The Effects of State-Level In Vitro Fertilization (IVF) Insurance Mandates on the Fertility of American Women

Abstract

ObjectiveCertain U.S. states have passed legislative mandates in the 1980’s and 1990’s requiring insurance companies to cover infertility treatments. Of these mandates, only several cover the actual costs of IVF. The objective of this study was to examine whether the IVF insurance mandates are associated with higher age-specific fertility rates (ASFRs) for American women over the period of 1975-2002.DesignRetrospective, population-based analysis.Materials and methodsWe accessed the U.S. National Centers for Disease ControlsPrevention website for Vital Statistics fertility data and U.S. Census Bureau website to access and analyze the ASFRs for all U.S. states from 1975-2002. The 3 analyzed groups included states which provide virtually complete coverage of IVF (IL, MA, RI), states which partially cover the costs of IVF for some or all of its citizens (AR, HI, MD, OH, WV), and states with no IVF mandate. Twenty six un-mandated states were randomly selected to serve as historical controls for the time trends of ASFR. A fixed effects model regression analysis was performed using Stata software to demonstrate the effect of a mandate versus no mandate on the time trend of ASFRs in each state.ResultsTabled 1ConclusionsThe fertility of younger American women has decreased over time while that of women older than 30 has increased. State-level IVF insurance mandates are associated with significantly increased fertility in women in their 30’s but decreases in the fertility of women in their late twenties. Further study is required to evaluate the population impact of policies regarding insurance coverage for infertility treatment on the child-bearing of older women and the fertility intentions of younger age-groups. ObjectiveCertain U.S. states have passed legislative mandates in the 1980’s and 1990’s requiring insurance companies to cover infertility treatments. Of these mandates, only several cover the actual costs of IVF. The objective of this study was to examine whether the IVF insurance mandates are associated with higher age-specific fertility rates (ASFRs) for American women over the period of 1975-2002. Certain U.S. states have passed legislative mandates in the 1980’s and 1990’s requiring insurance companies to cover infertility treatments. Of these mandates, only several cover the actual costs of IVF. The objective of this study was to examine whether the IVF insurance mandates are associated with higher age-specific fertility rates (ASFRs) for American women over the period of 1975-2002. DesignRetrospective, population-based analysis. Retrospective, population-based analysis. Materials and methodsWe accessed the U.S. National Centers for Disease ControlsPrevention website for Vital Statistics fertility data and U.S. Census Bureau website to access and analyze the ASFRs for all U.S. states from 1975-2002. The 3 analyzed groups included states which provide virtually complete coverage of IVF (IL, MA, RI), states which partially cover the costs of IVF for some or all of its citizens (AR, HI, MD, OH, WV), and states with no IVF mandate. Twenty six un-mandated states were randomly selected to serve as historical controls for the time trends of ASFR. A fixed effects model regression analysis was performed using Stata software to demonstrate the effect of a mandate versus no mandate on the time trend of ASFRs in each state. We accessed the U.S. National Centers for Disease ControlsPrevention website for Vital Statistics fertility data and U.S. Census Bureau website to access and analyze the ASFRs for all U.S. states from 1975-2002. The 3 analyzed groups included states which provide virtually complete coverage of IVF (IL, MA, RI), states which partially cover the costs of IVF for some or all of its citizens (AR, HI, MD, OH, WV), and states with no IVF mandate. Twenty six un-mandated states were randomly selected to serve as historical controls for the time trends of ASFR. A fixed effects model regression analysis was performed using Stata software to demonstrate the effect of a mandate versus no mandate on the time trend of ASFRs in each state. ResultsTabled 1 ConclusionsThe fertility of younger American women has decreased over time while that of women older than 30 has increased. State-level IVF insurance mandates are associated with significantly increased fertility in women in their 30’s but decreases in the fertility of women in their late twenties. Further study is required to evaluate the population impact of policies regarding insurance coverage for infertility treatment on the child-bearing of older women and the fertility intentions of younger age-groups. The fertility of younger American women has decreased over time while that of women older than 30 has increased. State-level IVF insurance mandates are associated with significantly increased fertility in women in their 30’s but decreases in the fertility of women in their late twenties. Further study is required to evaluate the population impact of policies regarding insurance coverage for infertility treatment on the child-bearing of older women and the fertility intentions of younger age-groups.