Insurance mandates and trends in infertility treatments

Objective: To examine the relationship between insurance mandates and the utilization and outcomes of assisted reproductive technologies (ART). Design: Using clinic-level data from 1990 to 2001, we examined differences between states with and without insurance mandates in rates of utilization and outcomes of ART using multivariable least squares regression. Setting: National clinic registry data. Patient(s): Clinics performing ART, no patient-level data. Intervention(s): The type of insurance mandate in each state during each year of the study. Main Outcome Measure(s): Cycles per 1,000 women aged 25-44 years, live births per 1,000 cycles, and multiple births per live ART birth. Result(s): Use of ART grew rapidly during the 1990s and grew most quickly in states that adopted comprehensive insurance mandates. Compared with states without mandates, births per cycle were 4% lower and multiples per ART birth were 2% lower in states with comprehensive mandates. Conclusion(s): Comprehensive insurance mandates are associated with greater utilization of ART and lower rates of births per cycle and multiple births per ART birth. Whether the differences in outcomes are due to differences in embryo transfer practices or to patient characteristics is unclear.