Comprehensive state IVF insurance mandates increase use of IVF treatments
States with comprehensive in vitro fertilization insurance mandates saw increased use of IVF and fewer embryos per transfer, according to a study published in American Journal of Obstetrics and Gynecology.
“Access to fertility care is a major issue in our field,” Tarun Jain, MD, associate professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine and medical director of Northwestern Fertility and Reproductive Medicine, West Region, told Healio. “Economic factors are the chief contributors of disparities in access to effective treatments for infertility, especially in vitro fertilization (IVF). We wanted to look at the impact of state-mandated insurance coverage on access and outcomes of IVF in the U.S.”
Jain and colleagues conducted a retrospective cohort study of 134,997 IVF cycles from 456 clinics in the United States using data reported by the 2018 CDC Assisted Reproductive Technology Fertility Clinic Success Rates Report. IVF cycles were classified as either being performed in states with comprehensive insurance coverage — defined as coverage for IVF with minimal restrictions — or noncomprehensive coverage.
After adjusting for patient age, the researchers found that IVF use was 132% higher in states with comprehensive coverage as compared with noncomprehensive states. This increase in use was observed regardless of age stratification. Live birth rate per cycle was also significantly higher in comprehensive states (35.4% vs 33.4%; P < .001), particularly among older age groups. Multiple birth rate as a percentage of all births was found to be significantly lower (10.2% vs 13.8%; P < .001), particularly for patients aged 37 years and younger.
“A surprising finding was that even with fewer embryos being transferred in states with mandated insurance coverage, the live birth rates were higher,” Jain told Healio. “Another surprising finding was that in mandated states, fewer frozen embryo transfer cycles were performed.”
Results also showed that states with comprehensive coverage had a significantly lower mean number of embryos per transfer (1.3 vs 1.36; P < .001), significantly fewer frozen transfers performed as a percentage of all embryo transfers (66.1% vs 76.3%; P < .001) and significantly fewer embryos transferred among fresh embryo transfers (1.55 vs. 1.67; P < .001).
“Economics play a significant role in access to fertility care in the U.S.,” Jain said. “Comprehensive insurance coverage for IVF is associated with increased access and use of such services, along with fewer embryos being transferred, leading to lower rate of multiples, while still have higher live birth rates.”