Veterans Affairs VA : Infertility services are covered by the VA medical benefits package, if infertility resulted from a service-connected condition. This includes infertility counseling, blood tests, genetic counseling, semen analysis, ultrasound imaging, surgery, medications and IVF as of However, the couple seeking services must be legally married, and the egg and sperm must come from said couple effectively excluding same sex couples.
Family planning providers are recommended to provide at minimum patient education about fertility and lifestyle modifications, a thorough medical history and physical exam, semen analysis, and if indicated, referrals for lab testing of hormone levels, additional diagnostic tests endometrial biopsy, ultrasound, HSG, laparoscopy and prescription of medications to promote fertility. However, studies of publicly funded family planning clinics suggest that availability of infertility services is uneven.
Per the Indian Health Services IHS provider manual, basic infertility diagnostics should be made available to women and men at IHS facilities, including a history, physical exam, basal temperature charting to predict ovulation , semen analysis and progesterone testing. However, it is unclear how accessible these services are in practice, and provision of infertility treatment is not mentioned. The ability to have and care for the family that you wish for is a fundamental tenet of reproductive justice.
For those who need it, this includes access to fertility services. A higher share of Black and Hispanic women are either covered by Medicaid or uninsured than White women and more women with private insurance sought fertility help than those with Medicaid or the uninsured. Furthermore, other societal factors also play a role. Misconceptions and stereotypes about fertility have often portrayed Black women as not requiring fertility assistance.
Combined with the history of discriminatory reproductive care and harm inflicted upon many women of color over decades, some may delay seeking infertility care or may not seek it at all.
Other research has found that use of fertility testing and treatment also varies by race. Racial inequities may exist for fertility preservation as well; a study of female patients in NY with cancer found disproportionately fewer Black and Hispanic patents utilized egg cryopreservation compared to White patients.
The high cost and limited coverage of infertility services make this care inaccessible to many people of color who may desire fertility preservation, but are unable to afford it. Iatrogenic, or medically induced, infertility refers to when a person becomes infertile due to a medical procedure done to treat another problem, most often chemotherapy or radiation for cancer.
In these situations, persons of reproductive age may desire future fertility, and may opt to freeze their eggs or sperm cryopreservation for later use. The American Society for Reproductive Medicine ASRM encourages clinicians to inform patients about fertility preservation options prior to undergoing treatment likely to cause iatrogenic infertility. However, the cost of egg or sperm retrieval and subsequent cryopreservation can be prohibitive, particularly if in the absence of insurance coverage.
No states currently require fertility preservation in their Medicaid plans. LGBTQ people may face heightened barriers to fertility care, and discrimination based on their gender identity or sexual orientation.
Section of the Affordable Care Act ACA prohibits discrimination in the health care sector based on sex, but the Trump Administration has eliminated these protections through regulatory changes.
Without the explicit protections that have been dropped in the current rules, LGBTQ patients may be denied health care, including fertility care, under religious freedom laws and proposed changes to the ACA. However, these changes are being challenged in the courts because they conflict with a recent Supreme Court decision stating that federal civil rights law prohibits discrimination based on sexual orientation and gender identity.
In a committee opinion, ASRM concluded it is the ethical duty of fertility programs to treat gay and lesbian couples and transgender persons, equally to heterosexual married couples. They write that assisted reproductive therapy should not be restricted based on sexual orientation or gender identity, and that fertility preservation should be offered to transgender people before gender transitions.
This allows transgender individuals the ability to have biological children in the future if desired. Despite this recommendation, in aforementioned states with mandated fertility preservation coverage for iatrogenic infertility, it remains unclear if this benefit extends to transgender individuals, whose gender affirming care can result in infertility.
Additionally, many state laws regarding mandates for infertility treatment contain stipulations that may exclude LGBTQ patients.
In other states, same-sex couples do not meet the definition of infertility, and thus may not qualify for these services. Data are lacking to fully capture the share of LGBTQ individuals who may utilize fertility assistance services.
Single persons are often excluded from access to infertility treatment. Some grants and other financing options also stipulate funds must go towards a married couple, excluding single and unmarried individuals. This is in opposition to the ASRM committee opinion, which states that fertility programs should offer their services to single parents and unmarried couples, without discrimination based on marital status.
On a federal level, efforts to pass legislation to require insurers to cover fertility services are largely stalled. There has been some more movement on the state level. Some states require private insurers to cover infertility services, the most recent of which was NH in Currently, NY continues to be the first and only state Medicaid program to cover any fertility treatment.
For those who desire to have children, obtaining fertility care can be a stressful process. Stigma around infertility, intensive and sometimes long or painful treatment regimens, and uncertainty about success can take a toll. On top of that, in the absence of insurance coverage, infertility care is cost prohibitive for most, particularly for low-income people and for more expensive services, like IVF or fertility preservation.
Achieving greater equity in access to fertility care will likely depend on addressing the needs faced by low-income persons, people of color and LGBTQ persons in fertility policy and coverage. Coverage and Use of Fertility Services in the U. Key Takeaways. Appendix 1: Private Insurance. Topics Women's Health Policy. The lower the ratio, the more solvent the business is. Net fixed assets represent long-term investment, so this percentage indicates relative capital investment structure.
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