Charges Information. Transparent charges with no hidden costs

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Charges Information Transparent charges with no hidden costs Bristol Centre for Reproductive Medicine Southmead Hospital, Bristol, BS10 5NB t: 0117 4146888 f: 0117 4146899 w: www.info@bcrm.org.uk

Cnsultation Packages; Consultations and Ultrasound Scans Consultation Packages, Consultations and Ultrasound Scans at BCRM 001 1 st consultation and ultrasound scan with Mr Akande or Ms Jefferys 250 080 1 st consultation and ultrasound scan with Fertility consultant 150 002 Follow up consultation 150 081 Short follow up consultation 90 003 Consultation with an Embryologist 100 004 Nurse consultation 120 008 Treatment support session/implications counselling (outside cycle tariff) 50 009 Diagnostic Fertility Ultrasound scan ( including AFC/ovarian reserve) 150 083 Pregnancy ultrasound scan 150 084 Cycle monitoring scan (outside cycle tariff) 150 352 Failure to notify BCRM of non-attendance 75 Consultations, Scans and treatment supplements at the SPIRE Bristol Hospital 085 1 st consultation & ultrasound scan with Mr Akande or Ms Jefferys 350 086 1 st consultation & ultrasound scan with Fertility consultant 250 087 Initial consultation 250 088 Follow up consultation 200 089 Short follow up consultation 150 090 Ultrasound scan 150 Additional surcharges for Fertility Treatments 091 IVF/ ICSI/ FET First Treatment cycle 390 092 IVF/ ICSI/ FET Repeat Treatment cycle 290 Fertility tests and procedures 099 Fertility MOT package : Comprehensive consultation including Fertility ultrasound with AFC; Fertility blood tests including AMH, FSH/ LH/ Estradiol/ Prolactin/ TSH/ SHBG/ Chlamydia serology and semen analysis 425 045 Endometrial scratch 150 048 Endometrial scratch under sedation 450 049 Tubal test: HyCoSy Hystero Constrast Sonography and Saline Sonogram (aqua scan) 390 058 Tubal test: HSG Hysterosalpingogram (X-ray test of tubes and womb cavity) 390 059 Endometrial Biopsy for histology 400 066 Endometrial biopsy for NK cells 400 067 Saline sonogram 250 044 Vaginal microscopy (HVS- CT/GC/TV PCR SWAB) 60 068 Chlamydia (swab) 50 069 Injection (per injection- for non BCRM registered clients) 75 070 Administration fee for blood tests (for non BCRM registered clients) 50 Andrology 010 Basic semen analysis (sperm test) includes semen microscopy & MAR antibody test 50 011 Advanced semen analysis - IVF/ICSI assessment includes recovery/survival & retrograde test 150 247 Pre-treatment sperm check 50 093 Sperm DNA fragmentation 350 033 Y chromosome microdeletions 200 094 Aneuploidy FISH 700 095 Sperm reactive oxidative test 100 096 Semen Culture 30 097 Pre-treatment sperm storage 345

Blood tests 060 Set 1: HB;TSH;Prolactin:FSH;LH;Rubella; Testosterone; SHBG;Oestradial 150 061 Set 2: Thrombophilia Screen 400 062 Set 3: Hepatitis B&C; HIV; Syphillis 60 063 Set 4: FSH;LH; Oestradiol: Prolactin 100 064 Set 5: Testosterone; SHBG 150 065 Set 6: Thyroid Profile : T4/T3/TSH 60 014 Rubella (IgG) 30 015 Chlamydia serology 40 016 Hepatitis B surface antigen & Hep b core antibody profile 50 017 Hepatitis C 30 101 Hepatitis B PCR 100 102 Hepatitis C PCR 100 018 Syphilis 30 019 CMV 50 020 HIV 30 021 FSH/LH 40 022 Prolactin 20 023 TSH 30 024 Testosterone 40 025 Progesterone 40 026 Oestradiol 30 027 Sex Hormone Binding Globulin (SHBG) 40 028 Anti-mullerian Hormone (AMH) 75 029 Haemoglobin 20 030 Blood group 30 031 Cystic Fibrosis screen 150 032 Chromosome Analysis 250 034 Thyroid antibodies 30 036 DHEAS * 037 Androstenendione * 038 Electrolytes & Urea 50 043 Liver function (LFT s) 50 046 HTLV1 &2 50 051 17-OH progesterone * 052 Free Beta HCG serology 50 053 Cortisol 30 054 Ferritin 30 055 Anti-cardiolipin antibodies 50 056 CA-125 50 057 ZIKA Virus serology 120

Fertility treatments 200 IUI - intrauterine insemination - natural cycle 600 201 IUI intrauterine insemination - programmed cycle (excludes drugs) 750 Approximate drug charges for IUI programmed cycle 200-600 202 IUI multiple cycles package - upto 3 programmed cycles (criteria apply-excludes drugs) 1500 355 HFEA licence fee per insemination cycle using DONOR sperm (DI) 40 231 Use of Donor sperm per cycle of treatment ( unknown donor) 900 232 Use of Donor sperm (known donor, donor screening & storage for upto 1 year) 2035 325 Import of donor sperm from commercial supplier (includes storage for upto 1 year) 190 205 IVF in vitro fertilisation 3200 Includes patient information meeting; individual nurse planning consultation; all monitoring ultrasound scans; egg collection with general anaesthetic sedation in the care of a consultant anaesthetist; laboratory costs; sperm preparation; assisted hatching blastocyst culture embryoglue the vitrification and storage of embryos/blastocysts for 1 year as applicable ; embryo/blastocyst transfer; pregnancy scan or follow up consultation; Treatment Support sessions including Counselling and other therapies 206 IVF with ICSI -Intra-Cytoplasmic Sperm Injection procedure 3995 Includes PIM; individual nurse planning consultation; all monitoring ultrasound scans; egg collection with general anaesthetic sedation in the care of a consultant anaesthetist; laboratory costs; sperm preparation; assisted hatching blastocyst culture embryoglue the vitrification and storage of embryos/blastocysts for 1 year as applicable ; embryo/blastocyst transfer; pregnancy scan or follow up consultation; Treatment Support sessions including Counselling and other therapies Approximate drug charges for IVF /ICSI 500-1800 207 IVF - multiple cycles package - up to 3 cycles of IVF (fresh or frozen transfers, criteria apply and 6400 excludes drugs) Additional charge per cycle for ICSI procedure 795 370 IVF planned deferred transfer cycle includes vitrification and storage of embryos/ blastocysts and 3700 embryo transfer 356 HFEA licence fee per cycle of IVF/ICSI and FET 80 210 ICSI procedure (in addition to IVF cycle charge) 795 216 FET Frozen embryo transfer (excluding drugs) 1150 Approximate drug charges for FET 200-400 209 IVF - egg sharing cycle - donation to unknown recipients (includes drugs and HFEA fee) 500 Egg donation treatment 212 Donor Egg Treatment IVF egg recipient cycle (includes donor eggs form unknown donor ) 5800 (excludes recipient drugs) 214 Donor Egg Treatment IVF egg recipient cycle - KNOWN DONOR supplement 975 Intra-couple egg donation treatment 227 IVF - intra-couple egg donor/ recipient cycle (excluding donor & recipient drugs & donor sperm) 5465 226 IVF Egg sharing cycle with intra-couple egg donation and donation to unknown recipient 1450 (including all drugs & HFEA fee)

Other treatment, procedures and supplements 222 Ovulation Induction with FSH ( per cycle) 450 217 Fertility Preservation : Oocytes 2500 Includes Egg collection, vitrification and storage for upto 1 year 326 Fertility Preservation : Sperm: 495 Includes short consultation; recovery test, freeze and storage for upto 1 year 246 Vitrification of embryos /blastocysts with 1 yr storage ( patient request outside of freeze criteria) 595 219 Surgical Sperm Recovery : with sedation (including upto 1 year storage ) 1600 240 Surgical Sperm Recovery: general anaesthetic sedation (including up to 1 year storage) 2200 221 Egg recipient waiting list fee (refundable if wait exceeds 1 year) 350 241 Embryo Transfer : Dummy Run 195 225 Sedation for Embryo Transfer 300 Treatment abroad 242 To arrange blood tests & /or prescriptions (per treatment episode) 250 243 To arrange prescriptions only (per treatment episode) includes 15 min consultation 150 244 Fertility monitoring scan 150 245 Treatment abroad package Includes up to 3 monitoring scans; 1 pregnancy scan; arranging blood tests and prescription (per treatment episode) and 15 minute consultation 650 Additional LABORATORY SERVICES 336 Embryoglue 150 324 Storage of embryos/blastocysts for 1 year 295 328 Storage of sperm for 1 year 295 330 Administration charge for the import of gametes or embryos/blastocysts from another HFEA (UK) None licenced centre to BCRM 325 Administration charge for the import of sperm from a commercial provider (includes up to 1 year storage) or The import of oocyte/embryo or blastocysts/partner sperm or donor sperm from another centre outside of the UK 190 332 Admin/laboratory preparation charge for the export of oocyte/embryo or blastocysts/partner 250 sperm from BCRM to another fertility centre 340 Complex import /export of gametes or embryos POA 333 Preparation and hire of shipper Refundable deposit for shipper None 300 Administration fees 350 Medical Report 150 370 Advice correspondence 80 351 Photocopy of patient record 50 353 Photocopy of patient test result ( per test) 10 334 Private prescription 75 335 Miscellaneous administration * 371 Miscellaneous clinical * 372 Miscellaneous laboratory *

Drugs 374 Northisterone 5mg tablets 10 300 Cetrotide subcutaneous injection : 0.25mgs: per syringe 30 301 Cetrotide subcutaneous injection : 0.25mgs: 5 syringes 135 302 Buseralin Nasal spray : 1 bottle 49 303 Buseralin subcutaneous injection : 1 viall 32 304 Gonal F Pen ( 25 per 75iu) : 300 iu 100 305 Gonal F Pen : 450iu 150 306 Gonal F Pen : 900iu 300 310 Menopur : 75iu per amp 25 311 Menopur: 150iu x 16 amp 800 309 Menopur: 150iu per amp 50 312 FET drug package ~350 313 Ovitrelle 250mcg pen 20 315 Cyclogest pessaries 4mg each @ 1.40 Cyclogest pessaries x28 per cycle Cyclogest pessaries x30 per cycle 316 IM progesterone 50mgs per ml 11 317 Cabergoline 0.25mg x 8 50 318 Progynova 2mg tablet each @ 25p Progynova 21 per week 5.25 360 Oesrodial patches 100mcg each 1.40 361 Lubion 25mgs per vial 9 362 Clexane 20mgs 5 363 Clexane 40 mgs 8 375 Bemfola per 75ru 25 376 Pregnyl 5000ul 15 377 Gonasi 5000iu 20 378 Rinitidine no charge 379 Testosterone gel tbc 380 Zoladex 3.6mg 120 381 Gestone 50mg/1ml 11 382 Clomiphene 50mg each @2 383 Pregnisolone 5mgs tablets each@10p 384 Ganirelix 30 385 Fyremadel 40 Refunds Cancelled natural cycle IUI during monitoring 230 Cancelled programmed IUI during monitoring 150 IVF cancelled before 1 st monitoring scan 2870 IVF cancelled before egg collection 1850 IVF cancelled after egg collection: no eggs retrieved 520 IVF cancelled after egg collection: failed fertilisation 320 ICSI cancelled before 1 st monitoring scan 3665 ICSI cancelled before egg collection 2645 ICSI cancelled after egg collection: no eggs retrieved 1315 ICSI cancelled after egg collection: no eggs injected 1115 ICSI cancelled after egg collection: failed fertilisation 245 FET : failed thaw 535 40 42 Please note charges may be subject to change at any time. The BCRM Finance team are pleased to take payment of the charges outlined at consultation on the day of attendance at BCRM. If in the exceptional circumstance that patients are unable to make payment at BCRM; an invoice will be raised and sent by email. Payment can be made by BACS or by telephone to the Finance team. For any additional enquiries: please contact the BCRM Finance team on 01174146888 or email finance@bcrm.org.uk