IVF Money-Back Guarantees

Does the IVF money-back scheme guarantee (MBG) a safety net, or is it just a marketing ploy? Research by ISB’s Madhu Viswanathan and co-authors finds that MBG clinics typically improve safe birth outcomes and reduce financial risks for patients, challenging critics who call them exploitative.

In vitro fertilisation (IVF) has revolutionised reproductive medicine, enabling millions of births worldwide. However, the decision to pursue IVF remains complex — physically, psychologically, and financially. The inherent information asymmetry or knowledge gap between clinics and patients further compounds this challenge, making patients susceptible to seemingly misleading claims.

In this environment, MBGs — where clinics refund treatment costs if a live birth is not achieved — have emerged as a controversial practice. While some argue that MBGs introduce treatment risks, others consider them like insurance safeguarding patients undertaking an expensive and uncertain treatment journey.

In response to this debate, research by ISB faculty Madhu Viswanathan and his co-authors Shan Yu and Mrinal Ghosh provides empirical evidence that MBG clinics tend to not only achieve higher live-birth rates but also mitigate financial risks for patients, challenging the perception that MBGs are mere marketing gimmicks. Understanding whether these guarantees offer genuine benefits or are merely hype is essential for patients, clinics, healthcare professionals, and policymakers.

How did they do it?

Researchers examined whether MBG clinics signal better treatment outcomes and higher-quality care than those without MBGs. They created an extensive dataset covering IVF clinics in the United States. The dataset included:

• Clinic-level treatment and outcome (e.g., number of embryos per transfer, live-birth rates).
• Statistics and clinic characteristics (e.g., number of doctors, treatment prices).
• Marketing practices, insurance mandates (state-level), and competitive landscape factors.
• Demographic and geographical characteristics.

Using this dataset, the researchers analysed differences in treatment outcomes between MBG clinics and clinics without MBGs while controlling for the observed differences in patient characteristics and treatment inputs. While accounting for any unobserved differences, they compared clinic quality and treatment outcomes.

What did they find?

In their dataset, 36% of IVF clinics in the US offered MBGs between 2010 and 2012. And after accounting for patient differences, the researchers found:

• MBG clinics achieved better treatment outcomes on average, i.e. higher live-birth rates than clinics that did not offer MBGs.
• On average, MBG clinics treated patients less aggressively without imposing higher multiple-birth risks.
• No evidence of selective screening was found. MBG clinics tend to treat patients with similar fertility profiles as non-MBG clinics, dismissing concerns that these clinics were selectively biased toward high-fertility patients to avoid refunds.

What does this mean for stakeholders?

Since MBGs act as signals of clinic quality, this scheme could be a useful alternative to insurance policy mandates. In the US, where IVF treatments can cost upwards of $14,000 per cycle and with limited state-level insurance coverage, MBGs could help patients access high-quality treatment options without facing financial risks. 

For clinics: High-quality providers not currently offering MBGs should consider adopting them. These differentiate clinics from their competitors and provide patients with greater confidence in their expertise, especially in a market where patients often struggle to assess whether a clinic can meet their needs.

For patients: MBGs may represent an important safety net, particularly in states that lack insurance coverage for IVF. By offering financial protection, MBGs may help mitigate patients' risks and make IVF treatments more accessible. 

For policymakers: MBGs function similarly to state insurance mandates by reducing patients' financial risks, which could ultimately encourage more patients to pursue IVF treatments. 

The study proves that clinics offering MBGs may deliver enhanced care by securing better outcomes while taking lower risks. This could reduce the appeal of deceptive practices and address some of the concerns about exploitation in the IVF market. 

The implications of this research extend beyond fertility treatments. In other expert-service markets — healthcare, legal, and financial services — where service quality is difficult to assess upfront, MBGs could function as both a quality signal and a risk-sharing mechanism. While MBG programs appear beneficial, the authors also call for further research to examine whether clinics misuse these schemes by pushing for unnecessary tests or procedures or charging higher prices.

Author: ISB Editorial Team