AUA Urology Advocacy Summit 2024: Fertility Preservation Coverage: Challenges and Strategies Facing State Legislatures

( The second day of the American Urological Association’s Annual Advocacy Summit included a panel focused on state advocacy related issues facing organized urology. Dr. Brian Duty opened the panel with an overview of the state-focused advocacy work undertaken by the AUA.

This includes monitoring and flagging legislation with the potential to impact urology, such as advocating against state laws expanding the scope of practice for naturopaths, pharmacists, and advanced practice providers outside of physician-led teams while supporting laws that mandate zero out-of-pocket costs for patients who undergo blood tests for prostate cancer screening. He added that resolutions and declarations that increase awareness to urologic issues are another important aspect of state advocacy, such as proclamations for Testis Cancer Awareness Month and Prostate Cancer Awareness Month.

Next, Dr. Akhil Muthigi presented an overview of the current status of insurance coverage for fertility preservation. He outlined that often, iatrogenic infertility can occur as result of cancer care. In these cases, patients are not adequately prepared for the significant financial burden associated with fertility preservation needed for family planning in an already stressful situation when embarking on cancer treatment. Dr. Muthigi explained that legislation requiring adequate coverage to fertility care can help ensure patients have the ability to access these services for family planning. The “Access to Infertility Treatment and Care Act” (S. 2353), introduced by Senator Cory Booker and Representative Rosa DeLauro (D-CT) is the first attempt at a federal law tackling this issue, although previously, specific states have passed legislation in this sphere. He concluded by underscoring the discrepancy between state and federal law mandates on fertility coverage, differing society guidelines, and delay in implementation of coverage by insurance companies, and encouraged the audience to focus efforts in these areas to improve fertility care access for urologic patients.

During the discussion portion of the session, Dr. Aaron Spitz stated that the very recent Alabama Supreme Court ruling regarding the consideration of in-vitro fertilization (IVF) embryos as children under the rule of law will be devastating for patients who seek fertility care. He emphasized that both patients and physicians will fear prosecution if embryos are discarded, and cited specific examples of IVF care being abandoned mid-cycle since the release of this court ruling. Further, he continued that it is impractical for couples to travel across state lines for fertility care, given the number of visits and procedures that are required. Both Dr. Spitz and Dr. Muthigi reinforced the need to advocate for common sense health policy that does not encroach upon urologists’ ability to provide evidence-based care. As the panel concluded, both Dr. Spitz and Dr. Muthigi referenced telehealth as a potential solution for patients who live in states with limited IVF access and fertility care coverage.

Presented by: Akhil Muthigi, MD, Member, AUA State Advocacy Committee; Member, American Society for Reproductive Medicine; Aaron Spitz, MD, Member, Society for the Study of Male Reproduction; Michael Leventhal, Men’s Health Network Brian Duty, MD, Chair, AUA State Advocacy Committee

Written by: Ruchika Talwar, MD, Urologic Oncology Fellow, Vanderbilt University Medical Center, during the 2024 AUA Advocacy Summit, Feb 26 to Feb 28, 2024