IVF Success or Refund Program to Share the Financial Risk of IVF
We understand that IVF is expensive and it is unfortunate that most insurance companies in Virginia do not offer coverage. We are hopeful that this will change in the near future and insurance companies will be mandated to cover IVF as is the case in many other East Coast states, such as Maryland, New Jersey, New York, Rhode Island, and Massachusetts. Until that time, we understand that this creates a difficult burden financially on many of our couples.
As successful as IVF has become there is still a significant proportion of couples who will not deliver a baby regardless of how many times IVF is attempted. This is where a refund program, often called a “shared risk” program, offers additional reassurance. We are pleased and excited to be able to offer such a program at the Reproductive Medicine & Surgery Center of Virginia, PLC.
The idea is if you elect to participate in the IVF Success or Refund Program you pay more than you would for a single cycle but you are guaranteed to have 4 completed IVF treatments for that one price and if you are not successful after the 4th attempt then your money is refunded 100%. We define success the same way you do- bringing home a baby.
Pricing for IVF Success or Refund Program:
|IVF with ICSI||$23,900|
|IVF with ICSI-Donor Egg*||$27,900|
* Includes cost of donor fees for first cycle, excludes cost of some recurring donor egg fees
(As a comparison, the cost of a single cycle IVF package is $8,400. If doing IVF with ICSI the cost of a single cycle is $10,150. Donor IVF costs $16,900 per cycle for an anonymous egg donor, and IVF with ICSI and an anonymous egg donor costs $18,650 per cycle.)
As you can see, if you do not conceive after the second IVF or IVF with ICSI treatment and need to go on to a third IVF treatment then you will save a significant amount of money by participating in the Program. In the case of Donor IVF there is cost savings if you need to do a second treatment cycle.
We have a lot of confidence in our program and we’re betting that we’ll get you pregnant and you’ll deliver your baby before you have completed 4 IVF treatments. In this way we share the financial risk of your treatments. Our program is highly successful and our group has been providing IVF care to this region for over 20 years. Programs with lower pregnancy success would be hard-pressed to offer a refund program.
Probably The Best Way To Help You Better Understand The Details Of The IVF Success or Refund Program Is To Answer Some Commonly Asked Questions By Our Patients (We’ll term the IVF Success or Refund Program just “the Program” below):
Who is eligible?
The vast majority of the couples in our practice would be eligible to participate in the Program. If you are 39 years old or older (unless you are using donor eggs) you will not be eligible. In fact, we need to determine that if you are 38 years old that there is reasonable time before your 39th birthday to complete 4 IVF treatment cycles, and any frozen embryo transfer cycles that may occur in-between. In general you need to notify us before you turn age 38 that you intend to do IVF and would like to be considered for this program.
If you have just turned 38 or are younger then our committee will meet to determine your eligibility. The decision of our committee takes into consideration many aspects including, but not limited to, age, diagnosis of infertility, sperm quality, follicle stimulating hormone and estradiol levels, social habits of both partners- such as smoking, alcohol and caffeine use, exercise level, presence of a hydrosalpinx (blocked Fallopian tube) or ovarian cyst(s), ultrasound measurements of the ovaries, total number of ovarian antral follicles, previous response to medication(s) to stimulate the ovaries, body mass index, and many other issues that have been shown to relate to IVF success. It may be a complicated decision-making process.
Not being eligible to participate in the IVF Success or Refund Program does not mean you do not have a good chance for IVF success. If we cannot provide you with participation in the Program then in the vast majority of cases we will still encourage you to do an IVF treatment cycle with us using the standard package price. We would also encourage you to investigate whether you might meet the entry criteria for another IVF center’s shared risk program.
If your husband/partner has male infertility count, we recommend ICSI you will be asked to sign a consent allowing us to do ICSI. If you do not want ICSI to be performed regardless of your husband’s/partner’s sperm quality then this may be an exclusion from participation. We know that a significant proportion of our couples will probably not have adequate fertilization without the use of ICSI. If this is the case and a couple chooses not to do ICSI their chances for success would be significantly reduced.
Additionally, if there are embryos remaining after the “fresh” embryo transfer, the couples participating in the Success or Refund Program need to agree to cryopreserve any extra embryos that meet criteria by the laboratory for freezing.
Couples doing Donor Egg IVF are eligible participate in the program in most circumstances.
If you smoke you may not be eligible for the program. Please be frank about this habit. A number of well-designed research studies have demonstrated that there may be as much as a 50% reduction in pregnancy success rates with smokers who undergo IVF. This is even with smoking of a limited number of cigarettes per day! If you are a smoker we will require you to have quit at least one month prior to starting your IVF treatment.
You are investing a lot of time, emotional energy and money in this process, and we are taking a significant risk to allow you to participate. As you can see, we feel very strongly about this. You certainly won’t be smoking once you are pregnant so you need to move up your timetable for smoking cessation.
How Are 4 IVF Treatment Cycles Counted?
We only count an IVF cycle if it is completed. We define this as an egg retrieval was performed and at least one egg was obtained. Cancelled cycles because of poor response to medications or egg retrievals that do not result in any eggs obtained would not be counted. A frozen-thawed embryo transfer cycle is not counted as one of the 4 IVF cycles. Any embryos that are viable and in excess of the number transferred to the uterus will be cryopreserved and used for a frozen-thawed embryo transfer prior to starting another “fresh” IVF cycle. All frozen-thawed embryo transfers of cryopreserved embryos that occur in between IVF cycles (see below) are part of the IVF Success or Refund Program, but only IVF cycles with successful egg retrievals are counted to determine 4 IVF attempts.
Are There Additional Tests Required For Couples Prior To Participating In The IVF Success Or Refund Program?
No. The screening tests are all the same. No additional testing is necessary.
Is The Treatment Any Different?
No. Your treatment will be individualized, as is the case with all our patients, to optimize your chances for success. Whether you participate in this shared risk refund program or not has no impact on your treatment or your chances for success.
What if I Miscarry?
If you miscarry, or have another unfortunate outcome such as a stillborn, then we have not helped you reach your goal of bringing a baby home. These would be considered a failed IVF attempt and if you had not completed 4 IVF treatments then you would be eligible to continue with the Program.
Are There Any Hidden Costs?
You need to know all of all the additional costs you will be responsible for before you enter this or any other program. “Shared risk” refund programs can differ significantly in what is covered and excluded. There are a certain number of cycles offered as a package with a guarantee of refund of this package price at the end if not successful. All shared risk programs have additional costs that are required in addition to the package price.
We want to be as frank and clear about this program as possible. It is important to understand that the cost of participating in a shared risk/refund program (whether with us or another IVF clinic that offers a similar program), or just purchasing a package for a single cycle of IVF, does not cover all the costs of the total price you will actually pay to complete an IVF treatment. And, when couples choose to participate in a shared risk IVF refund program but do not have success these other costs are not refunded.
For all couples these additional costs include the medications required for the IVF treatment and any pre-IVF testing/screening or treatment required prior to starting your IVF cycle. [Medications for IVF treatment usually cost between $2,000 and $4,000 and are purchased from a mail-order pharmacy. The variability in the medication costs is mostly due to the age of the female partner and/or how responsive a woman is to the medications.] There is an additional fee of $550 per egg retrieval for the anesthesia costs that is not included.
Cryopreservation of excess embryos and the cost of frozen-thawed embryo transfer cycles are both included in the Program. However, the annual fee for cryostorage of additional embryos and the medications required for a frozen-thawed embryo transfer are not included (See below- “What About Frozen-thawed Embryo Transfers of the Cryopreserved Embryos?”). For some of the couples that participate in IVF additional costs may exist, for instance procedures to obtain sperm for the male partner (example- testicular biopsy) or donor sperm, preimplantation genetic diagnosis. Complications of IVF and the pregnancy itself are not included in the Program, but in nearly all cases would be reimbursed by your health insurance company.
You have to take into consideration that there are still significant additional costs to each IVF treatment cycle whether you purchase a single cycle IVF package or you choose to participate in the IVF Success or Refund Program. Although you paid a package price you will continue to have costs (costs of medications at least) that occur with every IVF treatment. As mentioned above, other IVF clinics/programs that offer a shared risk/refund program have additional charges. We are not unique.
What If I Want To Withdraw From The Program Early?
It would not be reasonable to ask you to continue with IVF treatments if you do not wish to do so. You may remove yourself from the program at any time. Some couples will run out of emotional energy, encounter financial strains, experience marital problems, or have other issues that require them to discontinue therapy. If this is the case then you will receive a pro-rated refund. We believe this is the fairest way to handle your withdrawal. If you choose to participate in the Program you will ask us to take a risk with you to try 4 times to conceive or your money is refunded. If at a later date you decide you cannot follow through with the Program, for whatever reason, we don’t believe we have failed you and, therefore, a pro-rated refund is appropriate.
To be as fair as possible, if you withdraw after the first, second or third cycle we only charge you exactly what we would have charged you if you decided to pay for one IVF treatment only. In the case of standard IVF the cost would normally be $8,400 per IVF cycle, so the remainder is refunded- ($20,000-$8,400=) $11,600. The same is true for IVF-ICSI and IVF- Donor Egg with or without ICSI. See below for all the details.
Pro-Rated Refund for Self-Withdrawal from the ProgramIVF $20,000: After #1: $11,600; After #2: $11,600; After #3: $11,600; After #4: All
ICSI $23,900: After #1: $13,750; After #2: $13,750; After #3: $13,750; After #4: All
IVF-Donor* $25,900: After #1: $9,000; After #2: $9,000; After #3: $9,000; After #4: All
ICSI-Donor* $27,900: After #1: $9,250; After #2: $9,250; After #3: $9,250; After #4: All
*See below in section entitled “What About Donor Eggs?” for more details.
If you are a smoker we will require you to have quit at least one month prior to starting your IVF treatment. If you choose to continue smoking during your IVF treatments this is, of course, your decision but it would likely result in your withdrawal from the program. In this case you would receive a pro-rated, not full, refund. In effect, your decision to continue to smoke would be interpreted by us that you are withdrawing yourself from the program.
Can I Be Withdrawn From The Program?
Just as you have the right to withdraw from the program at any time, we have the right to withdraw you from the program at any time for any reason. If this occurs you will receive a full 100% refund of the package price regardless of how many cycles you have completed. There is not a pro-rated refund in this case, with the exception of a smoker- as noted above.
Why Would this Happen?
It would be uncommon, but, for instance, sometimes a patient will not respond to the treatments appropriately or will have an adverse reaction and it is apparent only after a failed IVF attempt that IVF is not a useful treatment option. When we need to remove you from the Program we believe that you did not fail to follow through with completing 4 IVF cycles so it would be unfair to do anything but refund you the entire package price. As noted above, the cost of medications, pre-IVF testing, anesthesia (if an egg retrieval occurred), and some other costs are not part of the Program, so cannot be refunded/reimbursed. Therefore, if you need to be withdrawn then we will refund 100% of the cost of the Program but you will have spent money on IVF medications, screening tests, and possibly other aspects that will not refunded/reimbursed.
What about Frozen-thawed Embryo Transfers Of The Cryopreserved Embryos?
The cost of a Frozen-thawed Embryo Transfer (FET) cycle is included in the Program. (The cost of a Frozen Embryo Transfer cycle is normally $2,150 but is included when enrolled in the Program). The cost of cryopreservation (freezing) of additional (excess) embryos is also included in the Program (and is normally $470). About 50% of the couples that would be eligible to participate in the Program would be expected to have additional embryos cryopreserved (frozen).
This is quite useful because it offers a simpler (less visits, less medications, etc.), lower cost alternative to become pregnant compared to starting over with another IVF treatment. We require that you use all frozen embryos prior to starting again with another fresh IVF treatment. The cost to store (cryostorage of) frozen embryos is $470 per year and is not included. Also, the cost of medications required to undergo a frozen-thawed embryo transfer cycle (FET) is not included in the Program.
What About Donor Eggs?
Most couples undergoing IVF with Donor Eggs will be eligible to participate in the Program.
Donor egg IVF is unique in that it involves another individual- the egg donor. The cost of advertising for, screening, matching, treating, and reimbursing the donor is expensive. The cost for a single cycle of Donor Egg IVF is $16,900, and if Donor Egg IVF +ICSI then the cost is $18,650. The cost of the doing Donor Egg IVF with the IVF Success or Refund Program is $25,900, and if Donor Egg IVF + ICSI then the cost is $27,900.
However, if you don’t conceive after the first cycle of IVF using a donor (plus any additional frozen-thawed cryopreserved embryo transfers) for each subsequent IVF-Donor cycle there will be an additional $5,000 fee to recruit and reimburse another egg donor. This is in addition to the cost of medications for you and the egg donor. This still represents a significant savings compared to paying for each Donor Egg IVF cycle separately (see below).
Couples are required to have Donor Insurance on their egg donor during stimulation. The cost is $245 per egg donation cycle. A check made out to New Life Agency is required prior to the donor starting medications.
How Do The Costs Of The IVF Success Or Refund Program Compare To Just Paying For Each IVF Treatment Cycle Separately?
Costs to a couple by paying for one IVF cycle package at a time:
|IVF||IVF+ICSI||Donor Egg IVF||Donor Egg IVF+ICSI|
*Cost increases for cycles using donor eggs due to $5,000 additional fee to recruit and reimburse a new donor for each subsequent IVF attempt.
You can see that for IVF or IVF + ICSI if you need to do more than two treatment cycles then you will have saved money by choosing the IVF Success or Refund Program. For Donor Egg IVF or Donor Egg IVF + ICSI you can already see the cost savings on cycle two by choosing the IVF Success or Refund Program. This also does not take into account any frozen-thawed cryopreserved embryo transfer (FET) cycles that you may do in-between IVF cycles. If paying for each cycle separately each FET cycle costs $2,150. So, this may increase the cost of each option above by as much as $2,150 x 4 = $8,600 (if you had frozen embryos after each IVF treatment cycle.) However, there are no additional charges for FET cycles because they are provided as part of the IVF Success or Refund Program.
What About Assisted Hatching of Embryos?
When indicated, Assisted Hatching of embryos is included in the Program.
What About Preimplantation Genetic Diagnosis (PGD)?
Only a small fraction of our couples require PGD as part of their IVF treatment. If this is required it is not part of the standard IVF package or the IVF Success or Refund Program and would be an additional charge.
What Can I Do To Increase The Chances Of Success?
Caffeine consumption, moderate (or greater) levels of exercise, and/or alcohol consumption have also been proven to lower pregnancy success rates. We ask that you exclude these beginning a least a few weeks prior to starting your IVF cycle. This is definitely a team effort and we ask you try to give 100% towards your success, the same that we will be providing to you.
What if I’m not Eligible to Participate in the ISR Program?
The “shared risk” refund program concept was begun at other IVF centers. In response to patient interest we are pleased to offer it. Most couples consider this a kind of insurance with regard to financial risk of IVF treatments. These programs were developed following a business model similar to how other insurance is offered.
The qualifications for inclusion are based on this business model and qualification does not necessarily equate with how likely it is you will conceive with IVF. We will always make an estimate for you as to what we believe your chances are for success with IVF. This is important information you need to help you to decide whether you want to participate in the IVF Success or Refund Program. If you fail to qualify for the ISR Program, it does not represent a change in the estimate of your chance to conceive that we have already discussed with you. We will still encourage you to do IVF.
Please contact us to answer any further questions you may have:
Financial: Jody Halloran (Practice Manager) 434-654-8520 (Jody.Halloran@rmscva.com)
IVF Program: Bonnie Reilly, RN (IVF Coordinator): 434-654-8875 (Bonnie.Reilly@rmscva.com)
Egg Donor Program: Stephanie Barrix, RN (Donor Coordinator):434-654-8875 (Stephanie.Barrix@rmscva.com)