Pros and Cons of IVF Refund (or Shared Risk) Programs

IVF refund programs offer the possibility of a full or partial refund if IVF treatment is not successful. These programs are sometimes called IVF shared risk because the clinic is also taking a risk that they will need to return some or all of the money. IVF is very expensive, and oftentimes, a couple can't afford to take a risk of IVF treatment and still afford adoption fees if things don't succeed. This is part of the appeal of refund packages.

Usually, an IVF refund package will ask for a flat fee for three to six cycles of IVF, though there are programs that offer a partial refund after just one cycle. The flat fee is typically (but not always) less than you’d pay if you were paying for each cycle individually. However, if you conceive after just one or even two cycles, you may pay more overall than you would have if you paid for one cycle at a time.

The refund programs are sometimes run by clinics themselves, and other times handled by an outside financial agency, which then provides the financing via associated fertility clinics.

Pros and Cons of IVF Shared Risk Programs

There are many factors to take into account before you decide whether or not an IVF refund program is right for you. Consider each of these pros and cons of participating.

Qualifying for an IVF Refund Program

Not just anyone can sign up for an IVF refund program. Every program has different qualifications, and they are unlikely to accept your application if your chances for success are low.

For example, many programs don’t allow women over 40 to participate. Others have a lower cut off, as young as 38. Also, if you have already gone through a number of failed IVF cycles, you may not qualify for a refund program.

Some programs offer donor egg refund programs, which could be an option for women 40 and up. But even for those programs, you need to meet qualifications to participate.

What’s the Catch?

IVF refund programs sound so great. If you don’t succeed, you get your money back! So… what’s the catch? Why would IVF clinics or financial programs offer a deal like this?

The fact of the matter is that since the offer is only given to couples with good chances for success, most will conceive before they use up their three or six already paid cycles. For those that conceive quickly, they will pay much more than if they had paid for the cycles individually.

Also, it’s important to realize that even with “full refund” programs, you’re not really getting all of your money back. This is important to keep in mind when looking at the quoted fee for an IVF refund program. You really need more cash than just that price, and those additional fees will not be refunded.

Fees that go above the IVF refund program itself, and which may or may not be covered, include:

• Pre-screening procedures, including blood work, semen analysis, and uterine assessment
• Monitoring costs, including office visits, blood work, and ultrasounds
• The cost of fertility drugs, which can be in the several thousands of dollars
• Anesthesia for egg retrieval
• Fees for beyond-the-basics IVF procedures, like assisted hatching, ICSI, preimplantation genetic diagnosis (PGD), blastocyst culture, cryopreservation
• If using an egg donor or surrogate, agency, and legal fees
• Embryo storage fees

Some IVF refund programs cover some of the fees above, but be sure to ask for a detailed explanation of what is and isn’t covered before you sign up.

Important note: Be sure the IVF refund program defines success as taking home a live baby. Some programs consider success a positive pregnancy test or a pregnancy that reaches a certain number of weeks. This means if you miscarry, no refund. If you conceive your first cycle, this is a tremendous financial loss. This risk is almost never worth taking.

Why Sign Up?

Despite all these downsides, there are still good reasons to sign up for an IVF refund program. For one, if you don’t succeed, at least you will get some of your money back. This may allow you to pursue adoption, or at least pay off some of the debts you acquired while trying to get pregnant.

Another reason couples sign up is for the peace of mind. They realize they may pay more per cycle than if they had gone one cycle at a time, but they feel better knowing that if they don’t succeed, they won’t be completely left for broke.

Also, because refund programs usually require you to participate in a set number of cycles to get the refund, your odds of giving up or dropping out of the program are lower.

For example, even if you feel like giving up after failed cycle number two, you may push on for the third since you don't want to lose your chance for a refund. And that third cycle may be the one that works for you.

Considerations Before Deciding to Participate in an IVF Shared Risk Program

Before you sign on the dotted line, be sure you are fully informed on the program and whether it’s right for you.

How does the refund program compare to an IVF package deal?

Many clinics also offer IVF package deals, where you can purchase a “package” of three or more IVF cycles at once. These cost less per cycle than if you were to pay per cycle as you went along.

IVF multi-cycle treatment packages are not the same as refund programs and may offer a better deal. For one, per cycle, IVF multi-package fees are typically lower than you’d pay per cycle. IVF refund packages are typically more expensive per cycle than if you were paying per cycle. This is because the refund packages need to make their money on the patients who succeed, so they can afford to give a refund to those that don’t.

A second possible advantage to a package deal is if you do get pregnant on the first or second try, you could come back to that same clinic in the future to do another cycle from your package to have another baby. (Read the contract carefully, though. You may need the cycles by a particular date.)

On the other hand, with an IVF package deal, there’s no refund if things don’t succeed.

What are your odds for success on your first or second try?

Most clinics will only offer a refund package to a couple that has good odds for success. This means that they are selling the refund guarantee to couples that may not really need it.

Of course, IVF is never guaranteed. That said, if your odds are better than average, a refund package may be a waste of money. Remember that with a refund package, you are paying a higher price per cycle in exchange for the refund benefit.

What is considered success?

Does the refund program consider a positive pregnancy test a success? Is it based on reaching a particular milestone in the pregnancy, like seeing the heartbeat or reaching 16 weeks? Ideally, you want a refund package that considered the birth of a live baby a success.

What exactly is included and what isn’t in the refund package?

There really doesn’t exist a 100 percent refund IVF package deal. There are always aspects of treatment that aren’t covered, from fertility testing to the drugs themselves (which can be very expensive.)

Make sure before you sign up that you fully understand what is included in the refund package deal and what you’ll be expected to pay beyond that. Also confirm how much of a refund you’ll receive. The percentages vary widely from clinic to clinic.

How aggressive will the treatment be handled?

There are ethical concerns that refund programs may influence doctors to treat a patient more aggressively than they otherwise would, to increase the odds of treatment success—even if the more aggressive treatment puts the patient at risk.

For example, the doctor may use higher doses of fertility drugs in hopes of stimulating and retrieving more eggs. Or, the doctor may want to transfer more embryos than is recommended. 

This is an uncomfortable topic, but one that is important to discuss with your doctor before you agree to a refund program. The majority of doctors are going to act in an ethical manner. However, doctors are human, and they can make mistakes in judgment like everybody else.