Parenting is among the most basic of human instincts. Clinics that market in-vitro fertilization procedures to childless couples know this well. Several fertility clinics around the U.S. these days aggressively tout such procedures, generally offering couples two options. The first is an a la carte program in which couples pay $7,500 per attempt at having a so-called test-tube baby. Alternatively, clinics offer a money-back guarantee. Couples pay $15,000 up front for three attempts—and if these fail, they get a full refund.

Which of these options represents the better choice? A study by David C. Schmittlein, chairperson of the Marketing Department at the Wharton School of the University of Pennsylvania, and his associate Donald G. Morrison of the University of California at Los Angeles, provides an answer as it examines this controversial issue.

The study shows, expectedly, that from the patients’ perspective, the choice is a no-brainer: Couples eager to have a child would clearly be better off choosing the money-back option. From the clinics’ point of view, however, this option is harder to explain. Chances of an in-vitro fertilization attempt resulting in a live birth are roughly one in five. In addition, the cost to the clinic per attempt is fairly high. Why, then, would clinics offer patients a money-back guarantee, when this is almost certain to result in the clinics’ losing money?

Schmittlein explains the reason is that aggressive marketing of money-back guarantees in the media has brought about a change in the behavior of infertile couples. In the past, childless couples tended to view in-vitro fertilization—a procedure usually not covered by health insurance—as their last resort. But now, for couples reassured by money-back guarantees, "in-vitro procedures are becoming the first choice," Schmittlein says. As a result, younger and relatively less infertile couples have been choosing in-vitro fertilization. As they do this relatively early in their attempts to have a child, clinics get a steady stream of business.

Schmittlein points out that while neither clinics—who profit from these procedures—nor patients—who get a baby or a refund—are likely to complain about this situation, it has serious public policy ramifications. Patients should be made aware of the risks of in-vitro fertilization procedures, such as the possibility of multiple births. Some studies also suggest a link between in-vitro fertilization and ovarian cancer. If couples were more fully informed, he adds, they might well choose less invasive procedures than in-vitro fertilization, especially in the early stages of their attempts at parenthood.