Could You Be Denied IVF?
Infertility doesn’t discriminate, but insurance companies and state legislatures do—by deciding which women deserve access to treatments.
By Erin Bried
(Photo: Adam Voorhes)
Cynthia Bolin, 35, always knew she wanted to be a mom. Twelve years ago, when she started seeing a fellow grad student, she declared, “I’m going to have a baby one day. If you’re not on board, we should part now.” The couple agreed to a plan, then spent seven years prepping for parenthood, buying a house in Baltimore, paying down their student loans and securing jobs as school psychologists. Natural conception wasn’t an option, so in 2010, they went to a Shady Grove Fertility center, where Bolin’s doctor recommended an IUI, a type of artificial insemination.
Bolin’s insurance covered infertility treatments (only a quarter of large-employer-sponsored plans cover in vivo fertilization, according to a survey by the consulting firm Mercer). But not, as it turned out, in her case. That’s because her partner, Lauren, is a woman. In a later letter, Bolin’s provider, CareFirst BlueCross BlueShield (which declined to comment for this story), elaborated: “Infertility services are excluded when the service involves the use of donor sperm; the [eggs] must be naturally produced by the member and fertilized with sperm naturally produced by the member’s spouse.”
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That last line—call it the husband clause—essentially blocks anyone other than straight, married couples from receiving help getting pregnant. Let that sink in: It forces all other eager parents-to-be, including single women, married lesbians, even some married straight couples with male-factor infertility, to find a way to afford the procedures or give up on their dreams of creating a family this way. “It felt like my insurance company was deeming me unworthy, simply because of who I fell in love with,” Bolin says.
While 15 states have passed mandates compelling insurance companies to at least offer plans that cover infertility services, four of them—Texas, Arkansas, Hawaii and Maryland—include a husband clause, meaning you can get the benefits only if you’re legally married to a man. (Coverage is optional everywhere else.)
“Even if a lesbian or single woman in these states needed in vitro fertilization because of medical infertility, like a blocked fallopian tube, she still wouldn’t be able to access care, because she’s using donor sperm,” says Barbara Collura, president of Resolve, an infertility advocacy group. “It’s discrimination, and it should be challenged in court,” adds Cathy Sakimura, family law director at the National Center for Lesbian Rights.
The husband clause isn’t the only barrier blocking large groups of women from receiving care. Since there is no standard definition of infertility, insurance providers make up their own. Many call it the inability to conceive after a year of frequent unprotected heterosexual sex. Straight married women must only vouch for their active-but-fruitless sex lives for coverage to kick in. But “when insurance companies ask single women or same-sex couples if they’ve been trying to conceive through frequent unprotected sex with a man and they say no, they’re generally automatically denied,” Sakimura says. (In 2013, California passed a law making it illegal to deny access to infertility coverage to unmarried or same-sex couples.)
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Critics argue that the lack of a male spouse doesn’t mean you’re medically infertile, and therefore coverage shouldn’t be required. And in some cases, couples are allowed to provide doctor-verified documentation that they’ve already tried between 6 and 12 rounds of artificial insemination without success. But with donor sperm costing roughly $800 per vial, that means unmarried women and married lesbians must bear not only the emotional weight of infertility but also a heavy financial one—as much as $12,000—before gaining access to coverage.
This burden of proof is unfair. “Do we actually expect single women to run the risk of having frequent unprotected sex just to first demonstrate their need for coverage?” asks I. Glenn Cohen, a Harvard law professor who specializes in bioethics. “And I’m not sure why we’d think a lesbian is more morally responsible for her inability to conceive a child on her own than the woman who is born infertile or has become infertile. Imagine if insurance companies started to require documentation as to why you’re infertile, and if it’s due to, say, an STD, as it is for many women, then they refused to help. We wouldn’t stand for that!”
Bolin and her partner (now wife, since Maryland passed marriage equality) paid for the IUI ($1,600, plus $1,200 for sperm) out of pocket. It didn’t work, so they tried again, spending about $6,000, mostly on credit cards. In January 2011, their son Oliver was born. In 2014, after two more rounds of IUI, neither covered by CareFirst, they welcomed their second son, Benjamin. Beneath their overwhelming joy, some frustration lingers. “If you think it’s every woman’s right to have a baby, then every woman should be covered,” Bolin says. “Otherwise, who has the power to say one woman can have a baby and another can’t?”
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