Giving Thanks for Infertility Coverage

I woke up this morning with a tension headache.  It’s because I start my second in vitro fertilization (IVF) cycle today, and, while I’m excited to be moving forward after waiting for the past month, I’m already experiencing stress because I know that the ovulatory stimulation medications will make me a complete zombie. 

For the next week and a half, I will have to struggle to lead a productive life while feeling exhausted beyond anything I could have comprehended pre-IVF.  (And, I have a great deal of experience with exhaustion as a result of prior workaholism.)  While I’ve made it through previous periods of exhaustion with the help of regular—not Diet—Coke®, I am trying to be healthy in anticipation of hopefully being pregnant, so I can’t even use caffeine intake to help me get through this.  I would almost feel sorry for myself if I didn’t feel so damn lucky to have the opportunity to do IVF.  I know how blessed I am, so I suck it up and shut up instead of complaining. 

In my July 18 post, I outlined the costs of my husband’s and my first IVF cycle—uninsured versus insured.  The uninsured costs are astronomical at $29,609.  Even the reduced-cost Agreed Pricing our IVF clinic has with our insurer is $22,572, so, if we wanted to pay out-of-pocket for cycles beyond our insured three—and could convince our clinic to accept the Agreed Pricing—we’d still be out nearly $23,000 per cycle.  Because we do have Illinois medical insurance, and Illinois is one of the 15 U.S. states that requires insurance coverage for infertility treatment, we’re paying $7,157 per cycle.  Even with our Illinois infertility coverage, our out-of-pocket is high because pre-implantation genetic diagnosis, or PGD ($4,000), and cryopreservation of embryos ($800) aren’t covered. 

However, we’re using our own eggs and sperm, so that saves us some money, since we produce our own for free.  I used donor sperm to conceive my son five years ago, and, at the time, each dose was $280, with each shipment costing $110, because it’s expensive to ship frozen sperm.  I ended up ordering seven doses in three shipments, so spent $2,290 just on sperm—which most women get for free.  However, the cost of donor sperm is nothing compared to the cost of donor eggs, which not only includes the cost of the donor’s IVF cycle, but also her payment for her services (time and eggs).

The 15 U.S. states that require infertility coverage are, in alphabetical order:  Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia.  Our country’s other 35 states do not require medical coverage of infertility, as if it’s not a medical problem.  Infertility is a medical problem that, left untreated, will create many other medical problems, for infertility is a major contributor to depression, and depressed people are more susceptible to just about every medical malady.

In the book Conquering Infertility, author Alice D. Domar, Ph.D., outlines the results of research conducted among infertility patients of the Mind/Body Medical Institute at Beth Israel Deaconess Medical Center as compared to the patients, also participating in mind/body programs, who have heart disease, cancer, HIV-positive status and chronic pain.  She summarized, “The first time we did this, we were stunned at the results:  The infertility patients were just as depressed and anxious as all the other women except the chronic-pain patients, who were the most depressed.  This was an astounding finding—the infertile women were every bit as depressed as the people who were confronting illnesses that could kill them!

First, the fact that only 15 states mandate coverage for infertility treatment is a call to action.  Resolve: The National Infertility Association is leading efforts to lobby for coverage, so click on www.resolve.org, then Take Action, then Insurance Coverage, then State Coverage, for specific information about how you can help lobby your state, if your state is not one of these 15.

Second, while it’s commendable that these 15 states require coverage, a great deal of the coverage is restrictive.  For example, in Arkansas, Hawaii, Maryland, and Texas, the patient’s eggs must be fertilized with her husband’s sperm.  What if her eggs aren’t viable?  What if he is sterile?  And, what if she is single?  Then the patient or patients are out of luck.

In Hawaii and Texas, the patient and the patient’s spouse must have a five-year history of infertility or the infertility has to be associated with at least one of the following conditions: endometriosis, DES exposure, blocked or surgically removed fallopian tubes, or abnormal male factors contributing to the infertility.

Arkansas has a lifetime maximum of just $15,000 for coverage, and HMOs aren’t required to offer coverage at all.

California doesn’t require coverage for IVF.

Connecticut only requires coverage to individuals who are under 40 years old.

Hawaii only mandates coverage for one IVF cycle.

Louisiana does not require insurers to cover fertility drugs, IVF or other assisted reproductive techniques.

New Jersey only covers patients under 46 years of age.

New York only covers patients ages 21 to 44.

Ohio does not require coverage of IVF, GIFT and ZIFT.

Rhode Island provides coverage only to women between the ages of 25 and 40.

Texas only requires IVF coverage.

In every state, employers who self-insure are exempt from the requirements of the law.

Six states—California, Connecticut, Illinois, Maryland, New Jersey and Texas—don’t require religious organizations to offer coverage.

Illinois doesn’t require employers with fewer than 25 employees to provide coverage. In Maryland and New Jersey, employers with fewer than 50 employees are exempt.

So, each night when I give myself an injection of Gonal-f®, which isn’t too painful, and each morning, when I give myself an injection of Menopur®, which stings like a bitch, I will be thankful.  When I have to drive downtown to my IVF clinic, over and over, for ultrasounds and blood tests, I will be thankful.  When, I get bruises from the shots and repeated blood draws, I will be thankful.  When I’m tired, I will be thankful.  I will not compare myself to those who can quickly and easily get pregnant on their own, “the natural way.”  Instead, I will compare myself to those thousands of others, in this country alone, who are unable to afford infertility treatments because their states don’t have coverage or they don’t qualify for the limited coverage provided.  I will be thankful that I can try to have a baby.  It may not work, but at least I will have the peace of mind that comes from having been given the opportunity to try.

Once again, to learn how to lobby your state for infertility coverage—whether you’d like it initiated or expanded—log on to www.resolve.org.

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