40 years later, why is IVF still not covered by insurance?

Health



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But to believe that IVF is like outsourcing, it's like believing that one of those so-called home improvement projects that are simple and easy to do will really only take a few hours. Materials have been meticulously created, created and combined, and the slightest misstep can send you back to the very beginning of the process.

There are regular early morning visits to the doctor's office, where blood is collected and vaginal ultrasounds are given – often by complete strangers. There are giant boxes of syringes, needles, powders and thinners sent directly to you, and you – who has never used a needle before – you have to mix, measure and you administer these crucial and expensive medications yourself. regularly. There are many tests, procedures, and much anticipated phone calls in the early evening that give the results.

All of this creates a terribly difficult experience, and even the greater likelihood of success is not enough to combat vulnerability A move to expand insurance coverage for the treatment of infertility in the US United has taken off in recent years as more and more doctors and patients feel frustrated by the high costs of medications and the way they are treated. they hinder the treatment. But to be successful, they must overcome decades of misunderstanding and poor characterization of infertility.

After 8 million births, IVF is not experimental

Forty years ago, Louise Joy Brown of Oldham UK became the first child to be born as a result of IVF. This means that doctors surgically removed an egg from his mother and combined it with his father's sperm in a petri dish.

For the next ten years, while little Louise was growing up well, the procedure was considered experimental, for obvious reasons. Insurance companies in the United States, which tend to avoid experimental medicine in general, have stayed out of the huge scientific breakthrough, said Dr. Richard M. Paulson, president coming out of the American Society for Reproductive Medicine.

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Paulson explains that some insurance companies continue to see things are born as a result of IVF in the world and they are as healthy as the general population.
Another thing that insurance companies have always ignored: women's bodies. Because infertility has long been considered a health problem among women, insurance companies have perceived it as a niche issue and have refused coverage to those who suffer it. In spite of the fact that almost half of the cases are due to "male infertility".

Just 30 years ago, "most insurance companies did not even cover obstetrics [childbirth]. Paulson says.

While insurance companies have slowly expanded their coverage of other aspects of reproductive health, IVF coverage remains rare. Meanwhile, about 12% of American women have difficulty getting pregnant or carrying a full term pregnancy, making infertility a condition about as common as diabetes.

IVF is not a lifestyle choice for rich and active women

Another common mistake is that IVF is a disease of the rich, the inevitable fate of women. a worker who pushed back a family until it was too late. Their lifestyle choices should not be the responsibility of anyone but theirs, he thinks, and they can probably afford it, anyway.

However, as Ann V. Bell points out in her book "Misconception" of lower socioeconomic status have more trouble conceiving children than their wealthy counterparts. Yes, we do not hear about them going through IVF – but that 's probably because they just can not afford it.
An article published in 2015 by the American Society for Reproductive Medicine indicated that low-income African-American and Hispanic patients were "under-represented in the population of patients with infertility". When they reach treatment access, "they experience lower success rates than those of non-Hispanic white women."
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"There are still many people who think that we do IVF because we want to do IVF We choose to do IVF The baby girl dreams of having babies via IVF, "said Barbara Collura, President and CEO of Resolve: The National Infertility Association.

The whole concept of IVF being expensive has more to do with the assumption that it is the thing of rich women than with the actual price tag. I just spent about $ 5,000 for a dental implant, that is, to repair a single tooth. The total cost of my infertility treatment was about $ 20,000 and included three surgeries, lots of expensive drugs, genetic tests, and routine surveillance for months. Apart from that, I have a son.

When we stop thinking about IVF as a life option and begin to think of it as a cure for a disease that affects women of all socio-economic backgrounds, IVF does not seem particularly expensive.

The insurance is not only to delay the death, but also to promote the welfare

Under these layers of sexism, the economy and l & # 39; ignorance are more thorny concerns. Is having a baby a privilege or a right? Are "necessary" health care only to avoid physical suffering or death? Or is it the "right to health" and the ability to remedy dysfunctions of an organism?

There are many conditions that fall within this concept of the right to health for which insurance covers treatment and which, in the general view, deserve treatment. Runners receive knee surgery so that they can continue running; breast cancer patients receive reconstructive breast surgery so they can feel again; Children born with hearing problems undergo surgery to improve their hearing.

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Yes, people could do without these interventions, just as infertile people could do without children. But should they do it? Infertility can lead to severe depression and anxiety, and the fallout can last a lifetime.

"I think of reproduction as a basic human right," said Dr. Kara N. Goldman, assistant professor of reproductive and infertility endocrinology at New York University , who advocated complete coverage of infertility in New York. "Patients should be able to have families, and we have medical care to make that possible."

Where the fight for cover is

Fortunately, the American health care system is starting to surface. In 2017, the American Medical Association said that infertility was a disease. In the summary of the decision, the association expressed hope that the new designation "would promote insurance coverage and payment" and eliminate some of the stigma.

This change is due in part to the lobbying of the American Society for Reproductive Medicine. In recent years, the company has made a strategic effort to ensure that more Americans have access to reproductive medicine. "We all feel this way and we realized that it was time to put our efforts behind it." President. He explained that he and his fellow infertility doctors have become more and more sensitive to the fact that a large part of the American population simply can not afford a treatment of infertility .

There is a growing concern that due to financial constraints, patients may make suboptimal decisions about treatment. They choose to transfer several embryos to the uterus at the same time, instead of the recommended single embryo transfer now, in order to avoid paying for more procedures. This entails a higher risk of complications for the mother and the child – and higher long-term health care costs for the insurance companies.

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Proponents of Resolve and the American Society for Reproductive Medicine hope that the designation of the American Medical Association will help them pass laws making mandatory coverage of infertility. Nine states require some degree of infertility coverage, some of which offer multiple IVF cycles, while others only offer less expensive and less effective treatments.

The most recent state to enact a law was in Delaware, where infertility patient Christie Gross, with the help of Resolve, led support for one of the most recent bills. more complete around. This includes coverage for infertility treatments, including IVF, as well as fertility preservation for cancer patients. Cancer treatment can leave a patient sterile, so this bill would give patients the ability to store ova, sperm or embryos in advance

"It must be a grassroots effort. Gross said. "He's extraordinarily exposed" to talk about infertility in public, but change will only happen when more people will be "ready to be the face behind the problem". Gross itself underwent the treatment of infertility by pleading for this law

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However, even though all 50 states have enacted similar laws, not everyone would be guaranteed coverage for infertility. Indeed, state laws can only impose workplaces with certain types of insurance – what's known as fully insured health plans – to cover treatment. Only a federal warrant may require everyone, no matter what type of insurance he has, to receive infertility coverage. Such universal coverage is the norm in Europe.
Along with these legislative battles, more and more people are struggling to cover infertility at their workplace. Employees are increasingly taking the initiative to explain to their employers how such coverage would improve morale, with only a minor impact on the bottom line.

These conversations are not always easy to have. For one, those who believe that life begins at conception are not always comfortable with the procedure because it tends to create embryos that remain unused. Few anti-abortion politicians want to be against a family-building tool like IVF, but they also do not want to support it directly.

In addition, many women diagnosed as infertile are still embarrassed or ashamed to share the news with family and friends. They respond to a stigma rooted in one of the oldest patriarchal tropes of the book: The value of a woman lies in the fertility of her womb. This has begun to change in recent years, as more and more women connect and share their experiences. However, we have not yet reached the critical point, when a critical mass of women realizes that silence is ultimately more harmful than disclosure.

I am one of the lucky ones. I had insurance coverage for IVF, and this led to the birth of my second child. Sometimes, when I look at it, I remember this incredible fortune and the many people who can not afford to make their own eyes a chubby toddler with bright eyes. It is a flagrant injustice whose remedy exists in the sight of all.

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