Schedule of Fees for Private Treatment

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1 Schedule of Fees for Private Treatment Fertility Treatment is personalized to each individual and couple, based on diagnosis and best treatment options. At Fertility Plus, we are mindful of the costs involved in providing fertility treatment, and our fees reflect the importance we place on ensuring our care remains as accessible as possible.

2 Consultations First Specialist Doctor Appointment, to discuss diagnosis and personalized treatment options with a medical fertility specialist: 30 minutes Subsequent Review Specialist Doctor Appointments: 30 minutes Orientation Appointment, comprehensive suite of care to set the plan for treatment, inclusive of appointments with: Specialist Fertility Doctor Fertility Nurse Counsellor Embryologist Counselling Appointment, when not included in a treatment package $235 $130 per appointment $235 $125 per 60 minute session Non-IVF Fertility Treatments Tracked Cycle: A fully monitored natural cycle using blood tests and ultrasound scan/s of the ovaries to detect ovulation and determine hormone profile $400 per cycle Ovulation Induction with Clomiphene to stimulate the ovaries, tracked with blood tests +/- ultrasound scan $275 per cycle medication $25 Ovulation Induction with Gonadotrophins, a fully monitored stimulated cycle using blood tests and ultrasound scan/s of the ovaries to detect ovulation and determine hormone profile. Follicle Stimulating Hormone (FSH) injections are used to stimulate the ovaries. Letrozole Cycle: a three month treatment cycle using Letrozole to stimulate ovulation, includes a medical review appointment every three months, blood tests, and contact with a doctor. $750 per cycle medication $ $2500 $475 per three month cycle medication $25

3 Intrauterine Insemination (IUI), Includes blood tests and ultrasound scan/s of the ovaries if required, to monitor follicular growth and detect ovulation. Two counselling sessions will be required when using donor sperm. IUI with partner s sperm IUI with personal donor s sperm Preparation of personal donor sperm. Includes screening, Prepair screening and first semen freeze. Additional fees for counselling and sperm freezing will be required. IUI with Fertility Plus sperm donor $1200 $1200 $1000 $1600 Reimbursement to clinic sperm donors $75 per sample attendance at clinic to a maximum amount of $750 reimbursed as petrol vouchers Charges for Cancelled or Incomplete non-ivf Cycles, (includes FER cycles); not inclusive of medication charges Booking Fee $150 Blood Tests Ultrasound Scans $15 per assay $100 per scan Miscellaneous Charges Ultrasound Scan $100 Early Pregnancy Monitoring includes blood monitoring and early pregnancy scan $350 Prescription Charge $25 Interpreter face to face or phone $50 per session Overseas Co-Ordination Charge per cycle $750

4 IVF Fertility Treatments (does not include medications) IVF Cycle, includes monitoring costs, egg collection, sperm preparation, embryo culture, embryo replacement, embryo freezing, first year of storage, two counselling sessions, early pregnancy monitoring, or a follow up consultation $7000 medication $ $3500 Refund for Cancelled or Incomplete IVF Cycle, not inclusive of medication charges When stopped before first blood test $6700 When stopped before egg collection $6000 If no eggs at ovum pick-up (OPU) $1200 If no embryos to transfer / freeze all (includes FER cycles) $800 Natural IVF Cycle - as per IVF cycle, with no FSH, orgalutran only and trigger injection (drugs not included) $5500 medication $1000 Refund for Cancelled or Incomplete Cycle, not inclusive of medication charges Discontinuation due to no response, minimal monitoring $4500 If no eggs at ovum pick-up (OPU) $1200 If no embryo to transfer $800 IVF Cycle to egg freezing as per IVF cycle, with no embryo culture or replacement Egg warming cycle - to embryo transfer or embryo freeze $6195 medication $ $3500 $3750 Frozen Embryo Replacement (FER) Cycle $1575 ICSI, sperm microinjection $1600 Assisted Hatching $125 Egg vitrification $995 General Anaesthetic $1100

5 Third Party Treatments Donor Egg Addition; includes cycle coordination and monitoring, final screening prior to commencing cycle (Does not include FER cycle) Donor Egg Work Up; includes medical consultation, two counselling sessions, screening blood tests and Prepair testing. $2100 $1785 Donor Egg Reimbursement Charge; billed to all recipients, reimbursed to egg donors as petrol vouchers $1500 Donor Egg Synchronisation Charge; co-ordination of IVF and FER cycle at same time $250 Donor Sperm Addition in IVF $300 Surrogacy Work up Charge; work up of potential surrogate screening tests and co-ordination with Nurses separate to ECART application which holds all counselling and medical interviews $1000 Surrogacy; FER co-ordination; calling two sets of patients in cycle $250 ECART Application; Surrogacy and Embryo Donation, includes all preparation and submission of required documentation to ECART, all appointments with a counsellor and consultant. This does not include the costs for legal preparations. This will be discussed during your initial counselling appointment. $2500 Application to ECART Storage, this is invoiced annually Sperm freezing $ months storage of frozen sperm, embryos or oocytes $264/year Additional Miscellaneous Fees Administration Charge for transporting sperm or embryos to or from another clinic in New Zealand Administration Charge for transporting sperm or embryos to another clinic outside New Zealand (excludes courier costs) $175 $200

6 Additional Sperm Costs These will vary according to the personalised nature of fertility treatment First Semen Analysis, includes antibody screening and morphology $175 Repeat Semen Analysis, repeated count. $110 Trial Sperm Wash undertaken after full semen analysis has already been completed, not on first semen analysis. $250 Testicular Surgery for Sperm Retrieval: Specialist Urologist $1750 Testicular Surgery for Sperm Retrieval: Routine $1050 SCSA Test $255 Sperm collection device $25 Medication Total medication costs will vary according to the personalised nature of treatment Down Regulation / LH Surge Protection Buserelin $240 Orgalutran $125 Stimulating Egg Production Gonal 300 $315 Gonal 450 $473 Gonal 900 $945 Puregon 300 $315 Puregon 600 $630 Puregon 900 $945 Elonva 100/150 $1375 / 7 days Menopur $60 / vial Triggering Ovulation Ovidrel $180 Buserelin $240 Maintaining the Uterine Lining Crinone $20 / day Utrogestan $32 / box

7 District Health Board Fertility Benefit: Fertility Plus offers staff working at any of the northern region DHB s a 10% discount on treatment, excluding medication charges. This is inclusive of ADHB, CMDHB, WDHB, NDHB and also includes St John Ambulance Staff. Notes about payment: Payment is required in full prior to completing treatment on the day of egg collection. Subsequent cycles will not be commenced if there is an outstanding balance. Prices are in NZ dollars and include GST. Prices may be subject to change without further notice. The chance of ovulation or pregnancy depends on many factors; there are no refunds if you do not respond to ovulation induction medication (Letrozole or Clomiphene) or if you do not become pregnant. Unused medications cannot be refunded once they have been issued to you.

8 MedPhoto&Graphics ADHB JUL18 CC6782 F85.04 Telephone Fax The National Women s Health website has good, accurate and up to date information which you may find helpful. nationalwomenshealth.adhb.govt.nz Fertility Plus Fee Schedule as at 1st July 2018