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

Insurance coverage mandates for infertility treatment were associated with lower intracytoplasmic sperm injection use for non–male-factor infertility cycles.

Volume 109, Issue 4, Pages 691–697


Ada C. Dieke, Dr.P.H., M.P.H., Akanksha Mehta, M.D., M.S., Dmitry M. Kissin, M.D., M.P.H., Ajay K. Nangia, M.B.B.S., Lee Warner, Ph.D., M.P.H., Sheree L. Boulet, Dr.P.H., M.P.H.



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.


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.


IVF cycles performed in U.S. fertility clinics.


Fresh IVF cycles.


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.


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 and without a mandate; however, for non–male-factor infertility cycles, the percentage increase in ICSI use was 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 ∼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.


Mandates for IVF coverage were associated with lower ICSI use for non–male-factor infertility cycles.

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