Introduction

Disparities in access to fertility treatment are well established in the female population, with cost often cited as a limitation to treatment. Fifteen states mandate insurance coverage for female infertility; of those, only eight require coverage for male infertility. Studies have demonstrated higher utilization of in vitro fertilization, intrauterine insemination, and ovulation-inducing medications in states with mandated coverage for female fertility. There is no analogous data in the male population. Our objective is to compare the utilization of male surgical infertility treatment in states that mandate coverage with states that do not.

Methods

Case log data provided by certifying and recertifying urologists between 2001 and 2014 to the American Board of Urology was reviewed. Male fertility procedures were identified by CPT code: 10021, 10022, 54500, 54505, 54900, 54901, 55200, 55300, 55400, 74440. Men ages 18-64, who had procedures performed in the United States (US) were included. US Census Bureau data from 2007 was used to determine median household income and population of men ages 18-64 per state.

Results

Of the 1244 urologists who logged at least one male fertility case between 2001 and 2014, 94 (7.6%) report specializing in andrology or infertility. These specialists performed 1052 of 4669 fertility cases (23%). The total number of male infertility cases per million men of reproductive age in the US was 49 (range: 6 in WY to 145 in DC (Figure 1)). Twenty-three states exceeded the national rate. Three locations had more than double the national rate (DC, TX and UT), none of which have mandated insurance coverage. In states with mandated male coverage, the number of male infertility cases per million men of reproductive age averaged 49 (range: 12 in WV to 58 in MA), which was the same as the national rate. State-based median household income did not correlate with cases performed per million men.

Conclusions

The number of fertility cases per million men of reproductive age varies widely by state, but does not appear to be related to male infertility insurance coverage status or median household income. The lack of disparity in utilization of male surgical infertility treatment suggests that patients will pursue these treatments regardless of insurance coverage status and income.

Funding

None