Impact of state insurance mandates on in vitro fertilization utilization among patients with recurrent pregnancy loss

OBJECTIVE: To evaluate if state in vitro fertilization (IVF) insurance mandates with language inclusive of patients with recurrent pregnancy loss (RPL) were associated with increased utilization of IVF for this indication in 2021. MATERIALS AND METHODS: State IVF mandate data from 2021 were collected from RESOLVE.org and verified using state government websites. Two clinicians independently assessed mandate language for inclusion of patients with RPL. IVF cycle data from 2021 were obtained from the Center for Disease Control's Assisted Reproductive Technology Report. A chi-squared test compared IVF cycles performed for RPL in states with IVF mandates inclusive of RPL, mandates exclusive of RPL, and no mandate. RESULTS: As of January 2021, 12 states had IVF mandates, six (50.0%) of which included RPL as an indication. The proportion of IVF cycles for RPL was higher in states with mandates inclusive of RPL (6,303/72,327 cycles, 8.7%) compared to those with mandates exclusive of RPL (5,288/92,648 cycles, 5.7%; p < 0.001) and states without a mandate (14,677/248,801 cycles, 5.9%; p < 0.001). The proportion of cycles for RPL was significantly lower in states with exclusive mandates compared to those without any mandate (p = 0.035). CONCLUSIONS: States with IVF mandates inclusive of RPL performed 53% more cycles for this indication than those with exclusive mandates or no mandate. Though RPL is not currently an accepted indication for IVF, future research may demonstrate utility of IVF for specific subgroups of patients with RPL, such as those with balanced translocations. Mandates should maintain inclusivity in defining who is eligible for fertility coverage so as not to exclude patients from accessing care as reproductive medicine advances.