How did you decide between Shared Risk or Single Cycle IVF?
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Anonymous
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My husband and I are both 35 and unexplained. We have had 3 failed IUIs, and one chemical while trying naturally. We have decided to move on to IVF with SG, but I am torn about whether to do a single cycle or go all in with shared risk. Since we are unexplained and all numbers are good, we are leaning towards taking a chance with single cycle, but I know there is no guarantee and since we are paying out of pocket we are obviously cost conscious.
Any help with how others made their decision or what others recommend would be helpful! Thanks in advance. |
Anonymous
| We did the version shared risk at Dominion. My rational was that if we end up with a baby, I'll be so happy that I won't care what it cost but if it doesn't work, then losing all that money too would just make it that much worse. Hope this helps! |
Anonymous
| Can't recommend shared risk enough. You just never know how long it's going to take. We thought we were a fairly straight-forward case as well, but it took us 6 IVF cycles. Pay the money once, then "forget" about it. |
Anonymous
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Totally recommend shared risk for the peace of mind. It will make that wait to test so much less stressful (and incidentally, reducing stress is something you should be doing while trying to get pregnant!).
Yeah, if you get pregnant on the first cycle, you'll shake your fist and say "Darn, we should have just done a single cycle." But lots of people don't, and it just is so much nicer to know you have a next step forward without shelling out a ton more cash. |
Anonymous
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Woah. Just want to provide a different perspective here...
There was a great link on reddit a few years ago (I can't find it now, but it's worth searching) about calculating the break even point. If you think it will take more than three cycles to get a baby, then shared risk gives you the better ROI. You also have to consider the out of pocket cost of medicine with shared risk! But if you are doing IVF without the add-ons (ICSI and PGS) and have some coverage for the meds, then single rounds make more sense financially. Or you may want to consider one round out of pocket to learn more about the quality of your embryos. If it fails, then you could move straight to shared risk. |
Anonymous
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Agree with all the PPs about the psychological benefits of shared risk - you just never know what's going to happen with biology so it seems a good place to hedge one's bets.
Another option you could also consider, which gives fewer cycles but is also (I am pretty sure) less expensive, is SG's multi-cycle discount. It includes two cycles and also cryopreservation and FETs for any and all additional embryos created during those cycles. We had to take that route because I was already 40 but wanted to use my own eggs, and the additional cost was totally worth the peace of mind. The whole process is so crazy expensive anyway, what's an additional $6K (was our thinking, based on the price they gave us - especially since we knew we'd want to freeze any additional embryos we might have anyway and that would've been an additional cost if we were buying a la carte). All that said, wishing you the very best of luck and that you get a beautiful healthy baby on the first go-round! |
Anonymous
| agree with the PPs too about shared risk. It makes the process so much less stressful b/c you're not (excuse the pun) putting all your eggs in one basket. |
Anonymous
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From reddit: http://www.reddit.com/r/statistics/comments/1pbjlf/can_someone_help_me_use_probability_to_make_this/
You're on the right track, TysonStoleMyPanties, but it turns out that the problem is a little more complicated. Given that the trials are independent (big assumption), the probability of success in each trial is 0.4. So the expected number of trials until success is 1/0.4 = 2.5. We could say that 2.5 trials would cost $30k, at $12k per trial, if we could pay for "half" or "partial" trials; however, I doubt that paying for partial trials is a possibility. We could pay for one, two, three, and so on trials. Using the geometric distribution, we can calculate the probability of success p in any given number of trials k, where the probability density function is given by pdf = p*(1-p)k-1. We see that the probability of success within the first two trials is the sum of the probability of success in the first trial (pdf=0.4) and the probability of success in the second trial (pdf=0.24), which is equal to 0.64 -- meaning that there is a 64% chance of success within the first two trials. From this, we also know that the probability of success in three or more trials is 1-0.64 = 0.36. We can calculate the pdf for each possible number of trials, but for the sake of convenience, I calculated the pdf for up to 12 trials. Here is the graph showing the calculated pdf for each of the first twelve trials along with the corresponding cost at $12k/trial. In order to choose the more cost-effective strategy, we could compare the expected cost of the pay-per-trial option with that of the unlimited trials option. The unlimited option costs $25k, which is slightly more than the cost of two pay-per-trial options ($24k), but considerably less than the cost of three pay-per-trial options ($36k). The more trials it takes, obviously, the more cost-effective the unlimited option would seem. At this point, it may seem intuitive to select the unlimited option because one would save a considerable amount of money if three or more trials were attempted; however, don't forget that one has a 64% chance of success within the first two trials. The strategy I would recommend depends upon how many unsuccessful trials the OP would be willing to attempt given the unlimited option had been purchased. Realistically, after a certain number of failed attempts, the OP's wife will quit attempting to get pregnant using this method of IVF, and the $25k will be a sunk cost. Let's say that the OP's wife would quit after five attempts. If they were using the pay-per-trial option, then they would have spent $35k ( =$60k - $25k ) more than had they used the unlimited option. But don't forget that there is only a 5.18% chance of that happening. Whereas, there is a 40% chance that the pay-per-trial option would save them $13k (i.e., there is a 40% chance of success within the first trial), and a 24$ chance that the pay-per-trial option would same them $1k. So, to compare the expected costs, we simply sum the difference in cost for each possibility from one to five trials (assuming the OP would stop after five unsuccessful trials), weighted by their respective probabilities. For example: Suppose that the outcome of each trial is independent of the previous outcomes. Also suppose that the probability of success is 0.4. Further suppose that the OP's wife would cease the series of IVF treatments after five unsuccessful trials, regardless of the payment scheme. The expected money saved using the pay-per-trial option compared with the unlimited option is given by 0.4($25k - $12k) + 0.24($25k - $24k) + 0.144($25k - $36k) + 0.0864($25k - $48k) + 0.05184 ($25k - $60k) = $0.0544k = $54.40. In conclusion, given the above assumptions, using the pay-per-trial option is expected to be slightly more cost-effective than the unlimited option. Please note that this estimation is sensitive to several factors. For instance, we have not incorporated risk aversion into this model. That is, if the OP's wife cannot afford paying ten's of thousands of dollars then purchasing the unlimited option may be the best option for her. Also, if the OP's wife would be willing to attempt more than five unsuccessful trials, then the unlimited option would be preferable. Finally, if the probability of success is less than 40%, but everything else remains unchanged, then the unlimited option may be the best way to go. OP, I'd be happy to crunch some numbers or explain the details if you would like more help estimating the cost-effectiveness given a different set of assumption. |
Anonymous
| Also remember that failed cycles will disqualify you from some shared risk programs. So it is not always the case that you can try some single cycles and then switch to shared risk if you're unsuccessful. That should weigh into your calculation as to which one to choose from the outset. (You can discuss w/ your dr. whether 1-2 failed cycles would disqualify you given you particular circumstance and clinic.) |
Anonymous
| I completely recommend Shared Risk, and this it's a no brainer. Yes, you could end up paying more if you're pregnant on the first try, but peace of mind really is everything when it comes to IVF. Furthermore, it's in the clinic's best interest to get you pregnant. Their money is on the line. That in and of itself really made me feel so much better about shelling out twice what we would have paid for a single cycle (we are doing ICSI and just added in PGS). For me, Shared Risk has been a life-saver. We did get pregnant on our first try but found out in our 2nd trimester that our baby had a trisomy. We chose to terminate, and were told we would still be in the Shared Risk program. It was the one sliver of good news during such a horrific period for us. |
Anonymous
I am so sorry for your situation.. I hope everything is now as you planned and wished. As for OP, we are almost in the same situation as you are. We are leaning more Shared Risk and here is why 1. since it is unexplained there is no guarantee we won't have same failed result with IVF (just like in IUI), I have read here some couple went through multiple cycles with unexplained. so it give peace on your mind if it fails you still have another, and another and up to 6 cycles tries (unless clinic will decide to terminate the Share Risk) 2. Share Risk guarantees to cover until you deliver a baby, so you are again covered if you have chemical, or miscarriage. I have heard many in my family had first as miscarriage so I don't want to risk there too. 3. We file expenses on our Taxes. It is a difficult decision, I hope you will chose the one that fits your needs. Good luck to everyone! |
Anonymous
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Shared Risk, no brainer. I know of ONE couple who did Shared Risk and got the baby first cycle, and they have no regrets.
Also, when you have a package, it often includes things (like frozen transfer, ICSI, etc.) that would be a la carte on top of the single cycle price. When your frozen transfers are included, you are more likely to go one by one, eSET, which is safer as far as a singleton pregnancy vs twin--because you don't have to pay for the next transfer if you don't succeed. Even cancellations don't cost you extra other than time and meds under shared risk, with pay-by-cycle you will pay a fee to either cancel or convert to IUI. You're young enough to qualify, if you fail and can't get into shared risk after that first cycle (as a PP mentioned), you will really regret not taking it when you could. The age cutoff to start is 38, not as far off as you think, you are young enough now, so take it now. You may want it again for the second one, and you'd still have time if you succeed quickly this time. Again, no brainer, Shared Risk. I don't think the odds are in your favor to succeed first try even at your age, and I think Shared Risk is only the cost of 2 cycles. Maybe 3 but the other costs that get absorbed that I mentioned will make up for a difference. |
Anonymous
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We are doing shared risk through Shady Grove, and I agree with many PPs here - if you think it's going to take more than one cycle (and it typically does) then it's worth it. Also, consider even if you DO get pregnant and give birth to a live baby after only one try, there's a good chance that you'll end up with extra embryos for more babies later (if that's what you want).
Another option is to consider "mini" IVF. Fewer drugs, usually a bit less expensive. My wife did a clinical trial out of NYC that studied mini vs traditional IVF. We randomly drew the mini arm for the study and ended up with one embryo....but that embryo is now our happy and healthy 2 year old boy. The name of that clinic is New Hope Fertility, in case you wanted to discuss this with them (doing mini, not the trial [which has since concluded]). We have kept up with many women who did the trial with us, and nearly all who did mini had a successful pregnancy. Also note that SG shared risk allows you to try up to 6 times without disqualifying you AND the contract stipulates you must give birth to a live baby. |
Anonymous
| Not OP, but in a similar situation. Do many people end up with frozen embryos? Of course we are hoping that we do, and that would influence the decision since it is included in the cost of shared risk. |
Anonymous
| I was in the 3:1 program (DE) and yes, each fresh cycle we had at least one frozen embryo. |