Insurance Coverage of Infertility Treatments and Procedures
| Publication year | 1990 |
| Pages | 663 |
| Citation | Vol. 19 No. 4 Pg. 663 |
1990, April, Pg. 663. Insurance Coverage of Infertility Treatments and Procedures
According to a recent article in the Sunday magazine of The Boston Globe, five million couples in the United States are clinically infertile.(fn1) The Congressional Office of Technology Assessment ("OTA") offers a more conservative estimate of 2.4 million infertile couples as of 1982, representing 13.9 percent of all married Americans.(fn2)
The good news about infertility is that one-half of the couples who go through the difficult maze of infertility treatments successfully conceive and have babies.(fn3) The bad news is that couples in the United States, or their health insurance providers, will spend more than $1 billion annually on infertility treatments, at least $66 million of which will be spent on in-vitro fertilization ("IVF") attempts.(fn4)
The high demand for infertility treatment and the high cost of some of those treatments raise the issue of whether the patients or their health insurance carriers should pay the billion-dollar cost of infertility. In Colorado, as in most states, health insurance coverage of all available infertility treatments is not yet mandatory. However, at least five states have passed legislation to require insurance coverage of infertility procedures. Similar laws have been introduced in the legislatures of eighteen other states.(fn5) This article discusses the cost of infertility treatments, reviews the status of the law concerning who will pay for such treatments in Colorado and in other jurisdictions and looks ahead to the future of health insurance coverage for infertility treatment in Colorado.
Infertility treatment can be divided into three stages, with costs increasing at each level. An infertile couple seeking treatment first undergoes a series of diagnostic tests which together generally cost less than $5,000. If the cause of infertility is discovered,(fn6) standard treatments are recommended.
These standard treatments form the second state of infertility treatment. For example, if the man is diagnosed as having a low sperm count, he will be counseled to avoid ingesting certain substances that adversely affect sperm production. Failure to ovulate and hormonal deficiencies in the woman are treated with hormone and fertility medications, such as Clomiphene citrate (Clomid) or Pergonal. Tubal surgery may be performed to repair or open blocked or damaged fallopian tubes. The OTA estimates the cost of eighteen months of these treatments to be $7,118.
If pregnancy does not result after tubal surgery and fertility drug treatments, the couple may turn to the third stage of infertility treatment: artificial insemination and IVF procedures. Artificial insemination and IVF give rise to the bulk of the disputes between infertile couples and their insurance carriers.
These third-stage procedures involve high costs and low success rates. In IVF, the woman's eggs are removed by laparoscopy or other means and are combined with the man's sperm in a culture dish. Fertilized eggs are then placed in the woman's uterus. Although IVF clinics do not have a uniform method for reporting success ratios, the overall average chance of delivering a baby from IVF is about 10 percent.(fn7) The cost of each IVF attempt is from $4,000 to $6,000.(fn8) The OTA estimates that couples who reach this stage of infertility incur costs of $9,376 per six months of treatment (two IVF cycles).
Tubal surgery may be avoided by the use of an artificial insemination technique called gamete intrafallopian transfer ("GIFT"). The overall success rate of GIFT is approximately 29 percent, which makes it biologically competitive with, if not superior to, IVF.(fn9) One GIFT attempt costs $2,500 to $6,000.
The total cost of infertility treatment from the initial diagnosis to the final insemination procedures can be more...
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