title: Assisted reproductive technology use, embryo transfer practices, and birth outcomes after infertility insurance mandates: New Jersey and Connecticut.
abstract: OBJECTIVE
  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 embryo transfer practices, and decreased multiple birth rates.
  
  
  METHODS
  Retrospective cohort study using data from the National ART Surveillance System. We explored trends in ART use, embryo transfer 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.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Cycles of ART performed in the United States between 1996 and 2013.
  
  
  METHODS
  Infertility insurance mandates including coverage for ART treatment passed in New Jersey (2001) and Connecticut (2005).
  
  
  METHODS
  Number of ART cycles performed, number of embryos transferred, multiple live birth rates.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: sgv0@cdc.gov.
authors.forename: Sara
authors.initials: S
authors.lastname: Crawford
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sheree L
authors.initials: SL
authors.lastname: Boulet
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.affiliation: Connecticut Department of Public Health, Hartford, Connecticut.
authors.forename: Carol
authors.initials: C
authors.lastname: Stone
authors.affiliation: Connecticut Department of Public Health, Hartford, Connecticut.
authors.forename: Jewel
authors.initials: J
authors.lastname: Mullen
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dmitry M
authors.initials: DM
authors.lastname: Kissin
mesh_terms: D000293:Adolescent; D000328:Adult; D003237:Connecticut; D004624:Embryo Transfer / Q000639:trends; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro / Q000639:trends; D017048:Health Care Costs / Q000331:legislation & jurisprudence; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence; D050498:Live Birth; D008297:Male; D009515:New Jersey; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology; D018873:Pregnancy Rate; D011272:Pregnancy, Multiple; D011787:Quality of Health Care / Q000639:trends; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Infertility insurance mandate; assisted reproductive technology (ART); embryo transfer; in vitro fertilization (IVF); multiple births