Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion
Ethics Committee of the American Society for Reproductive Medicine
Committee members:Judith Daar, Paula Amato, Jean Benward, Lee Rubin Collins, Joseph B Davis, Leslie Francis, Elena Gates, Sigal Klipstein, Barbara Koenig, Laurence McCullough, Richard Reindollar, Mark Sauer, Rebecca Sokol, Andrea Stein, Sean Tipton, …
Ethics Committee of the American Society for Reproductive Medicine (2015). Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2015.07.1139
Ethics Committee of the American Society for Reproductive Medicine. Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion. Fertility and sterility. 2015. doi:10.1016/j.fertnstert.2015.07.1139
Ethics Committee of the American Society for Reproductive Medicine. "Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion." Fertility and sterility, 2015.
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RRM Academy Synopsis
ASRM Ethics Committee urges insurance coverage for infertility care
A 2015 ASRM Ethics Committee opinion holds that creating a family is a basic human right.The committee backs more insurance coverage for assisted reproduction (ART). The committee says leaving infertility care out of most coverage operates to discriminate. Money is the chief barrier it names.
Key Findings
The committee names money as the chief reason people cannot reach effective treatment. The committee says social and cultural factors also play a role.
The committee calls the gaps in access, treatment and outcomes tied to ART "stratified reproduction" that "warrants correction."
The committee calls arguments against the medical necessity of treatment "unpersuasive." The committee calls adoption an excellent choice, and mandating it as the only option "paternalistic."
The committee supports expanding coverage as a matter of just access, and urges ART stakeholders to "actively support legislation" that lowers patients' costs.
The opinion cites a 2009 panel estimate that 24% of ART needs in the US were being met. The opinion cites a median IVF cycle price of $19,200.
Interpretation
The document is an ethics committee opinion. The committee cites published studies and surveys to support its points. Its conclusions are judgments about rights and fairness. The studies it cites describe associations, such as state insurance mandates and higher use of services. The committee says the reasons some minority women have lower treatment success are poorly understood. The report says it does not dictate an exclusive course of treatment.
RRM Context
Restorative reproductive medicine looks for why conception has not happened and treats those causes. The opinion frames access as access to ART. ART bypasses the reproductive system and leaves the cause unresolved. The opinion also says fibroids and sexually transmitted diseases, common biological causes of infertility, are inadequately researched across racial, ethnic and sex groups. It calls untreated infections that damage the tubes preventable.
Our editorial summary of this paper, not the article's abstract.
Abstract
In the United States, economic, racial, ethnic, geographic, and other disparities exist in access to fertility treatment and in treatment outcomes. This opinion examines the factors that contribute to these disparities and proposes actions to address them.
Ethics and Policy › Reproductive Ethics › Access to Treatment · Ethics and Policy › Reproductive Ethics › LGBTQ Rights · Cost and Access › Access and Coverage › Insurance Coverage
Judith Daar, Paula Amato, Jean Benward, Lee Rubin Collins, Joseph B Davis, Leslie Francis, Elena Gates, Sigal Klipstein, Barbara Koenig, Laurence McCullough, Richard Reindollar, Mark Sauer, Rebecca Sokol, Andrea Stein, Sean Tipton, 0000-0003-0284-2845
J Daar, P Amato, J Benward, L Collins, Joe Davis, Joey Davis, J Davis, L Francis, E Gates, S Klipstein, Barb Koenig, B Koenig, Larry McCullough, L McCullough, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, M Sauer, Becky Sokol, R Sokol, A Stein, S Tipton
PMID 26364838 26364838 DOI 10.1016/j.fertnstert.2015.07.1139 10.1016/j.fertnstert.2015.07.1139 Ethics Committee of the American Society for Reproductive Medicine et al. 2015, Ethics Committee of the American Society for Reproductive Medicine 2015
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