (female partner only) must be valid within 3 months of starting the 1st cycle of treatment 3. Mandatory screening tests must be carried out at the clinic. 4. For donors, HIV 1 & 2, Hepatitis B surface antigen, Hepatitis B core antibody, Hepatitis C, Chlamydia, Gonorrhoea, HTLV and Syphilis must be valid within 3 months of starting the 1st cycle of treatment 17

18 7.0 Medication During the planning of your treatment the doctor will prescribe an appropriate medication regime to suit your individual treatment needs. The types and dosage of the drugs will vary from patient to patient; For your convenience these drugs are provided from the clinic as part of a competitively priced package that includes all necessary syringes, needles and sharps bins and disposal. The package will be directly delivered to your door at a time convenient to you; Any additional drugs are available directly from the clinic. Just ask your nurse for further information. We source all our drugs directly from the manufacturer and stored and distributed in accordance with strict medicines management policies. You can be confident of their quality, traceability and safety. Please Note: If you choose to source your medication elsewhere please take every care to ensure that they are from a reliable and safe supplier. No responsibility will be taken for the quality or efficacy of medications not purchased from the clinic. The provision of a private prescription, syringes, needles and their disposal will be charged at 100. Buserelin 5.5ml 50 Cabergoline 1 box/8 tablets 56 Cetrotide 0.25mg 36 Cilest 1 strip 1.50 Clexane 20mg 10 Crinone 8% progesterone vaginal gel 35 Clexane 40mg 15 Clomid 50mg 2 Clomid 50mg (10) 20 Cyclo-Prognova 2mg (1 box/1 strip) 5 Cyclogest 400mg (15) 30 Doxycycline 100mg (8) 5 Elleste solo tablets 2mg (84) 16 Evorel 100mg (8) 28 Gonal F 75iu 27 Gonal F 300iu 108 Gonal F 450iu 162 Gonal F 900iu 324 Gonapeptyl depot 3.75mg 120 Loestrin 20 (1 strip) 7 Lubion 25mg 15 Lutigest (21) 35 18

19 Menopur 75iu 21 Menopur 600iu 168 Menopur 1200iu 336 Microgynon 30 (1 strip) 6 Orgalutran 0.25mg 32 Ovitrelle 250mcg 32 Prednisolone 5mg (56) 5 Pregnyl 5000iu 15 Progynova 1 mg (28) 4 Progynova 2mg (28) 8 Prontogest 100mg (3) 20 Prostap 3.75mg 200 Synarel mcg 150 Utrogestan 200mg (21) 35 Stimulation package 1 1,000 Gonal F 900iu x 3 OR Menopur 1200iu x 2 and 600iu x 1 HCGx1 Cetrotide x7 Stimulation package 2 (Flare) 800 Gonal F 900iu x 3 OR Menopur 1200iu x 2 and 600iu x 1 HCGx1 Buserelin 5.5ml x 1 IVF package 1,100 Gonal F 900iu x 3 OR Menopur 1200iu x 2 and 600iu x 1 HCGx1 Cetrotide x7 Cyclogest 400mg (15) x 4 OR Utrogestan 200mg (21) x 4 OR Lutigest 100mg (21) x 4 FET package 200 Progynova 2mg (28) x 2 boxes Progynova 1mg (28) x 1box Protogest 100mg (3) x 7 boxes Notes: 1. Drug requirements may vary depending on age, weight, hormone levels and pervious response to treatment. 2. There are no refunds given for unused drugs that have been removed from the premises. 3. Drugs cannot be supplied, nor taken from the premises without prior payment. 4. Additional drugs may be required on top of those initially prescribed. 19

20 8.1 Glossary of terms 8.0 Additional information Assisted Hatching Before an embryo can implant into the lining of the uterus it must hatch out of its shell. This usually occurs five or six days after fertilisation. An inability to hatch may be one of the reasons why successful implantation does not occur and this may be because the shell (known as the zona pellucida) is too thick or too hard. Assisted hatching is a laboratory procedure whereby a hole is made in the zona pellucida of a two or three-day old embryo in order to encourage the hatching process. This treated embryo is then placed back in the uterus, to implant and develop as a pregnancy. Blastocyst Following IVF or ICSI, embryo transfer can be performed two days after the egg collection (when the embryo contains two to four cells) or three days after (when the embryo contains six to nine cells). However, with improvements in culture media we can now culture embryos for five or six days more successfully than in the past. By this stage the embryos have numerous cells (approximately ) and start to form two distinct layers. The embryos are then known as blastocysts and it is at this stage in nature that spontaneously conceived embryos start to implant in the womb. HFEA The Human Fertilisation and Embryology Authority or HFEA are the licensing authority for all UK fertility centres. All patients and donors must be registered with the HFEA before any treatment can take place. The HFEA also record all pregnancy outcomes for patients having treatment. FET Thawed embryos may be replaced in a frozen embryo transfer (FET) during a natural cycle (without drugs) or in a cycle primed with hormone supplements. Surplus embryos may be cryopreserved (frozen) for your future use after a cycle of IVF or ICSI. Many of our patients hope to have spare embryos for freezing and use in a future cycle, but in practice this does not always happen. Hycosy A HyCoSy or hysterosalpingo contrast sonography is an ultrasound scan in which contrast medium is used to check the condition of your fallopian tubes. This is a procedure in which a small thin catheter is passed through the cervix into the uterus. Contrast fluid inserted into the catheter will detect any blockages in the tubes via the ultrasound scan. ICSI In an ICSI (intracytoplasmic sperm injection) cycle each suitable mature egg is injected with a single prepared sperm cell. This is obtained from the partner or from a donor sperm sample. Ovarian stimulation and egg collection in ICSI and IVF are exactly the same. Intralipid Infusion Intravenous intralipid (ILP) therapy has been suggested to be clinically beneficial to some patients with immune disorders associated with pregnancy. Elevated levels of CD56, CD56+ CD16, CD16+, CD69, CD94, CD161, and CD11c natural killer cells and elevated cytokines (TNF-a and IFN) have been observed in the blood of some women with recurrent miscarriages or recurrent implantation failure after IVF/ICSI. In recent studies ILP therapy has been linked with reduction in those levels, while other studies have proven the correlation of a reduction in NKs with an increased implantation rate and more favorable pregnancy outcome. Further research is currently being undertaken around the world to verify the above initial conclusions and to fully elucidate the mechanism of action of ILP administration. 20

21 IUI The technique of placing sperm directly into the uterus is called intrauterine insemination (or IUI). It is sometimes used in cases where the male partner has a mild sperm abnormality or anti-sperm antibodies. However, in recent years DIUI (donor IUI) has become the most commonly used fertility treatment for lesbian and single women. IVF IVF or in vitro fertilisation is the fertilisation of egg and sperm cells outside of the body. Following egg collection, the eggs and sperm are placed together in a Petri dish to allow fertilisation to take place. NK or Natural killer cells Natural killer cells are innate lymphocytes that are part of our body immune system. Numerous studies have supported the theory that elevated numbers of peripheral blood natural killer cells or higher levels of natural killer activity are predictors of pregnancy loss. Other studies have concluded that while levels may be higher, they are not predictive of outcome. Thus, the role of blood NK cell testing is still unclear, and further research is needed. PGD Pre-implanatation Genetic Diagnosis or PGD is used when a couple is known to be at risk of passing on a genetic disease to their baby. PGD can identify those embryos (if any) unaffected by the altered gene and so ensure that only unaffected embryos are transferred. In this way, PGD removes the risk of inherited transmission of genetic disease. Most PGD patients are fertile; they need IVF to produce sufficient embryos for analysis. PGS Pre-implantatation Genetic Screening (PGS) or aneuploidy screening is used to screen embryos prior to transfer for genetic abnormalities so that only healthy embryos are transferred. The aim is to improve pregnancy rates and make single embryo transfer more viable. Surgical Sperm Retrieval (SSR) An uncommon type of infertility (affecting 1 2% of the male population) occurs where the male partner has no sperm in the semen (azoospermia). In around half these cases sperm production by the testes is normal but there is a blockage which prevents sperm entering the semen (obstructive azoospermia) and being ejaculated normally. Surgical sperm retrieval enables us to extract sperm directly from the testes to be used for ICSI treatment. This is performed under sedation. Vitrification All our embryo freezing is now performed by vitrification, a technique whereby embryos are cooled at a very fast rate in high concentrations of freeze-protecting solutions so that the embryo is very quickly transformed to a glass-like state (i.e. it vitrifies ). Vitrification avoids the formation of ice crystals, which created problems with the former slow cooling method. Embryo survival rates after vitrification and warming are 90%, with excellent pregnancy rates. 21