Does Health Insurance Cover Infertility Treatment?

It might come as a shocker to most that 1 in 151 Indian couples experience infertility. While some of the common causes of infertility include late marriages, obesity, smoking, stressful lifestyles, high junk food intake, alcoholism, smoking, and drug addiction, some causes can be underlying. 

Today, infertility has become quite a major issue of concern in India due to a double-digit increase. Not only do these infertility symptoms affect couples emotionally, but they also treat them with major social and financial setbacks. 

In about 20% of cases, the problem arises with the male reproductive system (male infertility), while 40-50% of cases are caused by abnormalities in the female reproductive system leading to female infertility. However, the good news is this condition is treatable. Depending on the root cause, infertility can be treated, and pregnancy can be achieved in 85% to 90% of instances by medication, lifestyle changes, assisted reproductive technology (ART), or surgery2. This article speaks about the aspects related to infertility starting from causes to its treatment coverage. Stay tuned! 

What is Infertility? 

Infertility is a medical condition where a couple is unable to conceive because their reproductive systems are malfunctioning. There are numerous causes of infertility, and it can impact anyone.

Simply put, a doctor may diagnose infertility in patients who are usually 35 or older and are trying to conceive for a long time yet failing. Contrary to popular belief, infertility isn’t just a woman’s problem; men can be infertile, too. Men and women are equally likely to have fertility problems.

Speaking of women, primary infertility is a diagnosis given to a woman when she has never been able to conceive. However, a woman is diagnosed with secondary infertility if she has had a successful pregnancy in the past and is unable to conceive the next time. 

What are the Causes of Infertility?

Below is a breakdown of male infertility causes and female infertility causes. Take a look. 

Male Infertility Causes 

Male infertility is related to a lot of factors. Moreover, the reason why men face infertility differs from case to case. Yet, the major cases involve:

• Inefficient and effective sperm production (low sperm count signs) 
• Individual sperm count 
• Movement of the sperm 
• Shape of the sperm

Female Infertility Causes 

Female infertility occurs due to several factors. However, one thing they have in common is that each factor interferes with and affects the biological process. Any abnormalities in the following processes are the causes of infertility in females:

• Ovulation (when the egg is released from the ovary) 
• Fertilisation (takes place when the sperm meets the egg in the fallopian tube) 
• Implantation (takes place when a fertilised egg moves to the lining of the uterus to grow and develop into a baby). 

Common Causes of Infertility 

While biological processes exist, lifestyle habits contribute to the cause majorly. Some of the risk factors include: 

• Excessive alcoholism 
• Age (women being 35 and older, and men being 50)
• Over-exercising 
• Eating disorders (bulimia, anorexia nervosa) 
• Substance abuse 
• Chemotherapy or any kind of radiation therapy 
• Exposure to toxins like lead, pesticides, or harmful environmental toxins 
• Obesity/underweight 
• STI (Sexually transmitted infections) 
• Smoking and consuming tobacco 
• Chronic diseases
• Abnormalities in the hormone-producing centres of your brain (pituitary or hypothalamus or pituitary).

Infertility: Management and Treatment 

Infertility treatment plans are largely objective. When choosing a treatment, it's important to consider your age, the length of time you've been trying to conceive, and your preferences. While treatment may be necessary for just one spouse at a time, sometimes it involves both going through the processes. 

Treatment for infertility involves medicine, surgery, or ART (assisted reproductive technology). If you want to increase your chances of getting pregnant, you should try changing your lifestyle or being more consistent with your sexual activity. Treatment works best when it involves a mix of processes. 

Female Infertility Treatment 

This includes: 

• Make changes to your lifestyle, such as increasing or decreasing your weight, quitting smoking or drug use, and taking better care of other health issues.
• Taking fertility medicines to encourage your ovaries to release more eggs into the egg sac.
• Going for surgery can be an option. It takes place by removing scar tissue, polyps, fibroids, or obstructed fallopian tubes to restore normal uterine function.

Male Infertility Treatment 

This includes: 

• Improving the levels of testosterone and other hormones by medications helps with low sperm count signs. There are medications available for erectile dysfunction as well. 
• In order to fix structural issues or open blocks in the tubes that deliver sperm, some men require surgery. To increase the likelihood of conceiving, varicocele surgery can improve the health of sperm. 

Common Infertility Treatments: Assisted Conception

Alternatively, when the usual infertility treatment procedure fails, Assisted Conception enters. There are some options for assisted or artificial conception methods that are currently accessible. These approaches fix all types of infertility in men and women. Although these treatments are a bit expensive, they provide guaranteed results. 

1. In Vitro Fertilisation (IVF): This takes place in a controlled environment after sperm and eggs have been taken from the body through different methods and placed in a lab dish. Here, the sperm fertilises the egg. The healthcare practitioner will then transfer one to three fertilised eggs into the uterus. 

2. Intracytoplasmic Sperm Injection (ICSI): This procedure is performed during the IVF process. An embryologist will inject one single sperm directly into each egg. Later, the doctor will transfer one to three of these fertilised eggs into the uterus.

3. Intrauterine Insemination (IUI): Here, a medical professional will place the sperm into the uterus with a long, thin tube. IUI can also be referred to as artificial insemination.

4. Assisted Hatching: This involves facilitating embryo implantation in the uterine lining by removing the outer layer of an embryo.

5. Third-Party Conception: Some couples may have to use the eggs, sperm, or embryo of a third party, i.e., a donor. This is known as surrogate. 

Are Infertility Treatments Covered Under Health Insurance?

A single cycle of infertility treatment can cost anything around ₹1,00,000 to ₹4,00,000. The treatment is not usually covered by most insurance providers. Nevertheless, some providers may offer basic or supplementary health coverage that only covers the issue partially, depending on its severity. If you already have maternity insurance coverage, IVF insurance may be added at an extra cost.

Generally, many health insurance plans pay for the IUI. Speaking of IVF, it is a costly and time-consuming treatment that involves a lot of procedures. Hence, not all health insurance plans will cover this treatment. However, some insurance companies provide IVF coverage as an add-on.

Similarly, gamete intrafallopian transfer (GIFT) is another technique that is very similar to IVF. However, it is slightly less technical since it does not involve implanting embryos. Hence, this treatment can be covered in full or in part by your insurance provider depending on the policy and the firm.

In other terms, not all health insurance plans pay for infertility treatments in their entirety, although some do cover certain parts of the process. Considering the treatment expenses, it is likely that your savings might be in trouble. Hence, individuals should plan according to their future demands after comparing the possibilities, terms, and conditions offered by various health insurance firms.

Cover IVF with Care Classic Health Insurance

The average cost of IVF treatment in India can greatly vary from city to city. In some cities, the costs may be even more. However, At Care Health Insurance, IVF coverage is provided under its zone-based health policy termed as 'Care Classic' for sum insured more than 5 lakh. The plan offers a reimbursement facility for assisted reproductive treatment (ART) considering the following conditions:

• The coverage has a 3-year waiting period 
• For a sum insured over ₹5 lakh, Care will cover expenses up to ₹2 lakhs per policy year for IVF. 
• The benefit will be made available once in a block of 3 years. 

In a Nutshell

Experiencing infertility can be extremely difficult and disheartening. Not only does it impact your emotional well-being, but your relationships too. Moreover, the financial burden of infertility treatments can also be hefty. Nevertheless, the joy of being a parent knows no bounds. 

If you're facing infertility, connect with your healthcare provider and go over the therapy choices that best suit your case. Although most couples conceive naturally, very few might have to use assisted reproductive technology. Having a health insurance policy in place at these times not only helps you release the financial stress but saves your hard-earned money, too. Either way, it's a win-win situation! 

>> Also Read: Health Insurance for IVF Treatment

Disclaimers: The above information is for reference purposes only. Kindly consult your general physician for verified medical advice. The health insurance benefits are subject to policy terms and conditions. Refer to your policy documents for more information.