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Price List - INVICTA Fertility Clinics

Table of contents page

Preliminary diagnostic and consultations 2

Intrauterine insemination (IUI) 3

Intrauterine insemination (AID) 3

IVF Standard Program 4

IVF Optimum Program 5

IVF All Inclusive Program 6

IVF All Inclusive Genetics NGS Program 7

IVF Embryo Freezing Program 8

IVF Embryo Freezing Program 9

IVF Egg Freezing Program (fertility preservation) 10

IVF All Inclusive Egg Donation Programs 11-13

IVF All Inclusive N Program (natural cycle) 14

IVF All Inclusive Embryo Donation Program 15

IVF Program from Thawed Eggs (ICSI - CRIO) 15

IVF ETM - Frozen Embryo Transfer 16-17

Additional procedures & Cryopreservation 18-19

Individual screening tests 20-21

Laboratory tests packages for IVF All Inclusive Programs 22

IVF medications packages for IVF All Inclusive Programs 23

Additional informations 24

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 1 / 24
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Price List - INVICTA Fertility Clinics
Preliminary diagnostic & consultations
Consultations and Preliminary diagnostics Price PLN

Consultations and Gynaecology scanning


Gdansk, Wroclaw 200
Medical consultation with ultrasound (fertility specialist)
Warsaw 230

Gdansk, Wroclaw 400


Medical consultation with ultrasound (fertility specialist) / Krzysztof Łukaszuk, MD Ph. D.
Warsaw 430

Gdansk, Wroclaw 600


USG-HSG
Warsaw 850

Online consultation - phone (fertility specialist) 160-210

Gdansk, Wroclaw 180


Genetic consultation
Warsaw 200

Genetic consultation - phone 210

Anesthetic consultation 120

Preliminary diagnostic

Karyotype 385

Gdansk, Wroclaw
Initial test panel including AMH (female) 689
Warsaw 801

Sperm Analysis - Computer Assisted Sperm Analysis - CASA 120

Sperm DNA Fragmentation 530

More screening tests & hormonal assessments during treatment see page 20-21

Important:
Please collect your previous infertility treatment records and consult us
on any further diagnostics that may need to be performed before the the 1st visit.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 2 / 24
This document is the property of INVICTA Sp. z o.o. All rights reserved. INV.Z.KLN.10.KM.M.ENG.02_06
Price List - INVICTA Fertility Clinics
Intrauterine insemination (IUI)
INTRAUTERINE INSEMINATION OF SPERM FROM A PARTNER (IUI) Price PLN

✓ Sperm preparation
800
✓ Insemination

Additional procedures (if applicable):

Visit with ultrasound assessment (approx. 2 visits required) see page 2


Gdansk 211
Laboratory tests (PD8 and PD4 see page 22) (approx.)
Warsaw 277

Medications (approx.) 200-500

Screening tests prior to treatment & any hormonal assessments during treatment see page 20-21

Intrauterine insemination (AID)


INTRAUTERINE INSEMINATION OF DONOR SPERM (AID) Price PLN

✓ Donor sperm from INVICTA European Genetic Sperm Bank


✓ Sperm preparation 1.500
✓ Insemination

Additional procedures (if applicable):

Visit with ultrasound assessment (approx. 2 visits required) see page 2

Gdansk 211
Laboratory tests (PD8 and PD4 see page 22) (approx.)
Warsaw 277

Medications (approx.) 200-500

Screening tests prior to treatment & any hormonal assessments during treatment see page 20-21

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 3 / 24
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Price List - INVICTA Fertility Clinics
Standard IVF Program
STANDARD IVF PROGRAM Price PLN

✓ Stimulation – visits with ultrasound from 8th day of stimulation till the embryo transfer
✓ Hormonal examinations from 8th day of stimulation (PD4)
✓ Eggs collection with ultrasound (pick up)
✓ Semen preparation 6.500
✓ Embryo transfer (ET)
✓ Consultations with midwives
✓ Follow up medical consultation in the event of a negative outcome
The price does not include medications and other necessary visits.

Additional procedures (where applicable):

Visit with ultrasound assessment (approx. 2 visits required) see page 2

Anesthetic consultation (required) 120

General anesthesia for eggs collection procedure (recommended) 370

ICSI (recommended) 900

PICSI 550

IMSI-MSOME 550

Blastocyst culture (recommended) 500

AH - assisted hatching (recommended) 550

FAMSI 950

Implantation supervision after embryo transfer 450

Semen separation 1.100

Testicular biopsy under anesthesia (TESA/PESA) 1.500

Embryo Glue 320

Extended embryo monitoring – embryoscope (Gdansk clinic only) 850

Donor sperm (from INVICTA European Genetic Sperm Bank) 500

Cryopreservation see page 18-19

IVF medications (required)(approx.) 600 – 4.800

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 4 / 24
This document is the property of INVICTA Sp. z o.o. All rights reserved. INV.Z.KLN.10.KM.M.ENG.02_06
Price List - INVICTA Fertility Clinics
IVF Optimum Program
Price PLN

IVF OPTIMUM PROGRAM (without medications) 9.300

IVF OPTIMUM+ PROGRAM (with IVF medications without limits) 13.000

Programs include:

✓ Visits - ultrasound assessments during treatment cycle


✓ IVF medications without limits (L1 and/or L2) see page 23
✓ All tests during treatment cycle including:
Laboratory tests prior to egg collection surgery (anesthesia) (PD3); Stimulation
control - 8th day of stimulation tests (PD4); Laboratory tests prior to egg collection
surgery (pick up) (PD5);
see page 22
✓ Anesthetic consultation
✓ General anesthesia for eggs collection procedure
✓ Eggs collection with ultrasound (Pick up)
✓ Semen preparation
✓ ICSI
✓ Blastocyst culture
✓ Embryotransfer (ET)
✓ Embryos freezing (vitrification) and one year storage
✓ Follow up medical consultation in the event of a negative outcome

Additional procedures (where applicable):

Initial consultation with ultrasound (required) see page 2

PICSI 550

IMSI-MSOME 550

AH (assisted hatching) 550

FAMSI 950

Implantation supervision after embryo transfer 450

Semen separation 1.100

Testicular biopsy under anesthesia (TESA/PESA) 1.500

Embryo Glue 320

Extended embryo monitoring – embryoscope (Gdansk clinic only) 850

Donor sperm (from INVICTA European Genetic Sperm Bank) 500

PGS-NGS 360 – Preimplantation Genetic Screening of all Chromosomes 5.990

More screening tests & hormonal assessments during treatment see page 20-21

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 5 / 24
This document is the property of INVICTA Sp. z o.o. All rights reserved. INV.Z.KLN.10.KM.M.ENG.02_06
Price List - INVICTA Fertility Clinics
IVF All Inclusive Program
Price PLN

IVF ALL INCLUSIVE PROGRAM (without medications) 11.300

IVF ALL INCLUSIVE+ PROGRAM (with IVF medications without limits) 15.000

Programs include:

✓ Visits - ultrasound assessments during treatment cycle and consultations with


midwives
✓ IVF medications without limits (L1 and/or L2)
see page 23
✓ All tests during treatment cycle including:
Laboratory tests prior to egg collection surgery (anesthesia) (PD3); Stimulation
control - 8th day of stimulation tests (PD4); Laboratory tests prior to egg collection
surgery (pick up) (PD5); Laboratory tests- after embryo transfer (PD6)
see page 22
✓ Anesthetic consultation
✓ General anesthesia for eggs collection procedure
✓ Eggs collection with ultrasound (Pick up)
✓ Semen preparation
✓ ICSI
✓ Blastocyst culture
✓ AH (assisted hatching)
✓ IMSI-MSOME / FAMSI / Donor sperm (from INVICTA European Genetic Sperm Bank)
- one procedure for selection in accordance with medical indications
✓ Embryo Glue
✓ Embryotransfer (ET)
✓ Embryos freezing (vitrification) and one year storage
✓ Implantation supervision
✓ Follow up medical consultation in the event of a negative outcome

Additional procedures (where applicable):

Initial consultation with ultrasound (required) see page 2

Semen separation 1.100

Testicular biopsy under anesthesia (TESA/PESA) 1.500

PICSI 550

Extended embryo monitoring – embryoscope (Gdansk clinic only) 850

More screening tests & hormonal assessments during treatment see page 20-21

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 6 / 24
This document is the property of INVICTA Sp. z o.o. All rights reserved. INV.Z.KLN.10.KM.M.ENG.02_06
Price List - INVICTA Fertility Clinics
IVF All Inclusive Genetics NGS Program
Price PLN

IVF ALL INCLUSIVE GENETICS NGS PROGRAM (without medications) From 20.770

IVF ALL INCLUSIVE GENETICS NGS+ PROGRAM (with IVF medications without limits) From 25.170

Programs include:

✓ Visits - ultrasound assessments during treatment cycle and consultations with


midwives
✓ IVF medications without limits (L1 and/or L1A)
see page 23
✓ All tests during treatment cycle including:
Laboratory tests prior to egg collection surgery (anesthesia) (PD3); Stimulation
control - 8th day of stimulation tests (PD4); Laboratory tests prior to egg collection
surgery (pick up) (PD5); Laboratory tests- after embryo transfer (PD6), Laboratory
tests before frozen embryo transfer (PD7)
see page 22
✓ Anesthetic consultation
✓ General anesthesia for eggs collection procedure
✓ Eggs collection with ultrasound (Pick up)
✓ Semen preparation
✓ ICSI
✓ Blastocyst culture
✓ AH (assisted hatching)
✓ IMSI-MSOME / FAMSI / Donor sperm (from INVICTA European Genetic Sperm Bank)
- one procedure for selection in accordance with medical indications
✓ Embryo Glue
✓ PGS-NGS 360 – Preimplantation Genetic Screening of all Chromosomes
✓ Frozen embryo transfer
✓ Embryos freezing (vitrification) and one year storage
✓ Implantation supervision
✓ Follow up medical consultation in the event of a negative outcome

Additional procedures (where applicable):

Initial consultation with ultrasound (required) see page 2

Genetic consultation see page 2

Semen separation 1.100

Testicular biopsy under anesthesia (TESA/PESA) 1.500

PICSI 550

Extended embryo monitoring – embryoscope (Gdansk clinic only) 850

More screening tests & hormonal assessments during treatment see page 20-21

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 7 / 24
This document is the property of INVICTA Sp. z o.o. All rights reserved. INV.Z.KLN.10.KM.M.ENG.02_06
Price List - INVICTA Fertility Clinics
IVF Embryo Freezing Program
Price PLN

IVF EMBRYO FREEZING PROGRAM (without medications) 10.390

IVF EMBRYO FREEZING+ PROGRAM (with medications) 13.990

Programs include:

✓ Visits - ultrasound assessments during treatment cycle and consultations with


midwives
✓ IVF medications without limits (L2 and/or L2A)
see page 23
✓ All tests during treatment cycle including:
Laboratory tests prior to egg collection surgery (anesthesia) (PD3); Stimulation
control - 8th day of stimulation tests (PD4); Laboratory tests prior to egg collection
surgery (pick up) (PD5);
see page 22
✓ Anesthetic consultation
✓ General anesthesia for eggs collection procedure
✓ Eggs collection with ultrasound (Pick up)
✓ Semen preparation
✓ ICSI
✓ Blastocyst culture
✓ Biopsy of fresh embryos
✓ Biopsy material freezing
✓ Embryos freezing (vitrification) and one year storage
✓ Follow up medical consultation in the event of a negative outcome

Additional procedures (where applicable):

Initial consultation with ultrasound (required) see page 2

Semen separation 1.100

Testicular biopsy under anesthesia (TESA/PESA) 1.500

PICSI 550

FAMSI 950

IMSI-MSOME 550

PGS-NGS 360 – Preimplantation Genetic Screening of all Chromosomes 5.990

More screening tests & hormonal assessments during treatment see page 20-21

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 8 / 24
This document is the property of INVICTA Sp. z o.o. All rights reserved. INV.Z.KLN.10.KM.M.ENG.02_06
Price List - INVICTA Fertility Clinics
IVF Embryo Freezing Program (N)
Price PLN

IVF EMBRYO FREEZING PROGRAM (N) (without medications) 8.600

IVF EMBRYO FREEZING+ PROGRAM (N) (with medications) 12.200

Programs include:

✓ Visits - ultrasound assessments during treatment cycle and consultations with


midwives
✓ IVF medications without limits (L2 and/or L2A)
see page 23
✓ All tests during treatment cycle including:
Laboratory tests prior to egg collection surgery (anesthesia) (PD3); Stimulation
control - 8th day of stimulation tests (PD4); Laboratory tests prior to egg collection
surgery (pick up) (PD5);
see page 22
✓ Anesthetic consultation
✓ General anesthesia for eggs collection procedure
✓ Eggs collection with ultrasound (Pick up)
✓ Semen preparation
✓ ICSI
✓ Blastocyst culture
✓ Embryos freezing (vitrification) and one year storage
✓ Follow up medical consultation in the event of a negative outcome

Additional procedures (where applicable):

Initial consultation with ultrasound (required) see page 2

Semen separation 1.100

Testicular biopsy under anesthesia (TESA/PESA) 1.500

PICSI 550

FAMSI 950

IMSI-MSOME 550

PGS-NGS 360 – Preimplantation Genetic Screening of all Chromosomes 5.990

More screening tests & hormonal assessments during treatment see page 20-21

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 9 / 24
This document is the property of INVICTA Sp. z o.o. All rights reserved. INV.Z.KLN.10.KM.M.ENG.02_06
Price List - INVICTA Fertility Clinics
IVF Egg Freezing Program (fertility preservation)
Price PLN

IVF EGG FREEZING PROGRAM (without medications) 5.700

IVF EGG FREEZING+ PROGRAM (with IVF medications) 9.300

Program include:

✓ Visits - ultrasound assessments during treatment cycle and consultations with


midwives
✓ IVF medications without limits (L2 and/or L2A)
see page 23
✓ All tests during treatment cycle including:
Laboratory tests prior to egg collection surgery (anesthesia) (PD3); Stimulation
control - 8th day of stimulation tests (PD4); Laboratory tests prior to egg collection
surgery (pick up) (PD5);
see page 22
✓ Anesthetic consultation
✓ General anesthesia for eggs collection procedure
✓ Eggs collection with ultrasound (Pick up)
✓ Eggs freezing (vitrification) and one year storage
✓ Follow up medical consultation in the event of a negative outcome

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 10 / 24
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Price List - INVICTA Fertility Clinics
IVF All Inclusive Egg Donation Programs
Fresh eggs from donor > fresh embryo transfer
synchronized cycle
Price PLN

IVF ED ALL INCLUSIVE FRESH S 19.600

IVF ED ALL INCLUSIVE FRESH S TOTAL 25.000

Programs include:

✓ Donor’s selection (including all necessary tests and medications for the donor)
✓ Eggs collection from a donor with ultrasound (Pick up)
✓ Visits - ultrasound assessments during treatment cycle and consultations with
midwives
✓ IVF medications (L3)
see page 23
✓ All tests during treatment cycle including:
Laboratory tests- after embryo transfer (PD6), Laboratory tests before embryo
transfer (PD7)
see page 22
✓ Sperm preparation and freezing
✓ ICSI
✓ Blastocyst culture
✓ AH (assisted hatching)
✓ IMSI-MSOME / FAMSI / Donor sperm (from INVICTA European Genetic Sperm Bank)
- one procedure for selection in accordance with medical indications
✓ Embryo Glue
✓ Embryo transfer
✓ Implantation supervision (3 verifications)
✓ Follow up medical consultation in the event of a negative outcome

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 11 / 24
This document is the property of INVICTA Sp. z o.o. All rights reserved. INV.Z.KLN.10.KM.M.ENG.02_06
Price List - INVICTA Fertility Clinics
IVF All Inclusive Egg Donation Programs
Fresh eggs from donor > frozen embryo transfer
non-synchronized cycle
Price PLN

IVF ED ALL INCLUSIVE FRESH NS 18.600

IVF ED ALL INCLUSIVE FRESH NS TOTAL 24.000

Programs include:

✓ Donor’s selection (including all necessary tests and medications for the donor)
✓ Eggs collection from a donor with ultrasound (Pick up)
✓ Visits - ultrasound assessments during treatment cycle and consultations with
midwives
✓ IVF medications (L3)
see page 23
✓ All tests during treatment cycle including:
Laboratory tests- after embryo transfer (PD6), Laboratory tests before frozen embryo
transfer (PD7)
see page 22
✓ Sperm preparation and freezing
✓ ICSI
✓ Blastocyst culture
✓ AH (assisted hatching)
✓ IMSI-MSOME / FAMSI / Donor sperm (from INVICTA European Genetic Sperm Bank)
- one procedure for selection in accordance with medical indications
✓ Embryo Glue
✓ Frozen embryo transfer
✓ Implantation supervision (3 verifications)
✓ Follow up medical consultation in the event of a negative outcome

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 12 / 24
This document is the property of INVICTA Sp. z o.o. All rights reserved. INV.Z.KLN.10.KM.M.ENG.02_06
Price List - INVICTA Fertility Clinics
IVF All Inclusive Egg Donation Programs
Frozen eggs from Bank > frozen or fresh embryo transfer
Price PLN

IVF ED ALL INCLUSIVE FROZEN 17.000

IVF ED ALL INCLUSIVE FROZEN TOTAL 22.500

Programs include:

✓ Donor’s selection (including all necessary tests and medications for the donor)
✓ Frozen oocytes from European Genetic Egg Bank INVICTA
✓ Visits - ultrasound assessments during treatment cycle and consultations with
midwives
✓ IVF medications (L3)
see page. 23
✓ All tests during treatment cycle including:
Laboratory tests- after embryo transfer (PD6), Laboratory tests before embryo
transfer (PD7)
see page 22
✓ Sperm preparation and freezing
✓ ICSI
✓ Blastocyst culture
✓ AH (assisted hatching)
✓ IMSI-MSOME / FAMSI / Donor sperm (from INVICTA European Genetic Sperm Bank)
- one procedure for selection in accordance with medical indications
✓ Embryo Glue
✓ Embryo transfer / Frozen embryo transfer
✓ Implantation supervision (3 verifications)
✓ Follow up medical consultation in the event of a negative outcome

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 13 / 24
This document is the property of INVICTA Sp. z o.o. All rights reserved. INV.Z.KLN.10.KM.M.ENG.02_06
Price List - INVICTA Fertility Clinics
IVF All Inclusive N Program (natural cycle)
Price PLN

IVF ALL INCLUSIVE N (natural cycle) 8.300


✓ Visits - ultrasound assessments during treatment cycle and consultations with
midwives
✓ All tests during treatment cycle including:
Laboratory tests prior to egg collection surgery (anesthesia) (PD3); Stimulation
control - 8th day of stimulation tests (PD4); Laboratory tests prior to egg collection
surgery (pick up) (PD5);
see page 22
✓ Anesthetic consultation
✓ General anesthesia for eggs collection procedure
✓ Eggs collection with ultrasound (Pick up)
✓ Semen preparation
✓ ICSI
✓ Blastocyst culture
✓ Embryo transfer
✓ Follow up medical consultation in the event of a negative outcome

Additional procedures (where applicable):

Initial consultation with ultrasound (required) see page 2

PICSI 550

IMSI-MSOME 550

AH (assisted hatching) 550

FAMSI 950

Implantation supervision after embryo transfer 450

Semen separation 1.100

Testicular biopsy under anesthesia (TESA/PESA) 1.500

Embryo Glue 320

Extended embryo monitoring – embryoscope (Gdansk clinic only) 850

Donor sperm (from INVICTA European Genetic Sperm Bank) 500

PGS-NGS 360 – Preimplantation Genetic Screening of all Chromosomes 5.990

More screening tests & hormonal assessments during treatment see page 20-21

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 14 / 24
This document is the property of INVICTA Sp. z o.o. All rights reserved. INV.Z.KLN.10.KM.M.ENG.02_06
Price List - INVICTA Fertility Clinics
IVF All Inclusive Embryo Donation Program
Embryos from INVICTA Genetic Bank of Eggs and Embryos
Price PLN

IVF ALL INCLUSIVE EMBRYO DONATION (without medications) 6.900

IVF ALL INCLUSIVE EMBRYO DONATION+ (with IVF medications) 7.800

Programs include:

✓ Embryo from INVICTA Embryo Bank


✓ Visits - ultrasound assessments during treatment cycle and consultations with
midwives
✓ IVF medications (L3) see page 23
✓ All tests during treatment cycle including:
Laboratory tests before frozen embryo transfer (PD7) see page 22
✓ AH (assisted hatching)
✓ Frozen embryo transfer
✓ Follow up medical consultation in the event of a negative outcome

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

IVF Program from Thawed Eggs (ICSI - CRIO)


Price PLN

IVF ICSI CRIO (without medications) 8.200

IVF ICSI CRIO+ (with IVF medications) 9.000

Programs include:

✓ Visits - ultrasound assessments during treatment cycle and consultations with


midwives
✓ IVF medications (L3) see page 23
✓ All tests during treatment cycle including:
Laboratory tests before frozen embryo transfer (PD7) see page 22
✓ Semen preparation
✓ ICSI
✓ AH (assisted hatching)
✓ Embryo transfer
✓ Embryos freezing (vitrification) and one year storage
✓ Follow up medical consultation in the event of a negative outcome

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 15 / 24
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Price List - INVICTA Fertility Clinics
IVF ETM - Frozen Embryo Transfer
Price PLN

IVF ETM STANDARD (without medications) 1.800

IVF ETM STANDARD+ (with IVF medications) 2.650

Programs include:

✓ Visits - ultrasound assessments during treatment cycle and consultations with


midwives
✓ IVF medications (L3)
see page 23
✓ Frozen embryo transfer
✓ Follow up medical consultation in the event of a negative outcome

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Price PLN

IVF ETM OPTIMUM (without medications) 3.100

IVF ETM OPTIMUM+ (with IVF medications) 3.900

Programs include:

✓ Visits - ultrasound assessments during treatment cycle and consultations with


midwives
✓ IVF medications (L3)
see page 23
✓ All tests during treatment cycle including:
Laboratory tests before frozen embryo transfer (PD7)
see page 22
✓ AH (assisted hatching)
✓ Frozen embryo transfer
✓ Follow up medical consultation in the event of a negative outcome

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 16 / 24
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Price List - INVICTA Fertility Clinics

Price PLN

IVF ETM (without medications) 4.300

IVF ETM+ (with IVF medications) 5.100

Programs include:

✓ Visits - ultrasound assessments during treatment cycle and consultations with


midwives
✓ IVF medications (L3)
see page 23
✓ All tests during treatment cycle including:
Laboratory tests before frozen embryo transfer (PD7), Laboratory tests - verifications
after embryo transfer (PD6)
see page 22
✓ AH (assisted hatching)
✓ EmbryoGlue
✓ Frozen embryo transfer
✓ Implantation supervision after embryo transfer
✓ Follow up medical consultation in the event of a negative outcome

Payments and refunds: Payment must be received in full max 7 days after the first visit in clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 17 / 24
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Price List - INVICTA Fertility Clinics
Additional Procedures
Additional procedures Price PLN

General anesthesia for eggs collection procedure 370

ICSI 900

PICSI 550

IMSI-MSOME 550

Blastocyst culture 500

AH - assisted hatching 550

FAMSI 950

Semen separation 1.100

Testicular biopsy under anesthesia (TESA/PESA) 1.500

Embryo Glue 320

Extended embryo monitoring – embryoscope (Gdansk clinic only) 850

Donor sperm (from INVICTA European Genetic Sperm Bank) 500

Implantation supervision after embryo transfer 450

Cryopreservation Price PLN

Sperm freezing for testicular biopsy deposit + 1 year storage 600

Eggs freezing + 1 year storage 900


Annual storage fee (after the first year) 400

Semen freezing + 1 year storage 600


Annual storage fee (after the first year) 400

Embryo freezing + 1 year storage 800


Annual storage fee (after the first year) 400

Sperm freezing Price PLN

✓ Semen freezing + 1 year storage 600

Additional Procedures

Sperm Analysis 120

Infectious tests (PD2) see page 22

Annual storage fee (after the first year) 400

Testicular biopsy Price PLN

✓ Testicular biopsy under anesthesia (TESA/PESA) 1.500

Additional Procedures

Anesthetic consultation 120

Laboratory tests prior to surgery (anesthesia) (PD3); Infectious tests (PD2) see
page 22

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 18 / 24
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Price List - INVICTA Fertility Clinics
Hysteroscopy Price PLN

✓ Diagnostic hysteroscopy Gdansk 1.200

✓ Hysteroscopy OFFICE Warsaw 3.500 – 4.500

✓ Operating hysteroscopy Warsaw 3.300

Additional Procedures

Anesthetic consultation 120

Gdansk, Wroclaw 168


Laboratory tests prior to surgery (anesthesia) (PD3) see page 22
Warsaw 212

Histopathological examination 110

Laparoscopy
✓ Laparoscopy with anesthesia Warsaw 4.850

Additional Procedures

Anesthetic consultation 120

Gdansk, Wroclaw 168


Laboratory tests prior to surgery (anesthesia) (PD3) see page 22
Warsaw 212

Others
UMA Test (Uterine Muscle Activity Test) 200

Ovarian Rejuvenation with PRP (autologous platelet-rich plasma) 3.000

Endometrium activation with PRP (autologous platelet-rich plasma) 1.200

Atosiban intravenous infusion (prevention of excessive uterine


500-700
contractility)

Intralipid intravenous infusion (immunological factor therapy) 700

Autologous platelet - rich plasma (PRP) endometrial treatment 1.000

Individual screening tests


Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 19 / 24
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Price List - INVICTA Fertility Clinics
SPERM ANALYSIS Price PLN

Sperm Analysis - Computer Assisted Sperm Analysis - CASA 120

Sperm morphology 66

Sperm DNA Fragmentation 530

HOS - Hypo-osmotic swelling sperm test 165

MSOME - Motile Sperm Organelle Morphology Examination 165

Hyaluronan sperm binding test 275

HORMONAL TESTS
Gdansk, Wroclaw 150
AMH - Anti-Muellerian hormone
Warsaw 170

Gdansk, Wroclaw 150


Inhibin B
Warsaw 170

Gdansk, Wroclaw 32
FSH - follicle stimulating hormone
Warsaw 43

Gdansk, Wroclaw 32
E2 - estradiol
Warsaw 43

Gdansk, Wroclaw 32
PRG - progesterone
Warsaw 43

Gdansk, Wroclaw 32
LH - luteinizing Hormone
Warsaw 43

Gdansk, Wroclaw 29
TSH - stimulating hormone
Warsaw 33

Gdansk, Wroclaw 37
B-HCG - chorionic gonadotropin - beta subunit
Warsaw 44

TST - testosterone 50

SHBG - binding protein hormone 58

DHEA-SO4–dehydroepiandrosterone sulfate 49

Gdansk, Wroclaw 39
Anti-TPO - thyroid peroxidase antibodies
Warsaw 49

Gdansk, Wroclaw 61
MTCx2 - metoclopramide test x 2
Warsaw 86

INFECTIOUS TESTS & OTHER


Gdansk, Wroclaw 21
Hepatitis B virus - (HBV) - HBc Antibody (HBsAg)
Warsaw 37

Gdansk, Wroclaw 47
Hepatitis B virus - (HBV) - HBc Antibody (anti HBc)
Warsaw 55

Gdansk, Wroclaw 42
Hepatitis C (HCV) - antibody (anti-HCV)
Warsaw 44

Rubella virus (Rubella virus) - IgG 44

Rubella virus (Rubella virus) - IgM 44

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 20 / 24
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Price List - INVICTA Fertility Clinics
Gdansk, Wroclaw 31
Toxoplasma gondi - IgG antibody (anti-ToxoIgG)
Warsaw 38

Gdansk, Wroclaw 31
Toxoplasma gondi - IgM antibody (anti-ToxoIgM)
Warsaw 38

Cytomegalovirus (CMV) - IgG antibody (anti-CMV IgG) 44

Cytomegalovirus (CMV) - IgM antibody (anti-CMV IgM) 44

Chlamydia trachomatis – DNA detection 209

Gdansk, Wroclaw 8
Syphilis test (VDRL)
Warsaw 16

Gdansk, Wroclaw 37
Immunodeficiency virus (HIV) - antigen HIV1/HIV2 + antigen p24
Warsaw 44

Gdansk, Wroclaw 55
Determination of blood group and Rh factor
Warsaw 60

GENETIC TESTS

Karyotype 385

Leiden Factor V and prothrombin gene II 550

AZF 275

CFTR (2) 275

CFTR (33) 880

MTHFR 275

IMMUNOLOGICAL TESTS

Gdansk, Wroclaw 102


Protein C
Warsaw 110

Gdansk, Wroclaw 124


Protein S
Warsaw 132

Cardiolipin Antibodies IgG 77

Cardiolipin Antibodies IgM 77

Glycoprotein Antibodies IgG 93

Glycoprotein Antibodies IgM 93

Lupus anticoagulant 132

Homocysteine 61

Gdansk, Wroclaw 308


T lymphocytes subpopulation NK
Warsaw 328

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 21 / 24
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Price List - INVICTA Fertility Clinics
Laboratory tests packages
LABORATORY TESTS PACKAGES

(PD1) Infectious laboratory tests - female patient


- Gdańsk, Wrocław (609 PLN), Warszawa (664 PLN)
Hepatitis B virus (HBV) - HBs antigen (HBsAg); Hepatitis B virus (HBV) - HBc antibodies (anti Hbc); Hepatitis C
(HCV) - antibody (anti-HCV); Immunodeficiency virus (HIV) – antibodies HIV1/HIV2 + antigen p24; Syphilis test
(VDRL); Chlamydia trachomatis – detekcja DNA; Rubella virus (Rubella virus) – IgG antibodies; Rubella virus
(Rubella virus) – IgM antibodies; Toxoplasma gondi - IgG antibodies (anti-ToxoIgG); Toxoplasma gondi - IgM
antibodies (anti-ToxoIgM); Cytomegalovirus (CMV) - IgG antibodies (anti-CMV IgG); Cytomegalovirus (CMV) -
IgM antibodies (anti-CMV IgM);

(PD1Z) Infectious laboratory tests - female patient


- Gdańsk, Wrocław (459 PLN), Warszawa (500 PLN)
Hepatitis B virus (HBV) - HBs antigen (HBsAg); Hepatitis B virus (HBV) - HBc antibodies (anti Hbc); Hepatitis C
(HCV) - antibody (anti-HCV); Immunodeficiency virus (HIV) – antibodies HIV1/HIV2 + antigen p24; Syphilis test
(VDRL); Chlamydia trachomatis – detekcja DNA; Cytomegalovirus (CMV) - IgG antibodies (anti-CMV IgG);
Cytomegalovirus (CMV) - IgM antibodies (anti-CMV IgM);

(PD2) Infectious laboratory tests- male patient


- Gdańsk, Wrocław (459 PLN), Warszawa (500 PLN)
Hepatitis B virus (HBV) - HBs antigen (HBsAg); Hepatitis B virus (HBV) - HBc antibody (anti Hbc); Hepatitis C
(HCV) - antibody (anti-HCV); Immunodeficiency virus (HIV) – antibodies HIV1/HIV2 + antigen p24; Syphilis test
(VDRL); Chlamydia trachomatis – detekcja DNA; Cytomegalovirus (CMV) - IgG antibodies (anti-CMV IgG);
Cytomegalovirus (CMV) - IgM antibodies (anti-CMV IgM);

(PD3) Laboratory tests surgery (anesthesia)


- Gdańsk, Wrocław (168 PLN), Warszawa (212 PLN)
Urine examination; Peripheral blood morphology - 22 parameters (5 diff); The erythrocyte sedimentation rate of
red blood cells (ESR) - citrate blood 1; Glucose in Serum; Serum Sodium; Serum Potassium; Kaolin-activated
partial thromboplastin time (aPTT); Prothrombin time (PT); Fibrinogen; Serum Creatinine; Serum Urea;
Determination of blood group and Rh factor

(PD4) Laboratory tests - stimulation control - 8th day of stimulation


- Gdańsk, Wrocław (96 PLN), Warszawa (129 PLN)
Estradiol (E2); Luteinizing hormone (LH); Progesterone (PRG)

(PD5) Laboratory tests prior to egg collection (pick up)


- Gdańsk, Wrocław (48 PLN), Warszawa (60 PLN)
Peripheral blood morphology-22 parameters (5diff); Progesterone (PRG)

(PD6) Laboratory tests - verifications after embryo transfer


- Gdańsk, Wrocław (101 PLN), Warszawa (130 PLN)
Estradiol (E2); Chorionic gonadotropin - beta subunit - (B-HCG); Progesterone (PRG)

(PD7) Laboratory tests before embryo transfer


- Gdańsk, Wrocław (96 PLN), Warszawa (129 PLN)
Estradiol (E2); Luteinizing hormone (LH); Progesterone (PRG)

(PD8) Infectious tests - before IUI (for man) and before AID (for woman)
- Gdańsk, Wrocław (48 PLN), Warszawa (60 PLN)
Hepatitis B virus (HBV) - HBs antigen (HBsAg); Hepatitis C (HCV) - antibody (anti-HCV); Syphilis test (VDRL);
Immunodeficiency virus (HIV) - antigen HIV1/HIV2 + antigen p24IgG);

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 22 / 24
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Price List - INVICTA Fertility Clinics
IVF medications packages for All Inclusive IVF Programs
IVF MEDICATIONS PACKAGES

IVF Programs - medications package per one IVF cycle

Medications package per one IVF cycle including agonist (L1)


▪ Gonapeptyl (Decapeptyl, Dipherelina) One L1 or L1A
▪ Gonadotropins (Menopur, Puregon,GonalF,Fostimon,Merional) package for selection
▪ Ovitrelle (Choragon, Pregnyl) in accordance with
▪ Lutinus (2 op.) medical prescription.
In exceptional cases,
Medications package per one IVF cycle including antagonist (L1A) it may be necessary
for the doctor to
▪ Cetrotide replace the drugs
▪ Gonadotropins (Menopur, Puregon,GonalF,Fostimon,Merional) between packages.
▪ Ovitrelle(Choragon, Pregnyl)
▪ Lutinus (2 op.)

Egg freezing - medications package per one IVF cycle

Medications package per one IVF cycle including agonist (L2)


One L2 or L2A
▪ Gonapeptyl (Decapeptyl, Dipherelina) package for selection
▪ Gonadotropins (Menopur, Puregon,GonalF,Fostimon,Merional) in accordance with
▪ Ovitrelle (Choragon, Pregnyl) medical prescription.
In exceptional cases,
Medications package per one IVF cycle including antagonist (L2A) it may be necessary
for the doctor to
▪ Cetrotide replace the drugs
▪ Gonadotropins (Menopur, Puregon,GonalF,Fostimon,Merional) between packages.
▪ Ovitrelle(Choragon, Pregnyl)

ETM – frozen embryo transfer, biorstwo komórek jajowych - medications package per one IVF cycle

Medications package per one IVF cycle including agonist (L3)


▪ Estrofem
▪ Lutinus

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 23 / 24
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Price List - INVICTA Fertility Clinics
Additional informations

All fees for services performed in INVICTA must be paid in full


on or before the day when execution of program or service begins.
Cash and credit card payments are only accepted at the reception cash desk.
Accepted payment methods: cash (PLN only), VISA and MasterCard cards, bank transfer

Bank transfer payments:


please provide the first and last name of the patient for whom the service will be
executed together with an id and name of the service or program as a transfer title.

Payment must be made in full in accordance with current INVICTA Price List. Before the
payment is made please check the Price list for current prices.

Please cancel or reschedule the time of the service execution not later than 24 hours
before the agreed date of the beginning of the program/service, otherwise you may be
charged for the planned program/service.

NR KONTA

PKO BP SA O/Gdynia, 02 1020 1853 0000 9502 0067 5769 INVICTA GDANSK

PKO BP SA O/Gdynia, 60 1020 1853 0000 9002 0117 6460 INVICTA WARSZAWA

PKO BP SA O/Gdynia, 35 1020 1811 0000 0402 0253 5326 INVICTA WROCLAW

Price list does not constitute an offer to sell and is for information purposes only.
Prices are subject to change based on the currency exchange rate.

Price list is reviewed quarterly.


You will be expected to pay the full cost of all procedures
prior to starting treatment at the clinic.

Patients signatures: female…………………………………partner…………………………………..

INVICTA Fertility Clinics


Gdansk, Warsaw, Wroclaw: T: +48 58 58 58 801, E:ivf@invicta.pl www.invictaclinics.com,
Release date: 17.04.2018. Price list does not constitute an offer to sell and is for information purposes only. Page 24 / 24
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