ASRM Posters Show Disparities in Fertility Funding, Insurance Denials

With infertility increasing equally among men and women in the United States, access and affordability are areas of concern for individuals and couples seeking fertility treatment. According to 2 posters presented at the American Society for Reproductive Medicine (ASRM) 2023 Scientific Congress & Expo, disparities exist in fertility funding, with some facing insurance coverage denials for their care.

An analysis of data between 2004 and 2022 aimed to evaluate trends in funding and support toward male and female infertility research from the National Institutes of Health (NIH), as well as to understand public interest in infertility using Google Trends in the United States.¹

The researchers examined NIH RePORTER databases from urology and obstetrics and gynecology departments within US medical schools, using the search term “infertility” between 2004 to 2022. Google Trends database searches were conducted using the search terms “male infertility” and “female infertility” from January 1, 2004, to December 31, 2022.

The analysis revealed total grant funding for male infertility was $22,523,049, with a median (IQR) of $460,599 ($205,298-$765,810) per project, and total funding for female infertility was $376,748,653, with a median (IQR) of $300,390 ($189,321-$390,524) per project.

Additionally, Texas had the highest funding for research on male infertility, with $12,806,614, and California had the highest female infertility funding, with $99,708,513. Furthermore, Texas had the most funded projects (n = 21) among urology departments, and California had the most funded projects (n = 222) among obstetrics and gynecology departments.

Interestingly, the Google Trends patterns did not match the funding: Whereas there were 995 funded projects on female infertility and 45 funded projects on male infertility, relative search volume was higher for male infertility across the study period.

A second study poster to examine fertility-related independent medical review (IMR) cases, to better understand their success rates and educate physicians on best practices for utilizing IMR to expand patient care.²

Although fertility treatments have been deemed “medically necessary” by the World Health Organization, American Medical Association, and ASRM, only 14 states have mandated coverage for in vitro fertilization (IVF). However, many states can appeal insurance denials through IMR processes, such as in California where the appeals process is governed by the Department of Managed Healthcare (DMHC).

Using the DMHC IMR database, researchers reviewed cases pertaining to obstetrics and gynecology, urology, endocrinology, and cancer from 2001 to 2023. Data included a patient’s clinical history, coverage requested, duration of the appeals process, and reviewer characteristics.

A total of 34,616 IMR cases were filed during the study period, of which 133 cases pertained to fertility care. Of the coverage requested, 49% was for treatment, 21% for consult fees, 15% for diagnostic testing, and 15% for surgery.

Of these requests, 47% of insurance denials were overturned by the DMHC and 91% of cases submitted for cancer-related fertility preservation were overturned. Patients with cancer were also mostly able obtain coverage for cryostorage fees, subsequent IVF cycles in the case of poor initial cycle outcome, and preimplantation genetic testing (PGT) for cancer-causing mutations. Additionally, all patients who were carriers of disease-causing mutations were successful in receiving coverage for IVF and PGT.

However, insurance denials were upheld when cases were deemed medically unnecessary or experimental by medical society guidelines. Furthermore, denials only occurred for patients with cancer if the cancer treatment was not known to cause iatrogenic infertility.

References

1. Tinsley S, Olabode S, Thomas M, et al. Accessing funding and public interest into male and female infertility: analysis of NIH RePORTER & Google Trends databases. Poster presented at: ASRM Scientific Congress & Expo 2023; October 14-18, 2023; New Orleans, LA.

2. Tolani A, Deer C, Wang A, et al. What recourse do patients have when they are denied insurance coverage for fertility care? an analysis of the department of managed healthcare independent medical review dataset between 2001-2003. Poster presented at: ASRM Scientific Congress & Expo 2023; October 14-18, 2023; New Orleans, LA.