Insurance Status Crucial for In Vitro Fertilization Success

The high-cost of in vitro fertilization (IVF) may deter some women and their partners from seeking the procedure. However, those who undergo IVF without insurance coverage may be unlikely to seek a second treatment if the first does not lead to pregnancy, according to a new study published by The Journal of the American Medical Association.

The study authors discovered that patients who undergo IVF are more likely to give birth if their health insurance plan covers the procedure, compared with those without coverage.

"It's a simple and possibly obvious finding, but it highlights the importance of health insurance in the outcome of fertility treatments," said lead author Emily S. Jungheim, MD. "The biggest hurdle may not be the fertility treatment but the cost."

The American Pregnancy Association estimates that a single IVF treatment ranges from $12,000 to $17,000, with a success rate of more than 40% for those under 35 and 15% for those over 40.

It is known that age, lifestyle, cause of infertility, and reproductive history all play a role in the success of IVF, but the new study indicates that insurance status and related costs also are involved.

Included in the study were 1572 women who sought IVF from 2001 to 2010 at Washington University’s Fertility and Reproductive Medicine Center, which provides services for women located in Missouri and Illinois. The authors reported that the location of the clinic is significant because Illinois requires IVF coverage, while Missouri does not.

Approximately 56% of participants had coverage for the procedure, and 44% of participants paid for IVF out-of-pocket. Patients with insurance were observed to be slightly younger than those without coverage, according to the study.

Of the women with insurance coverage, 70% received an additional treatment if the first did not result in pregnancy.

For women with IVF coverage, the likelihood of birth after 4 attempts was 59% (515 births), and for women without coverage, the likelihood was 51% (350 births), according to the study. These findings were deemed statistically significant.

"The 2 groups were medically similar and had the same outcomes in individual cycles after controlling for factors such as age," Dr Jungheim said. "The difference is that women with coverage were more likely to come back and try again if they were initially unsuccessful. Given that they had the ability to try more times, they had a higher chance of giving birth."

Fifteen states have insurance laws that mandate coverage of infertility services, but only 5 states’ laws include coverage for IVF. Expanding coverage for IVF may increase the likelihood of birth and could reduce costs in the long term.

The authors noted that their findings may be limited due to the inclusion of data from only 1 fertility center, and some patients may have received additional treatments at other clinics, according to the study.

"However, these findings highlight the critical role insurance plays in determining whether a woman with fertility issues ultimately will have a baby," Dr Jungheim concluded. "Legislation mandating IVF insurance coverage may improve the delivery and outcomes of fertility treatments."