Monday, July 14, 2008

Call Me McJudgey

Husband decreed that I was being judgey about the following story/item I am about to relate so I had to put that in the subject line.

On Sunday Husband and I went to a class on C-Sections. It was informative and we had a tour of the maternity floors also (but they won't let you see the NICU). They are happy to have you start breastfeeding right away if the babies are fine (as soon as you leave the OR) and have them room-in with you if you want (the jury's out on that one for me so far - I'll blog separately about that!).

There was one other couple there who also happened to be expecting twins. She was 24 weeks along and neither child had cooperated so she did not know the sexes. The couple seemed older than us and mentioned another child.

During the tour we learned that this couple has a 20 year old son - and I'd probably peg them between 45 and 50 years old. Apparently they had been undergoing fertility treatments for FIVE YEARS!

Here's where I get "judgey" - the couple said they would not have done this (tried to have more kids) if it weren't for the fact Massachusetts health insurance covers it. The actual quote from the husband was "If we had been paying $30k a pop we wouldn't have done it".

While I think it is wonderful our state provides for covered fertility treatments I do not think that people should be taking advantage of it in their late 40s and be allowed (regardless of age) to have a million IVF attempts (this couple said they had been doing IVF rounds for years). We need to have some criteria around when these expensive treatments (age, physical condition) are an option and how often a women can undergo them. Otherwise we create the most expensive insurance program in the country (since realistically all insurance premiums collectively subsidize these treatments).

I also write this posting knowing full well that Husband and I would have attempted IVF if we needed to (we did not) but I also know it would not have been fair from a resource perspective (nor do I think I could have handled it emotionally) to do many IVF attempts (without knowing for sure I probably would have stopped by 4).

I know this will be a controversial post and I hope that people do write about their experiences with fertility treatments and thoughts about whether we need more parameters around their use.


Theresa said...
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Goddess in Progress said...

Definitely a slippery slope. I'm really glad that MA is so generous with the coverage, and I don't think it's totally unlimited. And I agree that it gets a little absurd when someone in their 50s or 60s gets pregnant with IVF, and I can see the argument for not doing it forever. But where do you draw the line? I've heard some people say that, once you have a single "successful" IVF (i.e. one or two babies), that should be it for you. Well, that doesn't seem right to me, to deny someone a second kid. But does the state also keep paying for the 6th or the 8th? I don't know. Like I said, slippery slope.

Alyson said...

I recently underwent IVF and am grateful that insurance covered it. I agree on the age/physical limitations idea. In fact, a fertility-challenged friend recently told me that she could not get coverage because she is over 42 or 43 (I can't remember which she said was the cutoff). I also agree that it shouldn't necessarily be one and done, but how many is the right number?

SMNYC said...

This is an interesting issue, and probably one explored slowly and thoughtfully. But due to the emotional nature of the question at hand, I doubt that happens very often. My first thought was “Either you buy into the concept of insurance, or you don’t”. An example would be (if I were still living in MA) that I’m subsidizing your health costs for having a child since I don’t have any of my own, and that’s not fair. And my property taxes are subsidizing your children’s future public (assumed) education and that’s not fair either. OBVIOUSLY this isn’t what I really think, because life’s just more complicated than that.

My second thought was “Limits/Criteria are fine as long as they’re based in fact. Not in generalized statistics. All 40 year olds are not created equal after all. And enough of my friends are 35 and panicking about suddenly being “at risk” and needing to have kids “right now”. They certainly don’t need the added pressure of being at risk and also risking losing insurance coverage as well.

My third thought though is where things get really fuzzy and this is already and overly long comment. We have the technology to determine who is more “at risk” than others. Lets say its through a combination of physical exam, DNA testing and a magic wand. Lets also say for added giggles, that there’s a MORAL element to this as well. Should single women receive the same benefits as married women? What’s in the best interest of the future child? (I’m not suggesting there SHOULD be, but some might). Should DNA testing be allowed for something like this? They could test you at 11 years old and determine the probability of you bearing children and decide THEN whether or not to cover you. Is that right?

I’m not qualified to determine who’s covered and who isn’t. Solomon I’m not. Have you ever met anyone you thought was qualified to make that kind of decision? Someone you’d be willing to give the power to determine whether or not you could have children? I’d love to meet them if you have.

SMNYC said...

Sorry for the afterthought but:

The real question you should be asking and discussing is not whether or not insurance should cover "riskier" pregnancies or not.

The question you're really asking is whether or not rich people have more of a right to cutting edge medical technology than poor people. A public school teacher earning 40K/yr simply would never have the option of IVF. A big corporate lawyer might be able to swing it though.

Rebecca said...

I almost didn't post anything, because this is still a sensitive subject for me after years of dealing with infertility. However, I do have a couple of thoughts I wanted to share.

1) There are age limits. I think my clinic's cut off was around 43. There are a lot of tests you must undergo before the doctors will clear you for IVF (including, for me, 5 rounds of IUI with meds). Insurance also doesn't pay a donor for her time, although it will pay for medical costs. My guess is the mom you met was more like early 40's, not 50.

2) Few people do round after round. It's not simply the money, but the amount of pain, grief and medical intervention that are involved. My IVF cycle included three months of medical procedures and meds, including birth control pills, lupron shots, progesterone shots, with 1.5 inch needles (for 13 weeks), two kinds of stim shots, antibiotics, ultrasounds every other morning (at 7am) and surgery. It's nuts. It's also awful; the grief at not being able to have the family you want, how you want it, the fear that you will never be able to have kids the overwhelming disappointment & grief when it doesn't work. If people do this over and over, they must REALLY want a baby. It's a horrible, time consuming process that I wouldn't wish on anyone.

3) As with anything, I don't want politicians making my medical decisions for me. It needs to be a discussion between me, my husband and my doctor.

4) Analyses of this kind of mandated coverage shows that it does not cost people very much. The dad you talked to is giving you a high estimate--my insurance carrier paid $10,000 per fresh cycle and about $3000 per frozen cycle, not $30,000.

It's such a huge topic and one that most people don't truly understand, unless they or a close family member have been through it. I think you just ran into a fairly odd couple who gave you a skewed vision of what the MA system is like. FYI, many of us here (including myself) do NOT have unlimited coverage because of the many exceptions to this rule. I have a $30,000 lifetime cap.

Anyway, I didn't mean to say much and I said a book! Sorry 'bout that. Just be glad you don't need to know as much about this as many of us do. It's an education I could have done without.

Anonymous said...

As someone who has undergone IVF treatment while living in MA, I am superbly thankful for the insurance coverage offered to me. As other people have commented, there are limits. There are age cut-offs and mandatory IUI cycles before IVF (unless you have a valid medical reason to waive out). This insurance coverage also gave me the freedom to elect a single embryo transfer to avoid a multiple pregnancy. Without this coverage, given the costs of each IVF cycle, I probably would have opted to put more than one embryo back in and risked having twins or triplets, which I believe is even more of a drain on our system. I'm siding with your husband on this one. I know this is meant to be a light-hearted blog, but be aware of facts before you judge. And thank whatever god you pray to that you did not need to do IVF.

Helen said...

so, basically my insanely high health insurance on my poor teacher's salary is going towards a fifty year old couple having twins.....hmmmm......

a crapshack in nova said...

I think there are already some "nataural" limits in place. The obvious one being that many women over 42-ish will not successfully carry a pregnancy, even with donor eggs. I seriously doubt there are hordes of 50+ year old women lining up for IVF treatments. I think the reason the 50 and 60 year old women make the news is because they *are* so far off the norm.

I personally take a fairly neutral stance towards this issue. Who am I to tell someone what is right for their family? I feel very strongly that medical decisions are already too often made by some bean-counter in a cubicle at an insurance company (whether a health insurance company or a malpractice insurance company) with zero medical knowledge. And that's a load of crap.

It would seem to me that if there were to be a logical cutoff for IVF procedures, it would be at each individual woman's onset of menopause, since that is the body's natural "reproductive limit." In the case of someone with early menopause (premature ovarian failure and whatnot) then the average age of menopause (52ish?) could be used as the cutoff. Just a thought.