Adventures in making and raising our test-tube babies

Thursday, May 22, 2008

Sharing Risks

This is a post about money. Specifically, it's a post about the Shared Risk programs that some fertility clinics offer.

The essence of the shared risk programs is that you can pay for a package instead of individual treatments. For a lump sum, you can buy up to 4 or 6 (it varies) IVF cycles. You can use as many of those cycles as you need to get pregnant (or in the case of our clinic, bring a live baby home from the hospital). If at the end of the program you don't get the defined results, you get some or all of your money back. You can use that to start adoption proceedings -- also an expensive proposition.

Here are some reasons why the programs are controversial. First, the American Medical Association generally holds that it's unethical for doctors to charge for their services based on the medical outcome they get. That would do wacky things to the medical industry. Also, the programs imply a guarantee that the couple will get a certain result. Guaranteeing medical results is also tricky. And if the couple happens to get lucky on the first or second try, then they will have overpaid for the services that they actually end up using. Finally, the programs are only open to people with a good enough prognosis to ensure fairly quick pregnancy. The more it looks like you're actually going to need all the cycles, the less open the clinic will be to accepting you.

The reasons I advocate the programs are based on financial practicality and emotion. First, the lump sum we pay for the shared risk programs is an enormous amount of money. But for some couples who actually need the six cycles to have a baby, its the only way they would have been able to pay for that much care. I know of a sweet 3-month old baby named Charlie who would never have been conceived were it not for a full six-cycle shared risk program. I have good friends who don't live near any clinics that offer a shared risk plan, and as the number of cycles they need grows, it is getting near impossible to pay for any more. When money runs out, treatment runs out. No baby. If they could do shared risk, they would get more tries at success, or at least they'd get a guaranteed lump of money back to pay for an adoption or other options. Otherwise, there is no money left over to pursue other routes once they reach the end of the IVF line.

Another huge benefit is that the shared risk program takes finances out of the family planning decision-making. The first time we did IVF, we paid for the one treatment. That was foolish, in retrospect, because our chances of success were less than 50%. We just hadn't been able to bear paying more money than we needed to, because it was so exhorbitant, and we really couldn't afford even one treatment on its own, much less lots. When the cycle failed, we took a long time to decide whether and when to do another cycle, because we had to figure out the source of yet another astronomical payment. When we decided to move forward, we told our doctor that we'd like to enroll in the shared risk program this time around, now that we really appreciated how iffy this all was. He told us we were no longer candidates because we had "flunked" the first time. Yes, he said "flunked."

So we went to a different clinic that would still let us into the program. We paid a lot of money to them, did an IVF cycle, and it failed too. And you know what? As soon as that happened, we DIDN'T HAVE TO THINK ABOUT MONEY! We knew we were going to try again right away, and just keep trying until it worked. We spared ourselves the terrible exercise of balancing money on one side with fear of declining egg quality and lower chances of success on the other side. Ugh. Just do it. We could just do it. Thank God! Thank GOD!

Perhaps just as importantly, as a benefit that kicks in even if you get pregnant the first time, the shared risk program offers peace of mind as soon as you write the check. It comes from knowing that there are more chances waiting for you. Because on its own, IVF is really stressful and scary. It also invokes fears of never having a baby, your eggs getting too old, being left out of a new generation of parents... it's all so hard. It comes to everything riding on a small number of cells in the middle of your body. You obsess. You worry. You think about them all the time and will them -- with closed eyes and gritted teeth, oops, and then long relaxing loving deep breaths, and then a furrowed brow, no a relaxed brow, deep breath -- to survive. But if you know that this is not the last chance, that your whole life doesn't depend on this attempt, it's so much better. Much more relaxing, to say the least. Maybe it's even more conducive to being successful. Just eliminating that pressure is worth all the money in the world. And fortunately, you don't have to pay all the money in the world.

And that is why I think the shared risk programs are a really great deal. Because nobody can afford one IVF cycle, much less six. So if you can't afford one cycle, then you also can't afford to enroll in a shared risk program. At that point, what the hell is the difference. That's what credit cards, home equity loans, rich uncles are for: mortgaging your soul for stuff you want. Capital One, you're welcome. Shady Grove Fertility Shared Risk Program, thank you.


Tracy said...

I definitely see the advantage to that program. I really think that is the way we would have went (had we ended up needing ART). The knowledge I would get SOMETHING at the end, either my baby or at least some money back, would be worth it.

Kay Bailey said...

One P.S. I want to add. IVF is ridiculously expensive, but having seen the amount of work the clinics put into each cycle, I think they earn every penny. Regardless of the value and worth, it's a luxury that most people can't even begin to afford. I feel very lucky to be in a position to do all this stuff. Very, very lucky.

DAVs said...

Good post Kay. I'm glad you can go into the next cycle without the added stress of paying for it.
I guess in some weird way, we're "lucky" we could do one cycle, let alone this upcoming fourth. But yeah, in hindsight....shared risk would have been a much, much better choice for us. But our first clinic didn't have it, and now that we've flunked thrice..well come on, would you let us in?

Anonymous said...

Shared risk is the way to go for sure! Our Dr. tried to steer us away from it because he thought we would get it on the first cycle, but there was no convincing us. We had to have that extra insurance that if it didn't work after 3 times, we could have that GIANT sum of money back to pursue adoption. Otherwise we'd be heartbroken and broke. But he was right and it worked the first time and we paid too much, but we don't care. We keep telling each other that we paid extra to make sure it worked.

We feel very lucky lucky.