Same-sex female couples start IVF earlier after insurance expansion in New York

NEW ORLEANS — Same-sex female couples initiated IVF about 8 months earlier in the year after, compared with the 3 years before, New York state required insurers to provide earlier access to nonheterosexual patients, a speaker said.

In February 2021, New York state expanded its definition of “infertility” to explicitly include people trying to conceive regardless of sexual orientation or gender identity. The state directed insurers to immediately cover infertility treatments for same-sex couples without requiring them to undergo months of fertility testing, Samantha Estevez, MD, a fellow in reproductive endocrinology and infertility at Icahn School of Medicine at Mount Sinai, said during a presentation at the ASRM Scientific Congress & Expo.

“Increasing insurance coverage may contribute to increased access to fertility care for same-sex couples,” Estevez told Healio.

In a retrospective cohort study, Estevez and colleagues compared time from first consultation to IVF or co-IVF, and from first consultation to pregnancy, for same-sex female couples before and after insurance expansion. They reviewed patient records from an academic private fertility center on all same-sex female couples undergoing the procedures from 2018 to 2020 (n = 250) and from 2021 to 2022 (n = 35).

The researchers found a median time to IVF for the earlier group of 292 days vs. 173 days for the more recent group (P .01). In addition, a greater percentage of the more recent group compared with the earlier group started IVF treatment less than 1 year after initial consultation (86% vs. 59%; P = .02). After adjusting for age, BMI and anti-Mullerian hormone levels, couples started IVF 250 days earlier on average after insurance expansion compared with before (95% CI, 103-397; P .001). Time from initial consultation to pregnancy was not significantly different between the groups likely because the number of couples in the group after expansion was small, Estevez said.

“LGBTQIA+ couples have a strong desire to build families. Our finding of increased utilization of IVF services by same-sex female couples supports this and demonstrates a need for continued education and outreach to this patient population as they become an even larger part of our patient population,” Estevez told Healio. “Despite the challenges faced by LGBTQIA+ people when it comes to building families, equitable access to fertility care can be achieved by joining clinical, legal and advocacy efforts.”