Female physicians identified cost and access barriers to fertility care, which are especially relevant as more US women are choosing to delay childrearing.
A clinical opinion article published in the American Journal of Obstetrics & Gynecology evaluated cost and access barriers to fertility care among female physicians, with researchers proposing solutions that may help make the process more feasible and inclusive.
“Facing an infertility diagnosis while being a female physician presents a real and relevant struggle for 1 in 4 women. Currently, there is a gross absence of adequate fertility insurance coverage for all female physicians,” the authors wrote.
Over the past 2 decades, more women have chosen to delay having children. This is especially relevant in female physicians who are delaying childrearing by 7 years more than the general population, one study found. The article associates this statistic with economic burden, or “financial toxicity,” and a lack of insurance coverage.
The average of entering residency for physicians is around 27 years old, which would make the average physician around 31 to 34 years old by the end of residency and fellowship training. According to the 2019 Accreditation Council for Graduate Medical Education, there are almost 5500 active physician trainees in the United States, of whom 83.8% are female.
This population of female physicians works maximum hours during their childbearing years, while having a high debt-to-income ratio. In 2019, the cumulative medical school debt at the time of graduation was around $241,600, while average starting residency salaries were $61,000.
Furthermore, a 2021 Survey on Fertility Benefits commissioned by RESOLVE: The National Infertility Association found that 51.4% of female physicians reported moderate to severe burnout associated with reproductive disorders, such as infertility or recurrent miscarriages. Additionally, 66% of responders reported low levels of personal accomplishment.
There are many cost barriers when it comes to fertility care for women in the United States. According to the American Society of Representative Medicine, only 24% of infertile couples have access to the care they need to get pregnant. This is primarily due to a lack of insurance coverage by employers. For example, in 2015, only 32% of “megaemployers” (companies with more than 50,000 employees) offered assisted reproductive technology (ART) as part of their health benefits program.
Out-of-pocket costs for a single cycle of in vitro fertilization (IVF) can range between $12,400 and $19,000, according to prior studies. A fresh embryo transfer costs an additional $3045. Typically, couples will need to have more than 1 IVF cycle, accumulating a total cost of $100,000 to $200,000 to achieve a healthy live birth.
As of 2021, 19 states (Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New Hampshire, New York, Ohio, Rhode Island, Texas, Utah, and West Virginia) had infertility coverage mandates in place. However, laws vary state by state, and most employee coverage is capped by “lifetime maximums” that range anywhere from $15,000 to $100,000.
In addition, insurance plans can be unclear in explaining what the benefits cover. IVF is not the initial treatment received by many couples. Rather, they are often given simpler treatments that can quickly reach over the lifetime maximum coverage.
Disparity in reproductive coverage is especially prominent in lesbian, gay, bisexual, transgender, and queer populations. For example, the infertility mandate in Texas states that “the fertilization or attempted fertilization of patients oocytes is made only with sperm of the patient’s spouse.”
Given what the article calls a “gross absence of adequate fertility coverage,” the authors suggest possible solutions, including advocacy for state-mandated fertility coverage, transparent employer-employee ART rates, and increased awareness within medical programs regarding the effects of delaying childrearing and preventative measures. Another solution could be to implement fertility screening into routine women’s wellness visits to help address risk factors and increase fertility awareness.
The authors believe that transparency and awareness can help bridge the gap between reproductivity and equal and accessible care.
“Overall, the idea that access to reproductive medicine can vary by geographic location, sexual orientation, and employer highlights a lack of infertility coverage standards. Despite these factors, all people should have equal access to reproductive medicine, which we can obtain through institutional transparency to help create national standards in insurance coverage,” concluded the authors.
Veade A, Martin C, Dombrowski M, Omurtag K. Female physician infertility: the lack of adequate insurance coverage. Am J Obstet Gynecol. Published online September 5, 2022. doi:10.1016/j.ajog.2022.08.049