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 2023 Scientific Conference & Exposition of the American Society for Reproductive Medicine (ASRM), disparities exist in fertility funding, with some facing being denied coverage for their care.

Analyzed data from 2004 to 2022 to assess funding trends and support for research on male and female infertility by the National Institutes of Health (NIH), as well as understand public concerns about Infertility issues using Google Trends in the United States.^first

Researchers examined the NIH ReportER database from departments of urology, obstetrics and gynecology in US medical schools, using infertility search terms from 2004 to 2022. Baseline searches Google Trends data conducted using the search terms male infertility and female infertility from January 1, 2004 to December 31, 2022.

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

Additionally, Texas has the highest funding for male infertility research at $12,806,614 and California has the highest funding for female infertility at $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, Google Trends patterns do not match funding sources: While there are 995 funded projects on female infertility and 45 funded projects on male infertility, the relative search volume for male fertility was higher throughout the study period.

The second research poster aims to examine cases of independent medical reviews related to fertility (IMR), to better understand their success rates and to educate physicians on practical methods best practices for using IMR to expand patient care.²

Although fertility treatments are deemed medically necessary by the World Health Organization, the American Medical Association, and ASRM, only 14 states require coverage of in vitro fertilization test (IVF). However, many states can appeal coverage denials through the IMR process, such as in California, where the appeals process is administered by the Department of Managed Health Care (DMHC).

Using the DMHC IMR database, researchers reviewed cases related to obstetrics, urology, endocrinology, and cancer from 2001 to 2023. Data included clinical history patient clinical status, required coverage, length of the appeals process, and reviewer characteristics.

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

Of these claims, 47% of coverage denials were overturned by DMHC, and 91% of cases filed for cancer-related fertility preservation were overturned. Cancer patients can also most likely have their cryopreservation costs covered, subsequent IVF cycles in case of poor initial cycle results, and preimplantation genetic testing (PGT) to detect mutations. cancer-causing variables. Additionally, all patients with disease-causing mutations were successful in receiving IVF and PGT coverage.

However, coverage denials remain in place when cases are deemed medically unnecessary or experimental according to medical association guidelines. Furthermore, rejection only occurs for cancer patients if the cancer treatment does not cause treatment-induced infertility.

Presenter

1. Tinsley S, Olabode S, Thomas M, et al. Access to funding and public interest in male and female infertility: analysis of the NIH ReportER & Google Trends database. 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 can patients turn to when they are denied fertility care coverage? an analysis of managed care department independent medical review data sets for the period 2001-2003. Poster presented at: ASRM Scientific Congress & Expo 2023; October 14-18, 2023; New Orleans, LA.