An article in the September 2010 issue of Fertility & Sterility examines the influence of a non-medical factor, insurance coverage, on IVF outcome.
They studied 91,753 fresh, nondonor IVF cycles in the United States and compared those conducted in states with mandated insurance coverage for IVF with those in states which did not mandate coverage. Cycles conducted in nonmandated states had a significantly higher pregnancy rate (38.8% vs. 35%) and live-birth rate (32.2% vs. 29.1%) than mandated states. But nonmandated states also had a significantly higher twin rate (28.1% vs. 26%) and triplet rate (3.9% vs. 3.4%). The average number of embryos transferred was also significantly higher in nonmandated states (2.6 vs. 2.2). These findings were more pronounced in the <35 and 35–37 age groups.
The reason is apparent. When couples are paying for IVF themselves there is greater pressure to succeed in an early cycle and thus more embryos are transferred and more multiple pregnancies result. The answer is also apparent.