Insurance Coverage for In Vitro Fertilization is Associated with Higher Live Birth Rates in a National Sample of Privately Insured Patients.

OBJECTIVE

To evaluate associations between employer-sponsored insurance coverage for in vitro fertilization (IVF) and pregnancy, live birth, and multiple birth rates for patients with and without insurance coverage for their IVF.

DESIGN

Retrospective cohort study SUBJECTS: US women aged 22-44 in Optum's de-identified Clinformatics® Data Mart Database (Optum® CDM) who underwent IVF from 2013 to 2020.

EXPOSURE: Insurance coverage for IVF MAIN OUTCOME MEASURES: Cumulative live birth rates within 2.5 years of the first IVF cycle; pregnancy, live birth, and multiple birth rates per IVF cycle; and the number of IVF cycles initiated within 2.5 years of the first IVF cycle.

RESULTS

Patients with employer-sponsored insurance coverage for IVF had a higher probability of having a living birth within 2.5 years after the first IVF cycle compared to patients without insurance coverage for IVF [63% vs 53%; odds ratio (OR) 1.52, 95% Confidence Interval (CI): 1.35-1.73; all results are adjusted]. IVF cycles covered by insurance had a higher probability of having a pregnancy than IVF cycles not covered by insurance (53% vs 49%, respectively; OR 1.20, 95% CI: 1.09-1.31; all results are adjusted). IVF cycles covered by insurance had a higher probability of having a live birth than IVF cycles not covered by insurance (37% vs 33%, respectively; OR 1.17, 95% CI: 1.07-1.29; all results are adjusted). The rate of multiple births was similar among IVF cycles with and without insurance coverage (13% vs. 13%; OR 1.04, 95% CI: 0.84 to 1.29; all results are adjusted). We also found that patients with employer-sponsored insurance coverage for IVF initiated more IVF cycles within 2.5 years of their first IVF cycle than patients without insurance coverage for IVF (1.9 vs. 1.7 IVF cycles, respectively; count ratio 1.12, 95% CI: 1.08-1.17; all results are adjusted).

CONCLUSION

Employer-sponsored insurance coverage for IVF was associated with an increase in cumulative live birth rates, largely driven by patients with insurance coverage for IVF initiating more IVF cycles and having higher live birth rates per IVF cycle. There is increasing interest in expanding access to IVF in the US, and our findings should inform policymakers, including employers, about the importance of employer-sponsored insurance coverage for IVF as a tool to help patients build their families.