Competition, insurance mandates, and clinical practices and outcomes at in vitro fertilization clinics

The high cost of in vitro fertilization (IVF) procedures coupled with public availability of success rates may influence IVF practice patterns and success rates but may be mitigated by mandated insurance coverage for IVF procedures. This study examined associations of competition with IVF practice patterns and success rates by insurance mandate status.

We used publicly available 2018 National Assisted Reproductive Technology Surveillance System data from the CDC. We defined competition as distance to nearest clinic and number of clinics within certain radii. We used linear regression to explore associations of competition, insurance mandate status, and interactions between competition and mandate status with clinical practice patterns (e.g., percentage of cycles among patients < 35 years, percentage of cycles using ICSI, average number of embryos transferred) and IVF success rates (e.g., live birth rates). We also assessed the percentage of variation in outcomes explained by our models, R².

For practice patterns, the largest R² value was 0.3518, meaning only 35.18% of the variability in the practice pattern variable was explained by competition and insurance mandate status. In most cases, the R² values were less than 0.20, indicating little to no association. Less than 10% of the variability in success rates was explained by competition and insurance mandate status.

The multiple regression analyses all yielded low R² values, indicating weak associations. These encouraging results coincide with previous studies, suggesting that competition, even by insurance mandate status, does not have a strong association with IVF practice patterns or success rates.