Insurance Limits Drive PGT-A Utilization in IVF Cycles
Women with limited insurance benefits for in vitro fertilization are twice as likely to use preimplantation genetic testing for aneuploidy on their embryos to make each cycle count, researchers reported at the American Society For Reproductive Medicine 2026 annual meeting, Medscape reported.
When patients know their covered cycles are finite, they appear twice as likely to use PGT-A, independently of their age and ovarian reserve, according to study co-author Ecem Esencan, MD, a reproductive endocrinology and infertility fellow at Northwestern University in Chicago. The findings suggest that insurance coverage variations directly influence patient treatment decisions during fertility care.
Northwestern University Cohort Study Design
Esencan and her colleagues reviewed records from 208 women participating in the PROMISE cohort study, a prospective analysis of individuals undergoing their first cycle of IVF at the Northwestern University academic center. Financial counselors conducted standardized primary insurance reviews for all participants to document IVF coverage, plan details, and deductibles.
Investigators divided the cohort into three groups based on insurance plan access: no coverage, restricted coverage with lifetime cycle or financial limits, and comprehensive coverage featuring annual or unlimited cycle-based access. The primary outcome measured was PGT-A utilization. Study authors used multivariable logistic regression to assess connections between coverage type and PGT-A use, adjusting for patient age, anti-Müllerian hormone levels, and body mass index.
Restricted Coverage and Testing Rates
Among the study participants, 23 women had no IVF insurance coverage, 104 women had restricted coverage, and 81 women had comprehensive coverage. Baseline characteristics showed no differences across the groups regarding age, BMI, ovarian reserve, self-reported stress, race, or socioeconomic status.
Testing rates varied significantly among the groups with available data. Among 168 women with recorded PGT-A utilization, 72% of patients with restricted coverage pursued the testing. In contrast, 57% of those with comprehensive coverage and 52% of patients with no coverage underwent PGT-A.
In multivariable analysis limited to patients with insurance and adjusted for clinical factors, restricted coverage remained independently associated with increased PGT-A utilization. The adjusted odds ratio was 2.10 with a 95% confidence interval ranging from 1.07 to 4.12.
Clinical Implications and Expert Perspectives
The findings highlight how financial structures alter clinical decisions in reproductive medicine. Session co-moderator Alexis Hood, MD, noted that restrictive insurance policies may inadvertently drive up out-of-pocket patient costs through additional testing procedures like PGT-A.
Primary care physicians frequently encounter patients navigating infertility challenges, Hood told Medscape Medical News. She emphasized that comprehensive insurance coverage remains vital for overall health, noting that patients facing restricted coverage incur additional expenses for PGT-A that standard plans rarely cover.
Frequently Asked Questions About IVF Insurance Limits and PGT-A
What specific patient factors were controlled for in the Northwestern University study?
Researchers adjusted their multivariable logistic regression analysis for patient age, anti-Müllerian hormone levels as a measure of ovarian reserve, and body mass index to isolate the impact of insurance coverage.
What percentage of patients pursued PGT-A under restricted versus comprehensive insurance plans?
Among patients with available data, 72% of those with restricted coverage pursued PGT-A, compared with 57% of patients who held comprehensive coverage.
Who authored the study presented at the American Society For Reproductive Medicine 2026 meeting?
The abstract was authored by study co-author Ecem Esencan, MD, and her colleagues at Northwestern University in Chicago.
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