聚焦ASRM2025：IVF保险强制覆盖政策及保险保障，与活产率提高、治疗利用率上升相关
体外受精（IVF）保险强制覆盖政策及保险保障，与活产率提高、治疗利用率上升相关
美国得克萨斯州圣安东尼奥讯——在2025年美国生殖医学学会（American Society for Reproductive Medicine, ASRM）科学大会暨博览会上，研究人员发布了新数据，揭示了体外受精（in vitro fertilization, IVF）保险强制覆盖政策及保险保障对治疗利用率和活产率的影响。研究表明，当IVF纳入保险覆盖范围后，无论经济状况如何，也无论面临何种医疗难题，更多家庭都能获得生育机会，实现家庭扩容。
两项研究分别从不同维度探讨了保险政策对IVF使用情况及结局的影响：
O-215：评估各州法定医学必要性生育力保存政策对治疗利用率的影响：该研究分析了保险覆盖要求对“因接受化疗等持续治疗而需生育医疗服务”患者使用IVF治疗的影响。研究发现，针对接受生育治疗的癌症患者，法定IVF保险覆盖政策使患者的周期利用率提高了42%，且这一效果不受种族或民族因素影响。
O-224：美国体外受精（IVF）保险保障与治疗结局——基于全国索赔数据的私人参保患者研究：在另一项相关研究中，研究者探讨了保险保障对IVF结局的影响。研究发现，拥有保险保障与更高的累积活产率显著相关。
“无论收入水平如何，每一位希望组建家庭的人都应能获得改变人生的生育医疗服务，从而实现生育愿望。没有人应该在癌症治疗和组建家庭的机会之间做出选择。IVF保险强制覆盖政策是帮助癌症患者实现家庭梦想的关键工具。”生育力保存联盟（Alliance for Fertility Preservation）执行董事Joyce Reinecke表示。
尽管2023年美国IVF使用率有所上升，全年借助IVF诞生的婴儿超过9.5万名，但ASRM估计，不足25%的不孕夫妇能充分获得不孕治疗服务。
这些研究共同推动了ASRM的使命——通过循证研究、临床创新和政策倡导，改善生殖健康水平。
该两项研究还将作为增刊发表于ASRM的旗舰同行评审期刊《生殖与不孕》（Fertility and Sterility）。
附：英文摘要原文
O-215：
OBJECTIVE: To determine whether state mandates for fertility preservation in individuals undergoing gonadotoxic therapy result in greater utilization of oocyte and embryo cryopreservation treatments.
MATERIALS AND METHODS: Using deidentified cycle data from SART, we analyzed the number of patients and cycles performed for fertility preservation in the setting of gonadotoxic therapy in states with and without mandated coverage for this indication. We compared our primary outcome to the number of reproductive-aged women by state and race/ethnicity, and as a percentage of all cryopreservation cycles. Our secondary outcome analyzed differences in sociodemographic and reproductive characteristics between those undergoing cryopreservation for gonadotoxic therapy in states with and without mandates. We categorized patients into one of two cohorts based on whether an oncofertility mandate was in effect at the time of their oocyte or embryo cryopreservation. We also stratified patients and cycles by the timing of oncofertility mandate implementation to determine the effect of such policies over time, with respect to race. We compared cohorts using Fisher’s exact test, Pearson’s chi-square test, or the Wilcoxon rank sum test, where appropriate.
RESULTS: We identified 5,818 unique patients undergoing oocyte and embryo cryopreservation cycles with an indication of fertility preservation for gonadotoxic treatment between 2016 and 2022. The most common race of all identified patients was white (n=2782, 47.82%). More Asian and Hispanic/Latino patients had cycles performed in mandate states. Patients residing in a mandated state were significantly more likely to pursue more than one cycle (12.54% v 9.06%, p<0.001), although the percentages were low in both cohorts. When comparing the effect of oncofertility mandates with respect to time, an increase in the number of total oncofertility cryopreservation cycles performed in states with a mandate was appreciated with respect to policy implementation (476 cycles one year prior to mandate, 645 cycles the year of mandate implementation, 676 cycles one year after mandate implemented). This represented a 42% increase in utilization the year following an insurance mandate. In each year, most cycles were performed in white patients.
CONCLUSIONS: Oncofertility insurance mandates increased the utilization of cycles by 42% among patients seeking medically indicated infertility care. When analyzing the effect of insurance mandates with respect to race, it is reassuring that no discrete trends were observed, which suggests these policies benefit patients regardless of race/ethnicity. However, the overall absolute number of cycles performed among individuals seeking reproductive prior to pursuing gonadotoxic therapy was numerically low.
IMPACT STATEMENT: Current oncofertility insurance mandates have an equitable impact on patients, regardless of race/ethnicity; however, overall utilization of infertility services for this indication remain low. Further work is needed to understand how these policies can increase overall access to reproductive care.
Presenting Author
David Boedeker
Walter Reed National Military Medical Center
O-224：
OBJECTIVE: To assess the association between insurance coverage for in vitro fertilization (IVF) and reproductive outcomes, including live birth and multiple birth rates.
MATERIALS AND METHODS: Using 2013–2020 United States claims data for insured individuals from Optum's de-identified Clinformatics® Data Mart Database, we developed and validated an algorithm to identify covered and uncovered IVF cycles based on observed patterns of pelvic ultrasounds, hormone assays, and antibiotic use. We developed a second algorithm to identify annual employer-provided IVF coverage based on the percentage of paid IVF claims in a given year. IVF cycles were considered insured if the patient’s employer offered IVF coverage during that calendar year. Live births were identified using diagnostic and procedural codes. Our outcomes of interest were multiple birth rate, cumulative live birth within 2.5 years of the first IVF cycle, live birth rate per cycle, and number of IVF cycles initiated. We assessed the association of reproductive outcomes with IVF coverage status using Logistic and Poisson regression models adjusted for year, age, comorbidities, state of residence, and employer size..
RESULTS: Our final sample included 8,277 patients undergoing 15,876 IVF cycles (Table 1). Patients with insurance coverage for IVF were more likely to have a live birth within 2.5 years (OR 1.54, 95% CI 1.37-1.74) and had higher rates of live birth per IVF cycle (OR 1.16, 95% CI 1.06-1.28). Also, patients with IVF coverage initiated significantly more IVF cycles (2.0 vs 1.7, p<0.001). The multiple birth rate did not differ significantly between groups.
CONCLUSIONS: Insurance coverage for IVF was significantly associated with a higher cumulative live birth rate but not multiple birth rate. This finding was driven by higher live birth rates per cycle and more IVF cycles initiated among insured patients.
IMPACT STATEMENT: Cost is the greatest barrier to fertility care in the United States. Insurance coverage for IVF improves access to care and may improve live birth rates by facilitating patients to seek care earlier and pursue multiple cycles of IVF. Given increasing interest in expanding access to IVF in the United States, our findings will help inform future health policy.
Table 1. Birth Outcomes Among Covered and Uncovered IVF cycles
Presenting Author
Benjamin J Peipert
University of Pennsylvania, Division of Reproductive Endocrinology and Infertility
