Feb 15, 2009

Mandating IVF coverage

In 2002, Harvard Medical School researchers found, unsurprisingly, that compared with women who pay out of pocket, those whose insurance fully covered IVF were significantly less likely to have multiples since they chose to have fewer implanted embryos. And while international comparisons are fraught with confounders, it's worth noting that Sweden and Australia have almost twice as many IVF births per capita as we do, yet their infant mortality rates remain comfortably lower. At least one difference may be that their national health insurances subsidize IVF, and thus there is less incentive to implant multiple embryos per cycle.


Taken together, America has selected a policy that encourages multiples. Since insurers aren't compelled to cover costs for IVF, self-paying women attempt to get pregnant in as few cycles as possible. As a result, officials find it hard to justify legally restricting how many embryos can be implanted. Since they're paying for it, the thinking goes, women should be free to implant as many embryos as they wish. The result? More multiples, more costs, poorer child health, and, on occasion, bizarre cases like that of Nadya Suleman.

Having children is not a right. I shouldn't have to pay higher health insurance premiums--were I lucky enough to even have health insurance--to finance someone's unrequited maternal instinct.

And as for Nadya Suleman, how about screening patients for psychological problems? Even plastic surgeons do this and people who have a mania for repeated plastic surgery are only hurting themselves. And they aren't doing it on the taxpayer's dime.

Reproductive specialists have a responsibility to the lives they are creating as well as to their primary patients. Clearly, this unemployed single mother with six children already has more than a natural, human desire to be a parent. It's become an obsession that's been fed by her doctor, who looks to be a sort of Dr. Frankenstein of infertility.

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