Do insurance plans cover infertility treatment?

The services covered by insurance will depend on where you live and the type of insurance plan. Fifteen states currently have laws that require insurers to cover or offer to cover at least a portion of infertility diagnosis and treatment. Those states are Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. HOWEVER, the existing laws vary greatly in their scope of what might be covered. For more information about specific laws in each of those states, you may contact your state's Insurance Commissioner's office. To learn about pending insurance legislation in your state, you may contact your State Representative.

Whether or not you live in a state with an infertility insurance law, you can choose to consult with your employer's Human Resources Department to determine the exact coverage your plan provides. Another resource for determining coverage is, "Infertility Insurance Advisor: An Insurance Counseling Program for Infertile Couples." This booklet is available for a small fee from RESOLVE, an infertility patient advocacy and information organization.

Because the desire to have children and be a parent is fundamental to being human, people should not be denied insurance coverage for medically appropriate treatment for problems of infertility.

How is infertility diagnosed?

As already noted, couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will conduct a physical examination of both partners to determine their general state of health and to search for physical disorders that may be contributing to infertility. The doctor will usually interview both partners about their sexual habits in order to determine whether intercourse is taking place properly for conception.

If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.

When should someone get tested for infertility?

The American Society of Reproductive Medicine recommends that women under 35 begin testing after trying to conceive unsuccessfully for 12 months. The recommendation for women over 35 is to begin testing after trying to conceive unsuccessfully for 6 months. Some couples or individuals find that they are more relaxed when trying to conceive if they believe that everything is normal.

What causes infertility in women?

The most common cause of female infertility is ovulation disorders. Problems with ovulation affect about 25% of all infertility situations. Other causes of female infertility include blocked fallopian tubes, which can happen when a woman has had pelvic inflammatory disease or endometriosis; Congenital anomalies (birth defects) involving the structure of the uterus, and uterine fibroids which are associated with repeated miscarriages; and aging, since the ability for ovaries to produce eggs tends to decline with age, especially after the age of 35.

Fetal Growth Restriction; Intrauterine Growth Restriction (IUGR); Small for Gestational Age

Are there different types of Fetal Growth Restriction?

There are basically two different types of fetal growth restriction:

Symmetric or primary growth restriction is characterized by all internal organs being reduced in size. Symmetric growth restriction accounts for 20% to 25% of all cases of growth restriction.

Asymmetric or secondary growth restriction is characterized by the head and brain being normal in size, but the abdomen is smaller. Typically this is not evident until the third trimester.

What are the risk factors for developing Fetal Growth Restriction?

Pregnancies that have any of the following conditions may be at a greater risk for developing fetal growth restriction:

• Maternal weight of less than 100 pounds
• Poor nutrition during pregnancy
• Birth defects or chromosomal abnormalities
• Use of drugs, cigarettes, and/or alcohol
• Pregnancy induced hypertension (PIH)
• Placental abnormalities
• Umbilical cord abnormalities
• Multiple pregnancy
• Gestational diabetes in the mother
• Low levels of amniotic fluid or oligohydramnios
  

How is Fetal Growth Restriction diagnosed?

One of the most important things when diagnosing fetal growth restriction is to ensure accurate dating of the pregnancy. Gestational age can be calculated by using the first day of your last menstrual period (LMP) and also by early ultrasound calculations.

Once gestational age has been established, the following methods can be used to diagnose fetal growth restriction:

• Fundal height that does not coincide with gestational age
  
• Measurements calculated in an ultrasound are smaller than would be expected for the gestational age
• Abnormal findings discovered by a Doppler ultrasound
  

How is Fetal Growth Restriction treated?

Despite new research, the optimal treatment for fetal growth restriction remains problematic. Most likely the treatment will depend on how far along you are in your pregnancy.

• If gestational age is 34 weeks or greater, health care providers may recommend being induced for an early delivery.
  
• If gestational age is less than 34 weeks, health care providers will continue monitoring until 34 weeks or beyond. Fetal well-being and the amount of amniotic fluid will be monitored during this time. If either of these becomes a concern, then immediate delivery may be recommended.

Depending on your health care provider, you will likely have appointments every 2 to 6 weeks until you deliver. If delivery is suggested prior to 34 weeks, your health care provider may perform an amniocentesis to help evaluate fetal lung maturity.