State-mandated insurance coverage is associated with the approach to hydrosalpinges before IVF

Abstract

The aim of this study was to determine whether practice in states with infertility insurance mandates is associated with physician-reported practice patterns regarding hydrosalpinx management in assisted reproduction clinics. A cross-sectional, internet-based survey of 442 members of Society for Reproductive Endocrinology and Infertility or Society of Reproductive Surgeons was performed. Physicians practising in states without infertility insurance mandates were more likely to report performing diagnostic surgery after an inconclusive hysterosalpingogram than physicians practising in states with mandates (RR 1.2, 95% CI 1.1–1.3, P < 0.01). Additionally, respondents in states without mandates were more likely to report that, due to lack of infertility insurance coverage, they did not perform salpingectomy (SPX) or proximal tubal occlusion (PTO) before assisted reproduction treatment (RR 1.4, 95% CI 1.1–1.8, P = 0.01). Finally, respondents in states without mandates were less likely to report that the presence of assisted reproduction treatment coverage determined the urgency with which they pursued SPX or PTO before treatment (RR 0.7, 95% CI 0.5–1.0, NS). These results persisted after controlling for physician years in practice, age and clinic volume. In conclusion, self-reported physician practice interventions for hydrosalpinges before assisted reproduction treatment may be associated with state-mandated infertility insurance.

Limitations and barriers in access to care for male factor infertility

“…Whether infertility care should be covered by health insurance is an active and ongoing debate. Available evidence indicates that state insurance mandates impact access to care for couples with female factor infertility and influence the medical and surgical care patients receive for infertility before attempting ART (44,45). Not surprisingly, mandated insurance coverage is to be associated with increased use of ART (46,47), but this does not necessarily imply an inappropriate utilization of healthcare resources.…”

State-Mandated Insurance Coverage and Preimplantation Genetic Testing in the United States

“…In the United States, fertility treatment is largely self-funded, and, as of 2021, only 13 states mandate that health insurance include IVF costs. 18 Previous studies demonstrate associations between IVF insurance coverage and a number of IVF practice patterns, [19][20][21] but it is not known whether preimplantation genetic testing use or indication varies by state-mandated IVF insurance. Given the unclear benefits and cost-effectiveness for certain couples and potential harm, it is important to understand how and why preimplantation genetic testing is being used.…”

“…Cycles were categorized by the presence of mandated insurance coverage in the fertility clinic’s state as a mandate state (Arkansas, Connecticut, Hawaii, Illinois, Massachusetts, Maryland, Montana, New Jersey, Ohio, Rhode Island, and West Virginia), or nonmandate state (remaining states and the District of Columbia). 19–21 There were no changes in state mandate categorization during the study period. 18 If the clinic state was missing, the state for the patient’s residence was used.…”

Infertility, Inequality, and How Lack of Insurance Coverage Compromises Reproductive Autonomy

“…27 In a survey including over 400 infertility specialists, physicians practicing in states without an insurance mandate were more likely not to perform salpingectomy or proximal tubal occlusion before providing ART due to lack of infertility insurance coverage. 28 This finding suggests that patients without insurance coverage with tubal factor infertility secondary to hydrosalpinges are likely to receive substandard care and are likely to have worse outcomes if they do pursue self-pay IVF without the appropriate surgery. Because chlamydia infection, a common cause of tubal factor infertility, is 6 times more common in black women and 2 times more common in Hispanic women than in white women, the practice of bypassing surgical treatment prior to ART represents a disparity in treatment that falls along both economic and racial lines.…”