Room for Dissent on IVF?

dissent

Should IVF Coverage Be Mandatory?

Writer Christina Gombar first posed this provocative question in 2009.  In a stand against RESOLVE’s stated goal to “control the conversation,” she agreed to let me repost her dissent perspective here.

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A couple of Decembers ago, I got an email from Resolve, the national infertility organization — a plea for end-of-year, tax-deductible donations.

“Imagine a world where fertility treatment didn’t exist …”  began the missive.

It had been years since I looked to Resolve for aid in my finally defunct effort to have a family. The organization then claimed to serve a dual purpose: to provide information and support to those pursuing children, and reconciliation to those who wind up without. But Resolve’s overwhelming number of communications and services, and its only lobbying activities – urging Congress to pass laws to make insurance coverage for fertility treatment mandatory — were geared toward the baby quest.

So I deleted their emails after a quick skim. But having planted the idea of a world where fertility treatments didn’t exist, I couldn’t resist an honest answer: “I honestly wish they didn’t!”

This spurred an instant response, offering a plea for my “healing” – as if only a wrong-thinking person could even question the fertility system.

I hit the reply key, and then typed in: “The fertility industry makes those of us for whom the system didn’t work even more of an anomaly than we already are.”

Within minutes, a Resolve staffer called. She stressed that Resolve was there to listen to people like me.

“Good. All I’m saying is — if infertility is defined as an illness, then that makes those of us without children sick and abnormal, right? I can’t reconcile to my situation if society can’t reconcile itself to me. Plus – I have a real illness – having infertility over the age of 35 isn’t an illness, it’s biology.”

The staffer was dumbfounded.

I continued, “I’ve worked hard for the little financial security I have, so I’m really cheap and risk-averse. I knew most IVFs in my age group failed. If it were a stock, I wouldn’t have bought it. But because it was someone else’s financial risk – I gave it a shot. But I’d never have gambled on it with my own money. I’d never have got sucked into the emotional maelstrom. And if no fertility treatments existed at all, I’d have much more easily accepted my childless state. And so would the rest of the world.”

A lengthy conversation ensued. I insisted on a precise definition of infertility.

I explained that at 28 it’s an illness that should be cured, when possible, and paid for by medical insurance. At 48, IVF is an artificial prolonging of the motherhood timeline. Was it fair to make other policyholders in the insurance risk pool subsidize that?

The Resolve staffer was shocked.

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Seems the once-taboo arguments Christina raised in 2009 are coming out in the open. In Australia, lawmakers are considering whether to reduce coverage. At present the Australian government spends approximately A$240 million a year on fertility treatments. Even the American Medical Association Journal of Ethics in 2014 came down against a health insurance mandate for IVF after considering all the arguments made by advocates.

For a variety of troubling reasons we believe they have failed to prove that insurance coverage should be mandated to address this issue. Analysis of access to and utilization of ART in states with insurance mandates reveals major social and ethnic disparities, and, while mandating coverage in select states did make ART more broadly available to those with health insurance, it did not make the distribution of ART more equitable.

The journal authors concluded, “arguments about cost effectiveness remain unconvincing, given the complexities of both the technology and the outcomes being measured (pregnancy as distinct from live birth and a baby who makes it home from the hospital).”

In other words, the high failure rate of IVF is still too much of a gamble — and the house always wins. A press release out this week makes clear the for-profit fertility industry is doing just fine. It’s projected to reach $27B by 2022.

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Update: Happy to report that our blog post here led to further discussion.
The #fertility industry's lobbying efforts to increase #health insurance coverage demands more… Click To Tweet
You can read further about why this topic needs greater debate and scrutiny here on Greg’s post: Infertility Insurance Coverage. Here’s our Twitter exchange. Welcome comments below or on Twitter or on our Facebook page.
IVF Scrutiny

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5 thoughts on “Room for Dissent on IVF?

  1. I could say exactly the same: I honestly wish that IVF didn’t exist!

    In my country, 6 IVFs are paid by the state insurance. The condition is that the woman is under 41.

    But as I have said before, I wish that not that many IVFs would be free of charge. Then I wouldn’t have that many unsuccessful IVFs. I hate to think about the damage I did to my body.

  2. I struggle with this question. I think that with as abused as fertility treatments have become that the world would be better off without them. It seems that people of my grandparent’s generation without children were much less ostracized by society, almost like not having children was one point on the continuum of families, whereas couples of my generation are looked down upon (especially if we didn’t try every possible treatment).

    I do feel that a thorough infertility diagnostic panel for all couples who have been trying to get pregnant for over a year should be universally covered. I feel like answers are empowering and help couples to make informed decisions regarding treatment. I can’t even tell you how many people I know who either had to pay out of pocket for diagnostic tests or couldn’t get them because of cost. We were lucky that our insurance covered testing (minus the deductible and the 10% that we were responsible for), but we were still on the hook for over $2000.

    I also think that there needs to be a greater emphasis on mental healthcare during infertility, treatment or not.

  3. I’ve thought about writing an unpopular piece about this topic. The reason I don’t think infertility should be covered by insurance is that it doesn’t address the issue of why treating infertility is so expensive. Even for those people where IVF works it is still expensive that the couple takes on.

    Work on controlling the cost of diagnosing and treating infertility. Once that is accomplished then worry about how its covered.

    1. Pamela Tsigdinos

      Encourage you to write that piece, Greg. There is so much wrong with the way reproductive medicine is packaged and dispensed. It’s curiously been one of the few areas of medicine that’s had a free pass — enabling practitioners, drug companies and service providers to do whatever they please and, Cha-Ching!, cash in every step of the way.

  4. I am very late to this, but so glad that you published it, and that Christina wrote it. I enjoyed her comments – particularly that infertility over the age of 35 is biology, not illness, and the implications of that.

    An unregulated industry allows such a situation where medical ethics haven’t caught up with the new reproductive technologies, and where capitalism and market forces are running riot.

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