The proportion of in vitro fertilization (IVF) multiple births was lower in the eight states that provide insurance coverage for couples seeking IVF treatment, primarily due to fewer embryos transferred per cycle, Yale School of Medicine researchers report in an abstract presented at the American Society for Reproductive Medicine meeting in Atlanta, Georgia, October 17-21.
IVF remains an expensive treatment option for those with infertility, and many cannot afford it. A course of treatment averages about $9,500 dollars, not including medication. As of 2006, Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey and Rhode Island mandated full insurance coverage for IVF, while another seven states provide infertility coverage, but not for IVF.
J. Ryan Martin, M.D., a researcher in Yale's Department of Obstetrics, Gynecology & Reproductive Sciences, and Pasquale Patrizio, M.D., director of the Yale Fertility Center, studied whether insurance coverage affected the outcome in IVF. Using data submitted to the Society for Assisted Reproductive Technology, they analyzed outcomes on women aged 35 and younger who underwent IVF. Outcomes from IVF-insurance-mandated states were compared to outcomes from states without such a mandate.
In states without insurance coverage for IVF, the number of live births per cycle and multiple births were significantly higher, likely due to the higher number of embryos being transferred. Patrizio said that in states without coverage for IVF, the higher rate of multiple births ultimately means higher costs for couples, insurance companies, and society at large due to the higher pregnancy rate and birth complications.
"These results suggest that when couples bear the expense of IVF, physicians might feel pressure to transfer more embryos," said Patrizio. "This highlights the delicate balance a physician must strike between obtaining a positive reproductive outcome and avoiding higher order multiple births."
He added, "These results should encourage insurances to provide IVF coverage because it may lower the rate of multiple births, promotes maternal fetal health and is cost-effective in the long run. The lack of IVF coverage in the majority of states also deprives many infertile couples access to effective treatment."
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