You Have The Right To Build A Family
The American Society for Reproductive Medicine (ASRM) released a white paper on the current state of patients’ access to fertility care in the United States and outlining steps we can take to improve that access. At the same time, the Society’s flagship journal, Fertility and Sterility, is publishing online a series of articles addressing specific challenges patients may face when seeking needed fertility care.
The white paper and journal articles grew out of ASRM’s Access to Care Summit, which convened Society leadership and experts from the United States and around the world to identify and examine the difficulties patients face when trying to access fertility care and to explore ways to address them.
The white paper summarizes the presentations at the Summit and highlights key points; shares ideas and recommendations brought up in group breakout sessions and concludes with a list of actionable strategies, derived by ASRM leadership from the Summit discussions. These are steps that ASRM and its members can take to make real changes in this vital area in the future. The journal articles authored by Summit presenters, appeared together in the May 2016 issue of Fertility and Sterility and are available online now at www.fertstert.org.
In “Access to and Utilization of Infertility Services in the United States: Framing the Challenges,” Dr. Eli Adashi and Ms. Laura Dean distill the problem: in the United States, for those affected by infertility, the right to build a family is “a function of economic prowess.” Surveying the availability of infertility services and assisted reproductive technologies (ARTs) in the United States, they discuss the declining use of these treatments and ways this decline may be attributed to the lack of access to services within the US health insurance environment. As compared to other countries, public payers in the US for the most part do not cover infertility services and, while a few state mandates for some coverage are in place, most private plans are exempted, leaving the majority of patients to pay out of pocket for their infertility care. “Can we modify ART practice to broaden reproductive care access?” (Paulson et al) raises the possibility of simplifying fertility treatments to make them more affordable and available to more patients.
While economic and geographic barriers to receiving infertility care are perhaps the most universal, other barriers affect individuals’ prospects for receiving infertility treatment and for its success. In “Racial and Ethnic Disparities in Assisted Reproductive Technology Access and Outcomes,” Drs. Molly Quinn and Victor Fujimoto discuss the need for equality in access to care as well as research to identify the reasons underlying different rates of infertility among different racial and ethnic groups, differing ART outcomes, and to improve those outcomes. Camilla Rich and Dr. Alice Domar note that after financial constraints, the main reasons patients discontinue treatment are the emotional burdens and stress of infertility and its treatment. “Addressing the Emotional Barriers to Access to Reproductive Care” calls for making patients’ psychological needs a higher priority- that true access to care requires support, understanding, and ongoing communication with the care team. Accessing care for male infertility is complicated by challenges to measuring its prevalence. “Limitations and Barriers in Access to Care for Male Factor Infertility” (Mehta et al) describes the financial, geographic, socio-cultural, ethnic, and psychological obstacles encountered by men suffering from infertility. The biggest obstacle to access, however, may be that the problem is under-recognized.
Richard Paulson, MD, chair of the Access to Care summit said, “The summit and resulting papers provide an important framework as we take on this important problem. We have heard our members express their frustration that they have the tools to help patients, but the patients can’t get access to those tools. ASRM is not going to be able to solve the problem alone, but we can, and must work to improve the situation for our patients.”
Owen Davis, MD, President of ASRM, stated, “Our most recent strategic plan identified access to care as a priority item, and we are already moving to address it. We launched a ‘Serving our Veterans’ campaign to help that population get care. At our Scientific Congress this year we will have a portion of our program dedicated to examining this issue and seeing how people are addressing it.”
“Infertility patients today have a stunning array of treatment options, but they are of no use to patients who cannot get access to them. ASRM is committed to improving care for ALL patients,” Dr. Davis said.