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Patient Information Cycle Number Fresh Oxford Fertility Unit Charges – 1st April 2014 or Frozen Patient Sticker Name of CCG Funding Patient Sticker Signature of staff to confirm criteria met STAFF USE ONLY Tick if Cycle NHS Funded STAFF USE ONLY Tick if performed NHS Funding STAFF USE ONLY Tick if Required STAFF USE ONLY Tick if performed Consultations IVF or IVM Treatment Medical Consultation £190 Nurse Planning Consultation (includes ultrasound scan) £215 IVF cycle £3400* IVM cycle (including ICSI) £2370* * These charges include all ultrasound scans & oestrogen blood tests, egg collection under sedation, laboratory costs, embryo culture to day 3, embryo transfer, one pregnancy scan, follow up medical consultation if within 3 months, one counselling session Other IVF Charges ICSI £1130 Blastocyst culture £515 HFEA Licence Fee £75 Embryo Glue £155 EmbryoScope© £415 Use of Donor Sperm in an IVF cycle £505 Cyst Aspiration under sedation £260 Embryo Transfer under sedation £260 IMSI £415 Assisted Hatching £515 Endometrial Scratch £235 Patient Information Oxford Fertility Unit Charges – 1st April 2014 Endometrial Scratch under sedation Other Fertility Treatments Other Fertility Charges £490 Drugs for IVF £900-£1900 Drugs for IVM £105 Gynaecological or Early Pregnancy Scan £185 HyCoSy £395 Ovulation Induction cycle (OI) £465 Frozen Embryo Replacement cycle (FER) £930* Intra-Uterine Insemination cycle (IUI) £1290* Use of Donor sperm £505 Drugs for FER/OI £300-£500 * These charges include all ultrasound scans, laboratory costs, embryo replacement (FER), one pregnancy scan, HFEA licence fee for FER. PGS/PGD Biopsy procedure for PGS/PGD samples £1130 PGS – aCGH (analysis of up to 8 embryos) £2270* Additional analysis (per embryo) £325 PGD – price on application *This charge does not include embryo freezing and subsequent replacement cycles if required. Genetic Testing DNA Fragmentation Analysis of sperm £415 Sperm Aneuploidy (5 chromosome test) £620 Y-Chromosome Micro-Deletion blood test £260 Semen Analysis £180 SSR (Surgical Sperm Retrieval) £955 Andrology (NB- does not include freezing and storage costs) Freezing Charges Reviewed 06.02.14 Embryo Freezing (inc. first year storage) £760 Subsequent Annual Embryo / Sperm / Egg Storage (by Direct Debit) £285 © 2013 Oxford Fertility Unit FAE Price List 2014 v1 Page 2 of 5 Patient Information Oxford Fertility Unit Charges – 1st April 2014 Egg Sharer Costs Embryo Freezing (inc. 3 years storage) £1560 Embryo Freezing (inc. 10 years storage) £4365 Sperm Freeze (inc. first year storage) £390 Sperm Freeze (inc. 3 years storage) £1185 Sperm Freeze (inc. 10 years storage) £3580 Subsequent Sperm Freezing per sample £235 Supplement for Slow (Day 3) Freezing £225 Egg Sharer cycle (IVF) No charge* Egg Sharer cycle (ICSI) £1135* If Egg Sharing does not proceed £1030* * These charges include all ultrasound scans and oestrogen blood tests, drugs for the IVF cycle, egg collection under sedation, laboratory costs, embryo culture to day 3, embryo transfer, one pregnancy scan, follow up medical consultation if within 3 months, one counselling session. Egg / Embryo Recipient Treatment Egg/Embryo Donation Registration £695 – nonrefundable Egg Donation Recipient Trial cycle £570 Egg Donation Recipient IVF cycle £8035* Egg Donation Recipient ICSI cycle £9170* Embryo Recipient cycle £3605* * These charges include all ultrasound scans & oestrogen blood tests, laboratory costs, embryo transfer, one pregnancy scan, one counselling session. Other Charges Recipient Drugs £250-£400 HFEA Licence Fee Patient from Overseas £75 IVF cycle £8755* * These charges include all pre-treatment appointments, ultrasound scans & oestrogen blood tests, drugs for the IVF cycle, egg collection under sedation, laboratory costs, embryo transfer, one pregnancy scan, follow up medical consultation if within 3 months, one counseling session Oxford IVI IVI Egg Recipient Cycle £8240* *These charges include all medical consultations once treatment commences, ultrasound scans & blood tests, drugs for the cycle, laboratory costs, ICSI, embryo transfer, BHCG blood test, pregnancy scan(s), one counseling session and a follow up medical consultation. It does not include the cost of transporting frozen sperm to Spain. Reviewed 06.02.14 © 2013 Oxford Fertility Unit Price List 2014 v1 Page 3 of 5 Patient Information Oxford Fertility Unit Charges – 1st April 2014 Blood Tests Female Hormone Profile £190 (FSH, LH, Testosterone, Prolactin, TSH, AMH) Male Hormone Profile £120 (FSH, LH, Testosterone, Prolactin, TSH) Reviewed 06.02.14 FSH £45 LH £45 AMH £70 TSH £45 Prolactin £45 Oestrogen £45 Progesterone £60 Testosterone £45 Female Thrombophilia £475 Beta hCG £45 HIV, Hepatitis B (all) & Hepatitis C £185 Hepatitis B antigen £80 Hepatitis B core antibody £65 Hepatitis C £70 HIV £45 CMV £80 Rubella £45 Syphilis £45 Karyotyping £275 Cystic Fibrosis £170 Blood Group/Rh £45 © 2013 Oxford Fertility Unit Price List 2014 v1 Page 4 of 5 Patient Information Oxford Fertility Unit Charges – 1st April 2014 Other Services Counselling Sessions £85 Copy of medical records £50 Refunds Refunds may be made if a cycle is cancelled or abandoned for medical reasons. The following amounts are retained by the Unit from the initial payment. Cancellation of IVF cycle before egg collection Cancellation of IVM cycle before egg collection Cancellation of an FER cycle Cancellation of PGS/aCGH Cancellation of IUI £660 £260 £200 £260 £250 In the event that we are unable to collect any eggs at egg collection a refund of £500 will be made. How to pay: Payment can be made by credit card/debit card or by cash, in person or over the telephone. Please note we are unable to accept American Express cards. Our prices are reviewed annually in line with the financial year. Please note that if you book for treatment after 1st April 2015 prices may have changed. I confirm the above costs have been explained to me. Patient Signature………………………….. Date…………………….. Print Name………………………….. Patient Signature………………………….. Date…………………….. Print Name………………………….. Clinic Signature……………………………Print Name………………………………Date……………. One copy to remain in notes and one copy to be retained by the patient Reviewed 06.02.14 © 2013 Oxford Fertility Unit Price List 2014 v1 Page 5 of 5
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