The rate of twins and triplets in the U.S. has soared 70 percent in recent decades, thanks in large part to new technologies to overcome infertility. But the rise in multiple births means more premature babies and health complications.
Now, a new study finds that providing insurance coverage for fertility treatments means fewer multiple births.
Specifically, the study looks at in vitro fertilization, or IVF. That's where sperm and egg are mixed in a laboratory, then one or more embryos are put into a woman's uterus. The number of embryos transferred is key. More means a greater likelihood of getting pregnant — but also a greater risk of twins or triplets.
Dr. Pasquale Patrizio, the head of Yale Fertility Center, finds that patients are more likely to take that risk when they're the ones who pay.
"The average number of embryos that were transferred in the states where patients have to pay is 2.6," he says. "In the states where insurance covers it, it's 2.2."
His study, in the current issue of the journal Fertility and Sterility, finds this translates into 2 percent fewer multiple births in states that require IVF coverage. It may not sound like much, but Patrizio says given the severe medical complications many such infants can face, it is "highly significant."
"When you do the calculation in terms of cost," he says, " it is much more economical to provide the service upfront and not to end up with twins and triplets."
J.P. Wieske isn't so sure. He's with the Council for Affordable Health Insurance, which opposes mandates in general.
"You're looking at doing those procedures again and again until you reach your success rate," Wieske says. "You may not find that there is any savings at all when you actually add up the numbers."
IVF costs on average $12,000. A premature baby can run up tens, or even hundreds of thousands of dollars in care if there are serious complications and a long stay in the neonatal intensive care unit.
In any case, only eight states now require insurers to cover IVF. And far from a growing trend, Wieske says a couple of states have considered dropping the mandate in recent years.
In another study out this week in The Journal of Pediatrics, Keith Barrington of Sainte-Justine University Hospital in Montreal suggests the greatest savings happen when rules require the use of only one embryo in IVF. This is mandated by several European countries with national health care systems. Barrington says Quebec began experimenting with such a policy last year. So far, the number of IVF pregnancies has more than doubled.
"But the number of twin pregnancies has gone from 30 percent to under 4 percent," says Barrington. "And there's no triplets."
Barrington says such a requirement in the U.S. could prevent the deaths of 700 premature twins and triplets a year.
There is no talk of such a policy here, though one insurance company, Aetna, has started encouraging single embryo transfer. It's offering patients two IVFs for the price of one. Aetna says it will track the effort to see if it achieves the cost savings it expects.