I attended an all-girls Catholic high school because of my mother’s passionate, “research based” (her words) belief that “an all-girls education sets young women up to succeed” (also her words). Despite my resistance at first, the Academy of St. Elizabeth’s allowed me to come into who I was and be unabashedly myself at all times (yea, yea we get it Mum, you’re always right). However, there were a few things I missed out on. The first thing I missed was the daily interaction with the opposite sex, which caused a very rude awakening upon transitioning to college. The second was a comprehensive sex education. Let’s just say the Catholic Church’s “abstinence-based sex education” leaves a lot to be desired. My sex education consisted of an excruciatingly blunt conversation with my mother at age 12, the internet, and Coach Carr from Mean Girls stating, “If you have sex, you will get pregnant and die.” This, by the way, is how I picture all high school sex ed classes– plus that condom over the banana scene, which I am grateful to have missed out on (mostly because I cannot imagine having to look Sister Gloria in the eye after a class like that). All in all, the only thing I learned about sex was basically that if you did have sex you would get pregnant no matter what. No if’s, and’s, or but’s about it.
Fast-forward a few years to a fresh-faced graduate starting a summer internship at a pharmaceutical company that specializes in in vitro fertilization (IVF). The government affairs office, where I worked, partnered with advocacy groups to try and get in vitro fertilization procedures covered by insurance through individual state’s plans. Going into this position, I knew what IVF was, but I had no idea how many individuals and couples were affected by this disease as defined by World Health Organization— the inability of a sexually active couple to achieve a clinical pregnancy in 12 months or more of regular sexual intercourse. I also did not realize how costly one procedure could be, let alone the cost of a few procedures, because usually more than one is required before it takes. A few things I learned were:
- 1 in 8 couples (12 percent of married women) have trouble getting pregnant or carrying the pregnancy to term.
- 7.4 million women (11.9 percent) have received infertility treatments in their lifetime.
- Infertility equally affects both men and women.
- A couple ages 29-33 with normal reproductive systems has only a 20-25 percent chance of conceiving on any given month.
“Cost is one of the biggest barriers to receiving these treatments, as 46 percent of people do not have insurance coverage for infertility.”
Fifteen states do have an insurance mandate to offer some or full coverage of fertility treatments. These include:
- New Jersey
- New York
- Rhode Island
- West Virginia
The average cost of IVF in America runs about $11,000 to $12,000 and that does not include the annual storage cost of the cryopreserved eggs (frozen eggs), which costs another $8,000 per year. Then, every time you need to thaw and use the eggs it costs another $6,500 for every cycle. Although many states do have some mandated coverage for IVF, many policies are from years ago and do not cover the more advanced technological procedures that are less costly and much more effective.
Many states do not cover more than one cycle when on average it takes about 3 before success. Some states create their own definition of what constitutes as infertility. Where the WHO defines infertility as “inability to conceive after 1 year of trying,” Texas’s mandate requires the couple try for 5 years before they even think about providing some coverage. States that do not require coverage of IVF have a higher rate of “high-order pregnancies,” which means that they implant more than one egg and can result in 3 or more fetuses. This poses a much higher possibility for risk during pregnancy and birth for the mother and the fetuses. However, if you cannot afford more than one cycle of IVF, then you might be forced to implant more than one embryo in the hopes that one of them is successful.
Reproductive rights is an extremely hot-button issue in today’s political climate, but we don’t talk about this aspect nearly enough. On the federal level, The Affordable Care Act does not require coverage of infertility treatments. The 15 states that do have infertility coverage mandates may have chosen the Essential Health Benefits plan that does include an IVF mandate. However, this impacts the individual and small group markets only in that state.
Celebrities such as Khloe Kardashian, Chrissy Teigen, Courtney Cox, Emma Thompson, and Celine Dion have all been very open about their pregnancy struggles and their ultimate turn to IVF treatments. They talk about how absolutely emotional and difficult infertility and the IVF process can be. However, they have the luxury of being able to afford, where many women do not. Many people do want to have their own children but simply do not have the ability to do so. Cost is one of the biggest barriers to receiving these treatments, as 46 percent of people do not have insurance coverage for infertility. Denying coverage or only providing limited coverage with technologically redundant methods, creates extreme obstacles for couples or individuals who want to start and raise a family of their own.