Presentations

Abstract

Introduction: Coverage for in vitro fertilization (IVF) and fertility preservation varies widely state by state and is relatively limited across the country. Prior to 2017, 15 states had varying degrees of coverage for fertility, with 8 specifically mandating IVF coverage. From 2017-2020, 9 states enacted some level of fertility coverage with fertility preservation included. The primary outcome of this study was to assess the impact of state insurance mandates that include fertility preservation coverage for medically-induced (iatrogenic) infertility enacted between 2017-2020 on fertility preservation utilization rates using aggregated data from the Center for Disease Control (CDC) from 2016 (pre) and 2021 (post).

Methods: We conducted a retrospective cohort study using cycle information compiled from CDC national summary reports. FP utilization in 2016, pre-mandate, was compared to utilization in 2021, post-mandate in states with and without FP-inclusive insurance mandates enacted between 2017-2020. Risk ratio and Poisson regression models were utilized to determine differences in the mean number of FP cycles amongst states with FP-inclusive insurance mandates compared to states without. A p-value <0.05 indicated statistical significance.

Results: There were 9 states with FP-inclusive insurance mandates and 43 states (including Washington DC and Puerto Rico) without. From 2016-2021, FP cycles increased between 36.1-90.5% in the states with FP mandates. There was a significant increase in FP cycle utilization in states with an inclusive insurance mandate compared to those states without such a mandate over the study period (RR 1.80 vs 1.37; p<0.001). New Hampshire enacted a mandate in 2020, but clinics did not report data to the CDC in 2016 and were therefore excluded.

Conclusion: In 2021, there were 8 states that provided CDC data, that enacted insurance mandates including FP between 2016-2020. States with FP-inclusive insurance coverage for patients with iatrogenic infertility had increased utilization rates compared to non-mandated states. States that have implemented insurance coverage for fertility preservation in cases of medically induced infertility have experienced increases in FP utilization. This study emphasizes the importance of ongoing efforts to enhance patient access to fertility preservation services.