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Why is IVF still uninsured 40 years later?



But believing that IVF is like outsourcing is like believing that one of these supposedly simple, do-it-yourself home renovation really will only take a few hours. Materials must be carefully procured, created and combined, and the slightest mistake can send you back to the beginning of the process.

There are regular early morning visits to the doctor's office, where blood is drawn and vaginal ultrasounds are performed – often by complete strangers. There are huge boxes of syringes, needles, powders and diluents that are sent directly to your home. And you – who have never shot anyone in the mouth before – should mix and measure these important and expensive medications on a regular basis. There are numerous tests, procedures and eagerly awaited phone calls in the early evening that provide the results.

All this provides a terrible experience, and even the highest probability of success is not enough to combat the vulnerability one feels when being pumped full of hormones and longing to receive.

A move to expand insurance coverage for infertility treatment in the United States has increased in recent years as a growing number of physicians and patients become frustrated with the high cost of ownership and the way they impede treatment. But to be successful, they must undo decades of misunderstandings and malformations of infertility.

After 8 million births, IVF is not "experimental"

Forty years ago, Louise Joy Brown of Oldham in the United Kingdom became the first child to be born as a result of IVF. This means that doctors surgically remove an egg from their mother and combine it with sperm from her father in a petri dish.

For the next decade or so ̵

1; while little Louise grew up healthy – the process was considered experimental for obvious reasons. Insurance companies in the United States, who generally remain aloof from experimental medicine, kept away from the enormous scientific breakthrough. Richard M. Paulson, immediate president of the American Society for Reproductive Medicine.

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Paulson stated that some insurance companies still see it that way, although 8 million babies were identified as a result of IVF born around the world and they are just as healthy as the general population.
Another thing that insurance companies have historically eluded: the bodies of women. As infertility was long considered a health issue for women, insurance companies considered it a niche issue and denied coverage to those affected. This is despite the fact that almost half of all cases are due to "male factor infertility".

Even 30 years ago, "most insurance companies did not even cover obstetrics [childbirth] .It was all out of my own pocket". Paulson said:

While insurance companies have slowly expanded their coverage of other aspects of reproductive health, IVF coverage remains rare. Meanwhile, about 12% of American women have difficulty getting pregnant or having a pregnancy, making infertility a condition that is about as common as diabetes.

IVF is not a lifestyle choice for rich, working women

Another common misconception is that IVF is a disease of a rich man, the inevitable fate of a successful workaholics, a family until then was taken too late. Your choice of lifestyle should not be someone's responsibility, but their own, the way of thinking, and they probably can afford it anyway.

However, as Ann V. Bell points out in her book Misconception, studies have found that women of lower socioeconomic status find it harder to conceive children than their wealthy counterparts. Yes, we do not hear that they are going through IVF – but that's probably because they just can not afford it.
A report from the American Society for Reproductive Medicine from 2015 found that low-income African-American and Hispanic patients are underrepresented in the infertility patient population. When they get access to treatment, they "experience lower success rates compared to non-Hispanic white women."
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"There are still many people who think that we are doing IVF because we want to do IVF, that we choose IVF, but no, the little girl dreams of having babies about IVF," Barbara Collura said , President and CEO of Resolve: the National Infertility Association.

The whole idea of ​​IVF, which is expensive, has more to do with the assumption that it is up to the wealthy women, as with the actual price tag. I just spent $ 5,000 on a dental implant – it's a single tooth. The total cost of my infertility treatment was about $ 20,000 and included three surgical procedures, a lot of expensive medication, genetic testing, and monthly routine checks. I have a son out of that.

If we stop thinking about IVF as a lifestyle option and start to consider it a cure for a disease that affects women from all socio-economic backgrounds, IVF does not seem to be particularly expensive

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Thorny concerns lie beneath these layers of sexism, business and ignorance. Is a baby a privilege or a right? Is "necessary" health care only to prevent physical suffering or death? Or is it about the "right to health" and the ability to correct the malfunction of a single body?

There are many conditions that fall under this concept of the right to health, for which insurance covers the treatment and we generally agree that they deserve treatment. Runners get a knee operation so they can keep walking; Breast cancer patients receive reconstructive breast surgery so they can feel like themselves again; Children with hearing problems will receive surgery to improve their hearing.

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Yes, people could get along without these interventions, so how infertile people get along without children. But should they have to? Infertility can lead to severe depression and anxiety, and the fallout can last a lifetime.

"I think about procreation as a basic human right," Dr. Kara N. Goldman, assistant professor of reproductive endocrinology and infertility at New York University, who advocates comprehensive infertility in New York. "Patients should be able to have families, and we need medical care to make that happen."

Where the battle for cover

Luckily, the American health system is beginning to prevail. In 2017, the American Medical Association declared infertility to be a disease. In the summary of the decision, the association expressed the hope that the new term "would promote insurance coverage and pay" and remove the stigma.

This shift was partly due to the lobbying of the American Society for Reproductive Medicine. In recent years, the Company has made strategic efforts to ensure that more Americans have access to reproductive medicine.

"We all feel that way and have realized that it is time to support our efforts," said Paulson, the company's past president. He explained that he and his fellow infertility physicians have become increasingly sensitive to the fact that a large proportion of the American population simply can not afford the treatment of infertility.

There is also a growing concern that patients are making suboptimal decisions about treatment due to financial constraints. They choose to transfer multiple embryos to the uterus at the same time instead of the single embryo transfer now recommended to avoid paying more procedures. This leads to a higher risk of complications for mother and child – and higher costs for the long-term health care of insurance companies.

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Proponents of Resolve and the American Society for Reproductive Medicine hope that the appointment of the American Medical Association will help them persuade states to legislate Demand infertility coverage. Nine states require some infertility, some of which offer multiple IVF rounds, while others offer only less expensive and less effective treatments.

The last state to pass a law was in Delaware, where infertility patient Christie Gross, with the help of Resolve, led the support for one of the most comprehensive bills. This includes the coverage of infertility treatments, including IVF, as well as the preservation of fertility in cancer patients. The cancer treatment may leave a barren condition, so this bill would allow the patient to store eggs, sperm or embryos beforehand.

"This must be an effort that comes from the grassroots, it has to come from patients". Said Gross. "It is extremely revealing" to talk about infertility in public, but change will only happen if more people are "ready to face the problem". Gross himself underwent infertility treatment while advocating for this law.

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However, even if all 50 states passed similar laws, not everyone would be guaranteed infertility guaranteed. Because state laws can only provide jobs with certain types of insurance – so-called fully insured health insurance – to cover the costs. Only a federal mandate can require that everyone, no matter what kind of insurance they have, receives infertility coverage. Such universal coverage is the norm in Europe.
In addition to these legislative struggles, there are a growing number of individuals fighting for and gaining infertility protection at their workplaces. Employees are increasingly taking it upon themselves to explain to their employers how such reporting would bolster morale, with little impact on the bottom line.

These conversations are not always easy. For one thing, those who believe that life begins at conception are not always satisfied with the procedure because it tends to produce embryos that remain unused. Few anti-abortion politicians want to be the ones who oppose a family-building tool like IVF, but they do not want to support it directly.

Many women diagnosed as infertile are still ashamed or ashamed to share the news with family and friends. They respond to a stigma rooted in one of the book's earliest patriarchal tropes: the value of a woman lies in the fertility of her lap. This has changed in recent years as more and more women go online and share their experiences. Still, we still need to focus when a critical mass of women realize that silence is ultimately more harmful than disclosure.

I am one of the lucky ones. I had IVF insurance and it led to the birth of my second child. Sometimes, when I look at him, I am reminded of this incredible fortune and the many people out there who can not afford to make a bright-eyed, chubby toddler. This is a blatant injustice, the remedy of which is at first sight.


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