Access to Fertility Preservation: A Policy Review on State-Level Mandates for Iatrogenic Infertility

Fertility preservation (FP) services are a critical piece of family planning for patients with iatrogenic infertility, which is defined as infertility resulting from undergoing a gonadotoxic medical treatment or procedure. There is currently no national mandate for health care plans to cover FP services, and state mandates for coverage are quite heterogenous.

Between 2016 and 2024, 18 states have passed FP mandates that vary greatly in which diagnoses are covered, for how long the coverage lasts, and if there are additional measures impacting the coverage. Particularly as the legislative landscape around FP rapidly changes, this study aimed to analyze state-level mandates to characterize which patients have reliable access to FP services. This study analyzed state-level mandates on FP services for iatrogenic infertility to build a standardized framework that compares the language in each bill.

Based on close review of each state-level mandate, the following comparison coverage factors were identified for the policy review: clinical diagnoses; type of health plan, including Medicaid; FP services mandated; the time period of coverage; maximum cost; and any religious exemptions.

Key takeaways include: nonspecific legislative language appears to cover a broader set of patients; there remains insufficient detail on storage logistics of cryopreserved tissue, if covered; most states do not cover Medicaid patients; religious exemption conditions can pose barriers for patients seeking gender-affirming care; and experimental treatments are not commonly covered.