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Why Isn't Infertility
Insurance Reimbursement Routinely Offered? |
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By:
Craig
R. Sweet, M.D.
Craig
W. Sohn, Esq.
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Quick Jumps On This Web Page:
The
definition of disease is, “An interruption, cessation or disorder of body
functions, systems or organs.” (American Heritage College Dictionary, Boston:
Houghton Mifflin Company, 1993.) Certainly, infertility is the interruption of
the reproductive process. However, it may be more important to realize that
infertility is most often a symptom of an underlying disease process.
Now,
let’s see if infertility can be defined as a symptom of underlying disease,
based on accepted medical definitions.
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A Disease Must Have at Least Two of The Following:
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With Examples Where Infertility Is A Symptom of Underlying Disease
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1.
Recognized etiologic agent(s) or cause(s)
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Pelvic adhesions,
infection, endometriosis, ovulatory disorders and genetic disorders are
only a few of the known causes of infertility.
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2.
Identifiable group of signs and symptoms
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The signs are the
physical findings seen with the diseases that cause infertility while the
basic symptom of infertility is the inability to conceive for at least 12
–months.
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3.
Have consistent anatomical alternations
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Obstructive problems
in both the female and the male reproductive tract are common causes of
infertility.
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In summary, infertility may be a disease itself, but more commonly, is a symptom
of an underlying problem. Infertility has to occur for one or more reasons.
Physicians are not always able to determine the precise reasons but they are
often able to determine one of more contributing factors in well over 90% of the
cases.
(top)
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Why
Are Fertility/Infertility Treatments Considered Elective Processes?
During
the 1960’s, with the development of the oral contraceptive pill, an entire
generation was suddenly able to control its reproductive destiny. Then, when
abortion became legalized in 1973, women were given an additional tool with
which to control their reproductive lives. Both forms of reproductive
independence came with a price. If fertility was an elective decision, was not
infertility also controllable and essentially an elective process?
It is of no surprise that this concept of elective fertility/infertility
continues to be an issue. Well-meaning friends constantly often encourage
infertile couples to “relax” or “take a vacation” in order to conceive.
These not-so-subtle remarks imply that the couple somehow has control over their
fertility. In truth, they have minimal control.
It should
be clearly understood that for the vast majority of patients, infertility is
simply not elective but acquired – they do not choose it. One would not say
that a patient chooses to have cardiovascular disease. In reality, patients may
contribute to their risks through sedentary life-styles, obesity, smoking and
alcohol consumption. Still, patients are relatively innocent bystanders to a
disease process. Infertility is really no different.
The
argument is building. Infertility is a disease, a symptom of an underlying
disease and it is rarely elective. Because of society’s current mistaken
perception that infertility is
elective, insurance companies and employers rarely offer infertility coverage.
(top)
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Should
Infertility Treatments Really Be Equated (Politically or Emotionally) With
Abortion?
There is
a political tendency in this country to lump such issues as the assisted
reproductive technologies, such as in vitro fertilization (IVF), with abortion.
Those individuals who work in the field of Reproductive Endocrinology are doing
their absolute best to assist nature in creating life and not destroying it. We
“till the soil,” and while doing so, we feel a tremendous amount of respect
towards the eggs, sperm and especially the embryos we help to create. We are in
awe of the fertilization process, the miracle of life, and we find it
unfortunate that there are some who equate what we do with abortion.
Unfortunately, since abortion is such a politically sensitive subject,
infertility treatments, specifically IVF, tend to be lumped together as an
undesirable societal ill. It is important to recognize that the treatment for
infertility and elective termination of a pregnancy are totally different issues
and that the public, as well as our legislative bodies, would do well to
understand the distinctions.
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Picture
an insurance company as a used car dealer. The dealer offers many different
types of cars to the employer, who in turn, selects and provides a car to the
employee for company use. In this situation, it is the employer who decides
whether to offer the employee an inexpensive automobile with the bare
necessities or a more expensive car with all the bells and whistles. It is the
car dealer’s (insurance company’s) best interests to offer the employer a
wide variety of cars (insurance options) or the employer will go to another
dealer. It is the employer’s responsibility to select which cars (insurance
options) will be provided (including whether infertility treatments will be a
covered service).
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Reproductive health and fertility treatments slowly gained legitimacy in the
1960’s. With the advent of In Vitro Fertilization (IVF) in 1978, technological
advances finally made it possible for infertile couples to have children. Within
the past two decades, media coverage of the emerging technologies and success
stories allowed us to discuss these issues with increased frequency, exposure
and acceptance.
Still, a
significant infertile minority remained quiet -- men with male-factor
infertility. Only with the advent of successful fertility procedures during the
past decade, did some the patients with male-factor infertility begin to talk
about their condition. The media, by providing opportunities for discussion of
male-factor infertility and treatments, has helped the public accept and
understand the sensitive male perspective.
Patients
are feeling confident enough to begin to question the perspective of elective
infertility, the failure of insurance companies to cover infertility and the
failure of employers to offer infertility healthcare. It has become increasingly
apparent that it is not appropriate to exclude infertility treatments that
attempt to remedy medical issues that are preventing the conception of a child.
Interestingly, as patients with increasing confidence and self-assurance have
spoken up about infertility and the lack of adequate insurance coverage, they
have slowly become aware that it would be necessary to describe infertility as a
type of disability. It has become a form of obligatory self-deprecation. On the
one hand, the infertile patient seeks recognition of his or her problem as a
medical disease, just like everyone else’s. On the other hand, the infertile
patient simultaneously moving infertility into the disability arena in order to
prove discrimination.
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Click on any of the links below to continue this commentary:
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updated 2/7/2000 |
