Differences in ICSI utilization rates among states with insurance mandates for ART coverage

Area of Science:

• Reproductive Medicine
• Health Services Research
• Public Health Policy

Background:

• Assisted reproductive technology (ART) insurance mandates may influence the selective use of ART resources, such as intracytoplasmic sperm injection (ICSI).
• Understanding variations in ICSI utilization based on state mandates is crucial for equitable access to fertility treatments.

Purpose of the Study:

• To investigate if ICSI utilization rates differ based on state-level ART insurance mandates.
• To assess the association between ICSI use, male factor infertility, preimplantation genetic testing (PGT), and live birth rates.

Main Methods:

• Retrospective analysis of 2018 Centers for Disease Control (CDC) data.
• Comparison of ART clinics in 8 ART-mandated states versus 42 non-mandated states.
• Statistical analysis including ANOVA and Welch t-tests, with Bonferroni Correction for significance.

Main Results:

• Significant variations in ICSI rates were observed among ART-mandated states and between mandated and non-mandated states.
• Higher male factor rates were found in Hawaii compared to several other states and the aggregate of non-mandated states.
• No significant differences in PGT use or live birth rates were reported across age groups or mandate statuses.

Conclusions:

• ICSI utilization varies significantly among states with ART insurance mandates, independent of live birth rates.
• State insurance mandates and male factor prevalence alone do not fully explain differences in ICSI use.
• Non-clinical factors likely play a substantial role in driving ICSI utilization rates within specific states.