Report documents gaps in infertility treatment access

Economic, social, and cultural factors all have an impact on Americans’ access to effective infertility treatment, a new report states.

Providers and others should understand the disparities and work to help solve them, according to the report, prepared by the Ethics Committee of the American Society for Reproductive Medicine (ASRM).

The report cites research conducted in 2009 by an expert panel that found that less than a quarter-24%-of the assisted reproductive technology (ART) needs in the U.S. population were being met.

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Released in September 2015, the report makes several key points, including that economic factors most dominantly fuel access concerns. Most people in the U.S. pay out of pocket for infertility care. Given that a single cycle of in vitro fertilization (IVF) can cost in the neighborhood of 50% of an average person’s annual disposable income, the treatment is out of financial reach for many in middle to lower socioeconomic statuses.

There also are non-economic barriers preventing access to infertility care, including the time off work required for many who seek cycle-based treatment and the fact that ART clinics and male reproductive specialists are unevenly distributed geographically. If ART clinics aren’t nearby, that time can increase substantially. Other factors that come into play include cultural and social influences that discourage some from getting treatment. Language barriers can contribute to a lack of understanding about treatment availability, and even physician bias might prevent patients from getting needed treatments, the authors wrote.

“Reducing or eliminating barriers to infertility treatment for both men and women is a mission we must undertake as professionals and as advocates for our patients,” said ASRM President Rebecca Z. Sokol, MD, MPH, in an ASRM press release. “Advances can be made on many fronts, including educating the public about infertility and its prevention, expanding insurance coverage, developing lower cost, effective treatment protocols, conducting research, and improving patient-physician communication and outreach about infertility.”

NEXT: Challenges remain

But challenges remain. While national and international medical and public health organizations define infertility as a disease, only six states have comprehensive or near-comprehensive mandates for private insurance coverage for its diagnosis and treatment, including IVF, according to the press release.

“Studies have shown improved access and greater utilization of services result in better public health outcomes, specifically a lower incidence of high-order multiple births (triplets or more) in the states with mandated IVF coverage,” according to the release. “But the mandates are limited by Federal law exempting privately funded plans from compliance and state statutes that include restrictions such as waiting periods, a limit of one or two cycles, and limitation of coverage to heterosexual married couples using their own eggs and sperm.”

Researchers have found disparities in IVF outcomes among racial and ethnic groups. Among those findings: IVF success rates are lower for African-American, Asian, and Hispanic women compared to non-Hispanic Caucasian women. More research is needed to find out why this might be the case, according to the authors.

ASRM is convening a task force to work on increasing infertility treatment access to all Americans, according to ASRM Executive Director Richard H. Reindollar, MD.

“We will develop strategies for improving insurance coverage as well as recommendations that clinicians can use in their practices to making care easier for individual patients,” Dr. Reindollar said.

Still, more research is needed, looking at the causes of disparities in access to infertility treatment and how to reduce those, according to the report.

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