Kate Johnson

October 21, 2015

BALTIMORE — State-mandated insurance for in vitro fertilization (IVF) reduces the rate of multiple births in the highest-risk women — those younger than 35 years who receive day-5 embryo transfers — new research indicates.

"Improving insurance coverage for IVF might make single-embryo transfer a more acceptable option for patients and providers," said Meredith Provost, MD, from the Duke University Medical Center in Durham, North Carolina.

"And the increased uptake of elective single-embryo transfer is necessary to reduce multiple gestations in the United States," she told Medscape Medical News.

However, even for the highest-risk women, 33% of all births in insurance-mandated states involve multiples.

This suggests that although insurance is important, "other factors are playing a role" in driving multiple birth rates, said principal investigator Jennifer Eaton, MD, also from Duke.

Dr Provost presented the study findings here at the American Society for Reproductive Medicine 2015 Annual Meeting.

The retrospective study involved 173,968 first-time IVF cycles that took place from 2007 to 2011. The women, aged 20 to 42 years, were identified from the Society for Assisted Reproductive Technologies Clinical Outcomes Reporting System (SART-CORS).

Of this cohort, 26% of the women came from six states with mandated IVF insurance (Connecticut, Hawaii, Illinois, Massachusetts, Maryland, and New Jersey), and 74% came from 34 states without mandated insurance.

Young Women

Half the women from mandated states were younger than 35 years, as were half the women from unmandated states.

For the highest-risk women, the rate of multiple births was significantly lower in states with mandatory insurance than in those without, after patient and cycle characteristics were controlled for (odds ratio [OR], 0.81; P < .0001).

And for these women, the rate of elective single-embryo transfer was significantly higher in states with mandatory insurance than in those without (22% vs 13%; OR, 2.6, P < .0001).

"But even in mandated states, 78% of women with day-5 transfers did not have elective single-embryo transfer," Dr Provost pointed out, adding that it "is rarely performed in older women."

In fact, in an adjusted analysis, insurance status was shown to have no effect on multiple births in older women.

"One factor that might have influenced our findings is the fact that even in mandated states, many patients do not have coverage because of diagnosis requirements or limits on coverage," Dr Eaton explained. "Additionally, there is often reluctance on the part of the provider or patient to do a single-embryo transfer. There is a need to improve patient education regarding the risks of multiple gestation."

These findings "show there is an advantage to insurance coverage for patients with infertility care," Jim Toner, MD, president of the Society of Assisted Reproductive Technology, said during a news conference.

In addition to opening up access, insurance "makes single-embryo transfer a much more acceptable option to patients," he said.

But a "single-embryo transfer is not always the right choice," Dr Toner added. "If a couple has failed multiple attempts or if embryo quality is not ideal, then it makes sense to at least consider putting back more than one embryo."

Dr Provost, Dr Eaton, and Dr Toner have disclosed no relevant financial relationships.

American Society for Reproductive Medicine (ASRM) 2015 Annual Meeting: Abstract O-40. October 19, 2015.

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