Access to and use of infertility services in the United States: framing the challenges

Improved underwriting of infertility care must constitute a central goal of the professional societies concerned with access to and use of United States infertility and assisted reproduction technology services.

Eli Y. Adashi, M.D., M.S., Laura A. Dean, B.A.

Volume 105, Issue 5, Pages 1113-1118


An overview of access to and use of general infertility and assisted reproductive technology (ART) services in the United States shows the ever-use of infertility services features declining trends. Moreover, the use of ART services lags relative to other member nations of the Organization for Economic Co-operation and Development (OECD). Access to and use of general infertility and ART services is primarily undermined by a severely constrained underwriting universe dominated by self-insured employers and by a finite number of state infertility insurance mandates. The contribution of traditional public and private payers to the underwriting of ART is limited. As compared with OECD member nations wherein the access to and underwriting of general infertility and ART services is universal, the current status quo in the United States can only be characterized as lugubrious. Further, the current state of affairs is socially unjust in that the right to build a family in the face of infertility appears to have become a function of economic prowess. Given the dominance of the self-insured employers as underwriters of general infertility and ART services, advocacy directed at this interest group is likely to prove most productive. Improving the state of underwriting of general infertility and ART services in the United States must be embraced as a central moral imperative and as an unwavering strategic goal of the professional societies entrusted with the reproductive health of women and men.

  • Jason Kovac

    important topic. Jim Dupree has published a few articles on this subject with a focus on the male side. One was in an issue of the Asian Journal of Andrology that I recently edited (PMID: 27030084) along with a commentary that I wrote with Ryan Smith and L. Lipshultz (PMID: 27048787). Another paper dealing with barriers from Dupree, Jim Smith and Ajay Nangia (PMID: 27054307). Important topic worthy of discussion.

  • Hopefully this article can help start a larger discussion about the enormous challenges regarding access to infertility services in the US. It appears paradoxical and frustrating that while great advances in our field have equipped providers with more options than ever to help patients create families, there is a declining trend of for the ever-use of infertility services.
    Even though the right to procreate may be seen by many as a fundamental human right, there appears to be a widespread misconception that infertility treatment is an entirely elective service (much like elective plastic surgery).
    If this perception cannot be changed by advocacy efforts, the gap between those with and without access to reproductive services will only increase.
    It can only be hoped that this special F+S section, including this article, can increase awareness of the issue, and kick-start efforts that will eventually lead to the necessary changes in perception and policies.

    • Eli Adashi

      Alex, thanks for the thoughtful comments! All best. Eli

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