How Do Shared-Risk IVF Programs Work?

How do shared-risk IVF programs work? You pay one higher, upfront fee to a clinic for a set number of IVF attempts. If you don't reach the program's definition of success, the clinic refunds some or all of that fee under its program rules.

The specifics vary by program, including what counts as a cycle, how the deposit works, who qualifies, and what's excluded.

So how does shared-risk IVF work in practice? This guide walks through the mechanics one step at a time, using the American Society for Reproductive Medicine (ASRM) as a neutral guide. At the end, we cover a different way to plan for IVF costs using the Sunfish IVF Success Program.

What is a shared-risk IVF program?

A shared-risk IVF program is a payment structure some fertility clinics and other providers offer. Instead of paying for each IVF cycle as you go, you pay a higher fee up front for a package of cycles.

The ASRM Ethics Committee describes these programs in its 2023 opinion on financial "risk-sharing" or refund programs, published in Fertility and Sterility in 2024. Patients pay a higher initial fee for a package of multiple cycles, discounted compared with paying separately per cycle. They may receive a partial or complete refund if they don't become pregnant or deliver a baby.

ASRM also notes that providers use several names for the same idea, including "risk-sharing," "warranty," "refund," and "outcome" programs. If you've seen those terms, you've seen this category.

These programs are most often available to people who pay for IVF out of pocket. They're also fairly common. The ASRM opinion cites a survey of Society for Reproductive Endocrinology and Infertility members (published 2019) in which 58% of group practices offered some sort of refund program.

To see how these programs differ from other refund options, read our guide to what an IVF refund program is.

How shared-risk IVF programs work, step by step

Looking for IVF shared-risk program details? Every program sets its own rules. The steps below show the typical order.

1. The clinic sets a higher flat fee

The clinic bases the fee on your age and the services involved. Some clinics collect the flat amount as a refundable deposit, and many limit these programs to patients who are not using insurance.

2. You pass eligibility

You usually have to qualify first. A program may look at things like age, ovarian reserve (a measure of how many eggs you have left, usually found through bloodwork and an ultrasound), and whether you're using insurance. Exactly what counts differs by program.

This is the answer to "who qualifies for an IVF refund program?" There's no single standard. ASRM says the criteria for joining and leaving a program must be clearly stated in marketing materials or as early in the evaluation process as possible. Ask for them in writing before you decide.

3. You learn what counts as a cycle, and how many you get

"Up to six cycles" sounds simple, but the details matter. Say a program includes up to six IVF cycles, plus the frozen embryo transfers that follow. A few questions come up right away. Does a cycle that ends in pregnancy loss use up one of the six? Does each frozen embryo transfer count as its own attempt? Programs answer these differently, and the answer is in the contract.

Ask how your clinic defines a cycle, and whether frozen embryo transfers are included or counted separately.

4. You learn what "success" means, and when the clinic keeps the fee

This is the step people most often miss. ASRM says the program must define success clearly, whether that's a live birth or a pregnancy of a specified length. If you reach that definition, the clinic usually keeps the full fee.

That has a cost. ASRM notes that patients who succeed early often pay more than they would have under fee-for-service pricing.

5. You learn when, and how much, is refunded

Refund terms vary from program to program. Say a program refunds 100% of the deposit if attempts are unsuccessful or the patient withdraws. Even then, the contract may list exceptions, such as steps you must complete or conditions that end your eligibility. Another program might refund only part of the fee. The size of the refund is only half the picture, because the conditions attached to it matter just as much.

Read the contract for exceptions, timing, and any steps you must complete to qualify for a refund. Our guide on how to get an IVF refund covers what to look for.

6. You learn what's excluded

Most programs don't cover everything. ASRM says screening and medication costs, which can be considerable, are ordinarily not included. Before you sign, ensure there is a written list of what's excluded, with estimated costs.

What a shared-risk program can't promise

A refund is not a promise of a baby. ASRM says patients should understand that acceptance into a program is "not (and cannot be) a guarantee of pregnancy and/or delivery."

ASRM also recommends talking with a financial counselor before you join. The goal is to be sure you understand the cost and that it's realistic for you.

Your chances of success matter too. ASRM says programs should tell you your own chances. The CDC publishes clinic-specific success rates for U.S. fertility clinics. The CDC cautions that comparing clinics may not be meaningful because patient populations and treatment methods differ.

Questions to ask before you sign

Consider asking:

• What is the total fee, and how much of it is a refundable deposit?
• How do you define a cycle, and do frozen embryo transfers count?
• What counts as success: a pregnancy, or a live birth?
• When would I qualify for a refund, and how much would it be?
• What isn't included, such as testing, medications, and complications?
• What are my own chances of success, based on my age and testing?

A shared-risk program may not fit you if you'd rather pay as you go, if the eligibility rules screen you out, or if you expect to succeed early (see step 4). ASRM says patients should be counseled about alternatives, including fee-for-service.

Another way to plan for IVF costs: the Sunfish IVF Success Program

Sunfish's IVF and Egg Freezing Success Programs are packages a patient buys outright at a partner fertility clinic, for a price quoted before treatment begins.

Sunfish's IVF Success Program includes every transfer of a patient's eligible embryos at one fixed price for up to a year,² in place of the separate fee a fertility clinic charges for each frozen embryo transfer.

Sunfish prices each IVF Success Program from a predictive cost forecast, and, on the Gold Program, returns a partial refund of up to $15,000, or a discount to continue treatment, if that forecast proves inaccurate.¹

Sunfish's Egg Freezing Success Program includes a second retrieval cycle at no extra cost for Gold Program members whose first cycle falls short of the mature egg count Sunfish predicted for them.

Sunfish accepts patients into its IVF Success Program at 100% eligibility, with no exclusions on age, diagnosis, or insurance, where many IVF programs screen applicants out by age or health data.

Sunfish collaborates with a member's fertility clinic to support their care rather than replace it, and the member and their doctor make every medical decision.

Medication is priced separately through our partner pharmacies, with a lowest-price match. PGT-A genetic testing is billed by your clinic. Every member also gets a dedicated Planning Partner.

See how the Sunfish IVF Success Program works.

Frequently asked questions

What is a shared-risk IVF program?

It's a multi-cycle IVF package paid up front, with refund terms attached. ASRM groups these under "risk-sharing" or refund programs.

Who qualifies for a shared-risk IVF program?

Each program sets its own rules, so there's no single answer. Factors may include age, fertility testing, and insurance status. Ask for the written criteria before you commit.

What counts as a cycle in a shared-risk program?

Programs define this differently. Ask whether a cycle that ends in pregnancy loss, or a frozen embryo transfer, uses up one of your included attempts.

What happens to your fee if you have a baby on the first try?

The clinic usually keeps the full fee. That can mean paying more than fee-for-service would have cost, which is why step 4 matters.

How much of the fee is refunded if the program's definition of success isn't met?

It ranges from part of the fee to all of it, depending on the program. Step 5 shows an example of refund terms.

Are medications included in shared-risk programs?

Usually not. Step 6 shows what ASRM says is typically excluded.

Do shared-risk programs publish their success rates?

Not always in a form you can compare. ASRM says eligible patients should be told their clinic-specific chances of success. The CDC publishes clinic-level rates, with a caution that comparisons may be misleading.

How is the Sunfish IVF Success Program different from a shared-risk program?

Sunfish offers a different kind of program: one fixed price with financial protection, rather than a multi-cycle package paid as a deposit. The section above has the details.

¹ As part of the Sunfish IVF Success Program, Sunfish provides a Custom Financial Plan using Sunfish's proprietary software that calculates the expected financial costs for each family to achieve a Live Birth based on a range of factors. If you fail to achieve a Live Birth within your custom financial plan budget and there are unexpected financial costs that were not accurately predicted by the Financial Planning Tool, our software Warranty may entitle you to receive a partial refund of your treatment package costs. Additional costs may be incurred outside of the Treatment Package Costs. See our Sunfish IVF Success Program Agreement for conditions and details.

² See contract for eligibility requirements.