IVF success tied to the coverage of the insurance


Women who have insurance coverage for in vitro fertilization (IVF) are more likely to have a baby than women who pay completely out-of-pocket for fertility treatments, a US study suggests.

In each attempt of IVF, insurance status does not influence whether women who had a baby, the study found. But when the first cycle of IVF fails, what often happens, women have more chance to try again if their insurance covered at least part of the costs.

A cycle of IVF can cost around 12,000 euros, with a further $5,000 for additional drugs women may need, said lead study author Dr. Emily Jungheim Washington University in St. Louis School of Medicine in Missouri.

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“Women without coverage for IVF were significantly less likely to try another IVF cycle, probably because the cost was too high,” Jungheim said by e-mail. “This was not a factor for women with a cover, making them more likely to have a baby.”

A growing number of American women are using fertility treatments to get pregnant, even if the total fertility rate decreases. It is increasingly common as women wait longer to have babies and get married or avoid marriage at all, and the technological developments make more treatments available.

Each year, approximately 1.6 percent of all AMERICAN babies are designed with the help of assistive reproductive technology, according to the Centers for Disease Control and Prevention. IVF is the most common approach. It involves extracting a woman’s eggs, fertilizing them in a lab, then transferring the embryos into the uterus of the woman.

The researchers examined the data on 1,572 women seen at the University of Washington Physicians, the Fertility and Reproductive Medicine Center from 2001 to 2010. The centre attracts patients from Illinois, a state that requires insurers to cover up to four cycles of IVF, and Missouri, that do not mandate IVF coverage.

Overall, 875 women (56 percent) had IVF coverage; 40 percent had state-mandated benefits and 60 percent had benefits, without a state requirement. The other women lacked coverage, and paid for fertility treatments out-of-pocket.

After the first cycle of IVF, 39 percent of the women with the coverage of the insurance and 38 percent of women without fertility benefits had a baby, a difference was not statistically significant, the researchers report in JAMA.

With insurance, 70 percent of women who do not succeed the first time, tried again, compared with 52 percent of the women without fertility benefits.

After up to four IVF cycles, the cumulative chances of delivering a baby were better with the insurance: 57 percent compared to 51 percent without IVF coverage.

Limitations of the research are the lack of information about the women of the actual out-of-pocket costs or fertility treatments women would have continued on other clinics, the authors note.

However, it is clear that patients with limited financial resources can skip IVF entirely or stop treatment after one or two cycles because of the cost, said Judy Stern, a researcher in obstetrics at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire which is not involved in the study.

“Perhaps it is because of this, the population, IVF is already largely a population with a higher education and income than the general population,” Stern said by e-mail. Mandated IVF benefits would be expanding the access, ” Stern added.

Costs may also push some women consider implanting more embryos in an IVF cycle, which may increase the chance of pregnancy, but also stimulate the potential for complications such as preterm delivery or fetal growth retardation, said Dr. Kevin Doody, president of the Society for Assisted Reproductive Technology executive council.

“IVF cycles done in the respective states have fewer embryos at a time because of the financial pressure associated with treatment failure results in pressure from the patient to transfer more embryos to increase the chance of pregnancy,” Doody said by e-mail.

“This results in an increased risk of multiple pregnancy,” Doody added. “The current system, in which the infertile couple usually has to bear the costs of IVF, but the society tends to pay for the consequences of a multiple pregnancy is a broken system.”

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