Not So Easy to Attain

(image by Natalia Drepina)

Ever since we decided to pursue IVF, we've been working under the assumption that we would use the Attain IVF program, which basically offers bundled plans of fresh cycles and frozen transfers at a discounted price. The idea is that committing to a course of treatment up front, and paying for it up front, will reduce stress and increase your chances of success. And you can reap a savings if you do end up needing multiple cycles to have a baby, which most people do.

The risk — of course, there has to be a risk or else Attain would be too good to be true — is that if you end up getting pregnant and have a baby on your very first try, you will not reap a savings. Instead, you will have actually paid more than you would have if you had opted instead to pay-as-you-go directly with your clinic.

This part of the deal has bothered me from the beginning. How would I feel if we did miraculously find success with our first cycle? Would I be upset? Or would I be happy and not care about the extra cost? My nurse as well as a few close friends that I confided in all said that I would fall in the latter camp. That I would be so ecstatic to finally achieve this thing that I've wanted for so long that the money wouldn't even matter.

So, my husband and I decided to accept the risk and move forward.

But we still wanted to do so cautiously, which is why we decided, after much deliberation, that we would use the 50% refund plan. You pay a couple thousand more for the package (2 egg retrievals, 2 fresh transfers, and unlimited frozen transfers) but you get a safety net: If after you've exhausted all your Attain plan options you still don't "take home a baby," you will receive a refund of up to 50%. (There is also a 100% plan that, again, costs a few thousand more.) It's like paying for travel insurance; if something happens that prevents you from arriving at your intended destination, it's not all a total loss.

Unfortunately for us, as it turns out, we won't be able to have this peace of mind as we go through IVF.

At this point, all systems are a go for starting IVF except the financial component. We've been trying and trying and trying to get it all squared away but it's been difficult and time consuming because there are too many cooks in the kitchen, so to speak: Our clinic (RSC), Attain, and the loan company. Our clinic needed to submit an application to Attain for us, Attain needed to verify information with the clinic, the loan company needed to verify information with Attain, and then we needed to sign a contract with Attain and finalize our loan documents.

I finally got our contract from Attain on Tuesday and when I opened it I was surprised to see not only a higher price tag than I was initially quoted but also that we were slated to use the "Core" plan —  also known as the no-refund plan. When I spoke with my RSC financial coordinator yesterday, she was not much help. She didn't know how to answer my questions and was as confused as I, and told me to just call Attain. Fine. I did.

My Attain rep, on the other hand, didn't miss a beat: We don't qualify for the refund plans because my AMH level is too low. They look for an AMH of 1.2 or higher and mine is definitely not that. My AMH level is 0.4.

I had hoped that it was just an oversight, that my financial coordinator had applied for the wrong plan, or that maybe it was because the folks at Attain thought we would be using ICSI (we are still not sure). But no. We don't qualify for a refund because of me.

Now, let's read between the lines because, well, that's what I do and I think what all women do, especially infertile ones:

We don't qualify because I am too risky. The likelihood that I will get pregnant through IVF is not great and Attain doesn't want to have to give us any of our money back when it doesn't work.

We can't kid ourselves. Fertility clinics and programs like Attain are in the business of making babies, yes. But they are also in the business of making money. And the odds are they'd lose money on me. I'm not worth the gamble. I was willing to throw the dice and use Attain, but they are not willing to bet on me.

After getting off the phone yesterday, all my questions answered, I felt hurt and angry. Sad that the (seeming) sense of security we would have gotten from the refund program was stripped away. Depressed that it was all because of me and my shoddy egg supply. And angry that the refund plans were ever presented to us as a viable option. My AMH level has been known since before coming to RSC. This is not new information. Even while I was on the phone with my financial coordinator yesterday, before talking to Attain, she kept insisting that we qualify for all the plans. BUT WE DON'T. I called her back and left a not-so-nice but not-as-mean-as-I-should-have message with the update.

We're not sure where to go from here but we spent the evening pricing out various scenarios on a pay-as-we-go basis to compare to the Attain Core plan. At this point I'm leaning toward pay-as-we-go because I think all value in Attain has been lost. If we get pregnant on the first go, we're screwed (we've paid double what we needed to). If we don't get pregnant at all, we're screwed (we're in the hole $25,000+ with no baby to show for it). To make Attain worthwhile, we would need to have one failed round of IVF, followed by a failed frozen transfer, then another failed IVF cycle, and then a frozen that finally takes. That's the only way the numbers make sense.

I don't have a pretty bow to tie up this post with, so I'll just go back to the beginning and state the obvious: IVF is most certainly not easy to Attain.