title: State-mandated insurance coverage is associated with the approach to hydrosalpinges before IVF.
abstract: The aim of this study was to determine whether practice in states with infertility insurance mandates is associated with physician-reported practice patterns regarding hydrosalpinx management in assisted reproduction clinics. A cross-sectional, internet-based survey of 442 members of Society for Reproductive Endocrinology and Infertility or Society of Reproductive Surgeons was performed. Physicians practising in states without infertility insurance mandates were more likely to report performing diagnostic surgery after an inconclusive hysterosalpingogram than physicians practising in states with mandates (RR 1.2, 95% CI 1.1-1.3, P < 0.01). Additionally, respondents in states without mandates were more likely to report that, due to lack of infertility insurance coverage, they did not perform salpingectomy (SPX) or proximal tubal occlusion (PTO) before assisted reproduction treatment (RR 1.4, 95% CI 1.1-1.8, P = 0.01). Finally, respondents in states without mandates were less likely to report that the presence of assisted reproduction treatment coverage determined the urgency with which they pursued SPX or PTO before treatment (RR 0.7, 95% CI 0.5-1.0, NS). These results persisted after controlling for physician years in practice, age and clinic volume. In conclusion, self-reported physician practice interventions for hydrosalpinges before assisted reproduction treatment may be associated with state-mandated infertility insurance. Fallopian tube dysfunction is a known cause of infertility and severe dysfunction is manifested by dilation and occlusion, known as hydrosalpinx. Outcomes with assisted reproductive techniques (ART) are lower when hydrosalpinges are present and while there are several theories for this, reproductive specialist recommend "neutralizing" the tube either by occlusion or removal in order to enhance pregnancy rates. In the United States, coverage for infertility services is not uniform with only 15 states having some legislation requiring infertility benefits. Some states where ART is covered liberally, physicians might have different practice patterns related to the neutralization of hydrosalpinges compared to those who are in non -mandated states. We utilized a survey of over 400 providers in the United States to examine their practice patterns as it relates to hydrosalpinges based on which state they practice in and whether or not that state has mandated coverage of not.
authors.affiliation: Washington University School of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, United States. Electronic address: omurtagk@wudosis.wustl.edu.
authors.forename: Kenan
authors.initials: K
authors.lastname: Omurtag
authors.affiliation: Washington University School of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, United States.
authors.forename: Natalia M
authors.initials: NM
authors.lastname: Grindler
authors.affiliation: Washington University School of Medicine, Department of Obstetrics and Gynecology, Division of Clinical Research, United States.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Roehl
authors.affiliation: University of Alabama Birmingham School of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, United States.
authors.forename: G Wright
authors.initials: GW
authors.lastname: Bates
authors.affiliation: Fertility Centers of Illinois, Chicago, IL, United States.
authors.forename: Angeline N
authors.initials: AN
authors.lastname: Beltsos
authors.affiliation: Washington University School of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, United States.
authors.forename: Randall R
authors.initials: RR
authors.lastname: Odem
authors.affiliation: Washington University School of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, United States.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Jungheim
mesh_terms: D003430:Cross-Sectional Studies; D005184:Fallopian Tube Diseases / Q000628:therapy*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D019458:Insurance Coverage; D009313:National Health Programs / Q000639:trends*; D018456:Reproductive Medicine / Q000639:trends*; D027724:Reproductive Techniques, Assisted / Q000191:economics; D013246:Sterilization, Tubal / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States
keywords: assisted reproduction treatment; hydrosalpinx; insurance coverage; mandate; salpingectomy