Not everyone has the experience to share their view of Infertility treatment, over a 40 year time span, in a state pre and post an Infertility health benefit mandate. We are honored to share the perspective of Reproductive Endocrinologist, Dr. Selwyn Oskowitz. His words give us a better understanding how mandated benefits helped develop improved treatments for Infertility.
Treatment for Infertility in Massachusetts Before and After the Nation’s Best Infertility Mandate
Dr. Selwyn Oskowitz. April 30, 2012
With the 1987 landmark Infertility mandate, employed patients became eligible for comprehensive coverage for most Infertility treatments, including medications, IUIs, IVF and donor gamete treatments. Excluded were treatments involving gestational carriers and where the diagnosis was a previous sterilization, the mandate was less clear.
Prior to 1987 treatments were usually undertaken by Ob Gyns with an interest in infertility or who had a specific surgical expertise. There were very few Reproductive Endocrinologists and the vast majority did not perform IVF until after 1986. Ob Gyns did the workup whish was a lot more complicated that it is today. Patients were on monthly Temperature charts mailed in to their doctor awaiting further suggestions. Of the patient was not ovulating, Clomid was prescribed – often for 6 months without a follow up visit. Hypothalamic or ‘Clomid resistant’ patients were referred to specialty clinics for possible Pergonal use. Ovarian hyperstimulation syndrome (OHSS) was a dreaded and common occurrence. The Gyn units had an OHSS patient hospitalized every other week. These patients were critically ill and suffered severe pain, distended abdomens, catheters in their bladders and weeks of observation before spontaneous recovery. Multiple births were much more frequent as monitoring was difficult (no same day estradiols, no vaginal ultrasounds etc).
In 1987 Ectopic pregnancies were only just being treated by a few surgeons with laparoscopy with the majority still needing laparotomy. Tubal surgery however was common for pelvic infections, scar or endometriosis; many patients undergoing multiple laparotomies then ending up in an ectopic with yet another laparotomy. Insurance companies paid liberally for these surgeries and prolonged hospitalizations. Little was done to report success rates. Patients stopped treatment short of success in large numbers for the painful medical burden or not being able to afford Pergonal.
Research in IVF was started in MA as early as 1938 and made great progress after the first IVF Baby, Louise Brown, was born in 1978 in the UK. We had all the techniques validated from LH surge monitoring; Egg retrieval; sperm preparation but of course no egg insemination. MA law however appeared prohibitive of actual fertilization of the egg. But this new knowledge allowed us to wash sperm and enable the sperm to be placed intrauterine (IUI). This gave better outcomes than the then customary cervical inseminations.
In 1984 IVF became legal and available at the Beth Israel, Brigham and Womens hospital and one private group. The first IVF baby in MA was the result of the research led by Dr Melvin Taymor and Machelle Seibel at the Beth Israel Hospital. Selwyn Oskowitz (author) performed the first embryo transfer in this case and delivered the baby girl July 24th 1984. The stimulation was done with Clomid alone. There were long waiting lists and of course all retrievals were done by 1-2 hour laparoscopy with full anesthesia intubation and hospitalized. The lengthy time was due to the multiple infections / surgeries that had left behind more adhesions and obscured the ovaries.
Today we can perform retrievals by vaginal ultrasound, as an outpatient procedure with minimal anesthesia. And thanks to our magnificent insurance mandate, more patients can be treated to success, at a lower cost, with lower multiple births than in any non-insured state.
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