By fertility experts from Spain.
IVF Refund Guarantee and IVF Money Back Guarantee programmes are becoming more and more popular. It’s not surprising since they seem like an ideal solution for patients looking for some peace of mind during their uncertain fertility journey. The webinar is hosted by Dimitris Kavakas, an expert in the fertility travel sector and the CEO of the Redia IVF Travel company offering refund guarantee programmes, thus helping IVF patients manage their budget.
According to Dimitris Kavakas, the first thing we should bear in mind is that despite medical advances, IVF treatment has still a significant percentage of failure. There is no guarantee of an immediate pregnancy and successful treatment for the first time. That’s why from a financial point of view, IVF is an unpredictable process: you have no guarantee whether you succeed or fail. Dimitris has met a lot of patients who have been trying to succeed for several cycles and were financially devastated.
Success rates – the evidence to believe in?
Dimitris makes an interesting point warning us against blindly believing in success rates. In fact, every patient going to a fertility clinic asks mainly about success rates and every fertility clinic likes to boast about success rates as well. Dimitris explains why we should take everything a clinic says with a grain of salt. A success rate may mean many different things: a pregnancy rate (it relates to positive results of a pregnancy test), a heartbeat, 12th week of pregnancy ( the so-called 3-month rate) or live birth. Because of that, clinics may easily manipulate their actual results and mislead their patients. Dimitris highlights that there is a long way from a positive pregnancy rate to live birth, with an average miscarriage rate ranging from 5% to 25%. Age grouping can be also manipulated to make success rates look more impressive.
In some countries, like the UK and Spain, there is a state agency that controls fertility clinics so the success rates they publish should be the real ones. But elsewhere there may be clinics putting completely false success rates as nobody checks on them. So one has to be aware of the reality and check beforehand how a clinic they choose to produce their success rates in order not to be taken in by their promises.
What factors affect success?
According to Dimitris, there are a few components of a successful IVF treatment. All IVF patients should be aware of that complexity in order to assess their chances in a realistic way. The most important is the quality of the genetic material: both egg and sperm. Another factor is age – it mostly refers to a female partner, but recent research shows that a male factor is also important as the sperm quality diminishes with age.
The lab quality and scientific expertise play a crucial role as well. Dimitris recalls the statistics showing that in IVF treatment almost 70% of success depends on the quality of the lab while only 30% refers to a doctor and his/her expertise. So it is not enough to search for a doctor with a reputation and a famous name, not considering the kind of lab and technology available in the clinic this particular doctor works for. Then there is the type of treatment applied that matters. Unfortunately, for some clinics quantity is more important than quality and they apply the same protocols to everybody without paying attention to the individual needs of a patient. So Dimitris advises patients to look for clinics with tailor-made protocols suiting their needs instead of everybody’s needs.
Finally, success is an accumulative process meaning that it is important to realise you may not succeed in the first attempt. Dimitris assures it is common to have a few transfers and a couple of cycles before you can achieve your success.
Taking all the above issues into account, it becomes clear that foreseeing the effects of one’s IVF treatment is not literally possible. In such a case, it is good to have at least one constant that would make the whole process less stressful and unpredictable. What Dimitris means by that is the overall cost of the treatment.
Dimitris explains that a refund guarantee programme will help you deal with the financial insecurity of the treatment. It is your ability to do a multi-cycle programme at the set cost.
Still not convinced?
Although money-back programmes may seem like an ideal solution, you have to remember that they do have their cons as well. During the webinar, Dimitris pays our attention to two criteria that all the patients have to take into account while considering their refund-based IVF financing plan.
First of all, it is the eligibility criteria. It means that you need to be checked beforehand. You have to remember that the company offering a refund guarantee program is not an NGO or charity. Simply it is not there to lose money. They need to check if the possibility of a risk, for them meaning a refund, is not exceptionally high in your case.
Insurance companies will check certain details to minimise the risk. For example, if it is an own egg IVF treatment, they can ask for hormonal tests, look at karyotypes or endometrium. Similarly, they will look at the male partner and check his semen analysis and karyotypes to make sure sperm is good quality. Besides, there are age limitations. IVF treatment with the use of own eggs is generally for women below 40 (or up to 37) for a full money-back guarantee. In the case of egg donation, the only case of concern is quality of endometrium. A woman is asked for a transvaginal ultrasound scan and in case of a male factor, the quality of sperm is checked. There is no age limitation in egg donation. Of course, different countries have legal age limitations – in most European countries it is the age of 50.
Secondly, the thing to consider is your chances to succeed in the first cycle. You may wonder what happens if you pay for e.g. three cycles but you succeed in the first one. Obviously, you’ve got the baby you’ve always wanted but you have paid much more. Dimitris explains that it is a part of your chances and just like in case of any insurance, you do not get anything back. However, in most proper refund guarantee programs, live birth should be guaranteed. If it is only a positive pregnancy test or heartbeat, then Dimitris suggests having a second thought about such programme.
You may be interested in reading our comprehensive guide regarding IVF Refund and Money Back Guarantee Programmes
As the number of refund guarantee programmes on the market is growing, it is good to know how to differentiate among the different options and choose the most reliable offer. According to Dimitris, you should mainly look at what is included in the programme: what services, lab methods and medications. Remember that the latter are generally very expensive. For example, the cost of a medication for a 3-cycle program can be up to 4,000 GBP so it may significantly influence your budget if it is not included in the programme.
Secondly, is the refund percentage of 50%, 70% or 100%? Dimitris suggests making it clear if the total amount is guaranteed or just a percentage. The same refers to excluded extras. For example, the medication included in the programme may not be refundable so you need to know what is refundable and what you will get back in case of a failure.
Dimitris also highlights the difference between two types of guarantees: the positive pregnancy test and live birth. Some programmes guarantee a positive pregnancy test (where there is around 25% miscarriage rate). You may, for instance, pay 15,000 GBP and you get a positive pregnancy test in the first transfer and then you miscarry. In such case, you lose all your money. In case of a positive heartbeat, there is a 15% miscarriage rate and in case of 12-week pregnancy, there is a 5% miscarriage rate. A live birth guarantee is undoubtedly the best – in this case, you are guaranteed that you either have a baby or your money back.
Last but not least is your travel costs. In this case, Dimitris advises doing one’s own calculations very precisely before making an actual decision. For example, a clinic that is an hour-flight away from your home may be much cheaper than the one that is a 5-hour flight away. So you have to decide what is affordable and acceptable for you. Sometimes you need to compare 2 or 3 countries and clinics not only in terms of their offer but also and in relation to hotels’ and flights’ prices. It is important because travel costs are not included in any refund guarantee programme.
If you go for a refund guarantee program then the company that offers you the program has to guarantee that. So you know that the clinics they recommend are already screened because it’s in the vested interest of the company. I have such a company which I don’t want to promote now but we make sure that the clinics we work with are the best and they produce actual results, not just marketing. So a part of their success and of the results they produce is personalised service. You’ll understand if it’s personalised service by the way you are treated by the personnel. Clinics that offer personalised service have coordinators who immediately are in communication with you, they answer your questions, provide you support. They arrange Skype with a doctor to do consultation, they organise your trip, they meet you and take you everywhere – in other words, they’re taking care of you. That’s what personalised service means. In clinics where they do not offer personalised service you wait in a queue of 20 or 30 to be called. Maybe then you’ll understand that it’s not a personalised service but you may understand it too late and you’ll be committed to treatment in that place.
I cannot name clinics live but obviously, we know such clinics. All the companies that work like we do and offer a refund guarantee program look for high-quality clinics so to guarantee they are not going to lose money by giving back refunds all the time. The money-back guarantee is not given by the clinic, it’s given by us, by the insurance company. We decide to work with the clinic because we screened that clinic and we believe they could produce good results and good quality. These are the clinics for which we offer 100% refund guarantee program. I’m happy to talk in person and exchange emails with anyone who is interested in finding more details about such clinics.
As I said, I cannot name the clinic here but I can do it in emails. The cost depends on the clinic and the country. I can give you a rough idea of the programs we work for. We want to ensure that there are no surprises so we include medications, lab methods such as ICSI, blastocysts, frozen transfers, freezing costs. We include everything into 3-cycle programs with 100% refund guarantee. I’m telling this to give you the price changes but also for you to be able to compare. I cannot talk about other companies’ programms. It depends on the country. For example, in Spain it’s from 16000 GBP to 18000 GBP, in Greece, a popular destination for IVF and egg donation, it’s slightly cheaper, from 13000 GBP to 15000 GBP. There are similar prices in the Check Republic. It varies between the clinics because the price of the program is an algorithm, it develops on the prices of the treatment itself and the success rates of the clinic. So it may be the case that a clinic is more expensive but because it has very high success rates, it may actually be cheaper from a clinic that is cheaper but has low success rates. And there are countries that appear to be cheaper but the programs are not cheaper. And I have to explain that this is because the success rates of those clinics are low and that is why the program tends to be more expensive. There are also countries in Eastern Europe such as Georgia and Ukraine and they’re between 11000 to 13000 GBP. Turkey is also in that range of price. So egg donation is a different price and only IVF is also a different price. But you need to expect from at least 10000 GBP for the cheaper program, that can up to 18000 GBP for the most expensive clinic.
I think that a patient can do it, we do not do it as a company. Embryos belong to a patient so this is not an issue of a refund guarantee company that offers the insurance. A patient signs the legal paperwork with the clinic that had ownership of the embryos that they produce. So these are their embryos. Even if they become pregnant and have a child first time and they still have embryos, these are their embryos. They can do whatever they want with them. They can pay the cost and transport them to the UK if they want. So this is not a problem. This is a matter of state legislation but within the EU and since the UK is still in the EU you can still bring the embryos. I don’t know what will happen after Brexit but nobody knows that. The only issue would be egg donation. The UK legislation requires the donor to be known while most of the countries in Europe have anonymous egg donation. So there might be a problem in bringing embryos from egg donation into the UK from Europe.
You have to see what you signed. Obviously, you signed the contract that explained exactly what you’d be getting. If the company has not fulfilled the contract, you can request something. Was it a refund guarantee program or not? The question is ambiguous. Sometimes clinics go into an IVF process and they say: We guarantee a minimum of embryos. But if the clinic did not do what they promised, you should ask for something. I don’t know if it is a refund or if you should ask for explanations.
I cannot mention any company names here, I’m sorry. But they exist. There are good proven courier services everywhere. They are easy to be found. But obviously, I don’t want to name any company live here.
If a guarantee is 12 weeks, it’s not perfect but the biggest risk of miscarriage is the first 12 weeks. So after 12 weeks, the miscarriage rate is 5% or less. But it still exists. How could you avoid it? For example, in our refund guarantee program contract, we ask a patient to avoid extreme sports. That even includes biking as it is risky. If you have an accident while biking or e.g. skiing, you lose your baby. So you should avoid doing exercise that risk accidents. You should also have a good obstetrician and you should have regular visits to the obstetrician. Firstly, once a month and at later stages, from the 7th month, it’s twice a month or even every week to make sure everything goes fine. Just have an obstetrician that you trust and that is a good scientist and takes care of you to avoid miscarriage. And keep on taking the medication the obstetrician recommends.
Spain is an interesting case. Actually, the law doesn’t say anything about 50, they recommend 50 but they don’t prohibit it. They leave it up to the clinic to decide whether a patient is fit enough to be pregnant after 50. It means that it’s their only responsibility if something happens. It means that doctors in clinics in Spain will not do any treatment after 50 because they fear of the liability. If something happens to the lady in pregnancy, they’re responsible for it. So nobody would do it. I don’t know whether they will increase the age or not. There is nothing to suggest that they would do so.
You can search for a courier company that does genetic material transportation and they will tell you. I don’t have the knowledge, we’re not dealing with such issues. But the courier service that does them, they know the legal process and would advise you what to do.
Poland is in the EU so it should be allowed. I don’t know if there is any restriction by the Polish government. It is the patient who has to initiate the transport and not the clinic. The clinic has no right to refuse, it can only refuse to organise the transport. The clinic has no responsibility to organise transport. It’s the patient who has to organise the courier and then the courier will do all the paperwork. They will first talk to the recipient clinic in Poland or whatever country that is, and then they would request embryos from the sending clinic. The sending clinic would just send the embryos when it is presented to all the documentation.
It depends on the program. Our programmes are 3-cycle programmes because this is the average number of cycles that an average person needs to achieve success.
You can do one program and have 3 cycles. And in each cycle you have any transfers, depending how many embryos you develop. If it is unsuccessful and you get a refund, obviously you cannot do it again. But if it is a success in the first cycle, then yes, you can do another program for a second baby.
I suppose you mean Europe. I know we work with Georgia and Ukraine also offers that. And Russia offers treatment between 50 and 55. These are the only ones I know.
This depends on the protocol. I don’t think this is an issue at all. Yes, everything has to do with your lining. There is no problem to have a woman at menopause to induce a cycle and to get her pregnant. This is easy with egg donation so the only thing is the lining. This is done by the doctor by using medication. You can fix your cycle, you can induce cycle and you can schedule treatment. The best way to go round is by having the donor produce the embryos, fertilise them and freeze them. And when you’re ready for the transfer, they thaw the embryos and transfer them. So that’s the most successful way of proceeding. Of course, you can do the matching of cycles but it’s risky. Even a day wrong and you can lose the embryos and have a failed cycle because of that. The safest way the most of European clinics use now is called the freeze off. So they freeze off the embryos and when you are 100% ready and you have the best endometrium lining, they go for a transfer.
Yes, the technology of vitrification changed everything in the IVF industry. Nowadays freezing fertilised eggs (embryos) is actually proven to be more successful. It has a 100% survival rate in embryos so it saves much stress. Because when you freeze the embryos, you can find the exact window of implantation. In a frozen transfer cycle that can actually boost the success rate. So many quality clinics have chosen to go for frozen transfers only. So it’s a choice and it goes well. Ten years ago it was a different picture. The survival rate of embryos was 25-30%. Now it’s almost 100%.
This is too medical I think. A doctor should comment on the suitability of ERA test. It depends what PGS was that. Which lab did the PGS? Was it day 3? Was it day 5? Was it NGS? Did they check all the chromosomes? Or maybe was it the old technology that checked a few chromosomes only? So without having complete information you cannot really answer such questions. I’m happy to discuss with that person in person and to go through documentation and be more precise because obviously without having data you cannot comment and give advice.
Nowadays in most clinics, fresh and frozen success rate is almost the same. In some cases, the frozen is higher, for the reasons I mentioned before. Not because the frozen is better but because the window of implantation of the cycle can be more accurate in a frozen transfer cycle.