Differences in ICSI utilization rates among states with insurance mandates for ART coverage

Abstract Background Assisted reproductive technology (ART) insurance mandates promote more selective utilization of ART clinic resources including intracytoplasmic sperm injection (ICSI). Our objective was to examine whether ICSI utilization differs by state insurance mandates for ART coverage and a...

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Autores principales:	Pavel Zagadailov, Kyung S. Cho, David B. Seifer
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Assisted reproductive technology In-vitro fertilization State insurance mandates Intracytoplasmic sperm injection Utilization rates Live birth rate Gynecology and obstetrics RG1-991 Reproduction QH471-489
Acceso en línea:	https://doaj.org/article/cc9192957e2641059250014aa81d6f79
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spelling	oai:doaj.org-article:cc9192957e2641059250014aa81d6f792021-12-05T12:24:07ZDifferences in ICSI utilization rates among states with insurance mandates for ART coverage10.1186/s12958-021-00856-41477-7827https://doaj.org/article/cc9192957e2641059250014aa81d6f792021-11-01T00:00:00Zhttps://doi.org/10.1186/s12958-021-00856-4https://doaj.org/toc/1477-7827Abstract Background Assisted reproductive technology (ART) insurance mandates promote more selective utilization of ART clinic resources including intracytoplasmic sperm injection (ICSI). Our objective was to examine whether ICSI utilization differs by state insurance mandates for ART coverage and assess if such a difference is associated with male factor, preimplantation genetic testing (PGT), and/or live birth rates. Methods In this retrospective analysis of the Centers for Disease Control (CDC) data from 2018, ART clinics in ART-mandated states (n = 8, AR, CT, HI, IL, MD, MA, NJ, RI) were compared individually to one another and with non-mandated states in aggregate (n = 42) for use of ICSI, male factor, PGT, and live birth rates. ANOVA was used to evaluate differences between ART-mandated states and non-mandated states. Individual ART-mandated states were compared using Welch t-tests. Statistical significance was determined by Bonferroni Correction. Results There were significant differences in ICSI rates (%, mean ± SD) between MA (53.3 ± 21.3) and HI (90.7 ± 19.6), p = 0.028; IL (86.5 ± 18.7) and MA, p = 0.002; IL and MD (57.2 ± 30.8), p = 0.039; IL and NJ (62.0 ± 26.8), p = 0.007; between non-mandated states in aggregate (79.9 ± 19.9) and MA, p = 0.006, and NJ (62.0 ± 26.8), p = 0.02. Male factor rates of HI (65.8 ± 16.0) were significantly greater compared to CT (18.8 ± 8.7), IL (26.0 ± 11.9), MA (26.9 ± 6.6), MD (29.3 ± 9.9), NJ (30.6 ± 17.9), and non-mandated states in aggregate (29.7 ± 13.7), all p < 0.0001. No significant differences were reported for use of PGT and/or live birth rates across all age groups regardless of mandate status. Conclusions ICSI use varied significantly among ART-mandated states while demonstrating no differences in live birth rates. These data suggest that the prevalence of male factor and the presence of a state insurance mandate are not the only factors influencing ICSI use. It is suggested that other non-clinical factors may impact the rate of ICSI utilization in a given state.Pavel ZagadailovKyung S. ChoDavid B. SeiferBMCarticleAssisted reproductive technologyIn-vitro fertilizationState insurance mandatesIntracytoplasmic sperm injectionUtilization ratesLive birth rateGynecology and obstetricsRG1-991ReproductionQH471-489ENReproductive Biology and Endocrinology, Vol 19, Iss 1, Pp 1-6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Assisted reproductive technology In-vitro fertilization State insurance mandates Intracytoplasmic sperm injection Utilization rates Live birth rate Gynecology and obstetrics RG1-991 Reproduction QH471-489
spellingShingle	Assisted reproductive technology In-vitro fertilization State insurance mandates Intracytoplasmic sperm injection Utilization rates Live birth rate Gynecology and obstetrics RG1-991 Reproduction QH471-489 Pavel Zagadailov Kyung S. Cho David B. Seifer Differences in ICSI utilization rates among states with insurance mandates for ART coverage
description	Abstract Background Assisted reproductive technology (ART) insurance mandates promote more selective utilization of ART clinic resources including intracytoplasmic sperm injection (ICSI). Our objective was to examine whether ICSI utilization differs by state insurance mandates for ART coverage and assess if such a difference is associated with male factor, preimplantation genetic testing (PGT), and/or live birth rates. Methods In this retrospective analysis of the Centers for Disease Control (CDC) data from 2018, ART clinics in ART-mandated states (n = 8, AR, CT, HI, IL, MD, MA, NJ, RI) were compared individually to one another and with non-mandated states in aggregate (n = 42) for use of ICSI, male factor, PGT, and live birth rates. ANOVA was used to evaluate differences between ART-mandated states and non-mandated states. Individual ART-mandated states were compared using Welch t-tests. Statistical significance was determined by Bonferroni Correction. Results There were significant differences in ICSI rates (%, mean ± SD) between MA (53.3 ± 21.3) and HI (90.7 ± 19.6), p = 0.028; IL (86.5 ± 18.7) and MA, p = 0.002; IL and MD (57.2 ± 30.8), p = 0.039; IL and NJ (62.0 ± 26.8), p = 0.007; between non-mandated states in aggregate (79.9 ± 19.9) and MA, p = 0.006, and NJ (62.0 ± 26.8), p = 0.02. Male factor rates of HI (65.8 ± 16.0) were significantly greater compared to CT (18.8 ± 8.7), IL (26.0 ± 11.9), MA (26.9 ± 6.6), MD (29.3 ± 9.9), NJ (30.6 ± 17.9), and non-mandated states in aggregate (29.7 ± 13.7), all p < 0.0001. No significant differences were reported for use of PGT and/or live birth rates across all age groups regardless of mandate status. Conclusions ICSI use varied significantly among ART-mandated states while demonstrating no differences in live birth rates. These data suggest that the prevalence of male factor and the presence of a state insurance mandate are not the only factors influencing ICSI use. It is suggested that other non-clinical factors may impact the rate of ICSI utilization in a given state.
format	article
author	Pavel Zagadailov Kyung S. Cho David B. Seifer
author_facet	Pavel Zagadailov Kyung S. Cho David B. Seifer
author_sort	Pavel Zagadailov
title	Differences in ICSI utilization rates among states with insurance mandates for ART coverage
title_short	Differences in ICSI utilization rates among states with insurance mandates for ART coverage
title_full	Differences in ICSI utilization rates among states with insurance mandates for ART coverage
title_fullStr	Differences in ICSI utilization rates among states with insurance mandates for ART coverage
title_full_unstemmed	Differences in ICSI utilization rates among states with insurance mandates for ART coverage
title_sort	differences in icsi utilization rates among states with insurance mandates for art coverage
publisher	BMC
publishDate	2021
url	https://doaj.org/article/cc9192957e2641059250014aa81d6f79
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Differences in ICSI utilization rates among states with insurance mandates for ART coverage

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