IVF prices. Self funding. IVF, ICSI, IUI and cycle monitoring price list. Valid 1 April March 2018

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1 IVF prices Self funding IVF, ICSI, IUI and cycle monitoring price list Valid 1 April March 2018 This price list provides information about our treatments, investigations and package prices. Please note that payment will need to be made before treatment commences. Consultation and initial investigation Initial consultant consultation 250 Baseline or pregnancy scan 235 3D Investigation scan 365 3D Aqua or saline scan 410 Hysterosalpingogram (HSG) 465 HyCoSy 520 Selective salpingography (x-ray) 885 Semen analysis hour swim sperm test 100 Reactive oxygen species (ROS) sperm test 190

2 Treatment packages All cycle prices are provided in packages and include the following clinical support from pretreatment coordination meeting to the early pregnancy scan, ultrasound scans, blood tests (excluding virology), egg collection and embryo transfer, HFEA licence fee, one counselling session plus six week pregnancy scan or one consultant review (for fresh cycles only) within three months of the pregnancy test. Drugs are charged separately and vary from patient to patient. At the time of your coordination appointment you will be required to pay in full for the treatment package. At egg collection, if there are no eggs we regret that Imperial Private Healthcare is unable to provide a refund. In- vitro fertilisation (IVF)* treatment package 3,745 Intracytoplasmic sperm injection (ICSI)* 4,785 Egg freezing cycle (including first year s storage, excluding embryo transfer) 3,120 Embryo freezing cycle (including first year s storage, excluding embryo transfer) 3,850 Embryo freezing cycle with ICSI (including first year s storage, excluding embryo transfer) 4,890 Egg donation cycle (including first year s storage) 7,175 Frozen embryo transfer (FET) 1,040 Intrauterine insemination (IUI) 990 *Follicle/cycle monitoring - charged per scan and blood test 175 per scan *All prices exclude medication and the storage of excess embryos. Optional extras that may be required Laparoscopy and hysteroscopy including resection of fibroid or adhesiolysis 3,650 Laparotomy (myomectomy, tubal microsurgery) 5,720 Surgical extraction of sperm (MESA) 3,120

3 Optional extras that may be required General counselling first three sessions free for NHS patients General counselling first session free private patients Counselling for egg/sperm donation or surrogacy, first session nil nil nil Follow up counselling appointments 50 Frozen Embryo Replacement Cycle (FERC) 1,040 Laser assisted hatching 415 PICSI sperm selection 105 Embryo glue 52 Cyst drainage under sedation 600 Embryo transfer under sedation 470 Embryo freezing (including first year of storage) 935 Sperm freezing prior to IVF (including first year of storage) 415 Donor sperm (depends on type and availability) Price varies Annual storage fee 310 Movement of frozen samples administration fee 210 Endometrial scratch 365 IM Injection 10 TED (Anti-thrombosis) stockings 10 Genetic testing Recombine pre-treatment genetic screen per couple 835 Pre-implementation genetic diagnosis (PGD) with karyomapping * 5,200 PGS next generation sequencing (NGS includes freeze, biopsy) ** 2,300 Additional analysis (per embryo) 105 DNA fragmentation for sperm sample 300 *PGD price includes biopsy analysis of up to 9 embryos, freezing and storage of embryos for an initial 3 months. It includes a non-refundable work-up fee of 400 in case of cancellation after the work-up has been done. This price excludes IVF/ICSI cycle and transfer **PGS price includes biopsy, analysis of up to 5 embryos, freezing

4 Blood tests CMV (Antigen) 95 TPHA 95 QHCG (Beta HCG) 90 FSH 60 LH 60 E2 (Oestrodiol) 60 Cystic fibrosis 130 HEP B DNA (viral load) 260 HEP C quantification (viral load) 225 Anti mullerian hormone (AMH) 110 Y-deletion 180 Treponemal serology 50 Thyroid antibodies 90 Thyroid function test 90 Recurrent miscarriage profile 755 Natural killer profile 545

5 Blood tests and virology packages IVF A Virology screen HIV, hepatitis B, hepatitis B core AB, hepatitis C 150 IVF B Egg donors and surrogate IVF blood group &Rh, HIV, hepatitis B, hepatitis B core AB, hepatitis C, HTLV 1&2, cystic fibrosis, chromosomes (karyotype), TPHA, CMV, chlamydia & gonorrhoea, 720 IVF C At risk donor surrogate or recipient Hb electro phoresis 90 IVF D At risk donor surrogate or recipient tay-sachs 295 IVF E Egg recipient and surrogate - Blood group &Rh, HIV, hepatitis B, hepatitis C, HTLV 1&2, TPHA, CMV, chlamydia & gonorrhoea 235 IVF F Chlamydia urine screen 80 IVF G Gonorrhoea urine screen 50 IVF H E2 FSH plus inhibin AMH 150 IVF I Chromosomes (karyotype) 320 IVF J Female using donor sperm - Blood group &Rh, HIV, Hepatitis B, Hepatitis B core AB, Hepatitis C, CMV 255 Prices are applicable until the end of March 2017

6 Additional information Payment methods We prefer that you pay using debit or credit cards. We accept card payments in person or via the telephone in advance of your treatment. We will accept cash via the Cashiers in the Sainsbury Wing at Hammersmith Hospital. Deposits To secure your booking, we require a deposit that will be based on the outcome of your initial consultation. We accept payment by cheque payable to Imperial College Healthcare NHS Trust or by all major credit or debit cards with the exception of American Express. After your discharge home, any credit remaining on your account will be returned to you. Insurance If you are insured and your insurance company is paying your account, please contact them to confirm the terms of your cover and obtain a pre-authorisation number. You must provide confirmation of cover prior to your discharge home. If confirmation is not provided within this period, you will be eligible to meet all charges. Refunds and cancellation Imperial Private Healthcare appreciates that there are a number of reasons that a patient may decide not to proceed with their treatment or treatment is discontinued for medical reasons. In these circumstances a full or partial refund may apply depending on the treatments delivered so far. Refunds will be made by bank transfer or by cheque. If you are unable to, or decide not to go ahead with your treatment please provide us with the original receipt and we will make the appropriate refund of any treatment costs. If you would like to apply for a full refund, please telephone the clinic on select option 6 and speak to a member of staff. Further details of the cancellation fees per treatment type are as follows: IVF, ICSI, egg freezing or egg donation cycle If your cycle is discontinued for medical reasons before any drugs are taken, we will refund you the cost of the IVF treatment package. We cannot make any refunds for the cost of pre-treatment investigations or the cost of drugs for the treatment cycle. If an IVF, ICSI, egg freezing or egg donation cycle is discontinued for medical reasons after the drugs have started and before any eggs are collected, there will be a refund of the IVF treatment package cost less the cancellation fee. If no eggs are collected or eggs do not fertilise, then no refund can be made. If you are having an IVF or ICSI cycle and your embryo transfer is cancelled because of a medical reason, your embryos will be frozen and you will be offered a frozen cycle once you have recovered. You will be asked to pay for freezing your eggs or embryos but will not be expected to pay for a subsequent frozen embryo replacement cycle. IUI In the event that insemination does not take place but you have already started the stimulation drugs, a refund will be given less the cancellation fee. We do not refund any costs relating to the pre-treatment procedures or drugs. If you start an IUI cycle but the cycle is converted to IVF, you will be asked to pay the additional cost which is the difference between the cost of IUI and IVF. Donor sperm cycle If your treatment using donor sperm is cancelled for any reason, then a refund will be offered according to the criteria as set out above, depending on the type of cycle. Payment for the donor sperm cannot be refunded FET If an FET cycle is cancelled for medical reasons before your embryos are thawed, we will refund the full cost of the treatment package less a cancellation fee. If when the embryos are thawed they fail to thaw successfully, there will be no refund. We are not able to refund the cost of drugs. Freezing Once you have paid for freezing of embryos or eggs, if these procedures do not go ahead for any reason, then you will be eligible for a refund of the cost of the procedure.

7 Cancellation fees A cancellation fee will be applicable if a cycle is abandoned, to cover the costs already incurred. Cancelled IVF or ICSI before medication is started Cancelled IVF or ICSI after one treatment scan Cancelled IVF or ICSI cycle after more than one scan but before egg collection 800 Cancelled IUI cycle prior to insemination 350 Cancelled FET after co-ordination appointment 150 Cancelled FET after one treatment scan 500 Wolfson Fertility Centre, Hammersmith Hospital, London, W12 Telephone: +44 (0) Website: Proud to be part of Imperial College Healthcare NHS Trust Our private healthcare income is reinvested to support our NHS services

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