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Michelle Obama's IVF journey could help more women

In an interview with "Good Morning America"'s Robin Roberts for her new memoir "Becoming," Michelle Obama re...

Posted: Nov 15, 2018 4:56 AM
Updated: Nov 15, 2018 4:56 AM

In an interview with "Good Morning America"'s Robin Roberts for her new memoir "Becoming," Michelle Obama revealed that her two daughters, Malia and Sasha, were conceived using in-vitro fertilization (IVF). Malia, Obama's eldest daughter, was born in 1998, 20 years after the birth of the first IVF baby, Louise Brown, in a hospital in Oldham, England. In 1998, according to the Centers for Disease Control and Prevention, slightly over 80,000 assisted reproductive technology procedures (ARTs) were performed in the United States. Two decades later, that figure has more than tripled. Nearly 2% of live births in the US are the result of IVF and other ARTs (including intrauterine transfer and intracytoplasmic sperm injection, or ICSI, in which the sperm is injected directly into the egg to effect fertilization). Over eight million children have been born via IVF worldwide. A recent survey by the Pew Research Center found that 9% of women aged 35 to 44 reported that they or their partner had undergone fertility treatment.

Obama's disclosure that their children were the product of IVF is a welcome addition to this public conversation about infertility, one which will hopefully prompt some women and men to reconsider whether it could be a solution for them. It is inevitable that Obama's star power will help demystify this medical process. But what greater public familiarity with IVF won't do is help the many women and couples struggling with infertility for whom the principal obstacle to parenthood is financial, not psychological. For too many, the price of IVF places the procedure out of reach. The spiraling costs associated with the "infertility industry" mean that the benefits of new assisted reproductive technologies (ARTs) are not equally available to all.

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Professional women like Michelle Obama remain most likely to pursue IVF, not just because they have put their careers before childbirth and left it too late to have babies the natural way, as the common cultural myth goes, but because they can afford to. (According to the CDC's most recent report, less than one-third of ART treatments result from a diagnosis of diminished ovarian reserve, which tends to correlate with advanced maternal age, lower than the number of treatments performed as a result of male-factor infertility.)

IVF's high price tag, combined with an uneven insurance coverage has created an entrenched social division between IVF haves and have nots. When the Pew Research Center's figure of 9% of women or couples who have undergone infertility treatment is broken down by race, the discrepancies are stark. While 12% of white women report that they or their partners have undergone treatment, only 3% of black women, and 5% of Hispanic women report the same. This is despite the fact that, as Ann V. Bell recently wrote in "Misconception," women of color are in fact more likely to suffer from infertility. The education gap is equally stark. While 56% of adults with a postgraduate degree say that they have either undergone infertility treatment or know someone who has, only 20% of those with a high school degree or less report experience or knowledge of infertility treatment.

There is, to a certain extent, a chicken and egg aspect to the lower instance of IVF amongst women of color. Because they encounter fewer friends and family who have undergone IVF, they are less likely to consider it as an option. Obama's speaking out about her own infertility will hopefully show African-American and other minority women that IVF is not exclusively a white woman's solution. But while Obama's revelation may inspire a greater interest in the procedure, it does nothing to lower the financial barriers to infertility treatment.

In her recent "Conceivability: What I Learned Exploring the Frontiers of Fertility," Elizabeth Katkin describes spending nearly $200,000 in pursuit of a baby. Katkin's experience is exceptional, and involved eight IVF cycles in America, England, and Russia. More typical is the case of Nurse Frankie, the featured patient on the episode of ABC's long-running medical drama "Grey's Anatomy," which aired the night before Michelle Obama's "Good Morning America" interview. Frankie, described on the show as "skating towards 40," paid "$41,632 for three rounds of IVF and a miscarriage." An IVF cycle costs, on average, $17,000 for drugs and treatment, with additional costs of several thousands of dollars if a patient uses ICSI to increase the chances of success in cases of male-factor infertility; freezes her embryos; or opts to submit her embryos to preimplantation genetic screening (PGS). A bill of $41,632 for three rounds of treatment would be about par for the course for someone whose health insurance partially covered the IVF medication protocol but not the treatment itself.

Sixty-three percent of American women pay for IVF treatment entirely out-of-pocket. Patients who meet strict age and health criteria can potentially hedge against the costs of multiple rounds of IVF by opting for one of the myriad "baby or your money back" programs, first pioneered by Maryland-based Shady Grove Fertility in 1993, which cap the costs for multiple rounds of IVF between $20,000 and $40,000 dollars (often excluding the cost of necessary drugs), with the promise of a refund if the treatments are not ultimately successful. The schemes are essentially shared risk pools for women pursuing infertility treatment without insurance, as those who become pregnant on the first round do not receive a partial refund and effectively cross-subsidize patients requiring multiple rounds of treatment.

A handful of states, including most recently Delaware, require health insurance companies to provide at least limited IVF coverage. Texas requires health insurers to offer policies that cover IVF but do not compel employers to select those policies for their employees. Even in states where some form of IVF coverage is mandatory, out-of-pocket costs can run into the thousands of dollars. According to Fertility IQ, a private organization founded by former infertility patients which collates information on US patients' experience of infertility treatment, the technology, consulting and accounting, and banking and finance sectors rank highest in terms of fertility benefits offered, while the industrial and retail sectors rank lowest.

IVF came of age in the wake of the second-wave feminist movement and campaigns for abortion rights, which both argued that biology was not destiny and that a woman's reproductive choices were her own to make, without interference from the state. Together these two convictions have, up to now, also largely stymied any united campaign by women to ensure that IVF was covered by health insurance or, in countries with national health systems, financed by the state. The result is that IVF has grown up largely within the private marketplace, with prices determined by what the market will bear. While an ever-growing number of professional women are finding the resources to conquer infertility through IVF and other assisted reproductive technologies, the treatment's high price tag means that many are effectively priced out of motherhood.

The recent shift in the abortion wars towards a focus on accessibility and affordability, as embodied in the landmark 2016 Whole Woman's Health v. Hellerstedt case, or Congressional efforts to limit access to abortion services by defunding Planned Parenthood, underscore the reality that a woman's reproductive choices are not her own to make if practical and financial realities limit her ability to pursue some choices. Michelle Obama has done a great service to infertile women and couples in sharing her own IVF journey. Her status as a role model for many women across the racial and social spectrum makes her ideally positioned to take the conversation further, and push women, doctors, and legislators to re-evaluate whether the comparatively unregulated expansion of the IVF industry in America has actually increased the average woman's ability to control her own fertility.

This article was updated to reflect more exact price information provided directly by Shady Grove Fertility.

Mississippi Coronavirus Cases

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Reported Deaths: 1944
CountyConfirmedDeaths
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DeSoto371031
Harrison260136
Madison245569
Jackson231444
Rankin230735
Jones193159
Forrest182656
Washington170142
Lee152142
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Scott101120
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Copiah96228
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Pike94037
Holmes91049
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Yazoo84113
Lincoln83442
Monroe82155
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Wayne78021
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Union66216
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Winston62916
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George5956
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Smith40613
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Clay40114
Jasper3949
Itawamba38710
Tippah37414
Tunica3587
Clarke33626
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Lawrence3238
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Humphreys29712
Quitman2691
Carroll26111
Greene25612
Perry2428
Amite2376
Webster23712
Kemper23314
Jefferson Davis2336
Wilkinson21513
Stone2115
Sharkey2045
Jefferson1957
Benton1451
Choctaw1354
Franklin1312
Issaquena272
Unassigned00

Alabama Coronavirus Cases

Confirmed Cases: 100801

Reported Deaths: 1814
CountyConfirmedDeaths
Jefferson13366246
Mobile10581212
Montgomery6825151
Madison546934
Tuscaloosa426979
Unassigned392566
Baldwin367029
Shelby333437
Marshall319438
Lee270847
Morgan241819
Etowah218034
DeKalb183414
Calhoun181918
Elmore176039
Walker154465
Houston142813
Russell13892
St. Clair136320
Limestone135913
Dallas133624
Franklin129722
Cullman123012
Colbert121517
Lauderdale119020
Autauga116222
Escambia108817
Talladega105414
Jackson10264
Tallapoosa87579
Chambers84738
Dale84329
Clarke82610
Chilton8189
Blount8165
Butler77036
Coffee7656
Covington74021
Pike7137
Marion58226
Barbour5796
Lowndes57124
Marengo56616
Hale48526
Bullock48111
Winston45711
Perry4454
Bibb4445
Washington44412
Wilcox43410
Monroe4236
Pickens4089
Randolph40211
Conecuh39310
Sumter36618
Lawrence3542
Macon33914
Crenshaw3326
Choctaw28912
Cherokee2768
Clay2675
Geneva2652
Henry2643
Greene25211
Lamar2302
Fayette2235
Cleburne1291
Coosa1053
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