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Release: March 27, 2001

UI study suggests more insurance plans could cover infertility treatment costs

IOWA CITY, Iowa -- Many health insurance plans could be expanded, at a reasonable cost to subscribers, to cover cost-effective treatments such as in vitro fertilization (IVF) for couples and individuals with infertility, according to a University of Iowa Health Care study.

In addition to helping people choose the most suitable care for their infertility situation, the policy change could help reduce inequities in access to infertility health care, the researchers said.

"In many instances, health insurance plans do not cover any or certain procedures associated with infertility care," said the study's principal investigator Brad Van Voorhis, M.D., UI associate professor of obstetrics and gynecology. "As a result, many couples and individuals must make decisions based on what they can afford to do, not what might be the best treatment mode, or even the most cost-effective, in the long-run."

Van Voorhis and co-investigator Craig Syrop, M.D., UI professor of obstetrics and gynecology, based their findings on research they and other scientists have conducted on the most cost-effective ways to treat infertile couples.

In this study, the investigators found that in vitro fertilization can be less expensive than using traditional treatments for certain patients. In vitro fertilization may be used when a woman's fallopian tubes are blocked. The procedure involves combining sperm and eggs taken from couples or other donors. After a few days of incubation, a certain number of the resulting embryos are then placed in the woman's uterus. Some, but not all, women then become pregnant.

"Previous studies pointed out that in vitro fertilization was quite expensive," Van Voorhis said. "The novelty of this study was that we looked at all types of infertility treatment and compared them to IVF. We found that IVF is often more expensive on a cost-per-delivery basis compared to less invasive procedures. However, we also found that IVF was more cost-effective than tubal surgery."

Van Voorhis said he and colleagues often recommend that women with tubal disease are best treated by first using IVF and not trying tubal surgery. This surgery is meant to open blocked fallopian tubes, usually by removing scar tissue. However, the scar tissue often returns following the surgery or the tube is damaged, leading to tubal or ectopic (abnormal) pregnancies.

He and colleagues are also studying whether IVF may be the best first-line treatment in situations where men have low sperm-counts or sperm with low motility, conditions that reduce the chances of fertilization.

In Iowa, one of the major health plan providers covers many infertility-related procedures. However, plans nationwide typically do not offer extensive coverage, and individuals must cover the costs out-of-pocket or settle for only certain types of treatment. For couples who do not have tubal disease or severe male-infertility factors, insemination-based therapies, either intrauterine insemination (IUI) and/or super-ovulation-IUI, are usually tried before resorting to IVF.

IUI involves taking sperm and placing them past the cervix so they have a greater chance of reaching the fallopian tubes, where fertilization takes place. The procedure usually results in a higher pregnancy rate than intercourse does. Super-ovulation IUI uses the same procedure as IUI, plus the woman takes medication that causes her to ovulate (release) up to four eggs a month instead of just one.

"Based on plans such as that used by the University of Iowa, we can quantitate for insurance companies what it costs to cover infertility, and it doesn't turn out to be nearly as expensive as what many companies think it is going to be," Van Voorhis said.

A 1995 UI insurance plan showed that infertility costs per member were $.070 of the total health care coverage of $83.20 per month. Overall, infertility diagnoses and treatments accounted for less than 1 percent of the total annual health care costs over a three-year period.

Previous research shows that infertility treatment is impacted by economic factors. A Mount Sinai Medical Center study showed that nearly two out of three women with tubal infertility treated by IVF were white and in upper socioeconomic groups. In contrast, four out of five women with tubal infertility treated by tubal surgery were black or Hispanic and in lower socioeconomic groups.

Van Voorhis said patients without adequate insurance coverage who have greater personal economic resources also make choices that affect their treatment. Patients paying directly for the IVF procedure may be willing to take more risks than people with insurance coverage.

A couple may want more embryos put back than is typical of program recommendations because they are covering the procedure out-of pocket, and it may be their last or only chance, Van Voorhis said. These couples then may have pregnancies of triplets, quadruplets or higher order multiples, which is riskier.

"We saw that for couples who are spending their own money, it becomes quite an issue as to how quickly to move from one therapy to the next," Van Voorhis said. "We thought it was important to try to define which treatments are the most cost-effective so we could best advise our patients on how we should go about treating the problem."

Van Voorhis added that the desire to reproduce in couples with infertility is very real and an important aspect of life.

"Infertility is a significant, common problem, and we have effective treatments for it," he said. "Therefore, we just don't understand why infertility treatment is an area of medicine that is singled out as non-essential and therefore not covered by many health insurance plans."

The study was published in the December 2000 issue of Clinical Obstetrics and Gynecology.

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