Should IVF Coverage Be Mandatory?
A couple of Decembers ago, I got an email from Resolve, the national infertility organization — a plea for end-of-year, tax-deductable donations. “Imagine a world where fertility treatment didn’t exist …” began the missive.
It had been years since I looked to Resolve for aid in my finally defunct effort to have a family. The organization claims to serve a dual purpose: to prove information and support to those pursuing children, and reconciliation to those who wind up without. But the overwhelming number of communications and services, and the only lobbying activities – urging Congress to pass laws to make insurance coverage for fertility treatment mandatory — were geared towards the baby quest.
So I deleted their emails after a quick skim. But having planted the idea of a world where fertility treatments didn’t exist, I couldn’t resist an honest answer: “I honestly wish they didn’t!”
This spurred an instant response, offering a plea for my “healing” – as if only a wrong-thinking person could even question the fertility system.
I hit the reply key, and then typed in: “The fertility industry makes those of us for whom the system didn’t work even more of an anomaly than we already are.”
Within minutes, a Resolve staffer called. She stressed that Resolve was there to listen to people like me.
“Good. All I’m saying is — if infertility is defined as an illness, then that makes those of us without children sick and abnormal, right? I can’t reconcile to my situation if society can’t reconcile itself to me. Plus – I have a real illness – having infertility over the age of 35 isn’t an illness, it’s biology.”
The staffer was dumbfounded.
I continued, “I’ve worked hard for the little financial security I have, so I’m really cheap and risk-averse. I knew most IVF’s in my age group failed. If it were a stock, I wouldn’t have bought it. But because it was someone else’s financial risk – I gave it a shot. But I’d never have gambled on it with my own money. I’d never have got sucked into the emotional maelstrom. And if no fertility treatments existed at all, I’d have much more easily accepted my childless state. And so would the rest of the world.”
A lengthy conversation ensued. I insisted on a precise definition of infertility. At 28 it’s an illness that should be cured when possible, and paid for by medical insurance. At 48, IVF is an artificial prolonging of the motherhood timeline. Was it fair to make other policyholders in the insurance risk pool subsidize that? The Resolve staffer was shocked.
But this year, the once-taboo arguments I raised are coming out in the open.
In July, Salon’s Broadsheet column backed the Family Building Act of 2009, which calls for insurance companies to provide IVF coverage. Fifteen states currently require it, and Resolve would like to make it a national mandate.
The financial logic behind insurer-provided IVF is that those who can’t afford the more expensive and precise IVF procedure use the cheaper fertility drug clomid, which may cause the release of too many eggs, resulting dangerous multiple births that tax the health care system more in the long run.
Of infertility, Broadsheet columnist Lynn Harris declared, “It appears that we can no longer afford to treat its treatment as a luxury.”
Some commenters disagreed, with the predictable advice: You can always adopt. Which prompted corrective replies from other readers who pointed out that adoption is often more expensive and risky than IVF.
Other responder’s put the argument in the context of the larger health care crisis: “When society can afford insurance coverage to provide life-saving treatments for all the children already here who need them, then we can spend more money creating new children.”
Consider Yourself Warned
In Britain, authorities recommend giving a fertility test at 30, seeing it as an awareness tool. Fertility counseling should go hand in hand with other kinds of sex ed.
A former chairman of the British Fertility Society said it was crucial to tackle a “widespread misapprehension” about the success rate of fertility treatments. The chances dip sharply with age: from 31% for women aged under 35, to below 5% among women over 41.
This summer, the death of a Spanish woman who gave birth at 66, leaving a toddler orphaned (she was unmarried) spawned heated debate on the blogs over whether or not there should be a ceiling-age for fertility treatments.
In Newsweek, African American writer Raina Kelly spoke out: “Sometimes for the sake of the children-to-be, we may have to put away our longings and grieve for the children we might have had rather than go to the ends of the earth to get them. We have to think about the children, not just the having them.”
Some feminist voices argue that the reproduction playing field should be leveled – that if men can become parents at sixty, then so should women. Personally, I wonder if this is something to envy – but I’d hate to see reproduction outlawed for one sex and not the other.
The Motherlode on Stillbirth
In her New York Times Motherlode column, Lisa Belkin asked readers how to respond to a family who’s experienced stillbirth. Again, sparks fly in the comments section, with one commentator saying that words like “tragedy” should be reserved for mass events, like the Holocaust or Hurricane Katrina.
Which button do I push for a dead baby?
Stillbirth is more common that Down’s Syndrome, SIDS and HIV – one in every 160 pregnancies. Few expectant parents are aware of this, and so come to it completely unprepared — in an increasingly impersonal medical environment with no protocol for addressing it.
NPR’s Tell Me More recently ran a segment featuring two parents of stillbirths who are trying to do something about that.
Guest Sherokee Isle, who suffered a stillbirth in 1981, is trying to make sure hospitals have on hand a copy of her book, Empty Arms: Coping After Miscarriage, Stillbirth and Infant Death.
She and fellow guest Alan Goldenbach, who recently wrote of his wife’s stillbirth in The Washington Post (http://www.washingtonpost.com/wp-dyn/content/article/2009/07/06/AR2009070602918.html) point out that parents-to-be aren’t told that when movement slows down near due date, it’s a danger sign. They are lobbying for more research to find out why stillbirths occur.
In June of 2008, then-Sen. Barack Obama introduced the Preventing Stillbirth and SUID Act of 2008, but it was unable to gain much traction. (“SUID” stands for “sudden unexpected infant death.”) Sen. Frank R. Lautenberg (D-N.J.) continues the effort, “We need to know more about stillbirths to help increase awareness and prevention,” Lautenberg said. “We are crafting legislation to improve data collection so we can better understand what’s causing stillbirths and help parents looking for answers.”