Dr Mark Trolice calls for changes to US infertility insurance for fairness for all

Countries across the globe have different regulations when it comes to the financial side of fertility treatment. And no more so than the USA, where anyone wanting any form of fertility treatment will need medical insurance to cover costs

So IVF babble asked Dr Mark Trolice, the medical director of the IVF Center, a clinic based in Orlando, Florida and Clinical Associate Professor in the Department of Obstetrics & Gynecology (OB/GYN) at the University of Florida in Gainesville and the University of Central Florida, to explain how it works in the US

“Research by the World Health Organisation estimated that in 2010, 48.5 million couples worldwide endured the challenging journey of infertility. The findings revealed 1.9 percent of women aged 20-44 experienced primary infertility (inability to have their first child) and 10.5 percent of women were unable to have another child (secondary infertility) after five years of trying to conceive.

“About one hundred countries use assisted reproductive technologies with 1.6 million cycles and 400,000 babies born each year for a worldwide total of nearly 5 million births, according to the International Committee Monitoring the Assisted Reproductive Technologies (ICMART).

“In 2009, the World Health Organization (WHO) designated infertility as ‘a disease of the reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse’. The WHO also concluded ‘infertility generates disability (an impairment of function), and thus access to health care falls under the Convention on the Rights of Persons with Disability’.

“Per the American Society for Reproductive Medicine (ASRM), ‘infertility is the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery. The duration of unprotected intercourse with failure to conceive should be about 12 months before an infertility evaluation is undertaken, unless medical history, age, or physical findings dictate earlier evaluation and treatment’.

In 2017, the American Medical Association joined the WHO and ASRM to classify infertility as a disease

“The US Supreme Court also labelled infertility as a disability in 1998 under the Americans with Disabilities Act (ADA). However, the court stated a person is not considered disabled under the act if the disability can be overcome by treatment. Unfortunately, in 2000, a lower court ruled it is not discriminatory for an employer’s health plan to excludes infertility treatment if it applies to all employees.

“Despite the designation of infertility as a disease and a disability associated with a profound psychological burden and impaired quality of life, the prevalence of insurance coverage for infertility treatment pales in comparison to many other medical diseases that are arguably less devastating. Employers have been more likely to offer insurance benefits to cover a benign skin rash that has minimal consequences then they would for infertility.

A federal mandate is required

“In the US, only 16 states mandate some form of infertility insurance coverage and only five provide this for fertility preservation. However, even if all 50 US states enacted similar laws, not all patients would be guaranteed infertility coverage. This is because state laws can mandate only workplaces with specific types of insurance (i.e., fully insured health plans) to cover treatment. Only a federal mandate can require all patients will receives infertility coverage.

“As a result, a large number of infertility patients are either forced to self-pay for treatment (many pay $20,000 for IVF in the U.S.) without a guarantee of outcome or accept an inability to receive therapy that may fulfil their dreams of being a parent.

“Nevertheless, in the US, there is a growing trend of employers offering their employees various forms of infertility insurance benefits. Even front line hourly employees are slowly being given the opportunity for infertility insurance coverage.

“Coverage for IVF varies across the globe. Of equal concern is the lack of infertility insurance coverage for patients in need of egg and/or sperm donation, a gestational carrier, or who are LGBTQ. Of note, a survey by the Family Equality Council showed that 63 percent of LGBTQ population, aged 18-35, have plans to expand their family.

“Clearly, a disease with a disability warrants more attention and financial assistance than is currently being offered.”

What do you think of Dr Trolice’s comments? Should a federal mandate be put in place to help anyone with fertility issues who doesn’t have the insurance covered required? Email us at mystory@ivfbabble.com