Nationally, more than one percent of all U.S. births result from assisted reproductive technologies (ART) like in virto fertilization (IVF), according to the Centers for Disease Control and Prevention. In Massachusetts, 147,213 women have trouble getting pregnant or carrying the pregnancy to term, according to the national patient advocacy group RESOLVE. As the average age of pregnant women continues to rise, this number is expected to increase.
In honor of National Infertility Awareness Week (April 20 -26), RESOLVE has taken a look at the status of fertility services across the country. Massachusetts was one of five states nationally to receive an ‘A’ for fertility resources. The state’s New England neighbor Connecticut also received an ‘A’, Rhode Island scored a ‘B’, while Maine and Vermont scored ‘C’, and New Hampshire received an ‘F’.
RESOLVE (which started in Massachusetts before moving its operation to Washington, D.C.) assigned grades based on the number of fertility specialists in the state, the number of women with fertility issues, the status of insurance mandate laws that require coverage for services, as well as the number of RESOLVE peer support groups.
“While the number of RESOLVE support groups does not necessarily represent a legitimate assessment of access to fertility health care services, the other qualifiers are more objective indicators of the quality of fertility services in a state,” said Dr. Brian Berger, fertility specialist and medical director of the South Shore Center and director of Boston IVF’s Donor Egg and Gestational Carrier program. “What I like is someone is looking at this and bringing it to the forefront, bringing light to the subject of access to these services across the country.”
Massachusetts has 42 fertility specialists in the state and requires insurance companies to cover some fertility treatments, which help to make services that can average almost $20,000 per cycle slightly more affordable.
As of March 2012, 15 states had laws that require insurers to cover infertility diagnosis and treatment, but Dr. Berger points out that the level of coverage is the current battle. Self-insured employers are not required to cover fertility services in Massachusetts, for instance.
“That’s one set back with this score card, is they didn’t review the quality of the insurance mandate,” said Dr. Berger. “Massachusetts probably has the best mandate in the United States, but California also has a mandate and they aren’t nearly the same state to state. Some of the insurance mandates are so minimum it’s not much better than zero coverage.”
Massachusetts is arguably the most progressive state with regard to access to fertility treatment services (the state legislature passed an insurance mandate in the 1980s). While there are approximately 1,000 board-certified fertility specialists nationwide, 42 of those specialists practice in Massachusetts. Dr. Berger said it’s hard to tell whether there are more fertility specialists in the state because of a more progressive insurance payment system, or if other reasons make the state more attractive to physicians, but he said women certainly have better access to care here.
The trouble is, the number of physicians and centers providing these services are not proportional to the women seeking treatment for fertility issues.
“The number of fertility centers providing services in Massachusetts is less than 10, while in Boston there are five or six,” said Dr. Berger. RESOLVE has identified states in the report card as “key states for action.” These states have mandates that the advocacy group feels may be in jeopardy or where lawmakers may pass laws that negatively impact access to infertility care services.
“We need to fortify the access to care that we already have,” said Dr. Berger. “There are always threats to decrease the ability of patients to get services, and insurance companies are always trying to be more stringent on their coverage by cutting back on the populations they serve or increasing eligibility requirements for services.”
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