Establishing Insurance Coverage for Iatrogenic Infertility

  • Joyce D. ReineckeEmail author
  • Nanette Elster
  • Joseph Letourneau
  • Meghan Bowman-Curci


Numerous studies have found that patients experience distress and anxiety when faced with infertility following cancer treatment. Despite strong demand for fertility preservation, access to these services remains limited because of a lack of insurance coverage.


Fertility preservation Insurance coverage Advocacy Legislation Cost Barrier Quality of life 


  1. 1.
    Center for Disease Control and Prevention. United States cancer statistics: data visualizations.,, Published 2017. Accessed 8 June 2018.
  2. 2.
    National Cancer Institute. Cancer stat facts: female breast cancer. Published 2014. Accessed 14 July 2018.
  3. 3.
    Green DM, Kawashima T, Stovall M, et al. Fertility of male survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Onocol. 2010;28(2):332–9.CrossRefGoogle Scholar
  4. 4.
    Green DM, Kawashima T, Stovall M, et al. Fertility of female survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Onocol. 2009;27(16):332–9.Google Scholar
  5. 5.
    Katsifis GETA. Ovarian failure in systemic lupus erythematosus patients treated with pulsed intravenous cyclophosphamide. Lupus. 2004;13:673–8.CrossRefGoogle Scholar
  6. 6.
    Rovoa T, Passweg J, Heim D, Meyer-Monard S, Holzgreve W. Spermatogenesis in long term survivors after allogenic hematopoietic stem cell transplantation is associated with age, time interval since transplantation, and apparently absence of chronic GVHD. Blood. 2006;108(3):1100.CrossRefGoogle Scholar
  7. 7.
    Nahata L, Bowman-Curci M, Quinn GP. Exploring fertility preservation intentions among transgender youth. J Adolesc Health. 2018;62(2):123–5.CrossRefGoogle Scholar
  8. 8.
    Chen D, Simons L, Johnson EK, et al. Fertility preservation for transgender adolescents. J Adolesc Health. 2017;61(1):120–3.CrossRefGoogle Scholar
  9. 9.
    Dean M, Rauscher EA. “It was an Emotional Baby”: previvors’ family planning decision-making styles about hereditary breast and ovarian cancer risk. J Genet Couns. 2017;26(6):1301–13.CrossRefGoogle Scholar
  10. 10.
    Insogna IG, Ginsburg ES. PAH. Fertility preservation in BRCA carriers: special considerations. In:Managing BRCA mutation carriers. Cham: Springer; 2017. p. 171–86.CrossRefGoogle Scholar
  11. 11.
    van der Kaaij M, Heutte N, Meijnders P, Abeilard-Lemoisson E, et al. Premature ovarian failure and fertility in long-term survivors of Hodgkin’s lymphoma: a European Organisation for Research and Treatment of Cancer Lymphoma Group and Groupe d’Étude des Lymphomes de l’Adulte Cohort study. J Clin Onocol. 2012;30(3):291–9.CrossRefGoogle Scholar
  12. 12.
    Woodruff TK. The emergence of a new interdiscipline: oncofertility. In:Oncofertility fertility preservation for cancer survivors. Cham: Springer; 2007. p. 3–11.CrossRefGoogle Scholar
  13. 13.
    Walsh SK, Ginsburg ES, Lehmann LS, Partridge AH. Oncofertility: fertile ground for conflict between patient autonomy and medical values. Oncologist. 2017;22(7):860–3.CrossRefGoogle Scholar
  14. 14.
    American Society for Reproductive Medicine. Recommendations for gamete and embryo donation: a committee opinion. Fertil Steril. 2012;99(1):47–62.Google Scholar
  15. 15.
    Center for Disease and Prevention. Mean age of mothers is on the rise: United States, 2000–2014. Published 2016.
  16. 16.
    History. World’s first test tube baby born. Published 2010.
  17. 17.
    Fortin C, Abele S. Increased length of awareness of assisted reproductive technologies fosters positive attitudes and acceptance among women. Int J Fertil Steril. 2016;9(4):452–64.PubMedGoogle Scholar
  18. 18.
    Lewis EI, Missmer SA, Farland LV, Ginsburg ES. Public support in the United States for elective oocyte cryopreservation. Fertil Steril. 2016;106(5):1183–9.CrossRefGoogle Scholar
  19. 19.
    Quinn GP, Vadaparampil ST, Bell-Ellison BA, Gwede CK, Albrecht TL. Patient–physician communication barriers regarding fertility preservation among newly diagnosed cancer patients. Soc Sci Med. 2008;66(3):784–9.CrossRefGoogle Scholar
  20. 20.
    Schover LR. Patient attitudes toward fertility preservation. Pediatr Blood Cancer. 2009;53(2):281–4.CrossRefGoogle Scholar
  21. 21.
    Rashedi AS, de Roo SF, Ataman LM, et al. Survey of fertility preservation options available to patients with cancer around the globe. J Glob Oncol. 2017;4:1–16.PubMedGoogle Scholar
  22. 22.
  23. 23.
    FertilityIQ. The costs of egg freezing. Published 2017. Accessed 14 July 2018.
  24. 24.
    Bona K, Lynch DM, Ramsey S, et al. Cancer-related financial toxicity and its pervasive effects on patients and families: solving a national health and economic crisis hiding in plain sight. 2018.
  25. 25.
    Zafar YS, Peppercorn JM, Schrag D, et al. The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist. 2013;18(4):381–90.CrossRefGoogle Scholar
  26. 26.
    Zafar YS. Financial toxicity of cancer care: it’s time to intervene. J Natl Cancer Inst. 2016;108(5):djv370.CrossRefGoogle Scholar
  27. 27.
    Carrera PM, Kantarjian HM, Blinder VS. The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA A J Cancer Clin. 2018;68(2):153–65.CrossRefGoogle Scholar
  28. 28.
    Weliver D. The 2015 Millennial Money Survey: how much do 20-somethings earn and save? Published 2015.
  29. 29.
    Beauchamp TL, Childress JF. Principles of biomedical ethics. New York: Oxford University Press; 2009.Google Scholar
  30. 30.
    Aiken W, LaFollette H. Whose child? Children’s rights, parental authority, and state power. Totowa: Rowman and Littlefield. p. 1980.Google Scholar
  31. 31.
    Frith H, Harcourt D, Fussell A. Anticipating an altered appearance: women undergoing chemotherapy treatment for breast cancer. Eur J Oncol Nurs. 2007;11(5):385–91.CrossRefGoogle Scholar
  32. 32.
    Stevens LA, McGrath MH, Druss RG, Kister SJ, Gump FE, Forde KA. The psychological impact of immediate breast reconstruction for women with early breast cancer. Plast Reconstr Surg. 1984;73(4):69–628.CrossRefGoogle Scholar
  33. 33.
    Campo-Engelstein L. Insurance coverage for cancer treatment-induced conditions: comparing fertility preservation technology and breast reconstructive surgery. DePaul Law Rev. 2012;61(3):849–60.Google Scholar
  34. 34.
    Benedict C, Shuk E, Ford JS. Fertility issues in adolescent and young adult cancer survivors. J Adolesc Young Adult Oncol. 2016;5(1):48–57.CrossRefGoogle Scholar
  35. 35.
    Gonçalves V, Sehovic I, Quinn G. Childbearing attitudes and decisions of young breast cancer survivors: a systematic review. Hum Reprod. 2014;20(2):279–92.Google Scholar
  36. 36.
    Howard-Anderson J, Ganz PA, Bower JE, Stanton AL. Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104(5):386–405.CrossRefGoogle Scholar
  37. 37.
    Partridge AH, Gelber S, Peppercorn J, Sampson E, Knudsen K, Laufer M, Rosenberg R, Przypyszny M, Rein A, Winer EP. Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol. 2004;22(20):4174–83.CrossRefGoogle Scholar
  38. 38.
    Jeruss JS, Partridge AH. Use of tamoxifen by young women is influenced by fertility concerns. J Natl Cancer Inst. 2015;107(10):djv202.CrossRefGoogle Scholar
  39. 39.
    Resolve. Infertility coverage by state. Published 2018. Accessed 1 Aug 2018.
  40. 40.
    United Healthcare. Personal communication, February 1, 2018.Google Scholar
  41. 41.
    California Health Benefits Review Program (CHBRP). Analysis of assembly bill 219: health care coverage: cancer treatment. Oakland: CHBRP; 2013.Google Scholar
  42. 42.
    Skinner D. Defining medical necessity under the patient protection and affordable care act. Public Adm Rev. 2013;73(1):49–59.CrossRefGoogle Scholar
  43. 43.
    American Medical Association. Statement of the American Medical Association to the Institute of Medicine’s Committee on Determination of Essential Health Benefits. Washington, DC: AMA; 2011.Google Scholar
  44. 44.
    SART. AMA adopts ASRM sponsored resolution to designate infertility a disease.Google Scholar
  45. 45.
    Oktay K, Harvey BE, Partridge A, et al. Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Onocol. 2018.
  46. 46.
    American Society of Reproductive Medicine. Fertility preservation and reproduction in patients facing gonadotoxic therapies: a committee opinion. Fertil Steril. 2013;100(5):1224–31.CrossRefGoogle Scholar
  47. 47.
    Association AM. Oncofertility and fertility preservation treatment. Published 2013.
  48. 48.
    California Department of Managed Healthcare. Internal Medical Review Decision, Reference ID: EI11-12274. Internal Medical Review Decision, Reference ID: EI11-12274.
  49. 49.
    California health benefits review program report, analysis of California Senate Bill 172 fertility preservation: a report to the 2017–2018 California State Legislature. 26.Google Scholar
  50. 50.
    Alliance for Fertility Preservation. How much does fertility preservation cost? Accessed 15 Aug 2018.
  51. 51.
    Novak D, Bender K. Annual mandate report: coverage for fertility preservation for iatrogenic infertility. 2017.Google Scholar
  52. 52.
    Klosky JL, et al. Prevalence and predictors of sperm banking in adolescents newly diagnosed with cancer: examination of adolescent, parent, and provider factors influencing fertility preservation outcomes. J Clin Onocol. 2017;35(34):3830–6.CrossRefGoogle Scholar
  53. 53.
    Letourneau JM, Ebbel EE, Katz PP, et al. Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer. 2012;118(6):1710–7.CrossRefGoogle Scholar
  54. 54.
    Blumen H, Fitch K, Polkus V. Comparison of treatment costs for breast cancer, by tumor stage and type of service. Am Health Drug Benefits. 2016;9(1):23–32.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Blue Cross Blue Shield of Massachusetts. Product portfolio and benefit design updates. 2009.
  56. 56.
    Hayes-Lattin B. Insurance coverage for fertility preservation – what can we do? In: Oncofertility Consortium Conference. Chicago; 2015.Google Scholar
  57. 57.
    Tran M. Apple and Facebook offer to freeze eggs for female employees. The Guardian. Published 2014.
  58. 58.
    Hall G. These tech companies pay for egg-freezing as an employee benefit. Silicon Val Bus J. Published 2017.
  59. 59.
    Veterans Health Administration. Infertility evaluation and treatment: veterans health directive 1332. Washington, DC: Veterans Health Administratio; 2017.Google Scholar
  60. 60.
    State of New Jersey. Senate Bill 1423. 2002.
  61. 61.
    State of New Jersey. Group health insurance policy to provide coverage for treatment of infertility, NJ Rev Stat § 17B:27-46.1x. 2013.Google Scholar
  62. 62.
    State of Connecticut. An act requiring health insurance coverage for fertility preservation for insureds diagnosed with cancer: HB 7124. 2017.
  63. 63.
    State of Rhode Island. An act relating to insurance- coverage for infertility, § 27-20-20 A. 2017.Google Scholar
  64. 64.
    State of Connecticut. An act requiring health insurance coverage for fertility preservation for insureds diagnosed with cancer: HB 7124. 2005.Google Scholar
  65. 65.
    Arditi L. RI requires coverage for ‘fertility preservation’ by private insurers. Providence J. Published 2017.
  66. 66.
    California Department of Managed Health Care Staff. Private communication. 2018.Google Scholar
  67. 67.
    State of Maryland. Health insurance – coverage of fertility preservation procedures for iatrogenic infertility, HB 908. 2018.Google Scholar
  68. 68.
    Insurance CD-Fertility Preservation: HB 2617. 2018.Google Scholar
  69. 69.
    State of Maryland. Maryland Insurance Code Ann §15–810. 2000.Google Scholar
  70. 70.
    State of Delaware. An act to amend title 18 of the Delaware code relating to insurance coverage for obstetrical and gynecological services: Senate Bill 139. 2018.
  71. 71.
    State of New Jersey. An act concerning health benefits coverage for fertility preservation services under certain health insurance plans and supplementing various parts of statutory law, Assembly Bill 3150. 2018.Google Scholar
  72. 72.
    State of New Jersey. An act concerning health benefits coverage for fertility preservation services under certain health insurance plans and supplementing various parts of statutory law, Senate Bill 2133. 2018.Google Scholar
  73. 73.
    Employee Retirement Income Security Act of 1974. 1974.Google Scholar
  74. 74.
    Employee Benefit Research Institute. ERISA pre-emption: implications for health reform and coverage. Published 2008. Accessed 20 Aug 2018.
  75. 75.
    Wade K. Health insurance coverage for infertility treatment and procedures—Conn. Gen. Stat. § 38a-509 and § 38a-536. 2015.
  76. 76.
    State of Connecticut Insurance Department. Health insurance coverage for infertility treatment and procedures—Conn. Gen. Stat. § 38a-509 and § 38a-536. 2015.
  77. 77.
    California Department of Managed Healthcare. Internal Medical Review Decision, References IDs: MN17-26855; MN17-27049; MN17-26920; MN17-2718.Google Scholar
  78. 78.
    California Department of Managed Healthcare. Internal Medical Review, Reference ID: MN17-27186.Google Scholar
  79. 79.
    American Society of Reproductive Medicine. California Department of Managed Health Care determines fertility preservation is a covered benefit under existing law. ASRM Bull. 2018;20(3).Google Scholar
  80. 80.
    Walter JR, Shuai X, Woodruff TK. A call for fertility preservation coverage for breast cancer patients: the cost of consistency. J Natl Cancer Ins. 2017;109(5).
  81. 81.
    Cardozo ER, Huber J, Stuckey AR, Alvero RJ. Mandating coverage for fertility preservation – a step in the right direction. New Engl J Med. 2017;377:1607–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Joyce D. Reinecke
    • 1
    Email author
  • Nanette Elster
    • 2
  • Joseph Letourneau
    • 3
  • Meghan Bowman-Curci
    • 4
  1. 1.Alliance for Fertility Preservation (501 ©(3))LafayetteUSA
  2. 2.Stritch School of Medicine, Neiswanger Institute for BioethicsLoyola University ChicagoChicagoUSA
  3. 3.Department of OB/GYNUniversity of UtahSalt Lake CityUSA
  4. 4.Alliance for Fertility Preservation (501 ©(3)) Moffitt Cancer Center, Health Outcomes and Behavior Program Lafayette, CA, USAHealth Outcomes and Behavior Program Moffitt Cancer Center TampaUSA

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