Fertility Guarantee Programs and Surrogacy: Is It Worth the Cost?

If you aren’t one of the lucky ones who has health insurance that covers infertility treatment, you know firsthand how expensive it can be. Fertility centers know the same, and most offer different kinds of treatment and payment options to help ease the financial burden.

One of the more popular options being offered at fertility centers across the country is a kind of “guarantee” program in which you pay a fixed amount up front and they offer you a certain number of fresh and frozen embryo transfer cycles in exchange. You pay the same amount whether you get pregnant on the first cycle or the fifth (or more, depending on the program). Some programs even offer a money-back guarantee, refunding you as much as 100% of your fee if you don’t have a baby.

These programs can be just the reassurance nervous couples need if they’re feeling apprehensive about succeeding at IVF treatment. They can alleviate the pressure couple feel about mounting medical bills should multiple cycles be necessary, because the fees are fixed and paid up front. And should the couple not succeed at becoming or staying pregnant, their money (or most of it) is refunded to them so they can use it for other family-building options, like adoption.

It’s important to note that there is no one standard shared risk program – each fertility center establishes their own guidelines for how much they charge, what is included, how much is refunded, and in what cases refunds are issued (e.g., some fertility centers will refund your money if you don’t take a baby home from the hospital, while others will only refund your money prior to the twelfth week of pregnancy, or other various terms). If you’re considering a fertility guarantee program, it pays to thoroughly investigate all of the options offered at the different practices you’re considering using.

Fertility centers also carefully screen patients to determine if they’re eligible to participate in a shared risk program – it’s not an option open to every patient who walks in the door. Screening factors used to determine eligibility include (but may not be limited to) the age of the mother, the general health and risk factors of the mother, the results of physical exams and tests, along with blood test results, and what prior fertility treatment has been done already, as well as the health and test results of the father. Using an egg or sperm donor or a gestational carrier (if any of these are appropriate) is generally a factor that improves your chances of success, and thus, improves your chance of being accepted into a shared risk program.

But in the case of gestational surrogacy, is paying the higher upfront cost of a shared risk program a smart thing to do?

As with most anything related to fertility, the answer is that it depends.

People pursue surrogacy for basically one of three reasons: the couple or single parent is male; the woman has a uterine condition that precludes her from carrying (or she has no uterus); or the woman has a medical condition (unrelated to reproduction) that makes pregnancy too dangerous to attempt. To look at the issue of whether or not multiple cycles might be necessary to achieve a pregnancy (which is what makes a shared risk program a good deal for fertility patients), we have to examine the specific reason why someone is using a gestational surrogate.

In the case of an intended father (or fathers), an egg donor is used, so there shouldn’t be significant factors that would prohibit pregnancy, especially if they are using a proven gestational carrier. If they have concerns about the health and success rates of their potential embryos, it may be more cost effective to pay for preimplantation genetic testing to screen for potential abnormalities and know they’re transferring the ones with the best chance of success rather than pay for a shared risk program.

The same applies for a couple where the woman is unable to carry for herself because of a medical condition unrelated to fertility. As long as she’s in the ideal age range for ovarian health and can produce eggs successfully, this couple stands a good chance of getting pregnant with a proven (or at least well-screened) gestational carrier. Of course this doesn’t mean that they will get pregnant on the first cycle – it’s by no means unusual for seemingly healthy couples to need two or three IVF cycles to achieve a pregnancy that sticks. Again, preimplantation genetic testing may increase the odds of success, but that’s an added fee. Couples in this situation should compare the price of a shared risk program to how many cycles, if paid for individually, have a similar cost in order to assess which is potentially most cost effective.

If the couple has struggled with embryo health and uterine health issues (and is not using an egg or sperm donor) and is moving onto a gestational carrier, a shared risk program may be a good bet. By using a host uterus they can (mostly) eliminate that variable from consideration, leaving only the quality of the eggs and resulting embryos as the main factor to take into account when estimating their chances of a successful surrogate pregnancy. The same may apply if the mother is at the upper end of qualifying for the shared risk program, because age is one of the most significant factors in egg production and fertilization and embryo health. In this case, multiple egg retrievals, preimplantation genetic testing and fresh transfer cycles may quickly cost more than a shared risk program, making the latter the best deal.

As with anything fertility-related, there are rarely any clear-cut answers when considering the various options available to you. And certainly adding the element of financial risk to the already stressful process of IVF can make even the most confident couples question each of their decisions along the way. If you’ve selected a fertility center and are interested in a shared risk program, be sure you’re clear on exactly what is and is not included, and discuss the various potential scenarios with your financial counselor and your doctor. If you’re deciding between two or more fertility centers, be sure to discuss all of the various cycle and payment options available to you and get the information in writing, so you can compare the benefits and drawbacks of each. And if at all possible, find out the success rates for patients that most resemble your own age and medical circumstance to get the most accurate estimate of your own success.

Making the financial decisions that go along with fertility treatments is by no means an easy task, but the more information you have, the more confident you will feel, which puts you in a great position for the most exciting part – making a baby and becoming parents!