Women with insurance coverage for in vitro fertilization (IVF) were more likely to attempt IVF again and had a higher probability of live birth than women who self-paid for IVF, according to a study published by JAMA.
Because IVF is expensive and often cost-prohibitive, some states mandate IVF insurance coverage. Emily S. Jungheim, M.D., M.S.C.I., of the Washington University in St. Louis School of Medicine, and colleagues examined the cumulative probability of live birth among women with and without IVF insurance coverage at the Fertility and Reproductive Medicine Center at Washington University, a center located near the border between Illinois, which mandates IVF coverage, and Missouri, which does not.
Women initiating IVF from 2001 through 2010 were included and observed through 2014.
Of the 1,572 women in the sample, 56 percent had IVF insurance coverage (40 percent mandated, 60 percent nonmandated) and 44 percent were self-pay. The two groups did not differ medically, but patients with coverage were younger. The researchers found that IVF coverage status was not associated with probability of live birth in individual cycles. However, the proportion returning for a second cycle if unsuccessful in the first cycle was 0.703 among women with coverage compared with 0.516 among self-paying women. The average cumulative live birth probability after four cycles for women with coverage, 0.585, was significantly higher than that for self-paying women, 0.505. The difference in cumulative live birth rates adjusting for patient risk factors between insured and self-pay patients after four cycles narrowed to 0.054, but was still significant.
"These findings demonstrate legislation mandating IVF insurance coverage may improve the delivery and outcomes of fertility treatments," the authors write.
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(doi:10.1001/jama.2017.0727; the study is available pre-embargo at the For the Media website)
Editor's Note: This work was supported by a grant from the Women's Reproductive Health Research Program of the National Institutes of Health. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
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JAMA