Ethics Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org (2021). Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion. Fertility and sterility, 116(1), 54-63. https://doi.org/10.1016/j.fertnstert.2021.02.019
Ethics Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org. Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion. Fertility and sterility. 2021;116(1):54-63. doi:10.1016/j.fertnstert.2021.02.019
Ethics Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org. "Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion." Fertility and sterility, vol. 116, no. 1, 2021, pp. 54-63.
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RRM Academy Synopsis
ASRM backs infertility coverage, including for single and LGBTQ people
In a 2021 ethics opinion, the ASRM Ethics Committee backs insurance coverage for infertility care, including for single and LGBTQ people. Older state laws defined infertility by sex between a man and a woman. The definition left out same-sex couples and single people. The Committee opposes clinics that turn them away. It draws on surveys and studies.
Key Findings
The Committee says providers who turn away unpartnered individuals and same-sex couples impair fair access, "a practice that this Committee rejects."
The Committee supports wider insurance coverage for infertility care. It finds it "not acceptable" for members to decline all patient insurance, particularly when reimbursement rates are reasonable.
One report cited places the median United States price of an IVF cycle, with medications, at $19,200. Women lacking IVF coverage were 3 times more likely to stop after 1 cycle.
The opinion calls the objection that coverage costs too much "baseless." A 2016 Massachusetts report put infertility treatment between 0.12% and 0.95% of premium costs.
Studies cited in the opinion suggest African-American, Asian, and Hispanic women with access to ART have lower success rates than non-Hispanic white women. The Committee calls for more research.
The ASRM Ethics Committee's Position
“Fair access also is impaired by providers who refuse to treat unpartnered individuals and same-sex couples, a practice that this Committee rejects.”
Quoted verbatim from this paper.
Interpretation
The document is an ethics opinion, a professional society's stated position. The opinion reports no original data. Figures in it come from surveys, industry reports, and observational studies of different years and designs. Differences in success by race and ethnicity are associations, and the opinion calls them "poorly understood." The Committee adds that other plans of management may be appropriate. The scope is ART and other infertility services in the United States.
RRM Context
Restorative reproductive medicine starts from the cause of infertility. The opinion lists fibroids, endometriosis, azoospermia, and sexually transmitted diseases as common causes. It says these get too little study by race, ethnicity, or sex. The coverage argument covers ART. ART bypasses the reproductive system and leaves the cause of failed conception unresolved.
Our editorial summary of this paper, not the article's abstract.
Abstract
In the United States, economic, racial, ethnic, geographic, and other disparities prevent access to fertility treatment and affect treatment outcomes. This opinion examines the factors that contribute to these disparities, proposes actions to address them, and replaces the document of the same name, last published in 2015.
Ethics and Policy › Reproductive Ethics › Access to Treatment · Ethics and Policy › Reproductive Ethics › LGBTQ Rights · Cost and Access › Access and Coverage › Insurance Coverage
Sigal Klipstein, Ricardo Azziz, Katherine Cameron, Lee Collins, Christos Coutifaris, Susan Crockin, Judith Daar, Joseph Davis, Ruth Farrell, Catherine Hammack-Aviran, Elizabeth Ginsburg, Mandy Katz-Jaffe, Jennifer Kawwass, Catherine Racowsky, Robert Rebar, Richard Reindollar, Ginny Ryan, Mary Samplaski, Peter Schlegel, David Shalowitz, Chevis Shannon, Sean Tipton, Lynn Westphal, Julianne Zweifel, 0000-0003-0284-2845
S Klipstein, R Azziz, Kathy Cameron, Kate Cameron, Katie Cameron, K Cameron, L Collins, C Coutifaris, Sue Crockin, S Crockin, J Daar, Joe Davis, Joey Davis, J Davis, R Farrell, Cathy Hammack-Aviran, Kate Hammack-Aviran, C Hammack-Aviran, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, M Katz-Jaffe, Jen Kawwass, Jenny Kawwass, J Kawwass, Cathy Racowsky, Kate Racowsky, C Racowsky, Bob Rebar, Rob Rebar, Bobby Rebar, R Rebar, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, G Ryan, M Samplaski, Pete Schlegel, P Schlegel, Dave Shalowitz, D Shalowitz, C Shannon, S Tipton, L Westphal, J Zweifel
PMID 34148590 34148590 DOI 10.1016/j.fertnstert.2021.02.019 10.1016/j.fertnstert.2021.02.019 Ethics Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org et al. 2021, Ethics Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org 2021