IVF in Sweden
An overdue post ahead.
When I started this blog back in January, just prior to us starting IVF/ICSI #1, I got into contact with all of you wonderful people. You describe your journeys through infertility, which you travel on different continents and in different countries. I learned a lot about IUIs, IVF, Chlomid, and whatnot, how things are done in the US, Canada, Australia, other parts of Europe and even Africa. You all describe how you experience it, how it is done in your part of the world. Whereas I think that the methods used in ART are similar (not to be mixed up with “the same”) throughout the world, it appears as if the pre-conditions can be somewhat different.
Thus, here I go. Here’s a peek into my ART world. Since there is so much to write, I devide this whole IVF in Sweden topic into parts, this post being part 1, where I from both a personal as well as factual point of view try to explain the situation. I can’t guarantee that I will be completely objective, but I will try to bring in many facts.
I know, I have done this before, but I’ll start with a short introduction of the country of Sweden, since the demographics and history do play a role in how ART is handled and viewed here from a legislative and social point of view.
Sweden is small. Very small. Not necessarily when it comes to square kilometers, but when it comes to population. 9 Million. That’s all. That’s just some more than the population of New York City. It takes about 2 days to drive from the most southern point of Sweden to the North, where you hit the arctic circle.
The Swedish Welfare State (and here I copy from Wikipedia)
“The state provides for tax-funded childcare, parental leave, a ceiling on health care costs, tax-funded education (all levels up to, and including university), retirement pensions, tax-funded dental care up to 20 years of age and sick leave (partly paid by the employer). A similar situation prevails in many other European countries, although the Swedish welfare state is one of the most extensive. Parents are entitled to a total of 480 days partly paid leave between birth and the child's eighth birthday, with 60 days reserved specifically for each parent, in effect providing the father with two so called "daddy-months"; this has been the source of much controversy.
The welfare state requires high taxes. Since the late 1960s, Sweden has had the highest tax quota (as percentage of GDP) in the industrialized world, but today the difference is only a couple of percentage points of GDP above that of other high-tax countries such as France, Belgium and Denmark. Sweden has a two step progressive tax scale with a municipal income tax of about 30% and an additional high-income state tax of 20-25% when a salary exceeds roughly 300 000 SEK per year. The employing company pays an additional 32% of an "Employer's fee". In addition, a national VAT of 25% or 18% is added to many things bought by private citizens, with the exception of food (12% VAT), transports, and books (6% VAT). Certain items are taxed at higher rates, e.g. petrol/diesel and alcoholic beverages.”
So, when you are reproductively challenged, you should be glad to be living in Sweden, shouldn’t you? The welfare state will take care of you, right? Well, it does, in a way. It’s a fight though. But what isn’t when it comes to infertility?
After a year of trying to conceive and not having succeeded to get pregnant (or having had multiple miscarriages) one is advised to visit an OB. This however, depending on where you live, can become already the first high hurdle. Waiting times for an OB appointment can take up to 1 year. For us it took 5 month and 22 phone calls to 22 OBs asking if it was possible that I become one of their patients.
Once at the OB, the normal tests are done. This article describes what kind of testing they do (only in Swedish – what you don’t understand Swedish?). If/when these initial tests are done and they find the reason for the underlying infertility the OB refers either directly to a RE or to the fertility department of the local (or nearest) hospital, in order for them to do more extended test, i.e. TESA. This referral can take up to 1.5 years, again, dependent on where you live. It took 8 months for us. Once at the fertility department a thorough analysis of the status of your reproductive capabilities, probing, poking, wanding, and the rest of the package is done. Having the results of that, one is once again referred, back to the OB with the request for the OB to refer the infertile couple to an RE. In Sweden, most health care is governmentally controlled and financed (yes, yes all our tax money), however government doesn’t want to have anything to do with the infertiles and leaves baby making business to the private health sector, although they put up the cash for the treatment. The referral from the OB to the RE takes about 9 month on average.
All in all, one is,in the worst case, busy trying to conceive a grand total of (us):
Good old-fashioned sex 12 month (12)
Trying to get appointment with OB 12 month (5)
Testing at OB 2 month (2)
Referral to local hospital 18 month (8)
Testing at local hospital 6 month (6)
Referral to RE 9 month (6)
Grand total 59 month (39)
Now you know with what we have been busy the 39 months (prior to our first visit at the RE in February 2006), mostly we have been waiting and stuck in fucking referral hell.
Once at the RE things begin to look better. No more referral hell. Since all of Swedens REs clincs are privately owned and run, things tend to go quickly and smoothly. There are 15 REs clinics in Sweden doing IVF. If your OB and the local hospital attest to the Swedish social security (Socialstyrelsen) office, that you cannot naturally conceive due to one of the many medical reason (female and male factor), social security bears the cost of IVF. In fact, it all pretty much depends on where in the country you live again. Personally, we have 3 IVF/ICSI cycles covered by social security, however in many other parts of the country only one IVF attempt is covered. The age of the woman as well as prior children play a role in determining if you are a candidate for governmentally financed baby making or not. Siblings are, as a rule not covered, only one child (or 2 if you are having twins). If you want to extend your family, you better start saving up.
Here’s what people pay who are not covered by social security:
IUI 700 US$
Standard IVF
Cycle 1 3350 US$
Cycle 2 3000 US$
IVF/ICSI
Cycle 1 4000 US$
Cycle 2 3000 US$
IVF/ICSI (with TESA)
Cycle 1 4200 US$
Cycle 2 3750 US$
Freezing of Sperm/Embryos 1300 US$
Storage of frozen sperm/embryos 140 US$ / year
Package deal:
Standard IVF (three cycles) 6700 US$
IVF/ICSI (three cycles) 6700 US$
Comparing these prices to what many of you are paying/paid, I think the Swedes who are not covered by social security, i.e. unexplained infertility or secondary infertility, are still somewhat lucky. Lucky, since we do not pay for medications. Everybody in Sweden is covered by the so-called high-cost protection. If you need medication costing more than 170 US Dollars per year, social security covers the extra costs. With medications costing approximately 1000 US Dollars per IVF cycle one has one worry less when undergoing IVF. FYI, GPD per capita is just under 30000 US Dollars per year.
Now, I have already written a lot, and I haven’t even started going into the specifics of IVF treatment in Sweden. I am going to cut here and continue in my next post. These topics lie ahead:
• Choices of medications. Protocols.
• Choices of embryos.
• Fertilization and transfer (1 vs. more than 1 embryo)
• Acupuncture, and alternative medicine.
• The patient – the unknowing participant
• Psychological support
• Usage of donor sperm/donor eggs
• The Beta – What’s that? Beta? A pee stick is all you are going to get.
Oh, but before I go, I just wanted to let you know I am doing OK. I still feel very detached from this cycle. I am not in the same place where I was during IVF/ICSI #1. It’s OK though; at least work is not suffering that much this time.