ACCESS TO WORK LEAVE AND IN VITRO FERTILIZATION (IVF) OUTCOMES

Abstract

BackgroundAssisted Reproductive Technology (ART) including IVF is the most expensive method of infertility treatment, at a median cost of $19,000/cycle (1). It is also the most time intensive, resulting in an average of 8.74 days taken off work per cycle (2). In 2009, only an estimated 24% of ART need was being met in the U.S. ART is responsible for 1.5% of total live births in the U.S., compared to 3% in Europe despite no difference in incidence (1). The financial burden of care has been researched extensively, and state mandated insurance coverage improves access and outcomes associated with IVF. States with mandated coverage have fewer embryos transferred and fewer multiple births per cycle (3). There is less research examining the amount of time off work that is required during treatment. Existing literature suggests that increased time off from work is associated with increased stress and early termination of care (4,5). However, to our knowledge, there is no research examining access to employment leave during IVF and how this influences outcomes.ObjectiveTo examine the current state of access to employment leave during IVF cycles, evaluate the relationship between access to employment leave during IVF treatment and IVF outcomes as measured by number of embryos transferred, live birth rate, and multiple pregnancy rate in an academic infertility clinic located in a state with no insurance mandate.Materials and MethodsWomen who underwent IVF with a fresh embryo transfer from 2016-2018 were asked to complete an email survey with questions about their access to work leave, type of work leave, ease of requesting leave, and impact of taking leave on their work. IVF outcomes were collected from the clinic’s SART data set and demographics were collected from both the SART data and clinic records.ResultsOf the 409 cycles identified during the study period, 335 had email addresses and were contacted. 69 responses were received (20.5% response rate). 46 patients reported having access to leave during IVF, 17 patients reported not having access, and 6 patients did not require leave (unemployed or self-employed). Patients without leave transferred 1.4 embryos per cycle, had a live birth rate of 52.9%, and 17.6% of cycles resulted in multiple pregnancies. In patients with leave, 1.6 embryos were transferred per cycle, the live birth rate was 50%, and the rate of multiple pregnancies was 13%. There are no statistically significant differences between the groups for any of the outcomes. There is a significant difference (0.0342) in the percentage of patients that believe time off for IVF affected their work, 65% of patients in the group without access to leave felt time off affected their work compared to 35% of the group with leave.ConclusionsThe present study found no difference in IVF outcomes based on patient access to work leave during treatment, however it suggests that limited access to leave could be a barrier, preventing people from receiving appropriate fertility treatment. Research investigating the barriers that limit access to care serves as an important tool to help address the socioeconomic discrepancies that exist with infertility treatment.