Health Care Bill Offers Little Comfort to Infertile Couples

No more pre-existing conditions, but IVF still not covered.

ByABC News
April 22, 2010, 5:02 PM

April 23, 2010— -- Jody and Greg Miller of Potomac, Md., say they were fortunate to give birth to triplets in 2000, after spending $22,000 on in vitro fertilization because their insurance company didn't cover fertility treatments.

But when their insurance premiums were costing them one-third of their net income as self-employed workers, they applied to Care First -- Blue Cross/Blue Shield hoping to get a more reasonable policy for the family.

Instead they received a letter accepting their three children, but the Millers were rejected for having two pre-existing conditions: "infertility" and "spousal infertility."

"This was very alarming and extremely concerning," said Jody Miller, 42, who testified before Congress last year during the health care debate. "I have also never heard of spousal infertility. Is 'spousal cancer' or 'spousal HIV' terms that are used?"

Insurance companies will no longer be able to turn away couples for any kind of pre-existing condition, including infertility, because of sweeping health care reform that will go into effect in 2014.

Couples like the Millers -- she is an exercise physiologist and he owns a carpentry business -- who are relegated to high-risk pools, are excited that they might soon be able to buy individual insurance policies at reasonable rates.

Though couples can't be turned down for health insurance because of infertility, that doesn't necessarily mean they'll get coverage for fertility treatments.

For the 7.3 million couples in the U.S. who struggle with infertility, the new health care bill carries no mandates to cover the soaring cost of assisted reproduction procedures like IVF and egg donation.

"The law itself is fairly silent on what exact benefits have to be offered -- that's yet to be determined," said Sean Tipton, spokesman for the American Society for Reproductive Medicine (ASRM).

"I am not terribly optimistic that this country is suddenly going to treat infertility appropriately," he said. "We have a crumby history."

The average cost, according to ASRM, is about $12,400 a cycle, but "accessory procedures" -- such as sperm injection and hatching the egg -- can up the price tag. The cost of a donor egg can exceed $5,000.

Infertility -- defined as the inability to conceive after one year of unprotected intercourse (six months if the woman is over age 35) or the inability to carry a pregnancy to live birth --- affects an estimated 1 in 8 couples in the United States, according to RESOLVE, the National Infertility Association.

Of the 62 million women of reproductive age in 2002, about 1.2 million, or 2 percent, had an infertility-related medical appointment within the previous year, and 10 percent had an infertility-related medical visit at some point in the past, according to the Centers for Disease Control.

In vitro fertilization -- the most common type of assisted reproductive technology -- was pioneered in 1978 by doctors in the United Kingdom, and has been used in the United States since 1981.

In 2008, 361 U.S. clinics reported data to the Society for Assisted Reproductive Technology on 140,795 treatment cycles leading to the birth of 56,790 babies. The success rates for healthy women under 35 are as high as 50 percent.

"Jody's story in startling," said Barbara Collura, executive director of RESOLVE, who has heard increasing complaints from couples worry about the financial burden of fertility treatments.

Josie, a 42-year-old from Virginia Beach, Va., and her husband have visited several clinics to inquire about IVF. Some charge as much as $17,000 for just one try.

"In vitro is our only option but we cannot afford this and our insurance doesn't cover it," said Josie, who didn't want to share her last name.

"We also have tried to purchase health insurance on our own but couldn't find one to cover fertility," she said. "Financing such a dream is impossible as both my husband and I don't have the best credit. Our dream is fading."