How much does it cost to treat infertility?

Author: Li Li, Guangdong Provincial Maternal and Child Health Hospital

Reviewer: Liu Fenghua, Chief Physician, Guangdong Provincial Women and Children's Health Hospital

A colleague of mine has been married for three years and has been actively trying to get pregnant but has not been able to. She went to the hospital for a check-up and found out that she was infertile. The treatment costs are very high and she doesn't know if it can be reimbursed, which makes her already tight life even more stretched.

So, what exactly is infertility? What are the causes? What tests are generally needed? How much does it cost? Can it be reimbursed? Let's answer them one by one.

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1. What is infertility? What are the causes?

Infertility refers to the inability of a man and a woman to become pregnant naturally within one year after having normal sexual life without taking any contraceptive measures.

Affected by various reasons, the number of infertile couples in modern society is gradually increasing. Relevant data show that the proportion of infertile couples in childbearing age has reached 20%.

There are many reasons for the current high incidence of infertility, as follows:

First of all, it is the reasons of men and women themselves. Female infertility is mainly related to reproductive organs. If a woman's reproductive organs are congenitally maldeveloped, she suffers from serious gynecological diseases, or has frequent miscarriages, it will cause problems with the uterus, ovaries, and fallopian tubes, thus affecting normal conception. If a man has poor sexual function or abnormal semen, it may also lead to infertility.

Secondly, people in modern society are under too much pressure in life, and their work and rest and diet are irregular, which can also cause their immunity to be reduced and hormone levels to be abnormal, thus affecting natural conception.

Therefore, infertility is related to both men and women, and the couple needs to go to the hospital together for examination and treatment.

2. What examinations are generally needed for infertility?

Male infertility examinations have fewer items and are quick to perform, so couples can do it in the order of first the male and then the female. In general, in addition to sexual function, male examinations mainly focus on semen and vas deferens, and any abnormalities can be easily detected.

The examination items for female infertility are numerous and complicated, and generally the following factors need to be checked:

① Fallopian tube factors account for about 40% of female infertility.

② Ovulation disorders account for about 40% of female infertility.

③Endometriosis , which accounts for about 10% of female infertility, is a relatively common reproductive endocrine disease that may cause infertility by affecting the anatomical structure of the pelvic cavity, endometrial function, and egg quality.

④ Uterine factors , such as endometrial lesions (endometritis, endometrial polyps, intrauterine adhesions, endometrial tuberculosis, etc.), uterine fibroids (submucosal fibroids have a greater impact), uterine malformations, etc., can cause infertility or miscarriage by affecting embryo implantation.

⑤ Cervical factors . The cervix is ​​the channel for sperm to enter the uterine cavity. Cervical inflammation, adhesions, dysplasia, tumors, abnormal mucus, abnormal position, etc. may all lead to infertility.

⑥ Vulvar and vaginal factors , including congenital developmental abnormalities or structural abnormalities caused by acquired trauma, make it impossible for women to have normal sexual life, leading to infertility. In addition, severe recurrent vaginitis can also cause infertility.

After understanding the specific causes of infertility, couples should not only cooperate with normal medical treatment, but also learn to adjust their mood in their daily lives, not put too much psychological pressure on themselves, and develop healthy and regular living habits.

The treatment of infertility is a gradual process. The specific circumstances of each couple are different and the time spent is also different. During this period, the cost of treatment is a considerable expense.

3. How much does the treatment cost? Can it be reimbursed?

The circumstances that lead to infertility are different for every couple, so there are differences in treatment plans. It is impossible to give a relatively clear amount for treatment costs, and there are also some differences in relevant policies and charging standards in each province.

Taking Guangdong Province where I live as an example, artificial insemination (including pre-examination costs) generally costs 3,000 to 6,000 yuan per cycle, and controlled ovulation induction cycle in vitro fertilization (IVF) costs 20,000 to 50,000 yuan per cycle. The cost depends on the ovulation induction scheme used, the type and dosage of ovulation induction drugs, and related operations such as intracytoplasmic sperm injection (ICSI), assisted hatching, embryo freezing, and preimplantation genetic diagnosis (PGD)/preimplantation genetic screening (PGS). When there are remaining embryos that need to be frozen, embryo freezing and storage fees need to be paid; when frozen embryos are transferred, it usually costs 3,000 to 4,000 yuan per time; if ovulation is needed again, except for some pre-examinations, most of the costs need to be recalculated.

In recent years, the birth rate of newborns in my country has dropped significantly. In order to promote fertility, the National Health Commission and 17 other departments issued the "Guiding Opinions on Further Improving and Implementing Active Birth Support Measures", pointing out that local governments should comprehensively consider the affordability of medical insurance (including maternity insurance) funds, relevant technical norms and other factors, and gradually include appropriate labor analgesia and assisted reproductive technology projects into the fund payment scope according to procedures. At present, many places have officially issued relevant policies. For example, the Beijing Municipal Medical Insurance Bureau, together with the Beijing Municipal Health Commission and the Beijing Municipal Human Resources and Social Security Bureau, issued the "Notice on Standardizing the Adjustment of Some Medical Service Price Items", which stipulates that from March 26, 2022, a total of 15 designated basic medical insurance medical institutions in Beijing with assisted reproductive qualifications will perform in vitro fertilization embryo culture, blastocyst culture, frozen embryo recovery, testicular/epididymal sperm separation, semen freezing recovery, sperm optimization, sperm optimization-density gradient centrifugation, embryonic single gene disease diagnosis, embryonic morphological evaluation, preimplantation embryo genetic testing for chromosomal diseases, blastocyst/blastomere/polar body biopsy, comprehensive evaluation of ovulation induction treatment, transvaginal puncture egg retrieval, intrauterine insemination, embryo transfer and intracytoplasmic sperm injection.

A total of 16 assisted reproductive technology projects involving a wide range of people, necessary for diagnosis and treatment, mature in technology, safe and reliable are included in the scope of Class A reimbursement of medical insurance. However, the specific implementation of such policies across the country still requires a gradual process. I believe that in the near future, the majority of families suffering from infertility will be able to enjoy the benefits of medical insurance.

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