Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
Fertil Steril. 2018 Apr;109(4):691-697. doi: 10.1016/j.fertnstert.2017.12.027. Epub 2018 Mar 24.
To compare indications and trends in intracytoplasmic sperm injection (ICSI) use for in vitro fertilization (IVF) cycles among residents of states with and without insurance mandates for IVF coverage.
Cross-sectional analysis of the National Assisted Reproductive Technology Surveillance System from 2011 to 2015 for the main outcome and from 2000 to 2015 for trends.
IVF cycles performed in U.S. fertility clinics.
PATIENT(S): Fresh IVF cycles.
INTERVENTION(S): Residency in a state with an insurance mandate for IVF (n = 8 states) versus no mandate (n = 43 states, including DC).
MAIN OUTCOME MEASURE(S): ICSI use by insurance coverage mandate status stratified by male-factor infertility diagnosis.
RESULT(S): During 2000-2015, there were 1,356,377 fresh IVF cycles, of which 25.8% (n = 350,344) were performed for residents of states with an insurance coverage mandate for IVF. ICSI use increased significantly during 2000-2015 in states both with and without a mandate; however, for non-male-factor infertility cycles, the percentage increase in ICSI use was greater among nonmandate states (34.6% in 2000 to 73.9% in 2015) versus mandate states (39.5% in 2000 to 63.5% in 2015). For male-factor infertility cycles, this percentage increase was ∼7.3% regardless of residency in a state with an insurance mandate for IVF. From 2011 to 2015, ICSI use was lower in mandate versus nonmandate states, both for cycles with (91.5% vs. 94.5%), and without (60.3% vs. 70.9%) male-factor infertility.
CONCLUSION(S): Mandates for IVF coverage were associated with lower ICSI use for non-male-factor infertility cycles.
比较有和没有保险要求覆盖体外受精（IVF）的州的居民在 IVF 周期中进行胞浆内精子注射（ICSI）的适应证和趋势。
2011 年至 2015 年对国家辅助生殖技术监测系统进行主要结局的横断面分析，2000 年至 2015 年对趋势进行分析。
美国生育诊所进行的 IVF 周期。
新鲜 IVF 周期。
居住在有 IVF 保险要求的州（n = 8 个州）与没有要求的州（n = 43 个州，包括哥伦比亚特区）。
按男性因素不育诊断分层的保险覆盖要求状态的 ICSI 使用情况。
2000 年至 2015 年期间，共有 1356377 个新鲜 IVF 周期，其中 25.8%（n = 350344）为有 IVF 保险覆盖要求的州的居民进行。2000 年至 2015 年期间，无论是否有要求，ICSI 的使用均显著增加；然而，对于非男性因素不育周期，非要求州的 ICSI 使用增加百分比（2000 年的 34.6%至 2015 年的 73.9%）高于要求州（2000 年的 39.5%至 2015 年的 63.5%）。对于男性因素不育周期，无论居住在有 IVF 保险要求的州，这一百分比的增加约为 7.3%。2011 年至 2015 年，在有要求和没有要求的州，对于有（91.5%对 94.5%）和没有（60.3%对 70.9%）男性因素不育的周期，ICSI 的使用均较低。
IVF 覆盖的要求与非男性因素不育周期 ICSI 使用减少相关。
