I've seen ads for a fertility clinic that guarantees success in helping women have babies. Consider me skeptical. Can this or any other clinic really back up such a claim?

It should be the goal of every clinic to succeed in helping every couple that hopes to conceive. In reality, though, this can not be guaranteed. In my practice, I work with couples to explore the causes of their infertility and to outline all possible treatment options. By empowering couples to explore these options and participate as a partner in the decision-making process, I believe each and every couple is helped.

What these ads refer to is a financial agreement offered by some clinics to couples whose history suggests that they're likely to be successful in conceiving a child through reproductive technologies. If the couple is accepted into the clinic, they pay in advance for a specified course of treatment. If the couple successfully conceives and the woman carries the pregnancy beyond the first trimester, the clinic keeps the money. If the couple is not successful, their money is returned.

In general, patients pay much more for these "guaranteed" treatments than they would for a single cycle of in vitro fertilization therapy. These programs remind me of the ancient Chinese practice that required patients to pay their physicians for staying well and not for treating illness.