Lower pregnancy rates in U.S. states that mandate fertility treatments

Infertile women in states that require health insurers to cover the costs of in vitro fertilisation are less likely to become pregnant each time doctors attempt to make a test-tube baby, according to a study in the New England Journal of Medicine.

But women in those states also are less likely to give birth to more than one child at a time if they undergo the technique, researchers found.

The conclusions by the researchers from Brigham and Women's Hospital in Boston illustrate how insurance coverage influences how doctors practise medicine.

The differences apparently relate to the fact that doctors in states where coverage was mandatory tend to implant fewer embryos, reducing the likelihood of both pregnancy and multiple births.

The rate of vitro fertilisation was 2.8 times greater in states that mandated full insurance coverage of in vitro fertilisation than in those that did not mandate coverage.

The team found that while 31.8 percent of the embryo transfers produced a baby in states with no coverage, the success rate declined to 28.5 percent when the insurance coverage was complete.

Among the pregnancies, 11.2 percent produced at least three or more foetuses among women with no coverage, compared to 9.7 percent for women with full coverage.

Researchers noted that because patients must pay when insurance doesn't cover the costs of in vitro fertilisation, doctors may be "under pressure to obtain a 'successful' outcome the first time and therefore transfer more embryos" with each attempt, increasing the likelihood of multiple births.

Source: Alison McCook, Insurance Sways Outcome of in Vitro Fertilisation, Reuters Health, August 28, 2002; and Tarun Jain, Bernard L. Harlow and Mark D. Hornstein, Insurance Coverage and Outcomes of in Vitro Fertilisation, New England Journal of Medicine, August 29, 2002.

For Reuters article
http://www.reuters.com/news_article.jhtml?type=search&StoryID=1383949
For NEJM text http://content.nejm.org/cgi/content/full/347/9/661

For more Analysis of Employer Mandates
http://www.ncpa.org/iss/hea

FMF Policy Bulletin\17 September 2002