 "Pregnant")
Ratika (name changed) married at 33 and wanted to start a family soon after. Despite her plans, she struggled to conceive for three years due to multiple health issues. Her doctor in Delhi recommended IVF.
IVF, or in vitro fertilisation, involves the combination of a woman's egg with a man's sperm in a laboratory dish. The fertilised egg develops into an embryo, which is then implanted into the woman's womb.
However, IVF requires a great deal of patience, perseverance, and determination from most couples.
Ratika underwent her first IVF treatment in 2017 but failed to conceive. She persevered through four attempts at top hospitals in Delhi and Mumbai.
"The journey was exhausting, both emotionally and physically. I couldn't discuss it with my friends and family because only my husband, who was very supportive, and I knew about the situation," she shared.
But she remained resolute and returned to the IVF centres with renewed positivity after every attempt. "Thankfully, on my last attempt, I was able to conceive," she said.
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Undergoing multiple cycles isn't easy. "You have to take a lot of medicines and injections during the process. That is a little problematic. There are hormonal changes in the body because those are hormonal medicines," she explained, adding, "Medication and the process exhaust you from the inside. If you don't get a positive response, then you get stressed and tense."
When asked if she would encourage others with fertility issues to opt for this procedure, Ratika said, "Despite the pain and wait, once you hold your baby in your arms, you'll see it was worth it."
Ratika's baby will turn six months old this May.
To understand how IVF works and how couples hoping to become parents can save up for IVF, Business Standard consulted experts from the medical and insurance sectors.
3. Financing options: Fertility clinics often offer payment plans or financing options to help manage the costs of IVF treatments.
4. Insurance doesn't cover everything: Infertility treatments are not typically included under 'Maternity' cover, which usually only addresses childbirth costs.
5. Legislative Support for ART: The Assisted Reproductive Technology (Regulation) Act, 2021, aims to improve the quality and ethical standards of infertility treatment in India.
What conditions make parents ideal candidates for IVF?
"Ideal candidates for IVF typically include individuals or couples who face certain fertility challenges that make it difficult for them to conceive naturally," says Dr Nupur Gupta, Director-Obstetrics & Gynaecology, Fortis Memorial Research Institute, Gurugram and senior gynaecologist from Plum Telehealth.
Conditions that might make IVF necessary include:
1. Blocked Fallopian Tubes
2. Anovulatory cycles
3. Low AMH
4. Endometriosis
5. Failed IUI Cycles
6. Azoospermia
7. Unexplained infertility
8. Genetic Disorders
How much does IVF cost?
"Over the last decade, the cost of IVF treatment has significantly dropped by more than 50%. However, it is still a pricey affair," explains Dr Kshitiz Murdia, CEO & Co-Founder of Indira IVF, where treatments start from Rs 1.35 lakh per cycle.
Dr Gupta adds, "The cost of IVF can vary significantly depending on factors such as the clinic, geographical location, specific treatment protocols, and individual patient needs. In India, costs typically range from Rs 1 to 2 lakh, but these are general estimates and actual costs can differ."
"It's important to note that the cost of IVF often includes several components such as consultation fees, diagnostic tests, medications, ultrasound monitoring, the IVF procedure itself, laboratory fees, embryo transfer, and sometimes additional procedures like genetic testing or embryo freezing. These costs can add up and may vary from one clinic to another," she further explained.
Charges explained
When considering IVF, prospective parents should examine the base fee along with the total cost, which includes the price of hormones and any additional charges such as Intracytoplasmic Sperm Injection (ICSI), genetic testing of embryos, a trial transfer, and cryostorage fees for embryos.
"ICSI costs are generally aligned with standard IVF cycle fees. The expenses for genetic testing vary depending on the number of embryos analysed. Cryopreservation typically amounts to about Rs 1.5 lakh for embryo storage. These costs, combined with the IVF base fees, constitute the total expenses incurred during an IVF treatment cycle," Dr Gupta said.
What's the cost if you are using a sperm donor, gestational carrier or surrogate?
"Using a sperm donor for intrauterine insemination (IUI) is generally more economical compared to IVF, which tends to be costlier due to the additional procedures and laboratory work involved," Dr Gupta explained. "The advanced package of surrogacy in India can range from Rs 11,00,000 to 20,00,000, covering the compensation for the surrogate mother, IVF cycle with egg or sperm donor, and medication charges."
"The cost for a sperm donor ranges from Rs 20,000 to 25,000. According to the Surrogacy (Regulation) Act of 2021, commercial surrogacy is prohibited. Only non-commercial agreements are allowed, where the surrogate does not receive any compensation. The act allows for gestational surrogacy, which uses assisted reproductive technologies like IVF," said Dr Aashita Jain, Consultant and Centre Head, Birla Fertility & IVF, Surat.
The Supreme Court of India explained that as per Rule 14(a) of the Surrogacy Rules, the child must be related to the intended couple, especially the husband.
Breakdown of IVF costs:
Standard IVF cycle cost: Starts from Rs 1.35 lakh
Cost range across clinics: Typically Rs 1.35 lakh to Rs 2 lakh
Components included:
- Consultation
- Diagnostic tests
- Medications
- Ultrasound monitoring
- IVF procedure
- Lab fees
- Embryo transfer
Additional costs:
- Genetic testing
- Embryo freezing
- Intracytoplasmic Sperm Injection (ICSI)
- Trial transfer
- Cryostorage: Rs 1.5 lakh for embryo storage.
Costs with donor sperm, gestational carrier, or surrogate:
Sperm donor cost: Rs 20,000 to Rs 25,000.
Surrogacy package: Rs 11 lakh to Rs 20 lakh
Surrogacy type: Non-commercial as per 2021 regulation, uses IVF technology
Mini IVF vs Full IVF: Differences in procedure and cost
"Mini IVF involves using lower doses of fertility medications to stimulate the ovaries, resulting in the production of fewer eggs, typically one or two follicles. This reduces the risk of ovarian hyperstimulation syndrome and lowers medication costs," Dr Gupta explained. "In contrast, traditional IVF uses higher doses of medications, leading to the production of multiple eggs."
Both procedures include ovarian stimulation, monitoring of follicular development, egg retrieval, laboratory fertilisation, and embryo transfer. "However, mini IVF may require fewer monitoring visits and less medication, generally making it less expensive than traditional IVF," she added.
"The cost of mini IVF typically ranges from Rs 70,000 to Rs 1,80,000 per cycle, not including medications. Medication costs for mini IVF can range from as low as Rs 5,000 for Clomid to Rs 50,000 for injectable hormones," Dr Gupta said.
Exploring insurance options for IVF
Now let's look into the insurance part.
"Since infertility is not considered a life-threatening disease, it has historically not been included in most group and medical insurance schemes," said Dr Murdia.
She elaborated on how Indira IVF has partnered with SafeTree to introduce India's first infertility-related insurance, which covers two IVF and two intrauterine insemination (IUI) cycles each after a waiting period of 24 months.
Additionally, Birla Fertility & IVF has teamed up with Care Insurance to include IVF treatment in their insurance offerings. "They also offer a No Cost EMI, which helps our patients manage their finances better," she noted.
Sarthak Sinha, Lead Enterprise Sales at Plum, commented, "Whether insurance covers IVF varies greatly depending on the insurance provider, the specific plan, and the region. In many cases, IVF is not fully covered by insurance, or coverage may be limited to certain conditions or requirements. Less than 1% of corporates in India offer infertility coverage under Group Health Insurance."
"Among Plum’s clients, approximately 2% have already included IVF covers under their group policy. Notable companies like Whatfix, CRED, and Epifi have IVF covers in their corporate health policies provided by Plum," he added.
Some insurance plans may cover certain aspects of IVF treatment, such as diagnostic testing or medications, while others may offer more comprehensive coverage that includes procedures like egg retrieval and embryo transfer. "However, even when coverage is provided, there may be restrictions such as age limits, the number of cycles covered, or requirements related to infertility diagnosis," he explained.
Under what circumstances is IVF covered in insurance?
The circumstances under which IVF is covered by insurance can vary greatly depending on the insurance provider, the specific plan, and local regulations. Here are some key factors that may influence coverage:
Policy coverage: Some insurance plans include coverage for infertility treatments like IVF as part of the standard package, while others offer it as an optional extra or do not cover it at all. It's crucial to review your insurance policy or contact your provider to understand what is covered.
Limits and restrictions: Even when IVF is covered, there might be limitations. These could include a cap on the number of IVF cycles, age restrictions, or a need for prior authorisation. Specific eligibility criteria may also apply.
Employer-based coverage: Coverage for IVF through employer health plans can vary. Some companies include IVF coverage in their health benefits to attract and retain employees.
What is the cool-off period?
"The cool-off period is an industry-first, which is one year. After the waiting period, they can avail the benefits of the insurance", said Dr Murdia.
Meanwhile, Plum offer's GHI and the advantage of Group health insurance is that there is no cooling period/waiting period one can avail of the policy as soon as they enrol in one.
When can it be rejected by insurance?
"Insurance providers might reject coverage for IVF under various circumstances, based on policy terms and the specific situation," explains Sarthak Sinha. Reasons for denial can include lacking a documented infertility diagnosis, policies explicitly excluding infertility treatments, or limitations on coverage like cycle caps or age restrictions.
"Coverage can also be denied if the treatment is sought from an out-of-network provider without prior authorisation, or due to non-disclosure or incorrect disclosure of vital information like age, occupation, income, existing insurance plans, or pre-existing medical conditions."
Is insurance only for one child or even the second?
"Insurance coverage for IVF generally relates to the treatment process rather than the number of children conceived from the procedure. If covered, insurance typically pays for the procedure-related expenses, including diagnostic tests, medications, and the IVF cycle, regardless of the outcome or the number of children born," Sinha noted.
"If IVF is included under maternity coverage or similar terms, it usually has a cap on the total amount covered, not on the number of cycles or children."
It's worth noting that contrary to popular belief, infertility and sterility treatments are not covered under 'Maternity' cover, which typically only covers the delivery of a newborn baby. Therefore, checking the specifics of your policy is essential.
On the benefits of broader insurance coverage, Kshitiz Murdia comments, "The benefits are seen on two fronts – professional and personal. Firstly, more corporates are adding infertility treatment to medical insurance for their employees. Secondly, with greater awareness of the impacts of late marriage, families in urban areas are gifting these schemes to newly-weds planning to start their families."
These developments are part of slow but significant progress in the realm of ART, regulated by the Assisted Reproductive Technology (Regulation) Act, 2021. This legislation aims to transform a fragmented market into a consolidated one focused on patient-centric, high-quality, safe, effective, transparent, and ethical reproductive health solutions supported by technology.
Citing the World Health Organisation (WHO), Dr Murdia notes that around one in six adults globally experiences infertility. In India, this figure is about 33-34 million couples of reproductive age facing lifetime infertility. This issue is reflected in India’s dropping total fertility rate (TFR), which has seen a significant decline over the last 70 years. A recent report in The Lancet predicts that India’s TFR will fall to 1.29 by 2050 and further to 1.04 by 2100.
"These trends are influenced by several factors. There’s a notable shift in lifestyle and aspirations, with people marrying later and thus delaying childbearing, which complicates natural and safe conception. Lifestyle diseases such as diabetes, hypertension, and heart conditions also pose challenges," she explains.
"An IVF treatment can cost upwards of Rs 1.5 lakh, a sum not feasible for every couple. There's a significant need for policy-level action to make these treatments more accessible," says Abhishek Aggrawal, Chief Business Officer at Birla Fertility & IVF, C K Birla Group.
