AMA Fails Infertility Community: FWR Response 5 of 5

by Davina Fankhauser
President - Fertility Within Reach

“Who Pays? Mandated Insurance Coverage for Assisted Reproductive Technology,1” published by the American Medical Association Journal of Ethics, examines the arguments for mandating insurance coverage for assisted reproductive technology (ART) which includes in vitro fertilization (IVF).  Overall, the researchers concluded, with almost palpable condescension, that while infertility is a hardship, it should not be mandated because the option of adoption is a good alternative. 

Fertility Within Reach has written a five page response to this article.  We are going to share our reaction multiple blog posts. 

Retort #5:  The Cost of Infertility Health Benefits

While ART is not inexpensive, it is also not a burden to states that are experienced with mandating its coverage, as reported by the AMA authors.  According to the State-Mandated Health Insurance Benefits and Health Insurance Costs in Massachusetts13, published in 2013, Infertility benefits are “provided in the self-insured market at nearly the level they are provided in the fully-insured market, suggesting that these benefits are cost-effective, popular with employees, or both.”  Since the Affordable Care Act stemmed from the example of mandated coverage in Massachusetts, this finding further supports the conclusion “that including infertility as an essential health benefit will be cost effective.” And while these authors express concerns about the cost mandated infertility would add to premiums and our government, they don’t share the financial return on investment when the 5 million people born via ART become tax paying citizens who in turn, will pay our government much more than the cost of their parents’ treatment to create their lives. 

Another report referenced by Dr. Rosoff and Katie Falloon is, “The number of triplets or higher-order multiples has risen more than 400 percent since 1980, mostly because of increasing use of fertility treatments.”  What they neglect to include is a recent article by the Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report, published December 6, 2013/ 62 (ss09); 1-24.  The CDC reports, “Since 2000 (the first year for which state-specific data were reported by CDC), the percentage of ART-conceived multiple infants in the United States declined by 13.0% (from 53.0% in 2000 to 46.0% in 2010). A sharp decline was noted in the rate of ART-conceived triplets and higher order infants of 67.0% (from 9.0% in 2000 to 3.0% in 2010) and a lesser decline in ART-conceived twin infant rates of 2.0% (from 44.0% in 2000 to 43.0% in 2010).”14 In fact, insurers such as Aetna offer infertility patients two additional IVF cycles, in addition to the four they are mandated to provide in the state of Connecticut, if patients are willing to transfer a single embryo during their first two IVF procedures.  Even insurers recognize that the outcome costs they most want to avoid are those associated with poor outcomes from higher order multiple births. Mandated coverage of ART can reduce the incidences of multiple births and thus the poor obstetrical and natal outcomes that are more likely associated with higher order multiple births.

As science and patient education improve, so do the choices and outcomes associated with the health care provided.  Access to timely and appropriate health care is of great value to patients, medical professionals, and insurers.  The article produced by Dr. Rosoff and Katie Falloon missed an opportunity to actually evaluate the cost of mandated insurance coverage for infertility treatment.  Their incomplete and socially biased overview is a disservice to The American Medical Association, its members and the patients they serve.

Retort #1: Infertility and Adoption was posted Monday, January 13, 2014.  Here we utilize research to point out how Dr. Rosoff and Katie Falloon grossly minimize the adoption process, in terms of cost, time, and legal issues.

Retort #2: Equal Access was posted on Tuesday, January 14, 2014.  FWR shares research to support the idea, as long as there are exceptions to providing infertility health benefits, there will be a lack of equal access to infertility health care.  A lack of care denies infertility patients the opportunity to overcome their disability.

Retort #3:  Medical Care vs. Alternative Treatments was posted on Wednesday, January 15, 2014.  FWR examines the authors’ belief that if a nonmedical/alternative means is available, then the state should not offer coverage for medical treatment.

Retort #4:  The Impact of Infertility was posted on Thursday, January 16, 2014.  FWR utilizes research to show infertility is not “simply” about not being pregnant, but a disease of the reproductive system which produces real emotional, as well as physical complications.

About the authors:

Davina Fankhauser, MA is the co-founder and President of Fertility Within Reach, a national non-profit organization which helps patients gain access to infertility health benefits to treat their medical condition in a timely and appropriate manner.  She works collaboratively with medical professionals and organizations to bring accurate information to patients, employers, insurers and legislators.  Davina lobbied at the Massachusetts State House and saw the successful passage of an update to the medical definition of infertility within the state.  She also testified before the Massachusetts Division of Insurance to request Oocyte Cryopreservation be a required benefit of infertility.  Working with medical directors, she presented recommended Oocyte Cryopreservation guidelines to insurers.  These companies are now offering Oocyte Cryopreservation to infertility patients as well as patients facing medical treatments which will render them infertile. 

Katie Falloon is a second-year medical student at Duke University School of Medicine in Durham, North Carolina. She graduated magna cum laude from Yale University with a degree in English.

Philip M. Rosoff, MD, MA, is a professor of pediatrics (oncology) and medicine at the Duke University School of Medicine and Duke University Medical Center in Durham, North Carolina. He is also chair of the center’s ethics committee and a member of the Trent Center for Bioethics, Humanities and History of Medicine. His research interests and scholarly work are in the area of medical resource allocation, especially rationing. His book Rationing Is Not a Four-Letter Word: Setting Limits on Healthcare will be published in spring 2014 by MIT Press.


1. Virtual Mentor. January 2014, Volume 16, Number 1: 63-69.

16. Compass Health Analytics. (2013). State mandated health insurance benefits and health insurance cost in Massachusetts. Retrieved from

17.  Center for Disease Control and Prevention. (2013). Assisted Reproductive Technology Surveillance, United States, 2010.  Surveillance Summaries, Vol. 62, No. 9.  Atlanta, GA: US Department of Health and Human Services.



Trackback from your site.

Davina Fankhauser

President - Fertility Within Reach

Comments (2)

  • Jennifer Eaton, M.D., M.S.C.I.



    Thank you for responding to this article. I am the director of ART at Duke (the authors’ institution) and I also found the article to contain many inaccuracies. One of my fellows and I wrote a correspondence piece that was published in the April edition of Virtual Mentor. I hope that our response provides a more accurate presentation of the data and clarifies many of the points raised by the authors.


    Jennifer Eaton, M.D., M.S.C.I.


    • Davina Fankhauser


      Thank you for your comment on this blog Dr. Eaton. Dr. Kenan Omurtag shared the good news with us that your response was published. Your work was more informative and less biased. I appreciate your efforts to clarify the facts.

      Our sincerest thanks for all you do to help patients and create accurate awareness around infertility treatment.

      All my best,
      Davina Fankhauser
      President, Fertility Within Reach


Leave a comment