JOGNN
AW H O N N P O S I T I O N S T A T E M E N T
Infertility Treatment as a Covered Health Insurance Benefit
An official position statement of the Association of Women’s Health, Obstetric and Neonatal Nurses
Approved by the AWHONN Board of Directors, November 2000. Revised and reapproved December 2013.
AWHONN 2000 L St. N.W., Suite 740 Washington, DC 20036 (800) 673-8499
Position he Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) supports the inclusion of all non-experimental infertility treatments as a covered health insurance benefit in public and private plans. Infertility is a disease of the reproductive system, and treatment should not be considered an elective therapy or procedure. Women who require gonadotoxic therapies to treat medical conditions such as cancer should be offered the option to cryopreserve embryos through in vitro fertilization or eggs through ovulation induction and egg retrieval.
T
Background In the United States, infertility affects 6.8 million women and their partners with men and women being equally affected (American Society of Reproductive Medicine [ASRM], 2013). The most common reason for male infertility is the production of none, too few, or damaged sperm cells, whereas the most common reason for female infertility is an ovulation disorder (Centers for Disease Control and Prevention [CDC], 2013). There is a perception that all infertility treatments are exceedingly costly. In actuality, as therapeutic options have increased and technology has improved, treatment costs have decreased. Approximately 12% of women of reproductive age in the United States have received some level of infertility services (Chandra, Martinez, Mosher, Abma, & Jones, 2005), and of these women the majority required only basic medical advice or diagnostic tests. Only 3% of women seeking treatment for infertility required more sophisticated treatment such as in vitro fertilization (IVF) (American Society for Reproductive Medicine [ASRM], 2013). In vitro fertilization can cost more than $10,000 for one full cycle (Chambers, Sullivan, Ishihara, Chapman, & Adamson, 2009). Health insurance coverage for infertility treatments, especially IVF, is limited. Fifteen states
264
have passed laws requiring that insurance policies cover some level of infertility treatment: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia (RESOLVE: The National Infertility Association, 2013). However, these laws vary greatly regarding the scope of coverage mandated. The variation in insurance coverage exists despite the fact that the cost to include assisted reproductive technologies as part of a standard healthcare benefits package is estimated at $3.14 per employee per year (Sonfield, 1999). In states with mandated infertility insurance coverage, the rate of utilization for infertility treatments is substantially higher than the U.S. average. Further, the rate of multiple births is lower in states with coverage. It is theorized that when people with comprehensive insurance coverage are free to make decisions based on medical necessity rather than financial considerations, there are fewer multiple births and costly complications (Jain, Harlow, & Hornstein, 2002). One related example is the use of single embryo transfer, which has significantly reduced the cost of health care, specifically the costs associated with multiple gestations (Stillman, Richter, Banks, & Graham, 2009).
Fertility Preservation Advances in cancer therapies and high survival rates associated with these treatments have resulted in the need for women to have the option to preserve fertility through embryo or oocyte preservation. In response to the advancement in these technologies, ASRM and the Society for Assisted Reproductive Technology (SART) maintain that oocyte cryopreservation should not be considered experimental (2013). Further, ASRM, SART and the American Medical Association (AMA) maintain that fertility preservation should be offered in certain instances (AMA, 2013). These circumstances include fertility preservation for women receiving gonadotoxic therapies for cancer or other
C 2014 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
http://jognn.awhonn.org
AW H O N N P O S I T I O N S T A T E M E N T
medical diseases and certain genetic disorders such as BRCA mutations (Practice Committees of American Society for Reproductive Medicine & Society for Assisted Reproductive Technology, 2013).
Centers for Disease Control and Prevention. (2013). Infertility FAQs. Retrieved from http://www.cdc.gov/reproductivehealth/infertility Chambers, G., Sullivan, E., Ishihara, O., Chapman, M., & Adamson, G. (2009). The economic impacts of assisted reproductive technology: A review of selected developed countries. Fertility and Sterility, 91(6), 2281–2294. Chandra, A., Martinez, G.M., Mosher, W.D., Abma, J.C., & Jones, J.
The Role of the Nurse Nurses play integral roles in education, coordination of care, and research in settings where women and men experiencing infertility seek care. Nurses can provide emotional support and advocacy for families undergoing fertility challenges. Nurses who plan or provide care to women in primary care, oncology, and reproductive health settings should stay current on issues related to infertility and fertility preservation.
Fertility, family planning, and reproductive health of U.S. women: Data from the 2002 National Survey of Family Growth. Vital and Health Statistics, 23(25), 1–174. Jain, T., Harlow, B., & Hornstein, M. (2002) Insurance coverage and outcomes of in vitro fertilization. New England Journal of Medicine, 347(9), 661–666. Practice Committees of American Society for Reproductive Medicine & Society for Assisted Reproductive Technology. (2013). Mature oocyte cryopreservation: a guideline. Fertility and Sterility, 99(1), 37–43. doi: 10.1016/j.fertnstert.2012.09.028. Epub 2012 Oct 22. RESOLVE:
The
surance
National coverage
Infertility in
Association.
your
state.
(2013).
Retrieved
Infrom
http://www.resolve.org/family-building-options/insurance_ coverage/state-coverage.html
References American Society of Reproductive Medicine. (2013). Quick facts about infertility. Retrieved from http://www.asrm.org/detail. aspx?id=2322
Sonfield, tility
A.
(1999).
treatment
Drive raises
for
insurance
questions
of
coverage equity,
of
infer-
cost.
The
Guttmacher Report on Public Policy, 2(5). Retrieved from http://www.guttmacher.org/pubs/tgr/02/5/gr020504.html
American Medical Association. (2013). AMA adopts new poli-
Stillman, R., Richter, K., Banks, N., & Graham, J. (2009). Elective single
cies on first day of voting at annual meeting. Retrieved
embryo transfer: A 6-year progressive implementation of 784
from http://www.ama-assn.org/ama/pub/news/news/2013/2013-
single blastocyst transfers and the influence of payment method
06-17-new-ama-policies-annual-meeting.page
on patient choice. Fertility and Sterility, 92(6), 1895–1906.
JOGNN 2014; Vol. 43, Issue 2
265
AW H O N N P O S I T I O N S T A T E M E N T
Infertility Treatment as a Covered Health Insurance Benefit
An official position statement of the Association of Women’s Health, Obstetric and Neonatal Nurses
Approved by the AWHONN Board of Directors, November 2000. Revised and reapproved December 2013.
AWHONN 2000 L St. N.W., Suite 740 Washington, DC 20036 (800) 673-8499
Position he Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) supports the inclusion of all non-experimental infertility treatments as a covered health insurance benefit in public and private plans. Infertility is a disease of the reproductive system, and treatment should not be considered an elective therapy or procedure. Women who require gonadotoxic therapies to treat medical conditions such as cancer should be offered the option to cryopreserve embryos through in vitro fertilization or eggs through ovulation induction and egg retrieval.
T
Background In the United States, infertility affects 6.8 million women and their partners with men and women being equally affected (American Society of Reproductive Medicine [ASRM], 2013). The most common reason for male infertility is the production of none, too few, or damaged sperm cells, whereas the most common reason for female infertility is an ovulation disorder (Centers for Disease Control and Prevention [CDC], 2013). There is a perception that all infertility treatments are exceedingly costly. In actuality, as therapeutic options have increased and technology has improved, treatment costs have decreased. Approximately 12% of women of reproductive age in the United States have received some level of infertility services (Chandra, Martinez, Mosher, Abma, & Jones, 2005), and of these women the majority required only basic medical advice or diagnostic tests. Only 3% of women seeking treatment for infertility required more sophisticated treatment such as in vitro fertilization (IVF) (American Society for Reproductive Medicine [ASRM], 2013). In vitro fertilization can cost more than $10,000 for one full cycle (Chambers, Sullivan, Ishihara, Chapman, & Adamson, 2009). Health insurance coverage for infertility treatments, especially IVF, is limited. Fifteen states
264
have passed laws requiring that insurance policies cover some level of infertility treatment: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia (RESOLVE: The National Infertility Association, 2013). However, these laws vary greatly regarding the scope of coverage mandated. The variation in insurance coverage exists despite the fact that the cost to include assisted reproductive technologies as part of a standard healthcare benefits package is estimated at $3.14 per employee per year (Sonfield, 1999). In states with mandated infertility insurance coverage, the rate of utilization for infertility treatments is substantially higher than the U.S. average. Further, the rate of multiple births is lower in states with coverage. It is theorized that when people with comprehensive insurance coverage are free to make decisions based on medical necessity rather than financial considerations, there are fewer multiple births and costly complications (Jain, Harlow, & Hornstein, 2002). One related example is the use of single embryo transfer, which has significantly reduced the cost of health care, specifically the costs associated with multiple gestations (Stillman, Richter, Banks, & Graham, 2009).
Fertility Preservation Advances in cancer therapies and high survival rates associated with these treatments have resulted in the need for women to have the option to preserve fertility through embryo or oocyte preservation. In response to the advancement in these technologies, ASRM and the Society for Assisted Reproductive Technology (SART) maintain that oocyte cryopreservation should not be considered experimental (2013). Further, ASRM, SART and the American Medical Association (AMA) maintain that fertility preservation should be offered in certain instances (AMA, 2013). These circumstances include fertility preservation for women receiving gonadotoxic therapies for cancer or other
C 2014 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
http://jognn.awhonn.org
AW H O N N P O S I T I O N S T A T E M E N T
medical diseases and certain genetic disorders such as BRCA mutations (Practice Committees of American Society for Reproductive Medicine & Society for Assisted Reproductive Technology, 2013).
Centers for Disease Control and Prevention. (2013). Infertility FAQs. Retrieved from http://www.cdc.gov/reproductivehealth/infertility Chambers, G., Sullivan, E., Ishihara, O., Chapman, M., & Adamson, G. (2009). The economic impacts of assisted reproductive technology: A review of selected developed countries. Fertility and Sterility, 91(6), 2281–2294. Chandra, A., Martinez, G.M., Mosher, W.D., Abma, J.C., & Jones, J.
The Role of the Nurse Nurses play integral roles in education, coordination of care, and research in settings where women and men experiencing infertility seek care. Nurses can provide emotional support and advocacy for families undergoing fertility challenges. Nurses who plan or provide care to women in primary care, oncology, and reproductive health settings should stay current on issues related to infertility and fertility preservation.
Fertility, family planning, and reproductive health of U.S. women: Data from the 2002 National Survey of Family Growth. Vital and Health Statistics, 23(25), 1–174. Jain, T., Harlow, B., & Hornstein, M. (2002) Insurance coverage and outcomes of in vitro fertilization. New England Journal of Medicine, 347(9), 661–666. Practice Committees of American Society for Reproductive Medicine & Society for Assisted Reproductive Technology. (2013). Mature oocyte cryopreservation: a guideline. Fertility and Sterility, 99(1), 37–43. doi: 10.1016/j.fertnstert.2012.09.028. Epub 2012 Oct 22. RESOLVE:
The
surance
National coverage
Infertility in
Association.
your
state.
(2013).
Retrieved
Infrom
http://www.resolve.org/family-building-options/insurance_ coverage/state-coverage.html
References American Society of Reproductive Medicine. (2013). Quick facts about infertility. Retrieved from http://www.asrm.org/detail. aspx?id=2322
Sonfield, tility
A.
(1999).
treatment
Drive raises
for
insurance
questions
of
coverage equity,
of
infer-
cost.
The
Guttmacher Report on Public Policy, 2(5). Retrieved from http://www.guttmacher.org/pubs/tgr/02/5/gr020504.html
American Medical Association. (2013). AMA adopts new poli-
Stillman, R., Richter, K., Banks, N., & Graham, J. (2009). Elective single
cies on first day of voting at annual meeting. Retrieved
embryo transfer: A 6-year progressive implementation of 784
from http://www.ama-assn.org/ama/pub/news/news/2013/2013-
single blastocyst transfers and the influence of payment method
06-17-new-ama-policies-annual-meeting.page
on patient choice. Fertility and Sterility, 92(6), 1895–1906.
JOGNN 2014; Vol. 43, Issue 2
265
