A Baby, or Cash Back

Some IVF Centers Offer Risk-Sharing Deals

In vitro fertilization, or IVF, is a costly way to build a family. Many health insurance policies don't cover it. Each try costs $10,000 to $12,000 or more -- and only about one-third of women get pregnant on the first try. Once a couple has spent their life savings, or perhaps run up all their credit cards, on one, two or more attempts, there may be no money left.

In response, some fertility clinics have begun to offer guarantee or "shared-risk" programs: If you don't have a baby, you get most of your money back. But there is a catch: If you do get pregnant and give birth, that could wind up being one expensive kid.

In addition, some observers question the motives and ethics behind the baby guarantees. Are the deals always in patients' interest? Or does the money riding on the outcome sway clinics to implant more embryos than advisable? So far, there's little evidence to bear out such fears.

"My sense is that the shared-risk programs are performing in a very ethical and useful way," said John Robertson, a law professor specializing in bioethics at the University of Texas School of Law and chairman of the ethics committee of the American Society of Reproductive Medicine. "The main issue is that the couple be informed about the risks and benefits, about what their chances are of getting pregnant and having a baby on the first try. They're in essence buying insurance. They need to be informed about whether it's a good deal."

Leanna and Dan Curry, of Oak Hill, Va., wanted to start a family as soon as they got married in 1996. They were both healthy and didn't expect getting pregnant would be a problem for Leanna. But it was. After three years of trying, they decided to take the high-tech route.

Leanna and Dan both had health insurance, but their policies did not cover IVF. In 1999 they signed up for the shared-risk program at Shady Grove Fertility Reproductive Science Center in Rockville.

The Currys paid an upfront fee of $20,000 -- roughly what it would have cost them to make two IVF attempts using the conventional pay-as-you-go approach. For that fee, Shady Grove Fertility agreed to attempt up to three "cycles" of IVF on Leanna, plus additional attempts with any frozen embryos left over from these IVF cycles. Everything was paid for upfront except medications.

The deal was that if Leanna became pregnant and delivered a baby, Shady Grove Fertility kept the whole fee.

If she didn't have a baby, they'd refund the $20,000.

Either the couple or the clinic could halt the program at any time, and the couple would be refunded the money. But no one expected that to happen. All Leanna's screening tests had come back normal, and she was considered a good candidate.