title: Does insurance coverage decrease the risk for multiple births associated with assisted reproductive technology?
abstract: OBJECTIVE
  To determine whether insurance coverage for ART is associated with transfer of fewer embryos and decreased risk of multiple births.
  
  
  METHODS
  Retrospective cohort study of a population-based sample of IVF procedures performed in six U.S. states during 1998.
  
  
  METHODS
  Three states with mandated insurance coverage (Illinois, Massachusetts, and Rhode Island) and three states without coverage (Indiana, Michigan, and New Jersey).
  
  
  METHODS
  Seven thousand, five hundred sixty-one IVF transfer procedures in patients < or = 35 years of age.
  
  
  METHODS
  Number of embryos transferred, multiple-birth rate, triplet or higher order birth rate, and triplet or higher order gestation rate.
  
  
  RESULTS
  A smaller proportion of procedures included transfer of three or more embryos in Massachusetts (64%) and Rhode Island (74%) than in the noninsurance states (82%). The multiple-birth rate in Massachusetts (38%) was less than in the noninsurance states (43%). The insurance states all had protective odds ratios for triplet or higher order births, but only the odds ratio (0.2) for Massachusetts was significant. This decreased risk in Massachusetts resulted from several factors, including a smaller proportion of patients with three or more embryos transferred, lower implantation rates when three or more embryos were transferred, and greater rates of fetal loss among triplet or higher order gestations.
  
  
  CONCLUSIONS
  Insurance appears to affect embryo transfer practices. Whether this translates into decreased multiple birth risk is less clear.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3717, USA. mtr6@cdc.gov
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Reynolds
authors.forename: Laura A
authors.initials: LA
authors.lastname: Schieve
authors.forename: Gary
authors.initials: G
authors.lastname: Jeng
authors.forename: Herbert B
authors.initials: HB
authors.lastname: Peterson
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004624:Embryo Transfer / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics* / Q000331:legislation & jurisprudence / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois; D007231:Infant, Newborn; D007246:Infertility / Q000628:therapy; D019458:Insurance Coverage / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D016017:Odds Ratio; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012237:Rhode Island; D018570:Risk Assessment