A Baby, or Cash Back

Stillman maintains that shared risk allows doctors to implant fewer embryos per cycle than fee-for-service plans -- because it's not a one-shot deal. Shady Grove Fertility averages 2.1 embryos implanted per cycle, which he says is one of the lowest rates in the country.

Want an Extended Warranty?

A somewhat different approach to "a baby or your money back" is, in essence, a warranty program.

Advanced Reproductive Care (ARC) is a network of 73 clinics in 38 states, including Virginia and the District. Over the past three years, the group has sold money-back guarantees to more than 1,000 patients, according to founder G. David Adamson, a reproductive endocrinologist.

Here's how it works: A patient buys a three-cycle package, the price of which is determined by age and other variables. For example, a healthy 33-year-old woman might pay $20,640 for three IVF attempts, plus up to three attempts with frozen embryos. For a warranty, she would pay an additional $8,075.

ARC pays the woman's clinic a portion of the $20,640, whether or not the patient gets pregnant.

Should a warranty-carrying patient fail to have a baby, she would receive her $20,640 back from ARC, though she would forfeit the $8,075. In other words, the attempts will have cost her $8,075, instead of $20,640 without the warranty -- or about $25,500 if she paid for three attempts individually. (Again, the cost of medications isn't included in this example, although other refund plans do cover drugs.)

What sets this kind of plan apart from shared-risk plans is that the clinic receives the same fee regardless of whether a baby results, said G. David Adamson, a reproductive endocrinologist who founded the network. The ensures that doctors' decisions are based on good medicine, not remuneration, he said. ARC offers financing, which Adamson hopes will encourage couples to try IVF sooner -- while their chances of getting pregnant are better. Recent CDC data show that in IVF with nondonor eggs, 35 percent of women under 35 get pregnant in one cycle. By 38 to 40, the rate drops to 20 percent. At 41 to 42, it's 10 percent, and over 42, it's only 4 percent.

Perhaps if they don't have to save up $20,000 first, Adamson figures, they can get their family started earlier.•

Resources

Fertility Centers that have shared-risk or warranty plans include:

• Advanced Reproductive Care (member practices in the District and Virginia), 888-990-2727.