Pass legislation to increase insurance for in vitro fertilization

Just days before the birth of the now-famous octuplets, Rep. Anthony Weiner (D-N.Y.) introduced the Family Building Act of 2009, H.R. 697. The Act seeks to amend the Public Health Service Act and the Employee Retirement Income Security Act (ERISA) and requires insurers who cover obstetrical services to extend coverage to non-experimental treatment of infertility, including in vitro fertilization (IVF).

This month, New York Sen. Kirsten Gillibrand (D) announced that she will introduce the same legislation in the upper chamber. Both the House and Senate bills would require that patients meet certain conditions in order to receive coverage by their group health plan, and would prevent insurers from dodging the Act’s requirements.

{mosads}I applaud the leadership of Sen. Gillibrand and Rep. Weiner in championing legislation that takes an important first step toward improving the way insurers view infertility. As a doctor and the founder and director of New Hope Fertility Center in New York City, I am witness to the agony felt by families struggling to conceive. I am hopeful that legislation such as the Family Building Act will bring much-needed attention to the issues surrounding infertility, issues that Congress can no longer afford to ignore.

While the Family Building Act raises the public profile of infertility, the Act, in its current form, is not a silver bullet for improving the way IVF treatments are conducted and covered. Also, as made evident by the “Octomom” media frenzy, there are serious problems with current IVF practices.

One of the most significant issues is that multiple-embryo transfers have become common practice. Multiple births are responsible for approximately one-quarter of all premature deliveries before 32 weeks and a contributor to infant mortality rates. Moreover, every premature baby born before 28 weeks costs the healthcare system about $66,000 for neonatal care alone. For this reason, many European and Asian countries regulate the number of embryos that may be transferred.

Sadly, the only federal regulation in place today with regard to fertility clinics in the U.S. provides incentives to physicians and clinics to transfer multiple embryos, and to withhold IVF treatment from patients in lower success rate categories based on factors such as age. The Fertility Clinic Success Rate and Certification Act of 1992 requires clinics to annually report their success rates for pregnancies and births.  The lack of alternate regulation, coupled with failure by the insurance industry to cover IVF treatment in the U.S., has encouraged patients to insist on multiple embryo transfers to get the most out of the enormous out-of-pocket fees they incur per cycle. And, because doctors are rewarded for better success rates, the emphasis moves from quality to quantity so that clinics may boost their success rates despite potentially dangerous and expensive health complications.

If IVF were more accessible and reimbursed by health insurers, and if embryo transfers were regulated, there would be consequences for clinics and physicians who practice irresponsibly. Patients would have access to multiple, single-embryo transfer cycles and insurers would save money they now spend on the health complications the current situation precipitates. In other words, if IVF were covered and regulated appropriately, it would be nearly impossible for IVF to lead to high-order multiples with their attendant risks.

While the legislation proposed by Sen. Gillibrand and Rep. Weiner addresses this problem from an insurance perspective, it does not incorporate all the critical pieces that would encourage more responsible IVF practices among patients and physicians. Group health coverage, though necessary, is only one part of the solution.

We must challenge our legislators to dig deeper and set age limitations on insurance coverage to encourage responsible spending. Regulators must also revise the outdated IVF reporting system and start providing incentives that encourage responsible medical practices, rather than rewarding those physicians who only strive to bolster the misleading success rates of their clinics.

Infertility is a healthcare problem facing millions of women and men in the U.S. This week, advocates from across the nation will convene in Washington to encourage Congress to invest time and resources into improving the current IVF treatment and coverage model. It is crucial that legislators and doctors work together to create a regulated and safe environment for IVF patients that upholds the integrity of our country’s medical profession.

Zhang is founder and director of New Hope Fertility Center in New York City.