Academic journal article Defense Counsel Journal

Infertility and the ADA: Health Insurance Coverage for Infertility Treatment

Academic journal article Defense Counsel Journal

Infertility and the ADA: Health Insurance Coverage for Infertility Treatment

Article excerpt

A FOUR-YEAR-OLD boy tells his mother what he is going to do when he is a daddy. A three-year-old girl is upset because she can't find the bottle to feed her "baby" doll.

The idea of parenthood and family is ingrained and taken for granted in our society. But those who are physically unable to conceive, impregnate or carry a pregnancy frequently find their circumstances trivialized and ignored. As medical research advances, myths about infertility have retreated, but it is still treated with suspicion.

Infertility is now recognized as a disease, yet its treatment still is not provided full insurance coverage. With the advent of the Americans with Disabilities Act, 42 U.S.C. [subsections] 12101-12213, it is time that infertility be recognized as a disability and be covered by employer-contracted health insurance.


Infertility is defined as the condition of a presumably healthy individual who is unable to conceive or produce conception during a period of one year.(1) In contrast, a fertile couple in their 20s has an approximate 20 percent chance of achieving pregnancy in any given month, with a cumulative success rate of 93 percent over a period of one year. That rate drops for a couple in their 30s to 10 percent in a given month, with a cumulative rate of 72 percent over one year.(2) Inferetility is a medical condition that impacts the lives of more than for millions couples in North America today.(3) Although stereotypically thought of as a female problem, infertility affects men and women in equal numbers, with 20 percent of the cases attributed to a combination of male/female factors or as undiagnosable.(4)

A. Treatment

The causes of infertility generally fall into two very broad categories: (1) hormonal imbalances and (2) physical abnormalities of the reproductive organs. For both men and women, treatment falls into four categories.

1. Drug Therapy

Hormone therapy is used primarily to return hormones to normal levels. Common drugs given to women are (1) clomiphene, a low-level hormone drug used to normalize a menstrual cycle but not recommended for use longer than six months, and (2) gonadtropins, which are hormones used to increase the stimulation of the ovaries. Although these are the most common drugs used, virtually any female hormone not being produced at normal levels may be supplemented. Some of these same drugs, such as clomiphene, as well as male hormones, are used in treating male infertility. Antibiotics also might be used to treat either sex.(5)

2. Surgery

Surgery is used to repair damaged organs. Common procedures for females include laparoscopy and laparotomy. Laparotomy is frequently required for tubal surgery, a procedure that attempts to repair or clear blocked fallopian tubes. A laparoscopy is commonly used to remove either endometriosis or fibroid tumors. Either type may be used for any of these or other diagnoses, however, depending on the individual case. The most common surgery for males is varicocele surgery, which is used to reduce excessive blood flow to the testicles. Surgery for men is also used to correct blockages or other physical abnormalities.(6)

3. Intrauterine Insemination

IUI is used to address male infertility or bypass cervical problems. It is a procedure to bring sperm and egg closer together artificially by medically injecting sperm high into the uterus. There are many variations of this procedure, including the use of a variety of fertility drugs along with the IUI.(7)

4. Assisted Reproductive Technologies

ARTs are used to bypass physical problems. They are variations on the technique of removing eggs from the ovaries, joining them with sperm outside of the female body and returning either the mixture to the fallopian tubes or fertilized eggs to the uterus. In vitro fertilization (IVF), the oldest and most widely known ART, consists of joining egg and sperm in a petri dish and then returning fertilized eggs directly to the uterus. …

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