Insurance coverage and in vitro fertilization outcomes: a U.S. perspective

ObjectiveTo compare the impact of mandated IVF insurance coverage on ET practices and resulting multiple pregnancy rates.DesignRetrospective analysis of all fresh, nondonor IVF cycles performed in the United States in 2006.SettingUnited States.Patient(s)A total of 91,753 fresh, nondonor IVF cycles in the United States.Intervention(s)None.Main Outcome Measure(s)Pregnancy rate, live-birth rate, embryos transferred, multiple pregnancy rate.Result(s)Overall, nonmandated states had a significantly higher pregnancy rate (38.8% vs. 35%) and live-birth rate (32.2% vs. 29.1%) than mandated states. Nonmandated states also had a significantly higher twin rate (28.1% vs. 26%) and triplet rate (3.9% vs. 3.4%). The average number of embryos transferred was also significantly higher in nonmandated states (2.6 vs. 2.2). These findings were more pronounced in the <35 and 35–37 age groups.Conclusion(s)In the last 8 years, despite a reduction in the average number of embryos transferred and multiple pregnancy rates, there is a continued association between mandated IVF coverage, the transfer of fewer embryos, and lower rates of multiple pregnancies and births, particularly in the younger age groups.