Trying to have a baby with the aid of modern reproductive technology can feel like visiting a gambling parlor with the highest possible stakes.
So consider the pitch that many fertility clinics now put in front of people like Kristi and Carleton Chambers.
After several miscarriages, the Leesburg, Va., couple took their doctors up on an offer to hand over $50,000 — $20,000 more than what they might have paid for the in vitro fertilization and other services that they needed at the time. In return, the clinic promised multiple procedures until they gave birth, and if it didn’t work, they would get a full refund.
The catch? If they made a baby on the first try, the practice would keep all their money. That is exactly what happened — to their great joy. After their baby boy was born, the couple eventually signed up for a similar deal and ended up with twins.
Welcome to the fertility casino, which frequently presents the rarest of scenarios: A commercial entity offers a potentially money-losing proposition to customers in exchange for a generous supply of in vitro fertilization procedures. People pay tens of thousands of dollars for the privilege, and when they come out with a newborn in their arms they’re often thrilled to be on the losing end financially.
So who wins? The house. Doctors (and third-party companies that help manage these programs and may take on any financial risk) keep careful track of their data. So they set prices at profitable points given the odds.
Here’s how the house can stack the deck: By admitting only people who have a better-than-even chance of bearing a child early in the process. Those people, however, may not need to pay extra for such a plan, given that their clinics picked them precisely because they were such good bets.
“It’s kind of like the clinic bets on your success, and you bet on your failure,” said Sarah Burke, a Pittsburgh woman who became a parent after enrolling in such a program.
Some of the overall performance numbers of fertility clinics are available in federal databases, but at my request, FertilityIQ, an information clearinghouse and doctor-review service, recently gathered some additional data.
Of the 54 people it found who had enrolled in a baby-or-your-money-back program, 30 of them achieved success not just in the first I.V.F. “cycle” (when doctors retrieve eggs) but on the first transfer — that is, the first time, after retrieval, that doctors attempt to implant an embryo or embryos they created with those eggs. A total of 67 percent were successful in the first cycle, which is at least 20 percentage points or so higher than the birthrate that similarly aged women nationwide experience in any I.V.F. cycle.
So are those two sets of women comparable? Not exactly.
While we shouldn’t make too much out of a sample size this small, FertilityIQ’s founders, Jake Anderson and Deborah Bialis, believe that doctors cherry-pick patients who have a high likelihood of success. According to Mr. Anderson and Ms. Bialis, a married couple who were themselves treated for infertility before becoming parents, medical professionals screen the harder cases out — say, people with more problematic diagnoses or those who are older or have a high body mass index.
That’s what happened to Johanna Hernandez of Marana, Ariz., who — after two miscarriages and struggles with I.V.F. — couldn’t get into a program that offered multiple rounds and a refund. “We’re in such a precarious position,” she said. “At the beginning, there’s no way to know that you’re going to need these programs. But at the end, they just won’t help you.”
Ms. Hernandez and her husband paid for additional à la carte treatment, had one more miscarriage along the way and now have a baby boy.
Another way for doctors to improve the odds of producing more babies would be to implant more embryos during each transfer. The American Society for Reproductive Medicine frowns on this, given the additional risks that come with twins and triplets. It has also warned of this possibility in a position paper on the package deals and refund programs, which are known in the industry as “risk-sharing.”
New York Times – April 14, 2017 by Ron Leiber
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