Intracytoplasmic sperm injection use in states with and without insurance coverage mandates for infertility treatment, United States, 2000-2015

Objective: To compare indications and trends in intracytoplasmic sperm injection (ICSI) use for in vitro fertilization (IVF) cycles among residents of states with and without insurance mandates for IVF coverage. Design: Cross-sectional analysis of the National Assisted Reproductive Technology Surveillance System from 2011 to 2015 for the main outcome and from 2000 to 2015 for trends. Setting: IVF cycles performed in U.S. fertility clinics. Patient(s): Fresh IVF cycles. Intervention(s): Residency in a state with an insurance mandate for IVF (n = 8 states) versus no mandate (n = 43 states, including DC). Main Outcome Measure(s): ICSI use by insurance coverage mandate status stratified by male-factor infertility diagnosis. Result(s): During 2000-2015, there were 1,356,377 fresh IVF cycles, of which 25.8%(n = 350,344) were performed for residents of states with an insurance coverage mandate for IVF. ICSI use increased significantly during 2000-2015 in states both with andwithout a mandate; however, for non-male-factor infertility cycles, the percentage increase in ICSI usewas greater among nonmandate states (34.6% in 2000 to 73.9% in 2015) versus mandate states (39.5% in 2000 to 63.5% in 2015). For male-factor infertility cycles, this percentage increase was similar to 7.3% regardless of residency in a state with an insurance mandate for IVF. From 2011 to 2015, ICSI use was lower in mandate versus nonmandate states, both for cycles with (91.5% vs. 94.5%), and without (60.3% vs. 70.9%) male-factor infertility. Conclusion(s): Mandates for IVF coverage were associated with lower ICSI use for non-male-factor infertility cycles. (C) 2018 by American Society for Reproductive Medicine.