SSI Support in IVF Treatment
For IVF report, our patients are required to provide the following conditions published by the Social Security Institution. Our patients who have a report that indicates the treatment is appropriate can be treated in our clinic.
Social Security Institution Health Practice Communiqué (SUT 2012)
2.4.4.İ- Assisted Reproduction Method Treatments
(1) In-vitro fertilization procedures (IVF) are considered as "assisted reproduction methods" defined in 63rd article of the law no. 5510. Ovulation induction (OI) and intrauterine insemination (IUI) are not evaluated in this context.
2.4.4.İ.1- In-vitro Fertilization (IVF)
Couples who are married and do not have children in their current marriage (except adopted children) and have general health insurance; the costs of IVF treatments (limited to a maximum of three trials (cycles)) belong to the woman herself and the wife to whom the man is obliged to care are covered by the institution if the following conditions are met.
a) The fact that after medical treatments, the health board report has been issued that she cannot have children with normal medical methods and that she can have children only by assisted reproductive method,
b) Over 23 years of age, under 39 years of age,
c) The center where the application is made is contracted / protocoled with the institution,
d) Having a general health insurance for at least five years or being a dependent person and having 900 premium days for general health insurance, or her partner providing the necessary conditions if the woman with general health insurance does not carry the conditions in this bench,
e) Documentation by the contracted/protocolhealth boards with the institution that no results from other treatment methods have been obtained in the last three years.
(2) If the woman who started IVF treatment has passed her 40 on the date of IVF application (the date of embryo transfer), the costs of IVF treatment will not be covered by the institution. However, if a valid health report is found before the date the woman turns 40 and embryo transfer has been carried out within 30 days from the date of the report, the health services related to IVF treatment will be provided by the institution.
(3) IVF treatments, which are transferred to the institution and paid by social security institutions before, are taken into account in the calculation of the number of processes.
(4) In order to pay the IVF costs, it is sufficient to state in the health board report that there is no systemic disease that may prevent the continuation of pregnancy in the woman who will be undergoing IVF.
2.4.4.İ-1-1 - IVF Indications
1) Male factor: In spite of uro-andrological therapy, cases of oligoastenospermia and azoospermia in all three separate spermiograms performed at least 15 days apart, with the total number of progressive motil sperm less than 5 million. However, spermiogram results are not sought if a disease is documented by the relevant expert physician's report that shows that ejaculated sperm can’t be obtained by normal way.
2) Female factor:
a) Tubal factor: Cases with the presence of Primary Silier Dyskinesia-Carcigener Syndrome, bilateral complete tubal obstruction cases approved by laparoscopy (severe distal tubal disease, bilateral organic proximal tubal obstruction, bilateral tubal obstruction or lack of tube), cases that severe pelvic adhesion is observed or patients that could not conceive after tubal surgery (laparoscopy or open surgery).
b) Endometriosis: Mild to moderate endometriosis, advanced stage (stage 3-4) endometriosis.
c) Hormonal-Ovulatory Disorders: Cases that are unresponsive to standard treatment in anovulation in DSÖ Group I-II patients.
3) Unexplained Infertility: Inability to conceive for 3 years or more from the date of marriage, despite the normal examinations of both men and women and the application of at least two trials OI+IUI with gonadotropins.
4) Other Indications: Cases with poor ovarian response or low ovarian reserve.
2.4.4.İ-1-2 - IVF Medical Board Report
(1) Medical board report required for IVF treatment; it will be organized by third stage medical boards established with the participation of two obstetricians and obstetricians and a urology specialist in their institutions that have obstetrics clinic and urology clinic (including urology clinics, but urology specialists serve as consultants, including obstetrics and gynecology hospitals).
(2) In the medical board reports; patient age, credentials, diagnosis, indication, treatment to be applied will be specified, and the daily and maximum doses of the drugs to be used will also be included taking into account the provisions contained in article 4.2.42.B of SUT.
(3) In the medical board report;
a) For the male factor; in cases with a total progressive motile sperm count higher than 5 million in oligoastenozoospermia,"OI+IUI" treatment were applied twice with gonadotropin but could not be conceived (This condition is not sought in cases of oligoastenozoospermia with less than 5 million and azoospermia),
b) In patients with advanced stage (stage 3-4) endometriosis; that pregnancy could not be achieved for one year after the treatment of endometriosis surgery, or that pregnancy could not be achieved after "OI+IUI" treatment with gonadotropin, which was administered twice after surgical treatment,
c) In cases of mild to moderate endometriosis; that pregnancy cannot be achieved after at least two trials of gonadotropins with "OI+IUI" treatment,
d) In cases of unexplained infertility; It should be stated that pregnancy cannot be obtained after gonadotropin "OI+IUI" treatment,
which has been tried at least twice.
(a) In the presence of Primary Silier Dyskinesia-Carcigener Syndrome,
(b) Bilateral complete tubal obstruction cases approved by laparoscopy (severe distal tubal disease, bilateral organic proximal tubal obstruction, bilateral tubal obstruction or lack of tube),
(c) Cases that severe pelvic adhesion is observed or patients that could not conceive after tubal surgery (laparoscopy or open surgery).
(d) Cases that are unresponsive to standard treatment in anovulation in DSÖ Group I-II patients,
"OI and/or OI+IUI" treatment is not required before IVF, provided that the clinical and laboratory findings underlying the diagnosis are stated in the medical board report.
(5) If IVF is not carried out within 6 months from the date of the health board report, it should be re-issued. However, if the drugs are supplied during this period, the maximum dose is taken into account.
(6) A health board report must be issued for each IVF treatment.
2.4.4.İ-2 - IVF Treatment for the Birth of a Stem Cell Donor Sibling
(1) If the patient has a child and his treatment is not possible by any other medical method and is deemed medically compulsory, preimplantation genetic screening for the treatment of this child is intended for the birth of the appropriate stem cell donor sibling, and expenses related to IVF treatments carried out on behalf of the child patient by third stage medical boards with bone marrow transplantation centers, which specifies these conditions and is based on the report of the health board involving a geneticist, will be covered by the institution without applying the provisions of article 2.4.4.İ-1 of SUT. Apart from this condition, preimplantation genetic screening and IVF costs associated with this procedure are not covered by the institution.
(2) Families may apply to one of the contractual/protocoled assisted reproduction treatment centers (IVF centers) according to the report of the medical board.
(3) The provisions contained in article 4.2.42.C of SUT apply to drug doses determined by the Health Board report.
2.4.4.İ.1.3- Payment of IVF Treatment Fees
(1) IVF treatment is billed on the basis of the price specified in the EK-2/C list addition of SUT. At this price; ovulation follow-up, oocyte aspiration, sperm-oocyte preparation and incubation, ICSI (micro injection), methods of obtaining invasive sperm, examination and analysis costs performed on men and women before the procedure, the transfer of embryos and cost of consumables is included.
(2) The embryo freezing price can only be billed at the price listed on the EK-2/B list addition of SUT after the first attempt.
(3) In the event that IVF cannot be performed on the patient; processes made up to this time will be billed with a 10% discount on the EK-2/B list addition of SUT. In this case, these processes will not be included in the number of trials. However, the drugs used are taken into account as the maximum dose.
(4) If IVF treatment is performed by the transfer of the embryo freezing, the procedures will be billed through the "Transfer of the embryo with freezing" process which is included in the EK-2/C list addition of SUT. In this case, the process will be included in the number of trials.
(5) In births that occur more than once due to the transfer of more than one embryo, except in cases where the reason for age factor, embryo quality and similar medical necessity is documented by the physician who performs the application, the health service costs that will appear until the discharge of the babies are not covered by the institution. If the treatment of the infants concerned is carried out in a contracted/protocoled health service institution outside the health service provider that performs the embryo transfer process, the expenses are covered by the institution, but the costs paid are is deducted from the center that makes the transfer.
2.4.4.İ.1.4- Keeping Records
(1) In the assisted reproduction treatment centers contracted/protocoled with the Institution, it is compulsory to keep the record of any medical procedures performed under IVF and to submit the records held during the audit. Center manager and licensee are jointly responsible in keeping these records accurately and in a healthy manner.
2) Information on whether married couples have children, a valid population record sample for spouses, will be kept in the patient file held at the center.
Clinical application paperwork list of patients with SSI reports:
• IVF Delegation Report (original)
• Population registration sample (belonging to spouses)
• SSI premium payroll
• Photocopy of spouse’s ID
• Marriage certificate photocopy