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Public opinions regarding infertility treatment insurance coverage among marginalized patient populations

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

To assess public support for insurance coverage of infertility treatment among marginalized patient groups.

Methods

A cross-sectional, web survey-based study using a national sample of 1226 US adults. Participants responded to questions measuring their beliefs and attitudes towards support for infertility treatment insurance coverage among specific patient populations. We then evaluated the opinions of only the participants who supported infertility treatment insurance coverage for patients meeting the standard definition of infertility. Associations between demographic data of participants and support for infertility treatment insurance coverage among these marginalized groups were queried.

Results

Of the total responses, 61.9% of the respondents generally supported insurance coverage for infertility. Of the total responses, 54.5% did not support any insurance coverage for lesbian, gay, or transgender patients. Of those who generally supported the insurance coverage for infertility, 53.0% supported coverage for gay patients requiring infertility services, 54.6% supported coverage for lesbian patients, and 42.5% supported coverage for transgender patients. Of the total responses, 47.6% did not support insurance for green card holders, undocumented immigrants, or refugees. Of those who supported the insurance coverage for infertility in general, 63.6% supported insurance coverage for patients with green cards, 29.8% for refugees, and 20.7% for undocumented patients. For disability and genetic conditions, 39.5% did not support coverage for any groups. Of those who support the insurance coverage for infertility in general, there was most support for patients with physical disabilities (60.2%) followed by genetic disease (47.9%), then mental disabilities (31.4%).

Conclusion

Even among those who support insurance coverage for infertility in general, approximately less than half of them supported these same treatments for marginalized groups, including the diverse sexuality and gender (DSG), immigrant, and disabled populations. Increased education and awareness of infertility is needed among the general population to garner acceptance of infertility as a disease and support insurance coverage of infertility treatment for all persons.

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References

  1. Sunderam S, Kissin DM, Zhang Y, Jewett A, Boulet SL, Warner L, et al. Assisted reproductive technology surveillance - United States, 2018. MMWR Surveill Summ. 2022;71(4):1–19. https://doi.org/10.15585/mmwr.ss7104a1.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sunderam S, Kissin DM, Crawford SB, Folger SG, Jamieson DJ, Barfield WD, et al. Assisted reproductive technology surveillance–United States, 2011. MMWR Surveill Summ. 2014;63(10):1–28.

    PubMed  Google Scholar 

  3. Chambers GM, Sullivan EA, Ishihara O, Chapman MG, Adamson GD. The economic impact of assisted reproductive technology: a review of selected developed countries. Fertil Steril. 2009;91(6):2281–94. https://doi.org/10.1016/j.fertnstert.2009.04.029.

    Article  PubMed  Google Scholar 

  4. asrm@asrm.org ECotASfRMEa. Disparities in access to effective treatment for infertility in the United States: an ethics committee opinion. Fertil Steril. 2021;116(1):54–63. https://doi.org/10.1016/j.fertnstert.2021.02.019.

  5. Beroukhim G, Mahabamunuge J, Pal L. Racial disparities in access to reproductive health and fertility care in the United States. Curr Opin Obstet Gynecol. 2022;34(3):138–46. https://doi.org/10.1097/GCO.0000000000000780.

    Article  PubMed  Google Scholar 

  6. Ho JR AL, Mok-Lin E, Hoffman JR, Smith JF, Herndon CN. Public attitudes in the United States toward insurance coverage for in vitro fertilization and the provision of infertility services to lower income patients. F&S Reports. 2022:122-9

  7. Resolve. Insurance coverage by state. https://resolve.org/learn/financial-resources-for-family-building/insurance-coverage/insurance-coverage-by-state/. Accessed July 15, 2022.

  8. Nachtigall RD, MacDougall K, Davis AC, Beyene Y. Expensive but worth it: older parents’ attitudes and opinions about the costs and insurance coverage for in vitro fertilization. Fertil Steril. 2012;97(1):82–7. https://doi.org/10.1016/j.fertnstert.2011.10.019.

    Article  PubMed  Google Scholar 

  9. Medicine ECotASfR. Disparities in access to effective treatment for infertility in the United States: an ethics committee opinion. Fertil Steril. 2015;104(5):1104–10. https://doi.org/10.1016/j.fertnstert.2015.07.1139.

  10. asrm@asrm.org ECotASfRMEa. Access to fertility treatment irrespective of marital status, sexual orientation, or gender identity: an ethics committee opinion. Fertil Steril. 2021;116(2):326–30. https://doi.org/10.1016/j.fertnstert.2021.03.034.

  11. De Wert G, Dondorp W, Shenfield F, Barri P, Devroey P, Diedrich K, et al. ESHRE Task Force on Ethics and Law 23: medically assisted reproduction in singles, lesbian and gay couples, and transsexual people†. Hum Reprod. 2014;29(9):1859–65. https://doi.org/10.1093/humrep/deu183.

    Article  PubMed  Google Scholar 

  12. Kawwass JF, Penzias AS, Adashi EY. Fertility-a human right worthy of mandated insurance coverage: the evolution, limitations, and future of access to care. Fertil Steril. 2021;115(1):29–42. https://doi.org/10.1016/j.fertnstert.2020.09.155.

    Article  PubMed  Google Scholar 

  13. Fertility IQ. Using a spermbank. https://www.fertilityiq.com/becoming-a-single-mother/donor-sperm-iui-and-ivf-for-single-women#using-a-sperm-bank-smc. Accessed 14 July 2022.

  14. Seifer DB, Wantman E, Sparks AE, Luke B, Doody KJ, Toner JP, et al. National survey of the Society for Assisted Reproductive Technology membership regarding insurance coverage for assisted reproductive technologies. Fertil Steril. 2018;110(6):1081-8.e1. https://doi.org/10.1016/j.fertnstert.2018.07.016.

    Article  PubMed  Google Scholar 

  15. asrm@asrm.org ECotASfRMEa. Access to fertility services by transgender and nonbinary persons: an ethics committee opinion. Fertil Steril. 2021;115(4):874–8. https://doi.org/10.1016/j.fertnstert.2021.01.049.

  16. Kelley AS, Qin Y, Marsh EE, Dupree JM. Disparities in accessing infertility care in the United States: results from the National Health and Nutrition Examination Survey, 2013–16. Fertil Steril. 2019;112(3):562–8. https://doi.org/10.1016/j.fertnstert.2019.04.044.

    Article  PubMed  Google Scholar 

  17. Ho JR, Hoffman JR, Aghajanova L, Smith JF, Cardenas M, Herndon CN. Demographic analysis of a low resource, socioculturally diverse urban community presenting for infertility care in a United States public hospital. Contracept Reprod Med. 2017;2:17. https://doi.org/10.1186/s40834-017-0044-7.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Insogna IG, Ginsburg ES. Infertility, inequality, and how lack of insurance coverage compromises reproductive autonomy. AMA J Ethics. 2018;20(12):E1152–9. https://doi.org/10.1001/amajethics.2018.1152.

    Article  PubMed  Google Scholar 

  19. Benagiano G, Farris M. Public health policy and infertility. Reprod Biomed Online. 2003;7(6):606–14. https://doi.org/10.1016/s1472-6483(10)62082-2.

    Article  CAS  PubMed  Google Scholar 

  20. Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. The international glossary on infertility and fertility care, 2017. Hum Reprod. 2017;32(9):1786–801. https://doi.org/10.1093/humrep/dex234.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This work was funded by Molinaro-Blonigan Fund at the University of Iowa Hospitals and Clinics.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52241, USA

    Aya Iwamoto, Karen M. Summers & Abigail C. Mancuso

Authors
  1. Aya Iwamoto
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  2. Karen M. Summers
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  3. Abigail C. Mancuso
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Correspondence to Aya Iwamoto.

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This study received exempt status by the Institutional Review Board (IRB) at the University of Iowa.

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Iwamoto, A., Summers, K.M. & Mancuso, A.C. Public opinions regarding infertility treatment insurance coverage among marginalized patient populations. J Assist Reprod Genet 40, 589–598 (2023). https://doi.org/10.1007/s10815-022-02687-7

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  • DOI: https://doi.org/10.1007/s10815-022-02687-7

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