Infertility, Inequality, and How Lack of Insurance Coverage Compromises Reproductive Autonomy

Abstract

Disparities in access to infertility care and insurance coverage of infertility treatment represent marked injustices in US health care. The World Health Organization defines infertility as a disease. Infertility has multiple associated billing codes in use, as determined by the International Statistical Classification of Diseases and Related Health Problems. However, the often-prohibitive costs associated with infertility treatment, coupled with the lack of universal insurance coverage mandates, contribute to health care inequity, particularly along racial and socioeconomic lines. The Problem of Infertility Infertility has been unequivocally defined as a disease state by the World Health Organization (WHO). 1 The WHO recognizes that infertility confers a disability, and it is now fifth on the international list of serious disabilities in women. 1 Moreover, it is a disease with billable codes that physicians can use when charging patients and their insurance companies, as determined by the International Statistical Classification of Diseases and Related Health Problems. 2 Despite the expense associated with infertility treatment, the lack of mandated insurance coverage for this disease implies that infertility is a condition undeserving of financial assistance and minimizes its importance to patients. Infertility, a broad disease state that encompasses the inability to achieve a viable pregnancy within 1 year of attempting to conceive, 3 is a condition affecting millions of patients in the United States. A recent survey found that, in the United States, 12% of women aged 15 to 44, or 7.3 million women, have used infertility services. 4 The same survey reported that 12.1% of women have impaired fecundity (the ability to conceive biologic offspring), and 6.7% of married women are infertile. 4,5 Among men in that age group, the rate of infertility is 9.4%, with 15.8% of married men aged 25 to 44 classified as infertile or subfertile. 6 There are myriad causes of infertility. In women, these causes include tubal abnormalities, ovulatory dysfunction, premature ovarian insufficiency, and uterine

Socioeconomic status and fertility treatment outcomes in high-income countries: a review of the current literature

“…The postcode lottery of fertility treatment in the UK means that in many boroughs access is limited by stringent criteria, and the number of IVF cycles funded maybe none or up to three. In the USA there are only 16 states with a mandate for insurers to offer funding for fertility treatment (including California, but IVF is not covered as standard) with patients accessing treatment in the other states having to finance their care privately ('Infertility, Inequality, and How Lack of Insurance Coverage Compromises Reproductive Autonomy', Insogna & Ginsburg, 2018). Ireland remains one of only two European Union countries not to offer national funding for assisted conception, but by contrast, both Finland and Israel have very generous state funding for fertility treatment.…”

Healthcare Policy: Federally Mandated Insurance Coverage for Infertility Treatment

“…According to MedlinePlus (n.d.), infertility is the inability to become pregnant after 12 months of trying to conceive and includes miscarriages and stillbirths. Despite the WHO and the AMA classifying infertility as a disease, there is no federally mandated insurance coverage for infertility treatment (Insogna & Ginsburg, 2018;Strauss, 2018).…”

“…Of those 19 states, 13 have comprehensive coverage for costs associated with IVF, and 10 have fertility preservation laws (RESOLVE, 2020) (see Table 1). However, coverage may not exist for other ART treatments and associated medications (Insogna & Ginsburg, 2018).…”

Economic costs of infertility care for patients in low-income and middle-income countries: a systematic review protocol

“…22 The limited financial insurance for ART treatments, although the associated high costs, implies that infertility is viewed as a condition underserving of financial assistance in LMICs. 23 Consequently, the high cost of care borne by individuals is reported among the key barriers to accessing assisted reproduction services. 24 In LMICs infertility services are generally accessed by the well-off, at mainly private health facilities.…”