Infertility Treatments and Financial Options: Sharing the Risks with Patients to Achieve Success

By: ART Fertility Program of Alabama, Drs. Honea, Houserman, Long and Allemand

Some people never seek fertility care because they are overwhelmed by the fact that they have infertility and by the vast array of therapies available. Only about 20% of couples need the advanced therapies of IVF or Egg Recipient cycles.

One of the biggest stresses on couples with infertility is the fear of needing fertility services that are not covered by insurance. Most services are covered to some extent except IVF and Egg Donation. Every patient who comes into the ART Fertility Program of Alabama meets with a financial counselor to understand what their insurance covers.

One of the more important contributions we have made at the ART Fertility Program of Alabama is developing our Shared Risk Refund Program for IVF and Egg Donation. This Plan is ultimately the most successful way for qualified couples who need IVF or egg donation to have a baby.  It has been well studied that most couples with infertility need two or three cycles to have a baby. Couples often stop pursuing fertility care because they are so devastated if they do not become pregnant the first cycle; or if they become pregnant and miscarry; they are overwhelmed and give up. Couples need a plan that is bigger than one cycle.  They need a plan to achieve a live birth. At least 75-80% of couples have a baby (or two) with the Plan or receive a significant refund.

The Shared Risk Refund Plan is offered for both IVF and egg recipient patients.  The Plan guarantees that if a qualified couple does not achieve a live birth, the refundable portion of the plan fee will be returned so that other alternatives can be pursued. If attempting a single cycle, couples feel that everything depends on the outcome of that one cycle. With the Shared Risk Refund Plan, the pressure is off. Couples know they can do multiple IVF or egg recipient cycles and use their frozen embryos until they achieve the outcome that they desire or have a good alternative.

It is important to point out that while the Shared Risk Refund Plan is available for egg recipients as well as IVF, they are structured differently. There is an additional fee for egg donor expenses if a second cycle is needed.  For egg recipient patients using the Plan, the process provides a similar peace of mind because they are not thinking of it as only one procedure.  They are thinking of it as a process.  And that is how you have to think about fertility.  It often takes multiple tries as shown in the Shared Risk Refund Plan.

What are Patients’ Options?

With the Shared Risk Refund Plan, couples receive the first cycle and any frozen embryo cycles if needed.  If they do not become pregnant or miscarry, they receive the second cycle and any frozen embryo cycles. This fee includes ICSI, embryo freezing and thawing and laser hatching of embryos if indicated.  If the course of care changes as a result of the findings from the first cycle, alternatives may be available to complete the Plan; for example, using donor eggs or sperm if there is a problem

identified. If they do not have a baby, they get back at least 60% of the refundable portion of the cycle. They can then use the refund to pursue another appropriate infertility direction or other options they desire. (Embryo or egg donation for failed IVF, adoption, gestational carrier). 

There is also a three-cycle Shared Risk Refund Plan for certain patient situations, which gives them three opportunities.  Certain criteria must be met to be eligible for these Plans. Those eligible must have a good number of eggs, be in a fertile age range (less than 35 unless using donor eggs), and usually must complete the Plan before they turn 35 for two cycle and 36 for three cycle.  Some are required to do the three-cycle Plan due to other specific fertility factors as their chance of pregnancy is slightly lower each cycle.

If insurance covers IVF or egg recipient services, they cannot use the Shared Risk Refund Plan. The counselor will discuss whether financial help is needed if services are not covered.  For those who do not have insurance coverage, our financial counselor will meet with them to guide them to resources that may help them with financing.  We offer counseling for all of our patients on financial issues and the different options to consider before starting any process.

We’re Here to Offer Patients a Path

Many patients don’t know about the Shared Risk Refund Plan before they walk in the door. They don’t see a clear path.  It is our job to show them their options, review expected outcomes for their unique issues and help them weigh the risks and benefits so they can choose the best path for them. And when most couples succeed in having their baby -- that is a better path!