An IVF refund program, sometimes marketed as a “shared risk” plan, lets you pay a single upfront fee covering multiple IVF cycles and refunds some or all of that money if treatment doesn’t result in a live birth. Prices typically run between $20,000 and $35,000. The programs make sense for patients whose per-cycle odds are modest enough that they’re likely to need several attempts, and they often cost more than paying per cycle for patients who succeed quickly.
How the Structure Works
You pay a flat fee covering a set number of cycles, usually up to six fresh egg retrievals plus any frozen embryo transfers needed along the way. If none of those cycles produce a baby, you get a refund of some or all of the upfront payment. If treatment succeeds, the clinic keeps the full fee even if you only needed one cycle out of the six you paid for.
The definition of “success” in the contract is the single most important detail to confirm before signing. Some programs define it as a live birth, so you only lose refund eligibility when you actually bring home a baby. Others define success as a clinical pregnancy (a confirmed heartbeat on ultrasound), which means you can forfeit your refund even if that pregnancy ends in miscarriage. The American Society for Reproductive Medicine requires that programs clearly specify this definition upfront.1American Society for Reproductive Medicine. Financial Risk-Sharing or Refund Programs in Assisted Reproduction – An Ethics Committee Opinion
Refund tiers vary. Some programs offer a 100% refund if treatment fails; others return 70% or 50%. Lower refund percentages generally come with lower upfront fees.
Who Qualifies
Clinics screen applicants carefully because the guarantee only works financially if most enrolled patients have a reasonable chance of success. The criteria are designed to keep the clinic’s risk manageable, not to serve every patient who wants in.
Age is the biggest gate. Most programs require women using their own eggs to be 40 or younger, with some clinics setting the cutoff lower. At Shady Grove Fertility, all egg retrievals must happen before a woman’s 41st birthday.2Shady Grove Fertility. Shared Risk 100% Refund Program Other clinics draw the line at 37 or 38. If you’re close to a program’s age limit, how the cutoff applies (enrollment date versus cycle start or completion) matters.
Beyond age, clinics look at ovarian reserve through blood work. Common thresholds include an Anti-Müllerian Hormone (AMH) level of at least 1.0 ng/mL and a Follicle Stimulating Hormone (FSH) level below 10–12 mIU/mL. BMI is often capped at 35. A history of multiple failed IVF cycles or certain uterine abnormalities may exclude you as well. These thresholds vary by clinic, so a rejection from one program doesn’t mean you’ll be turned away everywhere.
Women over 40 aren’t automatically excluded. Several clinics offer shared risk plans for patients using donor eggs, which carry higher per-cycle success rates regardless of the recipient’s age. Shady Grove extends its program to patients 41 and older when they use donor eggs.2Shady Grove Fertility. Shared Risk 100% Refund Program Donor egg plans typically carry a higher upfront fee because donor recruitment, screening, and compensation are folded in, and the medical focus shifts from the patient’s ovarian reserve to the donor’s, with the patient still needing a healthy uterine environment.
What the Fee Covers
The package fee typically covers physician consultations, egg retrievals, embryo culture and transfer, lab work during monitored cycles, and all frozen embryo transfers needed within the program period. What it doesn’t cover adds up fast:
- Fertility medications, which run roughly $1,500 to $7,000 per cycle depending on the protocol and your response.
- Preimplantation genetic testing (PGT-A), typically $4,000 to $5,000 per cycle and almost always billed separately.
- Anesthesia for egg retrievals.
- Initial diagnostic testing and any pre-enrollment workups.
The ASRM’s ethics committee has noted that these excluded costs can be “considerable.”1American Society for Reproductive Medicine. Financial Risk-Sharing or Refund Programs in Assisted Reproduction – An Ethics Committee Opinion Even a 100% refund won’t reimburse medications or genetic testing, so a failed treatment course still leaves you several thousand dollars out of pocket.
When It Saves Money and When It Doesn’t
A single IVF cycle at most clinics runs roughly $12,000 to $18,000 including medications and monitoring. If you conceive on your first or second cycle, you’ll almost certainly have paid more under a shared risk plan than you would have paying per cycle. The ASRM has warned directly that “good prognosis patients who achieve pregnancy after the first cycle or before the program is complete will often end up paying more for IVF treatment” than they would have without a shared risk program.1American Society for Reproductive Medicine. Financial Risk-Sharing or Refund Programs in Assisted Reproduction – An Ethics Committee Opinion
That overpayment is the business model. Clinics select patients with good prognoses, knowing most will succeed within one or two cycles and never use all the cycles they paid for. The excess revenue from early successes funds the refunds owed to patients who don’t succeed. It’s insurance math, not a scam, but you’re paying a premium for peace of mind. If your doctor tells you your per-cycle odds are above 50%, run the fee-for-service numbers before committing.
ASRM guidelines require clinics to counsel patients about per-cycle alternatives and to communicate individual success probabilities clearly, so patients aren’t pushed into more expensive programs than they need.1American Society for Reproductive Medicine. Financial Risk-Sharing or Refund Programs in Assisted Reproduction – An Ethics Committee Opinion If a clinic steers you toward the shared risk plan without walking through fee-for-service, treat that as a warning sign.
Contract Terms Worth Scrutinizing
The enrollment contract is a legal document drafted to protect the clinic’s interests. A few provisions show up consistently.
Many contracts give the clinic the right to terminate your participation at the end of a completed cycle, often if your clinical response falls outside the program’s criteria during treatment. If that happens, you typically owe the clinic’s standard per-cycle fees for all services received up to that point, which may be deducted from any refund owed to you.3Harvard Journal on Legislation. Financing Fertility In the worst case, you pay the full shared risk price, get terminated after two cycles, and receive a refund reduced by the retroactive per-cycle charges.
Look closely at what happens if you voluntarily withdraw. Some programs offer a prorated refund; others keep the full payment. Check whether the contract locks you into a specific clinic location or physician, and whether you can pause treatment for medical or personal reasons without forfeiting your spot. Having a reproductive law attorney review the contract before signing is worth the cost on a document that governs tens of thousands of dollars.
Check Insurance First
Roughly 23 states mandate some form of insurance coverage for infertility treatment, though the scope varies widely. Some require coverage of IVF specifically; others cover only diagnosis or less intensive treatments. Before committing to a shared risk program, confirm what your employer-sponsored or individual health plan actually covers. Patients sometimes enroll in a $30,000 refund program without realizing their insurance would have covered individual cycles at a fraction of the cost.
Some employers in non-mandate states voluntarily include fertility benefits. If your plan covers a limited number of cycles, you might use insurance for the first attempt or two and only turn to a shared risk program if those fail. Coordinating the two can get complicated: some programs require you to use insurance first, while others don’t accept insurance at all for bundled cycles. Clarify this with both your insurer and the clinic’s financial coordinator before enrollment.
Tax Treatment
IVF expenses qualify as deductible medical expenses under federal tax law. The IRS explicitly includes in vitro fertilization, fertility medications, and related procedures.4Internal Revenue Service. Publication 502, Medical and Dental Expenses You can deduct these costs to the extent your total medical expenses for the year exceed 7.5% of your adjusted gross income.5Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses You must itemize on Schedule A, so the deduction only helps if your total itemized deductions exceed the standard deduction.
The refund creates a wrinkle. If you deducted IVF expenses in a prior year and then receive a refund, you generally must report that refund as income in the year you receive it, up to the amount the prior deduction actually reduced your tax. If the deduction didn’t lower your tax bill (because your medical expenses didn’t clear the 7.5% threshold, for example), you don’t need to report the refund as income.4Internal Revenue Service. Publication 502, Medical and Dental Expenses Keep detailed records of every payment and refund, including the breakdown of what was covered under the program fee versus what you paid separately for medications and testing. Those excluded costs are independently deductible and aren’t affected by any refund of the bundled fee.