The BWH study examined whether or not having health insurance that covers infertility treatments, like IVF, affected patient care. The researchers found that in the 39 states that do not require insurance companies to cover IVF --where patients must pay for the procedure entirely out-of-pocket -- women were two and half times less likely to attempt IVF, which can cost more than $10,000 per treatment. However, those states showed higher pregnancy and multiple-birth rates resulting from IVF procedures than states that offered partial or full insurance coverage.
"It seems that insurance coverage influences outcomes in IVF," said Mark Hornstein, MD, one of the principal authors of the study. "Those who pay out-of-pocket are more likely to receive more embryos, and have more multiple births."
Hornstein and his colleagues reviewed the data from over 80,000 IVF procedures performed in 1998. In that year, just three states had laws requiring complete coverage of IVF procedures, and five provided for partial coverage. Today 14 states have laws mandating either partial or complete infertility coverage.
Hornstein stressed that the study only analyzed data and did not attempt to chronicle women's attitudes or decisions around IVF. BWH researchers agreed that their findings parallel what many health care providers in the field have already observed: women who have some form of infertility insurance coverage can access high-tech care more frequently. However, mandated insurance coverage seems to lead to slightly lower pregnancy rates but with less multiple-birth pregnancies.
"This study illustrates the irony of IVF today," said Hornstein. "Uninsured women seem to be getting pregnant slightly more often than those who are insured. But they're also experiencing the increased risks associated with multiple births."
Being pregnant with triplets is considered a high-risk pregnancy which can often result in the mother delivering prematurely, and can lead to developmental problems for the unborn babies. Fetal morbidity rates also increase.
"This research doesn't determine whether insurance coverage for IVF is or isn't necessary," said Hornstein. "The results imply, however, that insurance policy may affect the choices physicians and patients make."