The impact of health benefit design on patients with infertility.

Abstract

Objectives: Assisted reproductive technology (ART) is a treatment option available to patients diagnosed with infertility. This study evaluated the impact of infertility benefit coverage on ART utilization and pregnancy-related outcomes, addressing a gap in previous research.

Study design: Retrospective analysis.

Methods: This study utilized the Workpartners Research Reference Database containing claims from self-insured employers in the US from 2010 to 2022. Women aged 18 to 42 years with at least 1 infertility diagnosis and at least 2 years of continuous enrollment after the initial infertility diagnosis were classified into 1 of 2 cohorts: high cohort (those with both infertility diagnostic and treatment coverage) or low cohort (those with only diagnostic coverage or no diagnostic nor treatment coverage). Binary outcomes were analyzed using logistic regression and continuous outcomes were analyzed using 2-stage stepwise regressions. Models controlled for differences in employee demographics, job-related variables (exempt status, full-time status, hourly vs salary, annual salary), and number of insured dependents.

Results: Of the 10,820 women who met the inclusion criteria, 7589 (70.1%) were in the high cohort and 3231 (29.9%) were in the low cohort, with mean (SE) ages of 34.4 (0.06) vs 33.5 (0.11) years, respectively (P < .0001). The high cohort had a higher adjusted likelihood than the low cohort of using ART medications (P < .0001) and having ART procedures performed (P < .0001). The high cohort also used a higher number of unique ART medications and procedures. The likelihood of becoming pregnant with any ART utilization was 69.6% for the high cohort and 65.3% for the low cohort (P = .0089). The only significant difference in pregnancy-related complications was claims for oligohydramnios (9.3% vs 7.2%, respectively; P = .0294).

Conclusions: Health benefit design that includes infertility treatment coverage resulted in significantly higher use of unique ART medications, number of ART procedures performed, and successful pregnancy outcomes.