In vitro fertilization availability and utilization in the United States: a study of demographic, social, and economic factors
ABSTRACT To characterize the demographic correlates of IVF availability and utilization.
Demographic analysis of public data.
Each of the 50 states in the United States was used as a unit of analysis.
Patients undergoing IVF, as demographically estimated.
Publicly available data were collected through the Society for Assisted Reproductive Technology and the Centers for Disease Control. The US Census Bureau data were collected by using software available from the Centers for Disease Control.
The number of physicians performing IVF and the number of IVF cycles per 100,000 reproductive-age women were used to estimate IVF availability and utilization.
In 2005, 1,031 providers performed 98,242 fresh IVF cycles in 430 centers. Overall availability was 2.5 IVF physicians per 100,000, and utilization was 236 IVF cycles per 100,000. Availability and utilization of IVF were highly correlated. Mean IVF availability and utilization were significantly higher in states with IVF insurance coverage. In adjusted analyses, IVF availability correlated positively with mandated insurance coverage, percentage of single persons, and median income. Utilization of IVF correlated with IVF availability, percentage urbanization, and percentage of individuals >or=25 years of age who had a bachelor's degree.
Lower rates of IVF utilization in some states are correlated with a lack of insurance coverage and decreased availability of physicians providing this service.
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ABSTRACT: To investigate the relationship between economic activities, insurance mandates, and the use of in vitro fertilization (IVF) in the United States. We examined the correlation between the coincident index (a proxy for overall economic conditions) and IVF use at the national level from 2000 to 2011. We then analyzed the relationship at the state level through longitudinal regression models. The base model tested the correlation at the state level. Additional models examined whether this relationship was affected, both separately and jointly, by insurance mandates and the Great Recession. Not applicable. Not applicable. None. Direction and magnitude of the relationship between the coincident index and IVF use, and influences of insurance mandates and the Great Recession. The coincident index was positively correlated with IVF use at the national level (correlation coefficient = 0.89). At the state level, an increase of one unit in the coincident index was associated with an increase of 16 IVF cycles per 1 million women, with a significantly greater increase in IVF use in states with insurance mandates than in states without mandates (27 versus 15 IVF cycles per 1 million women). The Great Recession did not alter the relationship between the coincident index and IVF use. Our study demonstrates a positive relationship between the economy and IVF use, with greater magnitude in states with insurance mandates. This relationship was not affected by the Great Recession regardless of mandated insurance coverage. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.Fertility and Sterility 12/2014; 103(2). DOI:10.1016/j.fertnstert.2014.10.042 · 4.30 Impact Factor
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ABSTRACT: Despite the growing use of assisted reproductive technologies (ART) worldwide, there is only a limited understanding of the economics of ART to inform policy about effective, safe and equitable financing of ART treatment. A review was undertaken of key studies regarding the costs and consequences of ART treatment, specifically examining the direct and indirect costs of treatment, economic drivers of utilization and clinical practice and broader economic consequences of ART-conceived children. The direct costs of ART treatment vary substantially between countries, with the USA standing out as the most expensive. The direct costs generally reflect the costliness of the underlying healthcare system. If unsubsidized, direct costs represent a significant economic burden to patients. The level of affordability of ART treatment is an important driver of utilization, treatment choices, embryo transfer practices and ultimately multiple birth rates. The costs associated with caring for multiple-birth ART infants and their mothers are substantial, reflecting the underlying morbidity associated with such pregnancies. Investment analysis of ART treatment and ART-conceived children indicates that appropriate funding of ART services appears to represent sound fiscal policy. The complex interaction between the cost of ART treatment and how treatments are subsidized in different healthcare settings and for different patient groups has far-reaching consequences for ART utilization, clinical practice and infant outcomes. A greater understanding of the economics of ART is needed to inform policy decisions and to ensure the best possible outcomes from ART treatment.Human Reproduction Update 10/2010; 16(6):603-13. DOI:10.1093/humupd/dmq013 · 8.66 Impact Factor
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ABSTRACT: Whilst the association between maternal periconceptional diet and adult offspring health is well characterised, our understanding of the impact of paternal nutrition at the time of conception on offspring phenotype remains poorly defined. Therefore, we determined the effect of a paternal preconception low protein diet (LPD) on adult offspring cardiovascular and metabolic health in mice. Male C57BL/6 mice were fed either normal protein diet (18% casein; NPD) or LPD (9% casein) for 7 weeks prior to mating. At birth, a reduced male:female ratio (P=0.03) and increased male offspring weight (P=0.009) were observed in litters from LPD compared to NPD stud males with no differences in mean litter size. LPD offspring were heavier than NPD offspring at 2 and 3 weeks of age (P<0.02). However, no subsequent differences in body weight were observed. Adult male offspring derived from LPD studs developed relative hypotension (decreased by 9.2 mmHg) and elevated heart rate (P<0.05), whilst both male and female offspring displayed vascular dysfunction and impaired glucose tolerance relative to NPD offspring. At cull (24 weeks), LPD males had elevated adiposity (P=0.04), reduced heart:body weight ratio (P=0.04) and elevated circulating TNF-α levels (P=0.015) when compared to NPD males. Transcript expression in offspring heart and liver tissue was reduced for genes involved in calcium signalling (Adcy, Plcb, Prkcb) and metabolism (Fto) in LPD offspring (P<0.03). These novel data reveal the impact of sub-optimal paternal nutrition on adult offspring cardiovascular and metabolic homeostasis, and provide some insight into the underlying regulatory mechanisms.AJP Heart and Circulatory Physiology 03/2014; 306(10). DOI:10.1152/ajpheart.00981.2013 · 4.01 Impact Factor