IN VITRO FERTILIZATION INSURANCE COVERAGE AND CHANCES OF A LIVE BIRTH
Methods: We evaluated patient-level data from women undergoing IVF at Washington University between 2001 and 2008 to determine the cumulative probability of having a live birth stratified by IVF insurance coverage. We collected demographic data (age, patient IVF insurance coverage status, ZIP code of residence, average family income in the patient’s ZIP code of residence, antral follicle count associated with each oocyte retrieval, race, infertility diagnosis, and obstetrical history), and IVF cycle data(fresh versus frozen-embryo transfer, IVF cycle number, year of IVF cycle, total gonadotropin used, peak estradiol, use of intracytoplasmic sperm injection (ICSI), and number of embryos transferred) to control for potential confounders. Our primary outcome was the cumulative chance of having a live birth from IVF after five cycles according to IVF insurance coverage status, which was determined by incorporating the probability of obtaining a live birth each cycle and the patient’s decision to return for additional treatment cycles.
Results: Women with IVF insurance coverage were more likely to return for an additional IVF cycle after an unsuccessful cycle. The cumulative probability of having a live birth after five cycles for those with IVF insurance coverage was 0.635 (95% CI = [0.5592, 0.7132]) and 0.5553 (95% CI = [0.4738, 0.6393]) for those without coverage. The difference in the cumulative live birth rate between the insured and the uninsured was significant at 0.0793 with 95% CI = [0.0237, 0.1337]. This indicated that the insured patients had a significantly higher cumulative live birth rate after five cycles of IVF when we explicitly took into account the probability of returning for an additional cycle of IVF after failure.
Conclusions: By increasing the likelihood that individuals will return for additional IVF treatment after a failed IVF cycle, IVF insurance coverage is associated with an increased cumulative chance of having a live birth.