Should IVF be covered as a medical necessity?

Fascinating discussion going on in the MedBlogosphere about in vitro fertilization and whetehr it should be covered by insurance carriers. I'm going to link to InsureBlog's post on it, and from there you can find others.

Make sure you read the comments too.

Frankly my gut reaction was to say, no, IVF is not medically necessary, bearing children is not medically necessary. Even though stats indicate that women who don't bear children are at higher risk for some cancers, I still don't think that makes it medically necessary to have children.

Disclosure: I say all of this as a childless by choice 41 year old woman.

Of course, as soon as you make such confident statements a case arises that challenges it: like the woman who comments on Henry's blog about her endometriosis, and the fact the carrying a child to term is one way to cure it (the other being the antithesis of childbirth: drugs that would put her into early menopause.)

But let's leave aside her exception for the moment and address only cases where childbirth is not the cure for an underlying medical problem, but a desired outcome that is impeded by an underlying medical problem. The same commenter said "In summary, pregnancy is normal. Infertility is abnormal and largely traced to medical reasons." And I'm not sure I buy that argument. How do we know that? There's no way to say this without offending someone: but couldn't infertility or inability to bring a fetus to term be a natural thing too?

The reason the discussion is so fraught with peril is that, like in so many other things, the existing situation seems plagued by inconsistencies. Well, yes, if men can get Viagra covered to address their erectile dysfunction (I mean, isn't that also an underlying medical problem impeding a desired outcome?) then why shouldn't women get IVF covered? (Leaving aside the massive cost differential.)

And if certain male causes for infertility are treated (the same commenter writes: "Male factor infertility due to varicoeles is readily treated by surgery and covered as medically necessary") then clearly female causes for infertility should be too, right?

I'm all for fair and equal treatment.

But if I were to look at it out of context of what other treatments are covered, and if I were to look at cases of infertility caused by underlying medical problems that aren't painful and life-threatening (a lot of "what-if's" I know) I would still have to say it's elective.

But certainly I must be biased and resistant to supporting a message that bearing children is somehow necessary to have a "full"or "normal" or "quality" life!

Comments

[hgstern]

.
Excellent post, Elisa, and thanx for the link!

As you mentioned, the issue is "fraught with peril," primarily because it is so volatile.

And I agree that there are procedures/med's that, strictly speaking, have no business being covered. The fact that they are doesn't ameliorate the fact that IVF shouldn't be either.

BTW, I'm having trouble with trackbacks to this post; could be me (likely) but I wondered if you've noticed TB problems, as well.

[Elisa Camahort]

Thanks Henry. I haven't noticed any trackback issues, but, like tagging, I often forget to even use trackbacks at all!

[Jenn]

Interesting points. I wrote my own post on this too. I don't think it will ever be considered medically necessary, but I do think it should be covered. I do not think benefits should be denied on the basis of diagnosis. It's an extremely volatile and emotionally charged issue. Add in the political issues with "left over" embryos and stem cell research and it's even more volatile.

[Linda]

IVF is so costly, time consuming and prone to failure but there are some people who have found alternatives that worked for them.

Of course these might not work for you but there’s an excellent source of information, publications and resources to help women with fertility and infertility at my website:

Your Fertility

Linda