Assisted reproductive technology use embryo transfer practices and birth outcomes after infertility insurance mandates: New Jersey and Connecticut

Infertility insurance mandates in New Jersey and Connecticut were associated with increased ART treatment use, but not a decrease in the number of embryos transferred or the multiple birth rate.

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Sara Crawford, Ph.D., Sheree L. Boulet, Dr.P.H., M.P.H., Denise J. Jamieson, M.D., M.P.H., Carol Stone, Ph.D., M.P.H., M.A.S., M.A., Jewel Mullen, M.D., M.P.H., M.P.A., Dmitry M. Kissin, M.D., M.P.H.

Volume 105, Issue 2, Pages 347-355



To explore whether recently enacted infertility mandates including coverage for assisted reproductive technology (ART) treatment in New Jersey (2001) and Connecticut (2005) increased ART use, improved ET practices, and decreased multiple birth rates.


Retrospective cohort study using data from the National ART Surveillance System. We explored trends in ART use, ET practices and birth outcomes, and compared changes in practices and outcomes during a 2-year period before and after passing the mandate between mandate and non-mandate states.


Not applicable.


Cycles of ART performed in the United States between 1996 and 2013.


Infertility insurance mandates including coverage for ART treatment passed in New Jersey (2001) and Connecticut (2005).

Main Outcome Measures(s):

Number of ART cycles performed, number of embryos transferred, multiple live birth rates.


Both New Jersey and Connecticut experienced an increase in ART use greater than the non-mandate states. The mean number of embryos transferred decreased significantly in New Jersey and Connecticut; however, the magnitudes were not significantly different from non-mandate states. There was no significant change in ART birth outcomes in either mandate state except for an increase in live births in Connecticut; the magnitude was not different from non-mandate states.


The infertility insurance mandates passed in New Jersey and Connecticut were associated with increased ART treatment use but not a decrease in the number of embryos transferred or the rate of multiples; however, applicability of the mandates was limited.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

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. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.