Both the American Society for Reproductive Medicine and the American College of Obstetricians and Gynecologists have classified infertility as a disease affecting the functioning of the reproductive systems, although many couples have no actual disease or explained reason for their infertility issues. Over 7 million people, or 1 in 7 couples of reproductive age, are afflicted with infertility issues. Yet, in the United States, only 15 states require insurance companies to offer any coverage for fertility treatments. And in many of the states that do require some coverage, insurance companies are able to use loopholes and restrictions to make access nearly unattainable anyway.
The result of these often arbitrary insurance guidelines is that for many couples and individuals coverage for infertility issues is as hard to come by as coverage for elective procedures, if not harder. Most insurance companies site cost as a reason to limit coverage; others argue that fertility treatment is elective because the inability to conceive does not threaten the overall health of the patient. But both arguments ignore the very tangible negative effects a battle with infertility can cause.
The effects of infertility reach beyond the inability to conceive. Infertility has been connected with increased rates of stress, depression, and anxiety, as well as strained relationships with partners, family, friends, and employers. For many, the inability to conceive has the same detrimental impact on psychological health as a sudden traumatic experience.
Yet despite the overwhelming evidence that infertility is a psychologically and physically debilitating problem for many, when the Institute of Medicine (IOM), an independent medical advisory board, met in 2011 to offer advice for the new state-by-state coverage requirements under the Affordable Care Act, their report made no mention of fertility treatments.
The report does emphasize the need for required maternity and newborn services, mental health services, preventative and wellness services, as well as chronic disease management. But the report also encourages insurers to weigh treatment costs with their effectiveness before providing coverage. Most companies cite costs as their primary reason for not currently offering coverage, and though the success rate of fertility treatments range from 59 to 85%, insurers could still argue that the costs outweigh the risk of ineffectiveness.
The potential for this report to further hinder the coverage of infertility treatments is especially tragic in light of some additional data: over 90% of insurers that cover fertility treatments (including fertility drugs and, in some cases, in vitro) report no additional overall health care costs.
It makes sense that health care costs would remain relatively stagnant despite coverage of fertility treatments. First, the availability of coverage does not negate the psychological and physical toll conception through IVF or similar treatments usually requires. For most people, the decision to go through treatment will still be a tough one, and the likelihood of a sudden, exponential increase in the use of fertility treatments seems slim.
Second, the availability of treatment for those who have spent years navigating the heart-wrenching waters of failed attempts at conceptions—weighing the deep, unshakeable desire to have a child with the potential of a string of physically taxing procedures, financial instability, and further disappointments—may lead to decreased use of mental and physical health services down the line. Much of the psychological stress (and resultant physical stress) fertility patients experience is directly related to the financial difficulties many face in trying to pay for treatment. Subsidized or fully insured coverage could relieve a lot of the stress-related medical costs associated with fertility treatments. And, in the face of something as emotionally and physically taxing as an infertility crisis, medical bills should not have to be an added stressor.
In light of the available information, resistance to fertility treatment coverage seems to have little grounding in medical or economic research. Yet we don’t seem to be any closer to guaranteeing access for the 7 million people suffering from infertility issues. One light at the end of the tunnel might exist, however: the same IOM report suggests that the coverage guidelines be reworked every year to fit the changing demands of the medical industry.
As responsibility for insurance guidelines shifts to the states in the aftermath of the Affordable Care Act, the issue of infertility coverage will become increasingly political. And in this case, the politicization of an issue could be beneficial—because political means public, and public means public-influenced.
So now, it’s time to rally for the cause. Join (or start) a support group; write to your congressmen, state representatives, and senators; attend a National Infertility Awareness Week event; encourage your friends and family to learn about infertility. Whatever you do, make it clear to your local and national leaders that infertility treatments need to be covered, that those afflicted need support, not added costs and stress. Let’s spread the word, spread awareness, and make sure the next IOM report provides a little more justice.