WEDNESDAY, Aug. 28, 2002 (HealthDayNews) -- Multiple births of "test-tube babies" are more likely when health insurance doesn't cover in vitro fertilization (IVF), a survey finds.
Couples are more likely to have a large number of eggs that are fertilized in a laboratory dish implanted when the money -- $10,000 and more per try -- comes out of their pockets, says a report in tomorrow's issue of the New England Journal of Medicine.
And so both the rate of successful pregnancies and the percentage of births of three or more fetuses are both higher, says Dr. Mark D. Hornstein, director of the division of reproductive endocrinology at Brigham and Women's Hospital in Boston, who led the survey.
Does that mean insurance coverage is preferable? "You can spin it both ways," Hornstein says. "In the case of an individual patient, it is an argument for coverage, because what you are able to do is make a decision in terms of your best interest, and multiple births are not in the best interest of the individual patient.
"If insurance coverage were mandated throughout the country, you would end with more treatments. The overall pregnancy rate would be lower, but you would also have an increase in the absolute number of births."
He has his own opinion, which he says is not necessarily based on data from the study: "I think coverage is good if you are an infertile couple." The reason is that problems are more common in pregnancies that end in multiple births, Hornstein says.
His study used data reported in 1998 by 360 American fertility clinics. Only 31 of those clinics were in the three states -- Illinois, Massachusetts, and Rhode Island -- where law required full health insurance coverage of IVF, with another 27 clinics in five states requiring partial coverage.
The number of fertilization attempts was higher in states that required full coverage (3.35 tries per 1,000 women of reproductive age) or partial coverage (1.46 tries) compared to the no-coverage states (1.21 tries).
The success rate, measured in live births, was highest in the no-coverage states, 25.7 percent, than in the full-coverage states (22.7 percent) or partial coverage states (22.2 percent), but 11.2 percent of the pregnancies with three or more fetuses were in the no-coverage states, 8.9 percent in the partial coverage states and 9.7 percent in the full coverage states.
Is full coverage something that the country could afford? Hornstein cites the numbers in an accompanying editorial, in which people in a survey said they would be willing to pay an average of $32 a year to have every couple covered. The actual cost of coverage would be $3 per patient, Hornstein says.
And multiple births cost a lot, says the editorial by Dr. David S. Guzick of the University of Rochester School of Medicine in New York. "The estimated direct medical expenses of a gestation involving three or more fetuses are about $340,000, and this figure does not include the costs of long-term care and special education for disabilities resulting from prematurity," he writes.
Right now, just 14 states have legislation requiring coverage, says Sean Tipton, director of public affairs of the American Society for Reproductive Medicine. Legislatures in New York and New Jersey passed laws requiring coverage this year, while the California legislature rejected it.
Coverage varies state by state, Tipton says. "Massachusetts has the broadest legislation, requiring comprehensive coverage with very few limits," he says. Texas, by contrast, says a health insurer must provide coverage if an employer asks for it, while Illinois law requires payment for four attempts.
It's impossible to say how many people have insurance coverage for in vitro fertilization, Tipton says. "We have tried, and frankly, we have given up trying," he says. "Generally, a lot of high-tech companies are likely to provide coverage, also companies with strong unions. Insurers will tailor coverage to individual employers."
The society and its member doctors lobby vigorously for better coverage, and insurance companies lobby right back, Tipton says. In the short term, not providing coverage does reduce their costs, he acknowledges, but the society's argument is that "if you have multiple gestations you are more likely to have complications, so you are better off protecting against multiple births."
And there is a stronger "moral argument," Tipton maintains. "We are arguing that infertility ought to be treated like any other disease," he says.
What To Do
You can get more information about how IVF is done from the American Society for Reproductive Medicine or the InterNational Council on Infertility Information Dissemination.
