When insurance covers IVF, more women will use it
IVF is expensive and typically not covered by insurance
When insurance covers in vitro fertilization, more women struggling with infertility, especially those with limited financial resources, will use the method to improve their chances of having a baby, a new study suggests.
Researchers found that when the University of Michigan’s health insurance plan started covering IVF, use of the technology nearly tripled overall and increased by more than nine-fold among employees and dependents in lower-salary brackets, according to the report published in JAMA.
“It’s important to realize that infertility is a disease and unlike many other diseases, historically it has not been well covered by health insurance,” said study leader Dr. James Dupree from the University of Michigan in Ann Arbor.
“Infertility does not appear to discriminate based on how much money you have or what kind of job you have. But people are not using IVF in the same way,” Dupree said. “Insurance can help mitigate those disparities.”
Dupree and his colleagues hope their findings will spur decision-makers in state governments and at companies to decide IVF ought to be covered, “from an access to care equity perspective,” he said.
“As a urologist, I see the heartbreak, anguish and stress all the time,” Dupree said. “I tell people we have this great treatment that will allow you to have children with your DNA. Then they start asking how much it costs. When they say they can’t afford it, it’s heartbreaking.”
When the University of Michigan began to cover IVF in 2015, Dupree and his colleagues saw an opportunity to study how big of an impact insurance coverage might make.
The researchers pored over claims data from October 2012 to January 2017 for women aged 22 to 42. For the years 2015 through 2016, they were able to find information on IVF claims directly, unless women used clinics not affiliated with the university.
For women who used a different clinic between 2015 and 2016 and women who might have had IVF before it was covered, the researchers needed to use surrogate measures to determine who had the procedure.
In those cases, “since we couldn’t look for a bill for IVF, we needed a different method,” Dupree said. “When women go through an IVF cycle they are given a very specific pattern of medications and they receive certain patterns of ultrasound, which were covered benefits that are visible in the paid claims.”
When the researchers compared IVF related claims from 2013-2014 to those from 2015-2016, they found use of IVF nearly tripled, rising from 34.3 per 10,000 women to 92.6 per 10,00 women.
When they looked at IVF use according to the insured employee’s salary, they found the biggest jump – more than nine-fold – in low-salary brackets, with rates rising from roughly 8 per 10,000 women to nearly 79 per 10,000 in the low-salary group.
Women in the high salary group also saw an increase in use, but it was smaller, more than doubling, rising from roughly 57 per 10,000 to roughly 132 per 10,000.
Fairness isn’t the only reason for insurance companies to start paying for IVF, said Dr. Mark Perloe, a reproductive endocrinologist at SGF Atlanta.
When women with infertility problems don’t have coverage for IVF, they are often resort to other means in their struggle to have a baby, Perloe said.
Among those methods is the use of drugs that stimulate the ovaries to produce more eggs in a given cycle. And that “dramatically increases the risk of multiple births,” Perloe said.
Further, when IVF isn’t covered, patients often spend more time trying with less effective treatments before deciding they have to somehow raise the money to pay for IVF. “But by then, the woman may be too old, having passed the time when her fertility was optimal,” Perloe said.
SOURCE: bit.ly/2qY7w5y JAMA, online November 13, 2019.
What is IVF In vitro fertilisation – Wiki
In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm outside the body, in vitro (“in glass”). The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova (egg or eggs) from the woman’s ovaries and letting sperm fertilise them in a liquid in a laboratory.
After the fertilised egg (zygote) undergoes embryo culture for 2–6 days, it is implanted in the same or another woman’s uterus, with the intention of establishing a successful pregnancy.
IVF is a type of assisted reproductive technology used for infertility treatment and gestational surrogacy. A fertilised egg may be implanted into a surrogate’s uterus, and the resulting child is genetically unrelated to the surrogate.
Some countries have banned or otherwise regulate the availability of IVF treatment, giving rise to fertility tourism. Restrictions on the availability of IVF include costs and age, in order for a woman to carry a healthy pregnancy to term. IVF is generally not used until less invasive or expensive options have failed or been determined unlikely to work.
In 1978 Louise Brown was the first child successfully born after her mother received IVF treatment. Brown was born as a result of natural-cycle IVF, where no stimulation was made. The procedure took place at Dr Kershaw’s Cottage Hospital (now Dr Kershaw’s Hospice) in Royton, Oldham, England.
Robert G. Edwards was awarded the Nobel Prize in Physiology or Medicine in 2010. The physiologist co-developed the treatment together with Patrick Steptoe and embryologist Jean Purdy but the latter two were not eligible for consideration as they had died and the Nobel Prize is not awarded posthumously.
With egg donation and IVF, women who are past their reproductive years, have infertile male partners, have idiopathic female-fertility issues, or have reached menopause can still become pregnant. Adriana Iliescu held the record for a while as the oldest woman to give birth using IVF and a donor egg, when she gave birth in 2004 at the age of 66. In September 2019, a 74-year-old woman became the oldest-ever to give birth after she delivered twins at a hospital in Guntur, Andhra Pradesh.
After the IVF treatment, some couples get pregnant without any fertility treatments. In 2018 it was estimated that eight million children had been born worldwide using IVF and other assisted reproduction techniques.
How does IVF work?
IVF stands for in vitro fertilization. It’s one of the more widely known types of assisted reproductive technology (ART). IVF works by using a combination of medicines and surgical procedures to help sperm fertilize an egg, and help the fertilized egg implant in your uterus.
First, you take medication that makes several of your eggs mature and ready for fertilization. Then the doctor takes the eggs out of your body and mixes them with sperm in a lab, to help the sperm fertilize the eggs. Then they put 1 or more fertilized eggs (embryos) directly into your uterus. Pregnancy happens if any of the embryos implant in the lining of your uterus.
IVF has many steps, and it takes several months to complete the whole process. It sometimes works on the first try, but many people need more than 1 round of IVF to get pregnant. IVF definitely increases your chances of pregnancy if you’re having fertility problems, but there’s no guarantee — everyone’s body is different and IVF won’t work for everyone.
What’s the IVF process?
The first step in IVF is taking fertility medications for several months to help your ovaries produce several eggs that are mature and ready for fertilization. This is called ovulation induction. You may get regular ultrasounds or blood tests to measure your hormone levels and keep track of your egg production.
Once your ovaries have produced enough mature eggs, your doctor removes the eggs from your body (this is called egg retrieval). Egg retrieval is a minor surgical procedure that’s done at your doctor’s office or at a fertility clinic.
You’ll get medicine to help you be relaxed and comfortable during the procedure. Using an ultrasound to see inside your body, the doctor puts a thin, hollow tube through your vagina and into the ovary and follicles that hold your eggs. The needle is connected to a suction device that gently pulls the eggs out of each follicle.
In a lab, your eggs are mixed with sperm cells from your partner or a donor — this is called insemination. The eggs and sperm are stored together in a special container, and fertilization happens. For sperm that have lower motility (don’t swim as well), they may be injected directly into the eggs to promote fertilization. As the cells in the fertilized eggs divide and become embryos, people who work at the lab monitor the progress.
About 3-5 days after the egg retrieval, 1 or more embryos are put into your uterus (this is called embryo transfer). The doctor slides a thin tube through your cervix into your uterus, and inserts the embryo directly into your uterus through the tube.
Pregnancy happens if any of the embryos attach to the lining of your uterus. Embryo transfer is done at your doctor’s office or at a fertility clinic, and it’s usually not painful.
Plan on resting for the rest of the day after your embryo transfer. You can go back to your normal activities the next day. You may also take pills or get daily shots of a hormone called progesterone for the first 8-10 weeks after the embryo transfer. The hormones make it easier for the embryo to survive in your uterus.
What are the side effects of IVF?
Like all medications and medical procedures, IVF has some risks and possible side effects. These include:
bloating, cramping, breast tenderness, mood swings, headaches, bruising from shots, allergic reaction to medicines, bleeding, infection
Your doctor can talk with you about any questions or concerns you have about IVF risks and side effects.
IVF can also be difficult emotionally, both for the person having the procedures and for their partner and/or family. Many people doing IVF treatments struggle with depression and anxiety throughout the process.
Talking with people who’ve been through fertility struggles and IVF can be really helpful if you’re feeling overwhelmed or discouraged. Online and in-person communities are also good places to meet people who understand what you’re going through and can offer advice and support. Counselors and therapists can also be sources of comfort.
How much does IVF cost?
IVF tends to be pretty expensive. A few states have laws that say health insurance companies must cover some or all of the costs of infertility treatment if you meet certain requirements. But many insurance plans don’t offer any fertility treatment coverage at all.
You can find more information about insurance coverage of IVF and other fertility treatments at The National Infertility Association.
The fees for 1 cycle of IVF include medicines, procedures, anesthesia, ultrasounds, blood tests, lab work, and embryo storage. The exact cost of a single IVF cycle varies, but it can be up to $15,000 or more.