Expanding IVF Insurance Coverage in the U.S. Could Reduce Multifetal Pregnancies and Lower Overall Healthcare Costs

In the United States, the cost of a single in vitro fertilization (IVF) cycle ranges from $12,000 to $15,000, yet most Americans lack insurance coverage for IVF.

Uninsured patients often opt to transfer multiple embryos in a single cycle to increase their chances of pregnancy, resulting in a higher incidence of twins and triplets that place a significant burden on the U.S. healthcare system.

VCBeat (WeChat ID: vcbeat) has compiled articles from CNBC and The New York Times on the economic and health risks that IVF poses to Americans.

Debbie Astorino welcomed her triplets, Kevin, Kerri, and Sheri, in 1997.

Thanks to in vitro fertilization (IVF) technology, the family was finally able to welcome their baby. Prior to this, they had spent nine years trying various methods, all of which failed to result in a successful pregnancy. Throughout the entire IVF process, they incurred costs exceeding $10,000.

Worse still, Debbie’s doctor told her that she had only a 25% chance of becoming pregnant, which is why Debbie chose to take steps to increase her odds of conception.

“This was a one-time deal for us,” Debbie said. “I remember crying and begging the doctor to transfer all four embryos, but he refused and insisted on transferring only three. He told us that implanting four would pose risks to both the babies and me, but what he didn’t understand was that this was our only chance to have children. We couldn’t start over again.”

The result is that three embryos are more than enough.

Debbie Astorino's Triplets Spent Eight Weeks in the Neonatal Intensive Care Unit

Debbie said, “I’m grateful that he didn’t transfer four embryos, because the baby indeed has severe health issues.”

Premature birth and low birth weight are common complications of multiple births. For the first eight weeks after birth, the triplets received round-the-clock care in the neonatal intensive care unit (NICU).

The medical costs required to care for triplets are extremely high. The Debbie family submitted medical bills exceeding $1 million after the children were born.

She said, “Insurance covered most of our post-treatment medical expenses, but it did not cover the costs associated with in vitro fertilization (IVF).”

Two decades have passed, yet the situation has remained largely unchanged. According to a 2015 study, the cost of in vitro fertilization (IVF) remains prohibitively high, with only a 29% chance of successful pregnancy per cycle. Economic factors continue to influence IVF practices, and multiple births accompanied by substantial medical expenses are occurring with increasing frequency.

Approximately one in eight couples, or 12% of married women, experience difficulty conceiving or carrying a pregnancy to term. This figure has been rising over the years, largely due to the increasing age of expectant mothers.

Couples are delaying childbearing, so once they decide to have children, an increasing number are turning to in vitro fertilization (IVF) for assistance. Today, approximately 1 in every 60 newborns is born through IVF technology.

But even as demand for in vitro fertilization (IVF) continues to rise, insurance coverage remains limited. A 2017 study by Mercer found thatAmong insurance companies with more than 500 employees, only 26% include in vitro fertilization (IVF) in their coverage.。

As a result, many Americans have to pay for in vitro fertilization (IVF) out of their own pockets.

Marisa and Brad Hillman, residents of Oxford, Connecticut, spent over $40,000 during four cycles of in vitro fertilization (IVF). They not only took out a home equity loan but also moved in with Marisa’s parents to save money.

Like Hillman, those who pay for IVF out of pocket typically weigh whether to transfer a single embryo or multiple embryos at once.

The Doctor Refused Hillman's Request to Implant Three Embryos

This is also why, when they reached the third cycle of in vitro fertilization (IVF), they requested that the doctor implant three embryos.

“We have six frozen embryos. If we transfer only one embryo at a time, the cost is $2,000 per transfer. Alternatively, we can choose to transfer three embryos at once, but the cost remains $2,000. The price does not change with an increased number of embryos transferred.”

Their doctor refused their request to implant three embryos, transferring only two. Marisa is now pregnant with twin girls, with a due date in December this year.

The Hillmans’ story is not unique.

Barbara Collura, President of RESOLVE: The National Infertility Association, stated, “You may have saved $10,000 to $15,000 on your own, tapped into your 401(k) retirement savings, or borrowed the money from friends and family. You likely feel that this IVF cycle is your only chance. This mindset, in fact, carries significant risks.”

Today, nearly 40% of babies born through in vitro fertilization (IVF) are multiples.

The risks for mothers carrying multiple fetuses are considerable. Dmitry Kissin of the U.S. Centers for Disease Control and Prevention stated, “Risks for mothers carrying multiples include hypertension, gestational diabetes, and a higher rate of cesarean sections. Risks for infants include low birth weight, preterm birth, and disabilities such as autism and cerebral palsy.”

Kissin stated, “Following IVF procedures, the risk of maternal mortality during pregnancy is three times higher for mothers carrying multiples than for those carrying a single fetus. For the infants, the risk of death within the first month of life is six times higher for twins and 14 times higher for triplets compared to singleton births.”

No one understands this risk better than Debbie Astorino. She said, “When people see that I have triplets, they think it’s wonderful. Unfortunately, no one can easily have triplets; the journey is quite fraught with challenges.”

Debbie suffered from gestational diabetes and severely dangerous hypertension. After 23 weeks of pregnancy, she was hospitalized for bed rest; at that time, her triplets weighed only 2.8 to 3.9 pounds at birth.

The cost of treating these complications is extremely high.

Richard Paulson, President of the American Society for Reproductive Medicine, stated, “Evidence has shown thatCovering the costs of infertility treatment and limiting the number of embryos transferred can actually reduce overall healthcare expenditures in the United States.. But the issue is that we must spend a significant amount of capital to overcome the initial hurdles.”

Some studies have confirmed his claims.

As early as 1998, researchers in Sweden concluded that single-embryo transfer is more cost-effective than multiple-embryo transfer when calculating the costs associated with multiple pregnancies.

In mid-2010, Quebec’s universal health insurance began covering all costs associated with in vitro fertilization (IVF), subject to the condition that patients undergo single-embryo transfer only.

As a result, the rate of multiple births in Quebec has declined, and the cost per birth has also decreased.

Bradley Van Voorhis, director of the in vitro fertilization program at the University of Iowa Carver College of Medicine, said that U.S. insurance companies may be able to keep pace with this trend.

He said, “This will become a nationwide trend. Especially when insurance companies recognize that,”If their insurance coverage includes the costs of in vitro fertilization (IVF), the greatest cost they would incur is merely when paying out insurance benefits for extremely preterm infants."As a result, an increasing number of insurance companies will require couples undergoing in vitro fertilization (IVF) to undergo single-embryo transfer."

However, others argue that there is currently insufficient data to economically persuade employers to cover the costs of in vitro fertilization (IVF). Reports indicate that only a small fraction of companies in the United States offer generous fertility treatment benefits to employees, while the majority provide either minimal reimbursement or none at all.

“It is clearly a compensatory measure,” said David Kaplan, Senior Partner at Mercer’s Health business. “However, we do not know whether this compensation is fully funded by employers; it largely depends on the employers’ returns and many other factors.”

This year,Infertility is officially recognized as a disease by the American Medical Association, this long-awaited news has brought jubilation to the entire infertility industry. Many hope that it will serve as a catalyst for expanding insurance coverage for infertility treatments.

Meanwhile, Barbara Collura, President of the Infertility Awareness Association, stated that it is necessary to educate employers about the benefits of providing infertility insurance coverage for their employees.

“What we are doing is still far from enough. We should provide these companies with relevant data and information in this field, as well as benefit design proposals for IVF treatment, to inform them of what employees truly need and want,” she said. “When people are no longer burdened by the financial aspects of medical decision-making, they actually make better healthcare choices, leading to improved medical outcomes and better health.”

Those who support expanding the scope of insurance coverage state that this policy willHelps alleviate financial concerns in critical medical decisions, potentially reducing the incidence of multiple births。

They also stated that, in the long run, this policy could ultimately save money for patients, employers, and the entire healthcare system.

References:

https://wire.ama-assn.org/ama-news/ama-backs-global-health-experts-calling-infertility-disease

https://www.cnbc.com/2017/11/17/most-patients-getting-ivf-arent-covered-by-insurance.html

https://www.nytimes.com/2017/11/15/your-money/infertility-treatment-coverage.html