The Illinois infertility insurance coverage mandate, when it was passed in 1991, was meant to help build families in the face of rising infertility and costs for fertility treatments. The mandate requires group health insurance plans that cover more than 25 employees to cover diagnosis and treatment of infertility up to and including four In vitro fertilization (IVF) attempts. It has been hugely helpful for many people struggling to get pregnant. But it has also had unintended consequences.
While the Patient Protection and Affordable Care Act (ACA) allowed for Illinois to offer acupuncture coverage under some health insurance plans, acupuncture is still not covered widely.
When a couple is faced with the decision of how to approach their fertility journey, it’s hard not to factor in the coverage of 4 IVF treatments. It almost becomes a baseline approach. It’s almost as if doctors say, “Well, since we have these 4 treatments covered, let’s start there – what do we have to lose?”
It turns out patients can lose time, money and emotional and physical well-being from multiple IVF treatments in short succession. In Illinois, reproductive endocrinologists are often doing what’s called “batch cycles”, which involves a few fresh, consecutive stimulation cycles and genetic screening of the embryos (which is an uncovered expense) so that they can then ideally transfer a genetically viable embryo. It has become fairly commonplace since the IVF mandate, but there is reason to question if IVF if over-used.
An article in Medical News Today describes how Dr. Esme I. Kamphuis of the Centre for Reproductive Medicine at the University of Amsterdam in the Netherland asked that very question. He and his team performed an analysis of IVF and points out that between 2000 and 2010, the number of annual IVF cycles in the US increased from 90,000 to 150,000. However, the proportion of IVF cycles for fallopian tubal problems (the reason IVF was developed in the first place) reduced from 25% to 16% during this period. Unexplained fertility accounts for around 25-30% of couples undergoing IVF treatment, and when not treated with IVF straight away, most of these couples are able to conceive naturally before treatment. Dr. Esme says:
In a cohort of 500 Dutch subfertile couples with on average almost 2 years of unexplained subfertility, 60% conceived naturally after the initial assessment in the fertility clinic. Other observational studies have confirmed natural conceptions in couples with subfertility for 2-3 years.
To be clear, we at Collaborative Care are not opposed to IVF, and we definitely work with many patients who are concurrently undergoing IVF, or planning for a cycle in the future. We just want a couple’s fertility journey to be based on the best available treatment, not based on what’s covered by insurance or the default solution. Sometimes IVF is the better approach, and sometimes Chinese medicine is the better approach–and often the quickest one too.
At Collaborative Care, we want to do what’s best for patients in achieving their fertility goals. We have developed a unique Qualified Program that will help qualifying patients keep costs to a fixed amount. Contact us if you’d like to learn more.