By 2020, 12 states had enacted legislation mandating insurance coverage for in vitro fertilization (IVF). However, these mandates are not uniform or consistent among states. Seven states explicitly include coverage for male infertility evaluation and treatment in addition to IVF. While an additional five states mandate IVF coverage without explicitly including male infertility care, all remaining states in the United States have no infertility insurance coverage mandates or protections. In our recently published study, In Vitro Fertilization Utilization Rates and Outcomes in States with and without Insurance Coverage Mandates for Male Infertility Care, we examined whether inclusion of male infertility coverage within state IVF mandates was associated with differences in IVF utilization and outcomes.
We found that both IVF utilization and the absolute number of live births resulting from IVF were highest in states with an insurance coverage mandate that includes coverage for male infertility care. IVF utilization was sixfold higher in states that have insurance coverage mandates for both female and male infertility care, in comparison to states without any infertility coverage mandates. Furthermore, we also found that IVF utilization was 1.6 times higher in states that have coverage mandates for both females and males, in comparison to states that only mandate coverage for IVF. Similarly, the number of live births following IVF was also highest in states with coverage mandates for both females and males (154 live births per 100,000 women), in comparison to 31.9 live births per 100,000 women in states with no coverage mandates.
We believe this study is the first published evidence of differences in IVF utilization associated specifically with state insurance mandates that include male infertility coverage. Our results suggest that IVF is performed more often and that more babies are born when the male has insurance coverage for infertility care, too. These findings underscore the importance of addressing infertility as a couple-based condition rather than focusing insurance coverage solely on IVF. When male infertility evaluation and treatment are more accessible, more couples may become eligible for and ultimately pursue IVF, resulting in higher utilization and improved reproductive outcomes. This work provides insights into how state-wide legislation can affect fertility at the individual level.
While causality cannot be established given the retrospective, cross-sectional nature of this analysis, our findings suggest that state-level insurance mandates, particularly those that include coverage for male infertility care, may serve as an important policy lever to improve access to infertility treatments. Given ongoing declines in fertility rates and disparities in reproductive healthcare access, the inclusion of male infertility care within insurance coverage mandates merits consideration in evolving comprehensive infertility policy design.
Written by: Amelia A. Khoei, MD, MPH, and James M. Dupree, MD
- Department of Urology, University of Michigan, Ann Arbor, MI
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