High cost of fertility treatment can be prohibitively expensive

KELA sometimes compensates only three rounds of treatment

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The cost of fertility treatment can frustrate the hopes of some parents to have a child of their own. Many would like the Social Insurance Institution (KELA) to compensate more than three rounds of the rather expensive treatment.
     KELA has begun deciding on a case-by-case basis on compensating for fertility treatment, and couples do not know at the beginning of treatment if the rebate is forthcoming.
     
Many doctors feel that the compensation of more than three rounds of treatment would be a justified.
     “Nowadays we have very meticulous test tube fertilisation treatments, and we even treat patients without hormones”, says Viveca Söderström-Anttila, head physician of the infertility treatment clinic of the Finnish Family Federation.
     “Young couples in particular often need more than three treatments. Patients aged 25 to 38, who have a clear medical problem in the background, should be compensated for four and even five treatments.”
     
For young women, the likelihood for getting pregnant is better than with older patients, even though a number of rounds of treatment might be necessary”, she says.
     The maximum age for fertility treatment has been raised from 40 to 43 years in February this year. Female fertility declines significantly at about the age of 38, so older women need to determine if infertility is caused by age or some disorder.
     One round of fertility treatment, including procedures, drugs, and other expenses, costs EUR 2,000 - 2,500. KELA compensation covers about a third of the cost.
     “Primarily we compensate for successful treatments”, says Marja-Leena Sankari, head physician at KELA.
     If a fourth round of treatment is needed, KELA wants a doctor’s statement with details on the patient’s background factors and medicines to be used. On the basis of that information KELA will make its decision on whether or not to compensate.
     
“Many have to think whether or not they can afford the treatment, especially if the prognosis is not the best possible. As no advance decision on compensation is forthcoming, we need to warn people that there is no guarantee that the compensation will come”, Söderström-Anttila says.
     
More patients have been asking for fertility treatment, says Professor Aarne I. Koskimies of the Felicitas clinic.
     He says that research has shown that the cumulative pregnancy rate increases all the way to the sixth round of treatment, after which it evens out and declines. “Many have a good prognosis and indications to continue treatment after a third round”, Koskimies says.
     According to the National Research and Development Centre for Welfare and Health (STAKES), the success rate after three or four rounds of treatment is about 50 per cent.
     
Both male and female infertility are on the increase, Koskimies says. Semen is weaker, and youth obesity and environmental factors weaken fertility.
     About 400 couples are in line for treatment at the Helsinki and Uusimaa Hospital District (HUS). The treatment is within the treatment guarantee programme for public health care, which means that treatment should be made available within six months.
     HUS only takes couples into treatment, and only the couples’ own sperm and egg cells are used for the in vitro fertilisation. Treatment is not given any more when the likelihood of pregnancy falls below ten per cent.
     
Some go abroad for treatment, either to Estonia or St. Petersburg. “Mothers often come back from there with twins”, says Mika Gissler from STAKES.
     Finland generally uses the single embryo implant method, which minimises the possibility of multiple births.


Previously in HS International Edition:
  BREAKING NEWS: Parliament votes to allow fertility treatment for single women and lesbian couples (13.10.2006)

Links:
  Family Federation of Finland: Infertility

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