What is infertility?
Infertility is a disease that outcomes in the irregular function of the reproductive system.
Infertility stops people from building families – one of the most fundamental and highly valued human activities. A recent Supreme Court declaration concluded that reproduction is a major life activity as defined by the Americans with Disabilities Act.
Infertility affects people of all ethnic backgrounds and socio-economic levels.
The scope of infertility
Infertility affects more than six million Americans of reproductive age. It affects both men and women in about equal numbers. The mean age of those seeking infertility treatment is about 32.
One in six couples is incapable of conceiving a child without some form of medical intervention.
Infertility treatment and its cost
There are few sectors of medicine that have advanced as quickly as infertility treatment in the past two decades.
Infertility treatment is provided by reproductive endocrinologists or other MDs who are specialists in reproductive health, typically in a hospital setting. Though most people associate treatment with “high tech” procedures such as IVF, only 5-10% of patients actually need these treatments.
About 2/3 of infertile couples who seek treatment succeed in giving birth.
The hidden cost of infertility
Many patients with no coverage for infertility treatment will instead undergo more costly and less appropriate treatments – such as tubal surgery – which are covered.
As with other serious diseases such as cancer and heart disease, infertility can lead to depression and anxiety, affecting job performance and productivity, as well as relationships with family and friends.
Insurance coverage for infertility treatment
13 states mandate some form of coverage for infertility treatment.
A 1997 study by benefits consultant William M. Mercer found that the cost of including assisted reproductive technology (ART) as a covered benefit is $2.49 per member per year.
In Massachusetts, which has the most comprehensive state mandate, one insurer reported that in 1993, infertility coverage represented only 0.4% of the total family health insurance premium.
Time Magazine recently reported that many large companies that did not previously pay for in vitro fertilization have been telling their health plans to add this coverage. HMOs for 22% of big employers now cover this treatment, up from 19% in 1996.
The cost of comprehensive infertility insurance coverage is manageable.
Insurance coverage for infertility allows the use of the most appropriate procedures, rather than the use of treatments that may be more expensive and less appropriate, but covered. The result is lower overall costs and improved outcomes.