What are they?
Shared risk programs, aka IVF Refund programs, are an interesting vehicle for reducing the financial risk of having to undergo multiple IVF cycles. Getting pregnant through IVF, despite the best efforts of the brightest physicians and doctors around the world, is still an odds game. Patients trying to get pregnant through IVF are basically rolling the dice for a successful pregnancy. Depending on your age and condition, these odds can vary from under 10% per cycle to upwards of 75/80%, if using donor eggs. As such, it is not uncommon for patients to need several rounds of IVF treatment in order to take home a baby.
IVF is not an inexpensive treatment and the financial burden of having to go through many cycles of treatment can be overwhelming. To help put fertility patients financial worries at ease clinics developed programs that would, for eligible patients, put limits on the potential costs of their treatment cycles. You can think of them as a form of infertility insurance that helps protect the patients from financial loss. And thus shared risk programs were born.
How do Shared risk programs work?
Essentially, these programs offer patients a flat-fee that will cover a set amount of treatment cycles and, if the treatment is not successful, offer a partial or full refund of those fees. These programs are beneficial to both parties. They give patients a clear amount that they know will get them to their goal of getting pregnant, or they will get a refund that they can use to pursue alternate avenues of reaching their goal. For the clinic, there are several benefits: they allow them to collect a larger fee (usually the equivalent of several full IVF cycles) upfront from the patients; since it is a flat fee collected, the clinic stands to make a profit if they can get the patients pregnant on the first cycle with decreasing profits with subsequent cycle. However, the clinics will lose a lot of money if they are unsuccessful and cannot get the couple pregnant. In this fashion both parties share risk. The patient might end up paying a little more for their IVF costs, but have the ability to cycle several times and even get their money back if all cycles are unsuccessful. The clinics have the opportunity to collect a greater fee if they provide quick success, but also balance that with the potential of losing part/all of their fees if the treatment ultimately doesn’t work.
How much do shared risk programs cost?
These IVF refund programs usually cost between 2x-3x the cost of a single IVF cycle, and will usually cover all clinical appointments and procedures required in the cycle. Cycle medications are almost always extra as they are sold by third party pharmacies so be aware there will be additional costs each cycle that will not be refundable. If you are choosing to participate in a shared risk program I would clarify this detail, and make sure you know what is and is not included in the program fees.
What are the eligibility requirements for Shared Risk Programs?
Since the IVF clinics bear a significant financial risk in offering these types of programs, and that the average success rates of IVF range between 10-60% depending on the age group they place restrictions on who can sign up for this type of program. It is in their best interest to offer this type of program to the patients who get pregnant most easily. This means an age cutoff and other medical qualifiers that like normal day three hormonal panels, a normal uterine cavity, and sperm parameters within certain ranges. These will vary clinic to clinic, so if you are interested in this type of option be sure to ask your doctor if you are eligible.
Are Shared Risk Programs Ethical?
Shared risk programs have been reviewed by the Ethics Committee of ASRM (American Society of Reproductive Medicine) and found to be perfectly ethical. They ruled that “that shared risk programs may be viewed as a form of insurance against the risk of failure that might appeal to some couples seeking IVF. The appeal arises from the general absence of health insurance coverage for IVF”. They concluded that as long as clinics were upfront with the costs and benefits of such programs vs regular pay-per-service models, and did not create false expectations, or promises, shared risk programs were an ethical and potentially valuable method of paying for treatment.
Should I use a Shared risk program?
This is not an easy question, and certainly not one I should be answering for you. Shared risk programs offer a great way to control the costs of your fertility treatment, but at a potential higher cost if you are successful right away. You should carefully weigh the benefits and risks the program(s) offers you and make your decision after considering what is best for you and your family.
What is the best Shared risk program in the Pacific Northwest?
Now down to the nitty gritty. This is not an easy question, and as a Seattleite I admit I did not fully research the options in Idaho or Oregon. However, after looking at the programs offered by all the major clinics in the area I have concluded that the Peace of Mind 100% IVF Refund Program offered by Overlake Reproductive Health to be the most comprehensive program out there right now. It rises above the others programs such as Seattle Reproductive Medicine’s Attain IVF Refund program, or Oregon Reproductive Medicines IVF Refund Program in that it offers a complete refund and more treatment cycles! So if you are considering an IVF refund program and live in the Seattle Area then ORH’s is the best one out there right now.
Well there you have it. I hope I was able to answer your questions about shared risk programs. As I said in the beginning of this article these refund programs are an interesting vehicle that offers patients a means to help control the costs of their infertility treatment. If you have used a shared risk program before, have any questions or comments, or just want to say hello, please do so in the comments.