CONTACT: BECKY SOGLIN
Iowa City IA 52242
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Release: March 27, 2001
UI study suggests more insurance plans could cover infertility treatment
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
"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
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
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