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The Objective of Infertility Insurance Mandates: IVF Coverage
Laura Elm | 15 April 2022
“You can’t get more pro-life than making sure people can have families.”
Virginia State Delegate Dan I. Helmer (D)
Virginia House of Delegates. Committee Hearing on HB480:
Health insurance; coverage for the diagnosis of and treatment for infertility.
February 3, 2022[i]
The suffering of infertility has been part of our human experience since practically the very beginning. “When Rachel saw that she bore Jacob no children, she envied her sister; and she said to Jacob, ‘Give me children, or I shall die!”[ii]
Sadly, the number of people whose hopes for children go unfulfilled is higher today than many imagine. The latest published data on infertility in the United States shows that for married women aged 15 to 49 years, 19.4% are unable to get pregnant after one year of unprotected intercourse (infertility), 26% have difficulty getting pregnant or carrying a pregnancy to term (impaired fecundity), and 12.2% have received infertility services.[iii]
To alleviate the suffering of those with infertility, medical treatment and research should be encouraged, so long as they are placed "at the service of the human person, of his inalienable rights, and his true and integral good according to the design and will of God.[iv] In short, “science without conscience can only lead to man's ruin.”[v]
Within this framework and given that a wide range of fertility treatments exist today, precisely which one(s) does a legislator mean when sponsoring a bill aimed at “making sure that people can have families?”
It’s All About IVF
The goal of Pro-Family legislation is to protect all people challenged in their family building and improve the lives of our community. Examples of specific Pro-Family policies include equal access to reproductive medical care, insurance coverage for IVF and fertility preservation, and dismantling barriers to adoption and the use of third-party reproduction, including donor sperm and egg and surrogacy.[vi]
RESOLVE: The National Infertility Association. (emphasis added)
When a bill joins health insurance and infertility treatment, it must be recognized that the purpose is coverage of in vitro fertilization (IVF). IVF is an Assisted Reproductive Technology (ART) usually described in terms of its process: ovarian stimulation, egg retrieval, fertilization, and embryo transfer. More to the point, IVF is the generation of new, living human beings (human embryos) in a laboratory by a scientist whose role it is to determine their subsequent fate: transfer to a uterus, cryopreservation storage, or disposal.
Most infertility mandates have their origins and support in The National Infertility Association (RESOLVE). Founded in 1974 as a support network, RESOLVE’s mission is increasingly dominated by legislative advocacy. RESOLVE is a strategic partner of the American Society for Reproductive Medicine (ASRM) and its affiliate, the Society for Assisted Reproductive Technology (SART). SART member clinics perform the “overwhelming majority” of IVF cycles in the U.S.[vii] In 2019, RESOLVE and ASRM entered a 3-year, $1M collaboration agreement in order to “accelerate RESOLVES’s grassroots advocacy efforts and enhance its Coverage at Work Program.”[viii] RESOLVE and ASRM’s 2022 Federal Advocacy Day is planned for May 18, the theme of which is Respond with RESOLVE (#WeCanAll).[ix] RESOLVE’s highest-ranking legislative priority is “increasing the number of people with access to health insurance that covers infertility medical treatment, and specifically IVF.”[x] RESOLVE opposes “so-called personhood bills” as they “could make common fertility treatments like IVF illegal.[xi] (emphasis added)
IVF coverage is the purpose of state and federal level infertility mandates, yet the terms “IVF” and “in vitro fertilization may never appear in the bill. Respect-life advocates must therefore be savvy when searching for and interpreting these bills.
IVF – Not in the Bill’s Title
Titles for IVF coverage bills usually state “infertility” or “fertility” treatments, services, or “preservation:”
Virginia. HB 480. “Health insurance; coverage for the diagnosis of and treatment for infertility and fertility preservation.” Introduced on 1/11/22. Helmer (D). [xii]
Washington. HB 1730 / SB5647. “Concerning fertility services; infertility and fertility preservation insurance coverage.” Pre-filed on 1/3/22 and 1/4/22, respectively. Rep. Stonier (D). Sen. Robinson (D).[xiii], [xiv]
The bill’s title may omit a therapeutic target altogether, as occurred in Utah (2020):
Utah. HB 214. “Insurance coverage modifications.” Introduced 1/29/20. Governor signed 3/28/20. Ward (R).[xv]
Utah HB 214 differed significantly from typical IVF coverage mandates. First, it was sponsored by a Republican. Second, the beneficiaries are not people with infertility, but instead people in whom indicators of certain genetic diseases (i.e., qualified conditions) have been detected and who wish to have children. IVF, with the implied use of preimplantation genetic diagnostics (PGD), would be utilized to create embryonic humans, test them for a qualifying condition, and discard those who test positive.
IVF – Not in the Bill’s Body
“IVF” may not appear in the body of the bill either. In its absence, other terminology will point to the technology. Using Virginia HB 480 as a typical example: (emphasis and numbering added), below are five key terms and their role in IVF:
Such required coverage shall include four completed (1) oocyte retrievals with unlimited (2) embryo transfers in accordance with the guidelines of the (3) American Society for Reproductive Medicine, using (4) single embryo transfer when recommended and medically appropriate and (5) storage of gametes and tissue for fertility preservation purposes.[xvi]
(1) Oocyte retrieval: a step in the process of IVF whereby eggs are taken from the ovaries using an ultrasound guided needle and suction device.[xvii] Retrieved eggs are taken to the embryology lab, where they are prepared and await fertilization or freezing.
(2) Embryo transfer: a step in the process of IVF whereby eggs which have been fertilized (embryos) are placed into a woman’s uterus via a catheter. If the procedure is successful, the embryo will implant within a few days after transfer.[xviii]
(3) Single Embryo Transfer: Elective single embryo transfer (eSET) is the transfer of a single embryo generated through in vitro fertilization (IVF) into the mother’s uterus for pregnancy, even when multiple healthy embryos are available.[xix]
The ASRM Practice Committee’s most recent opinion paper on the limits of embryos to transfer supports eSET: in any age group (<35 to 42), when the embryo’s prognosis is “Euploid (demonstrated euploid embryos, best prognosis),” the recommendation is to transfer only one embryo. “Demonstrated euploid” indicates the concomitant use of genetic testing to verify that an embryo contains the normal number of 46 chromosomes.[xx] Although genetic testing is not identified by name in the mandate, it would likely be in-scope for coverage:
Preimplantation genetic testing (PGT) is widely used today in in-vitro fertilization (IVF) centers over the world for selecting euploid embryos for transfer and to improve clinical outcomes in terms of embryo implantation, clinical pregnancy, and live birth rates.[xxi]
(4) Storage of Gametes and Tissue
Cryopreservation and storage of gametes (i.e., sperm, eggs) enables future IVF. “Tissue” may be a euphemism for embryonic human beings.
(5) American Society for Reproductive Medicine (ASRM)
Any mention of ASRM should trigger the thought of IVF. ASRM is an 8,000 member[xxii], $15M[xxiii] professional association “dedicated to the advancement of the art, science, and practice of reproductive medicine.[xxiv] Its affiliate, SART, is the United States’ “primary organization of professionals dedicated to the practice of assisted reproductive technologies (ART).”[xxv]
Other Clues Indicating IVF
From Virginia HB 480 (emphasis added):
"Infertility" means a disease, condition, or status characterized by…a person's inability to reproduce either as a single individual or with such person's partner without medical intervention…[xxvi]
When the definition of infertility expands to include single people and same-sex couples, there will be increased utilization rates and premium impacts, as well as the need for 3rd party reproductive services only functional within the context of IVF.
No insurance policy, subscription contract, or health care plan shall impose… any exclusions, limitations, or other restrictions on coverage of any fertility services based on a covered individual's participation in fertility services provided by or to a third party.[xxvii]
Third-party reproduction is the involvement in the reproductive process of someone other than the individual or couple who plan to raise the to-be-conceived-child, and refers to: donated eggs, donated sperm, donated embryonic humans, and surrogates or gestational-carriers.
Omissions and Redefinitions
Returning to the beginning. IVF, while never explicitly stated in the infertility mandate, is its reasons for being. At the same time, the procedure-which-will-not-be-named is misconstrued as pro-life, a term that has fallen victim to redefinition. Being pro-life is not about making people in labs for the purpose of “family-building.” An authentic pro-life position is one which acknowledges and respects the right to life of every human being; that is, the right of an innocent human being to be protected from being killed. The IVF process does not protect the right to life of the human person(s) whom it brings it existence.
[i] Virginia House of Delegates Video Streaming (virginiageneralassembly.gov)
[iv] Catechism of the Catholic Church: 2375
[xix] https://dallasivf.com/fertility-treatments/ivf/single-embryo transfers/#:~:text=eSET%20facts,of%20a%20single%20healthy%20child.
[xxi] Greco E, Litwicka K, Minasi MG, Cursio E, Greco PF, Barillari P. Preimplantation Genetic Testing: Where We Are Today. Int J Mol Sci. 2020;21(12):4381. Published 2020 Jun 19. doi:10.3390/ijms21124381. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352684/#:~:text=Background%3A%20Preimplantation%20genetic%20testing%20(PGT,pregnancy%2C%20and%20live%20birth%20rates.
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