Embryo transfer practices and perinatal outcomes by insurance mandate status

Boulet, Sheree L.; Crawford, Sara; Zhang, Yujia; Sunderam, Saswati; Cohen, Bruce; Bernson, Dana; McKane, Patricia; Bailey, Marie; Jamieson, Denise J.; Kissin, Dmitry M.

doi:10.1016/j.fertnstert.2015.05.015

Cited by 37 publications

(26 citation statements)

References 20 publications

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“…Approximately 48% of all eSET cycles occurred in the six States with the greatest number of ART cycles (CA, NY, IL, MA, NJ, TX) performed; three of these States (IL, MA, and NJ) have the most comprehensive insurance mandates inclusive of ART (IVF). An association between the number of embryos transferred and insurance coverage has been reported, with an increased rate of adverse perinatal outcomes in States without insurance mandated coverage (10, 24). Our results indicate that the likelihood of eSET was greater in States with an insurance mandate inclusive of ART coverage compared to States with fertility insurance non inclusive of ART.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004–2012

Styer

Luke

Vitek

et al. 2016

Fertility and Sterility

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Objective To evaluate factors associated with elective single embryo transfer (eSET) utilization and its effect on assisted reproductive technology (ART) outcomes in the United States. Design Historical cohort Setting Not applicable Patient(s) Fresh IVF cycles of women 18–37 years using autologous oocytes with either one (SET) or two (DET) embryos transferred and reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System between 2004 and 2012. Cycles were categorized into four groups with[+] or without[−] supernumerary embryos cryopreserved. The SET group with embryos cryopreserved was designated as eSET. Interventions None Main Outcomes Measure(s) The likelihood of eSET utilization, live birth, and singleton non-low birthweight term live birth, modeled using logistic regression. Presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Result(s) The study included 263,375 cycles (21,917 SET[−]cryopreservation, 20,996 SET [+]cryopreservation, 103,371 DET[−]cryopreservation, and 117,091 DET[+]cryopreservation). The utilization of eSET (SET[+]cryopreservation) increased from 1.8% in 2004 to 14.9% in 2012 (aOR 7.66, 95% CI 6.87, 8.53), and was more likely with ART insurance coverage (1.60, 1.54–1.66), Asian race (1.26, 1.20–1.33), uterine factor diagnosis (1.48, 1.37–1.59), retrieval of ≥ 16 oocytes (2.85, 2.55–3.19), and the transfer of day 5–6 embryos (4.23, 4.06–4.40); eSET was less likely in women ages 35–37 years (0.76, 0.73–0.80). Compared to DET cycles, the likelihood of the ideal outcome, term non-low birthweight singleton live birth, was increased 45–52% with eSET. Conclusions Expanding insurance coverage for IVF would facilitate the broader use of eSET, and reduce the morbidity and healthcare costs associated with multiple pregnancies.

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Section: Discussionmentioning

confidence: 99%

Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004–2012

Styer

Luke

Vitek

et al. 2016

Fertility and Sterility

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“…Findings indicate that cuts to numbers of embryos transferred per cycle can be counterbalanced by increased fertility treatment uptake, especially among older women; factors which contribute to increases in multipleinfant pregnancies and births [48][49][50][51].…”

Section: Asrm-sart Embryo Transfer Guidelinesmentioning

confidence: 99%

“…The scope of the mandates varies as to the range of services permitted, patient requirements, and coverage exceptions [48][49][50][51]117]. Applicability to surrogate IVF treatment, prenatal care, delivery, and infant medical coverage remains uncertain [90,118].…”

Section: Mandated Embryo Transfer Limits and Insurance Coveragementioning

confidence: 99%

“One for Sorrow, Two for Joy?”: American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients

White

2017

J Assist Reprod Genet

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In January 2016, Melissa Cook, a California gestational surrogate experiencing a multiple-birth pregnancy following the in vitro fertilization (IVF) transfer of three embryos comprised of donor eggs and sperm provided by the intended father, went to the media when the intended father requested that she undergo a fetal reduction because twins were less expensive to raise than triplets. Much of the legal interest in this case to date has centered on the enforceability of surrogacy contracts. However, the Cook case also raises troubling issues about fertility treatment practices involving gestational surrogates, twin preference, and third-party reproduction medical decision-making. This paper focuses on multiple-embryo transfers in the context of US surrogacy arrangements.Offering an original analysis of data obtained from the US national-assisted reproduction registry, it examines singleand multiple-embryo transfer trends over a 12-year period (2003 to 2014). Findings reveal that recommended guidelines were followed in fewer than 42% of the cases in 2014. The paper argues that ensuring equitable medical treatment for all recipients of IVF requires the adoption of treatment guidelines tailored to, and offering protections for, specific patient groups, and that, once in place, guidelines must be robustly implemented.

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“…A mandate to cover infertility treatments leads to increased safer use of IVF, decreased use of riskier treatments, and higher first birth rates for women over 35 years [11, 17, 20–22]. Despite the demonstrated benefits, many states have yet to provide their citizens with mandated coverage.…”

Section: Costs and Coverage Of Infertility Treatmentmentioning

confidence: 99%

Clinical vignettes and global health considerations of infertility care in under-resourced patients

Chow

Mahalingaiah

2016

Fertil Res and Pract

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The ability to receive standard of care for a diagnosis of infertility is a factor of one’s financial state and educational level, which are often correlated. Providing infertility care in an under-resourced tertiary care environment provides challenges but also opportunities for unique successes in creating a family. Among the under-represented populations are recent immigrants and refugees. Challenges arise when the infertility treatment is futile or when the standard of care is inaccessible due to cost and scheduling. Unique accomplishments are noted when families are built and hope is restored for couples fleeing from genocide and war-inflicted countries. This article will highlight two clinical vignettes from the Division of Reproductive Endocrinology and Infertility clinic at Boston University School of Medicine/Boston Medical Center. Thereafter, the article will summarize the barriers to care in the United States among those with low socioeconomic status, with non-dominant racial status (non-Caucasian), and with refugee status. All identifiers have been removed and names altered in the patient vignettes.Electronic supplementary materialThe online version of this article (doi:10.1186/s40738-016-0017-6) contains supplementary material, which is available to authorized users.

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Embryo transfer practices and perinatal outcomes by insurance mandate status

Cited by 37 publications

References 20 publications

Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004–2012

Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004–2012

“One for Sorrow, Two for Joy?”: American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients

Clinical vignettes and global health considerations of infertility care in under-resourced patients

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