Five surprising infertility and IVF facts you should know

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An egg with sperm around it like a halo

There is a lot of misinformation and willful denial about infertility and the values of IVF and other assisted reproductive technologies (ART). These are a handful of the dizzying facts I’ve learned after three rounds of IVF and three years of navigating infertility.

1. Not everyone who pursues IVF can’t conceive.

There are many reasons someone who can naturally conceive a pregnancy would pursue IVF. These aren’t the reasons that Paris Hilton chose IVF and, unfortunately, they don’t receive the visibility (or insurance coverage!) they deserve.

People with cancer who hope to have a genetic child may choose to freeze their eggs or embryos with IVF to preserve their fertility before undergoing treatment. Treatments like chemotherapy and radiation destroy sperm and eggs, causing infertility.

Those who carry life-altering and limiting genetic disorders like muscular atrophy may pursue IVF to select embryos unaffected by the genetic disorder to transfer.

In my case, I carry a chromosome inversion, which increases my risk of pregnancy loss due to genetically atypical pregnancies. With IVF, people like me can use a test called PGT-SR to test our embryos and select ones for transfer that are unaffected.

2. IVF coverage varies significantly by state and employer.

Individual states can decide whether insurance companies must offer IVF coverage and whether any of it will be paid for. Currently, only 13 states have passed IVF insurance laws. Even in the most progressive seeming state, California, IVF coverage is not required. California law requires group insurers to offer infertility coverage (but not cover it) and this excludes IVF. To compare, Massachusetts currently requires employers with more than 50 employees to offer IVF coverage and insurers are required to sponsor three IVF cycles, up to $100,000 total.

Your employer’s insurance coverage will often depend on your state’s IVF insurance laws. For example, even though I work for one of the largest employers in my state—the University of California—because the state itself does not mandate coverage, the university system takes its cue from the state and offers zero IVF coverage.

And remember in #1 above where I mention that cancer patients may decide to freeze their eggs or embryos before undergoing treatment? Only 12 states have fertility preservation laws on the books, which require insurers to cover some of this treatment.

3. Infertility disproportionately affects women of color.

Infertility has a PR problem. Much of the depictions of infertility and IVF center upper middle-class white families. Worse, conversations in popular media revolve around celebrities choosing IVF to have multiples or to choose their future baby’s eye color.

In reality, infertility disproportionately affects women of color, especially Black women, who experience infertility at twice the rate of white women. That IVF might only be an option for white elites is the self-fulfilling prophecy of the stigmas around IVF. If insurers and employers see IVF as an elective procedure for the 1% and thus don’t offer coverage, they ensure that only the 1% can afford it.

When the University of Michigan began offering its employees IVF coverage, it saw that a more equitable distribution of people using the benefit, with IVF use increasing more than nine times among women in the university’s lowest-salary bracket.

4. Infertility is classified as a disease but not treated as one.

Infertility is recognized as a disease by the American Medical Association, the American Society for Reproductive Medicine, the American Congress of Obstetricians and Gynecologists, and the World Health Organization.

Despite this classification, infertility’s known cures are often considered elective and uncovered by insurance.

5. It may take more than one round of IVF to be successful and that’s OK.

To add to IVF’s stigma is a misunderstanding of biology.

Employers who are resistant to adding IVF coverage will often cite the success rate of one round of IVF—which varies based on a number of factors, but is about 50% in women under 35 years old—as if it were a detraction from its benefits.

If IVF is our best cure for many forms of infertility, and it may take two rounds to produce a viable pregnancy, then the goalposts of “success” for IVF should be considered the average number of rounds it takes to produce a viable pregnancy, not just one round of IVF.

With IVF, reproductive endocrinologists are working with a multitude of changing biological variables from the patient’s age and health to their genetic composition. In addition, some people respond well to certain drug dosages, others don’t; some people have more follicles—or chances for embryos—than others; etc. It’s like trying to play chess with a chameleon. And yet it can work more than 1/2 of the time. To me, it’s a feat, not a caveat.

Can you imagine if you had cancer and radiation therapy was the only option, yet because radiation therapy is not always 100% successful the first time, your insurance doesn’t cover it? That’s what we do with IVF.

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