Mandate Insurance Coverage for Infertility

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Mandate insurance coverage for infertility 
 
Currently infertility services for women are not covered by most insurance companies. While activists fight daily for protected access to abortion and for assisted coverage of birth control, the right to bear a child has not been supported or covered by insurance companies. If you are seeking medical assistance to conceive a child, the costs can easily exceed over $25,000.00. With the average US income for an American family being around $56,515.00, this makes seeking medical assistance an uphill battle.  
If infertility was covered by insurance companies, then this rate would be negotiated. Currently there is no maximum amount that a family can be charged for infertility treatment. Many women seek credit based loans which can be financially disastrous.
 
Current Statistics:
 
Women with an impaired ability to get pregnant or carry a baby to term): 7.5 million
Percent of women aged 15-44 with impaired fecundity: 12.3%
Number of married women aged 15-44 that are infertile (unable to get pregnant after at least 12 consecutive months of unprotected sex with husband): 1.0 million

Number of women aged 15-44 who have ever used infertility services: 6.9 million"
Medical Costs for Infertility Treatment
"Average cost of an IUI cycle: $865; Median Cost: $350
Average Cost of an IVF cycle using fresh embryos (not including medications): $8,158; Median Cost: $7,500
Average additional cost of ICSI procedure: $1,544; Median Cost: $1,500
Average additional cost of PGD procedure: $3,550; Median Cost: $3,200
(Note: Medications for IVF are $3,000 $5,000 per fresh cycle on average.)"
(These were obtained via the website Resolve, The National Infertility Association)
 Typical Experiences for Women Facing Infertility Issues:
Women pay $250-$500 to sit with an Infertility specialist, usually a Reproductive endocrinologist. Lab tests and ultrasounds usually follow which is another $200-$3000 fee.
IF, the woman can qualify for treatment, the medications are prescribed. Some of these medications cost upward of $200. These costs are per cycle. A woman’s' typical cycle is 28-35 days.
 
What Insurance Companies Need To Provide As Part Of Coverage
1) Lifetime maximum coverage of 4 cycles of ovulation induction.
2) Lifetime maximum coverage of 3 cycles of intrauterine insemination.
3) Lifetime maximum coverage of 3 cycles of IVF, with not more than 2 embryo implantations per cycle. Each fertilization or transfer is credited as one cycle towards the maximum.
4) Coverage for IVF and low tubal ovum transfer to individuals who have been unable to conceive or sustain a successful pregnancy through less expensive and medically viable infertility treatment or procedures for greater than 1 consecutive year, unless the individual’s physician determines that those treatments are likely to be unsuccessful.
5)Require infertility treatment or procedures to be performed at facilities that conform to the American Society of Reproductive Medicine and the Society of Reproductive Endocrinology and Infertility Guidelines.
 
Cites:
Centers for Disease Control and Prevention. (2015). Retrieved from http://www.cdc.gov/nchs/fastats/infertility.htm
Resolve. (2015). Retrieved from http://www.resolve.org/about-infertility/medical-conditions/
 Resolve. (2015). Retrieved from http://www.resolve.org/family-building-options/insurance_coverage/the-costs-of-infertility-treatment.html
 
Appendix: Different Causes Of Infertility:
Endometriosis
According to "Res age suffer from endometriosis.
Luteal Phase Defect
Abnormalities in endometrial development -- luteal phase defect (LPD) - are associated with infertility and early miscarriage. Luteal phase defect occurs when the endometrium is inadequately prepared, either because the secretion of progesterone by the ovary is below normal or because the endometrium isn't responding to the normal stimulation by progesterone.
Male Factor
30% of infertility is due a male problem such as structural abnormalities, sperm production disorders, ejaculatory disturbances and immunologic disorders.
 
Multiple Miscarriages
Miscarriage can leave you with deep- rooted feelings of loss and sorrow. These feelings must be confronted and dealt with, not suppressed, as is often urged by friends and family. It is important to take action and see an infertility specialist if you have experienced 2 or more miscarriages.
Ovulatory Disorders
Approximately 30% of female infertility problems are the result of ovulation disorders. There are many factors that can affect ovulation. In this section we will discuss mainly pituitary causes.
Polycystic Ovary Syndrome (PCOS)
PCOS is a very common hormone disorder in women, a leading cause of infertility, and one of the most under diagnosed diseases in the United States. PCOS is characterized by a myriad of seemingly unrelated symptoms and may include irregular or absent periods, lack of ovulation, weight gain, acne, excessive facial hair and infertility. Even more serious, women with PCOS may be at higher risk for developing cardiovascular disease, Type 2 Diabetes, and endometrial cancer, especially if PCOS is left untreated.
Poor Responder
The term poor responder has been used to define women who require large doses of stimulation medications and who make less than an optimal number of eggs. There is no uniform definition of poor responders, but many clinics have used a cutoff of less than four mature oocytes at the time of chg. or a peak estradiol of less than 500.
Premature Ovarian Failure
Premature ovarian failure is defined as the cessation of menstrual periods before the age of 40. It occurs in 1 in 1,000 women between the ages of 15 and 29 and 1 in 100 women between the ages of 30 and 39. The average age of onset is 27 years. Premature ovarian failure can be both shocking and devastating as there are relatively few treatment options.
 
Secondary Infertility
Although many Americans are affected by the painful experience of secondary infertility, it generally remains an unacknowledged and invisible condition. Secondary infertility is defined as the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children.
 
Unexplained Infertility
Approximately one in five couples will experience unexplained infertility despite completing a full infertility work-up. The emotional response to hearing, "There is no apparent reason for your infertility" can be difficult, maddening and frustrating. Fortunately, there are many options available for the couple diagnosed with unexplained infertility.
 
Uterine Factors
Abnormalities of the uterus can have a significant impact on the ability of a woman to conceive and to carry a pregnancy successfully. Some women have an abnormally developed uterus from birth (congenital) while others may develop a uterine problem due to infection or surgery (acquired).”
 
Cites:
Centers for Disease Control and Prevention. (2015). Retrieved from http://www.cdc.gov/nchs/fastats/infertility.htm
Resolve. (2015). Retrieved from http://www.resolve.org/about-infertility/medical-conditions/
 Resolve. (2015). Retrieved from http://www.resolve.org/family-building-options/insurance_coverage/the-costs-of-infertility-treatment.html
 
 
 
 
Sample costs for infertility treatments without insurance coverage:
Day 1-5 of menstruation
Initial fertility testing: TSH, it D, FSH, LH, Estrogen, AMH level and prolactin---- ~ $1200.00
Baseline Estrogen and ultrasound---- ~ $550-$600
Days 6-11
Clomid or Letrozole is prescribed to aide in ovulation. Each medication runs between $150-$600 depending on pharmacy
Uterus and Tubes are assessed. A hysterosalpingogram is prescribed to assess tubal patency which costs approximately $2000-$3000
Hysteroscopy-- ~$1500
A saline ultrasound may be prescribed to rule out uterine abnormalities this procedure starts at $900
Mid-Cycle day 21 Progesterone level is monitored to check for ovulation, this costs ~ $200
LH, Estrogen, Progesterone and mid cycle ultrasound are performed totaling $600-$1000
IUI can be performed if woman ovulated, this costs --- $1,500
If patient remains anovulatory but has a follicle that is above ~19 mm then HCG trigger shot is prescribed which costs an additional $200
Over the counter pregnancy tests range from $10-$30 and Ovulation predictor kits can cost an upward of $50
An in office pregnancy test is approximately $100
A semen analysis for the male is performed which costs approximately $150
A SDFA may be ordered which is an additional $250
******These costs are per 28 day cycle. They are repeated without discount or change every cycle.
 
IUI (Intrauterine insemination cycle)
Treatment  phase & Procedure
Approximate Cost
Baseline check: Ultrasound, office visit, venipuncture, Estradiol level
~ $550
Mid-Cycle check
F/U ultrasound, office visit, venipuncture, estradiol, progesterone and LH
~ $600
IUI
~ $300
Sperm prep for insemination
~ $250
Medications
~$200-$300
Additional labs
~$300
Beta HCG
~$100
 
IVF CYCLE
COST:
Average Cost of an IVF cycle using fresh embryos (not including medications): $12,400.00 [1]
Average additional cost of ICSI procedure: $1,544
(Note: Medications for IVF are $3,000 $5,000 per fresh cycle on average.)
 
[1] The American Society for Reproductive Medicine



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