The following is a summary of “Impact of insurance mandates on donor oocyte utilization: an analysis of 39,338 donor oocyte cycles from the Society for Assisted Reproductive Technology registry” published in the December 2022 issue of Obstetrics & Gynecology by George et al.
A total of 19 states have approved laws requiring insurance companies to cover assisted reproductive technologies, and regional differences in vitro fertilization prices were substantial. As a result, it has been discovered that the use of assisted reproductive technology varies by location and is related to the requirement for insurance. However, it was uncertain if patients using donor oocytes differed geographically. According to the insurance requirement status of the Society for Assisted Reproductive Technology facility where the assisted reproductive technology cycle was done, researchers, for a study, sought to identify the patient and cycle-specific factors related to the use of donor oocytes.
The 39,338 donor oocyte cycles and 242,555 autologous oocyte cycles carried out in the United States between January 1, 2014, and December 31, 2016, were included in the retrospective cohort analysis utilizing national data obtained from the Society for Assisted Reproductive Technology registry. The stratification of cycles was based on the insurance requirements of the state where the assisted reproductive technology cycle was carried out: comprehensive (coverage for at least 4 cycles of ART), limited (coverage for just 1-3 cycles), offer (insurance requirements exist but do not cover ART treatment), and no mandate. The recipient’s prior autologous assisted reproductive technology cycles represented the main outcome. Age, serum FSH level, frozen donor oocyte use, day of embryo transfer, number of embryos transferred, clinical pregnancy rate, and live birth rate were the secondary outcomes. Analysis results were adjusted for recipient age, the number of transplanted embryos, and the day of transfer.
Prior to using donor oocytes, patients in no mandate (mean, 1.1; standard deviation, 1.6) states underwent fewer autologous assisted reproductive technology cycles than those in the offer (mean, 1.7; standard deviation, 2.5; P<.01), limited (mean, 1.5; standard deviation, 2.5; P<.01), and comprehensive (mean, 1.7; standard deviation, 2.0; P<.01) states. In comparison to patients in the offer (relative risk, 0.54; 95% CI, 0.52-0.57), limited (relative risk, 0.50; 95% CI, 0.46-0.54), and comprehensive (relative risk, 0.94; 95% CI, 0.89-0.99) states, patients in no mandate states were more likely to use frozen oocytes. Regardless of insurance requirements, clinical pregnancy and live birth rates among receivers of donation oocytes were comparable.
Patients without state-mandated insurance coverage of assisted reproductive technology were more likely to use frozen donor oocytes and undergo fewer autologous in vitro fertilization cycles than their counterparts in states with partial or full insurance coverage, despite having similar ages and ovarian reserve parameters. The variations in the use of donor oocytes emphasize the costs involved in using assisted reproductive technologies in uninsured jurisdictions.