Currently, 15 states in our nation require insurance companies to offer some sort of coverage for infertility diagnosis and treatment.1 This mandate should spread to all 50 states, and here is why:
“Your pregnancy test came back negative,” I said naturally to the 34-year-old patient I was seeing for a routine visit. Before I could rattle off the next lab result in her chart, she immediately burst into tears. I grabbed a box of tissues and quickly passed them to the sobbing woman across from me. This was not the reaction I had been expecting. But when I told her she wasn’t pregnant, I didn’t realize that she and her husband had been trying for 2 years to have a baby. I didn’t realize that she had put off starting a family so she could further her career as an educator. And I didn’t realize how the thought of not having a child, a dream she had since she herself was a child, was making her sick with depression and anxiety.
What my patient was struggling with was infertility. Infertility is a disease of the reproductive system characterized by the failure to become pregnant after 12 months of regular unprotected sex, and it affects 1 in 8 couples in the United States.1 Fortunately, there are numerous treatment options for these couples, including medications and in vitro fertilization (IVF), among others. The bad news is that, without insurance coverage, some of these treatments are prohibitively expensive. For example, just one cycle of IVF costs roughly $12,000.
Infertility is a disabling medical condition, and it can significantly reduce quality of life. If we have the capability to treat this medical condition effectively, don’t we have a duty to do so, and do so in a way that is accessible to those who need it?
One might debate this, saying there is a difference between access and insurance coverage. While I agree that a difference does exist, I would respond that affordability is encompassed within accessibility, and offering insurance coverage is one method of increasing the affordability of, and therefore access to, treatment.
Another argument is that we as a society simply cannot afford to treat this condition. This is a reasonable concern, especially in a time when we are attempting to expand healthcare accessibility to all. However, less than 3% of couples with infertility require advanced techniques like IVF that carry with them a hefty price tag, with 85-90% receiving effective treatment from lifestyle changes, medications, or surgical procedures.1 What does that mean in terms of cost? An example can be drawn from clomiphene, a prescription medication that is typically first line in medical therapy for infertility. For one cycle of clomiphene, the cost is approximately $20.2 This is similar to the cost of a one-month prescription of lisinopril, a blood pressure medication that is nearly always covered by insurance.
One might disagree with the comparison of clomiphene and lisinopril in this context, saying that lisinopril is a necessary medication for reducing mortality and as such should be covered, while infertility is not a matter of life and death, and therefore should not be covered. I would respond that there are a variety of conditions commonly covered by insurance that are not a matter of life and death, but relate more to quality of life, such as osteoarthritis or acne. Insurance should be for more than simply preventing death.
Now let us look at this from a different angle. Today, women are earning positions in the workforce that historically have belonged to men. This is a great thing, as we are moving in the direction of gender equality. However, it takes time to build a career. Years of school and work experience needed to advance add up, and women nowadays often find themselves in their thirties before feeling prepared for children. Unfortunately, fertility starts to drop at increasingly rapid rates around age 30. This puts an intense pressure on women, making them feel as if they must choose between children and a career. If we truly want to live in a society where men and women are equal, we need to build a system in which women do not need to make this choice. Coverage of infertility treatment is a show of support in this endeavor.
Following the subject of women’s rights, I feel that it is important to clarify that infertility is not only a female issue. In fact, about half of all infertility cases are attributable to male factors.1 Both men and women should be interested parties in the coverage of treatment for this medical condition.
“Why don’t these couples just adopt?” This is an argument against covering infertility treatment heard often, and I am certainly not averse to adoption. Quite the opposite, I think it is a wonderful option for those who have difficulty conceiving on their own. However, adoption is very expensive as well, often well over the cost of basic infertility treatments plus a round of IVF.3 It should be on the list of possibilities for couples with infertility, but it should not be the only item on that list.
For those still concerned with the costs of offering infertility coverage, I understand. My argument does not demand free and unlimited treatment. I do believe co-pays are reasonable to expect under these plans, just as I believe coverage of an unlimited number of IVF cycles to achieve pregnancy would be unreasonable and perhaps even medically futile. What I am arguing for is coverage that provides more of an opportunity for couples with infertility to seek treatment, especially when much of that treatment costs less than treatments for commonly covered conditions.
In the end, I think back to the woman left shattered by the news of yet another negative pregnancy test. Offering coverage for infertility treatment will help to alleviate that suffering for many, so that is a goal I am willing to work for. What about you?
- Resolve: The National Infertility Association. http://www.resolve.org/. Accessed 7 April 2017.
- “Clomiphene.” GoodRx. https://www.goodrx.com/clomiphene?drug-name=clomiphene. Accessed 7 April 2017.
- “Comparing the Costs of Domestic, International, and Foster Care Adoption.” American Adoptions. https://www.americanadoptions.com/adopt/the_costs_of_adopting. Accessed 7 April 2017.