Assessing Inequalities in Infertility Care Among Women
The World Health Organization classifies infertility as both a disease and a disability.
The World Health Organization classifies infertility as both a disease and a disability. Internationally, it is ranked as the fifth most serious disability in women. Despite this, access to infertility care is cost-prohibitive for millions of people in the United States.
A recent article published in the AMA Journal of Ethics describes the healthcare inequity surrounding infertility.
Infertility is defined as the inability to achieve a viable pregnancy within a year of attempting to conceive. More than 7 million women in the United States have used infertility services. Women who are infertile are twice as likely to suffer from anxiety and depression compared with fertile women.
"The Universal Declaration of Human Rights of 1948...states that all people have a right to found a family," noted the authors. "However, reproductive autonomy is being threatened by the exorbitant costs associated with infertility treatment."
The average cost of 1 IVF cycle, for example, is more than $12,000. Yearly fees for egg and embryo storage clock in at about $1000. Only a third of the states in the country offer infertility coverage mandates for private insurers. There is no coverage at all for patients with public or federal insurance.
Minority patients face additional obstacles when seeking treatment. African American and Hispanic women are underrepresented in the infertility clinic population, even though they have higher rates of infertility. Minority patients also face poorer outcomes when receiving treatment. African American, Hispanic, and Asian women had lower clinical pregnancy rates and live birth rates after IVF than white women.
"Infertility is a disease with a substantial psychosocial burden, and the lack of affordable options may have significant detrimental effects on the quality of life of millions of Americans," the authors wrote. "Infertility is implicitly designated as a disease undeserving of financial support, leaving many patients unable to fulfill their reproductive goals."
Insogna IG, Ginsburg ES. Infertility, inequality, and how lack of insurance coverage compromises reproductive autonomy. AMA J Ethics. 2018;20(12):E1152-E1159.