Cheryl, thank you for the mention and for raising these questions. Agreed the general public would very likely balk at a 62-yr old's quest for IVF funding. Have a look at what some other's thought when I took this (very unscientific) poll on this subject last week .

As with any mandated insurance coverage, limits will need to be set or else the fiscal note will ensure that any proposed legislation never makes it out of committee. There are some states that mandate infertility coverage (within limits) and those could potentially be used as a national model. The federal legislation that I have seen is not a carte blanche for baby making. There are definite parameters on what is covered and what isn't.

While I appreciate that I could be seen as a sympathetic case in the matter, my scenario would NOT be covered in those states with mandated coverage as MY eggs are not the ones being fertilized.

Another option (and I am just thinking out loud here) could be improving coverage around some of the most common contributors to infertility (PCOS, endometriosis, premature ovarian failure, cancers, etc.) to insure the secondary or resulting diagnosis of infertility. That would not address everyone's infertility, but it could provide the assurance that legislators and taxpayers need. But it all goes back to the question of is a little for a few enough, or is it all or nothing?
 

(Sorry to take up more space. I couldn't edit my previous comment).

While defining biological issues could be one way to achieve insurance coverage, the last thing I want to do is encourage a divide between those that are functionally and biologically infertile. Insurance is simply one issue.

Many barriers that we found in our own quest for treatments that were obviously constructed to limit access to those functionally infertile (i.e. "you have to be married before you can make an appointment here.") were simply Barriers to medical information.

A 62-yr old woman seeking motherhood would most likely be used as an example for legislators and other opponents of coverage, but a more likely scenario would be an older (but still young) woman in her 30s who felt that she could not adequately support a family until she reached a certain point in her career. That speaks to other societal issues beyond insurance, including but not limited to equitable wages and affordable child care.

Perhaps focusing on insurance coverage and who it should and shouldn't cover is too narrow a focus. Perhaps we need to broaden the discussion to include the adequacy of research and resources around women's health. Period.
 

What is the underlying principle that should determine whose infertility treatments the government mandates? Is it just a matter of limited resources that need to be rationed according to urgency (ie, cancer is more urgent than biological infertility; biological infertility is more urgent than functional infertility, etc.)? Or is there a line to be drawn between pregnancies that are in the public interest, and those that aren't? Is having children every individual's right once the technology to make it happen is available?
 

It's interesting that you state that my post brings the differences into sharp relief because my point is that the line is blurred and some people stand so firmly in both categories (such as Gabrielle) that I think it is dangerous to draw a line between functionally infertile and biologically infertile.

Robert Stillman at Shady Grove had an interesting thought in Embryo Culture that helped with drawing lines for coverage. Just as we wouldn't induce ovulation in a child prior to first menses, we can use the general age of menopause as a guideline for determining the upper end of treatment. But within age limits, I would ask for a lack of discrimination creating a state of inclusiveness for single and married, gay and straight, biologically and functionally infertile alike.

And this is not to say that those above the determined age of menopause should be kept from treatment--I'm not a doctor nor am I an ethicist so I don't believe I'm in a position to determine who receives or does not receive service. I also think you'd be hard pressed to find SART-accredited clinics that are performing DIVF on 62-year-olds.
 

Town Criers: How far are you willing to go in the name of inclusiveness? The case of lesbians and single women getting IVF is one in which people opt for a medical procedure intended to treat an illness they don't have because they believe it fits their lifestyle better than their own biological constitution does. A parallel situation that comes to mind is the demand by some people that doctors amputate their healthy limbs because they would prefer to live as amputees. Is this also something that the medical establishment should be obliged to perform, given that, as in the case of lesbians and single women, these people are seeking medical intervention not to treat an illness and restore health, but rather, in order to better live out their desired lifestyle?
 

Rita: I'm not sure about your analogy. Amputating healthy limbs would seem to go against the entire "First, do no harm..." thing. Also, the desire for children is a completely healthy desire. The desire to be missing a limb? Not so much. The would-be amputee needs to go to a shrink. I wouldn't counsel the same for a single woman wanting a child.
 

Isn't any invasive medical procedure not designed to treat an illness harmful, including cosmetic surgery? IVF is harmful, only the benefits for infertile women seem to outweigh the harm, just like chemotherapy would be harmful if cancer weren't even more so.

On what grounds do you distinguish between healthy and unhealthy desires?
 

Rita wrote: The case of lesbians and single women getting IVF is one in which people opt for a medical procedure intended to treat an illness they don't have because they believe it fits their lifestyle better than their own biological constitution does.

I am not sure I understand this comment, but I think you're saying that these women's infertility is social in nature — i.e., based on the relationships they have or do not — instead of biological.

If that's what you're saying, allow me to correct you. IVF is an invasive, expensive method that is generally considered a last resort in fertility treatment. If lesbians and single women are undergoing IVF, it's not because of their "lifestyle," it's because lower-tech methods haven't worked. It's because they are biologically infertile.
 

They might be biologically infertile, but they haven't tried to get pregnant naturally, so it's not clear that this is relevant. The point is that they are choosing insemination because they don't want to be impregnated the old-fashioned way.
 

Rita: You are making all sorts of assumptions here that don't hold true. First of all, numerous lesbians (myself included) HAVE tried the conventional way to have children, with no success. Many of us HAVE (myself included) full fertility workups that disclose reproductive problems (low hormone levels, anovulation, etc). If you think that most people would try IVF as a first resort, you are sorely mistaken. The introduction of numerous fresh sperm the conventional way (while monitoring fertility), numerous IUIs (unmedicated and medicated), much testing (HSGs), and the like predated the IVF in our case.

This is a red-herring issue that is used to derail compassionate coverage for infertility. My health insurance covers Viagra and treats male erectile dysfunction. However, it covers no diagnosis for my biological infertility. This makes no sense. And it's purely discriminatory.