In-vitro insurance?

Why infertility is a medical -- and public health -- problem that should be covered

By Lynn Harris

Published June 24, 2009 6:25PM (EDT)

Is Rep. Anthony Weiner (D-NY) some sort of soothsayer? Turns out he introduced the Family Building Act of 2009 (H.R. 697) mere days before the birth of the infamous octo-you-know-whos. The bill -- which Sen. Kirsten Gillibrand will introduce to her peeps this month -- would, as many states do already, require insurers who cover obstetrical services to, under certain conditions, extend coverage to infertility treatment, including in-vitro fertilization (IVF).

Writing this week  in The Hill, John Zhang, M.D., founder of the New Hope Fertility Clinic in New York City, expresses his support for the bill. "I am hopeful that legislation such as the Family Building Act will bring much-needed attention to the issues surrounding infertility, issues that Congress can no longer afford to ignore," he says. "[A]s made evident by the 'Octomom' media frenzy, there are serious problems with current IVF practices."

How could insurance coverage address them? I mean, your average doctor is not about to implant, you know, eight embryos. Right? No, but multiple-embryo transfers remain common for at least a couple of reasons. "The Fertility Clinic Success Rate and Certification Act of 1992 requires clinics to annually report their success rates for pregnancies and births. The lack of alternate regulation, coupled with failure by the insurance industry to cover IVF treatment in the U.S., has encouraged patients to insist on multiple embryo transfers to get the most out of the enormous out-of-pocket fees they incur per cycle," Zhang writes. "And, because doctors are rewarded for better success rates, the emphasis moves from quality to quantity so that clinics may boost their success rates despite potentially dangerous and expensive health complications." (Transferring two or more embryos doesn't mean more than one will survive. The aim is to increase the odds that one will survive.)

Something else Zhang doesn't mention: As author Liza Mundy pointed out in a Salon interview, "[I]n states where they don't cover IVF, patients' first treatment of choice will often be fertility drugs, which are a much more uncontrolled situation because a woman can ovulate 10, 15 eggs, and she can conceive octuplets. Truly high-order multiples are almost always caused by drugs. And often the patients who rely on the more powerful injectable [drugs] are working-class or lower-income women who can't afford IVF."

What's wrong with multiples? Zhang (and Mundy) aren't faulting individual families with double (and more) strollers. But at a population level, twins and up do become a public health issue. "Multiple births are responsible for approximately one-quarter of all premature deliveries before 32 weeks and a contributor to infant mortality rates," Zhang notes. "Moreover, every premature baby born before 28 weeks costs the healthcare system about $66,000 for neonatal care alone. For this reason, many European and Asian countries regulate the number of embryos that may be transferred."

(Let's get this out of the way: Many people who go down the IVF road get the question, "Why don't you just adopt?" Many of them would like to respond, "Why don't you?")

Anyway. This bill won't fix everything, Zhang says, but at least: "If IVF were more accessible and reimbursed by health insurers, and if embryo transfers were regulated, there would be consequences for clinics and physicians who practice irresponsibly. Patients would have access to multiple, single-embryo transfer cycles and insurers would save money they now spend on the health complications the current situation precipitates. In other words, if IVF were covered and regulated appropriately, it would be nearly impossible for IVF to lead to high-order multiples with their attendant risks." (Really, the risks are there even for twins.)

What would be interesting, of course, would be to analyze the rate, cost -- and, where possible, cause -- of multiple births in states where IVF is covered. But, as Zhang notes, infertility is already "a healthcare problem facing millions of women and men in the U.S." (Emphasis added to show appreciation for word choice.) It appears that we can no longer afford to treat its treatment as a luxury.

More on the business of fertility here.

Lynn Harris

Award-winning journalist Lynn Harris is author of the comic novel "Death by Chick Lit" and co-creator of She also writes for the New York Times, Glamour, and many others.

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