For a study, researchers sought to examine the relationship between state-mandated insurance coverage for infertility treatment in the United States and the use and indication for preimplantation genetic testing. A total of 301,465 in vitro fertilization (IVF) cycles were reported to the Society for Assisted Reproductive Technology between 2014 and 2016. Binomial logistic regression was used to investigate the relationships between state-mandated insurance coverage and the utilization of preimplantation genetic testing. Sex ratios were calculated using the neonate’s sex from each patient’s first successful cycle. The sex ratios were then evaluated based on state mandates and preimplantation genetic testing indications for elective sex selection.

Preimplantation genetic testing was used in 34% of IVF cycles in 2016, up from 17% in 2014. The growth was mostly driven by preimplantation genetic testing for aneuploidy. Preimplantation genetic testing was less common in jurisdictions with insurance coverage mandates than in states without mandates (risk ratio [RR] 0.69, 95% CI 0.67–0.71, P<.001). Preimplantation genetic testing for sex selection was also less common in states with requirements (RR 0.44, 95% CI 0.36–0.53, P<.001). The male/female sex ratio was higher in IVF cycles with preimplantation genetic testing for any indication (115) than in those without (105) (P<.001), and the use of preimplantation genetic testing specifically for elective sex selection had a significantly higher (164) male/female sex ratio than preimplantation genetic testing for other indications (112) (P<.001).

In the United Areas, the number of IVF cycles that included preimplantation genetic testing was growing, and it was highest in states where IVF is mostly self-funded. Preimplantation genetic testing for nonmedical sex selection was also more frequent in places where IVF was self-funded, and male kids were more likely to result. It was critical to keep an eye on these developments since they were contentious and might have ramifications for future population demographics.