IMPACT OF STATE IVF INSURANCE MANDATES ON EMBRYO TRANSFER PRACTICES IN THE UNITED STATES

Abstract

To characterize the impact of state IVF insurance mandates on embryo transfer practices in terms of mean number of embryos per transfer and utilization of fresh versus frozen embryo transfers. Data from the 2018 CDC ART Fertility Clinic Success Rates Report and the National ART Surveillance System (NASS) were used to calculate the number of embryos transferred per procedure and number of fresh and frozen embryo transfers. Data were stratified into two groups, “Comprehensive” and “Non-comprehensive,” based on the degree of IVF coverage mandated by state laws. Two-sample t-test and chi-square test were used to compare mean number of embryos transferred per procedure and frozen transfers as a share of all transfers, respectively, according to mandate status. In 2018, 456 clinics reported data to the CDC. Comprehensive IVF mandates were identified in 6 states. Mean number of embryos per transfer was significantly lower in states with comprehensive IVF mandates compared to states without these mandates among all transfer types. On age-group sub-analysis, this difference remained significant among transfers performed in younger age groups. Significantly more embryos were transferred in fresh than frozen embryo transfers. Significantly fewer frozen transfers as a share of all embryo transfers were performed in states with comprehensive IVF mandates.Tabled 1State Mandate to Cover IVFEmbryos per Transfer, AllOverallAge <35Ages 35-37Ages 38-40Ages 41-42Age >42Comprehensive1.301.181.241.401.681.88Non-comprehensive1.361.291.311.421.591.84P-value<0.001<0.001<0.0010.02<0.0010.3Embryos per Transfer, FreshComprehensive1.551.251.411.702.252.50Non-comprehensive1.671.421.601.892.182.30P-value<0.001<0.001<0.001<0.0010.090.04Embryos per Transfer, FrozenComprehensive1.181.151.161.191.311.44Non-comprehensive1.271.251.231.271.331.57P-value<0.001<0.001<0.001<0.0010.3<0.001% Frozen Transfers PerformedComprehensive66%67%69%67%59%54%Non-comprehensive76%76%79%77%71%66%P-value<0.001<0.001<0.001<0.001<0.001<0.001 Open table in a new tab Comprehensive IVF insurance mandates were associated with a significantly lower mean number of embryos transferred per procedure. More embryos were transferred in fresh compared to frozen embryo transfers. Frozen embryo transfers accounted for smaller share of embryo transfers in states with comprehensive IVF mandates.