Alternative Approaches to Funding Fertility Treatment

"The word 'refund' can also sound much simpler than the actual agreement," Elana Frank, CEO and founder of the Jewish Fertility Foundation, told Newsweek this summer.

She was talking about shared-risk IVF programs, but the sentence covers most of what follows. Almost everything offered to people paying for fertility treatment arrives with a reassuring name attached. Guarantee. Assistance. Savings. Peace of mind. Behind each one is a contract or a rate sheet, and the terms are where the actual cost lives.

Federal regulators estimate a single IVF cycle at $15,000 to $20,000, with an average of about 2.5 cycles to a pregnancy, and cite research putting the per-cycle figure as high as $38,015. Very few households have that in cash. So a whole market has grown up around the gap: refund programs, packaged cycles, specialty lenders, medical credit cards, employer carve-outs, manufacturer discount programs and crowdfunding. Some of it is genuinely good. Some of it is priced so that the person offering it wins on average. Below is each option, what it actually costs, and the specific question to ask before you sign. The ranking is rough but the principle holds: the further down this list you go, the more the risk sits with you.

The pitch is straightforward. You pay a higher flat fee up front for a package of several cycles, and if you do not end up with a baby, you get most or all of it back. Newsweek reports the premium typically runs 30% to 40% above the price of a single cycle, with refunds in the range of 70% to 100%.

The American Society for Reproductive Medicine has looked at these programs more than once and landed in the same place: permissible, not endorsed. Its 2023 ethics committee opinion records that "some have argued" these programs carry "a built-in potential conflict of interest that is likely to skew clinical decision-making toward achieving pregnancy," and names the specific risks, which are aggressive stimulation protocols and transferring more than one embryo in order to avoid paying a refund. In its own voice, the committee states that good-prognosis patients who succeed early "will often end up paying more" for treatment than they would have under fee for service.

Here is the mechanism that makes the math work for the clinic. To enroll, you generally have to pass a clinical screen. CCRM publishes its criteria, which is more than most: 39 or under at first retrieval, AMH of 1.5 or greater, day 3 FSH under 10, day 3 estradiol under 75, antral follicle count of 10 or more, BMI under 35, normal hysteroscopy, no more than two prior pregnancy losses of any kind, no more than one failed cycle, sperm count above 20 million, non-smoking for three months.

Those are the markers of someone likely to succeed quickly. FertilityIQ’s analysis of refund programs found that 67% of participants succeeded on their first retrieval, against a national baseline where roughly 34% of IVF cycles succeed. Those two numbers are not measured the same way, one being per retrieval and the other per cycle, but the gap is wide enough to make the point. Which produces the most useful sentence anyone has written about these programs:

"If your clinic has a refund program and offers it to you, this may be a sign they are ultra-confident in your case, and so you may not want to enroll in their program. You'd likely succeed, and early, anyways."

FertilityIQ

That is the whole trade in one line. The people accepted into a refund program are, by design, the people least likely to need the refund.

Medications are the most common exclusion, and they run several thousand dollars a cycle. Shady Grove’s shared risk program excludes consultations, diagnostic testing, outside services, medications, surgical sperm retrieval, and costs from complications. BUNDL sells an optional medication add-on at a flat rate it does not publish. FertilityIQ estimates that between exclusions and pre-treatment costs, "nearly all of us will pay 25 to 50% more for our care than the list price of the package."

ASRM’s opinion includes a requirement that sounds procedural and is not: "The definition of success, whether live birth or pregnancy of a specified duration, should be clearly specified." The fact that the ethics committee had to say this tells you how often it was not being said.

Shady Grove is one of the few programs that spells it out in public, and the language is unsparing: a cycle in which you conceived but lose the pregnancy at any point before delivery counts as one of your completed cycles. A loss at six weeks and a loss at thirty-eight weeks consume the same slot. BUNDL advertises something called "miscarriage protection" as a feature but publishes no definition of what it covers. CCRM refers to a "successful birth" and defines nothing further.

This is the single most under-covered question in fertility financing, and outside of Shady Grove, almost nobody answers it where a prospective patient can read it. If you are considering one of these programs, ask for the loss and stillbirth clauses in writing before you sign, and read them somewhere other than the clinic.

Worth knowing that not all packages work the same way. ARC Fertility’s program refunds you on success rather than failure: if you deliver before using all your cycles, you get money back for the unused ones. By FertilityIQ’s account, that refund is not prorated to the value of what you skipped, so first-cycle success on a three-cycle package returns considerably less than the two cycles you did not use were worth.

Four questions to ask about any refund program: What percentage of your patients actually received a refund last year? (Some clinics have never paid one.) What is excluded from the package price? How is a pregnancy loss treated, at any gestational age? And what happens if I am dropped from the program partway through?

Medical credit cards are the most expensive option most patients are offered, and they are offered at the moment people are least able to evaluate them, which is at the clinic, during a conversation about treatment.

The Consumer Financial Protection Bureau studied this market and found that Americans paid $1 billion in deferred interest on health care charges between 2018 and 2020, across more than 17 million purchases. The typical medical credit card carries an APR of 26.99%, against roughly 16% for general purpose cards. The report specifically names fertility treatment among the services financed this way.

The mechanism worth understanding is deferred interest, which is not the same as no interest. Interest accrues from the purchase date during the promotional window. If you clear the full balance before the window closes, it is waived. If you are even slightly short, it is all charged retroactively, calculated on the original amount.

CareCredit, the dominant product, currently lists a standard purchase APR of 32.99% and a penalty APR of 39.99%, with deferred interest promotions of 6 to 24 months. Its own explainer notes that "even a small remaining balance at the end of the promotional period may trigger the accrued interest to be added to your account."

Do that math on a $20,000 cycle. Pay down $19,000 over 24 months, miss the window with $1,000 left, and the interest is computed on the full $20,000 from day one. A 24-month payoff on $20,000 requires more than $830 a month, which is not a realistic plan for most households already paying for treatment.

This is not a hypothetical risk. In 2013 the CFPB ordered CareCredit to refund $34.1 million over deceptive enrollment, finding that roughly 85% of borrowers were signed up for deferred-interest plans, that many believed the card was interest free, and that clinic staff enrolling patients had received minimal training and were themselves confused about the product. More recently, The American Prospect reported that Synchrony, CareCredit’s parent, earned $3.7 billion in interest and fees from the card in 2024.

A few states have responded, though more narrowly than the headlines suggested. California’s SB 639, effective in 2020, does not ban the product; it stops providers from helping patients sign up in the office or pre-filling applications, and bars charging for services not yet performed. New York adopted similar rules on provider conduct in late 2024. The card itself remains available everywhere, and the deferred-interest structure works the same way in every state.

A handful of lenders specialize in fertility treatment. The advertised terms are considerably better than a medical credit card and vary more than the marketing suggests.

•       Future Family advertises 9.74% to 23.74% APR on up to $50,000, with no upfront loan fees, though the same disclosure notes membership fees attached to its concierge offering. On an $18,000 loan over five years, the difference between the floor and the middle of that APR range is roughly $3,800 in total repayment.

•       CapexMD advertises 8.99% to 24.99% fixed, terms from 6 to 84 months, with a $75 to $200 documentation fee.

•       Prosper advertises 8.99% to 35.99% with an origination fee of 1% to 9.99%.

•       Sunfish says outright that it is not a lender. It is a broker, which means the loan you get comes from someone else on terms you should read separately.

•       LightStream publishes no APR range or minimum score of its own, saying only that it charges no origination, late or prepayment fees and that the lowest rates require excellent credit. NerdWallet estimates its range at 7.99% to 25.44% with a 660 minimum.

Two things to watch. First, an origination fee deducted from proceeds means you borrow less than you owe: a $30,000 loan at a 9.99% origination fee puts about $27,000 in your account against a $30,000 balance. Second, the advertised floor rate is for excellent credit, and the spread between floor and ceiling on these products is wide enough to change whether the loan is a good idea at all.

One correction, because clinic financing pages are slow to update: Ally Lending no longer exists as a separate business. Synchrony, which owns CareCredit, acquired it in 2024.

It is also worth naming the thing lenders will not: there is a real chance you will finish this with the debt and without a baby. ASRM’s own opinion frames the conflict as one between the patient’s desire to become pregnant and their ability to preserve the financial capacity to pursue other paths to parenthood. Borrowing to the limit for one route can close the others.

If you have employer coverage, this is the highest-value hour you can spend, and open enrollment season is happening right now.

Start with a structural question: is your plan self-funded or fully insured? Twenty-five states have infertility insurance laws and fifteen mandate IVF, but KFF finds that 67% of covered workers are in self-funded plans, which federal law exempts from state mandates. If yours is self-funded, your state’s mandate does not apply to you, whatever the headlines said.

Then read the actual document rather than the benefits summary slide. New York’s insurance regulator publishes a consumer FAQ that is unusually honest about how mandate fine print behaves, and the traps it describes are common well beyond New York. Infertility is defined as failure to conceive after 12 months of trying, or six months if you are 35 or older, so a patient who already knows they need IVF may still wait out a clock. Only large group policies, meaning employers with more than 100 employees, must cover IVF, and then for three cycles. Insurers may consider whether basic treatments such as IUI would be medically appropriate to try first. And in the regulator’s own words: "A cycle that began, but was not completed, counts towards the three-cycle limit."

Carve-out benefits have their own shape. Progyny sells cycle-based coverage, where your employer buys a number of "Smart Cycles" and procedures draw down fractions of one. Carrot and similar vendors typically run on a dollar maximum. Both are better than nothing and neither works the way employees assume.

For a sense of what the fine print looks like in practice, the University of Pennsylvania publishes its Carrot benefit terms openly. The lifetime maximum is $30,000, and for two Penn-employed spouses it is $30,000 combined rather than each. Prescription drugs are not covered under the Carrot plan even when they are for fertility treatment, because they route through the pharmacy benefit separately. And third-party expenses such as donor or surrogate costs are treated as taxable income reported on the employee’s W-2. It is entirely possible to receive a $30,000 benefit and owe several thousand dollars in tax on part of it.

In May, three federal agencies proposed a rule creating fertility benefits as a new category of excepted benefits, which would let employers offer standalone fertility coverage outside the main medical plan with a combined lifetime maximum of $120,000 per participant, indexed to medical inflation after 2027. The comment period closed on July 13. As of this writing the rule is still proposed, not final, and it would apply to plan years beginning January 1, 2027. Which means the enrollment season happening now is the one where it either materializes or does not.

One limitation is getting almost no attention. As benefits lawyers at Epstein Becker Green have pointed out, the rule does not change tax law. Tax-free treatment of these benefits still requires a medical infertility diagnosis, which means single people and same-sex couples building families without one may still be taxed on a benefit their colleagues receive tax free.

What to ask HR, by name: the Summary Plan Description, the fertility-specific rider or benefit booklet, and the pharmacy formulary. Then: is the plan self-funded? Is the limit in cycles or dollars, and is it per person or per couple? What counts as a cycle, and does a cancelled one burn it? Is there a prior-IUI requirement? Are medications carved out? Which reimbursements are taxable?

All three major fertility drug manufacturers run patient assistance programs. EMD Serono has Fertility Instant Savings and Compassionate Care. Ferring runs a family of programs including HEART for uninsured patients, Heartbeat for cancer patients and Heart for Heroes for military families. Organon runs ReUnite Assist and ReUnite Oncofertility.

These are real and they help people. They also share a characteristic worth naming: none of them publishes a discount percentage, and the need-based tiers do not publish income cutoffs either. EMD Serono’s instant savings program states that there is no income eligibility requirement, while its Compassionate Care program says only that it involves financial eligibility checking. To find out whether you qualify for the deeper discount, and for how much, you apply and submit tax documentation, and then they tell you. It is not a market you can comparison shop.

There is also a condition that catches people. These programs are generally built for patients paying out of pocket. EMD Serono’s is explicitly for people who "choose to pay for their prescribed fertility medications out of pocket (self-pay) without using insurance benefits." If you have coverage of some kind, check the exclusions carefully before you count on manufacturer help.

The most reliable medication lever is also the dullest: call more than one specialty pharmacy. Cash prices for identical drugs differ meaningfully between them, and clinics often default patients to a single pharmacy without mentioning that.

IRS Publication 502 includes IVF as a deductible medical expense, specifically "including temporary storage of eggs or sperm." Note the word temporary; long-term elective storage is not covered. On surrogacy the publication is brief and absolute: "You can't include in medical expenses amounts paid for surrogacy expenses."

The practical limits matter more than the rule. You can only deduct medical expenses above 7.5% of adjusted gross income, and only if you itemize. A household taking the standard deduction gets nothing here. HSA and FSA eligibility follows the same definitions, which makes those accounts a straightforward way to pay for treatment with pre-tax dollars if you have access to one.

Asking people for money is the option most patients consider last and feel worst about. The research suggests the discomfort is misplaced but the expectations usually are not.

A study of 637 medical crowdfunding campaigns in PLOS ONE found that only 9.2% met their stated goal, with the average campaign reaching about 42% of what it asked for. A 2025 systematic review of 33 studies found that each standard deviation increase in socioeconomic status corresponded to a 31% increase in funds raised. The PLOS ONE authors found that Black recipients received about $22 less per donation than white recipients, and that the race effect remained significant after accounting for the size of a campaigner’s social network.

Fertility-specific numbers are more encouraging but point the same direction. A 2025 analysis in F&S Reports looked at 1,195 campaigns run by cancer patients seeking fertility treatment: median goal $15,000, median raised $6,540, with 22.7% reaching their target.

Read together, this is a fundraising mechanism that works best for people whose networks already have money. It is worth trying. It is not worth counting on, and it should not be the plan you build a treatment schedule around. GoFundMe takes 2.9% plus 30 cents per donation, which on a campaign funded by many small gifts is a meaningful bite.

Veterans should check VA benefits directly rather than assuming. The 2024 expansion removed the marriage requirement and now permits donor eggs, sperm and embryos, though eligibility still requires a service-connected disability that results in the inability to conceive without treatment, and the VA cannot cover surrogacy.

Mild or minimal stimulation IVF costs less and is often marketed on that basis. The evidence is narrower than the marketing. A meta-analysis of 15 randomized trials in poor ovarian responders found cumulative live birth rates comparable to conventional stimulation, alongside a higher risk of cycle cancellation (a risk ratio of 1.48) and slightly fewer eggs retrieved. The authors graded the certainty of those last two findings as low and very low respectively, so hold them loosely. The headline is that in this specific group, mild stimulation appears to do about as well for less. It is not established as equivalent for everyone, and it belongs in a conversation with your doctor rather than on a price list.

Usually means 100% of the program fee, which excludes medications, diagnostics and monitoring, and which you paid at a 30% to 40% premium over a single cycle. It is a refund of the premium product, not of what you spent.

Means interest is accruing right now and will be forgiven only if you clear the entire balance in time. Miss by a dollar and it is charged retroactively on the original amount.

Means something specific that is written down somewhere. Whether it covers medications, how a cancelled cycle is counted, whether the cap is shared with your spouse and which reimbursements are taxed are all separate questions with separate answers.

ASRM’s ethics opinion ends where most honest analysis of this ends. After pages of conditions under which refund programs might be acceptable, the committee writes that mandated insurance coverage is the best way to support patients, and would ultimately eliminate the need for these programs at all.

That is not much help this month. What is: every product described here is legible if you read it as a financial agreement rather than as an offer of help. The terms are knowable. Ask for them in writing, read them somewhere other than the clinic, and take the time you need.

Hear it from someone who went through it: Writer Doree Shafrir talked with Anna Sale on Death, Sex & Money about how IVF costs escalated past anything she had planned for.

•       ASRM: Financial Risk-Sharing or Refund Programs in Assisted Reproduction: the professional body’s conditions and cautions, in full.

•       CFPB: Medical Credit Cards and Financing Plans: the federal research on deferred interest, with the numbers.

•       FertilityIQ: IVF Refund and Package Programs: the most detailed independent analysis of package economics available.

•       New York DFS: Infertility Consumer FAQ: a regulator explaining how coverage fine print actually works.

•       IRS Publication 502: what is and is not a deductible medical expense.

•       RESOLVE: Insurance Coverage by State: current mandate status where you live.

Path to Parenthood publishes journalism and education, not medical advice. Everything here is meant to inform the questions you bring to your own care team, not replace their guidance for your specific situation. It is not legal or financial advice either.