The Great Recession insurance mandates and the use of in vitro fertilization services in the United States

There is a positive relationship between the economy and in vitro fertilization use in the United States, and this relationship is significantly stronger in states with insurance mandates.

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Sorapop Kiatpongsan, M.D., Ph.D., Robert S. Huckman, Ph.D., Mark D. Hornstein, M.D.

Volume 103, Issue 2, Pages 448-454



To investigate the relationship between economic activities, insurance mandates, and the use of in vitro fertilization (IVF) in the United States.


We examined the correlation between the coincident index (a proxy for overall economic conditions) and IVF use at the national level from 2000 to 2011. We then analyzed the relationship at the state level through longitudinal regression models. The base model tested the correlation at the state level. Additional models examined whether this relationship was affected, both separately and jointly, by insurance mandates and the Great Recession.


Not applicable.


Not applicable.



Main Outcome Measure(s):

Direction and magnitude of the relationship between the coincident index and IVF use, and influences of insurance mandates and the Great Recession.


The coincident index was positively correlated with IVF use at the national level (correlation coefficient = 0.89). At the state level, an increase of one unit in the coincident index was associated with an increase of 16 IVF cycles per 1 million women, with a significantly greater increase in IVF use in states with insurance mandates than in states without mandates (27 versus 15 IVF cycles per 1 million women). The Great Recession did not alter the relationship between the coincident index and IVF use.


Our study demonstrates a positive relationship between the economy and IVF use, with greater magnitude in states with insurance mandates. This relationship was not affected by the Great Recession regardless of mandated insurance coverage.

Category: Uncategorized · Tags: coincident index, economic condition, Great Recession, in vitro fertilization, insurance mandate

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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.