Comparison of Shared Risk Plans: OBP (3/4)

Outcome-Based Plan (OBP) is out-of state S’ own in-house program. As the name implies, the plan is based on the outcome - the desired outcome being to have a “live birth”. Otherwise, a refund is provided by the clinic.

It was refreshing to see a clinic to have it’s own in-house financing program but at the same time, it may be a 2-edged sword. Would they do anything unethical or against your will to make the cycle a success?

Anyhow, here’s what I got re OBP:

1. Plans

• One OBP cycle costs $17,900 for 1 egg retrieval (ER) and how ever many frozen embryo transfers (FET) it takes to use up all frozen embryos or until a live birth is achieved, whichever comes first. This is the same cost for all patients! How simple is that?
• The difference is actually in how much is refunded. The 3 numbers after the plan name (x/y/z) actually refers to refund percentages.

Plan 1A (100/75/50):Female patient < 30 years of age at cycle start
Plan 2A (75/55/35): Female patient 30-34 years of age at cycle start
Plan 3A (65/45/25): Female patient 35 - 38 years of age at cycle start
Plan 4A (60/35/10): Female patient 39 - 41 years of age at cycle start

For example… if I qualify under Plan 4A, I would be refunded 60% ($10,740) after the 1st IVF cycle , 35% ($6,265) after the 2nd IVF cycle, and 10% ($1,790) after the 3rd IVF cycle - with no live birth.

• In case you are using donor egg and/or surrogacy, they have a separate group of “Third-Party Parenting” set of plans.

2. Qualifications
OBP has the most well-defined criteria for qualification. I will quote them verbatim here as it speaks for itself and so that I will not misrepresent them. Moreover, qualification is done for every OBP cycle.

· All indicated screening/pre-cycle testing must be completed prior to the start of suppression therapy.

· Patient/ovum donor/embryo recipient must be of sufficient physical and mental health to undertake a pregnancy.

· Patient/ovum donor does not harbor any genetic or chromosomal deficiencies that might increase the likelihood of predictable birth defects in offspring.

· Patient/ovum donor must be able to demonstrate the ability to produce an adequate number of eggs by responding normally to a prescribed regimen of controlled ovarian stimulation with < 600 IU/day fertility medications as measured by blood tests for FSH and Estradiol drawn on the third day of a normal menstrual cycle with results of both in compliance with standards established by S’s laboratory,

· Patient/embryo recipients with alloimmune implantation problems as evidenced by the sharing of certain DQa and/or HLA similarities with the sperm provider are not eligible for participation in the OBP.

· Patient/embryo recipient must have a normal uterus/uterine cavity as assessed by fluid ultrasonography (FUS), hysteroscopy, or Magnetic Resonance Imaging (MRI).

· Patient/embryo recipient must have a uterine lining measuring at least 9.0 mm in thickness on the day of the hCG trigger, or following estrogen administration for embryo recipients undergoing ovum donation, gestational surrogacy or FET.

· In the absence of sperm in the male ejaculate, male partner must have normal testicular function (serum FSH <12 MIU/ml). If the FSH is >12 MIU/ml the couple must be willing if need be to use sperm from a qualified sperm donor.

· All sperm providers, regardless of their basic sperm parameters, who have not previously fathered a child or initiated a pregnancy that has advanced beyond the 12^th week, as well as those suffering from male infertility must have a Sperm DNA Integrity Assay (SDIA)^SM done, and the result must be normal or become normal after treatment. In cases where sperm providers are undergoing TESE, donor sperm back-up must be utilized.

· All participants must comply with all recommended medical protocols and directives related to treatment as prescribed by the SIRM physician and/or his/her designee.

· Patients undergoing Preimplantation Genetic Diagnosis (PGD) of their embryos will not be eligible to participate in the OBP.

· The patient cannot have had more than two (2) previous failed IVF cycles using the same type of procedure contemplated in the upcoming OBP.

· There can be no history of:

• Patient/ovum donor blood tests for FSH and Estradiol drawn on cycle day 3 with results of > 9.0 MIU/ml and >70 pg/ml, respectively;
• Patient/embryo recipient endometrial thickness < 9 mm as measured by ultrasound exam at the time of ovulation, or abnormal endometrial thickening during stimulation with fertility medications for IVF;
• Patient/embryo recipient having abnormal contour of the uterine cavity as evidenced by sonohysterogram, or hysteroscopy, that has or may have compromised implantation, normal placentation, fetal growth and development, or substantially increased the risk of premature delivery;
• Patient having two (2) or more previous failed IVF cycles using her own oocytes, ovum donation and/or surrogacy, depending upon the plan of treatment desired and/or recommended;
• Male partner FSH of > 12 MIU/ml or previous testicular biopsy showing abnormal spermatogenesis in cases TESE is being performed for non-obstructive azospermia.

3. Application - With the above details, you can actually self-select or deselect yourself already. But the process appears to be simply:

• Get all those tests done (You will need to get Lab requests from them for some special tests such as alloimmune and SDIA tests because they require them to be done by certain labs.)
• Read, understand, sign and submit the OBP Agreement form.
• Wait for results. (Don’t know how long it takes them to process this.)
• There is also “OBP on Contingency” clause that may still be a possibility even if you do not meet the above criteria. You may want to explore that further. On the other hand, it is also an out for them if during the process, you become disqualified.