Mandated IVF Coverage Would Reduce Likelihood Of High-Order Multiples, Opinion Piece Says

Main Category: Fertility
Also Included In: Pregnancy / Obstetrics;  Health Insurance / Medical Insurance
Article Date: 30 Jun 2009 - 5:00 PDT

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Federally mandated health insurance coverage of in vitro fertilization for women of childbearing age "could lower the extraordinary health care costs associated with the birth of triplets or more" and "even the reproductive odds, giving the middle-class and lower-income Americans access to treatment that is currently reserved for the well-off or the unusually well insured," according to a Washington Post opinion piece by Liza Mundy, a writer for the Post magazine and author of "Everything Conceivable: How Assisted Reproduction Is Changing Men, Women and the World." About one in eight U.S. couples experience infertility, defined as the inability to conceive within one year or to bring a pregnancy to term, Mundy writes. Infertility is about equally common among both sexes, though it is "possibly more common among the poor than among the rich, for the simple reason that the less money you have, the less likely you are to have had access to health care that could prevent serious consequences from relatively minor infections," according to Mundy. She adds that a low income does not prevent people from seeking infertility treatments -- "it just means that the treatment you get is more likely to saddle you with high-order multiples, whose care you are least likely to be able to afford."

Mundy cites Jon and Kate Gosselin, the couple from TLC's reality television show "Jon and Kate Plus 8," as an example of such a "scenario." According to Mundy, the Gosselins "were hardly affluent" and lived in Pennsylvania, "which like most states does not require insurers to cover IVF," when they sought infertility treatments. The Gosselins conceived a set of twins and, later, a set of sextuplets through intrauterine insemination, though the couple has said they had sought to have a singleton with the second pregnancy. The "good thing" about IUI is that it is "relatively cheap, a couple thousand dollars compared to the more than $10,000 average cost for a single round of IVF," Mundy writes. However, the "bad thing is that it's notoriously hard to control how many eggs will be fertilized" compared with IVF, she continues. IUI carries a higher risk for "'unpreventable high-order multiple births,'" Mundy writes, citing a recent study on the procedure. In addition, infants "born as multiples are far more likely to be premature, the health risks to infants and mother are much greater, and the toll on parents for triplets or more -- 'severe physical and psychological exhaustion' as one study put it -- is immense," Mundy states.

Mundy writes that a recent study in the journal Fertility and Sterility found that it "often makes sense to bypass IUI/injections and go straight to IVF." The study found that couples who were "fast tracked" to IVF "got pregnant more quickly, and the overall price tag for both treatment and delivery was thousands of dollars lower in the IVF-only group," according to Mundy. The study also noted that IVF success rates have significantly improved over the past two decades, meaning that the procedure has become more effective than IUI.

Mundy acknowledges that the "price tag for health care reform is already higher than anybody expected, so it's probably unreasonable to think that it could include better insurance coverage for the millions of Americans who suffer from infertility." However, health insurance coverage for IVF "is hardly the big-ticket item you might think," she continues. A 2002 study on Massachusetts' mandated coverage found that "the rise in the annual premiums is really a matter of just a few dollars," Mundy writes. "Yet replicating Massachusetts around the country is a tall order because of the persistent public view that infertility is somehow not a legitimate disease, or that infertility patients are to blame for their plight," she says.

Advocates for mandated IVF coverage "should work to make the long-term benefits clear: fewer high-order multiples, healthier children, less exhausted parents," according to Mundy. She concludes, "If sweeping health care reform includes more substantial IVF coverage, TLC will have fewer candidates for its carnival sideshow offerings, but that's a loss most of us could live with" (Mundy, Washington Post, 6/26).

Online Discussion

Washingtonpost.com on Monday at 11 a.m. ET will host an online discussion with Mundy regarding health care reform and coverage of IVF. Questions can be submitted online before or during the discussion (washingtonpost.com, 6/29).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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