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Published June 26, 2013, 11:40 PM

North Dakota earns ‘C’ in group’s ranking of fertility friendliness

FARGO - When Suzy Alberts and her husband, Kristopher, decided to pursue fertility treatments, they discovered their insurance wouldn’t cover the costs.

By: Sherri Richards, INFORUM

FARGO - When Suzy Alberts and her husband, Kristopher, decided to pursue fertility treatments, they discovered their insurance wouldn’t cover the costs.

“We both had good insurance but, unfortunately, neither covered infertility,” says Alberts, who is insured by United Healthcare through her employer.

Alberts says they faced three options: not spend money and have no children, spend money to adopt, or spend money on in vitro fertilization.

“My husband and I wanted to go through the experience,” she says. “The scary thing is it’s not guaranteed. Luckily it worked out well for us.”

They now have two children, 4-year-old Vanessa and 7-month-old Liam, both conceived through IVF.

They spent about $50,000 on infertility treatments.

Fifteen U.S. states have insurance mandates that require insurers to provide or offer coverage for infertility treatments. North Dakota and Minnesota are not among them.

This lack of insurance mandate, as well as recent proposed legislation, counted against North Dakota on a “fertility friendliness” scorecard recently issued by Resolve, a national association that promotes reproductive health and equal access to family-building options for men and women experiencing infertility.

The scorecard, the first ever released by the nonprofit group, compared access to infertility care in each state.

North Dakota received a “C.” Minnesota and South Dakota each earned a “B.”

Resolve used four criteria when grading each state: the number of infertility clinics compared to population, the number of Resolve support groups, insurance mandates and legislative climate.

Barbara Collura, president of Resolve, says North Dakota had a “double whammy of no insurance mandate and a consistent track record of bills that have been what we call ‘anti-family.’ ”

Resolve took issue with three bills from the state’s 2013 legislative session.

Senate Bill 2302, dealing with the ethical treatment of human embryos, and Senate Bill 2303, which defined “personhood” as it relates to certain medical procedures; both failed.

Senate Concurrent Resolution 4009, a proposed constitutional amendment that requires protection of life at any stage, will go before voters in November 2014.

Dr. Stephanie Dahl, a reproductive endocrinologist and obstetrician/gynecologist with Sanford Health, says the proposed legislation would ban common fertility treatments, including those frequently used for cancer patients who want to preserve their fertility.

Coverage vs. quality

Dahl also says she has seen the number of patients who have insurance coverage drop in the seven years she’s practiced at the Sanford Reproductive Medicine Clinic in Fargo, noting about 50 to 60 percent have infertility coverage.

Some companies will cover testing to establish a diagnosis but not treatment, she says.

Patients with Blue Cross Blue Shield of North Dakota typically have good coverage, she adds.

Nine of BCBSND’s 10 large employer benefit plans offer infertility coverage to employees, according to a written statement from the company.

BCBSND does not support benefit mandates, because they ultimately make health insurance more costly for everyone, said the company statement from spokeswoman Andrea Dinneen.

The statement points out that Resolve is sponsored by pharmaceutical companies and could be financially motivated to promote infertility mandates.

The five states that received an “A” on Resolve’s fertility scorecard all have insurance mandates.

Dr. Randle Corfman, medical director of the Midwest Center for Reproductive Health in Maple Grove, Minn., says in his opinion, mandated care has a negative impact on quality.

Corfman says success rates at infertility clinics in Illinois, the No. 3 ranked state, are not as good as those in Minnesota or North Dakota. He says couples from Illinois regularly travel to his clinic.

Fertility friendly

Corfman disagreed with the scorecard’s portrayal of North Dakota.

“I think it’s definitely a fertility friendly state,” he says.

Corfman treats infertility patients at Essentia Health in Fargo and travels to Bismarck and Minot as well.

The scorecard did not account for outreach care or satellite clinics, which can provide less invasive fertility treatments and monitor patients.

Dahl notes Sanford, which has the state’s lone certified fertility clinic, also does outreach across the state and provides tele-health services.

The scorecard also did not factor in other infertility support groups, such as those offered by clinics or faith groups. There is one Resolve support group in Bismarck.

Resolve’s initial scorecard gave North Dakota an “F,” based on an inaccurate infertile population number due to a transcription error.

Dahl hopes North Dakotans struggling with infertility don’t view the scorecard as a reflection of quality of care.

“Our patients receive very high quality care, and we do have good success rates,” she says.

Alberts, the Fargo mom, says Resolve’s website and scorecard could be helpful to people experiencing infertility, though she emphasized the care she received from Sanford was “great.”

Collura says the goal of the scorecard is to raise awareness of infertility, which affects one in eight U.S. couples, and encourage people to improve the climate in their states by starting support groups or contacting state legislators.

She says people who are diagnosed with infertility feel a loss of control.

“You want to do something for the next person who is diagnosed,” she says.

Dahl says she hopes the scorecard can start conversations, and that people aren’t discouraged by the state’s ranking.

“There still are resources. Even if someone doesn’t have insurance coverage, it’s not always a lot of expense to go through,” she says.

Readers can reach Forum reporter Sherri Richards at (701) 241-5556