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• W3092906247 abstract "To assess associations between insurance mandates for fertility care and indications for PGT over time. Retrospective cohort study. Fresh autologous IVF cycles from the 2007-2016 SART registry were analyzed in two time periods due to changes in SART cycle definitions in 2013. Given the introduction of “other” indication for PGT in 2009, we limited our analysis to 2009-2016. Frozen, cancelled, and banking cycles were excluded. Fertility clinics were categorized by level of insurance coverage mandated in their state: comprehensive, partial, and no coverage. Indications for PGT were categorized hierarchically as follows: genetic, balanced translocation, HLA typing, elective sex selection, aneuploidy, and other. Log binominal regression was used to analyze change in indication for PGT over time relative to mandate type. 99,726 cycles were included. The median age of women utilizing PGT remained fairly constant over time (37 years), and median ages by mandate were comparable. The most common indication for PGT across all years was aneuploidy. For most indications, state mandate impacted the rate of change in indication. No coverage states had a greater decline in proportion of genetic cycles, and there were no statistically significant differences between comprehensive and no coverage states for HLA typing. For both periods, elective sex selection was more commonly used in states with no coverage (p<0.0001). Additionally, the yearly proportion of cycles for elective sex selection decreased significantly over both periods (β = -0.24, SE = 0.01, p<0.0001 and β = -0.18, SE = 0.02, p<0.0001), although the number of elective sex selection cycles increased.Tabled 1Period12Year20092010201120122013201420152016Aneuploidy1331 (36.8)1480 (38.4)1537 (35.5)1522 (34.5)1657 (33.7)8297 (51.7)15183 (59.0)20029 (54.4)Elective Sex833 (23.0)875 (22.7)930 (21.5)625 (14.2)518 (10.5)1312 (8.2)1837 (7.1)2170 (5.9)Genetic861 (23.8)893 (23.2)980 (22.6)1061 (24.1)938 (19.1)1576 (9.8)1804 (7.0)1844 (5.0)Translocation331 (9.2)325 (8.4)516 (11.9)816 (18.5)1116 (22.7)2694 (16.8)2585 (10.0)3703 (10.1)HLA Typing50 (1.4)54 (1.4)61 (1.4)33 (0.7)18 (0.4)57 (0.4)91 (0.4)110 (0.3)Other208 (5.8)228 (5.9)307 (7.1)350 (7.9)674 (13.7)2122 (13.2)4243 (16.5)8941 (24.3)Legend: Values are n (% of PGT cycles that year). Open table in a new tab Legend: Values are n (% of PGT cycles that year). This is the first study to examine differences in PGT indication by insurance mandate and the first to examine trends over a period longer than two years. Our findings suggest indications for PGT have changed over time and vary by level of insurance coverage for fertility. As PGT utilization increases, it is vital we understand how and why PGT is applied in order to better understand outcomes." @default.
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• W3092906247 date "2020-09-01" @default.
• W3092906247 modified "2023-09-30" @default.
• W3092906247 title "STATE-MANDATED INSURANCE AND PREIMPLANTATION GENETIC TESTING (PGT) INDICATION IN THE UNITED STATES" @default.
• W3092906247 doi "https://doi.org/10.1016/j.fertnstert.2020.08.063" @default.
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