# How Health Insurance Benefit Design Affects Infertility Treatment and Birth Outcomes

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $707,586

## Abstract

PROJECT SUMMARY
One in six people in the United States have infertility, which is treated most effectively with in vitro fertilization
(IVF). IVF is a powerful therapy that requires careful decision-making by patients to balance the risks of IVF
with the chances of having a healthy live birth. The most consequential decision during IVF is about the
number of embryos to transfer into the uterus. Transferring multiple embryos improves the chances of a birth,
but it also increases the likelihood of multiple births, which are risky for mothers and infants. Historically, health
insurance excluded coverage for IVF, but employers have been rapidly expanding IVF coverage as they
compete for employees. Employers are creating these new IVF benefits with little research evidence to guide
them. Poorly designed IVF benefits could cause more harm than good by inadvertently incentivizing multiple
embryo transfers and multiple births or by delaying care. Our preliminary research found that IVF benefit
designs range from generous (e.g., covering multiple IVF cycles) to meager (e.g., a lifetime cap of $5,000
when IVF costs $15,000 per cycle) and that cost is a top concern for patients. Much remains unknown about
how to design safe, high-quality IVF benefits. The investigators’ long-term goal is to generate compelling new
evidence that can improve the design of IVF benefits and therefore promote the health of parents and infants.
The central hypothesis is that IVF benefit design influences patients’ decisions during IVF and thus affects their
health outcomes. The rationale for this project emerges from the rapidly shifting landscape of IVF coverage
across the US, which is outpacing a scant research evidence base. The central hypothesis will be tested by
completing three Specific Aims: (1) Define the characteristics of employer-sponsored IVF insurance
coverage in the US; (2) Quantify which elements of insurance coverage for IVF most influence patient
decision-making during IVF; and (3) Evaluate the health outcomes and medical expenditures
associated with nine different IVF benefit designs. This study will be completed using a multi-method
approach that unites systematic, nationwide evaluations of the characteristics of IVF benefit designs, a
sophisticated survey of patient decision-making under different IVF benefit designs, and an analysis of real-
world patient outcomes and medical expenditures under nine employers’ different IVF benefit designs. With
these data, we will be able to measure real-world health outcomes and medical expenditures after IVF, predict
health outcomes for mothers and infants for a range of IVF benefit designs grounded in existing coverage
nationwide, and advise employers and policymakers on how to create IVF benefits that promote maternal and
infant health and avoid unintended negative outcomes. The research is innovative because it will define the
characteristics of IVF coverage in the US for the first time and quantify which elements of i...

## Key facts

- **NIH application ID:** 10976923
- **Project number:** 1R01HD113625-01A1
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** James M Dupree
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $707,586
- **Award type:** 1
- **Project period:** 2024-09-21 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10976923

## Citation

> US National Institutes of Health, RePORTER application 10976923, How Health Insurance Benefit Design Affects Infertility Treatment and Birth Outcomes (1R01HD113625-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10976923. Licensed CC0.

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