“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 #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
Dr. Rosoff and Katie Falloon state that “the suffering experienced by the infertile must be greater and qualitatively different from that imposed by simply not being in the pregnant state and giving birth”. Those words trivialize what infertility is. It is not “simply” about not being pregnant. Infertility is a disease involving the reproductive system. Yes, there is emotional strain, largely connected to the fact that an individual’s body is not acting as it medically should, which can lead to patients feeling helpless, anxious, and depressed13. In addition to the mental health variable, there are also physical ailments that infertility patients may endure. Depending on the cause of infertility, the symptoms could vary from men having a constant discomfort or pain in their testicles to women, experiencing pain and other side effects from Endometriosis or Polycystic Ovarian Syndrome. Let’s not forget the women with a history of recurrent miscarriage due to a blood disorder, endocrine issue, or immune deficiency. Within online support communities you will find patients comparing their miscarriages to labor pains. 14. Yes, there is also physical pain associated with failures of the reproductive system.
Retort #5: The Cost of Infertility Health Benefits
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.
13. Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol. 1993; 14 Suppl: 45-52.
14. ftmbbgrl, (2011, June 3). Miscarriages and Labor Pains. [Msg 1 – 10] Message posted to http://www.whattoexpect.com/forums/july-2011-babies/archives/miscarriages-and-labor-pains.html
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