Oct 27, 2023 - Health

New "infertility" definition could help boost coverage in Washington

States where IVF and infertility are insured
Image credit: Data: Resolve; Map: Thomas Oide/Axios

A new, more expansive definition of "infertility" could lead to more help for hopeful LGBTQ+ or single parents in Washington state.

Why it matters: The broader definition could bolster efforts in Washington's Legislature to pass a law requiring many large insurance plans to cover infertility treatments, including for same-sex couples, state Rep. Monica Stonier (D-Vancouver) told Axios.

  • Coverage for treatments like egg freezing and in vitro fertilization remains limited in Washington, one of more than two dozen states that don't mandate that insurers cover fertility care.

Plus: Even without a state mandate, the definition change could prod insurers to extend infertility coverage to more people.

What's happening: The American Society for Reproductive Medicine (ASRM) has redefined infertility to include people who need medical intervention, such as donor eggs or sperm, to become pregnant.

  • Unlike before, the definition is no longer limited to a man and woman unable to achieve pregnancy.
  • Instead, it includes anyone needing help to conceive, regardless of their relationship status, gender identity or sexual orientation.

State of play: "There's been a real issue with getting access to treatment for certain causes of infertility including for single people [and] people in same-sex relationships," ASRM spokesperson Sean Tipton told Axios. "So, it became clear that we need to explicitly address that."

Zoom in: Despite the growing interest in fertility care — and more employers like Amazon offering fertility benefits to stay competitive in the labor market — insurance coverage of these often-pricey services can be hard to come by.

  • Earlier this year, Stonier sponsored a bill that would have required large group health plans in Washington to provide coverage for infertility treatments, including for same-sex couples. But the proposal stalled in a state Senate committee.
  • She plans to try to get the bill passed again after the Legislature reconvenes in January.

What they're saying: A more inclusive definition of infertility — which ASRM considers a disease, condition or statusis "a game changer" because several insurance plans rely on the ASRM definition of what's a disease to determine coverage, infertility specialist Lucky Sekhon told Axios.

  • At the Legislature, the broader definition "will help us make the case for why we should be mandating this coverage," Stonier told Axios.

It's also a significant show of support for patients, said Ginny Ryan, division chief of the infertility program at the University of Washington's medical school.

  • The change signals that leading medical professionals "have come together to say we understand that we need to provide services for everybody building a family," Ryan said.

The bottom line: The revised definition of infertility is "a sign that we as a society have become more progressive and more inclusive," Sekhon said.

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