Insurance coverage and in vitro fertilization outcomes: a U.S. perspective

Area of Science:

• Reproductive medicine
• Health economics
• Public health policy

Background:

• Mandated insurance coverage for in vitro fertilization (IVF) aims to improve access to fertility treatments.
• However, the impact of such mandates on clinical practices, specifically embryo transfer (ET) strategies and subsequent multiple pregnancy rates, requires investigation.

Purpose of the Study:

• To compare the effects of mandated versus non-mandated insurance coverage for IVF on embryo transfer practices.
• To analyze the resulting multiple pregnancy rates in states with and without mandated IVF insurance coverage.

Main Methods:

• Retrospective analysis of 91,753 fresh, nondonor IVF cycles conducted in the United States in 2006.
• Comparison of pregnancy rates, live-birth rates, embryos transferred, and multiple pregnancy rates between mandated and non-mandated states.

Main Results:

• Non-mandated states exhibited higher pregnancy rates (38.8% vs. 35%) and live-birth rates (32.2% vs. 29.1%) compared to mandated states.
• Multiple pregnancy rates, including twin (28.1% vs. 26%) and triplet rates (3.9% vs. 3.4%), were significantly higher in non-mandated states.
• The average number of embryos transferred was higher in non-mandated states (2.6 vs. 2.2), particularly in younger age groups (<35 and 35-37).

Conclusions:

• A continued association exists between mandated IVF coverage, reduced embryo transfer, and lower multiple pregnancy rates, especially in younger women.
• Despite overall reductions in embryo transfer and multiple births over time, policy impacts on IVF practices and outcomes persist.
• Findings suggest that mandated coverage may influence ET decisions, potentially impacting multiple birth rates.