Would you do shared risk at SG at 39?

[Anonymous]

This question came up in my other thread but posting here with the correct title. Secondary infertility, trying for a year and a half with one missed miscarriage at 12 weeks in there. Pursuing IVF at SG and all numbers look “good”. They gave us an 87% chance of taking home a baby after three cycles. In this case, would you do shared risk? No coverage by insurance. We can afford to pay out of pocket if we need to. Our plan is to try until the end of 2021 and then just be happy with our family of three. I am 39, husband is 41, son is 4.

[Anonymous]

What does shared risk mean?

[Anonymous]

Anonymous wrote:This question came up in my other thread but posting here with the correct title. Secondary infertility, trying for a year and a half with one missed miscarriage at 12 weeks in there. Pursuing IVF at SG and all numbers look “good”. They gave us an 87% chance of taking home a baby after three cycles. In this case, would you do shared risk? No coverage by insurance. We can afford to pay out of pocket if we need to. Our plan is to try until the end of 2021 and then just be happy with our family of three. I am 39, husband is 41, son is 4.

I know it’s more expensive if you are in that age bracket than if you are less than 35, but I’m not sure the price... maybe you could provide that. It’s worthwhile if you are under 35 because you probably should plan on paying for a retrieval and a FET. If you are under 35, it an obvious choice. For me, I love the peace of mind and knowing that if it doesn’t work we will get the money back.

[Anonymous]

Yes, I would.

[Anonymous]

I think it depends on how many times you see yourself going though IVF. I that program covers up to 6 cycles. If you would use more than 2-3 then yes it’s likely worth it because after 6 cycles, if they qualified you, probably high likelihood you will bring home a baby. But if you don’t want to do that many, it might not be as economical as a different package. I don’t know the specifics prices of all the packages.

[Anonymous]

Don’t have the doc right in front of me though I can look tmw to be sure. Shared risk is 28,500 plus 6,000 for genetic testing plus whatever the cost of medication is (5-7k?) So, the cost is around 40k. You get a baby or you get your money back, essentially. I believe one cycle is 10,800. So, if we do shared risk and get lucky on first or second cycles, we would pay more and SGF comes out ahead, if it takes longer, they come out ahead.

I know there is no way to know since it varies, but do most couples need multiple cycles?

[Anonymous]

Anonymous wrote:What does shared risk mean?

Google, every time.

[Anonymous]

Anonymous wrote:Don’t have the doc right in front of me though I can look tmw to be sure. Shared risk is 28,500 plus 6,000 for genetic testing plus whatever the cost of medication is (5-7k?) So, the cost is around 40k. You get a baby or you get your money back, essentially. I believe one cycle is 10,800. So, if we do shared risk and get lucky on first or second cycles, we would pay more and SGF comes out ahead, if it takes longer, they come out ahead.

I know there is no way to know since it varies, but do most couples need multiple cycles?

Well it’s $10,800 but I don’t think that includes ICSI or AH, which you need if you are testing the embryos, so you are probably looking at $12,500 -13,000 for the retrieval, $3,600 for testing, and $4,500 for a FET plus meds. If you only need one retrieval, the chances a transfer of a normal embryo will work are around 60%, so it’s not improbable to need more than one transfer. Plus if you miscarry you’d need to pay for another retrieval or transfer.

It’s kind of hard to know how many retrievals you might need until you do one and see how many normal embryos you get, if any.

[Anonymous]

I think if you want a baby enough to go through 2-3+ cycles, the shared risk program is a good deal.

I think a question to ask yourself is: if you get lucky and have a successful pregnancy on the first round, will you feel bad for having "overpaid" or will you just be happy with the outcome?

I think that even though the program covers up to 6 cycles, you can drop out anytime, so if you have one unsuccessful cycle and decide you're done, you can still get your money back. But if you know already that you only want to do 1 cycle regardless of outcome, then paying just paying for 1 cycle is probably the better bet. I would say though that the odds of a successful pregnancy from 1 cycle at 39 are probably 50/50 at best.

[Anonymous]

If you can afford it, I'd do the shared risk for the peace of mind that you'll definitely be able to do multiple cycles if needed. It's really impossible to know if you will actually need multiple cycles. At 39 (and with a decent ovarian reserve -- AFC of 19 and AMH around 3), I got lucky and only needed one retrieval and one transfer. But plenty of folks need several retrievals. .

[Anonymous]

Here is how I would approach the decision making. If money was not an issue - meaning you can comfortably afford it, I would do shared risk. If you get pregnant on the first or second cycle (which it is more likely that you would need more than one cycle), you will have "overpaid" but with the relaxation of not having to decide to continue or not each cycle. You will get what you want - baby - at a slightly higher price than if you did per cycle. If you do shared risk and it takes multiple cycles, again, you don't have to make the decision each month if you want to try again - you have already paid for the 6 cycles. And if you don't get the outcome you want, you know you are getting most of the money back. The money does not make the sting of not getting pregnant easier, but it is a thing.

If money is tight, you could do per cycle - HOWEVER, if you are someone who keeps pushing past your set limit - we will only spend 500,000 on a house but then spend 650,000 to get the one you want, or you say you will stop after 2 cycles but really will try again and maybe again - just spend the money now. You will be twice as mad about not getting pregnant if you don't have a take home baby AND you are out 65,000 and you did not do shared risk.

If at 39 they are letting you do shared risk, they think you have a good chance at getting pregnant. So that is a good sign.
Remember, this is a business, so they do careful calculations about profiles and who gets pregnant and who gets their money back. If they thought you were not going to get pregnant, they would not offer you shared risk. But, it might take a while to get all the pieces in order.

[Anonymous]

I would go with Shared Risk program, considering the doctor's motivation of success.

There is no bonus program for the doctor to help the patient succeed, which I wish there was. Therefore from profit point of view, the more cycle you do the more money they can get. Probably that is one of the reasons that a lot of RE doctors are not willing to think out of box. I feel like they just do the treatment without considering each patient's difference.

Given the shared risk program, if they help you succeed at the first try, it is equivalent for them getting a bonus without doing anything. They can spare their time to treat a new patient to earn more money.

So I would go with Shared Risk program if I can

[Anonymous]

Yes I would do shared risk no question

[Anonymous]

My advice is not to do shared risk. By way of background, I actually did shared risk at SGT and got pregnant the first cycle and have no regrets having gone that route in my late 40s. (Due to my age I had donor eggs and SGF requires you to do Shared Risk if you use donor eggs.). Here is why I would advise against shared risk for you. Shared risk gives you up to 6 cycles but a “cycle” is not what you think. A “cycle” is tied to your use of all viable embryos, so, if you get 15 viable eggs, that become 5 viable embryos, and you implant 1 at a time, it is one cycle. It is unlikely that you will go thru more than one cycle between now and the end of 2021. And it would be physically impossible to go thru 6. So, financially, you’re better off doing it one at a time.

[Anonymous]

Anonymous wrote:Don’t have the doc right in front of me though I can look tmw to be sure. Shared risk is 28,500 plus 6,000 for genetic testing plus whatever the cost of medication is (5-7k?) So, the cost is around 40k. You get a baby or you get your money back, essentially. I believe one cycle is 10,800. So, if we do shared risk and get lucky on first or second cycles, we would pay more and SGF comes out ahead, if it takes longer, they come out ahead.

I know there is no way to know since it varies, but do most couples need multiple cycles?

I am 39, was given similar statistics as you were, and I am currently in the Shared Risk Program at SGF. So I think, for our age bracket, since genetic testing is required, the cost of it is included in the $28,500. There's a footnote about this in the financial brochure which is written a little unclearly so I was expecting to pay an additional $6,000 on top of the $28,500, but I have only received and paid a bill for $28,500, and I have already gone through one round of PGT-A testing. Here's hoping I don't get a surprise bill for $6,000.

We have no insurance coverage for IVF, and I spent a lot of time weighing the pros and cons of doing Shared Risk vs. just purchasing cycle by cycle. I don't love the idea of possibly ending up spending more money then I had to, but I hate the idea of ending up with no child (AND no refund) after spending tens of thousands of dollars even more so I ultimately decided to go with Shared Risk. I believe the doctor told me that I had a little over 60% chance of having a child after one cycle of IVF (caveat: I can't actually remember if by one cycle she meant one retrieval and one transfer or if she meant one retrieval and possibly several transfers). Good odds yes, but I wasn't willing to bet that I wouldn't be in that 40% who require more than one retrieval or transfer. Shared Risk has reduced a good deal of the anxiety in an already very stressful process. There is a lot of unpredictability when it comes to IVF, particularly if you have not had any prior retrievals/transfers. Doctors can generally predict with some confidence whether you'll respond well to the medication, but it's completely up in the air what egg quality will be like, especially at this age. I was fortunate and ended up with 5 PGT-A normal embryos after my first (and only so far) retrieval, but I'm in a facebook group where there are women who had a similar number of eggs retrieved and ended up with no normal embryos. My transfer is scheduled for next month, and again, the results are unpredictable, even with a PGT-A normal embryo. For many women, even PGT-A normal embryos end up not implanting or have resulted in miscarriage.

It is very comforting for me to know that even if this process completely fails, the only wasted money will be limited to the cost of medication. I had two OOP IUIs prior to starting IVF, and each time one failed, it just felt like $2,000 down the drain. We are fortunate to live comfortably, but $4,000 for failed treatments still stung. Purchasing just one full IVF cycle (1 retrieval and 1 transfer) with PGT-A testing runs around 18k-19k at SGF and many of the other DMV area clinics. You could theoretically pay $10,500 for a single cycle, but you'd need to have a fresh transfer (not a guarantee; will depend on how your blood work looks around the time of retrieval), and if you end up with more embryos than the number being transferred, there would be an added cost to freeze the other embryos (which you would want to do because there's no guarantee the fresh transfer will be successful). Frozen embryo transfers are $4,600 at SGF, so the costs will add up if you end up needing several transfers.

I don't currently have any children and would probably be willing to go through 3-4 retrievals before moving on to other options, but you have the option of withdrawing from the Shared Risk program whenever. If you want to withdraw from the program, but still have normal embryos on ice, it's possible you could get a partial refund (depends how many retrievals/transfers you've already had). If you want to withdraw from the program and have no normal embryos on ice, you should get a full refund. SGF also has the right to terminate you from the program.