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Bronx Queens

IVF WITH DR BRANDEIS

    Pre-IVF evaluation

    1. At your first visit, Dr. Brandeis will look into the medical and reproductive histories of yourself and your partner. By considering your age, reproductive history and the underlying cause/causes for your infertility, Dr. Brandeis will advise you early on, sometimes even at your first visit

  • Whether you are a candidate for IVF, and
  • Your realistic chances for success.
  • He will require basic tests and procedures that are necessary to establish your fertility status -

  • Baseline hormone levels taken on Day 3 of a natural cycle
  • Baseline pelvic sonogram at the start of the cycle to assess your ovaries
  • Hysterosalpingogram (X-rays of your uterus and fallopian tubes)
  • Semen analysis with strict morphology
  • 2. If the tests indicate that you are a candidate for IVF, and if you have no abnormalities or medical conditions that should be treated before fertility treatment, you can proceed to IVF immediately.

    3. During the visit when the decision is made to proceed to IVF, Dr. Brandeis will explain the IVF process (or review it, if you have already done it before) and answer any questions that you and your partner may have.

  • You will both be given orders for blood tests to screen for infectious diseases and three or four genetic
  • diseases. These tests are required by the State of New York for couples undergoing IVF.
  • The first payment of $1,900 for the cycle fee is due at this time.
  • Collaboration with CNY

    For the past five years, Dr. Brandeis has worked with CNY (cnyfertility.com) in the treatment of his IVF patients.

  • CNY, one of the largest private, non hospital-based fertility centers in the state of New York, has state-of-the-art IVF facilities in Albany, Syracuse and Rochester.
  • It also has one of the best IVF success rates in the country.
  • Egg retrieval and embryo transfer are done at CNY Albany, which is 2-1/2 hours from the city by car or by train from Penn Station.
  • The patient only needs to go there twice – first for the egg retrieval, and then for the embryo transfer 3 or 5 days later. In both cases, patients can return home the same day – 3-4 hours after egg retrieval, and as early as 2 hours after embryo transfer
  • .
  • CNY charges our patients a package fee of $3000 covering the necessary medical and laboratory procedures in standard IVF cycles, in addition to some extra services provided free of charge. It is paid to CNY on the day of egg retrieval.
  • This package fee is unmatched by any fertility clinic in the United States, and enables us to bring down the cost of IVF considerably.
  • Costs beyond the cycle fee for standard IVF represent the cost of special services like PGD, testicular sperm extraction and egg-donor fees required for sex selection, post-vasectomy, and egg donation, respectively.
  • What to expect during the IVF process
  • Preparatory to the IVF cycle, you may be put on the pill for a month for better control of cycle timing and to help prevent ovarian cysts which can interfere with stimulation.
  • If you are put on the pill pre-IVF, the IVF cycle itself begins when you get your first period after the pill. In any case, the IVF treatment cycle begins on the day you get your period in the month you plan to undergo IVF.
  • You must call us the day you get your period (Day 1 of your IVF cycle).
  • During the cycle, you will be seen several times at the office (or at a lab and radiology office) for blood tests and ultrasound.
  • Please be prepared to commit yourself for 10-12 days to going for blood tests and ultrasound on the days you are instructed to do so. This is necessary for optimal results in your stimulation. If you work, we will give you the necessary excuse note so that during your stimulation, you can take a couple of hours off every day to do these tests.
  • These procedures should be done first thing in the morning, so that results are available by 5 p.m., as the doctor needs these to determine your daily medication and dosage.
  • Typically, this is what happens during your IVF cycle:

  • Cycle Day 1 (CD 1) CALL US
  • CD 2 Baseline blood tests and ultrasound If results are normal, stimulation is generally started on Day 3 of the cycle
  • CD 3 Day 1 STIM: Start stimulation at dosage given by Dr Brandeis for 2 days (initial dosage depends on patient’s age, weight, previous response to stimulation, number of follicles seen on Day 2 ultrasound)
  • CD 4 Day 2 STIM
  • CD 5 Day 3 STIM: Blood (E2) and ultrasound – to determine your response to medication, as shown by the estradiol level and by the number and size of ovarian follicles seen on ultrasound. After the first two days, the daily dosage will be adjusted according to this response.
  • CD 6 Day 4 STIM
  • CD 7 Day 5 STIM: Blood (E2) and ultrasound.
  • Typically, you will start a daily injection of Cetrotide (or Ganirelix) if the estradiol level is 200 and/or 1-2 follicles reach an average 10mm diameter. A second stimulation medication is usually added for the remaining days of stimulation.
  • CD 8 Day 6 STIM
  • CD 9 Day 7 STIM: Blood (E2, LH) and ultrasound. NB: Some patients may need to return daily for the remaining days of stimulation.
  • CD 10-12: Days 8, 9,10 STIM: Blood (E2, LH, PROG) and ultrasound DAILY. NB: Some patients may require 1-2 more days of stimulation, in which case, daily blood and ultrasound monitoring will continue.
  • When at least two of your follicles are 18mm in average diameter, you will take the last medication before egg retrieval (HCG or Lupron), both injectable, to help mature the eggs in time for the retrieval.
  • It is given 34-36 hours before the scheduled egg retrieval. Usually this is given at night for a morning egg retrieval two days later. (Ex: Saturday night for a Monday morning retrieval.)
  • You will take no other medications until after egg retrieval.
  • You and your partner are expected to be at CNY Albany by 7:30 a.m. on the day of egg retrieval. At this time, you will pay CNY the fee balance ($3000 or more, depending on the type of IVF you are doing)
  • to cover all the procedures you are doing with them.
  • You can be discharged 2-4 hours after the procedure, after anesthesia effects have worn off.
  • You will be given prescriptions for medications to be taken until the first pregnancy test two weeks after embryo transfer. Most patients are able to go to work the next day.
  • You will return to Albany 3-5 days later for the embryo transfer, which requires no anesthesia, so you can return home after one hour.
  • Staying home for a few days and avoiding any strenuous activity is usually recommended, but many patients can resume their regular activities right away except gym work and heavy lifting.
  • 12-14 days after embryo transfer, a blood pregnancy test will show if you have conceived. An ultrasound will check if you have any post-retrieval ovarian cysts.
  • If the pregnancy test is positive, you will repeat the blood tests every 2-3 days to make sure that the pregnancy hormone levels are rising appropriately. Ultrasound will show how many embryos have implanted.
  • Three weeks after embryo transfer, ultrasound will be able to detect the fetal heartbeat. This is considered the definitive clinical sign of pregnancy.
  • At this time, Dr. Brandeis will refer you to the obstetrician of your choice for pregnancy follow-up, pre-natal care and eventual delivery.
  • EXPLAINING THE COSTS OF IVF
    Pre-IVF Costs
    These include:
  • Your initial consultation with Dr. Brandeis
  • The basic fertility tests listed above
  • Blood tests for infectious-disease and genetic screening
  • Office visits before you start your IVF treatment
  • If you have health insurance:
  • All these pre-IVF costs are covered by any health plan that covers infertility, even if your personal policy does not cover fertility treatments like IVF.
  • HMO plans, as well as Medicare and Medicaid, do not cover infertility treatment or medications.
  • However, some HMO patients may be able to do the basic tests and the infectious disease screening tests through their primary physician, in which case the HMO would cover the services.
    - If your PCP agrees to order the genetic testing, these may also be covered.
  • If you have no health insurance, or you are unable to do these pre-IVF tests through your primary doctor, the following is a rough estimate of what it would cost out of pocket, at facilities we work with. (If you know of other radiologists or reference labs who can do these tests cheaper, please let us know so we can share the information with other self-pay patients).

  • Transvaginal pelvic sonogram $150
  • Hysterosalpingogram 250
  • Semen analysis 150
  • Infectious disease and genetic screening for both partners are done by Bio-Reference Laboratories, which offers a 70% discount on all lab work sent to them if the patient has no insurance or if her insurance does not cover the tests.
  • The panels for each individual cost about $900 at the discounted price. We will give you a discount card that you will fill out with your name and the invoice number when you get the bill from the lab – you send back the card with a payment corresponding to 30% of the indicated charges.

    IVF medications

    Medications represent a significant part of the expense of IVF treatment for patients who have no insurance, or whose plan does not cover fertility treatment. Most of the expense goes to medications used to stimulate the growth and development of multiple ovarian follicles during the IVF cycle in order to retrieve at least eight mature eggs. This can cost as much as $2,500 for patients requiring the ‘average’ stimulation dose. Younger women with normal weight usually require less stimulation.

    All other medications used in the typical IVF cycle will cost an additional $500-700. This includes the pre-IVF medication Lupron, which prepares your ovaries for stimulation, if Dr. Brandeis decides this will be the protocol most appropriate for you; and the post-retrieval medications intended primarily to prepare the lining of your uterus to maximize the chances of embryo implantation, and therefore, of conception.

    Under a program called Compassionate Care, Serono, the company that manufactures Gonal-F, the most widely-used ovarian stimulation medication in the past 10 years, offers a 50-75% discount to patients who have no insurance or whose plan does not cover fertility medications. The discount depends on the patient’s income level. From our experience with the program, almost all applicants are given the 75% discount, which represents considerable saving on a baseline cost of $2500 or more.

    Flat fee for self-pay IVF
    with two-step payment

    If you have no insurance coverage, or your plan does not cover IVF, the following explains the self-pay fee:

  • The total cost of medical and laboratory services for a standard IVF treatment cycle is $4,900.
  • This does not include medications which you will purchase directly from a fertility pharmacy (see below).
  • The first payment of $1,900 - in cash, certified check or money order – covers Dr. Brandeis’s fees for medical management of all your pre-IVF tests and procedures, and his management and monitoring of the IVF cycle itself (office visits, sonogram and blood drawing) over a two-month period covering the pre-IVF cycle and the actual IVF cycle to the first pregnancy test. The first payment is due at the time Dr. Brandeis orders your pre-IVF tests.
  • The balance of $3,000 will be paid on the day of egg retrieval to CNY.
  • As explained above, we are able to keep the cost of IVF down because of this arrangement with CNY.
  • Services covered by the IVF cycle fee
    With Dr. Brandeis –
  • Ordering and coordinating all tests and procedures for you and your partner from the day you decide to proceed to IVF
  • All office visits, telephone consultations, and telephone instructions after you have paid Dr. Brandeis’s cycle fee until the first pregnancy test
    - Medical management of your IVF process and monitoring of stimulation
    - Blood drawing and office ultrasound as needed With CNY
  • "Blood drawing With CNY
  • Anesthesia for egg retrieval
  • Egg retrieval
  • Laboratory fees for
    - Embryology, including ICSI & assisted hatching
    - Laboratory culture for 3-5 days
  • Embryo transfer Plus – at no extra charge:
  • Freezing of extra embryos
  • Embryo storage for six months
  • One frozen embryo transfer
  • Services not covered by the IVF cycle fee
  • Pre-IVF office visits and diagnostic tests
  • Semen analysis
  • Infectious disease screening & genetic studies (both partners)
  • Medications
  • Other radiological and surgical procedures that may be necessary before or after IVF (Pelvic MRI, laparoscopy, myomectomy, surgical procedures on fallopian tubes and ovaries, hysteroscopy, D&C, etc.)
  • Cost of donor sperm or surgical sperm retrieval
  • Ultrasound monitoring of early pregnancy
  • Treatment of ovarian hyperstimulation syndrome, ectopic pregnancy, or miscarriage.
  • Pre-natal and obstetric care