Abstract
BackgroundAssisted reproductive technology (ART) insurance mandates resulted in improved access to infertility treatments like intracytoplasmic sperm injection (ICSI). Our objective was to examine whether ART insurance mandates demonstrate an increased association with ICSI use.MethodsIn this retrospective cohort study, clinic-specific data for 2000–2016 from the Centers for Disease Control (CDC) were grouped by state and subgrouped by the presence and extent of ART state insurance mandates. Mandated (n = 8) and non-mandated (n = 22) states were compared for ICSI use and male factor (MF) infertility in fresh non-donor ART cycles with a transfer in women < 35 years. Clinical pregnancy (CPR), live birth (LBR) rates, preimplantation genetic testing (PGT), elective single-embryo transfer (eSET) and twin birth rates per clinic were evaluated utilizing Welch’s t-test. Pearson correlation was used to measure the strength of association between MF and ICSI; ICSI and CPR, and ICSI and LBR over time. Results were considered statistically significant at a p-value of < 0.05, with Bonferroni correction used for multiple comparisons.ResultsFrom 2000 to 2016, ICSI use per clinic increased in both mandated and non-mandated states. ICSI use per clinic in non-mandated states was significantly greater from 2011 to 2016 (p < 0.05, all years) than in mandated states. Clinics in mandated states had less MF (30.5 ± 15% vs 36.7 ± 15%; p < 0.001), lower CPR (39.8 ± 4% vs 43.4 ± 4%; p = 0.02) and lower LBR (33.9 ± 3.5% vs 37.9 ± 3.5%; p < 0.05). PGT rates were not significantly different. ICSI use in non-mandated states correlated with MF rates (r = 0.524, p = 0.03). A significant correlation between ICSI and CPR (r = 0.8, p < 0.001) and LBR (r = 0.7, p < 0.001) was noted in mandated states only. eSET rates were greater and twin rates were lower in mandated compared with non-mandated states.ConclusionsThere was greater use of ICSI per clinic in non-mandated states, which correlated with an increased frequency of MF. In mandated states, lower ICSI rates per clinic were accompanied by a positive correlation with CPR and LBR, as well as a trend for greater eSET rates and lower twin rates, suggesting that state mandates for ART coverage may encourage more selective utilization of laboratory resources.
Highlights
Assisted reproductive technology (ART) insurance mandates resulted in improved access to infertility treatments like intracytoplasmic sperm injection (ICSI)
From 2000 to 2016, absolute rates of ICSI use per clinic increased by 20% in both ART-mandated (42.5 ± 20 to 62.5 ± 19%) and non-mandated states (46.9 ± 20 to 67.6 ± 19%)
The percentage of ICSI use among clinics in non-mandated states has been greater from 2011 to 2016 (p < 0.05) compared with mandated states. (Fig. 1) Male factor diagnoses rate per clinic (Additional file 1) remained at consistent rates in both groups but was greater in non-mandated states (30.5 ± 15% for mandated and 36.7 ± 15% in nonmandated states in 2016) (p < 0.001)
Summary
Assisted reproductive technology (ART) insurance mandates resulted in improved access to infertility treatments like intracytoplasmic sperm injection (ICSI). State insurance mandates for Assisted Reproductive Technologies (ART, including IVF, or in vitro fertilization) result in increased access to infertility treatment and may influence clinical practice [1]. According to the American Society for Reproductive Medicine (ASRM), intracytoplasmic sperm injection (ICSI) is indicated for severe male factor (MF) infertility and for couples with prior failed fertilization with conventional insemination (using in vitro fertilization, or IVF). ICSI for diagnoses like unexplained infertility, low oocyte yield, and advanced maternal age has not demonstrated improved clinical outcomes but is still commonly used in clinical practice [13]. Previous studies evaluating state mandates [15] found an association with lower per-cycle use of ICSI for non-male factor indications, especially low oocyte yield and unexplained infertility. No previously published study has evaluated ICSI use for MF, using our subgroupings of ART state mandates
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.