Problem
Infertility remains one of the most common diseases affecting reproductive-age people in the U.S. In vitro fertilization (IVF) refers to an assisted reproductive technology (ART) that has been utilized since the 1970s to help couples affected by infertility to conceive. The procedure entails an egg fertilization with a sperm outside the human body, often in a laboratory dish, and the resulting embryo is implanted into a woman’s uterus.
IVF has become a popular and successful infertility treatment, with millions of babies born due to successful ART. Various conditions, including genetic disorders, polycystic ovary syndrome, and endometriosis, cause infertility. While other infertility treatments, such as intrauterine insemination (IUI) and fertility drugs, are available, IVF provides a safer option (Peipert et al., 2022a). The decision to require health insurers to cover IVF treatment is multifaceted, with valid points on both sides.
Health Policy Issue Overview
The health policy issue under investigation involves whether Congress should mandate all health insurers to cover IVF treatments and whether they should cover certain IVF treatments. The policy has caused debates among various stakeholders due to the unaffordability associated with no IVF insurance mandates. IVF can be costly, with a single cycle averaging $10,000 or more (Gardner et al., 2022).
The cost can significantly impact care access for multiple couples, leading to worries about the procedure’s affordability and the potential for unequal access to care. Most insurance firms fail to cover IVF treatments, leaving couples to pay for such procedures out of their pocket. As a result, such people can face significant financial burdens, particularly those who need many IVF cycles to conceive (Peipert et al., 2022a). Thus, some couples may find themselves unable to afford the procedure, questioning the far-reaching consequences of disproportionate health outcomes caused by the inability to access care.
IVF is not always covered by insurance, which makes it hard for lower- and middle-class families to access the care they need. Currently, insurance coverage for IVF treatments differs widely across various states and insurance plans. The lack of uniform coverage makes it difficult for couples, particularly if they reside in states with non-existent or limited coverage. Therefore, Congressional support for mandating all health insurance to cover IVF treatments has increased.
Advocates hope the move will ensure all couples have access to a significant treatment option, regardless of their insurance status or income. However, opponents consider the policy expensive and financially unsustainable in the long run (Peipert et al., 2022a). Thus, the insurance coverage issue is complex, and it is necessary to explore the pros and cons and adopt a preferred position.
Support for mandating insurance coverage for IVF treatments comes from the argument that infertility is a medical condition that deserves treatment. The American Society for Reproductive Medicine has recognized infertility as a disease that needs medical treatment, calling for increased access to care for those struggling with infertility (Kawwass et al., 2021). In addition, infertility may lead to various adverse health outcomes, including decreased quality of life, anxiety, and depression (Peipert et al., 2022a). Thus, ensuring IVF insurance coverage is mandated by Congress can improve access to care for those with infertility issues and can improve their overall well-being and health.
Advantages
IVF as an Effective Treatment
Proponents argue that Congress should make in vitro fertilization a necessary part of health insurance benefits since it is highly effective in addressing the infertility problem. The success rate for IVF ranges from 40% per cycle, depending on various factors, including the cause of infertility, the number of transferred embryos, and the woman’s age (von Wolff et al., 2019). Existing scholarship finds that couples who receive IVF treatment are more likely to conceive than couples who use alternative infertility treatment methods (Peipert et al., 2022b). IVF is also effective in terms of cost and success rate, making the policy seem feasible to proponents.
Cost-Effectiveness in the Long Term
Whereas IVF treatments can be costly upfront, they are cost-effective in the long run, especially for couples struggling with infertility for a long time. Research suggests that the cost of IVF treatments in the first year is higher compared to other treatments for infertility (Pan et al., 2019). However, the cumulative costs of infertility treatments in three years are lower for couples who received IVF treatments (Tannus & Dahan, 2019).
In addition, existing scholarship shows that couples receiving IVF treatments have a high chance of requiring other fertility treatments, reducing long-term treatment costs. Mandating IVF treatment coverage could help minimize the upfront costs of IVF and make it more accessible for couples dealing with infertility problems. Furthermore, by reducing the need for other fertility treatments in the future, proponents argue that IVF can be cost-effective in the long run (Peipert et al., 2022a). As a result, overall healthcare costs are reduced since more expensive complications are avoided by conducting the procedure.
Reducing Healthcare Disparities
Whereas IVF treatments are effective in helping couples conceive, they are prohibitively expensive. Thus, most couples cannot afford IVF treatments and, therefore, cannot benefit from them. Insurance coverage can make a significant impact on affordability and access to IVF (Peipert et al., 2022b). Nonetheless, disparities emerge in access to IVF treatments based on insurance status and income.
Research has found that uninsured and low-income women are less likely to receive infertility treatments, such as IVF, than their wealthy counterparts. Mandating IVF treatment coverage would reduce healthcare disparities by ensuring all couples have access to similar levels of care, regardless of insurance status or income (Tutt, 2021). As a result, the policy can promote health equity and minimize healthcare disparities.
Reducing the Risk of Multiple Pregnancies
Multiple pregnancies can amplify the risk of complications for both the babies and mothers, resulting in increased healthcare costs and serious health risks. When using IVF, healthcare providers can control the number of embryos transferred into the uterus. By transferring one or two embryos, the risk of multiple pregnancies decreases significantly (Peipert et al., 2022a). On the other hand, alternative fertility treatments, such as intrauterine insemination or ovulation induction, may lead to the release of multiple eggs, increasing the risk of multiple pregnancies.
Existing scholarship shows the importance of IVF treatments in reducing multiple pregnancies. When IVF is combined with single embryo transfer (SET), the rate of multiple pregnancies is reduced significantly compared to the transfer of two or more embryos (Kaprelian, 2019). By reducing the risk of multiple pregnancies, proponents argue that IVF can minimize healthcare costs to improve health outcomes for mothers and their babies (Peipert et al., 2022a). As a result, the argument can help address concerns regarding the financial sustainability of mandated IVF treatment coverage.
Improving Mental Health Outcomes
Support for the coverage of IVF treatment for all patients has emerged because IVF can improve the mental health outcomes of couples dealing with infertility issues. Infertility can have a massive impact on the well-being and mental health of couples who have problems conceiving (Peipert et al., 2022b). The emotional toll of infertility can be challenging since couples experience feelings of shame, loss, and grief.
Existing scholarship confirms that infertility may cause stress, depression, and anxiety, affecting a couple’s overall quality of life. IVF can enhance mental health outcomes for those struggling with infertility problems (Panda, 2021). The process of undergoing IVF can be emotionally challenging and stressful, but its successful completion can enhance mental health outcomes.
In addition, IVF can provide a sense of control and hope for couples struggling to conceive. By offering a treatment option that has a high success chance compared to other treatment forms, IVF helps alleviate feelings of despair and helplessness (Peipert et al., 2022a). As a result, their overall quality of life is improved, as stress is minimized. Furthermore, the relationship between those who succeed in conceiving through IVF improves, highlighting the significance of IVF (Panda, 2021).
Disadvantages
Expensive Treatment Form
Opponents of mandating IVF treatment coverage argue that the procedure is expensive and may not be cost-effective. IVF is a complex medical procedure that requires a significant number of resources and specialized medical staff to perform. As a result, the treatment cost becomes a major barrier to access for many people, especially those without health insurance covering IVF.
Furthermore, IVF costs can vary depending on various factors, including the type of procedure, the number of cycles needed for a successful pregnancy, and the clinic’s geographical location (von Wolff et al., 2019). Existing scholarship indicates that the high cost can be a significant barrier to access, especially for low-income people (Peipert et al., 2022b). The average IVF cost can be 10% of the household income, making it unaffordable for most families. Thus, disparities in access to treatment may occur due to income differences.
In addition, the high-cost IVF treatment may not always be cost-effective. An extensive review of existing scholarship shows that IVF cost-effectiveness can vary widely depending on various factors (von Wolff et al., 2019). In some cases, IVF costs can be outweighed by the probable benefits of the procedure, including the success rate of pregnancy. In other cases, possible benefits cannot justify it, especially if the treatment’s likelihood of success is low (Peipert et al., 2022a). High IVF costs make opponents of the position consider the benefits and costs while making policy decisions about the treatment’s coverage.
Higher Healthcare Costs
Requiring health insurers to cover IVF costs would increase their overall costs, which would then be passed on to consumers. As a result, average consumers pay higher deductibles or premiums. Requiring all health insurers to cover IVF costs could lead to an increase in healthcare costs of about $2.2 billion annually (Pan et al., 2019). Such an increase is significant, particularly given that a small number of people require IVF treatment annually.
In addition, IVF coverage mandates can lead to adverse selection where individuals who need such a treatment seek insurance plans that cover the treatment. As a result, insurers may be required to incur higher costs. IVF coverage mandates can divert resources away from other significant healthcare needs. Given the high treatment costs, mandating coverage can increase the budget for IVF treatment, reducing money for other resources (Kaprelian, 2019). Thus, policymakers should consider the costs and benefits of IVF coverage mandates before making decisions regarding the treatment.
Unguaranteed IVF Success Rate
Although IVF has improved significantly in the last decade, its success rate is not guaranteed. It varies depending on various factors and conditions. The success rate of IVF is about 30% per cycle in women below 35; however, the rate decreases as people age (von Wolff et al., 2019).
The success rate of IVF may also depend on the quality of the IVF center and the medical team’s expertise in performing the procedure. These factors suggest that IVF may not be the most effective treatment, and other cheaper methods may be more appropriate (Kawwass et al., 2021). With each subsequent cycle, couples experience a significant emotional toll and financial burden as they struggle to pay for additional treatment cycles.
Ethical Concerns
Opponents of IVF use and treatment raise important ethical issues regarding the fate, use, and creation of embryos and their impact on traditional family structures. A primary ethical concern is related to the fate of embryos utilized in the IVF process. IVF entails the creation of multiple embryos, but not all of them are implanted in the uterus, leading to embryo surplus.
An option could be freezing the embryos to use in the future, but it can also raise ethical concerns (von Schondorf-Gleicher et al., 2022). For instance, some people consider freezing embryos unethical due to the destruction of life (Peipert et al., 2022a). In addition, there are some concerns regarding storing embryos for long periods, which often leads to the loss of embryos caused by technical failures.
There are some concerns about the effect of IVF on traditional family structures. IVF can entail using eggs, donor sperm, or surrogate mothers, raising the question about the role of biological and genetic relationships in family structures. In addition, some people argue that focusing on IVF as an infertility solution can distract policymakers. As a result, they shun away from their duty of creating more comprehensive interventions and policies that address infertility causes, such as stress, environmental toxins, and other factors (Tutt, 2021).
Thus, policymakers must consider ethical concerns when deciding on IVF coverage mandates. In addition, mandating that all health insurers cover IVF can be seen as promoting a treatment that some find morally objectionable or ethically questionable (von Schondorf-Gleicher et al., 2022). While IVF can offer a valuable solution for couples who struggle with infertility, ethical concerns, limited success rates, and high costs must be considered to create an accommodating environment for them.
Final Position
The final position states that Congress should mandate all health insurers to cover IVF treatments; however, insurers should not be required to cover unlimited IVF treatments. The position was taken after considering the arguments presented by proponents and opponents of IVF treatment coverage mandates. Congress must limit coverage to a certain number of cycles while making the decision (Tutt, 2021). Whereas the cost of IVF procedures can be a barrier to accessing care, mandating coverage can increase treatment access for those requiring it (Peipert et al., 2022a). At the same time, limiting coverage to a specific number of cycles can help control costs and prevent treatment overuse.
Considering the proponents, it is evident that the numerous benefits of IVF are difficult to ignore. For multiple couples that struggle with infertility, IVF offers the only or the best option for achieving a successful pregnancy (Kaprelian, 2019). Furthermore, it may reduce the risk of multiple pregnancies, especially when combined with SET. As a result, it can successfully prevent negative health outcomes for both the mother and babies. IVF treatments can also improve mental health outcomes since they reduce the stress of waiting to get pregnant (Peipert et al., 2022a). Finally, some IVF may provide a safer and more cost-effective option compared to other treatments in the long run.
However, the Con position raises valid concerns that must be considered by anyone seeking to adopt any position on the healthcare policy issue. IVF offers an expensive option for couples struggling to conceive and thus may not be accessible to all people. In addition, mandating IVF treatment coverage may increase costs for all consumers (Kaprelian, 2019). Furthermore, several ethical concerns surround its use, particularly concerning the disposal and creation of embryos (Peipert et al., 2022a).
In addition, overuse of the treatment can be prevented by limiting coverage to certain in vitro fertilization cycles. The number of cycles is determined based on various factors, including costs, success rates, and medical necessity. Finally, a reasonable limit on the number of IVF treatments covered by insurers can ensure resources are used effectively.
For instance, policymakers could mandate insurers to cover a limited number of IVF cycles, with extra ones available for out-of-pocket or co-pay. Such a strategy can ensure the cost is non-prohibitive while limiting the potential for abuse. Similarly, policymakers could mandate couples to undergo preparatory steps such as counseling before undergoing IVF to reduce several risks (Peipert et al., 2022a). Overall, the personal stance tries to appease both sides of the argument on IVF treatment coverage.
References
Gardner, A., Smith, K. L., Huuki, E., Luizzi, J., Gunn, D. D., Campbell, S. B., & Pier, B. D. (2022). Current options to lower the cost of in vitro fertilization: A comprehensive review. F&S Reviews, 4(1), 66-77. Web.
Kaprelian, A. (2019). Significance of establishing and imposing state mandates for infertility patients (Master’s thesis, California State University, Northridge).
Kawwass, J. F., Penzias, A. S., & Adashi, E. Y. (2021). Fertility—a human right worthy of mandated insurance coverage: The evolution, limitations, and future of access to care. Fertility and Sterility, 115(1), 29-42. Web.
Pan, W., Tu, H., Jin, L., Hu, C., Li, Y., Wang, R., Huang, W., & Liao, S. (2019). Decision analysis about the cost-effectiveness of different in vitro fertilization-embryo transfer protocols under consideration by governments, hospitals, and patients. Medicine, 98(19), 1-10. Web.
Panda, K. (2021). Infertility: Its impact on physical, psychological, and social health. Indian Journal of Health Studies, 3(2), 24-34. Web.
Peipert, B. J., Chung, E. H., Harris, B. S., & Jain, T. (2022a). Impact of comprehensive state insurance mandates on in vitro fertilization utilization, embryo transfer practices, and outcomes in the United States. American Journal of Obstetrics and Gynecology, 227(1), 64-e1-64-e8. Web.
Peipert, B. J., Montoya, M. N., Bedrick, B. S., Seifer, D. B., & Jain, T. (2022b). Impact of in vitro fertilization state mandates for third-party insurance coverage in the United States: A review and critical assessment. Reproductive Biology and Endocrinology, 20(1), 1-12. Web.
Tannus, S., & Dahan, M. H. (2019). A decrease in American birth rates makes it imperative for the United States to implement state-mandated fertility coverage. Journal of Medical Economics, 22(3), 252-253. Web.
Tutt, T. G. (2021). Healthcare policy: Federally mandated insurance coverage for infertility treatment. Columbia Social Work Review, 19(1), 2-19. Web.
Von Schondorf-Gleicher, A., Mochizuki, L., Orvieto, R., Patrizio, P., Caplan, A. S., & Gleicher, N. (2022). Revisiting selected ethical aspects of current clinical in vitro fertilization (IVF) practice. Journal of Assisted Reproduction and Genetics, 39(3), 591-604. Web.
Von Wolff, M., Schwartz, A. K., Bitterlich, N., Stute, P., & Fäh, M. (2019). Only women’s age and the duration of infertility are the prognostic factors for the success rate of natural cycle IVF. Archives of Gynecology and Obstetrics, 299, 883-889. Web.