When we are given an initial estimate for an assisted reproduction treatment, the hormone medication necessary for the entire process is not usually included. In the end, this makes the whole treatment more expensive and patients are in for a surprise large outlay of money.
Whether it is artificial insemination (AI) or in vitro fertilization (IVF), each stage of the process requires a different type of medication. Furthermore, the hormonal dose of each drug may vary according to the response of each woman.
For these reasons, the cost of medication can vary greatly depending on the type of patient.
In this article, we will differentiate each stage of an assisted reproduction process in order to give an approximate cost in three different countries. Finally, we will discuss the price differences in medication between AI and IVF
Provided below is an index with the 11 points we are going to expand on in this article.
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What is ovarian suppression?
The first step before starting an assisted reproduction process is to inhibit the internal hormonal flow that regulates the woman's menstrual cycle. In this way, the ovaries remain at rest so that they can be stimulated with exogenous hormones and the ovarian follicles can grow all at the same time.
The drugs that achieve this effect are those containing the GnRH analog hormone. Listed below are some of these and their approximate prices in Spain, the USA and the UK respectively (please note prices are orientative and depend on where and where purchased):
Prices of ovarian supression medication in Spain
The typical prices in Spain for the hormonal medication used in this stage are:
- Cetrotide
- €60 for one vial and €250 for 7 vials.
- Orgalutran
- €29 for a container with 1 syringe and €129 for a pack of 5 syringes.
- Synarel
- €122.
- Procrin
- €31 for one multidose vial.
- Decapeptyl
- €24 for 7 ampoules for daily administration.
Prices of ovarian supression medication in the USA
The drug names and average prices in the United states are as follows:
- Cetrotide
- $80 for one vial and $250 for 3 vials.
- Orgalutran, also sold as Ganirelix
- $138 for a container with 1 syringe and $370 for a pack of 3 syringes.
- Synarel
- can vary in price greatly depending on where purchased, from $520 - $3000.
- Procrin, marketed under the name Lupron
- $400 per kit.
- Decapeptyl
- $110 for 7 vials for daily injection.
Prices of ovarian supression medication in the UK
Typical prices of the same medication in Great Britain are:
- Cetrotide
- £35 per vial.
- Orgalutran, also sold as Fyremedal or Ganirelix
- £20 for a pen containing 25mg.
- Synarel
- £52.
- Procrin, marketed under Prostap
- £200 per 3.75 mg kit.
- Decapeptyl
- £70 for 7 vials for daily injection.
There are more formats of these medications with higher hormonal doses which are therefore more expensive. However, the ones most commonly used in assisted reproduction are the ones we have indicated here. Additionaly, some of these drugs are used for short cycles and others for long cycles.
In a long cycle of ovarian stimulation, the ovarian suppression medication begins to be injected around day 21 of the previous cycle, i.e., approximately one week before menstruation. In contrast, in a short cycle, injections of these drugs are administered around day 6 of the cycle, after the menstrual period has finished.
The specialist will be in charge of prescribing the most appropriate type of medication for each woman according to her characteristics.
Controlled Ovarian Stimulation (COS)
Ovarian stimulation consists of the administration of exogenous gonadotropins to provoke multiple follicular development in the ovaries. The gonadotropins are the FSH and LH hormones secreted by the brain and involved in the regulation of the menstrual cycle.
The price difference in the medication of an AI treatment and an IVF treatment lies in this step. Stimulation protocols in IVF require higher hormone doses than in AI and, for this reason, drug costs are higher in the former.
What is the COS like in AI?
In an artificial insemination, a gentle stimulation is done so that only one or two follicles develop. As such, in order to give an approximate price for these drugs, we will rely on the lower hormone dosage forms.
Approximate prices of ovarian stimulation medication in Spain
These hormonal drugs in Spain can usually be purchased at the following prices:
- Gonal-f
- €126 for the 300 IU pen and €173 for the 450 IU pen.
- Menopur
- €60 for one vial and €131 for 5 vials.
- Puregon
- €148 for the 300 IU pen and €248 for the 600 IU pen.
- Pergoveris
- €120 for a package with 1 vial and €270 for a the package with 3 vials.
Approximate prices of ovarian stimulation medication in USA
The medicines used for COS for intrauterine insemination in the United States can vary depending on how and where you buy your medication. However, a guideline is:
- Gonal-f
- $159 for the 300 IU pen and $239 for the 450 IU pen.
- Menopur
- $174 for 5 vials.
- Puregon, known as Follistim
- $159 for the 300 IU pen and $319 for the 600 IU pen.
- Pergoveris, also sold as Luveris
- $28 per vial.
Approximate prices of ovarian stimulation medication in UK
In the UK, these same drugs can be purchased at around the following prices:
- Gonal-f
- £124 for the 300 IU pen and £186 for the 450 IU pen.
- Menopur
- £115 for 5 vials.
- Puregon, sold under the name Ovaleap
- £100 for the 300 IU pen and £143 for a 450 IU pen.
- Pergoveris
- £75 per vial.
The patient should keep in mind that, depending on each case, the physician may prescribe a higher dose of the drug and/or change it during treatment to adapt the ovarian response.
Therefore, in the course of treatment, the patient may have to purchase more hormone medication than originally indicated. It is also possible that the physician may instruct the patient to take two medications at the same time for stimulation, for example, Puregon and Menopur.
COS in IVF
The ovarian stimulation needed for IVF is more aggresive that for AI because follicular puncture requires more mature follicles. Therefore, the hormonal doses of the drugs are higher and so is the cost.
Approximate prices of COS medication for IVF in Spain
Prices for medication for this stage, in Spain, are:
- Gonal-f
- €263 for a package 10 vials of 75 IU, €304 and €346 for the pre-filled pens of 900 IU and 1050 IU respectively.
- Menopur
- €222 for 10 vials of dosis 75 IU. There is also the format of a 600 IU vial for €188 and 1200 IU for €333.
- Puregon
- €359 for the 900 IUI cartridge and €382 for the package of 10 vials.
- Elonva
- €509 for the 100 µg syringe and €610 for the 150 µg syringe.
- Pergoveris
- €780 for a package with 10 vials.
Approximate prices of COS medication for IVF in the USA
Again, in the US the prices can vary but are approximately:
- Gonal-f
- $469 for a pre-filled pens of 900 IU $545 for the 1050 IU format.
- Menopur
- $174 for a pack of 5 vials.
- Follistom (Puregon)
- $469 for the 900 IU cartridge
- Pergoveris
- $606 for a package with 450 IU.
Approximate prices of COS medication for IVF in the UK
If having treatment in the UK, you can expect to pay around the following for the hormone medicines:
- Gonal-f
- £31 per vial with 75IU or £372 for a pre-filled pens of 900 IU.
- Menopur
- £144 for the 600 IU format and £288 for the 1200 IU.
- Ovaleap (Puregon)
- £282 for the 900 IU cartridge
- Pergoveris
- £750 for a pack of 10 vials.
As with artificial insemination, the hormonal doses in IVF can be adapted to the ovarian response during the treatment, so it is quite common for the woman to need more medication than initially indicated by the doctor.
However, it is not advisable to buy more medication than necessary at the beginning of treatment, as these are very expensive drugs and it would be best to have as little left over medication as possible.
Likewise, it is also common for the physician to order two drugs to be administered at the same time, for example Gonal and Menopur, especially in women with low ovarian reserve.
Ovulation induction
Once the follicles have reached the appropriate size in the ovaries (16-18 mm), it is necessary to inject the hCG hormone about 34 hours before artificial insemination or follicular puncture. In this way we achieve the final maturation of the eggs and triggers ovulation.
In AI, the egg will be expelled into the fallopian tubes and the encounter with the sperm deposited in the uterus will take place. On the other hand, in IVF, the egg retrieval and fertilization in the laboratory must be programmed before the puncture.
The medications used to induce ovulation are as follows:
- Ovitrelle
- approximate prices of €50 in Spain, $78 in the US (Ovidrel) and £38 in the UK
- Decapeptyl
- the daily administration format is priced at €24, $110 and £70 in Spain, the USA and the UK respectively.
Assisted procreation, as any other medical treatment, requires that you rely on the professionalism of the doctors and staff of the clinic you choose. Obviously, each clinic is different. Get now your Fertility Report, which will select several clinics for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.
In general, there is a widespread tendency to use Ovitrelle in almost all stimulation protocols because of its high efficacy. However, it is also possible to use Decapeptyl in short protocols, as it has the advantage of avoiding ovarian hyperstimulation syndrome.
How is the luteal phase managed?
This is the last phase of all treatments in which hormonal medication must continue to be administered. This is progesterone, a hormone secreted by the ovary after ovulation takes place and which supports pregnancy.
Progesterone prepares the endometrium for optimal conditions at the time of embryo implantation. This is why it is so beneficial to administer it exogenously, especially when a frozen embryo transfer or ovodonation takes place.
Progesterone-containing drugs and their names and approximate prices are as follows:
Prices in Spain
If buying the medicine in Spain, you can expect to pay:
- Utrogestan
- €10.50 for 15 capsules and €42 for 60 capsules.
- Progeffik
- €10.50 for 15 capsules and €42 for 60 capsules.
- Crinone
- €26.88 for a package with 6 monodosis applicators.
- Prolutex
- €64.25 for a package with 7 single-dose vials.
Names and prices in the USA
Brand names and formats differ in each country, but here are some guide prices:
- Utrogestan
- $47 for a package of 30 capsules, with larger packs available at slightly cheaper prices per capsule.
- Cyclogest
- $70 for a box of 15 pessaries.
- Crinone
- $700 for a box of 18 pre-filled monodosis applicators.
- Prolutex
- $125 64.25 for the package with 7 vials.
Prices in the UK
In the United Kingdom, the approximate prices are:
- Utrogestan
- £21 for a box of 15 200mg capsules.
- Cyclogest
- £14for a package of 15 pessaries.
- Crinone
- £31 for a box of 15 pre-filled applicators of the 8% gel.
- Lubion
- £56 for a pack with 7, 25mg vials.
It is important to note that progesterone must be administered daily, which is why the Utrogestan and Progeffik / Cyclogest formats are the most economical available and the most widely used in fertility treatments.
The duration of treatment with progesterone can last up to 2 or 3 months if a positive beta-hCG result is achieved, according to the indications of each specialist.
The total price of AI
In Spain, an artificial insemination can cost around €700-€1,100 depending on the private clinic. To this initial price, one needs it add the cost of the medications used and other aspects such as the analysis and freezing of the semen if they are not included.
Costs of artificial insemination in other countries
Artificial insemination prices vary depending on the country where the treatments are performed.
In the United States, artificial insemination costs between $300 - $1,000 without insurance. However, if artificial insemination is performed with donor sperm, the price increases by 900 dollars.
In the UK these figures are approximately £700 - £1600 when paying privately, and an additional £600 if donor sperm is required. However, in some cases treatment may be available on the NHS.
As for medication, the sum of all the drugs used as seen throughout this article can vary between €250 and €600 in Spain. In the USA this figure is approximately $500 - $100. You can expect to pay from £250 - £600 in the United Kingdom.
This treatment is also about 400€ more expensive if donor sperm is used. If you want to learn more about the cost of AI, we recommend visiting the following article: How much does IUI cost?
Total cost of IVF
The cost of IVF in Spain can vary between €3,500 and €5,500 excluding medication. This price is independent of whether conventional IVF or intracytoplasmic sperm injection (ICSI) is used.
In the UK the cost of and IVF cycle ranges between £1500 to £5000, depending greatly on the clinic chosen. In some cases and areas it may be available on the NHS
If we add the price of the total medication, in Spain we find an additional cost of about €400 and €1,100. If in the USA these medication costs can be around $850 - $1500. In comparison, the costs in the UK of this medication is approximately £400 - £1200.
The cost can also increase considerably if complementary techniques such as preimplantation genetic diagnosis (PGD) are included. Similarly, the price is much higher if sperm donation or ovodonation is required.
For more detailed information about the price of IVF, don't forget to visit the following link: What is the average cost of IVF in the USA?
Real cases
We know how complicated it is to get an idea of the price of medication in assisted reproduction due to the wide variety of drug types, medical protocols and price ranges that exist.
Therefore, we would like to present two examples of our patients in Spain who followed different protocols for ovarian stimulation:
Long IVF cycle
A long ovarian stimulation protocol is one in which GnRH agonist drugs are used for the first phase of ovarian suppression.
The GnRH agonist drugs are Procrin, Decapeptyl and Synarel, which are cheaper than the antagonist drugs (Cetrotide and Orgalutran).
Below, we are going to indicate all the medication that this patient needed in each of the phases:
- Ovarian suppression: Procrin from day 21 of the previous cycle and for 19 days. Price: €31.
- Ovarian stimulation: Puregon 900 from day 2 of the cycle and for 10 days. Price: €350.
- Ovulation induction Ovitrelle 36 hours before follicular puncture. Price: €50.
- Progesterone: 2 large boxes of Utrogestan for 2 months. Price: €84.
- Others: box of contraceptives during the previous cycle and Zitromax antibiotic to avoid infections on the day of the puncture. Price: €20 and €4, respectively.
In total, our patient spent about €539 on her medication for an IVF treatment that was ultimately a success.
Short IVF cycle
In this case, the patient followed a short ovarian stimulation protocol, in which a GnRH antagonist (Orgalutran) was administered for ovarian suppression. Details of the medication guidelines and the money spent are discussed below:
- Ovarian suppression: Orgalutran for 6 days. One box of 5 syringes and one box of 1 syringe. Total Price. €158.
- Ovarian stimulation: Gonal-f and Menopur from day 2 of the cycle for 10 days. One box of Gonal-f 1050, one pen of Gonal-f 900 and one box of Menopur 75 with 10 vials. Total Price. €873.47.
- Ovulation induction Decapeptyl 36 hours before follicular puncture. Price: €24.
- Progesterone: 1 small box of Progeffik. Price: €10.50.
- Others: Zitromax antibiotic to avoid infections on the day of the puncture and vitamin D throughout all the stimulation process. Price: €8 and €46, respectively.
In total, our patient spent about €1,116 on her medication for her IVF treatment.
It should be noted that this cycle did not end with fresh embryo transfer, as there was a small risk of ovarian hisperstimulation and it was decided to freeze the embryos for transfer in a subsequent cycle.
In addition, these embryos were biopsied for PGD and also had to wait for the results to be obtained before the transfer could be made.
As a result, the patient had her menstrual period a few days after stopping progesterone.
FAQs from users
How much do IUI drugs cost?
The cost of drugs for intrauterine insemination (IUI will depend on several factors.
If the woman follows an ovarian stimulation, she will have to count the cost of hormonal injections. The cost may vary depending on her ovarian response and the number of days she will need to reach ovulation. On the other hand, if the woman performs the insemination in a natural cycle, she will only have to count the cost of the last injection of Ovitrelle to induce ovulation.
In addition, it should also be noted that the price of AI drugs can vary depending on the drugs used and the format, as they can be hormonal injections or daily tablets.
There is no fixed cost for the drugs and your practicioner can give you a specific estimate depending on your treatment plan and the protocol chosen.
Is it possible to get the medications needed on my health insurance?
In in Spain, the medication needed for your IVF treatment is covered by the social security only when the whole treatment is also covered in the same way. If you attend a private assisted reproduction clinic you will have to pay for the medication.
In the US, health insurance rarely covers the costs of the medication and you will have to pay for them.
In the UK, the NHS may cover part of the cost of the medication, but only if the treatment is being paid for by the NHS. If you are receiving private treatment then you will have to pay them separately.
Is the cost of medication for IVF the same as for IUI?
The cost of the medication is very personalized for each patient and each treatment.
In general, for an IUI stimulation, 2 medications are used, one to stimulate the ovaries and another to provoke ovulation, but in IVF another medication must be added to prevent spontaneous ovulation. From this information alone we can deduce that IVF medication is going to be more expensive. In addition, more doses of medication are usually used to stimulate the ovaries in IVF than in AI, so the cost of this medication will be higher at the end of the treatment.
For all these reasons, when we inform you of the costs that the different medications may involve, we always give a very approximate range of figures.
What is the cost of medication for IVF with frozen embryos?
This would be the case of a substituted IVF cycle, in which it is necessary to perform an endometrial preparation prior to the transfer of the frozen embryos. This requires ovarian suppression and the administration of exogenous estrogens and progesterone. The prices of these drugs in Spain are as follows:
- Ovarian supression (GnRH analogs): between €24 and €250.
- Estrogens: between €15 and €25.
- Progesterone: between €30 and €65.
This is the same medication as would be used when having IVF with donor eggs.
Why is it so important for ovarian stimulation to be personalized?
Dr. Carolina Arboleya of Ovoclinic Madrid, explained to us in an interview, the importance of personalizing ovarian stimulation:
To have the best results, we have to take into account all the factors, not only the previous cycles that the patient may have had, but all her history, gynecological pathologies, cycles that the patient usually has, what her periods are like, what her previous responses have been like... Depending on all of this and evaluating all the factors, we personalize the type of treatment as much as possible.
How much does the drug Menopur cost?
The price of Menopur in Spain varies according to the number of vials you purchase. In the case of 5 vials of 75 IU of Menopur, the cost is 131 euros. On the other hand, if there are 10 vials of 75 IU, the price of the drug amounts to 222 euros. In addition, there is also a single vial of 600 IU for 188 euros and 1200 IU for 333 euros.
Recommended reading
If you are interested in reading more about fertility treatment prices, we recommend the following post What is the price of assisted reproduction treatments.
If you want to learn more about the process of ovarian stimulation and what are the side effects of the medication, you can continue reading the following post: Ovarian stimulation protocols.
After an embryo transfer, it is normal to have symptoms that are more related to the medication than to a possible pregnancy. We recommend you read on for more information here: Symtpoms after embryo transfer.
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References
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Arici A, Byrd W, Bradshaw K, Kutteh WH, Marshburn P, Carr BR (1994). Evaluation of clomiphene citrate and human chorionic gonadotropin treatment: a prospective, randomized, crossover study during intrauterine insemination cycles. Fertil Steril;61:314 – 318. (view)
Balasch J, Ballescà JL, Pimentel C, Creus M, Fàbregues F, Vanrell JA (1994). Late low-dose pure follicle stimulating hormone for ovarian stimulation in intrauterine insemination cycles. Hum. Reprod.; 9: 1863– 1866. (view)
Bhattacharya S, Harrild K, Mollison J, Wordsworth S, Tay CCK, Harrold A, McQueen D, Lyall H, Johnston L, Burrage J et al. (2008). Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial. BMJ;337:716 – 723.
Coroleu B, Devesa M, y Alvarez M. Guía 18. Estimulación ovárica para FIV-ICSI en los ciclos con presunción de baja respuesta. Servicio de Medicina de la Reproducción Departamento de Obstetricia, Ginecología y Reproducción Hospital Universitario Quirón Dexeus, Barcelona. Sociedad Española de Fertilidad (SEF) y Sociedad Española de Ginecología y Obstetricia (SEGO) (view)
Ferraretti AP et al. (2011). ESHRE consensus on definition of poor response to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod; 26: 1616-24 (view)
Griesinger G. y col. (2006). GnRH-antagonists in ovarian stimulation for IVF in patients with poor response to gonadotropins, polycystic ovary syndrome, and risk of ovarian hyperstimulation: a meta-analysis. Reproductive BioMedicine Online; 13: 628-638 (ver)
Hamdine O. et al. (2015). Ovarian response prediction in GnRH antagonist treatment for IVF using anti-Müllerian hormone. Hum. Reprod.; 39: 170-8 (ver)
Lehert P, Kolibianakis EM, Venetis CA. y col. (2014). Recombinant human follicle-stimulating hormone (r-FSH) plus recombinant luteinizing hormone versus r-FSH alone for ovarian stimulation during assisted reproductive technology: a systematic review and meta-analysis. Reproductive Biology and Endocrinology; 12: article 17 (ver)
Nelson SM (2013). Biomarkers of ovarian response: current and future applications. Fertil. Steril.; 99: 963-9.
Rodríguez Gálvez, I., Tocino Díaz, A., Fernández Sánchez, M. Fármacos en la estimulación ovárica: clomifeno, gonadotropinas, análogos GnRH, hCG. En: Unidad 06, Bloque I: Esterilidad femenina. Máster en Reproducción Humana de la Universidad Rey Juan Carlos y el Instituto Valenciano de Infertilidad (IVI).
FAQs from users: 'How much do IUI drugs cost?', 'Is it possible to get the medications needed on my health insurance?', 'Is the cost of medication for IVF the same as for IUI?', 'What is the cost of medication for IVF with frozen embryos?', 'Why is it so important for ovarian stimulation to be personalized?' and 'How much does the drug Menopur cost?'.
Authors and contributors
More information about Michelle Lorraine Embleton
Very informative blog as today in our society there is a taboo of not accepting the fact that infertility does exist and we should see it as normal. Despite seeing the condition of a person we focus on their inability. Our society never thought of that person’s psychological condition.
Thank you for your comments SelectIVFIndia. We aim to provide up to date information on fertilty, infertility and assisted reproduction techniques, with no taboos.
We hope you continue to enjoy and use our wesbite in the future.
Hello
My partner is due to start treatment for an artificial insemination and we have to buy the drugs – is there anyway we can discounted prices? Chicago based. Thanks
Hi RobertProctor
In the US you can buy the medication needed from a pharmacy, from an online pharmacy or some clinics sell the medicines direct. It is worth doing a bit of investigation online to see the different prices available. If you do decide to buy from an online pharmacy, please make you sure you only do so from a reputable and licensed company that sell the correct products.
If you have any doubts you can always consult with your specialist.
I hope this helps and good luck with your treatment.