Opinion

The truth about infertility: It’s a disease

An illustration of a couple considering in-vitro fertilization, or IVF. (Image: Prazis Images, via Shutterstock)

For many families, the joys of parenthood are elusive. Infertility affects hundreds of thousands of women in California and millions more across the country.

Yet while safe and proven medical treatments like in-vitro fertilization (IVF) exist to overcome these barriers to pregnancy and allow couples the opportunity to have a family, access to IVF remains a privilege limited to those lucky enough to afford the out-of-pocket cost of treatment.

California’s infertility insurance law only requires health insurers to “offer” – not provide – coverage for fertility treatment.

Infertility is a medical condition that does not discriminate based on race, religion, socio-economic status, or sexuality.

According to the Centers for Disease Control and Prevention (CDC), about 12 percent of women ages 15-44 in the United States have difficulty getting pregnant or staying pregnant. And fertility struggles are not limited to women: approximately one-third of infertility is attributed to the female partner, one-third attributed to the male partner, and one-third is caused by a combination of problems in both partners or is unexplained.

The chance to be parents through IVF should not just be for the “haves”, the most affluent.  The out-of-pocket costs of IVF treatment are beyond the ability of many families to bear — the average cost of an IVF cycle is about $15,000. Most patients will require more than one cycle of IVF to achieve a pregnancy.

These facts may be surprising to many who believe infertility is, or should be, a covered insurance benefit. The truth is California’s infertility insurance law only requires health insurers to “offer” – not provide – coverage for fertility treatment and the law does not cover IVF treatment.

This is unacceptable, given that California law requires medically necessary health care services to be covered by insurance plans.

Infertility is a disease, as recognized by well-respected medical organizations such as the American Medical Association, the American Society for Reproductive Medicine, the American Congress of Obstetricians and Gynecologists, and the World Health Organization. Cost should never be a barrier to treating a disease, yet a recent study found that women aged 25-34 accrued an average of $30,000 of debt after undergoing fertility treatment.

Treatment for infertility, including IVF, should be covered by health insurance — just like other diseases. And under Assembly Bill 767 (Wicks), it will be.

AB 767 would update California law by requiring insurance coverage for infertility and fertility preservation treatments. The bill clarifies in state law that infertility is a disease and requires health care plans and insurance policies issued after January 1, 2020 to provide, not merely offer,coverage for infertility treatments and for planned egg freezing. Separate legislation in the Senate (SB 600) requires coverage for fertility preservation when the infertility arises as a result of, or is a side effect of, medically necessary treatment for a condition such as cancer or certain surgeries.

Nine states — Arkansas, Connecticut, Delaware, Hawaii, Illinois, Massachusetts, Maryland, New Jersey, and Rhode Island — require insurance companies to cover IVF treatments.

Concerns about additional costs have proven to be unfounded.

For example, an analysis of a similar proposal in New York state found that the addition of IVF to insurance plans would result in a miniscule increase of approximately 55 cents per member per month. And IVF may reduce multiple births, which occur at higher rates in states without IVF coverage when multiple embryos are transferred in one cycle with the hope of a live birth and avoiding paying the out-of-pocket costs for more than one IVF cycle.

Coverage of IVF decreases health care costs to the stateand results in healthier babies and moms.

This is not groundbreaking legislation. Nine states — Arkansas, Connecticut, Delaware, Hawaii, Illinois, Massachusetts, Maryland, New Jersey, and Rhode Island — require insurance companies to cover IVF treatments. California, a state known forleading the nation in its commitment to health innovation and equity, is essentially denying this basic right by continuing to maintain the status quo.

AB 767 is scheduled to be heard before the Assembly Health Committee in mid to late-April. Passing this important legislation will provide the opportunity to provide solutions, access to health care for families and individuals experiencing infertility, and help them to pass a legacy of love on to future generations.

Editor’s Note: Barbara Collura is the president and CEO of RESOLVE: The National Infertility Association.


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